Endometrial cancer

Cancer of the endometrium has increased in incidence, partly because people are living longer than before and reporting such cases more accurately. The word endometrium generally means the uterine endometrium which is the fundus or the corpus of the uterus. About 32,000 cases are reported every year with 5900 deaths. After breast, colorectal, and lung cancer, endometrial cancer is the fourth most common cancer in women and the most common pelvic neoplasm. Awareness about endometrial cancer is very less which is the reason for endometrial cancer to be in the fourth place. Hence, all women should be encouraged to have annual check ups, including the gynecological examination.

History plays an important role in diagnosing endometrial cancer. One third of the women with post menopausal bleeding have cancer of the uterus, mainly endometrial. Obese women have slightly higher risk of endometrial cancer because of the increased levels of estrone related to excess weight. To explain in detail, there is conversion of androstenedione to estrone in body fat, which exposes the uterus to unopposed estrogen. Obese women should be taken extra care by the medical professionals to evaluate the risk of having cancer of the endometrium.

Women who are on hormone replacement therapy (HRT) are at the potential risk of having endometrial cancer. Unopposed estrogen administered in HRT is the reason for putting the women on HRT at risk. Currently, progesterone is added to the HRT regimen to offset this risk. Hence, a good history and a proper physical examination plays a vital role in diagnosing endometrial cancer.

Investigations like endometrial aspiration and biopsy confirms the presence of endometrial cancer. The median age of having cancer of endometrium is 61, and most women are at least 55 when they are diagnosed with endometrial cancer. Women over 50 years with any potential risks (post menopausal bleeding, on HRT, obesity) are encouraged to undergo endometrial biopsy. Women who are on HRT without progesterone should undergo regular endometrial aspiration or biopsy to rule out hyperplasia, which is a precursor of endometrial cancer.Other factors that put the women at risk are nulliparity (those women with no children) and late menopause (who attain menopause after the age of 52).

Ultrasound is a painless way of measuring the thickness of the endometrium that will give an idea about the changes that has occured in the same. However, ultrasonography does not confirm the presence of endometrial cancer. Endometrial smears (aspiration) and biopsy are the direct ways of diagnosis of cancer of the endometrium. A tissue sample from the endometrium is obtained and analysed. It is a common out patient procedure performed during the gynecological pelvic examination.

Treatment is based on the stage of the cancer but its always total abdominal hysterectomy with bilateral salpingo oopherectomy (removal of uterus and the uterine tubes) which is suggested. External radiation and brachy therapy are suggested for those with risk of recurrence. Recurrent cancer usually occurs in the vagina. These lesions are treated with surgery and radiation, and in some cases with HRT and chemotherapy.

Early diagnosis with endometrial smears and biopsy once a year helps women to identify the cancer of the endometrium and treat them effectively without leaving any complications. Hence, an annual gynecological examination is a must for every woman.

Candidiasis

Thrush is a fungal or yeast infection affecting the mouth, esophagus, stomach and vagina. It is otherwise called as Candidiasis. It is caused by an organism called Candida albicans. Vagina is a susceptible host to the organism because Candida flourishes in airless, moist and warm areas. This organism Candida is normally present in our body and does not cause any problem, but when there is any other infection in the body like HIV or any AIDS related disease the infection becomes obvious. Vaginal thrush is generally related with sexually transmitted disease (STD) but can even present without a STD.

Women with vaginal thrush present with the complaint of a watery discharge or thick curdy white discharge which is usually itchy, painful and reddish in the vaginal region. The discharge is odorless and mostly patchy giving an appearance of cottage cheese. Some women complain of a burning sensation, bad odor, swelling, painful urination, painful intercourse and ulcers caused by scratching.

The cause is unknown. Conditions like HIV infection, uncontrolled diabetes, pregnancy induced diabetes, stress, long term steroids therapy, chemotherapy, birth control pills, certain antibiotics tend to increase the risk of having vaginal thrush. It is not difficult to diagnose a vaginal thrush because of its cottage cheese appearance, but some STD's like gonorrhea, chlamydia mimic the same signs and symptoms of a vaginal thrush (that should not be missed). Hence, it's always better to consult a doctor when symptoms appear (especially for the first time and if you are pregnant).

Diagnosis is made by collecting a history about the presence of any chronic illness or on any treatment that compromises the immune system and inspecting the vaginal area and discharge. A vaginal swab is collected by doing a pelvic examination and is sent to the lab to confirm the presence of the organism. The presence of candida in culture confirms the presence of infection.

Vaginal thrush subsides on its own. But unfortunately not always. Untreated vaginal thrush has a high chance of recurrence. Sometimes the woman may find itching and pain beyond control and seek some treatment. Antifungal creams and suppositories are generally used in its treatment. Some of the antifungal topical agents that can be bought over the counters are nystatin, miconazole, butoconazole, tioconazole, terconazole, and clotrimazole. If the infection does not subside with the topical agents, then oral antifungal agents are started. Some of the oral antifungal agents are fluconazole and ketoconazole. As vaginal thrush is common during pregnancy, it is always good to consult your treating doctor for safe medication.

Though infections like this cannot be prevented, there are certain steps that can be taken to avoid or be more careful from getting these types of infection. Wearing cotton panties, wearing loose panties and pants to make the vaginal area more airy, keeping the vaginal area clean and dry by simple washing and wiping after urination and while changing pads during periods, changing pads often before it overflows during periods, changing clothes after exercise or swimming and avoiding douches.

Vaginal thrush is not a sexually transmitted disease, so don't hesitate to visit a doctor and seek treatment while you have any of these symptoms. Studies show that it is normal for a woman to have three to four episodes of this yeast infection every year. Taking appropriate treatment avoids recurrences and unnecessary complications.