Oncquest Laboratories satellite lab network: Oncquest Laboratories Primary Service Centers:

! Oncquest - Ashlok Hospital, 25A Block, ! 10-B, Kasturba Gandhi Marg, New Delhi 01. AB Community Centre, Safdarjung Enclave, ! A-28, Kailash Colony, New Delhi 48. New Delhi 29. Tel: 011 4669 6438 Tel: 011 4106 2814 - 15

! 875, Main Railway Road, near Bus Stop, ! Oncquest - Jeevan Mala Hospital, New Rani Bagh, Delhi 34. Tel: 011 2702 5779Rohtak Road, Delhi 5. Tel : 011 2353 3030! J-16, Main Aurobindo Marg, Hauz Khas, ! Oncquest - Sama Hospital, 8 Siri Fort Road,

New Delhi 16. Tel: 011 4951 5253 - 5200New Delhi 49. Tel: 011 4311 1888! Life Care Centre, 35, Defence Enclave, opp. ! Oncquest - Dr Sudhir Jain Laboratory,

Preet Vihar, Delhi. Tel: 011 2241 404915 Shopping Centre, Pocket B, Siddhartha Extn., New Delhi 14. Tel: 011 2634 7846

! Dr. Mallika Shetty Clinic, Kandoji Chawl ! Oncquest - Nova Medical Centre, 4/16 Jerbai Wadia Marg, Parel, Mumbai 12. A-19, East of Kailash, New Delhi 65Tel: 022 6580 4666! Oncquest - GM Modi Hospital & Research

Centre, Press Enclave, Mandir Marg, Saket! 10, Ground Floor, 1st Cross, 4th Main, New Delhi 17. Tel: 011 4069 9999

Sampangiramnagar, Bengaluru 27. Tel: 080 2211 3349Oncquest - MD Oswal Cancer & Multispeciality

Hospital, G T Road, near Sherpur by-pass, ! 1-2-8/11,Gagan Mehal Road, Domalguda, Ludhiana 09. Tel: 0161 267 6100 - 01

Hyderabad 29. Tel: 040 6610 5767Oncquest - Nova Medical Centre

! 7/2A, Ground Floor, Dover Lane, Gariahat, 222, 5th Main Bellary Road, Sadashiv Nagar, Kolkatta 29. Tel: 033 4001 2295Bengaluru. Tel: 080 4098 7198

Oncquest - Nova Medical Centre, Opus 143, ! 116/120, Habbibullah Road, T. Nagar, 1st Cross, 5th Block, Kormangala, Bengaluru.

Chennai 17. Tel: 044 4212 1383Tel: 080 4348 5555

! Plot No. 2, Rookmani Palace, Raibareilly Oncquest - Nova Medical Centre, Ujagar Prints, Road, Lucknow. Tel: 099364 13052Sunder Baug, Borla Village, Chembur, ! Shop No. 8, Nayak Yousuf Apt., Chowk, Mumbai 88. Tel: 022 9334 4600

Lucknow. Tel: 093361 39399Oncquest - Central Lab Indore, 22-24 Yashwant Plaza, Indore 1. Tel: 0731 4001140

NEW DELHI DELHI

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Inside!

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Tumor Markers: A Ray of Hope Dealing with Cervical Cancer Prevention in India 14 Cancer Symptoms – Do Not IgnoreNew Tests LaunchedOncquest Network

Oncquest Laboratories Ltd.3, Factory Road

adjacent to Safdarjung HospitalNew Delhi-110 029

Tel: +91 11 2610 1240 Fax: +91 11 2618 2231

E-mail:info@oncquest.net

Visit us at: www.oncquest.net

Oncquest – An insight into DiagnosticsOncquest – An insight into DiagnosticsOncquest – An insight into DiagnosticsOncquest – An insight into DiagnosticsOncquest – An insight into DiagnosticsOncquest – An insight into DiagnosticsOncquest – An insight into DiagnosticsOncquest – An insight into DiagnosticsOncquest – An insight into DiagnosticsOncquest – An insight into DiagnosticsOncquest – An insight into Diagnostics

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A network spread across 85 cities in India

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Oncquest Laboratories Ltd.

Sample pick-up facilities available in all major cities across India. For queries, contact: 011 3061 1455, 011 3061 1432

Oncquest adheres to unmatched international guidelines of pathology at all stages. State-of-the-art laboratory offering comprehensive test menu in clinical diagnosis using most advanced techniques. Oncquest follows stringent quality norms as laid down by:

NABL ACCREDITEDCertificate No. M-0020

Issue No. 2 July – September 2011

I am pleased to present you the second edition of OnCore. I would like to thank the medical fraternity for their appreciation and support for the first issue. The current quarterly issue will enlighten you with the latest diagnostic trends in Human Papilloma Virus & Cervical Cancer and Role of Tumor markers in Diagnosis & Management of disease.

We hope that this second issue of OnCore will also carry out the same value addition to your clinical practice as the previous edition did. We welcome you to share your experiences, your expertise and your challenges or any other important message which you would like to share with all of our valued readers and clients.

For further suggestions, feedbacks & more details about OnCore content, please e-mail us at: info@oncquest.net. Our endeavor is to develop accurate customized solutions with timely service which can meet the challenging needs of the diagnostics industry. I look forward to your continued support and would not miss this opportunity to thank you for trusting Oncquest and having faith in our abilities.

Warm Regards

Dr. Ravi GaurVice President-OperationsOncquest Laboratories Ltd.

Comprehensive Test Menu for Human Papillomavirus:

Launched HPV laboratory testing by offering comprehensive test menu for diagnosis and prognosis of cervical cancer and lower genital cancer disease dynamics. Key Panels are:HPV DNA Test> Capable of detecting and differentiating

high-and-low-resik HPV types!13 High Risk (16, 18, 31, 33, 35, 39,

45, 51, 52, 56, 58, 59, 68) associated with Cervical cancer !5 Low Risk (6, 11, 42, 43, 44)> Gold standard for semi-quantitative

detection of HPV high risk types with!Clinical sensitivity of >96%!Negative Predictive Value of >99%

Liquid-based Pap TestBetter representative image of cervical cell morphology than Pap Smears. Better sample... More visibility... Better interpretation.

HPV GenotypingTo identity type specificity of 33 HPV HR and LR subtypes using PCR and Membrane Hybridization on liquid cytology, STM or biopsy specimens.! Wide limit of detection: Individual

types for 33 HPV Genotypes ! 18 High-risk HPV (HR_HPV) Genotypes! 15 Low-risk HPV (LR-HPV) Genotypes! Detects rare HPV Genotypes with its

“universal probe”

FLAER analysis & PNH Comprehensive Workup ProfileIntroducing two new panels to obviate the diagnostic dilemma in patients of Paroxysmal Nocturnal Haemoglobinuria (PNH) there by aiding in an early and accurate immunophenotypic diagnosis! FLAER Analysis: Include FLAER, CD 14

and CD 33 by flowcytometry! PNH Comprehensive Work up Panel-

Include CD 33, CD14, FLAER, CD55, CD 58, CD59 by flowcytometry

Immunodeficiency Panel Initiated Immunodeficiency Panel by flowcytometry in detecting various kinds of immunodeficiency’s in females which ultimately leads to miscarriages.! Panel includes Markers: CD19, CD3,

CD16, CD56, CD45 ! Helpful in detecting

immunodeficiency’s of various kinds! In frequent miscarriages

New Tests Launched

Oncquest want to affect the people it serves by providing customized diagnostic solutions

! at an early stage the diseases which afflict the populations we serve, through community outreach and our relationships with practitioners.

! with accuracy and reliability the diseases which are presented to us, using the best-in-class of technology available globally.

! effectively, the population from such diseases for the future, through education and knowledge sharing. In whole we believe in endorsing our mission i.e.

“To extend the survival and improve the quality of life of patients by evolving high- end technologically advanced, cost effective; branded molecular testing assays to assist doctors and patients to optimize patient care and diagnose diseases at e a r l y s t a g e s o f i n f e c t i o n o r malignancy”.

To Discover

To Diagnose

To Defend

Oncquest’s Mission

2 3

In today’s world, everyone is markers may also be elevated in non- certain treatments.susceptible to be caught in grasp of cancerous conditions. Thus, there

! Guide Treatment: A few tumor deadly disease like cancer. We are a r e on ly a handfu l o f we l l - marker levels may be used to living in a stressed environment, established tumor markers that are help the physicians to plan tightly scheduled 24x7 working with routinely used by physicians. appropriate therapy. no relaxation and improper eating

! Monitor Treatment: Tumor Tumor markers are one of the habits. Added to this, there is the risk markers can be used to monitor associated with pollution... exposure diagnostic modalities which in the effectiveness of treatment, to harmful chemicals which may conjunction with other tests, forms especially in advanced cancers. trigger several complex mechanisms a definitive tool for detection of A decrease or return to a normal inside our body resulting in the tumors. Tumor markers provide level may indicate that the growth of smal l cancer ce l l s information that can be used to:cancer is responding to therapy, somewhere deep inside. We may not ! Screen: Screening refers to whereas an increase may be aware of this growth until it grows looking for cancer in people who indicate that the cancer is not to a size that starts interfering in our have no symptoms of the responding and adjustments are daily routine. It may cause lumps, disease. Detection of cancer at needed. The information must obstructions and pains till finally it is an early stage helps to reduce its be used with care, since, other detected. spread and is easier to treat. conditions, too, can sometime Some tumor markers may be cause tumor markers to rise or Advancement in diagnostics like used in people with a strong fall. detection of “Tumor Markers” have family history of a particular

elevated the hopes of therapy for all cancer. ! D e t e r m i n e R e c u r r a e n c e : cancer patients, who live under a Currently one of the most ! D i a g n o s e : I n d i s e a s e d shadow. impor tan t u s e s o f tumor symptoms, tumor markers may

markers is to monitor for cancer help to figure out the source of Tumor markers are substances that recurrence. If an elevated tumor the cancer. are produced by the body in response marker first decreases after

! Stage: In some types of cancer, to cancer growth or by the cancer treatment and then rise again, it’s tumor marker levels can be used tissue itself. These substances can be a n i n d i c a t o r o f c a n c e r to determine the extent of tumor found in the blood, in the excretory recurrence. If it remains elevated spread into other tissues and urine, body fluids or tissue samples. even after surgery, then chances organs. Some tumor markers are specific for are that the cancer was not

a particular type of cancer, while completely removed during ! Prognosis: Some cancers may be others are seen in several cancer surgery.more or less responsive to types. Most of the well-known

Tumour MarkersA Ray of HopeDr. Monika Shashank Ph.D (Head Molecular Biology & Quality Systems)

Visit us at: www.oncquest.net

Tumor Markers Cancers What Else? When/how UsedAlpha-feto protein (AFP) Liver, germ cell ovarian It may elevate during Can be used for diagnosis,

and testicular cancer pregnancy monitor treatment, anddetermine recurrence

Cancer antigen 15-3 (CA 15-3) Breast cancer It may be elevated in benign Can be used to monitor breast conditions, lung and treatment, determine Stageovarian Cancer of disease & recurrence

Cancer antigen 19-9 (CA 19-9) Pancreatic cancer It is present in hepatobiliary Stage disease, monitor cancers and bile duct treatment, and determineobstruction recurrence

Cancer antigen 125 (CA 12-5) Ovarian Cancer It may be elevated in Can be used for diagnosis, endometriosis, some other monitor treatment andbenign conditions determine recurrence

Calcitonin Thyroid medullary It may be elevated in non- Can be used for diagnosis,carcinoma thyroid neoplasm monitor treatment and

determine recurrence

Chromogranin A (CgA) Carcinoid tumors and May be most sensitive tumor To help diagnose and monitorneuro-endocrine tumors marker for Carcinoid tumors

Estrogen receptors Breast Cancer ER +ve individual have better Determine prognosis andprognosis in breast cancer guides the treatment

Human chorionic Gestational trophoblastic It may elevate during Can be used for diagnosis,gonadotropin (hCG) disease and germ cell pregnancy and other benign monitor treatment and

tumors. conditions determine recurrence

Progesterone receptors Breast Cancer PR +ve individual have better Determine prognosis andprognosis in breast cancer guide treatment

Prostate specific antigen, Prostrate Cancer Elevated in benign prostatic Can be used for screen,total and free (PSA) hyperplasia, prostatitis and diagnosis

with age

Thyroglobulin Thyroid Cancer It may be used to determine Can be used to determinecause of hyperthyroidism & recurrencemonitor prognosis of Graves’ disease

CEA (Carcino-embryonic Colorectal, lung, breast, Elevated in other conditions Monitor treatment and antigen) thyroid, pancreatic, liver such as hepatitis, COPD, determine recurrence

cervix and bladder colitis, pancreatitis and in cigarette smokers

Her-2/neu Breast Oncogene that is present in Determine prognosis andmultiple copies in 20-30% of guide treatmentinvasive breast cancer

EGFR (Her-1) Solid tumors, such as of Not available in every Guide treatment andthe lung (non small cell), laboratory determine prognosishead and neck, colon, pancreas, or breast

NSE (Neuron-specific enolase) Neuroblastoma, small May be better than CEA for Monitor treatmentcell lung cancer following this particular

kind of lung cancer

S-100 Metastatic melanoma Not widely used Help diagnose

b2-microglobulin Non-Hodgkin’s, lymphoma, Increased B2M indicates Can be used to Correlates AIDS, Lymphocytic increasing cell reproduction with tumor burden, prognosis,leukemia, Viral hepatitis, rate commonly in response to therapy, Increase Renal transplantation inflammation, autoimmune with poor renal function

disease, lymphoma and viral infection specially in Multiple Myeloma

OTHER WIDELY USED TUMOR MARKERS

! Conducted a CME in Patna in association with association with Dr. Rajesh Parthsarthy in the month of Indian Society of Gastroenterology (Bihar & May at Uday Park, New Delhi.Jharkhand Chapter) on advancement of molecular

! Conducted an effective Cancer Screening Programme diagnostics in gastrointestinal diseases.in the month of May at Trajit Camp, New Delhi.

! Advanced tools in cancer diagnostics: Conducted a ! Organized an interactive programme with clinicians of workshop in association with Banjara Hills, Care

Nova Hospital, Koramangala and Sadashivanagar Hospital, Hyderabad to orient the technicians on Bengaluru to bring awareness on advance capabilities the different platforms in the area of cancer of Oncquest focusing on multiple tools, require in diagnosis.diagnosis and prognosis of cancers.

! Organized a preventive health screening camp in

Recent Activities...

COMMON TUMOR MARKERS

4 5

deve lopmen t i n women was t h e s h e e r A 51 year-old woman with no established beyond doubt. The population size history of cervical cancer screening International Agency for Research our country has, presented to her gynecologist at Holy on Cancer (IARC) – a World Health reporting over Family Hospital in New Delhi. Organisation (WHO) Agency – then 130,000 new cases and more than Having initiated a research project accepted that infection by some 80,000 deaths annually.for the first time in India on primary genotypes of human papillomavirus HPV testing in conjunction with Pap

The concept of a prevent ive (HPV) probably caused cervical by Liquid Cytology in 2005, her healthcare is quite a welcome change cancer [Van Asten M. Cervical doctor prescribed both an HPV test for India because making people Cancer: The Viral Factor. Today’s and a Pap Smear. The liquid cytology understand about it in an area like Life Science 1997; June:32-36] and it was read as normal, however, the cancer which is a very rare outcome took five more years to acknowledge HPV test was positive. The patient disease has always remained a big that HPV was a major cause of returned in six months for repeat challenge where our focus for past 6 cervical intraepithelial neoplasia testing, at which time the follow-up decades has been solely upon (CIN) (or Squamous Intraepithelial Pap test revealed atypical glandular treatment on which our entire Lesions, SIL) and cervical cancer. cells of undetermined significance healthcare system revolves. Despite Hence emerged a successful clinical (AGUS). As a result, her doctor rising middle class and upward diagnostic assay to correctly detect called for colposcopy-directed economy for over past two decades, HPV DNA to identify women who biopsy that disclosed high-grade our healthcare insurance sector cares may have been persistently infected cervical intraepithelial neoplasia more for patient hospitalization than a n d w h o m a y b e a t r i s k o f (HSIL), and cervical conization preventive diagnostic check-ups development of cervical cancer. showed a micro-invasive carcinoma which could potential ly save with positive margins. The patient

India was fairly quick among all significant healthcare GDP. Perhaps subsequently underwent radical Asian nations to introduce HPV the time now comes to give it a hysterectomy with node dissection, testing in 1998, and in a way accept serious policy guideline.with no residual carcinoma found in the concept of preventive healthcare the hysterectomy specimen. She Cytology Testingby the larger sections of healthcare remained free of evidence of disease It is now well recognized that providers. Thanks to the massive and at greater than two years and was effective identification and treatment m u l t i c e n t r i c e p i d e m i o l o g i c grateful to her doctor for having of pre-cancerous lesions must occur population research programs caught her precursor lesion just in to prevent the incidence of cervical initiated in 2000 by IARC /Gates time to spare her from aggressive cancer. Since early 1950s, Pap Smear Foundation, the results of which radiation and chemotherapy. or cytology screening has been a showed nearly 6 times reduction in

mainstay in the developed countries the prevalence of cervical cancer Screening for cervical abnormalities where annual screening has been among HPV screened women as has since come a long way during last fo l lowed and has been ve ry compared to other approaches (R five years in India, since the time in successful in the reduction of the Sankarnarayanan, N Engl J Med 2005 when HPV test ing was incidence of cervical cancer. In 2009 April: 360; 14). The enormous approved for primary screening by contrast, it has not benefitted benefit of this finding was suggestive the US FDA.resource-poor settings in vast of the adoption of HPV testing as a

Historical Background majority of the other world due to once-in-lifetime test to prevent the p r o c e d u r a l , l o g i s t i c a l a n d In 1976, Prof Herald zur Hausen and incidence of cervical cancer for low technological inadequacies. Gisam found Human Papillomavirus prevalence and resource poor

(HPV) DNA in cervical cancer and country like India. In unscreened D e s p i t e b e i n g h a i l e d a s a lower genital warts. In 1986, Attila populations, the risk of cervical breakthrough in medical science and Lorincz cloned HPV type 31 for the cancer is seen to be approximately saving countless lives, the Pap Smear first time followed by several other 40-100/100,000 and it assumes has its shortcomings in clinical types in quick succession. By 1992 a greatest empirical significance for settings which lead to both false direct connection with disease

negative (30-50% of high grade result, it has been suggested that the l e s ions and cance r s may go annual screening and follow up undetected) or false positive (the Pap interval for women with negative can falsely suspect disease in 5-20% High Risk HPV DNA tests could be of cases when there is none) results. increased to tri-annual in the Due to the fact that the Pap Smear countries where regular screening is cannot detect all women with pre- practiced.cancerous lesions, and cannot

HPV DNA test also determines a predict women with low-grade need for colposcopy by diagnosing epithelial abnormalities who are the women at a greater risk of likely to develop subsequent high- lesions (although the specificity of it missing a disease and also those who grade epithelial abnormalities, is greater than 90%). may develop a disease eventually. A women have had to be re-screened at woman does not need to panic or be a very frequent interval [Lorincz A. Therefore, women in India are e m o t i o n a l l y d i s t u r b e d . A Human Papilloma Virus Testing. required to be advised to have the gynaecologist may also order a Pathology Case Reviews. 1997; test as part of an annual check-up biopsy only if severe disease status Vol.2:1:43-48], yet a lot of anomaly after the age of 30.warrants.s u r r o u n d e d t h e a s p e c t s o f

By adding HPV testing to the observation, interpretations and Current gu ide l ines f rom the screening algorithm the relative reporting. American College of Obstetricians incidence of adenocarcinoma is also and Gynaecologists (ACOG) as well HPV Testing seen rising over the past decade as American Cancer Society (ACS) In an effort to reduce the number of (Kinney W, Sawaya GF, Sung HY, recommend that women should have false Pap Smear results, much Kearney KA, Miller M, Hiatt RA. HPV DNA testing alongside of Pap emphasis has been placed on Acta Cytol. 2003;47:167-171) tests at least once in three years. It is improving cervical screening during proving a fact that Pap Smear does seen through more than 300 the last decade by IARC. By miss on the adenocarcinoma. population based studies in different introducing a standardized, well- Clearly, at each screening event, the parts of the world over last 10 years. characterized and objective HPV potential for missing high-grade

DNA detection, the sensitivity and intraepithelial neoplasia not only That the Pap Smear lacks sensitivity accuracy of cervical screening is squamous, but also of glandular to detect majority of women with significantly enhanced. HPV Testing origin is a significant risk for missing precancer or early cervical cancer has proven itself in many studies a cervical cancer. worldwide as a very sensitive and specific for CIN and cancer.

Since the presence of persistent infection with high risk HPV DNA types is considered to be necessary for cervical cancer to develop, HPV testing is prognostic. The presence of high risk HPV DNA (even with normal cytology reporting) can identify women both with current precursor disease and those who are particularly at risk of progressing to more serious disease.

Conversely, the absence of detectable HPV DNA can identify women who are unlikely to develop a cervical lesion, or progress to a high-grade epithelial abnormality from a low-grade epithelial abnormality. As a

Dealing with Cervical CancerPrevention in IndiaDr. Dinesh Gupta Ph.D (Head HPV Lab & Cervical Cancer Programme)

Visit us at: www.oncquest.net

New InitiativesOncquest Laboratories acquires business of Gentech Diagnostics

Oncquest join hands with Central Laboratory, Indore

On 1st June 2011, with the announcement of the acquisition of Gentech Diagnostics we have strengthened our investigational spectrum into a new arena of diagnostics (i.e. HPV Laboratory Testing) by taking care of the Cervical Cancer & Lower Genital Cancer disease dynamics with a comprehensive test menu include Real-time PCRs, Hybrid capture 2 based HPV DNA analysis and liquid based cytology diagnostic and monitoring services.

The department of HPV DNA /LBC testing will be headed by Dr. Dinesh Gupta Ph.D (Ex director of Gentech Diagnostics).

On 1st August 2011, Oncquest joined hands with Central Reference Laboratory, Indore headed by Dr. Vinita Kothari. This association helps us in providing high-end specialized services at a faster pace in the central part of India.

Cancer Symptoms – Do Not Ignore

6 7

Visit us at: www.oncquest.net

are still afraid of “knowing” that E6/E7 mRNA as a biomarkerthey have a risk of cervical cancer That the Pap Smear lacks sensitivity while we now know that it is to detect majority of women with completely preventable and rather precancer or early cervical cancer easy to treat when detected early at lesions (although the specificity of is the CIN stage. Johns Hopkins greater than 90%) and conversely, Bloomberg School of Public Health that the sensitivity of high risk HPV while doing a joint work in rural DNA is superior to any of the current south India along with Indian approaches, a combined use of

correctly detect and treat the disease researchers experienced a major cervical cytology and HPV testing is right at the outpatient clinics, if obstacle in finding reluctance of generally believed to be costly and possible for the patient’s compliance women to undergo the pelvic labor intensive; which brings or when there is a reasonable examination required for either Pap significant financial burden for expectation that untreated patient Smear or visual inspection-based resource poor settings like India. will run the risk of the subsequent screening. This was compounded by There is a new mRNA detection development of cancer. The objective similarly poor compliance in the approach to ce rv i ca l cancer of evolving appropriate clinical f o l l o w - u p e x a m i n a t i o n a n d screening which greatly improves the guidelines for our country is quite treatment. On the contrary, the specificity and positive predictive r ight ly served by the Indian IARC sponsored programs at Nargis value (PPV) for CIN2+. There is a gynaecological associations such as Dutt Memorial Cancer Hospital robust body of work now available AOGIN-India, AGOI, ISCCP, supported by Tata Memorial on E6/E7 mRNA as indicators of FOGSI. It is important that we care H o s p i t a l h a d w i t n e s s e d a HPV integration and progression to not only for disease management but tremendous co-operation of the cancer, principally surrounding the also the psychological and emotional similar rural population in the state work of Prof Harald zur Hausen needs of the patients if they are of Maharashtra in the southern who received the Nobel in 2008 for predicted with disease. Clinically, no India, thanks to the excellent people-his work in this field. Determining an disease should be allowed to friendly program implementation actual biological event is eminently progress beyond CIN 3 stage. strategy adopted by them. as useful as determining the presence Therefore, in the cases of non-of a virus that represents a possible

There is a big hope with the pregnant women, decision to treat risk. This removes the concept of a introduction of the HPV vaccines in must occur at CIN 3 stage, usually at woman's age as regards the test last few years. But the true impact of CIN 2 stage and occasionally at CIN efficacy, as observed with HPV vaccines would only be realised in 1 depending upon ev idences testing approach. And finally a the next 4 to 5 decades when the available. The evidences are less t e chn ique i s go ing to a l low young adolescent recipients of the decisive in the case of CIN 2 because differentiation between squamous, regimen are able to still exhibit high a small percentage of CIN 2 cases ectocervical cells and the columnar; antibody titres and neutralise may regress untreated. Similarly, a endocervical cel ls , and bring persistent or any new HPV infections more conservative approach is consensus on clinical decisions to the with the passage of time and lifestyle needed for CIN 1 cases and re-treatment option. As lesions progress change. Though the current vaccines assessment of clinical presentation at in severity, E6/E7 mRNA over-are prophylactic, a time is not far 6- to 12-month interval with smear, expressing cells get distributed away when we will have them colposcopy and directed biopsy throughout the cervical epithelial therapeutic and applied to our outcomes. If the lesions still remain layer rather than being confined to women with precancer disease to inconclusive, an HPV test may be basal layer in low grade lesions cure them. Given any situation, repeated. Decision not to treat these (CIN1). screening efforts should not stop. women may be critical for those

Patient Counseling under 30 years of age keeping future A physician or a gynaecologist or a Cervical cancer, like any other reproductive potential in mind. pathologist’s role is considered far cancers, has a significant social More than two-third of CIN 1 are more important to provide effective impact and enhanced awareness likely to regress untreated.and adequate counseling to the with effective counseling among our patients and their family members. Treatment for CIN in pregnancy is women is what is going to assist its These clinical faculties should be contraindicated though there is no prevention from India. Our women trained and honed to screen, direct neonatal risk associated with

treatment. The hormonal milieu prior to decision to offer surgical is established among practicing during pregnancy too has no major treatment. clinicians, pathologists, researchers, impact on CIN progression, so a cancer NGOs, policy makers and

National Program:decision to treat could be deferred various women’s social organizers. What probably India requires to do for later period. The possibility of This forum could develop effective to prevent the rising incidence of Trachomonas, Chlamydia or other programs in the modular fashion to cervical cancer is to develop a state-common infections must be ruled out undertake enhanced awareness, wise strategy by which a connectivity

1. Unexplained Weight Loss

11. Changes in the Lymph Nodes6. Difficulty in Swallowing

2. Bloating

12. Fever7. Blood in the Wrong Place

3. Breast Changes

13. Fatigue8. Gnawing Abdominal Pain and Depression

4. Between-period Bleeding or Other Unusual Bleeding

14. Persistent Cough9. Mouth Changes

10. Pain

5. Skin Changes

If you suddenly develop bleeding on your skin Pain that persists and is unexplained needs to Many women would be delighted to lose or excessive scaling, that should be checked, be checked out.weight without trying. But unexplained too.weight loss—say 10 pounds in a month If you notice a lump or swelling in the lymph without an increase in exercise or a decrease If you have difficulty swallowing, you may nodes under your armpit or in your neck— or in food intake — should be checked out. have already changed your diet so chewing anywhere else — it could be worrisome.

isn’t so difficult, perhaps turning to soups or If you have a lymph node that gets Bloating is so common that many women just liquid foods such as protein shakes. progressively larger, and its been longer than live with it. But it could point to ovarian

But that difficulty could be a sign of a GI a month, see a doctor.cancer. Other symptoms of ovarian cancer

cancer, such as in the oesophagus. include abdominal pain or pelvic pain, feeling

If you have a fever that isn’t explained by full quickly -- even when you haven't eaten If you notice blood in your urine or your stool, influenza or other infection, it could point to much -- and urinary problems, such as having don’t assume it’s from a haemorrhoid. “It cancer. Fevers more often occur after cancer an urgent need to go to the bathroom.could be colon cancer.” has spread from its original site, but it can

If the bloating occurs almost every day and also point to early blood cancers such as Seeing blood in the toilet bowl may actually persists for more than a few weeks, you leukemia or lymphoma. Other cancer be f rom the vag ina i f a woman i s should consult your physician symptoms can include jaundice, or a change menstruating, But if not, it should be checked in the color of your stool.to rule out bladder or kidney cancer.

Redness and thickening of the skin on the breast, which could indicate a very rare but Fatigue is another vague symptom that could aggressive form of breast cancer and point to cancer—as well as a host of other Any woman who’s got a pain in the abdomen inflammatory breast cancer, also needs to be problems. It can set in after the cancer has and is feeling depressed needs a checkup. examined. If you have a rash that persists grown, but it may also occur early in certain Some researchers have found a link between over weeks, you have to get it evaluated. cancers, such as leukemia or with some colon depression and pancreatic cancer, but it’s a

or stomach cancer.poorly understood connection.

Bleeding after menopause could be a Coughs are expected with colds, the flu, Smokers should be especially alert for any symptom of endometrial cancer. GI bleeding allergies, and sometimes are a side effect of white patches inside the mouth or white could be a symptom of colorectal cancer. medications. But a very prolonged cough— spots on the tongue. Both can point to a E n d o m e t r i a l c a n c e r i s a c o m m o n defined as lasting more than three or four precancerous condition called leukoplakia gynaecologic cancer, at least three-quarters weeks — should not be ignored.that can progress to oral cancer.who get it have some abnormal bleeding as an early sign.

As people age they seem to complain more of various aches and pains, but pain, as vague Most of us know to look for any changes in If you have any symptoms kindly consult your as it may be, can also be an early symptom of moles—a well-known sign of skin cancer. doctor immediately or for more information some cancers , a l though most pa in But we should also watch for changes in skin email us at info@oncquest.netcomplaints are not from cancer.pigmentation.