Archive for the ‘American Cancer Society’ Category

Ovarian Cancer – five tips to make sure you get the medical care you need

Wednesday, May 11th, 2011

Did you know that more than 21,000 women are diagnosed with ovarian cancer in the U.S. each year? An astonishing 15,000 women die from ovarian cancer each year. Despite numerous advances in healthcare, the mortality rate for ovarian cancer has not improved in the last 30 years. Simply put, ovarian cancer is the deadliest of all gynecologic cancers. If the cancer is diagnosed in its early stages (i.e. before it spreads to other organs), the five-year survival rate is about 93.8%. However, if it the cancer is diagnosed in its later stages, the five-year survival rate is about 28.2%.

There is no question that ovarian cancer is quite deadly and that early diagnosis and treatment is key for survival. There is an abundance of information about ovarian cancer online and in other written sources. Simply put, take the time to familiarize yourself with the symptoms of this terrible disease. Let’s share with you some information, which I believe can make a difference. Call it a male lawyer’s perspective, if you will. I’ve seen what happens when early detection should have happened, but tragically did not.

1. Examine Your Medical History

Whenever the possibility for ovarian cancer exists, consider your medical history as you discuss your symptoms with your physician. If you are having symptoms consistent with ovarian cancer, take the initiative and discuss your symptoms and history with a gynecologist as opposed to your primary care physician. Make sure to tell your physician if you have any cancer history. Don’t forget to include information about any family history of cancer (parents, siblings, etc.). Of particular importance is any history of breast or ovarian cancer, although any cancer history is relevant. Unfortunately, women with a personal or family history of ovarian cancer or breast cancer are at a higher risk.

2. Understand and Appreciate Your Symptoms

Although your physician is likely to talk to you about ovarian cancer, it is always a good idea to familiarizer yourself with the signs and symptoms of ovarian cancer before your doctor’s appointment. Many of the symptoms of ovarian cancer overlap with the symptoms of cervical cancer. Therefore, if you are experiencing symptoms of cervical cancer, you and your physician should also discuss the possibility of ovarian cancer. We have seen cases were a physician will consider one or the other but not the possibility of both cancers. Here are some of the more common symptoms of ovarian cancer:

-          Irregular uterine bleeding

-          Abdominal  and/or pelvic pain

-          Abdominal fullness or bloating

-          Fatigue

-          Unexpected weight loss

-          Fatigue

-          Headaches

-          Frequent urination

-          Low back pain

Watch this video for more information about symptoms of ovarian cancer:

httpv://www.youtube.com/watch?v=fH9N4auMblE

 

Watch this video for more information about symptoms of cervical cancer:

httpv://www.youtube.com/watch?v=HHA_0HsjeBI&feature=related

3. Is it a solid mass?

If your radiographic studies reveal a mass, make sure that you get a clear answer as to whether the mass is solid or fluid-filled.  A fluid filled mass will typically turn out to be a cyst. It could also be a blocked fallopian tube (i.e., hydrosalpinx, hematosalpinx, pyosalpinx). Generally speaking, a fluid filled mass is less likely to be malignant. However, if your radiographic studies reveal a solid mass, especially one that arises from an ovary, the possibility of ovarian cancer must be seriously considered. If you are found to have a solid mass, talk to your gynecologist or primary care physician about consulting with a surgical oncologist.

4. Should you have a CA 125 blood test?

CA 125 is a protein. It is a tumor marker or biomarker for ovarian cancer because it is more prominent in ovarian cancer cells. The CA 125 test is a test designed to test the levels of CA 125 in a patient’s blood. Elevated CA 125 levels can be indicative of ovarian cancer. If your CA 125 levels are elevated, you and your physician should seriously consider the possibility of ovarian cancer. An elevated CA125 should prompt your physician to order additional radiographic studies, including a CT of the abdomen and pelvis, an ultrasound of abdomen and pelvis, a PET scan or even a CT pyelogram. You should also consider consulting an oncologist or a surgical oncologist. If you are found to have a solid mass and your CA 125 level is elevated, time is of the essence for further investigation and surgical intervention.  Ask your doctor about other tumor markers that can be tested.

5. Who is reading your ultrasound?

Many patients who present to their gynecologist with symptoms of ovarian cancer will initially undergo an ultrasound. A great number of gynecologists will themselves perform and interpret the ultrasound. Here is the problem. With all due respect to gynecologists, they are not trained ultrasonographers or even radiologists! Ultrasounds can be particularly difficult to read. This can be due to the patient’s position and, more frequently, the size of the patient. In heavier patients, a pelvic ultrasound can be quite limited if one is trying to visualize the ovaries, discern the presence of mass, or determine whether the mass is solid or fluid-filled. So, if your gynecologist is the only person to read your ultrasound, the result is potentially quite devastating. The mass could remain undiagnosed, and you may be told to come back if your symptoms get worse. The ultrasound may be interpreted as limited, and, for whatever reason, your gynecologist may simply neglect to order a more sensitive study (i.e. a CT scan). Instead, he or she may choose to monitor you for any further deterioration of symptoms.

In yet another instance, if the ultrasound is limited, a solid mass may be confused for a fluid-filled mass. Under these circumstances, you may be asked to follow-up in six months. The problem with all of these permutations is delay, and you cannot afford delay with ovarian cancer. Make sure that your radiographic studies, whatever they may be, are read by a skilled specialist in the interpretation of whatever study you undergo.

As we always say, be your own patient advocate and be an informed patient. Be an active participant in your medical care by being informed and by demanding the care you require. Having an understating of the types of mistakes that can be made during medical treatment is simply prudent.

Please share your familiarity or experience with ovarian cancer treatment. What do you think women should watch out for should they find themselves afflicted by this terrible disease?

For more information, see our other blogs:

Ovarian Cancer – Early Intervention is Key, What You Must Know…

New study links gene to ovarian cancer and may assist in early detection 

Ovarian Cancer – The Smear Test Won’t Tell You Much

 

Image from cancersyptomspage.com

Ovarian Cancer – Early Intervention is Key, What You Must Know…

Monday, January 3rd, 2011

According to the American Cancer Society, about 22, 000 women are diagnosed with ovarian cancer in the U.S. each year; about 14,000 of these patients will die as result of their cancer.  It is most noteworthy that the five-year survival rate is 90% when ovarian cancer is diagnosed before it has spread beyond the ovaries.  Yet, only about 20% of ovarian cancers are detected in the early stages.

Screening, more screening, monitoring and an understanding of the signs and symptoms of ovarian cancer are key to early detection.  A myth that must be dispelled is that cervical cancer is the same as ovarian cancer.  Just because a patient has a normal pap smear, does not exclude the possibility of ovarian cancer. Simply put, the pap smear test has nothing to do with the diagnosis of ovarian cancer. Unfortunately, recent studies suggest that many women rely on their normal pap smear result to conclude that they do not have an ovarian problem.

It must also be understood that what some doctors loosely characterize as an ovarian cyst does not necessarily exclude the possibility of ovarian cancer. If your doctor tells you that you have an ovarian cyst because of a mass identified on ultrasound, make sure to inquire about the basis for the conclusion that the mass is”just a cyst.” Sometimes the ultrasound is the only study performed to identify the mass.  As great as ultrasounds are, they are not always the most accurate studies.  This is particularly true for patients who are obese or overweight. Radiologists will often read ultrasounds in such patients as limited because of “body habitus” (the physique of the patient). Keep in mind that most of these ultrasounds are performed in clinics, and they are read by obstetricians, who are not trained radiologists. You must ask your physician if the mass is a solid mass or a mass filled with fluid. If it is a solid mass or your physician cannot answer the question, you may want to consider further studies. Don’t let your physician simply guess that the mass must be a cyst because of its size or because of some general statistical probability. In any event, both cysts and solid masses require further monitoring.

The symptoms of ovarian cancer include but are not limited to:

  • Swollen abdomen
  • Unusual or excessive vaginal bleeding
  • Pelvic and/or abdominal pain and/or heaviness
  • Back pain
  • Unexpected weight gain or loss
  • Increased urinary frequency or urgency
  • Lethargy
  • Constipation
  • Indigestion
  • Nausea and vomiting

If you and your physician suspect ovarian cancer, the following are useful diagnostic modalities:

  • Alpha fetoprotein
  • Blood chemistry
  • CA125 (may be done if ovarian cancer is strongly suspected or has been diagnosed, and to follow the cancer during or after treatment)
  • CBC
  • Quantitative serum HCG (blood pregnancy test)
  • Urinalysis
  • Abdominal CT scan or MRI of abdomen
  • GI series
  • Ultrasound
  • Pelvic laparoscopy
  • Exploratory laparotomy

If you are experiencing these symptoms, you may want to address the possibility of ovarian cancer with your physician.  Some physicians will generally perform an ultrasound. If they are not impressed with the ultrasound, they may not pursue any other diagnostic modalities.  If the ultrasound reveals a mass, some physicians may elect to wait and perform a follow-up ultrasound in a few months.

Notwithstanding how aggressive your physician is to rule out ovarian cancer, remember that physicians rely on your feedback, and you alone truly know the extent and severity of your symptoms.  Depending on your clinical presentation, waiting for 3 or 6 months for a repeat ultrasound may be unacceptable. Ovarian cancer can spread quickly within a matter of a few months from a stage I cancer to a stage IV cancer.  Take the initiative to fully explore all available diagnostic modalities with your physician. Don’t be uncomfortable asking your doctor for additional diagnostic tests or more frequent monitoring.  The worst thing you can do is become a passive participant in a complex and stressful process guided by a physician, who may not fully appreciate the extent and severity of your symptoms.

If you are an ovarian cancer patient, share your story with our readers. How long did it take for you to find out you had ovarian cancer? In retrospect, what would you have done differently as a patient?

Related Blogs:

New study links gene to ovarian cancer and may assist in early detection
Ovarian Cancer – The Smear Test Won’t Tell You Much

CT Scans – Are You Being Properly Protected Against Radiation?

Thursday, December 2nd, 2010

According to new research presented at the annual meeting of the Radiological Society of North America, breast shields should be used for men and women undergoing CT scans of the chest/lungs. According to Terry Healey, M.D., Director of thoracic radiation at Alpert Medical School of Brown University, the breast shield is capable of reducing the level of radiation by about 30%.  This is significant considering that radiation can cause or contribute to the development of various malignancies (e.g. breast cancer, lung cancer, esophageal cancer).

Although some physicians argue that the use of breast shields may impact the quality of the CT scan (i.e., by producing artifacts such as streaks or lines making the interpretation of the study more difficult), this new research suggests that the use of breast shields does not impact the diagnostic quality of the CT scan. A breast shield is nothing more than a thin piece of heavy metal placed in front of the chest during the CT scan procedure.

Researchers studied 50 patients, who needed CT scans of the chest. Most of the patients were undergoing the study to rule-out lung cancer.  For some patient the shield was placed directly on the chest. For other patients, the shield was slightly elevated from the chest surface. Overall, some artifact was present in about 2/3 of the cases. However, in the opinion of the researchers, there were no instances where the artifact interfered with the diagnostic quality of the radiographic study.

According to Judy Yee, M.D., vice chair of radiology at the University of California: ”[T]here’s no good reason not to use breast shields. The cost is relatively low and the benefit large.”

Perhaps a larger patient population is needed for the results of this research to be more widely accepted by the radiology community. We’d appreciate anyone who has experience in this field to share their thoughts on this topic. Do such shields cause artifact that makes the study less accurate and potentially dangerous to a patient? Does the accuracy of the scan, when a shield is used, depend on which type of scanner is used or which generation of scanner is being used? Are there other techniques that can be used to protect a patient yet not run the risk of artifact “mis-read”? We’re not physicians or radiology technicians, so we welcome any insights those who are might have on this topic.

If you are concerned about excessive radiation and need to undergo a chest CT, ask your radiologist if a protective shield can be used during your CT scan. Discuss the issue and – as we always stress – take charge of your own medical care. Be an informed patient and be responsible for your own health and safety. Know what the issues, risks and benefits are and discuss it with your doctor. Then – and only then – make an informed decision.

Image from emedicine.medscape.com

Should You Be Concerned About Cancer If You Have Lupus?

Tuesday, November 16th, 2010

Did you know that people with lupus are more likely to develop cancer?  According to a recent study presented at the American College of Rheumatology Annual Scientific Meeting, patients with lupus are 15 % more likely to develop cancer when compared with the general population.

The study also revealed that patients with lupus are three times more likely to develop lymphoma (cancer of the white blood cells) and that woman are less likely to develop estrogen-sensitive cancers if they have Lupus (breast cancer – 30% decreased risk, endometrium – 51% decreased risk,  ovary – 44% decreased risk).

With respect to other carcenomas, the following correlations were established:

  • 3.4 times more likely to develop non-Hodgkin’s lymphoma
  • 3.2 times more likely to develop any lymphoma
  • 2.8 times more likely to develop vulvo-vaginal cancers
  • 2. 2 times more likely to develop liver cancer
  • 1.7 times more likely to develop leukemia
  • 1.7 times more likely to develop cervical cancer
  • 1.2 times more likely to develop lung cancer

Systemic lupus (systemic lupus erythematosus or SLE) is an autoimmune disease, whereby the body’s immune system is unable to distinguish between harmful or foreign substances/tissue and normal/healthy tissue. As a result, the immune system ends up fighting healthy tissue as if it were diseased. Some of the symptoms associated with lupus include:

  • Arthritis
  • Fatigue
  • Fever
  • General discomfort, uneasiness or ill feeling (malaise)
  • Joint pain and swelling
  • Muscle aches
  • Nausea and vomiting
  • Pleural effusions
  • Pleurisy (causes chest pain)
  • Psychosis
  • Seizures
  • Sensitivity to sunlight
  • Skin rash — a “butterfly” rash over the cheeks and bridge of the nose affects about half of those with SLE. The rash gets worse when in sunlight. The rash may also be widespread.
  • Swollen glands

If you have lupus, you must appreciate your risk for developing cancer. The key to successful cancer treatment is early detection and treatment. Make sure that your doctor is aware of your lupus condition and that your risk for developing cancer is properly and systematically assessed.

Photo: from http://articles.elitefts.com

New study links gene to ovarian cancer and may assist in early detection

Tuesday, August 10th, 2010

A new study by Yale University Cancer Center identifies new genetic markers that may be used to assess a woman’s risk for ovariancancer. Specifically, researchers concluded that women with variations or mutations of the KRAS gene were more likely to develop ovarian cancer. The KRAS gene is a stretch of DNA, which is specifically designed to code the KRAS protein. The KRAS protein serves an important function in tissue signaling. In many ways, the protein is a catalyst. When it is activated, it  promulgates various growth factors and stimulates a number of receptors. It has been known for some time that KRAS gene variations or mutations are linked to various types of cancer. This study suggests that the KRAS gene variation is specifically linked to ovarian cancer.

About a quarter of all patients with ovarian cancer were found to have a KRAS gene mutation. About 61% of the patients with ovarian cancer that also had a family history of ovarian or breast cancer were found the have the KRAS gene mutation as well.

To date, scientists have identified a number of genetic markers for ovarian cancer. Among the better known markers are the BRCA1 and the BRCA2 genes. The new KRAS marker appears to have a stronger correlation to ovarian cancer. While about 50% of women with ovarian cancer had the BRCA1 and BRCA2 genes, 60% of women in the same patient population had the KRAS gene mutation. It is also important to note that women with the BRCA genes were more likely to develop ovarian cancer at a younger age. In contrast, the incidence of ovarian cancer in the population of women with the KRAS mutation was more prevalent after menopause.

The Yale study appears to be great news for all women. Ovarian cancer is a particularly difficult and lethal cancer because of its apparently latent and suttle  development. The sings and symptoms are not easy to recognize, and for many women, it is often too late by the time the cancer is diagnosed. This study suggests that testing for KRAS gene mutations is a significant step forward to better screen and assess women for ovarian cancer. For more information on ovarian cancer, please read our prior posting entitled Ovarian Cancer – The Smear Test Won’t Tell You Much.

Education should accompany prostate screening, new guidelines say – latimes.com

Saturday, March 6th, 2010

New guidelines for prostate cancer screening were issued Wednesday, March 3, 2010, by the American Cancer Society.  In reporting on these ‘changes,’ the L.A. Times, reminds us that “prostate cancer is the most common cancer in men after skin cancer, affecting 192,000 men each year and killing 27,000.”

In essence, these appear to be the significant features of these new guidelines: (1) physicians should better educate men about both the risks and benefits of using the PSA test for screening; (2) less use of a rectal exam for screening; and (3) a cutback in the use of “mass screening” for prostate cancer such as at community health fairs, community centers, and the like.  

Several recent studies have suggested that large numbers of tumors identified by PSA screening are inconsequential and that biopsies and treatment produce more harm than those tumors would.

The L.A. Times quotes Dr. Otis W. Brawley, chief medical officer of the American Cancer Society, who said the new guidelines were not that different from those issued in 1997 and 2001.  They are more a change in emphasis of informed consent to patients and direction to health care providers, who do such screening, to inform those patients of the relative risks and complications (of unnecessary treatment) associated with screening.

Now, Dr. Brawley added, “we have two clinical trials that very vividly illustrate the uncertainties associated with screening,” which makes it even more important for men contemplating the PSA tests to understand the risks. Those major trials showed that PSA screening does not lower the risk of death from prostate cancer and might actually increase it slightly, perhaps from unnecessary treatments.

The risks are not in the screening procedures themselves (PSA and/or rectal exam); they lie in what follows from screening – biopsies, radiation, prostactectomies and other forms of treatment.  The goal of the new guidelines – a better educated patient on the relative risks and complications  of screening and the resultant treatment that may follow (e.g. urinary incontinence and impotency) – is not embraced by all in the spheres of medicine and patient health.

Skip Lockwood, president of Zero — The Project to End Prostate Cancer, said that calls to end the digital rectal exam were “kind of nuts. . . . The whole concept that you would do anything to reduce the amount of information you have does not make sense to me.”

From the specialists in urology, there is also this admonition:

Dr. S. Adam Ramin, a urological oncology specialist at St. John’s Health Center in Santa Monica, said that the cancer society guidelines placed too much emphasis on whether the tests saved lives and not enough on whether they prevented complications from tumors, such as leaking of urine, incontinence, bone pain, anemia and weight loss.

“Although it is true that treatment will not necessarily save a lot of lives, it does prevent complications,” he said.

While the American Cancer Society is not advocating the termination of prostate cancer screening by any means, it is expressing a very worthwhile concern – are patients who are screened and advised of positive test results fully aware of the risks involved in treatment as well as the benefits (lessening of tumor complications, for example) when making potential life-altering decisions about treatment options?   The bottom line – have the test, get your results but understand in a meaningful way what your options are and what risks you run  - THEN decide.





Education should accompany prostate screening, new guidelines say – latimes.com.