Abnormal Vaginal Bleeding: Endometrial Cancer, Cervical Cancer and HPV Vaccination

This is a tricky situation where metastatic deposits are seen without knowing where they are coming from. A PET scan is needed to confirm there is no other site of disease in the body, and immunohistochemistry on the biopsy can give clues to where the cancer is arising from, guiding directed and targeted imaging afterward. Many times the primary is never found. If there are only liver metastases, treatment starts with a palliative intent, and depending on how the patient responds and their performance status, a curative approach involving surgery may later be attempted, though nothing can be assured to the patient in advance.

These are being evaluated as adjuvant therapy for cancer, but there is not yet sufficient scientific data backing them, so standard chemotherapy remains the primary reliance. What is showing real results is targeted therapy and immunotherapy, where survival has improved and recurrences and side effects have reduced. Cost has been a sore point since these are expensive medicines, but with generic versions now available and patient assistance programmes extending to international patients, these costs are coming down.

The most common complication with radiotherapy for left-sided breast cancers is cardiotoxicity. Radiation oncologists manage this with deep inspiratory breath-hold and gating techniques, training the patient to hold their breath during the active phase of radiotherapy so toxicity to the heart is reduced, chest wall motion is reduced, and radiation is delivered accurately to the target volume. More precise machines such as IGRT and 4D-CRT are also improving precision for left-sided breast and chest wall tumours.

Until very recently, patient assistance programmes for targeted therapy and immunotherapy were only available to Indian patients. Because these drugs are costly, companies assist with procuring them at up to a half or a third of the usual cost, which is out of reach for many domestic Indian patients too because of regulations. These regulations are now relaxing, and more international patients are able to receive the benefit of these programmes.

Not 20 packs per day, that would be 400 cigarettes a day, which is not possible. Pack-years is the number of packs smoked per day multiplied by the number of years smoked. Two packs a day for ten years makes 20 pack-years, as does one pack a day for twenty years, or half a pack a day for forty years.

It is vaginal bleeding occurring in women over 55 or who have already gone through menopause, and it needs evaluation for endometrial cancer, particularly when accompanied by vaginal discharge, haematuria or anaemia.

Girls aged 9 to 14 need two doses of the HPV vaccine, while those aged 15 to 26 need three doses, which can significantly reduce the risk of cervical cancer and other HPV-related cancers.