Hereditary Cancer Risk Assessment Basics

The goal of most hereditary cancer programs is to provide individual risk assessment that can be incorporated into the patient’s ongoing medical care. The programs usually evaluates families with multiple members with cancer (of the same or different type) for the purpose of assessing the likelihood of a hereditary cancer syndrome. Patients are usually referred by their physician based upon their personal medical and/or family histories.

Often several sessions are required. The initial session includes a review of the patient’s medical history as well as three generational family history. The counselor will review this information within the context of risk for a hereditary cancer syndrome. The benefits, risks and limitations of testing will be described in detail. Often testing options can be offered at an initial visit. However, sometimes it is necessary to collect medical records on affected family members in order to understand the risk that exists for the patient and family. 

Genetic testing will then be offered if appropriate. If the patient decides to proceed with testing a final appointment is scheduled to review the results in person. This visit includes interpretation of the results a discussion of how this information affects medical management and the impact on the extended family. 

Some important factors that would indicate this type of evaluation include:

• Cancer that developed at an early age, usually less than 50.
• Individuals with rare cancer i.e. male breast cancer.
• More than one primary cancer in an affected individual.
• Other physical signs such as colon polyps, moles, desmoids tumors, thyroid nodules, and fatty tumors.
• Different cancers in a family that are known to be genetically related such as breast and ovarian cancers.
• Several generations in the family affected by cancer.
• Clustering of cancers that are known to be genetically related (such as breast and ovarian, colon and uterine and breast and thyroid).
• Breast or ovarian cancer and Ashkenazi (eastern European) Jewish ancestry.
• An identified genetic mutation in the family.
• Known cancer syndrome in the family (for example Lynch syndrome, Cowden syndrome, MEN and others).

FOR MORE INFORMATION PLEASE TALK TO YOUR DOCTOR OR CLICK HERE 

Hyperthyroidism and Your Heart Health: What you should Know

In hyperthyroidism, caused by the overproduction of thyroid hormone, the heart muscle is "whipped" like a horse, and for a person with heart disease it's like whipping a tired horse. Thyroid hormone increases the force of contraction of, and the amount of oxygen demanded by, the heart muscle. It also increases the heart rate. For these reasons the work of the heart is greatly increased in hyperthyroidism. Hyperthyroidism increases the amount of nitric oxide in the lining of the blood vessels, causing them to dilate and become less stiff.

Cardiac symptoms of hyperthyroidism

Cardiac symptoms can be seen in anybody with hyperthyroidism, but can be particularly dangerous in people with underlying heart disease. Common symptoms include:

·         Fast heart rate (tachycardia) and palpitations. Occult hyperthyroidism is a common cause of an increased heart rate at rest and with mild exertion. Hyperthyroidism should always be ruled out with blood tests before making the diagnosis of Inappropriate Sinus Tachycardia. Especially in patients with underlying heart disease, hyperthyroidism can also produce a host of other arrhythmias such as Premature Ventricular Complex (PVC’s) ,  ventricular tachycardia and especially atrial fibrillation. Indeed, it is important to rule out hyperthyroidism in a patient with atrial fibrillation and no clear underlying cause.

·         Systolic hypertension. The forceful cardiac contraction increases the systolic blood pressure, though the increased relaxation in the blood vessels reduces the diastolic blood pressure.

·         Shortness of breath on exertion. This can be due to the skeletal muscle weakness cause by hyperthyroidism, or to a worsening in heart failure.

·         Heart failure. Hyperthyroidism itself can produce heart failure, but this condition is relatively rare. On the other hand, if pre-existing heart disease is present, worsening of heart failure with hyperthyroidism is common, and can be extremely difficult to treat.

·    Worsening angina. Patients with coronary artery disease often experience a marked worsening in symptoms with hyperthyroidism. These can include an increase in chest pain (angina) or even a heart attack.

As with hypothyroidism, hyperthyroidism can be present - and often is - without the classic, textbook symptoms. So patients with any of these cardiac symptoms that cannot otherwise be readily explained should have thyroid function measured. Furthermore, sometimes a "mild" hyperthyroidism can exist in which thyroid blood tests can be misinterpreted. In these cases thyroid hormone levels themselves are normal, but the level of thyroid stimulating hormone (TSH - a hormone excreted by the pituitary gland that regulates the thyroid gland) is low. 


A low TSH indicates hyperthyroidism, despite "normal" thyroid hormone levels. This pattern of thyroid blood tests especially ought to be sought in all patients displaying any of the above symptoms with no clear reason for them.

Treating hyperthyroidism

The "best" way of treating hyperthyroidism is controversial. In the U.S., most doctors immediately opt for ablating the overactive thyroid gland with radioactive iodine, then giving the patient thyroid hormone pills since the thyroid gland is no longer functional. This method is certainly "easiest" for the doctors, but often patients are left feeling chronically abnormal. Using drugs to partially suppress the thyroid gland - in the U. S., Tapazole or PTU - creates somewhat more of a long-term management issue for doctors, but may lead to ultimately happier patients.

Hypothyroidism's and Your Heart Health: What You Should Know

February is American Heart Month, and unfortunately, most of us know someone who has had heart disease or stroke and this month we will discuss how your thyroid health affects your heart health as well.

The thyroid, a small gland located in the neck, is responsible for modulating many vital bodily functions. By producing just the right amount of thyroid hormone, it helps to regulate the body's metabolism (specifically, how much oxygen and energy the body uses), as well as digestive function, muscle function, and the normal integrity of the skin. In fact, the thyroid has at least some effect on every organ in the body - including the heart.

For people with almost any type of heart disease, disorders of the thyroid gland can worsen old cardiac symptoms or cause new ones, and can accelerate the underlying heart problem. Even worse, doctors frequently forget to think about the thyroid when cardiac symptoms are worsening, and if they don't think of it they will miss it. Often, it's the savvy patient who reminds the doctor that thyroid function ought to be checked. This is why it is useful for those with heart disease to know a little about the cardiac effects of thyroid disease.

Disorders of the thyroid gland usually involve either the failure to produce enough thyroid hormone (hypothyroidism) or the production of too much (hyperthyroidism). Both types of thyroid disorders are common.

Hypothyroidism and the heart

Thyroid hormone is very important for normal cardiovascular function, so when not enough thyroid hormone is present neither the heart nor the blood vessels function normally. In hypothyroidism the heart muscle is weakened in both its contraction phase, and also its relaxation phase. This means that the heart cannot pump as vigorously as it should, and the amount of blood it ejects with each heart beat is reduced. In addition, because the heart muscle does not relax normally in between heart beats, a potentially serious condition called diastolic dysfunction may result. (Read about diastolic dysfunction here). Furthermore, hypothyroidism reduces the amount of nitric oxide in the lining of the blood vessels, causing them to stiffen.

Cardiac symptoms of hypothyroidism

Cardiac symptoms can be seen in anybody with hypothyroidism, but are especially likely in an individual who already has underlying heart disease. Common symptoms include:

·         Shortness of breath on exertion and poor exercise tolerance. These symptoms, in most patients with hypothyroidism, are due to weakness in the skeletal muscles; but in patients with heart disease, the symptoms may be due to worsening heart failure.

·         Slow heart rate (bradycardia.) The heart rate is modulated by thyroid hormone, so that in hypothyroidism the heart rate is typically 10 - 20 beats per minute slower than normal. Especially in patients who also have heart disease, however, hypothyroidism may worsen the tendency for premature beats and even tachycardias such as atrial fibrillation.

·         Diastolic hypertension. One might think that, because a lack of thyroid hormone slows down the metabolism, people with hypothyroidism might suffer from low blood pressure. Usually the opposite is true - the arteries are stiffer in hypothyroidism, which causes the diastolic blood pressure to rise.

·         Worsening of heart failure, or the new onset of heart failure. Hypothyroidism can make well-controlled heart failure worsen, and can produce heart failure for the first time in patients with relatively mild underlying heart disease.

·         Edema (swelling.) Swelling can occur as a result of worsening heart failure. In addition, hypothyroidism itself can produce a type of edema called myxedema, caused by an accumulation of abnormal proteins and other molecules in the interstitial fluid (fluid external to the body's cells.)

·    Worsening of coronary artery disease. While the reduction in thyroid hormone can actually make angina less frequent in patients who have angina, the increase in LDL cholesterol  (bad cholesterol) and in C-reactive protein seen with hypothyroidism can accelerate any underlying coronary artery disease.

Hypothyroidism can be an extremely subtle condition, and often occurs without the typical, constellation of "textbook" symptoms doctors usually expect. It also occurs far more commonly than most doctors realize. So if you have any of these symptoms and your doctor does not have a ready or convincing explanation for them, especially if you already have heart disease of any type, ask your doctor to measure thyroid hormone levels.

Helping Your Friends Help You During Your Cancer Treatment

Do not protect yourself by a fence, but rather by your friends. --Czech Proverb

Once friends learn of your cancer, they may begin to worry. Some will ask you to tell them ways to help. Others will wonder how they can help but may not know how to ask. You can help your friends cope with the news by letting them help you in some way. 


Think about the things your friends do well and don't mind doing. Make a list of things you think you might need. This way, when they ask you how they can be of help, you'll be able to share your list of needs and allow them to pick something they're willing to do.


Sample list of need:

• Baby-sit on days that I go to treatment.
• Prepare frozen meals for my "down days."
• Put my name on the prayer list at my place of worship.
• Bring me a few books from the library when you go.
• Visit for tea or coffee when you can.
• Let others know that it is alright to call or visit me (or let others know that I'm not ready for visitors just yet).

Family Matters: Talking to Your Elderly Parent About Your Cancer

Since people are living much longer these days, many people with cancer may also be caring for their aging parents. For example, you may help your parents with their shopping or take them to doctor. Your aging parents may even live with you.

You have to decide how much to tell your parents about your cancer. Your decision may depend on how well your parents can understand and cope with the news. If your parents are in good health, think about talking with them about your disease.

Now that you have cancer, you may need extra help caring for your parents. You may need help only while you are in treatment. Or you may need to make long-term changes in your parents' care. Talk with your family members, friends, health professionals, and community agencies to see how they can help.



Summing Up: Cancer and Your Family

Cancer will not only change your life, but also the lives of those around you. It impacts families and friends in different ways. Talking about cancer can be hard for some families. Routines of family life may change. Roles and duties within the family will change. Relationships can be both strained and strengthened. Dealing with money and insurance often become hard. You may need to change where you live and with whom, at least for a while. As you think about how cancer has changed your life and your family's life, think about reaching outside your family to get help. You may need help with household chores and errands. Respite care can give your regular caregivers a much-needed break. Counseling and support groups can help your family deal with the issues that cancer raises. Most families find that being honest and open about the cancer, about the problems that arise, and about their feelings, helps them handle the changes that cancer causes.

Family Matters: Talking To Adult Children About Cancer

Your relationship with your adult children may change now that you have cancer. You may:

• Ask them to take on new duties, such as making health care decisions, paying bills, or taking care of the house.
• Ask them to explain some of the information you've received from your doctor or to go with you to doctor's visits so they can also hear what the doctors are telling you.
• 
  
• Rely on them for emotional support. For instance, you may ask them to act as "go-betweens" with friends or other family members.
• Want them to spend a lot of time with you. This can be hard, especially if they have jobs or young families of their own.
• Find it hard to receive--rather than give--comfort and support from them.
• Feel awkward when they help with your physical care, such as feeding or bathing.

As the adult daughter of a woman with ovarian cancer said,

"Mom was always the rock in the family. Whenever any of us had a problem, we could go to her for help. Now we had to help her. It was almost as though we were the parents and she was the child. To make it even harder, we had our own children to take care of and jobs to go to."

Talking With Your Adult Children

It is important to talk about cancer with your adult children, even if they get upset or worry about you. Include them when talking about your treatment. Let them know your thoughts and wishes. They should be prepared in case you don't recover from your cancer.

Even adult children worry that their parents will die. When they learn that you have cancer, adult children may realize how important you are to them. They may feel guilty if they haven't been close with you. They may feel bad if they cannot spend a lot of time with you because they live far away or have other duties. Some of these feelings may make it harder to talk to your adult children. If you have trouble talking with your adult children, ask your doctor or nurse to suggest a counselor you can all talk with.

Make the most of the time you have with your adult children. Talk about how much you mean to each other. Express all your feelings--not just love but also anxiety, sadness, and anger. Don't worry about saying the wrong thing. It's better to share your feelings rather than hide them.

One who conceals grief finds no remedy for it. --Turkish Proverb

Cancer Risk for the Children of People Who Have Cancer

Now that you have cancer, your children may wonder about their chance of getting it as well. A higher risk for some types of cancer is passed from parent to child. However, this is not the case for every type. And everyone's body is different. If concerned, however, children should talk with a doctor about their risk of getting cancer.

Testing for certain genes can be a way to find out if a person is at higher risk of getting cancer. 

Although some genetic tests can be helpful, they don't always give people the kinds of answers they are seeking. Talk to your doctor if you or someone in your family wants to learn more about genetic changes that increase cancer risk.. He or she can refer you to a person who is specially trained in this area. These experts can help you think through your choices and answer your questions.

Family Matters: Talking To Your Children About Cancer

Even though your children will be sad and upset when they learn about your cancer, do not pretend that everything is okay. Even very young children can sense when something is wrong. They will see that you don't feel well or aren't spending as much time with them as you used to. They may notice that you have a lot of visitors and phone calls or that you need to be away from home for treatment and doctor's visits.

What the family talks about in the evening, the child will talk about in the morning. --Kenyan Proverb

Telling Children About Cancer

Children as young as 18 months old begin to think about and understand what is going on around them. It is important to be honest and tell your children that you are sick and the doctors are working to make you better. Telling them the truth is better than letting them imagine the worst. Give your children time to ask questions and express their feelings. And if they ask questions that you can't answer, let them know that you will find out the answers for them.

When you talk with your children, use words and terms they can understand. For example, say "doctor" instead of "oncologist" or "medicine" instead of "chemotherapy." Tell your children how much you love them and suggest ways they can help with your care. Share books about cancer that are written for children. Your doctor, nurse, or social worker can suggest good ones for your child.

Let other adults in your children's lives know about your cancer. This includes teachers, neighbors, coaches, or other relatives who can spend extra time with them. These other adults may be able to take your children to their activities, as well as listen to their feelings and concerns. Your doctor or nurse can also help by talking with your children and answering their questions. Or you can ask them if there's a child-life specialist on staff. This is a person who can help children understand medical issues and also offer psychological and emotional support.

How Children May React

Children can react to cancer in many different ways. For example, they may:

• be confused, scared, or lonely
• feel guilty and think that something they did or said caused your cancer
• feel angry when they are asked to be quiet or do more chores around the house
• miss the amount of attention they are used to getting
• regress and behave as they did when they were much younger
• get into trouble at school or at home
• be clingy and afraid to leave the house

"Now that my Mom has cancer, everything has changed. I want to be with her, but I want to hang out with my friends, too. She needs me to help with my little brother, but what I really want to do is play football like I used to."

Teenagers and a Parent's Cancer

Teens are at a time in their lives when they are trying to break away and be independent from their parents. When a parent has cancer, breaking away can be hard for them to do. They may become angry, act out, or get into trouble.

Try to get your teens to talk about their feelings. Tell them as much as they want to know about your cancer. Ask them for their opinions and, if possible, let them help you make decisions.

Teens may want to talk with other people in their lives. Friends can be a great source of support, especially those who also have serious illness in their family. Other family members, teachers, coaches, and spiritual leaders can also help. 

Encourage your teenage children to talk about their fears and feelings with people they trust and feel close to. Some towns even have support groups for teens whose parents have cancer. Also, ask your social worker about Internet resources for this group. Many have online chats and forums for support. 

What children of all ages need to know: About cancer Nothing your child did, thought, or said caused you to get cancer. You can't catch cancer from another person. Just because you have cancer does not mean that others in your family will get it, too. Just because you have cancer does not mean you will die from it. In fact, many people live with cancer for a long time. Scientists are finding many new ways to treat cancer. About living with cancer in the family Your child is not alone. Other children have parents who have cancer. It is okay to be upset, angry, or scared about your illness. Your child can't do anything to change the fact that you have cancer. Family members may act differently because they are worried about you. You will make sure that your children are taken care of, no matter what happens to you. About what they can do They can help you by doing nice things like washing dishes or drawing you a picture. They should still go to school and take part in sports and other fun activities. They can talk to other adults such as teachers, family members, and religious leaders.

Family Matters: Spouses and Partners

"I was very scared when my husband was diagnosed with cancer.  He had always taken care of me and we did everything together. I was afraid I simply wouldn't  be strong enough to help him through his treatment. I was so afraid that he might not recover, and I was also afraid to talk with him about my fears because I didn't want to upset him."  

Your husband, wife, or partner may feel just as scared by cancer as you do. You both may feel anxious, helpless, or afraid. You may find it hard to be taken care of by someone you love.

People react to cancer in different ways. Some cannot accept that cancer is a serious illness. Others try too hard to be "perfect" caregivers. And some people refuse to talk about cancer. For most people, thinking about the future is scary.

It helps if you and the people close to you can talk about your fears and concerns. You may want to meet with a counselor who can help both of you talk about these feelings.

Sharing Information

Including your spouse or partner in treatment decisions is important. You can meet with your doctor together and learn about your type of cancer. You might want to find out about common symptoms, treatment choices, and their side effects. This information will help both of you plan for the future.

Your spouse or partner will also need to know how to help take care of your body and your feelings. And, even though it's not easy, both of you should think about the future and make plans in case you don't survive your cancer. You may find it helpful to meet with a financial planner or a lawyer.

Staying Close

Everyone needs to feel needed and loved. You may have always been the "strong one" in your family, but now is the time to let your spouse or partner help you. This can be as simple as letting the other person fluff your pillow, bring you a cool drink, or read to you.

Feeling sexually close to your partner is also important. You may not be interested in sex when you're in treatment because you feel tired, sick to your stomach, or in pain. But when your treatment is over, you may feel like having sex again. Until then, you and your spouse or partner may need to find new ways to show that you care about each other. This can include touching, holding, hugging, and cuddling.

Time Away

Your spouse or partner needs to keep a sense of balance in his or her life. He or she needs time to take care of personal chores and errands. Your partner will also need time to sort through his or her own feelings about cancer. And most importantly, everyone needs time to rest. If you don't want to be alone when your loved one is away, think about getting respite care or asking a friend to stay with you. 

Family Matters: Changes to Roles in the Family

When someone in a family has cancer, everyone takes on new roles and responsibilities. For example, a child may be asked to do more chores or a spouse or partner may need to help pay bills, shop, or do yard work. Family members sometimes have trouble adjusting to these new roles.

Adjusting to Your New Situation

Many families have trouble getting used to the role changes that may be required when a loved one has cancer.

Money. Cancer can reduce the amount of money your family has to spend or save. If you're not able to work, someone else in your family may feel that he or she needs to get a job. You and your family may need to learn more about health insurance and find out what will be covered and what you need to pay for. Most people find it stressful to keep up with money matters. 

Living arrangements. People with cancer sometimes need to change where they live or whom they live with. Now that you have cancer, you may need to move in with someone else to get the care you need. This can be hard because you may feel that you are losing your independence, at least for a little while. Or, you may need to travel far from home for treatment. If you have to be away from home for treatments take a few little things from home with you. This way, there will be something familiar even in a strange place.

Daily activities. You may need help with duties such as paying bills, cooking meals, or coaching your children's teams. Asking others to do these things for you can be hard. A young father in treatment for colon cancer said,

"When I came home from the hospital, I wanted to be in charge again but simply didn't have the energy. It was so hard to ask for help! It was easier to accept help when I realized that my kids felt that they were contributing to my recovery."

Developing a Plan

Even when others offer to help, it's important to let people know that you can still do some things for yourself. As much as you're able, keep up with your normal routine by making decisions, doing household chores, and working on hobbies that you enjoy.

Asking for help is not a sign of weakness. Think about hiring someone or asking for a volunteer. You might be able to find a volunteer through groups in your community.

Paid help or volunteers may be able to help with:

• physical care, such as bathing or dressing
• household chores, such as cleaning or food shopping
• skilled care, such as giving you special feedings or medications

Respite care. Just as you need time for yourself, your family members also need time to rest, have fun, and take care of their other duties. Respite care is a way people can get the time they need. In respite care, someone comes to your home and takes care of you while your family member goes out for a while. Let your doctor or social worker know if you want to learn more about respite care. 

Learning You Have Cancer: Family Matters

Cancer will change your life and the lives of people around you. Your routines may be altered. Roles and duties may change. Relationships can be strained or strengthened. Dealing with money and insurance can cause problems. You may need to live with someone else for a while. You may need help with chores and errands. Most people find that if they, their friends, and family talk about the cancer and how it makes them feel, they feel closer to each other.

Families are not all alike. Your family may include a spouse (husband or wife), children, and parents. Or maybe you think of your partner or close friends as your family. In this book, "family" refers to you and those who love and support you.

Cancer affects the whole family, not just the person with the disease. How are the people in your family dealing with your cancer? Maybe they are afraid or angry, just like you.

When you first find out you have cancer and are going through treatments, day-to-day routines may change for everyone. For example, someone in your family may need to take time off work to drive you to treatments. You may need help with chores and errands.

How your family reacts to your cancer may depend a lot on how you've faced hard times in the past.

Some families find it easy to talk about cancer. They may easily share their feelings about the changes that cancer brings to their lives. Other families find it harder to talk about cancer. The people in these families may be used to solving problems alone and not want to talk about their feelings.

Families that have gone through divorce or had other losses may have even more trouble talking about cancer. As one woman with advanced thyroid cancer said,

"Talking about my cancer was rough at first. My husband and I divorced five years ago, so my mom had to move in and help me with the boys. Eventually, I was able to tell my ex-husband about my cancer, and he helped the boys understand. Our family has been through a lot, and we'll get through this, too. To me, the only constant in life is change."

If your family is having trouble talking about feelings, think about getting some help. Your doctor or nurse can refer you to a counselor who can help people in your family talk about what cancer means to them. Many families find that, even though it can be hard to do, they feel close to each other when they deal with cancer together.