Walnut Hill Ob/Gyn Associates Blog

Coital Incontinence Can Have a Significant Impact on a Woman's Life

Wed, 13 Jul 2011 00:00:00 -0500

Coital incontinence, also commonly called coital urinary incontinence, is a disorder of the pelvic floor muscles. Around 20-35% of women experience this embarrassing dysfunction even though it is likely that this number is much higher in reality. Due to the highly embarrassing nature of the subject many cases are most likely not reported. Coital incontinence (CI) is the urine leakage that occurs during sexual activities. The leakage can occur either during penetration or during orgasm and is spontaneous. Leakage during sex points to another form of this disorder, which is often called stress urinary incontinence. An overactive bladder is often present and caused by involuntary muscle spasms of the bladder wall.

When does urine leakage occur?

Urine leakage often occurs during exercise, laughing, coughing and sneezing. Having an already weak bladder explains why 80% of woman who reportedly have an overactive bladder experience coital incontinence. Woman after menopause are at greater risk to experience this disorder due to weaker pelvic floor muscles. Minimally invasive surgery can improve this condition and regular Kegel exercises are used to strengthen the pelvic floor muscles. Sometimes the use of medication shows a dramatic improvement. Many women rather try to deal with the problem themselves before they report and discuss it with their doctors. They start by using several products available for this condition.

Incontinence pads –what are they and how are they used?

Incontinence pads come in a wide variety of shapes for a variety of conditions. The absorbency strength varies as well. Most women have used similar products for their menstrual cycles. Types of incontinence pads are disposable shaped pads, standard pads, super pads, total protection pads or stick-on pads with an adhesive to prevent the pad from moving. The purpose of incontinence pads is to prevent urine from soiling clothes and furniture. Incontinence pads keep the urine away from a person’s skin, keeping the skin dry and preventing skin irritations.

Incontinence underwear is the most comfortable solution.

Incontinence products have come a long way in recent years. Underwear is either disposable or washable. Both kinds have different absorbency strengths like the incontinence pads mentioned above. Incontinence underwear is less noticeable under clothing than the pads and much more comfortable than a pad that can shift and move. The washable variety is made out of cotton and is even available with a lacy trim. This underwear still gives women the protection they need without feeling like they are wearing an unattractive undergarment.

The first step when a woman experiences coital incontinence should be to talk to her gynecologist or a urologist. The incontinence could be caused by an underlying problem like undiagnosed diabetes, a urinary tract infection or another issue. As part of the work up the doctor may ask you to take your temperature with a thermometer for an extended period of time. Your doctor may also suggest lifestyle changes in order to determine the proper treatment.

Woman stays in the game with minimally invasive OBGYN procedure

Fri, 11 Feb 2011 00:00:00 -0600

Karen Pharis’ active lifestyle became noticeably restricted 18 months ago. The 45-year-old lost her stamina for rigorous tennis, nor was she able to prepare patients for surgery in her job as a nurse. “For two days out of every month my activities were interrupted,” she says. “The bleeding was an inconvenience but more than that, at time, it was actually a hindrance to my busy schedule.”

During an annual checkup, she mentioned her atypical menstrual bleeding, prompting her doctor to order an ultrasound. It revealed she had fibroid tumors. Pharis was given options to monitor her condition or have a minimally invasive hysterectomy, a relatively new advancement in medicine.

“For years we made big incisions to take out the uterus,” says John D. Bertrand M.D., director of minimally invasive surgery at Texas Health Presbyterian Hospital Dallas. “Recovery time involved a two-to-four-night hospital stay with a six-to-eight-week period of bed rest at home.”

According to Bertrand, minimally invasive procedures have revolutionized gynecological surgery. A hysterectomy is now a day surgery with one to tow weeks of recovery time at home and requires only one to three tiny incisions.

“A woman is typically on her way home by noon from a 7:30 a.m. procedure,” Bertrand says. “Many women are not accustomed to the idea of returning to work within two weeks as they have seen their mother or aunt convalesce over five weeks.”

Using the da Vinci robot, a tool for minimally invasive hysterectomies, gynecologists at Texas Health Dallas are able to precisely control incisions with a robotic arm.

Pharis opted for the hysterectomy because it was minimally invasive, wouldn’t remover her ovaries so that she would have natural hormones, and most important, because it solved her problem.

“You have to look for the scars to see them,” she says. Ten days after her surgery, Pharis was able to comfortably travel 300 miles by car to watch her daughter’s soccer match and then return to work.“Three weeks after my procedure I played doubles in a tennis league match,” she says. “Four to five weeks later, I resumed strenuous cardio and weight workouts and after 10 weeks, I went water-skiing.”

Pharis says that she would have put off the surgery if her only option had been a traditional hysterectomy.“I’m fit and wanted to move on with my life, so it was a good option for me,” she says. “I never missed a beat.”

For more information about minimally invasive procedures offered at Texas Health hospitals, visit TexasHealth.org/CuttingEdge.

Minimally invasive hysterectomies at Texas Health Dallas include laparoscopic and robotic surgeries. The hospital is one of only three in the U.S. to be named a Center of Excellence for gynecological surgery by the American Institute for Minimally Invasive Surgery for its high volume of minimally invasive women’s surgeries and superior patient outcomes.

At what age should a girl start going to a gynecologist as opposed to her pediatrician?

Sat, 29 Jan 2011 22:19:22 -0600

Females should have their first gynecological exam by the age of 20, or when they become sexually active. At this point they should begin having yearly pap smears and pelvic exams. Many pediatricians are comfortable taking care of their patients' gynecological problems. If this is the case, your pediatrician may continue to see you for your gynecological exams. If you or your pediatrician feel that it would be more comfortable for you to see a gynecologist, you may be given a referral to one. Should your gynecological issues become more difficult, seeing a gynecologist may be to your benefit.

Indu S. Anand, MD

Dr. Anand is a former Assistant Professor in the Department of Obstetrics and Gynecology at the University of Tennessee Health Science Center, in Memphis, Tennessee. She now is in private practice in Atlanta, GA.

Anovulation

Sat, 29 Jan 2011 22:19:05 -0600

In a normal menstrual cycle there is regular hormone production and thickening of the lining of the uterus. This cycle prepares the endometrium (uterine lining) for implantation of a developing embryo. If no implantation occurs, the lining sheds, resulting in a menstrual period. There are two phases in the menstrual cycle: the follicular phase and the luteal phase. The follicular phase occurs prior to ovulation and involves thickening of the lining of the uterus. This phase usually lasts 10 to 14 days. The luteal phase is the period of time from ovulation to the onset of menses when the lining of the uterus undergoes stabilization prior to menses. This phase usually lasts 14 days.

Cycles are often irregular during the first 2 years after the onset of menstruation. These early cycles are often anovulatory-there is no ovulation during the menstrual cycle and therefore the luteal phase does not occur properly. Because of this a woman will experience irregular bleeding. As long as the menstrual cycles are no longer than 40 days, no shorter than 21 days, and the duration of bleeding is no longer than 7 days, this is considered normal in a woman.

If irregular bleeding lasts longer than 2 years or the blood flow is excessive, your physician may suggest further evaluation.

A Balanced Look at the Menstrual Cycle

Sat, 29 Jan 2011 22:18:50 -0600

Some young women feel it coming days before they get it. Others are hardly aware they have it. Friends who compare notes about their periods will probably find that menstruation--the monthly shedding of the lining of the uterus, or womb-affects each of them a little differently, both physically and emotionally.

"The menstrual cycle has its ups and downs of hormones, and different people react differently to hormonal swings," says Lisa Rarick, M.D., a gynecologist in FDA's Center for Drug Evaluation and Research. She explains that just before and during menstruation, levels of the female hormones estrogen and progesterone are low. That's when some women feel bloated, irritable or blue, or "just crummy," she says.

"Just crummy" might mean cramps, sore breasts, backache, headache, nausea, and feeling tired.

"A day or two after your period starts you begin to feel better. Hormone levels go back on the upswing and you get back to what you're accustomed to during the rest of your cycle," Rarick explains. (See "Monthly Changes.")

Cramps--A Common Complaint

More than half of menstruating women have cramp-like pain during their periods. The medical term for menstrual pain is dysmenorrhea. Cramps are usually felt in the pelvic area and lower abdomen, but can radiate to the lower back or down the legs.

"Many girls have cramps severe enough to keep them home from school," Rarick says. In fact, according to Danforth's Obstetrics and Gynecology, dysmenorrhea is the most frequent cause of absenteeism from school among younger women. Rarick says women seem to go through phases when cramps are severe, then get better for several years, and then maybe worsen again. She adds that most women find they have less menstrual pain after having children.

Mechanically, cramps are like labor pains. Just as the uterus contracts to open up the cervix (neck of the uterus) and push out a baby, it contracts to expel menstrual blood. Often, after several years of menstruating or after childbirth, the cervical opening enlarges. The uterus doesn't have to contract as much to discharge the menstrual flow, so there is less cramping.

Menstrual pain may also come from the bleeding process itself. When the uterine lining separates from the wall, it releases chemicals called prostaglandins. Prostaglandins cause blood vessels to narrow, impeding the supply of oxygen to the uterus. Just as the pain of a heart attack comes from insufficient blood to the muscles of the heart, too little blood to the uterine muscle might cause the pain of menstrual cramps.

Menstrual pain can have other causes, although these are rare among teenagers. They include tumors, fallopian tube infection, and endometriosis, a condition in which fragments of the lining of the uterus become embedded elsewhere in the body.

Pain, Pain Go Away

Sometimes, simple measures are all that's needed to feel better. Cutting down on salt might help reduce fluid buildup, and support hose may alleviate swelling in the legs or ankles. Crawling into bed for some extra rest or sleep is one way to deal with fatigue, and taking along a heating pad or hot water bottle eases cramps for some. Exercising also helps reduce pain in many young women, and may lift a blue mood as well.

Charles Debrovner, M.D., associate clinical professor of obstetrics and gynecology at New York University School of Medicine, explains that exercising during menstruation lessens pain because it causes release of brain chemicals called endorphins, which are natural painkillers. He says exercise may also decrease pain by affecting prostaglandin metabolism.

Rarick adds that exercise may also help because it increases blood flow, and because it "just makes a lot of people feel better in general."

If symptoms interfere with work, school or sleep, the American College of Obstetricians and Gynecologists recommends seeing a doctor, who may suggest taking one or more medicines. Certain anti-inflammatory drugs called NSAIDs (an abbreviation for nonsteroidal anti-inflammatory drugs) inhibit prostaglandin production, thus easing cramps. Prescription NSAIDs include naproxen (Naprosyn, Anaprox), ibuprofen (Motrin, IBU), indomethacin (Indocin), and mefenamic acid (Ponstel).

If needed, your doctor may prescribe stronger painkillers or diuretics, or even oral contraceptives. One side effect of birth control pills is relief of menstrual cramps.

"Birth control pills work two ways to lessen cramps," says Rarick. "They prevent the lining of the uterus from building up so much, so there's less bleeding. This means less prostaglandin production and blood vessel narrowing because there's less lining to separate, and fewer contractions because there's less tissue to push out."

Over-the-Counter Relief

In 1984, FDA approved ibuprofen in over-the-counter (OTC) strengths to be sold without a prescription. It's the active ingredient in medicines such as Advil, Nuprin and Motrin IB. In 1994, the agency approved naproxen for OTC marketing in lower doses than the prescription strength. OTC naproxen is sold under the brand name Aleve.

Like NSAIDs, aspirin also suppresses prostaglandins, but it's often not as effective as other NSAIDs for menstrual pain. Aspirin should never be used by children or teenagers who have chickenpox or flu symptoms before checking with a doctor. This is because Reye syndrome, a rare but sometimes deadly illness, may develop in children and teenagers who have taken aspirin or products that contain it while they were sick with chickenpox or flu.

Several OTC products, such as Midol and Pamprin, are specifically formulated for menstrual symptoms. Read the labels of these medicines before you buy them, because different formulations often contain different ingredients or strengths of ingredients. For example, Teen Formula Midol contains acetaminophen for pain and pamabrom (a mild diuretic) for fluid retention. Pamprin contains acetaminophen, pamabrom and pyrilamine maleate (an antihistamine) for tension and irritability. Cramp Relief Formula Midol IB contains as its sole ingredient ibuprofen. Manufacturers may change their products' ingredients from time to time, so it's a good idea to check the label each time you buy the product. Plain acetaminophen products like Tylenol, Datril, and Aspirin-Free Anacin also may help menstrual pain. It takes time for pain relievers to work, so it's best to take them before the pain gets bad and continue for one or two days, as needed.

Some 20 to 40 percent of menstruating women have PMS, or premenstrual syndrome. Starting anywhere from mid-cycle to a few days before menstruation begins, women with PMS may have one or all of a virtual laundry list of physical and emotional symptoms. They include breast swelling and tenderness, fluid retention, increased thirst or appetite, craving for sweets and salty foods, headaches, anxiety, restlessness, irritability, depression, hostility, and loss of self confidence. Experts say PMS doesn't usually affect teenagers, though. It increases with age and is more prevalent in the 30s and 40s.

From Menarche to Menopause

In the United States, the average age of menarche--a girl's first period-is 12 years, although it's normal to start as early as 10 or as late as 16. Menopause--when periods stop-usually occurs around age 50, although that, too, can vary by several years. Except perhaps for the first two years of menstruation-and barring pregnancy, nursing, and certain illnesses or other problems-the reproductive cycle repeats with predictable regularity every month.

Exercise, diet and stress can delay the onset of menstruation, Rarick says, or alter cycles once they've been established.

"Gymnasts, ballerinas and others who exercise strenuously can sometimes delay the onset of their periods, so you might not be surprised to find a 16- or 17-year-old in that group who hasn't started menstruating," she says. "Some experts believe the connection between exercise and amenorrhea [the absence of menstrual periods] is related to body fat content, because fat affects estrogen. Young women who are very thin from malnourishment may not start menstruating until they gain weight, with a certain portion of that weight being fat. So, girls who exercise a lot-who are all bone and muscle with no fat-may delay their periods."

Similarly, young women with severe eating disorders such as anorexia or bulimia often do not menstruate.

The American College of Obstetricians and Gynecologists recommends that a girl see her doctor if she hasn't started menstruating by age 16, or if by age 13 or 14 she hasn't begun to develop breasts or pubic and underarm hair.

Just Like Clockwork?

Many young women have very irregular periods the first couple years of menstruating--even skipping some months, until, as Rarick says, "the system is well-tuned."

In addition, she says, young women don't always ovulate every month when they first get their periods. She adds that there's no sure way for a young woman to know which month she is ovulating and which she is not. So, from the time her periods begin, a young woman should assume she can get pregnant each and every month, even if her periods are irregular.

Eventually, periods become regular, but even when they do, a missed or late period once a year--especially at a stressful time--is considered normal, according to Rarick.

Also, just as strenuous exercise and eating disorders can delay the onset of menstruation, they can also cause previously regular menstrual cycles to become irregular or stop completely.

Food and Drug Administration

U. S. Food and Drug Administration Center for Food Safety and Applied Nutrition

Primary Brain Cancer

Sat, 29 Jan 2011 22:18:08 -0600

What is Primary Brain Cancer?

A mass created by growth of abnormal cells or uncontrolled proliferation of cells in the brain. Primary brain cancer originates in the brain. Other names for this type of cancer include - Glioblastoma multiforme, Ependymoma, Glioma, Astrocytoma, Medulloblastoma, Neuroglioma, Oligodendroglioma, and Meningioma.

?Secondary? brain cancer originates as a primary cancer in a different part in the body which moves (metastases) into the brain.

Causes and Risks

Primary brain tumor includes any tumor that originates in the brain. Tumors may be localized to a small area, invasive (spread to nearby areas), benign (noncancerous), or malignant (cancerous). Tumors can directly destroy brain cells. They also can cause indirect damage to cells from inflammation, compression from growth of the tumor, cerebral edema (brain swelling), and increased intracranial pressure (the pressure within the skull).

Classification of brain tumors depends on the exact site of the tumor, type of tissue involved, benign or malignant tendencies of the tumor, and other factors. Childhood nervous system tumors are classified as infratentorial (located below the tentorium cerebelli) meaning they are in the posterior third of the brain, or as supratentorial meaning they are within the anterior two-thirds of the brain.

Central nervous system tumors account for about 20% of all childhood cancers. They are 2nd in incidence, only surpassed by leukemias. Two-thirds of brain tumors in children are infratentorial with peak ages of 5 to 9 years. The annual incidence in children less than 15 years old is 2.4 per 100,000. More than 1,200 new cases occur each year.

The cause of primary brain tumor is unknown. Some tumors (retinoblastoma, for example) tend to be hereditary. Others tumors (craniopharyngioma) are congenital. Tumors may occur at any age, but many have a particular age group in which they are more common. The most common childhood brain tumors are astrocytoma, medulloblastoma, ependymoma, and brain stem glioma. Gliomas account for 75% of brain tumors in pediatrics, but only 45% in adults. Outside of retinoblastomas, most brain tumors are rare in the first year of life.

Specific symptoms, treatment, and prognosis (probable outcome) vary according to the site and type of the tumor and the age and general health of the person.

Prevention is unknown.

Specific Tumor Types:

Cerebellar astrocytoma:

Accounts for 10 to 30% of pediatric brain tumors (peak age is 5 - 8 years old)
Usually benign, cystic, and slow-growing
Presenting signs usually include clumsiness of one hand, gait changes (stumbling to one side), headache, and vomiting
There is a 38 to 94% cure rate based upon the tumor type
Single or combination therapy includes surgery, radiation therapy, and chemotherapy

Medulloblastoma:

Most common pediatric brain tumor (20 to 25% of posterior fossa tumors)
Occurs more frequently in boys than girls, and in infants more than older children and adults; peakage is 3 - 5 years old
Presenting signs include headache, vomiting, ataxia, and lethargy
Can spread (metastasize) along the spinal cord
Surgical removal alone is not curative; radiation therapy and/or chemotherapy are often used
About 30 to 50% of children are disease-free in 10 years
If relapse occurs it is usually within the first 5 years of therapy
Children under 4 often have poorer outcomes because of the high incidence of metastatic disease at diagnosis in this age group; as well as lower doses of radiation used to reduce late effects of therapy

Ependymoma:

Accounts for 8 to 10% of pediatric brain tumors (3rd most common)
Tumor growth rates vary
Tumors located in the ventricles of the brain and obstruct the flow of CSF
Presenting signs include headache, vomiting, and ataxia
Single or combination therapy includes surgery, radiation therapy, and chemotherapy
Overall childhood survival is less than 30%; low-grade tumors have a 5-year survival rate of 80%; high-grade tumors may be fatal

Brainstem glioma:

Tumors of the pons and medulla
Occur almost exclusively in children
Accounts for 10 to 15% of primary brain tumors in children; average age is 6 years old
May grow to very large size before symptoms are present
Presenting signs include: double vision, facial weakness, difficulty walking, vomiting
Surgical removal is often difficult due to the location of the tumor
Radiation therapy and chemotherapy are used to shrink the tumor size and prolong life
Overall 5-year survival rate is 20 to 30%

Craniopharyngioma:

Tumor located near the pituitary stalk
Often benign, but close to vital structure making surgical removal difficult
Rare, less than 5% of childhood brain tumors; average age is 7 - 12 years old
Presenting signs include vision changes, headache, weight gain, endocrine changes
Treated with combination therapy, usually surgery and radiation therapy; there is some controversy over the optimal approach to therapy
Survival and cure rates are favorable, though endocrine dysfunction may persist as well as the effects of radiation on cognition (thinking ability)

Symptoms

Headache (recent onset of new type, persistent, worse on awakening)
Vomiting (possibly accompanied by nausea, more severe in the morning)
Personality changes and behavior changes
Emotional instability, rapid emotional changes
Intellectual decline (loss of memory, impaired calculating abilities, impaired judgment)
Seizures, new onset
Reduced level of consciousness (decreased alertness, stupor)
Vision changes (double vision, decreased vision)
Hearing loss
Decreased sensation of a body area
Weakness of a body area
Speech difficulties
Decreased coordination, clumsiness, falls
Fever (sometimes)
Weakness, lethargy
General ill feeling (malaise)
Positive Babinski?s reflex
Decerebrate posture
Decorticate posture

Symptoms in Infants

Bulging fontanelles
Sutures - separated
Opisthotonos
Increased head circumference
No red reflex in the eye

Note: Specific symptoms vary.

Additional Symptoms that may be associated with this disease:

Tongue problems
Swallowing difficulty
Smell, impaired
Obesity, onset
Movement, uncontrollable
Movement, dysfunctional
Menstruation, absent
Hiccups
Hand tremor
Facial paralysis
Eyes, pupils different size
Eye movements, uncontrollable
Eyelid drooping
Confusion
Breathing, absent temporarily
Behavior, unusual or strange

Signs and Tests

Examination often shows focal (isolated location) or general neurologic changes that are specific to the location of the tumor. Some tumors may not show symptoms until they are very large and cause rapid neurologic decline, others are characterized by slowly progressive symptoms. Most brain tumors will include signs typical of space-occupying masses (aggregations of cells) which cause increased intracranial pressure and compression of brain tissue.

The diagnosis may be confirmed, and the tumor localized, by:

CT scan of the head
MRI of the head
Angiogram of the head shows a space-occupying mass, which may or may not be highly vascular.
EEG may reveal focal (localized) abnormalities.
Examination of tissue removed from the tumor during surgery or CT scan-guided biopsy is used to confirm the exact type of tumor.

This disease may also alter the results of a CPK isoenzymes test.

Treatment

A primary brain tumor should have prompt treatment. Early treatment improves the chance of a good outcome for many tumors.

Treatment varies with the size and type of the tumor and the general health of the person. The goals of treatment may be cure of the disorder, relief of symptoms and improvement of function, or comfort.

Surgery is indicated for most primary brain tumors. Some may be completely excised (removed). Tumors that are deep, or that infiltrate brain tissue, may be debulked (removal of much of the mass of the tumor to reduce its size). Surgery may reduce intracranial pressure and relieve symptoms in cases when the tumor cannot be removed. Stereotactic (CT scan-guided) surgery may be helpful in removing deep tumors.

Radiation therapy may be advised for tumors that are sensitive to this treatment. Anticancer medications (chemotherapy) may be recommended.

Other medications may include:

Corticosteroids such as dexamethasone to reduce brain swelling
Osmotic diuretics such as urea or mannitol to reduce brain swelling (and associated increased intracranial pressure)
Anticonvulsants such as phenytoin to reduce seizures
Analgesics to control pain
Antacids or histamine blockers to control stress ulcers

Comfort measures, safety measures, physical therapy, occupational therapy, and other such steps may be required to improve quality of life. Counseling, support groups, and similar measures may be needed to help in coping with the disorder.

Legal advice may be helpful in formulating advanced directives, such as power of attorney, in cases where continued physical or intellectual decline is likely.

Prognosis and outcome vary.

Complications

Brain herniation (often fatal)
Permanent, progressive, profound neurologic losses
Loss of ability to interact
Loss of ability to function or care for self
Side effects of medications, including chemotherapy
Side effects of radiation treatments
Recurrence of tumor growth
death

Dr. Charles L. Schulman, M.D.

Dr. Schulman practices medicine at Cardiology Asosciates of Boston, and is an Assistant Clinical Professor at Harvard Medical School.

Bone Cancer

Sat, 29 Jan 2011 22:17:45 -0600

Primary bone cancer is cancer that arises in the bone. This is not to be confused with secondary, or metastatic bone cancer, where cancer has spread to the bone from another part of the body. Primary bone cancer is rare with approximately 2,500 cases diagnosed each year in the United States.

The most common form of bone cancer is osteosarcoma. It is seen most often in those ages 10 to 25, and most often occurs in the knees, upper legs, and upper arms.

Ewing’s Sarcoma is another form of bone cancer that primary affects children and young adults. It originates in the bone marrow and is most commonly found in the pelvis, upper legs, ribs, and arms.

Chondrosarcoma is a bone cancer that normally arises in the cartilage of the pelvis, upper legs, and shoulders and primarily affects adults. Although these cancers most often appear in these primary sites, bone cancer can affect any bone in the body.

There are many other forms of bone cancer including:

Multiple myeloma
Non-Hodgkins Lymphoma of Bone
Primary Hodgkins Lymphoma of Bone
Malignant Fibrosarcoma
Leukemia Granulocytic Sarcoma
Chordoma, Adamantinoma of Long Bones
Angiosarcoma

Symptoms and Diagnosis

The most common symptom of bone cancer is pain. Depending on the size and location of the tumor it can also cause swelling, pain in movement, fatigue, fever, loss of appetite, or anemia. If bone cancer is suspected, a complete medical examination would be followed by blood tests (to detect proteins that tend to be elevated when cancer is present) and x-rays or bone scans. If a tumor is present, a biopsy will be performed so the tumor cells can be examined to determine what type of cancer is present.

Treatment

Treatment of bone cancer is usually a combination of surgery, chemotherapy, and/or radiation therapy. Surgery involves the removal of the cancerous tissue along with surrounding tissue. In a number of cases this may involve the amputation of a limb, although the cancerous section of a bone is sometimes replaced with a prosthetic device. The use of pre- and post-operative chemotherapy has also made limb-sparing surgery more common.

After surgery, chemotherapy is often prescribed to kill malignant cells that may be circulating throughout the body. Radiation therapy used by itself or in conjunction with chemotherapy may be used to kill any other remaining cancer cells left at the surgery site.

Although once associated with a grim prognosis, great strides have been made in both survival rates and preservation of limb function after bone cancer surgery in recent years.

Metastatic or Secondary Bone Cancer

Cancers that can spread to the bones include:

Breast
Esophageal
GI tract
Kidney (Renal Cell Sarcoma)
Liver (hepatoma)
Lung
Skin
Merkle cell
Cutaneous T-cell lymphoma
Prostate
Stomach
Testicular
Thyroid cancer

The ribs, pelvis, and spine are usually the first bones involved.

Metastases are established when a single tumor cell or a clump of cells gain access to the blood stream, reach the bone marrow through blood vessels, and then multiply. Treatment is normally palliative, but varies depending on the type of cancer that is involved.

Early symptoms include persistant bone pain or sudden atraumatic pathologic fracture may be the presenting symptom.

Dr. Randall Holcomb M.D.

Basal Cell Carcinoma

Sat, 29 Jan 2011 22:17:28 -0600

Eyelid tumors are not uncommon and can be benign or malignant. The most common malignant eyelid tumors include basal cell carcinoma, sebaceous gland carcinoma, squamous cell carcinoma, and malignant melanoma. Skin cancer often involves the skin of the eyelid (most commonly the lower eyelid) or adjacent face; however, it may be found anywhere on the eyelid margins, corners of the eye, eyebrow skin, or adjacent areas of the face.

Basal Cell Carcinoma

Basal cell carcinoma, the most common eyelid malignancy, accounting for over ninety percent of all cancerous lid lesions. Lesions usually appear in the lower lid and medial canthal region as a firm, pearly nodule.

Basal cell carcinoma is a type of skin cancer that affects the skin's basal layer, the 5th layer of skin and invades areas under the skin. This condition does not become life-threatening unless it is ignored entirely. Lesion sizes vary from small to large (if left untreated).

The basal cell lesion appear in one of three ways:

The nodular form appears as a small, translucent, raised area with poorly defined edges, and is firm to the touch
The classic ulcerative presentation is a nodular lesion that over time has developed telangiectasia (a reddish hue caused by persistent, and virtually permanent, dilation of capillaries) along the surface and an atrophied inner portion, creating a "pearly," indurated outer margin with an excavated center
Less frequently, the sclerosing or morpheaform basal cell carcinoma form, which has a firm, pale, waxy yellow plaque with indistinct borders.

Causes

This disorder is caused by increasing age and by life-long exposure to the sun. The progression of this tumor is usually exceedingly slow. If left untreated the lesion may in time develop into a open sore and invade deeper structures. Fortunately, metastasis is rare, and complete recovery is possible with proper therapy.

Treatment

The treatment options for eyelid tumors vary according to the tumor and include observation, incisional biopsy, excisional biospy, eyelid reconstruction, radiotherapy, chemotherapy, and exenteration.

The growth can also be removed by:

Cryosurgery - destruction of abnormal tissue using freezing temperatures. Usually with liquid nitrogen.
Electrosurgery - destruction of abnormal tissue with the application of heat. Usually an electric cautery source.

Dr. Gary A. Passons, M.D.

Cancer: Treatment and Care

Sat, 29 Jan 2011 22:16:25 -0600

One of the most important considerations in the treatment of your cancer is deciding on a doctor. You can find a board-certified oncologist, or cancer specialist, by asking your primary care physician, managed-care representative, or contacting the oncology department at the hospital. Besides experience, there are other qualities that your doctor should have, which may require a little more research on your part.

You must feel that your oncologist is competent and up-to-date, and that he sees you as a partner in your cancer treatment. Your doctor should be willing to listen to your concerns, offer support, and explain treatment options and side effects in language that you understand.

It is important to include your primary care physician in decisions about your treatment and medical care. Think of your primary care physician as your gatekeeper, the doctor who has good knowledge about your overall health and who can refer you to other health professionals, when needed. Other members of the health care team, such as the nurse, dietitian, physical therapist, radiation therapist, and social worker are also excellent sources of information and explanations for various aspects of your treatment. So be sure to ask questions.

THE OFFICE VISIT

It is very common to feel anxious when initially visiting an oncologist. One way to remove some of the anxiety of a first visit is to bring a list of questions with you. Paper and pencil or a tape recorder may also help, so you can remember the answers given.

You might want to bring a family member or close friend with you for support, especially if you are feeling overwhelmed or upset. Some individuals, however, feel more comfortable speaking privately with the doctor. A good compromise may be for the friend to accompany you, but remain in the waiting room while you are with the doctor.

Good communication is critical to a doctor-patient relationship. Your initial meeting will help you gauge how comfortable you feel with this particular doctor. If your interaction is not satisfactory, you may want to seek another referral from your primary care physician, or you can call the oncology department of your local hospital for a list of names of local oncologists who treat your type of cancer.

Following is a list of questions you may want to ask about your treatment. Remember, if you do not understand the medical terminology at any time, be sure to ask.

QUESTIONS TO ASK YOUR PHYSICIAN AND OTHER HEALTH CARE PROVIDERS ABOUT YOUR TREATMENT

What is your experience in treating this type of cancer?
What kinds of treatment do you recommend and why?
What are the chances that the treatment(s) you suggest will be successful?
How long is treatment typically?
What are the side effects of the treatment?
How do you determine if symptoms I am experiencing are normal or adverse responses to the medications or other treatment?
What will my quality of life be during and after treatment?
Are clinical trials or investigational agents an option for me?
Who is available for medical questions when you are not?
Is a nurse or other health care professional available to deal with phone inquiries?
What is the schedule for follow-up and post-treatment?
When do you generally return phone calls?
What is the cost of treatment and is it covered by my health plan?

GETTING A SECOND OPINION

A second opinion can give you confidence in the information and recommendations you have already obtained, or it may offer a different approach to treatment. If the second physician disagrees with the initial consultation, you may even want to seek a third opinion. The important thing is that you receive the best state-of-the-art diagnostic tests and treatment, and that you have confidence in the care you are receiving.

You may ask your primary care physician for a referral for a second opinion, or you can ask the oncologist that you have already seen. You should not be uncomfortable asking for this referral. Many physicians welcome the additional input and reassurance provided by a second opinion. It is your right as a patient to obtain this information. If this request is met with resistance, give some extra thought to whether you wish to continue with this doctor.

Most insurance companies will pay for a second opinion; some require it. Check your insurance policy or ask about second-opinion coverage.

KEEP ASKING QUESTIONS

For many cancer patients, the first few days and weeks following a diagnosis of cancer are filled with a blur of appointments, tests and new information, often in a language that isn't quite clear. No one can be expected to remember everything the first time around. Your nurses and physicians know this and should encourage you to continue asking questions –– even the same questions two or three times.

There’s no need to feel embarrassed if you don’t understand the medical terminology being used. Ask to have the information explained in simpler language, and paraphrase the answers to make sure they’re clear to you. This information will affect important treatment and care decisions you’ll have to make. Being an involved, active participant in your treatment means asking questions to get the answers you need for those decisions.

UNDERSTANDING TREATMENT OPTIONS

"I know that the treatment of cancer is pretty complicated - I don't feel in control of what's happening unless I feel capable of making some choices."

METHODS OF TREATING CANCER

Modern medicine has developed several methods of treating cancer. The most common are surgery, radiation therapy, and chemotherapy. Other cancer treatments include hormone and investigational therapies. Complementary/alternative medicine (sometimes referred to as "integrative medicine") is becoming more integrated into mainstream medicine.

There is no "best" method of treating cancer. In deciding on a specific type of treatment, the physician must consider a number of factors, including the type, stage, and location of the cancer, as well as the health and age of the patient.

An individualized plan of care will generally fit into one of three categories:

It is very clear, based on the scientific literature, what should be done to treat your cancer. In many cases, clinical practice guidelines will direct your doctor to use these established practices.
It is not clear what to do, but there are several promising alternatives (e.g,. radiation vs. surgery). Your doctor will have a balanced discussion with you about the various options. You will be asked your preferences based on your cancer and your lifestyle.
It may be unclear what treatment to use. In this case you may wish to participate in a clinical trial of a promising new treatment.

A combination of treatments is commonly used to treat a specific cancer. Regardless of the type of treatment, the goal is the same –– to stop the uncontrolled growth of the cancer cells. Surgery does this by attempting to remove all the cancer cells. Radiation and chemotherapy work by destroying the cancer cells.

Your physician should be willing to discuss each of the treatment options or combination of treatment options under consideration, including the advantages and disadvantages, and complications or side effects of each type of treatment.

You will find a much more detailed discussion of the specific treatment options in the cancer-specific section, which is part of this CancerResource package. That information, drawn from the Physician's Data Query system of the federal government's National Cancer Institute, provides a detailed overview of the various treatment protocols for specific types of cancer.

Below is a brief description of the various treatment methods and their side effects.

Surgery

Surgery removes the tumor and any nearby tissue that may contain cancer cells. Sometimes, healthy tissue may have to be removed from around the tumor to help keep the cancer from spreading.

Cancer cells can spread by traveling through the bloodstream or the lymphatic system, which carries lymph fluid through the body. Surgeons often remove lymph nodes that are near the tumor to see if they contain cancer cells. This information contributes to treatment decisions. The location and extent of surgery determine the long- and short-term side effects.

Radiation Therapy

In radiation therapy (also called X-ray therapy, radiotherapy, cobalt treatment, or irradiation), high-energy rays are used to damage cancer cells so they are unable to grow and multiply.

Radiation therapy may be used before surgery to shrink the tumor or after surgery to destroy any cancer cells that may remain in the area. Most often, the radiation is delivered as a series of treatments using a machine that directs high-energy rays at the cancer. In some cases, however, radioactive material may be implanted at the tumor site to give continuous treatment over a period of time.

Even though radiation therapy is directed only to the area where treatment is needed, it can cause side effects. Most of the side effects are not permanent. The most common side effects of radiation therapy are fatigue, skin rashes or redness in the area being treated, reduced appetite and gastrointestinal upset. In some cases, radiation therapy may cause a decrease in the type of blood cells that help protect the body against infection, bleeding and anemia.

Chemotherapy

Chemotherapy, or treatment with anti-cancer drugs, is used to destroy cancer cells by disrupting their ability to grow and multiply. The type and stage of cancer determines which drugs are used, and often more than one drug is used during a single course of treatment.

Chemotherapy drugs poison the cancer cells. That action, as well as the toxic effect they may have on some normal, healthy cells can produce a wide range of temporary side effects. The most common side effects of chemotherapy include nausea and vomiting, hair loss, loss of appetite and fatigue. Other side effects include an increased chance of infection, bleeding and anemia.

Hormone Therapy

Some types of cancer depend on hormones for their growth, while other types of cancer may be suppressed by high doses of hormones. For these reasons, doctors may recommend therapy that either prevents cancer cells from getting the hormones they need to grow, or supplies amounts of hormones that limit the growth of cancer cells.

Hormone therapy is most commonly used to treat cancers of the breast, prostate and other hormone-responsive tissues. Drugs may be used to block the body's production of hormones, or surgery is performed to remove hormone-producing organs.

Hormone therapy can cause a number of side effects, depending on the specific drug or surgical procedure. In some cases, the treatment interferes with the body's normal production or use of hormones. For example, women taking tamoxifen may experience some symptoms of menopause, such as hot flashes. Patients may have nausea and vomiting, swelling and weight gain. Since some hormones cause an increase in appetite, they are occasionally prescribed for this purpose.

Investigational Therapies

Investigational therapies are new treatment approaches that are being tested in clinical trials. There is not yet sufficient data to make the therapy a standard method of treatment. Biological therapy and gene therapy are considered investigational therapies.

Biological therapy

Biological Therapy(sometimes called immunotherapy or biological response modifier therapy) uses the body’s immune system to fight cancer or to lessen some of the side effects of cancer treatment. This therapy may suppress or alter cancer cell growth, boost the killing power of immune system cells, or enhance the body’s ability to repair or replace normal cells damaged by other cancer treatments. Examples of biological therapy include interferon, interleukin-2, monoclonal antibodies, colony-stimulating factors, and vaccines.

Cancer vaccines are a form of biological therapy with potential to encourage the immune system to recognize cancer cells. They may help the body reject tumors and prevent them from recurring. Unlike other types of vaccines, cancer vaccines are injected after the disease is diagnosed. They are being studied for their possible use with other biological therapies and as a treatment for melanoma and many other types of cancers.

The side effects and severity of biological therapy depend on the type of treatment. It may cause flu-like symptoms, including fever, chills, nausea, vomiting and fatigue. Muscle aches and rashes at the site of injection may occur. Interleukin-2, in high doses, can have more severe side effects and is usually administered in the hospital where the patient is closely monitored.

Gene therapy

Initiated in the 1990's, gene therapy replaces an active cancer-causing gene, or oncogene, with a normal gene. It might also involve removing bone marrow from a cancer patient, inserting a "designer" gene, and then returning bone marrow to the patient.

At present, there are a number of serious obstacles to the complete success of gene therapy. These need to be overcome before this process is routinely available.

Clinical trials

Researchers use clinical trials to find out whether investigational therapies are safe and effective. These carefully controlled studies often compare the new therapy with standard treatment methods. In a clinical trial, some participants are given the best known treatment along with the investigational therapy, and some are given the best known treatment alone. This is at minimal or no cost to patients. The participants are randomized by chance to determine who will receive the investigational therapy and who will not. Sometimes the investigational therapy is not helpful, but other times it can lead to significant improvements in treatment and quality of life.

Patients who participate in clinical trials make an important contribution to the advancement of medical science and cancer care. For more information on clinical trials and how to participate in them, see AICR’s "Cancer Information: Where to Find Help" brochure, under Investigational Treatment.

Complementary and Alternative Medicine

Complementary/alternative medicine (CAM) can be described as diagnosis, treatment and/or prevention that complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine. CAM is now also referred to as "integrative medicine."

Complementary and alternative therapies include, but are not limited to:

Acupuncture
Botanicals/Herbals
Dietary Supplements and Antioxidants
Mind/Body Therapies
Macrobiotic Diets

While certain complementary/alternative therapies for cancer may appear to help some people, scientific evidence proving their effectiveness is often lacking. If you are already using or want to try complementary therapies, it is important to tell your doctor what you are doing. Some of these therapies may be harmful or may interfere with conventional treatments. There is often little information available about how herbal therapies and supplements interact with prescription drugs. In addition, many botanicals and herbals are poorly standardized, so it is not known exactly what is in them and in what amounts.

Always approach unconventional, alternative cancer therapies with caution. Keep in mind that just because a therapy is "natural" does not guarantee that it is harmless. Complementary therapies should complement, but never replace, traditional medical approaches to cancer treatment. For your own well-being, always inform your physician about any complementary therapies you are using.

AICR - American Institute for Cancer Research

The American Institute for Cancer Research is the nation's third largest cancer charity and focuses exclusively on the link between diet and cancer. The Institute provides a wide range of consumer education programs that have helped millions of Americans learn to make dietary changes for lower cancer risk. AICR also supports innovative research in cancer prevention and treatment at universities, hospitals and research centers across the U.S. The Institute has provided over $50 million in funding for research in diet, nutrition and cancer. Visit the Institute online at www.aicr.org

American Institute for Cancer Research
1759 R Street NW
Washington, DC 20009
1.800.843.8114

Cancer: Dealing With Insurance And Home Health Care Concerns

Sat, 29 Jan 2011 22:15:57 -0600

The financial impact of cancer is one the most stressful aspects of this illness. Below are some issues that may arise, with ideas on how to deal with them.

INSURANCE

"Will my insurance cover cancer treatment?"

People who had health and life insurance before treatment generally are able to keep it, although costs and benefits may change. Review your insurance policies to find out exactly what your coverage includes. Talk to your insurance provider to make sure you understand the extent of your coverage and its limitations. Also check your disability insurance or benefits to see if you are eligible to maintain your income during times when you may not be able to work.

It is very important that you keep careful records of all your covered expenses and claims. If a claim is turned down, you do not have to simply accept it. Ask your doctor to explain to the company why the services meet the requirements for coverage under your policy. If you are turned down again, find out if the company has an appeals process.

Cancer patients may find assistance with health care costs or applying for new policies in the following ways:

Cost and extended payment options may be negotiated with health care providers.
Medicare offers coverage to people 65 or older and to those who are permanently disabled, after two years of collecting disability payments.
Medicaid covers people who are in low-income brackets.
The U.S. Department of Veterans Affairs (VA) may be able to help with health care costs if a cancer patient or spouse is, or has been, a member of the Armed Forces. Any VA health care facility can provide information about these programs.
The Federal Government's Civilian Health and Medical Programs of the Uniformed Services (CHAMPUS) helps pay for civilian medical care for spouses and children of active duty Uniformed Services personnel, retired Uniformed Services personnel and their spouses and children, and spouses and children of active duty or retired active duty personnel who have died. For further information, contact the Information Office of CHAMPUS, Aurora, CO 80045.
If you want to apply for a new policy, health maintenance organizations often have open enrollment periods when you may be accepted regardless of your history.
You may be eligible for group insurance through a professional, fraternal or political organization to which you belong.

You also have the option of seeking medical advice or treatment from physicians or hospitals not affiliated with your health maintenance organization (HMO) or preferred provider organization (PPO). Out-of-pocket costs are higher if you decide on this option.

WHEN HEALTH INSURANCE DOESN'T COVER THE BILLS

Cancer and cancer treatment require careful financial planning, whether or not there is health insurance to cover some of the costs. The financial burdens of cancer are much more difficult for someone with no health insurance, but a lack of insurance should not mean a lack of competent medical care and treatment.

If you do not have health insurance, you will usually be expected to use as much of your own assets as possible to pay for your care and treatment. There may be other sources of financial assistance available, as your own assets become limited. Discuss this with your social worker.

The federally backed Medicaid program provides health coverage for the elderly and for people with no insurance and limited means. Your local or state office of social services (or welfare office) can supply information on eligibility and coverage. Requirements vary from state to state, so be sure to check the current regulations for your state of residence. In most cases, Medicaid covers direct medical costs, as well as home health care, when needed.

Some hospitals are required to provide treatment for needy patients under special federal aid construction programs. Speak with your physician, your local social services or welfare office, and your hospital's social worker to see what help may be available.

Some pharmaceutical manufacturers have patient assistance programs. To learn if your specific drug might be available at reduced cost or free of charge, ask your doctor to contact the drug manufacturer through such a program.

HOME HEALTH CARE

"The professionals that came to my home helped so much with my recovery. I don't know what I would have done without them."

At different stages of your cancer treatment, you may want to use the services of a home health care agency. Home health care agencies provide home visits by registered nurses to check on wound healing after surgery, to administer intravenous (IV) antibiotics or chemotherapy, or to monitor your condition between visits to your doctor. Some also can provide physical therapists to help with your recovery, or trained aides who can help with your personal care.

Health insurance coverage varies for these services, so it is important to find out exactly what your health insurance will pay for. Also, be sure to ask the agency a few key questions: the qualifications of its staff and whether they are bonded and insured; whether there is a minimum number of visits; whether they offer discounts for multiple visits; and the amount of notice required to have someone at the home.

If your health insurance is limited or does not cover this type of assistance, check with your local or state social services office to find out if you are eligible for state programs providing such assistance. In addition to medical assistance, there may be special programs in your area, such as Meals on Wheels, to help with the challenges of everyday living during the times when you may need it. Your local social services or welfare office, or your hospital social worker, should be able to provide information about these services and how to apply for them.

If you reside in an assisted living community, you may have access to home health care services. Call the management office to find out what services are available to residents of the community.

AICR - American Institute for Cancer Research

American Institute for Cancer Research
1759 R Street NW
Washington, DC 20009
1.800.843.8114

Breast Reconstruction

Sat, 29 Jan 2011 22:15:31 -0600

After a mastectomy, some women decide to wear a breast form (prosthesis). Others prefer to have breast reconstruction, either at the same time as the mastectomy or later on. Each option has its pros and cons, and what is right for one woman may not be right for another. What is important is that nearly every woman treated for breast cancer has choices. It is best to consult with a plastic surgeon before the mastectomy, even if reconstruction will be considered later on.

Various procedures are used to reconstruct the breast. Some use implants (either saline or silicone); others use tissue moved from another part of the woman's body. Concerns about the safety of silicone breast implants have restricted their use to clinical trials approved by the Food and Drug Administration. Women interested in having silicone implants should talk with their doctor about enrolling in one of these trials. A woman's age, body type, and the type of cancer treatment she had help determine which type of reconstruction is best. The women should ask the plastic surgeon to explain the risks and benefits of each type of reconstruction.

National Cancer Institute

Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
1-800-4-CANCER (1-800-422-6237)
TTY at 1-800-332-8615

Bone Marrow Transplant

Sat, 29 Jan 2011 22:14:45 -0600

About bone marrow transplant

A bone marrow transplant is a surgical procedure to transplant healthy bone marrow to a patient with deficient bone marrow function (usually due to chemotherapy or radiation treatment for cancer).

Bone marrow is a soft, fatty tissue found in bones that produces red and white blood cells. If a patient develops a disease of the blood cells (anemias, leukemias, or lymphomas) or if cancer treatment destroys bone marrow, a healthy bone marrow transplant can save a patient’s life.

Patients need bone marrow transplants in order to replenish white blood cells, which are needed to fight infection. Donated bone marrow must match the patient’s tissue type. As with all organ transplants, finding a donor is a significant problem, as is the cost of the surgery.

After a bone marrow transplant, the patient is hospitalized for 4-6 weeks and is isolated and under strict monitoring because of the risk of infection. It may take 6 months to 1 year for the patient to fully recover from this procedure. Relatively normal activities can be resumed as soon as the patient feels well enough and after consulting with a doctor.

Dr. Randall Holcomb M.D.

Biopsy

Sat, 29 Jan 2011 22:14:27 -0600

Many medical conditions, including all cases of cancer, must be diagnosed by removing a sample of tissue from the patient and sending it to a pathologist for examination. This procedure is called a biopsy and involves a microscopic examination of the tissue sample.

Biopsied specimens are obtained by a doctor and sent for examination to a pathologist, who prepares a report with information designed to help the primary doctor manage the patient's condition properly.

Although most biopsies are performed on unhealthy tissue for diagnosis of a disease, healthy tissue can be obtained for matching tissue-type for transplants.

Types of Biopsies

Shave biopsy: the outer part of the suspect skin area is removed. A local anesthetic is injected. Then a scalpel is used to cut off a growth protruding from the normal tissue.

Punch biopsy: a small cylinder of tissue is removed. A local anesthetic is injected. The skin around the biopsy site is pulled tight and a punch (a hollow instrument) is firmly introduced into the skin and rotated to obtain a sample; then the punch is removed. If a large sample is taken, the area may be closed with stitches.

Excision biopsy: the entire suspect area, organ or lump, is removed. Some types of tumors have to be examined whole to allow an accurate diagnosis. Excisional biopsies of most breast lumps are preferred to ensure diagnostic accuracy. A local anesthetic is injected. Then the entire lump, spot, or sore is removed, going as deep as necessary to get the entire area. The incision is then closed with stitches.

Incisional biopsy: a part of the suspicious area is removed. This type of biopsy is most commonly used for tumors of the soft tissues (muscle, fat, connective tissue) to distinguish benign conditions from malignant soft tissue tumors, called sarcomas.

Endoscopic biopsy: the most commonly performed type of biopsy of internal tissues. It is done through a fiberoptic endoscope the doctor inserts into the gastrointestinal tract, urinary bladder, abdominal cavity, joint cavity, mid-portion of the chest, or trachea and bronchial system, either through a natural body orifice or a small surgical incision. The endoscopist can directly visualize an abnormal area on the lining of the organ in question and pinch off tiny bits of tissue with forceps attached to a long cable that runs inside the endoscope.

Colposcopic biopsy: a gynecologic procedure generally used to evaluate a patient who has had an abnormal Pap smear. The colposcope is actually a close-focusing telescope that allows the physician to see in detail abnormal areas on the cervix of the uterus, so that a good representation of the abnormal area can be removed.

Fine needle aspiration: an extremely simple technique in which a needle no wider than that typically used to give routine injections is inserted into a tumor, and a few tens to thousands of cells are drawn up into a syringe. A diagnosis can often be rendered in a few minutes. Tumors of deep, hard-to-get-to structures (pancreas, lung, and liver, for instance) are especially good candidates for FNA, as the only other way to sample them is with major surgery. Such FNA procedures are typically done by a radiologist under guidance by ultrasound or computed tomography (CT scan) and require no anesthesia, not even local anesthesia. Thyroid lumps are also excellent candidates for FNA.

Bone marrow biopsy: In cases of abnormal blood counts, such as unexplained anemia, high white cell count, and low platelet count, it is necessary to examine the cells of the bone marrow. The skin over the biopsy site is deadened with a local anesthetic. A needle is inserted to deaden the surface membrane covering the bone. A large, rigid needle is then introduced into the marrow space and marrow cells are then drawn into the syringe. This is followed by a core biopsy, in which a slightly larger needle is used to extract a core of bone.

Skin Biopsy

Skin biopsies are performed to identify cancers and benign growths, to help diagnose chronic bacterial and fungal skin infections, and to identify other skin conditions.

When skin cancer is suspected some common biopsy interpretations include:

Normal tissue, no abnormalities
Not normal, but not cancerous or malignant (often some type of inflammation)
Not normal - difficult to interpret (another biopsy may be necessary for diagnosis)
Not normal - not cancerous but a pre-cancerous condition (tissue has characteristics of cancer or malignancy)
Cancer

Risks Involved

Risks involved with any biopsy depend on the technique and body part that is biopsied. All biopsies have the common risk of bleeding, pain, and infection. Also, anytime the skin is cut a scar will from.

In addition, there is always the risk that biopsy results may be inconclusive or difficult to interpret. If this occurs, additional biopsies may be required for a definite diagnosis.

Interpreting a Biopsy

Biopsied tissues may be prepared in many ways, often referred to as staining. Stained tissue is examined under a microscope. A pathologist studies the tissue and gives an opinion whether the tissue is normal or not.

Usually biopsy results are available within two or three days. Biopsy results that are unclear often cause delays. Sometimes, several pathologists will aid in the interpretation of a tissue sample.

A biopsy can reveal cancer but does not rule out the existence of cancer. If the tissue sample does not contain cancer cells within it, cancer may still exist somewhere else in areas not biopsied. Pre-cancerous tissue is usually monitored closely and may be treated with an anti-cancer treatment cream containing 5-fluorucacil. This cream is often as effective as surgery.

Dr. B. Wayne Blount, M.D.

Dr. Blount is the Past Professor and Chairman of the Department of Family Medicine at the University of Tennessee at Memphis School of Medicine.

Alternative to Chemotherapy Effective For Newly Diagnosed Multiple Myeloma Patients

Sat, 29 Jan 2011 22:14:09 -0600

Mayo Clinic Study Shows Alternative to Chemotherapy Effective For Newly Diagnosed Multiple Myeloma Patients.

Study finds oral combination of the drugs thalidomide plus dexamethasone as effective as intravenous chemotherapy, but without the side effects of nausea, vomiting and hair loss.

ROCHESTER, Minn. -- A Mayo Clinic study indicates patients who are newly diagnosed with multiple myeloma, a cancer of the bone marrow, may have a new and better-tolerated option to intravenous chemotherapy treatment.

The study will be published in the Nov. 1, 2002, issue of the Journal of Clinical Oncology. It is the first study to show that the oral combination of the drugs thalidomide plus dexamethasone provides treatment benefits equal to and in some cases better than the usual chemotherapy regimens administered to patients who are newly diagnosed with multiple myeloma. Previous studies at the University of Arkansas, Mayo Clinic and other cancer centers in the United States confirmed the use of thalidomide as an effective treatment for patients with relapsed multiple myeloma who had failed all other standard treatments.

The new study was a phase II clinical trial of 50 patients with newly diagnosed, active multiple myeloma. These patients ranged in age from 33 to 78. Of the 50 patients, 32 patients (64 percent) achieved a 50 percent or greater reduction in the amount of their tumor with the thalidomide plus dexamethasone treatment.

“The goal of both the standard chemotherapy approach and our research on the use of thalidomide plus dexamethasone is to reduce the amount of the cancer so patients can undergo stem cell retrieval and transplantation,” says Vincent Rajkumar, M.D., a Mayo Clinic hematologist/oncologist and lead researcher on the study.

“Our study with thalidomide plus dexamethasone represents a significant advancement because physicians now have an alternative to the more toxic and cumbersome chemotherapy regimens used to treat patients with newly diagnosed myeloma,” says Dr. Rajkumar. “For patients who are newly diagnosed with multiple myeloma, the study means they may not need to receive the series of intravenous chemotherapy treatments, and they won't experience the side effects often seen with such chemotherapy, including nausea, vomiting and hair loss.”

“The toxicity of thalidomide plus dexamethasone appears lower and the response rate is as good or better than that obtained using complex combinations of chemotherapy regimens,” he says. “The most serious side effect seen in six patients in the study involved blood clots in the legs. Other side effects included constipation, skin rash, numbness in the hands and feet, and sleepiness.”

He added that patients who are not candidates for stem cell transplantation may have the option to continue the thalidomide plus dexamethasone treatment at reduced doses.

Despite these encouraging and promising results, Dr. Rajkumar cautions that further studies are needed before the thalidomide plus dexamethasone treatment can be recommended for routine clinical use in patients. For that purpose, Dr. Rajkumar is now leading an Eastern Cooperative Oncology Group phase III clinical trial to investigate the effectiveness of thalidomide plus dexamethasone versus only dexamethasone for treatment of patients newly diagnosed with multiple myeloma. The results of this randomized trial will help establish the role of thalidomide plus dexamethasone in the initial treatment of multiple myeloma.

Although multiple myeloma accounts for only one percent of all cancers, it is among the most difficult cancers to treat and cure. This year, about 14,000 new cases of the cancer will be diagnosed in the United States, and more than 11,000 patients will die from it. The average survival time for a patient diagnosed with multiple myeloma is about three to four years. But there is significant hope based on promising results seen with thalidomide and other novel agents that the survival time can be significantly improved.

Thalidomide entered the medical treatment field in the mid-1950s as a sleeping pill. The drug was subsequently found to effectively control morning sickness during pregnancy. Later, the drug was found to cause severe malformations of the arms, legs and organs in an unborn child. By 1962, thalidomide was taken off the market worldwide.

In the last 10 years, researchers began studying thalidomide again as an anti-cancer agent. Although the exact mechanism of action in multiple myeloma is still unknown, researchers have found the drug effectively decreases the blood supply to cancers. It also boosts the immune system to better fight cancer.

Dexamethasone is a steroid medication that has been used for decades as the cornerstone of myeloma therapy.

Atypical Moles

Sat, 29 Jan 2011 22:13:04 -0600

Atypical moles, also called Clark's nevi or dysplastic nevi, are moles that are considered to be more likely to turn into melanoma than regular moles. Melanoma is a deadly form of skin cancer which kills quickly if not removed in time. These precancerous moles appear very similar to melanoma and feature an irregular border, slight variation in color, or asymmetry (if you cut the mole in half, the two halves do not look the same).

About one out of every ten people has at least one or atypical mole that looks different from an ordinary mole. Some people have "atypical mole syndrome" (AMS). These people have more than 100 atypical moles.

Causes

Exposing the skin to sunlight is directly related to the development of atypical moles. In addition, these moles tend to run in families and may be an inherited trait.

Prevention

People who have atypical moles and/or have a family history of melanoma should have a complete skin exam annually. Also, a self-exam of moles should be performed monthly to monitor any changes. Rapidly changing moles should be removed immediately. In addition, sunscreen applied to exposed skin areas reduces the risk of developing atypical moles.

Treatment

Atypical moles should be removed immediately if they change color, shape or size over a period of weeks to months or if they bleed or itch. These signs all suggest that an atypical mole may have turned into a melanoma.

If an atypical mole looks like it could be an early melanoma, the doctor will recommend removal as soon as possible. Sometimes the only way to be absolutely sure that an atypical mole is not a melanoma is to have it removed and analyzed. This procedure will leave a permanent scar.

Those who have AMS should see a physician regularly. A physician will probably photograph the moles to ascertain any changes over time.

Dr. B. Wayne Blount, M.D.

Dr. Blount is the Past Professor and Chairman of the Department of Family Medicine at the University of Tennessee at Memphis School of Medicine.