Why ovarian, uterine cancers are on rise in black women

A consultant Obstetrician and Gynecologist and Medical Director, May Fair Specialist Hospital, Onitsha, Anambra State, Dr. Raphael Nosike Omaliko, has given reasons ovarian and uterine cancers are on the rise, especially among black women.

A consultant Obstetrician and Gynecologist and Medical Director, May Fair Specialist Hospital, Onitsha, Anambra State, Dr. Raphael Nosike Omaliko, has given reasons ovarian and uterine cancers are on the rise, especially among black women.

Ovarian, uterine (endometrial) and cervical cancers are the most common gynaecologic cancers, which begin in the female reproductive organs. Less common gynaecologic cancers involve vulva, Fallopian tube, uterine wall (sarcoma), vagina, and placenta (pregnancy tissue: molar pregnancy).

Ovarian cancer refers to any cancerous growth that begins in the ovary. This is the part of the female body that produces eggs. Feeling full too quickly or difficulty eating, bloating, and abdominal or back pain are common only for ovarian cancer.

Endometrial cancer is cancer that affects the womb. The womb (uterus) is where a baby grows during pregnancy. The most common symptom of endometrial cancer is abnormal vaginal bleeding, ranging from a watery and blood-streaked flow to a flow that contains more blood.

Pelvic pain or pressure is common for ovarian and uterine cancers.

Endometrial cancer is one of the most curable of the gynaecologic cancers because most patients have well-differentiated tumours and localised disease.

Omaliko, who is also a Fellow of International College of Surgeon, in an interview with The Guardian said uterine and ovarian cancers may eventually become the third and fourth most common type among women.

The gynaecologist explained: “Cancer is a decease in which abnormal cells divide uncontrollably, and destroy normal body tissues.

“Ovarian cancer, is a very insidious disease that occurs in women, it comes in a gradual form. Since 1930, it has had an upsurge and it’s still increasing in incidents. The incidence in the United States of America (USA) is about 0.05 percent, it presents mainly in the middle ages, between 55 and 60 years of age and it is usually detected in a very late stage. In 75 per cent of cases, it is already in the third or fourth stage which are the late stages.”

According to Omaliko, some risk factors of ovarian cancer are: reduce family size (a woman who has very few children); later age of first conception (that is women who postpone getting pregnant or married); then family history; possible links with the use of fertility drugs; radiation; and higher social economic status. He said white women are more susceptible to the cancer of the ovary and blood group A is also a risk factor in increasing the occurrence of ovarian cancer.

Omaliko, however, said some factors have been known to reduce the risk factors such as a longterm use of oral conceptive pills, which reduce ovulation and the incidence of ovarian cancer. “Multiparous women (women with many children), have been found to have less incidence of ovarian cancer, breastfeeding, women who breast feed their children, in this case are less likely to have ovarian cancer. Lower social economic status (women who are poor in the society) have less incidence as well. Japanese, Hispanic, Chinese and blacks, have also been discovered to have less incidence of ovarian cancer. Blood group O also is a factor that can reduce the incidence of ovarian cancer,” he said.

Studies have shown that cancer of the uterus, also called endometrial cancer, is increasing so rapidly that it is expected to displace colorectal cancer by 2040 as the third most common cancer among women, and the fourth-leading cause of women’s cancer deaths.

The mortality rate has been increasing by almost two percent a year overall, with even sharper spikes among Asian, Hispanic and Black women, according to a recent study in JAMA Oncology. Despite the increase, there has been little public attention to the disease.

Overall survival rates are high when uterine cancer is detected early, but few women are aware that a change in menstrual bleeding, before or after menopause, is one of the main warning signs, along with pelvic pain and painful urination and intercourse.

Uterine cancer was long believed to be less common among Black women. But newer studies have confirmed that it is not only more likely to strike Black women, but also more likely to be deadly.

Black women die of uterine cancer at twice the rate of white women, according to a report in March from an expert panel convened by the American College of Obstetricians and Gynecologists.

The gap is one of the largest racial disparities observed for any cancer, the report said. Black women are also more likely to develop a form called non-endometrioid uterine cancer, which is more aggressive.

Omaliko said among all populations, uterine cancer is being detected more often in younger women who are still in their childbearing years as well as in women who don’t have any of the known risk factors, such as obesity, infertility and never having been pregnant.

What are the symptoms and signs of ovarian cancer? Omaliko said: “There are some etiological factors which has been mentioned earlier, fertility drugs such as clomiphene, which causes incessant ovulation can also be a risk factor. Nulliparity (women who haven’t given birth to any child).

“The disease is usually insidious, it comes in a gradual fashion and the patient may not know she is having ovarian cancer because it comes like any other abdominal upset and it can give gastric intestinal upset such as diarrhoea, vomiting and then urinary problems can also occur, difficulty in bowel movement (she may find it difficult to defecate), abnormal swelling, relative pains and this pains usually comes from twisting of the mass or bleeding into or out of the mass.

“To diagnose Ovarian cancer, the clinical evaluation is very significant. The clinician may be able to feel a solid or cystic mass that is something containing fluid in it. Ultrasound that has colour doppler application along with it increases the probability of diagnosing the disease. There are also biochemical tests called Tumour-markers CA125, which are also used.

“CA125 is a tumour marker used in the diagnosis of ovarian cancer; the upper limit of the level in blood usually 35units per litre but if it goes beyond that, the doctor will start suspecting that the patient may have ovarian cancer,” he said.

Omaliko said the treatment of ovarian cancer is usually a combination of medical modalities. “We have surgical treatment to eliminate the tumour mass as much as possible. Some surgeons with availability of the facilities do what we call ‘Frozen Section’ that is taking a chunk of the tumour during the surgery to histology and the results comes back to the theatre, while the surgery is still on to confirm if its cancer or not. The surgery is radical because we want to reduce the tumour mass and the spread,” he said.

Omaliko said that chemotherapy is very important, while drugs like plutonium amongst others have been employed in the treatment. “Radiotherapy is also an important modality and these modalities can be combined in the treatment of ovarian cancer,” he said.

Can ovarian cancer be prevented? “There is something called screening, the earlier we pick the tumour, the better because that would increase the prognosis. Some modalities have been employed like vagina ultrasound usually for small tumours and then abdominal ultrasound have also been employed in the screening. In genetics, there are three ovarian cancer syndromes; genetical modality can also be used to pick patients who are likely to have ovarian cancer,” he said.

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