On 31 January, 2026, Seniors Today hosted Dr Hemant B Tongaonkar, HOD and Principal Director, Urologic & Gynaecologic Oncosurgery on the weekly Health Live Webinar. He spoke on and answered questions about Management of Prostate and Gynaecologic Cancers in Seniors to spread awareness about cancer and to also spread awareness about cancers.
Dr Hemant B Tongaonkar is Director – Urologic & Gynaecologic Oncosurgery and Head – Surgical Oncology, at the Nanavati Max Hospital of Mumbai. He has nearly four decades of experience.
He was Head, Department of Surgical Oncology and Consultant Urologic & Gynaecologic Oncologist, at PD Hinduja National Hospital & Research Centre, Mumbai from January 2012-September 2021. He was Professor & Head, Department of Surgical Oncology and Head, Department of Urologic & Gynaecologic Oncology, Tata Memorial Hospital 2002-2012 and Consultant Urologic & Gynaecologic Oncologist, Tata Memorial Hospital 1992-2012.
Dr Tongaonkar has done his MBBS and MS in General Surgery at the University of Mumbai. He is Fellow of International College of Surgeons and Fellow of Association of Surgeons of India. He received the Urology Gold Medal of the Urological Society of India West Zone for outstanding contribution to the field of Urology in India 2015 and the Dr PV Rao Gold Medal of Urological Society of India for outstanding contribution to the specialty of Urologic Oncology in India 2016.
Prostate is a pear shaped gland, present in all males and is situated between the bladder and your outflow tract (called the urethra).
It increases in size and volume with age. This enlargement can be benign (non cancerous) or cancerous.
Causes/ risk factors of prostate cancer:
- Increasing age: by the age of 80 years, 80% of men will have prostate cancer. most of these are diagnosed in the 60+ years age group. However, it can be seen in the younger age group as well.
- Positive family history of prostate or breast cancer: risk of prostate cancer is 3 times higher in those with a positive family history
- Obesity
- Lack of physical activity
- Red meats and foods containing saturated fatty acids
- Smoking
- Alcohol consumption
Symptoms that one should look out for:
- Increased frequency of urination- especially at night (with or without the urgency to micturate)
- Weak stream or an interrupted stream
- Pain or burning while urinating
- Difficulty in starting or stopping the stream/ urination
- Dribbling of urine
- Sense of incomplete evacuation of bladder
- Blood in urine
- Blood in spam, painful ejaculation
- Sudden erectile dysfunction
- Bone pains/ fractures
- fatigue
- Loss of weight/ appetite
- Rectal pian
- Swelling in feet
Any/ all urinary symptoms do not necessarily mean that you have cancer. There are plenty of benign diseases that can cause similar symptoms and are very common. However, you should have yourself evaluated by a doctor, preferably by a urologist, if any of these symptoms present.
Evaluation of these symptoms to rule out prostate cancer will include:
- Blood investigations where in a S. PSA (Prostate Specific Antigen) test will be done. Raised levels indicate the presence of cancer. PSA level can be raised in non cancerous cases also, but if it is markedly raised, it does cause high suspicion for prostate cancer.
- Rectal examination: this helps the doctor evaluate the prostate for any irregularity, nodule or mass
- Multiparametric MRI: it is very specific for prostate cancer, it helps us see the entire architecture of the gland. It also helps us identify the area of concern which further helps us localise the area from which a biopsy can/ should be done
- Prostatic needle biopsy: this can be done, either from the rectum or the perineum. It is an OPD procedure, quite painless and with very few side effects.
- Histopathological examination
- If the histopathological examination shows signs of prostate cancer, a PET Scan is done to find out the extract of the spread of the cancer. This is done by a Prostate Specific (PSMA) Membrane Antigen PET Scan
Treatment modalities include:
- Robotic surgery: radical prostatectomy is done in the early stages of the disease
- If the patient has multiple comorbidities and cannot undergo surgery, he can be given external beam radiation therapy. The above two have a success rate of 90- 96%.
- In advanced stages: hormonal therapy, chemotherapy, immunotherapy, etc. can be done however the outcomes are poor.
Preventive measures for prostate cancer include:
- Know your risk- if you have a positive family history
- Get an annual PSA testing done, from and beyond the age of 55 years
- If you have higher risk factors, the age for starting PSA testing is from 45 years and up
- In case of any urinary symptoms- report to your physician
- Make necessary lifestyle changes such as regular exercise, healthy diet, quit smoking and avoid alcohol
Gynaecological cancers include:
- Uterine cancer
- Cervical cancer
- Ovarian cancer
Ovarian Cancer
Ovarian cancer is the most common in the senior/ elderly population.
It iOS also called “whispering cancer” or the “silent killer”
It is one of the most lethal and aggressive gynaecological cancers with the highest death rate
The majority of patients with ovarian cancers are diagnosed in the advanced stages where treatment is difficult and cure rates are poor.
The main cause for late diagnosis is lack of symptoms till the cancer has progressed to an advanced stage.
Risk factors include:
- Older age, however it can be seen in younger age groups as well
- Early onset of menstruation or late menopause
- Woman who have no children (nulliparous) or women with history of late pregnancies (age> 35 years)
- Oestrogen hormone replacement therapy after menopause, especially without supervision
- Use of certain fertility drugs especially ovarian stimulation drugs used during IVF
- Family history of breast cancer, ovarian cancer, uterine or large intestine cancer- risk is higher if 2 or more of first degree relatives have cancer
- Past history of breast, uterine or large intestine cancer
- Smoking
- Obesity
- Endometriosis
- Pelvic inflammatory disease
Even if you have none of the above mentioned risk factors, you can still get ovarian cancer
Symptoms of ovarian cancer are very vague and non specific, these days can be:
- Abdominal or pelvic pain, heaviness or backache
- Bloating, nausea, indigestion
- Early satiety
- Change in bowel habits- constipation, diarrhoea
- Increase in urinary frequency, urgency or urinary incontinence
- Menstrual irregularities
- Unexplained weight gain or loss
- Fatigue or weakness
- Unexplained breathlessness
Do not ignore any of these symptoms if they are persistent for more than 10 days.
Seek prompt medical attention and get a prompt sonography done, do not miss the opportunity for early detection.
Evaluation of these symptoms need to be done and the following investigations will be ordered:
- Tumor markers: Ca125, HE4, AFP, beta hCG, LDH
- Imaging: Ultrasonography, CT/ MRI/ PET scan
- Cytopathology
Treatment of ovarian cancer includes:
- Early stages of cancer can be treated by: surgery followed by chemotherapy. These have excellent results
- In young patients, fertility preserving surgeries are considered
- In advanced stages of the disease: surgery followed by chemotherapy or vice versa. However, fertility preservation is not possible and the results are poor
- In young patients with Germ Cell Tumours fertility preservation is routinely possible.
Advice regarding ovarian cancer:
- Seek whether you’re at a higher risk. If yes, consult with your gynaecologist for risk reducing surgery or other measures
- Have a healthy lifestyle
- Have your first child as early as possible
- Breast feed for 6 months to 1 year
- Beware of early symptoms and do not ignore persistent symptoms
- There is no screening test for early detection of ovarian cancer except for a high index of suspicion.
Uterine (endometrial) Cancer
Endometrium is the lining of the uterus which sheds every month during menstruation.
Endometrial cancer is the most common gynaecological cancer in the world and has now been showing a steady rise in the number of cases in India as well.
Risk factors or uterine cancer include:
- Age more than 70 years
- No children (nulliparous female)
- History of polycystic ovarian disease (PCOD)
- Obesity
- Diabetes mellitus or any other metabolic syndrome
- History of hormone replacement surgery at menopause
- Tamoxifen: medicine used in patients with breast cancer
- Genetic predisposition. Family history or breast, uterine or large intestine cancer
Symptoms of endometrial and cervical cancer are almost the same:
- Commonest in post menopausal women
- Abnormal uterine bleeding- this can be episodic or persistent. Sometimes can only present as spotting per vaginum
- Even a single episode of bleeding after menopause must be reported to your doctor and investigated and evaluated
- Irregular periods
- Abnormal vaginal discharge
- Pain during intercourse
- Back pain abdominal pain, abdominal distension, lower extremity swelling- indicate late stage of disease
- Early symptoms also mean early diagnosis
Investigations include:
- Ultrasonography can show endometrial mass, thickened endometrium
- Hysteroscopy is done to visualise the uterine cavity and curettage (scrapping) is also done- this is done as a diagnostic measure
- CT scan/ MRI/ PET scan
About 10% of uterine cancer patients are young and desirous of child bearing age. These women can get pregnant with high dose progesterone (hormone) treatment.
Some women with early stage uterine cancer can have successful pregnancies without compromising the cancer cure. However, this is not possible in all patients, especially in patients with advanced stages of cancer.
Treatment modalities of advanced endometrial cancer include:
- Surgery in adjunct with chemotherapy, radiation therapy and immunotherapy
- There are improved survival rates with the above treatment
Cervical Cancer:
Cervical cancer is a preventable cancer.
It is caused by the Human Papilloma Virus and is a sexually transmitted virus
There are more than 100 subtypes of the virus, some of which are high risk for cancer
The majority of the women in their reproductive age group will contract HPV infection. Most of which are cleared by the body.
HPV infection does not always mean cervical cancer.
However, persistent infection leads to premalignant changes and eventually, cervical cancer.
Risk factors for cervical cancer include:
- Early age of marriage
- Multiple sexual partners
- Early onset of sexual activity poor genital hygiene
- Early first pregnancy
- Multiple pregnancies with very short interval between each pregnancy
- Immi compromised states
- Tobacco use/ smoking
Cervical cancer is not hereditary and is not contagious either.
Since cervical cancer is a prophylactic/ preventive cancer there are HPV vaccines are available
These are prophylactic anti HPV vaccines
Should ideally be given to girls between the age of 9 to 14 years. Can be extended upto 15 to 26 years.
Ideally, the vaccine should be administered before the onset of sexual activity
There is a 2 to 3 dose schedule depending on the age and risk
It can be given upto 45 years of age after counselling of the patient and with due precautions. In this age group, the efficacy of the vaccine is sub optimal
This vaccines helps protect against more than 80% of HPV infections
Symptoms of Cervical Cancer:
- in the pre cancerous/ early stage, there are no symptoms
- The earliest symptoms, which might not be very useful for early diagnosis are-
- inter menstrual bleeding
- blood stained vaginal discharge
- Post menopausal bleeding
- Blood stained vaginal discharge
- Pelvic pain/ back pain, excessive bleeding per vaginum
- Foul smelling discharge
- Swelling in the lower extremities
In case of cervical cancer, you should not wait for the symptoms to appear
Get yourself checked and evaluated even when there are no symptoms
Since it is a preventable cancer, there are screening tests which are available. these are:
- Pap smear: can be done from the age of 21 to 65 years. It should be done once every 3 years.
- Should be done in any women who is sexually active
- Should also be done in women who have had their uterus removed
- HPV DNA testing: can be done from the age of 30 to 65 years
- Should be repeated once every 5 years
A combination of pap smear and HPV DNA testing can be done is a single swab once every 5 years and it gives the best results
Both of these procedures are quick, easy, painless, OPD procedures and widely available for effective and early diagnosis.
Treatment modalities in Cervical Cancer:
- Pre invasive disease:
- Cryotherapy
- Cauterisation
- LEEP
- Laser excision
Hysterectomy is not required in pre invasive/ early stages of the disease
- Invasive cancer:
- Radical hysterectomy by laparotomy (open) surgery
- Radiation therapy
- In even more advanced stages- radiation therapy and chemotherapy are done, no surgery is done. The treatment becomes more complicated and expensive in these stages.
Thus our strategy is to vaccinate the child and screen the mother.
