CANCER IN WOMEN : ADVANCES IN CHEMOTHERAPY
Dr. V.P. Gangadharan MD, DM, Lakshore Hospital, Cochin
Major cancers in women of concern are cancers of Breast,
Cervix, Ovary and uterus. Advances in chemotherapy have been mainly in cancers
of Breast and Ovary.
Targeted chemotherapy (selectively targeted against the tumor cells) is a major advance in chemotherapy. Capecitabine is a prodrug of 5 Flurouracil (5Fu) which gets converted to the active 5Fu at the tumor cell which express the enzyme TP. It is an oral drug, hence better accepted. Liposomal Doxorubicin is a modified
formulation of Doxorubicin by which the drug is made more active with less side effects. Hereceptin is a monoclonal antibody against Her 2 neu receptor and is effectively used in the management of Breast cancer patients expressing this receptor. Aromatase inhibitors like Arastrazole and Letrozole have been added to the
armamentarium of hormonal manipulators in Breast cancer. In short, advances in chemotherapy have been very promising in the management of cancer in women.
CONTRACEPTION : WHAT IS NEW?
Dr. Girija Gurudas, HOD, O & G, Medical Trust Hospital, Kochi
We have more than 145 contraceptive preparations available,
tailor made to optimally suite women obesity, acne hirsutism, menstrual
disturbances and medical
disorders complicating. Oral contraceptive (OC) pills are widely accepted, safe, reliable, effective and reversible method of fertility control which was introduced in 1960. Then a gradual reductions in the dose of both estrogen (E) and progestogen component was introduced. Not only reduction in dose, the progestogen in the 3rd generation pills have improved receptor selectivity highly effective but at the same time less androgenic than previous formulations – so least side effects and
discontinuation rate has become low. Women with acne and hirsuitism should be prescribed a pill with antiandrogen cyproterone acetate. Pill with drospirenon will be suitable for obese women. Progesterone only pill – 75 ug desogestrone only pill – 75 ug desogestrel – for lactating women. So that quantity and quality of breast milk not altered. Those women having bleeding disorders on anticogulant therapy, having severe dysmenorrhoea, extended cycle combined contraception available so that only 4 periods per year. It has to be taken continuously for 12 weeks. Women having unprotected coitus around ovulation – emergency contraception 50 ug EE + 250 ug LNG as soon as possible or within 72 hrs. Repeated after 12 hours. Hormone releasing 14 D LNG –14S releases 20 um progestogen per day, and can lasts for 5 years. So it is an alternative to surgical sterilization – suitable for women with DUB, endometriosis and adenomyosis. Transdermal contraceptive patch and vaginal horomal rings are other optionsThe health benefits of contraceptives. 1) stabilizes the menstrual cycle. 2) protect against ovarian cancer, endometrial cancer and colorectal cancer. 3) Protection against ectopic pregnancy PID, anaemia, endometriosis and DUB. Thus almost all gynaecological problems are ameliorated. For male contraception, RISUG (Reversible inhibition of sperm under guidance with SMA (Styrene malic acid unhydroxide complex) is under phase III trial in India. The vas deferens is occluded and the charm is that it is a readily reversible method unlike vasectomy.