 So they can also aware the many fits in keeping their health healthier and stronger. Good afternoon everyone. On behalf of Manipal Hospital Malaysia and our speaker Dr. Raj Shekhar, I would like to thank you all for showing interest in our health education webinar program, aiming to keep everyone aware and educated so as to keep your health healthier and stronger. Thanks again for actively participating in Dr. Raj Shekhar webinar. We request you to please hold for a few more minutes. Webinar will be starting shortly. Meantime, if you have any doubts or health related queries, you can put them in chat section below. Dr. Raj Shekhar will answer all those one by one at the end of the session. You can also share this Zoom Webinar link to your friends, families or WhatsApp groups so they can also avail the benefits in keeping their health healthier and stronger. Good afternoon everyone. On behalf of Manipal Hospital Malaysia and our speaker Dr. Raj Shekhar, I would like to thank you all for showing interest in our health education webinar program, aiming to keep everyone aware and educated so as to keep your health healthier and stronger. Thanks again for actively participating in Dr. Raj Shekhar webinar. We request you to please hold for a few more minutes. Webinar will be starting shortly. Meantime, if you have any doubts or health related queries, you can put them in chat section below. Dr. Raj Shekhar will answer all those one by one at the end of the session. You can also share this Zoom Webinar link to your friends, families or WhatsApp groups so they can also avail the benefits in keeping their health healthier and stronger. Today is a wonderful day. We have our guest speaker, Dr. Raj Shekhar, consultant surgical oncology from Manipal Hospital Malaysia. Dr. Raj Shekhar, a reno in the field of surgical oncology. He has done his MBBS, MS, DNVGS, DNV surgical oncology, FRCS, robotic fellowships. He speaks English, Kannada, Hindi, Telugu and Marathi. So please feel free to ask your queries in your preferred language. Over to you, Dr. We can start the session. Good afternoon everyone. Let us today know some facts and some realities and hopes, treatment, aspect of the most common cancers a woman suffer from. They are related to uterus that is endometrial cancer and cervical cancer. If you can see the screen over here, the inner lining is known as endometrium. Any part of the body can go for cancerous change. And the inner lining or inner most part of the uterus or what we say garbacoche, that is known as endometrium. And if there is any outgrowth or tumor over there, we call it as endometrial cancer. So as you can see, this is the uterus and the lower part is known as cervix. And this is the uterus main body and the inner lining is endometrium. You can see some changes which are happening here. These are the changes which are happening. So what is the cause of this? The cause exact cause is not known. But there are some changes which happen so that the cells in the endometrium keeps growing uncontrolled and the cells divide and they become so strong. So much mutated that they keep on growing and they keep on spreading. So what are the risk factors? Are there any risk factors who will develop more means who is more prone to this endometrial cancer? Yes, if there is an imbalance of female hormones, that is more estrogen, that is irregular menstrual cycle, polycystic oerian syndrome. In these conditions, what happens is there is more amount of estrogen. This estrogen is the main factor where this endometrium starts growing. And the other factors are people who are diabetic and people who are obese, they are at increased risk. And the one more thing is post-menopausal ladies means as the age advances, the risk of endometrial cancer also increases. And people who have more menstrual years means the menarche has started early. That means menstruation has started earlier than the 12 years of age and has lost it for more than 45 to 50 years. And it is going on. Means more the years of menstrual cycles or menstrual period, the higher the risk of hormonal exposure. And some people take hormone therapy, postmenopausal hormone replacement therapy, what we call it as. Or sometimes because of breast cancer, we will give hormonal treatment. These people are also at increased risk. And women who are never pregnant, they are also at increased risk of exposure to estrogen rather than testosterone. And there are some hereditary conditions like it is associated with colonic cancer. And sometimes there is a typical endometrial hyperplasia, which can also convert into cancer. So that's a risk factor. So now what are the symptoms? How do you detect or how do you suspect that a person is having endometrial cancer? One is irregular menstrual bleeding or intermenstrual bleeding. In between two cycles, you may bleed or there may be an excessive bleed during the menstrual period. There will be a lot of clots, then we should suspect something is wrong. And having bleeding after attaining menopause means menopause means cessation of menstrual cycle. At the age of 45 to 50 years, normally Indian women will stop continuing to have this menstrual cycle. And one year, two years, three years after a gap of this, again, you feel that there is a small amount of bleeding. That is an alarming sign. That is post menopausal bleeding. And lower abdominal pain means there is some amount of discomfort in the lower abdomen. Some pain, some discomfort, which is continuous. And having watery or blood pinched vaginal discharge is also an indication of this one. There is a symptom. So now, coming to the investigations, how to investigate and confirm that it is an endometrial cancer? Yes, you need to consult a specialist for that. And they will be doing the pelvic examination. Sometimes we ask for transvaginal ultrasound. And the main thing is histroscopy. The scope is introduced into the uterus. And if there is any abnormal growth, we will be seeing that and we'll be taking a biopsy from there. So that confirms the endometrial cancer. Sometimes you must have heard a DNC, dilatation and curatage. The pictures which were shown here, first there will be, the opening will be closed always. So it will be opened with the dilator and the biopsy forceps will be introduced inside and small piece will be taken. So that will tell us that yes, this is a confirmatory cancer. And how do you stage, what are the stages? Always in cancer, we have four stages. When it is on to endometrium, we say stage one and means that the uterus, we say stage one. If it goes into the cervix, the lower part of uterus, then we say stage two. And if it goes beyond the uterus to the perimetrium or ores, we say stage three. And when it goes beyond the pelvis, we say to the other organs, we say stage four. So that is this one. So what are the treatment options? Most of the times endometrial cancers are detected early because of irregular bleeding or heavy bleeding. So that's a good thing that it can be detected early. Most of women come early and options are four standard therapies. One is surgery, radiation, chemotherapy, hormone therapy. Majority of the times early cancers are treated by surgery and majority times it is curable. Stage one, stage two, most of the times it is curable. So the catch here is coming to the doctor at a very early stage. So surgery can be open, laparoscopic or robotic. And if at all, if there are some aggressive features in that, then we subject after the surgery for a radiation treatment. It can be external beam or it can be internal, what we call brachytherapy. So these are the two types. And chemotherapy, if at all it is advanced, it is stage three or stage four, then we use chemotherapy. Chemo therapy is nothing but injections or tablets being given. And hormonal treatment we give when it is very early stage and there is an important aspect like still women didn't have children. So we want to preserve the uterus. In that bridge gap, we give hormone treatment so that she can consume her children and immediately after that we treat it. But this is not a definitive treatment. It is, we are just buying the time. So these are the four modalities of treatment. Majority of the times endometrial cancer is curable. So if at all there is any heavy bleeding or post-menopausal bleeding or interminstrel bleeding, please consult your doctor. So we will be definitely able to cure it. Okay. Yeah, this is all about endometrial cancer. Now I'll be briefing about cervical cancer. Yes. This is also a cancer related to uterus, but the lower part of the uterus. The previous cancer was inner lining of the uterus that is endometrial. This is the lower portion of the uterus. This part is known as cervix. So if at all there is an overgrowth of this part, we call it as cervical cancer because this part is known as cervix. So now next is what is the cause of this cervical cancer? Until recent past, cervical cancer was the most common cancer in women. Now it is breast cancer. And even now the most, if you take the numbers, we have the highest statistics, highest number of cervical cancers in India. And fortunately recently we have identified that it is caused by the human papilloma virus infection in cervical cancer. And what are the risk factors which women are more prone for this cervical cancer? One is smoking and HIV, human immunodeficiency virus infection. Even those women are at increased risk and women who smoke and women who are taking birth control pills for more than five years or so. And multi-para, what we say having given birth to many children, more than three children and having several sexual partners because the chances of viral infection increases. So that is why those women are also at increased risk of having cervical cancer. So what are the symptoms? When we should suspect that there is a risk of cervical cancer or I need a developing cervical cancer. There will be a small amount of pelvic pain, constant pelvic pain or sometimes bleeding. Bleeding can be inter menstrual bleeding or excessive bleeding during menstrual period or bleeding just before or during or after intercourse, sexual intercourse. Or there can be vaginal discharge which is false smelling or sometimes may not be false smelling but still it continues to come even after taking antibiotics. And the other things are sometimes you may have increased urination, increased urge to make sure it or there can be some bleeding in the motion what you call a bowel movement. And sometimes back pain if it is growing into the back and sometimes in a late cases there can be a leg swelling. That is because it may have grown beyond the cervix and may be causing obstruction to the urators. So early signs most of the times it is mild discharge, mild pelvic pain and bleeding. So anytime you have this please consult a doctor. It don't have to be cancer always but still we want to rule out the worst. And how to diagnose this? A doctor will first do the pelvic examination. If at all there is a growth seen on the cervix then a punch biopsy will be taken that is a small tissue from there will be taken and sent to the lab for confirmation. If at all it is not clearly visible very early cancers then we do colposcopy that's a microscope magnification we see in the magnification and then we take the suspected area small biopsy and send it. And in one case we want to know the extent of CT scan. So that will stage the disease. So what are the treatment options? Cerebral cancer is very much treatable in stage one and stage two and early stage three. The main modalities for all cancers and including uterine cancers or surgery in the initial stages. If it is stage one or early and sometimes when they are very advanced we may go for targeted therapy. Each treatment will be given according to the stages so that will be decided by the doctor. The best part of cervical cancer is we can prevent it. Very few cancers we can really prevent it and among them the cervical cancer tops the list. Because there is a fantastic simple screening method which is available that is known as pap smear. That can be started at the age of 21 years itself and it should be done once in three years. And that goes for up to 29 years and from 30 to 65 years pap smear can be done once in three years as usual from 20 to 29. But there is one more special test available here that is known as human papilloma virus test. That is HPV test because it is the virus which causes cervical cancer. So if you test this then once in five years testing is also enough. And we can do both pap smear and HPV test that is also once in five years should be enough. And if at all a woman is older than 65 years and she is subjected to all these pap smear test and HPV test before 65 years and they were consistently negative probably we may stop doing after 65 years. And if at all she has not done before at all then probably we have to do it once in a while. Otherwise this woman who are already having undergone hysterectomy where uterus is already removed means cervix is already removed. We don't suggest this test. This is about screening which will detect the cancer very early. And there is a fantastic news about cervical cancer is we have vaccine very very few cancers have vaccines where we can prevent cancer from occurring at all. And one among them is cervical cancer. So this can be given between the age of 9 to 26 year old females and usually we say 10 to 11 years or 11 to 12 years girl can start taking this. If it already is taken at an early age means 10 to 12 years only two doses are enough at an interval of 6 months 6 to 12 months two doses of vaccines are enough. And if at all we give very early at around probably nine years probably we may have to give three doses and this is enough. And because most of the cervical cancers are caused by a human papilloma virus we have 80% chance that this cancer will not occur because some HPV infections rare infections can come in but majority are most common HPV infections. Can be prevented. So vaccine prevents six type of cancers because this HPV not only causes cervical cancer it causes some other cancers like oropharyngeal cancer like some warts or panile cancer all these can be prevented by taking this vaccine. So this is a fantastic thing. But in Indian setup even government has approved up to 45 years. Ideally it is taken before first sexual intercourse or first exposure to the woman papilloma virus. But nonetheless it can be taken if it is not taken before up to 45 years but protection may not be to that level of not exposed females but definitely there will be some amount of protection for the papilloma viruses which you are not exposed at. So that prevention can be done. So I would urge all the females in our country in our vicinity please advise or encourage or take yourself this vaccine. This is a wonderful this one which we have got in cancer which I think majority 99% of the cancer doesn't have this luxury of prevention. So we were able to identify what is the exact cause for cervical cancer and yes vaccine is there in the market. There are two brands available. Now please take it a cervix and goddess will take it and prevent it and also spread this news to others so that many women mother whether the sister or wife of anyone can be prevented from this dreaded disease. Thank you. Thank you so much. If at all you have any questions, please let me know. I'll answer that. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. covers some other way and go beyond the uterus, or there can be a pregnancy with that also. There are so many complications which can happen. So we know that IOD is there and we can easily solve the problem. How long does the cervix stay open after ovulation? See, this all depends on the hormonal, this one, we say it is not like ovulation has happened, cervix will open up, it is not like that. The mucus over there becomes very slimy and if at all there is an intercourse during that time the sperm can enter, but it doesn't mean that cervix is open and the infection can enter like that. It is not, the infection enters through the mucus, it makes its own way. And does the tissue removed from the cervix during colchoscopy grow back or does it stay missing? No, don't worry, the tissue taken is very, very small that doesn't change any of the anatomy or function of the uterus. So we don't have to worry about the amount of tissue removed during the biopsy during colchoscopy. It's very, very minimal, very minimal. And what is the role of cervix during birth? Yes, cervix, when baby starts growing in the uterus, initially it grows in the upper part of the uterus, lower part of the uterus is known as cervix and which remains closed. So that is, it's a door. So it protects the baby only during the last trimester when the mother is about to deliver the tip of cervix starts opening. So that keeps protected. So it's a very important organ for complete full-term pregnancy. And if you take HPV vaccine, will there be any side effects? No, I have not seen any side effects till now and it is not reported also. For 27-year-old girl, which HPV vaccine should we take? See, both vaccines are good. There are two brands available in the market. One is Gardasil and Cervarix. Whichever is available, please take it. Both are very good. And if at all you can take polyvalent where now nine HPV vaccines are, nine HPV virus strain is included. That's a better one, penta polyvalent. And what's a normal amount of fetal movement at 22 weeks pregnant after a cervical circulation? See, this is actually not related to cancer. So I would better avoid this because I'm not a specialist in this. It is better answered by a offshore hessian. Sorry for that. Is cervical cancer hereditary? Very, very rare that we come across hereditary cervical cancers. So I don't think endometrial cancers, yes. We have a genetic related, as I said, the colonic cancer, HNPCC, that is known as Lynch syndrome. But for cervical cancers, as of now, we don't have any related genetic genes related to that. So we don't have to worry about that. It is not hereditary. Why cervical cancer will occur after eight years? It takes time for each cancer from one cell to become multiple cells and grow out of control. And it is not like eight years. That is why, see, it is not eight years. Once in three years we do pap smear test or once in five years we do HPV test because during this period it grows. It is not eight years or a period of four to five years it grows. So once it starts, it keeps on changing. So I am 45 years old, can I take that vaccine? I think you are on the, before you get exposed to the human papilloma virus infection. And obviously it is transmitted because of sexual intercourse. And will it help, we take it after 40, as I said, yes. As the age advances because multiple human papilloma virus infection already, a woman will get in. So it may not protect as a girl who has taken at an early age, but there will be some amount of protection because there are so many viruses, types of HPV viruses. All viruses you might not have got infected. So that is, there will be some amount of protection with this polyvalent vaccine. And even if you have no symptoms, should you get screened? Yes, screening is nothing but detection of a cancer when you don't have symptoms. If you have symptoms, it is not screening. Then that means you need to show to a doctor when you don't have any symptoms, even then you go and check up, that is known as screening. So please get it because we can catch cancer at a very, very early stage. So definitely we can cure it. Means cure rate is that time 100%. So how body weight management is important to avoid this cancer? Yes, endometrial, as I said, endometrial cancer is related to obesity. And if we lose our weight, every woman I say, that is why as the age advances, we tend to put on weight, particularly after a childbearing, means a woman has got children. So she tend to put on weight because of hormonal changes. So every woman I advise, please take four to five kilometers of brisk walk where you sweat every day. At least you keep yourself 45 minutes to one hour. That will make a lot of difference in your health. Yes, I hope I have answered most of the questions. If at all someone has got any more questions, please I am happy to answer them. Thank you doctor. Doctor, we have a query from our participant. Yes. If someone is vaccinated for cervical cancer, but later in age, if the same person gets uterus cancer, will that avoid spreading to cervix? See, there are two types of cancer which should not get confused. One is endometrial cancer, one is cervical cancer. Endometrial cancer causes are totally different and cervical cancer causes are because of this virus infection. So if at all already immunized means you are unlikely to get cervical cancer, 80% of the times you are not likely to get cervical cancer. Endometrial cancer, yes, you are liable to get. Thank you doctor. We have our one more participant asking, my doctor is 15 years old. My daughter is 15 years old. How many dosage of vaccine is required to her? Yes, two doses of vaccines. If at all she is still within 15 years of age, then two doses is enough. If she has crossed 15, probably three doses should be enough. So also the participant is asking, is early menopause increases risk of cancer or can be avoided by any precautions? No, you don't have any control over that except that you have a regular brisk walking, means decrease the obesity because even fat will produce estrogen. So in turn, that is a stimulant for cancer. Other than that, you don't have direct control over the menstrual cycle. And if at all you have early menopause, actually it's a good thing that you avoid the risk of endometrial cancer and also breast cancer. Both are more common when menstrual cycle is there for 45, 50, 55 some women will bleed until 60 years. They have more risk of cancer, not early menopause. Thank you doctor. Thank you doctor for your time and sharing your views on cancers. Thank you all for joining the webinar. For booking appointments, contact details will be shared to you via SMS and WhatsApp. Also, we would like to inform, you can now avail 30% of on regular health checkups on Wednesdays. So for booking appointments, contact details will shared on your screen. Thank you. Thank you. Thank you doctor.