Carcinoma occuring with oc pill consumption

INTRODUCTION:
  • Naturally occurring estrogen and progesterone have been found to influence the development and growth of some cancers.
  • Overall, however, the risks of endometrialcand ovarian cancer appear to be reduced with the use of oral contraceptives, whereas the risks of breast, cervical, and liver cancer appear to be increased.
  • Use of COCs helps protect women from two kinds of cancers—cancer of the ovaries and cancer of the lining of the uterus (endometrial cancer). This protection continues for 15 or more years after stopping use.
Effect on breast cancer :
  • A woman’s risk of developing breast cancer depends on several factors:
  1. Beginning menstruation at an early age
  2. Experiencing menopause at a late age
  3. Later age at first pregnancy
  4. Not having children at all
  • A recent analysis of data from the Nurses’ Health Study, found that the participants who used oral contraceptives had a slight increase in breast cancer risk.
  • Many breast tumors may have their growth stimulated by estrogen
  • However, nearly all of the increased risk was seen among women who took a specific type of oral contraceptive, a “triphasic” pill, in which the dose of hormones is changed in three stages over the course of a woman’s monthly cycle.
Effect on ovarian cancer -
  • Oral contraceptive use has consistently been found to be associated with a reduced risk of ovarian cancer
  • Researchers have studied how the amount or type of hormones in oral contraceptives affects ovarian cancer risk
  • Oral contraceptive formulations with high levels of progestin were associated with a lower risk of ovarian cancer than formulations with low progestin levels . In another study, the Steroid Hormones and Reproductions (SHARE) Study, researchers investigated new, lower-dose progestins that have varying androgenic (testosterone-like) effects. They found no difference in ovarian cancer risk between androgenic and nonandrogenic pills.
Effect on endometrial cancer-
  • Women who use oral contraceptives have been shown to have a reduced risk of endometrial cancer. 
  • Protective effect increases with the length of time oral contraceptives are used and continues for many years after a woman stops using oral contraceptives .
  • Balance between estrogen & progesterone hormones changes during a woman's menstrual cycle each month. A shift in the balance of these hormones toward more estrogen increases a woman's risk for developing endometrial cancer.
  • After menopause, the ovaries stop making these hormones, but a small amount of estrogen is still made naturally in fat tissue. 
Effect on cervical cancer :
  • Long-term use of oral contraceptives (5 or more years) is associated with an increased risk of cervical cancer .
  • Virtually all cervical cancers are caused by persistent infection with high-risk, or oncogenic, types of HPV, and the association of cervical cancer with oral contraceptive use is likely to be indirect.
  • The hormones in oral contraceptives may change the susceptibility of cervical cells to HPV infection, affect their ability to clear the infection, or make it easier for HPV infection to cause changes that progress to cervical cancer.
Effect on liver cancer:
  • Oral contraceptive use is associated with an increase in the risk of benign liver tumors, such as hepatocellular adenomas. 
  • Estrogens in OCPs can cause mild inhibition of bilirubin excretion leading to jaundice in patients with inherited forms of bilirubin metabolism such as the Dubin Johnson syndrome. Benign tumors can form as lumps in different areas of the liver, and they have a high risk of bleeding or rupturing. However, these tumors rarely become malignant.
  • Whether oral contraceptive use increases the risk of malignant liver tumors, also known as hepatocellular carcinomas, is less clear. 
Benefits of use of combined OCP are:
  • Improvement of acne
  • Prevention of atherogenesis
  • Inhibition of hirsutism progression
  • Decreases risk of ectopic pregnancy
  • Decreases activity of rheumatoid arthritis
  • Improves dysmenorrhea from endometriosis
  • Decreases risk of endometrial and ovarian cancer
  • Reduces various benign breast diseases
  • Reduces menstrual blood loss and anemia
  • Decreases the incidence and severity of acute salpingitis

Exam Question
  • Use of oral contraceptive pills are known to pro­tect against Ovarian carcinoma, Endometrial carcinoma, Uterine sarcoma
  • Estrogen in the OCP causes Breast carcinoma, Endometrial carcinoma & Thromboembolism
  • The combined oral contraceptive pills decrease the risk of Endometrial cancer,Ovarian cancer & Ectopic pregnancy
  • Reason for hepatic involvement in oral contraceptives is Estrogen

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