In Nepal, the most common types of cancer that affect women are breast cancer, cervical cancer, ovarian cancer, and uterine cancer. There are also other types of cancers that affect women that aren’t as common as the five mentioned above. These include cancers of the lungs , brain tumors and other organs. Let’s take a look at the five most common cancers for women in Nepal to get an idea of which ones we should be especially concerned about.
Cervix Cancer is the most common cancer in females in Nepal.
Although breast cancer is more common in cities like Kathmandu, overall cancer of the cervix/ uterus is the number one cancer.
Signs and symptoms of cervical cancer :
- Bleeding or watery discharge
- Bleeding after between priods, after intercourse or after menopause.
- Low backache, lower abdomen pain
What causes cervical cancer?
Most cervical cancers are caused by the virus HPV, a sexually transmitted infection.
How is cervix cancer detected ?
It is usually detected by a regular screening program called PAP Smear .
Your gynae-doctor may also examine your cervix and take a sample of tissue for a biopsy if they suspect you have cancer.
How is cervical cancer treated?
The treatments for cervical cancer are radiation, chemotherapy, surgery, targeted therapy, and brachytherapy. Treatment of cervix cancer is incomplete without brachytherapy, so make sure that you receive brachytherapy.
Can cervical cancer be prevented?
There are some things you can do to prevent cervical cancer. Receiving regular gynecological exams and getting Pap tests are the most important steps to take toward preventing cervical cancer. Other things you can do are:
- Get HPV vaccine if available
- Limit your sexual partners.
- Stop smoking and using tobacco products.
Is there vaccine for cervix cancer?
Human papillomavirus (HPV) is the virus that causes cervical cancer in women and genital warts and also oral cancers in men and women. It’s a virus that can be transmitted through sexual contact. During intercourse or oral sex, HPV can make its way into the genitals, mouth, or throat and cause infection.
There are more than 40 types of HPV virus but only few types cause cancer. Now there is a vaccine available to prevent these cancers.
Getting the HPV vaccine reduces a woman’s risk of cervical cancer and precancerous growths substantially. Men cannot develop cervical cancer, but the HPV vaccine may prevent genital warts, penile cancer, anal cancer, and the spread of HPV to sexual partners.
When Should You Get the HPV Vaccine?
HPV vaccine works best when given before any exposure to HPV.
Routine vaccination is recommended for Ages 11–12 years, and can be started at age of 9 years
Catch-up Vaccination: Age 13–26 years, if not previously vaccinated
Vaccination is not recommended for everyone older than age 26 years. In general, HPV vaccination of people in this age range provides minimal benefit because most people have been exposed to HPV already. However, some adults aged 27–45 years who are not might be at risk for new HPV infection and might benefit from vaccination.For adults who are 27–46 years old, clinicians can consider discussing HPV vaccination with people who are most likely to benefit.
What is the schedule of vaccines?
- A 2-dose schedule is recommended for people who get the first dose before their 15th birthday. In a 2-dose series, the second dose should be given 6–12 months after the first dose (0, 6–12-month schedule).
- A 3-dose schedule is recommended for people who get the first dose on or after their 15th birthday, and for people with certain immuno-compromising conditions(HIV infection, cancer, transplantation, autoimmune disease, or taking immunosuppressant medications).In this schedule, the second dose should be given 1–2 months after the first dose, and the third dose should be given 6 months after the first dose (0, 1–2, 6-month schedule).
Should boys also get HPV vaccine?
The human papillomavirus (HPV) vaccine protects boys against HPV infections that can cause cancers of the anus, penis, and mouth/throat in men. Plus, when boys are vaccinated, they are less likely to spread HPV to their current and future partners.
1) Breast Cancer
Symptoms of breast cancer may include a lump or thickening of tissue. If you notice anything that feels unusual, contact your doctor as soon as possible. Breast cancer is often diagnosed with a physical exam and biopsy, which involves removing a sample of cells to be tested.
Treatment can include surgery (to remove tumors or lymph nodes), chemotherapy, radiation therapy and hormone therapy. Surgery can be either removal of tumor only, saving the breast or removal of the whole breast. Please talk to your doctor about which is more suitable in your case.
New treatment options are Targeted therapies, that target specific characteristics of cancer cells.Some targeted drugs are Trastuzumab (Herceptin) ,Palbociclib (Ibrance), ribociclib (Kisqali), abemaciclib (Verzenio), Olaparib , Avastin etc.
2) Ovarian Cancer
One of the most common cancers among women, ovarian cancer is known as the silent killer because symptoms are often vague and difficult to identify.
Around 5 – 15% are caused by an faulty gene which comes in family. Inherited genes that increase the risk of ovarian cancer include BRCA1 and BRCA2 genes. Faults in these genes also increase the risk of breast cancer. Now tests can be done to find these genes in patient and other family members.
Common symptoms are as follows. Treatment is mainly combination of surgery and chemotherapy. New drugs like targeted therapy eg PARP inhibitors (Olaparin) and Avastin (Bevacizumab) also have some role.
Symptoms of ovarina cancer may include:
A heavy feeling in the pelvis Pain in the lower abdomen Bleeding from the vagina Weight gain or loss Abnormal periods Unexplained back pain that gets worse Gas, nausea, vomiting, or loss of appetite
3) Thyroid Cancer
It is also one of the most common cancers in women worldwide. There are a lot of myths surrounding thyroid cancer, but it is actually quite treatable. Surgery to remove parts of your thyroid or entire thyroid can cure you—if diagnosed early enough. Without treatment, though, it can be deadly. Early detection is key! Don’t wait: get checked today by a medical professional specializing in treating cancer if you notice any unusual lumps or swelling around your neck area.
4) Gall Bladder Cancer
Gallbladder cancer is a relatively rare cancer worldwide , but the incidence is higher in areas in Nepal and North India around Ganga river. One potential hypothesis is the increased incidence of gallstones. The high incidence in Kathmandu is seen in population based cancer registry data.
Gallbladder cancer is most common among those between 50 and 70 years old. The disease develops when cells on the inner wall of your gallbladder develop abnormally. When these cells multiply too quickly, they form a tumor that may be either benign or malignant. Jaundice is most common symptom. Other symptoms are pain in abdomen, weight loss and lack of interest in food.
If diagnosis is done in early stage, surgery can be done for cure. If stage is late, chemotherapy are done to control symptoms and control disease.
5) Colon and rectum cancer
Colon and rectum cancer most often affects men older than 50 years of age and women older than 60 years of age. Because colorectal cancer progresses slowly and may not cause any symptoms during its early stages, regular screenings are extremely important to detect colon or rectal cancer as early as possible. By detecting colon or rectum cancer at an early stage, treatment options are greatly increased for a positive prognosis.
There are two types of screening tests: fecal occult blood test (FOBT) and colonoscopy. A FOBT checks for hidden blood in stool samples, while a colonoscpy allows doctors to examine part of your colon and check for growths or abnormal tissue changes.
Early stage colon and rectum cancer have very good cure rate. Treatment like surgery,radiotherapy , chemotherapy are used in various combination according to stage of disease.
In colon cancer that has not spread to other part of body, surgery is usually first treatment after which patient may need chemotherapy. But in Rectal cancer, usually giving radiotherapy and chemotherapy before doing surgery gives best results. This approach is called neo-adjuvant therapy.
Some Interesting and Alarming Data from Nepal.
In 2021, Subedi R and team reported comparison of cancer in City (Kathmandu) and Village (Rukum) from cancer registry. They found that for every one lakh population, 100 female were having cancer in Kathmandu while it was about 50 in Rukum. So cancer incidence was almost double in Kathmandu. Breast cancer was the most common site of cancer in Kathmandu , which was eight times higher compared to Rukum, whereas for cervix cancer , incidence in Kathmandu is 30% less than in Rukum.
According to WHO country profile, total number of cancer cases in 2018 was 26,184 and Total number of cancer deaths was 19,413. They have not separated according to sex. According to this report , 22.7% of cancer in Nepal is due to Tobacco, 20% due to infection, 3.2% due to alcohol and 1.7% due to occupational exposure.(population attributable fractions)
According to GLOBOCAN data from IARC/WHO, Cervix cancer is most common female cancer in Nepal with incidence of 19.4%, followed by Breast cancer 17.1%, Lung cancer 7.7% , Gallbladder cancer 6.1% and Ovarian cancers – 5.1%
Screening for female cancer
The three main screening tests for women are Pap smears, mammograms and physical exams by gynecologists. Typically, a woman will receive these tests every year or two. For cervical cancer screening (Pap smears), a nurse or doctor inserts a speculum into your vagina, then collects a sample of cells from your cervix. For breast cancer screening (mammograms), technicians take x-rays of your breasts, looking specifically at tissues that could develop cancer over time. Sometimes ultrasonography may also be used for screening in breast cancer.
Know more about screening program available at Kathmandu Cancer Center.
For colo-rectal cancer after 45-50 years of age, screening is recommended by fecal occult blood test(FOBT) every year and colonoscopy every 10 years.