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 

Cancer According to the Dictionary

When we hear the words, "You have cancer" the world suddenly stops and we can barely hear anything else. Then when it's time to digest the diagnosis we may still not really know what is cancer. Here we discuss a very basic and general definition of cancer.


Definition of Cancer: 

NOUN: Any of various malignant neoplasms characterized by the proliferation of, anaplastic cells that tend to invade, surrounding tissue and metastasize to new body sites. 1. The pathological condition characterized, by such growths. 2. A pernicious, spreading evil: A cancer of bigotry spread through the community. Characteristics of Cancer 

Abnormality:  Cells are the structural units of all living things. Each of us has trillions of cells, as does a growing tree. Cells make it possible for us to carry out all kinds of functions of life: the beating of the heart, breathing, digesting food, thinking, walking, and so on. However, all of these functions can only be carried out by normal healthy cells. Some cells stop functioning or behaving as they should, serving no useful purpose in the body at all, and become cancerous cells. 

Invasiveness:  Sometimes tumors do not stay harmlessly in one place. They destroy the part of the body in which they originate and then spread to other parts where they start new growth and cause more destruction. ;This characteristic distinguishes cancer from benign growths, which remain in the part of the body in which they start. Although benign tumors may grow quite large and press on neighboring structures, they do not spread to other parts of the body. Frequently, they are completely enclosed in a protective capsule of tissue and they typically do not pose danger to human life like malignant tumors (cancer) do. 

A group of diseases: Although cancer is often referred to as a single condition, it actually consists of more than 100 different diseases. These diseases are characterized by uncontrolled growth and spread of abnormal cells. Cancer can arise in many sites and behave differently depending on its organ of origin. Breast cancer, for example, has different characteristics than lung cancer. It is important to understand that cancer originating in one body organ takes its characteristics with it even if it

spreads to another part of the body. 

For example, metastatic breast cancer in the lungs continues to behave like breast cancer when viewed under a microscope, and it continues to look like a cancer that originated in the breast. 

Uncontrollability: The most fundamental characteristic of cells is their ability to reproduce themselves. They do this simply by dividing. One cell becomes two, the two become four, and so on. The division of normal and healthy cells occurs in a regulated and systematic fashion. In most parts of the body, the cells continually divide and form new cells to supply the material for growth or to replace worn-out or injured cells. For example, when you cut your finger, certain cells divide rapidly until the tissue is healed and the skin is repaired. They will then go back to their normal rate of division. In contrast, cancer cells divide in a haphazard manner. The result is that they typically pile up into a non-structured mass or tumor. 

Finding Reliable Health Information on the Web

The explosion of information on the internet has certainly benefited people with cancer, but has also added a good dose of confusion and new pressure. With thousands of websites offering cancer information, knowing which ones to trust can be difficult.

If you don't have a computer at home, most public libraries have computers with free internet access for your use. If you're not familiar with how to use computers or the internet, ask a friend, family member or staff person at the library to help you.

Where to begin ?

• A good place to begin is always with your health care team. Your doctor, nurse or social worker can tell you about websites or books related to your cancer type that will provide credible information. 

• Government institutions, like the National Cancer Institute (http://www.cancer.gov/), provide trustworthy, current information on cancer staging, new treatments, side effects management and more.

• Nonprofit organizations can refer you to helpful websites such as the following: 

1. CancerCare 

   http://www.cancercare.org/

   
   
2. Association of Cancer Online Resources 

   http://www.acor.org/

   
   
3. American Society of Clinical Oncology http://www.peoplelivingwithcancer.org/

   
   
4. University of Pennsylvania Oncology 

   http://www.oncolink.org/

Can I trust this website ?

What is the purpose of the website - educational or commercial ?

Educational websites, which are generally sponsored by nonprofit organizations, provide information about many different treatment options. Commercial sites, like those sponsored by pharmaceutical companies, will provide excellent information about their own products (drugs) and/or research procedures or clinical trials but are not a good place to learn about the full range of treatment options.

What is the website's or blog reputation?

Chances are, if you or your doctor or other professionals you trust have heard of the website, it's reliable.

What is the source of the information ?

Generally, nationally known cancer centers, medical schools, large nonprofit organizations, and government agencies provide the highest quality information but a number or new comers such as SJCCF are reliable information contenders with the best of them.

Is the information relevant to you ?

A good website provides information that speaks to your needs.

Can you identify the authors of the material?

If they are not experts in the field or if they are anonymous, their information could be misleading or inaccurate.

Are the links relevant and appropriate for the site?

Websites that refer you to commercial sources of information should be rejected because they may not be providing you with all the information you need to make an educated well informed decision.

Remember the internet is not a substitute for individual medical care. Use credible information you find on these sites and this blog to help you communicate more effectively with YOUR DOCTOR

That Dirty Word: FATIGUE

Fatigue is the most common side effect of cancer treatment. It is associated with treatments such as chemotherapy, radiation, biotherapy, surgery and cancer itself.  Fatigue experienced as a side effect of cancer treatment is not necessarily linked to exertion or activity, not completely relieved by rest, and more severe than fatigue of everyday life.

There are different patters of fatigue depending on the type of treatment a peson is receiving. People undergoing radiation treatment notice that fatigue increases over time, seems to be worse in the evening and is usually the worst at the end of treatment. Most people return to their pre-treatment activity level within three to twelve weeks, but for some it may take up to a year.

Thyroid cancer patients and survivors who have undergone thyroidectomy may experience a continual level of fatigue during their lifetime related to difficulties processing synthetic hormones or adjusting the optimal dosage for to their needs.

For people undergoing chemotherapy, the fatigue peaks right after treatment. These people will also notice that their fatigue is worse when their blood counts are at the lowest point. Some individuals received both radiation and chemotherapy at the same time, this increases the fatigue they experience.

Fatigue's impact can be felt physically, cognitively and emotionally. It means having less energy to do the things you do or want to do. Completing daily activities at home or work becomes more difficult. I can best describe cancer fatigue as having the lowest energy level with  arms and feet that feel like they weight a million pounds. Just gettin up and out of bed in the morning was nearly impossible for a little while.

Cancer related fatigue decreases your ability to concentrate or attention span, levels of alertness, comprehension, cognition and memory. Doing simple math like balancing the checkbook became a challenge. Making phone calls virtually impossible. Emotionally I found myself impatient, irritable and unmotivated regardless of how important something was.

Besided the actual cancer treatment there are several causes for extreme fatigue. These include emotional distress, sleep disturbances, medication, nutrition,  anemia (low red blood cell count), pain and other health conditions. Therefore more than just one cause may be contributing to the experience of fatigue during and after cancer treatment.

Your healthcare team will make every effort to rule out any condition that can be treated to improve your fatigue. Unfortunately often the exact cause cannot be found.  One of the best ways to manage cancer related fatigue is to keep a diary with daily fatigue ratings to monitor patterns of fatigue over time. 

Track when fatigue occurs and rate it from 0 (no fatigue) to 10 (you cannot get out of bed). Most people will begin to notice a pattern and be able to plan and do activities that are important to them when they are the least tired. The last 3 or 4 months of my biotherapy I knew I had to take a nap mid-morning and mid-afternoon if I wanted to be clear and present for my children during lunch and dinner.

Research has shown that exercise relieves fatigue. Walking daily will improve fatigue and emotional wellbeing greatly. It prevents muscles from weakening due to lack of use!  I thank God everyday for my dog, Mr. Max Schnauzer who I walk 3 times a day, rain or shine and who kept me motivated to walk even on days when I thought I couldn't even sit up.  Many mornings I made myself get up and get going for our morning walk and found that once we started walking I did feel better.

Mr. Max Schnauzer is a very special dog and he seems to sense when our daily routine is a bit much for me. He has been known to sit down near a bench so I can rest or simply turn around and take me home after only a few minutes. I owe a great deal of my fatigue fighting strategy success to my four legged little friend.

If weather is an issue or if you prefe peoples company over a furry creature many malls open early for walkers, so you do not have to worry about  bad weather, too high or too low temperatures. Always check with your healthcare team before beginning a walking program and listen to your body, if you are over doing it your body will let you know.

Another interesting fatigue fighting do is sitting down to complete tasks. When showering use a bath chair. Sorting and folding clothes can also be done sitting down. Sit at the kitchen table to cut and dice foor or mix ingredients. I used a counter height chair or bar stool many times to iron clothes and even do the dishes!

If you have little ones don't underestimate the fun and entertainment value of board games and reading books. Let them help you with putting on your socks and shoes, picking up toys, getting mail from the mailbox, making breakfast (fruit, toaster oven waffles or cold cereal) even lunch (PBJ's or TV dinners) and even taking out the garbage (I kept smaller trash cans around so the bags would not become too heavy for them).

Give yourself permission to accept help, delegate tasks and simply let go. You are more important than things or a picture perfect home. Have someone carry your groceries to the car. Let family and friends assist with meal preparations or household chores it's ok if you just sit down and read a good book or listen to music while others take care of the rest.

Establish and maintain a regular bedtime/wake time routine to ensure a good night's sleep. Avoid heavy meals, caffeine, alcohol or nicotine right before bedtime. Take a power nap for 30 minutes if you are tired during the day and remember to use an alarm to wake you. Do not let long daytime naps disrupt your nightime sleeping.

Uncontrolled pain can contribute to fatigue. It can disrupt sleep at night. Sometimes, the pain medication itself can cause fatigue or sleepiness. There is a fine line in adjusting pain medication so that you are pain free without being too drowsy. It's important that you communicate with your healthcare provider about your pain.

Maintain a balanced diet that includes plenty of protein for energy, fluids to maintain hydration, vegetables and fruit for vitamins and minerals. Often, people will not feel like eating large meals during treatment. I didn't so I made myself "graze" on smaller healthy meals and snacks throughout the day making sure that I had "something" to eat or drink with my family during their regular meal time.

Fatigue is one of the most debilitating symptons for people undergoing cancer treatment. And many times is a long term problem for survivors after treatment. Knowing that fatigue is a common side effect of the cancer experience and that there are ways to manage it can enhance a person's confidence and overall physcological well-being.

Remember it is always very important to communicate with your healthcare team about how fatigue is affecting your life. Fatigue helped me learn how to prioritize, delegate, let go and enjoy the little things in life. It was a lesson I needed to learn and I am glad I did.

Yes, It's Cancer: Now What?

First, take a deep breath and try not to panic. We know that hearing those words, “you have cancer” is scary. But many cancers are treatable, and thyroid cancer in most cases has a 100% survival rate, so try and stay positive until you know all you can about your diagnosis. The more you learn, the less panicked you will feel.

You may want to avoid researching on the internet until you speak with a specialist about your specific type of thyroid cancer. Every cancer prognosis is unique because of the person’s age, gender, current health status, family health history, the genetic  make-up of the cancer and when the cancer was caught. Make sure you know what you are researching first!

• Try not to panic and rush into treatment decisions before you have had a chance to think about your options, outcomes and associated costs. It’s important to understand the new terminology and explanation your doctor(s) have  provided. Make sure you have all your questions answered. There may be more than one option to consider, and a clear head is necessary for decision-making.

• Call your insurance company right away. Tell them about  your condition. Ask to have a “case manager” so that  you have only one person to talk to for all your questions,  getting approvals, bills, reimbursements, etc. If you don’t have insurance, don’t panic. There are financial resources listed in the FINANCIAL RESOURCES TAB IN THIS BLOG.

• Ask the nurse with whom you book your surgical consultation appointment what you need to bring with you to the appointment. If you have  a pathology report or scans, you will need to bring those. If doctors don’t have all your information, they won’t be able  to discuss your cancer and treatment options. Don’t sit in the waiting room for hours only to eventually find out you  didn’t bring the essential reports.

• Be prepared for your doctor’s appointments with a list of questions and concerns written down. Many times newly diagnosed cancer patients are so nervous and scared they forget what they wanted to talk to their doctors about during the visit. It happens to almost everyone. It's OK to make a list and bring it with you. It will make you a better patient and partner in your care.

• Try to bring someone with you who can take notes and ask questions with you. If this is not possible, prepare questions in advance and bring a tape recorder and tape the doctor’s conversation with his or her permission. Or  ask a nurse or volunteer at the doctor’s office to take notes for you if you are nervous and worried you may forget to ask an important question, misunderstand what the doctor says or miss something important about your treatment or next appointment.

• Learn about your treatment options so you can make good choices. Get a second opinion or even a third from  a surgeon and/or oncologist (and even a plastic surgeon if needed). Don’t be afraid to ask doctors lots of questions. The more you understand, the less frightening and overwhelming your treatments will be.

• If you have advanced thyroid cancer, find a doctor who takes part in a tumor board. A tumor board is an approach to treatment planning in which  several doctors with different specialties meet regularly to discuss the medical condition and treatment options of individual patients. A tumor board might be made up of a medical oncologist, who treats cancer with drugs, a surgical oncologist, who treats cancer with surgery, and a radiation oncologist, who treats cancer with radiation.

• Designate a friend or family member to communicate to your friends. You will be receiving many phone calls from well-wishers and repeating your updates will become tiresome. There are also internet options for you to help keep friends and family informed. Find those resources and use them. If you need help ask your friends or family to please look up these resources for you and set them up.

• If you work and are concerned about how to talk to your employer, go to cancerandcareers.org. It’s geared toward women, but the great advice it offers is for everyone.  It’s very important for you and your caregiver to understand the cost of your treatment options compared to the benefits of those treatments. For example, some therapies boast that that they give patients a “better” prognosis than another treatment option but will require a great deal of money because they are not covered by insurance. 

• Find out what “better” actually means because if studies show that the treatment outcome is only better by six weeks, for example, do you really want to mortgage your home, spend your children’s college savings and incur massive amounts of debt? 

Understanding Cancer Cells

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normal, healthy cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.

Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old or damaged cells do not die as they should. The build-up of extra cells often forms a mass of tissue called a growth or tumor.

Growths on the thyroid are often called nodules. Most thyroid nodules (more than 90 percent) are benign (not cancer). Benign nodules are not as harmful as malignant nodules (cancer):

• Benign nodules
  • are rarely a threat to life
  • don't invade the tissues around them
  • don't spread to other parts of the body
  • usually don't need to be removed
• Malignant nodules
  • may sometimes be a threat to life
  • can invade nearby tissues and organs
  • can spread to other parts of the body
  • often can be removed or destroyed, but sometimes the cancer returns

Cancer cells can spread by breaking away from the original tumor. They enter blood vessels or lymph vessels, which branch into all the tissues of the body. The cancer cells attach to other organs and grow to form new tumors that may damage those organs. The spread of cancer is called metastasis.

Iodine Radioisotope Effective for Bone Mets From Thyroid Cancer

NEW YORK (Reuters Health)- When differentiated thyroid cancer has spread to bone, iodine-131 can help stabilize the disease and significantly reduce pain, a Chinese team reports.

Iodine-131 has been used to treat differentiated thyroid cancer (DTC) for 70 years, the authors note, but it's been very difficult to evaluate its effect on DTC bone metastases.

"The indolent course of DTC requires very large cohorts of patients followed over several decades to confirm significant differences in prognostic factors and treatment efficacy," said Dr. Quan-Yong Luo and colleagues at Shanghai Sixth People's Hospital. "Moreover, DTC patients with bone metastasis are relatively rare."

In a report scheduled for the October print issue of the Journal of Clinical Endocrinology and Metabolism, available online now, the researchers report on 106 such patients treated at their center with oral I-131 therapy, up to 13 times at intervals of 4 to 12 months. Follow-up ranged from 1 to 17 years, with the median being 10.5 years.

Based on changes in serum thyroglobulin, I-131 significantly decreased disease activity in 37 cases (34.9%) and stabilized it in 56 patients (52.8%), the team reports.

Treatment also produced significant pain relief in 39 of 61 patients (63.9%) with painful bone metastases.

Survival rates were 86.5% at 5 years and 57.9% at 10 years, Dr. Luo and colleagues report. Factors independently associated with better prognosis were a solitary bone metastasis, the absence of non-osseous metastases, and bone surgery prior to I-131 therapy.

"In summary, I-131 therapy can significantly decrease or stabilize serum Tg (thyroglobulin) and alleviate bone pain. It can also shrink or stabilize lesions for most DTC patients with bone metastases, and therefore, it is an effective treatment modality for bone metastases from DTC," they write.

SOURCE: http://bit.ly/nup9n4

J Clin Endocrinol Metab 2011.

Suicide Risk Higher in Cancer Patients than General Population

The incidence of suicide among U.S. cancer patients is nearly twice that of the general population, and suicide rates vary among patients with cancers of different anatomic sites, according to a study published online August 11 in the Journal of Clinical Oncology (JCO). The risk remained elevated for as long as 15 years after diagnosis.

Researchers from the University of Washington analyzed Surveillance, Epidemiology, and End Results (SEER) data from nearly 3.6 million patients diagnosed with cancer from 1973 to 2002. They compared those data, which included 5,838 suicides, with data from the U.S. general population collected by the National Center for Health Statistics. The cancer patients had an adjusted rate of 31.4 suicides per 100,000 person-years, compared with 16.7 suicides in the general population. Suicide rates were particularly high for cancers of the lung/bronchus (81.7), stomach (71.7), oral cavity/pharynx/thyroid (53.1), and thyroid/larynx (46.8).

Two other studies that examined the association between cancer and suicide appear in the same issue of JCO. The second study, using data from Medicare patients in New Jersey, found that the "risk of suicide in older adults is higher among patients with cancer than among patients with other medical illnesses, even after psychiatric illness and the risk of dying within a year were accounted for." A third study of cancer center patients in Edinburgh, United Kingdom, found, "A substantial number of cancer outpatients report thoughts that they would be better off dead or had thoughts of hurting themselves."

In an editorial, Dr. Timothy Quill of the University of Rochester Medical Center, noted, "What is interesting and potentially important about the studies is that these thoughts about suicide and the associated risk factors that are relatively well known for terminally ill patients may be just as important for those patients with cancer who are survivors or are living with the disease, the constant threat of recurrence real or perceived being equal in relevance to the patients involved."

***********************************

Stevie JoEllie's Cancer Care Fund is working to develop and launch an access to care grant program for thyroid cancer patients and survivors nationwide. Please consider supporting our unique initiative that includes a set aside fund for healthcare access to assist thyroid cancer survivors with medical costs associated with follow up treatment, annual exams,  diagnostics and medications. 

SJCCFThyNet is a project of United Charitable Programs Inc., a 501(c) 3 Public Charity and as such all donations are tax deductible as allowed by law. 

[One time and recurring donations are fast and easy to set up.]

May is Skin Cancer Awareness Month

According to the Skin Cancer Foundation, one in Five Americans will develop skin cancer duting the course of their lives. Despite that prevalence, skin cancer remains the proverbial elephant in the room, a disease men and women are aware of but prefer not to think about.

Thanks to a societal trend that prefers to avoid or ignore the subject of skin cancer. However, as the following facts and figures about skin cancer attest, skin cancer is a topic that cannot be ignored and one men, women and children alike need to learn about to better reduce their risk of experiencing  this largely preventable disease.

• According to the American Cancer Society, men are more likely to develop non-melanoma and melanoma skin cancer than women. In fact, the Natonal Cancer Institute notes the majority of people diagnosed with melanoma are white men over the age of 50.

• The rate of skin cancers increases with age. However, skin cancers and specially melanomas can be found in younger people.

• The five year overall survival rate for melanoma, which represents the percentage of patients who live at least five years after diagnosis is 91%. This includes patients who are disease free, in remission or undergoing continuing treatment.

• The five year localized survival rate for melanoma is 98%. Localized cancer represents cancer that, at the time of diagnosis, has not spread to the other parts of the body.

• The National Cancer Institute Surveillance Epidemiology and End Results program notes that nearly 800,000 Americans are living with a history of melanoma and 13 million are living with a history of non melanoma skin cancer.

• Basal cell carcinoma, a slow growing and painless type of non melanoma skin cancer, is the most common form of cancer in the United States. Roughly 2.8 million cases of BCC are diagnosed annually in the U.S. Though rarely fatal, BCC's can be unsightly if the cancer is allowed to grow.

• According to the National Cancer Institute, between 40% to 50 % of Americans who live to age 65 will have melanoma or nonmelanoma skin cancer at least once in their lifetime.

• Roughly 90% of nonmelanoma skin cancers are associated with exposure to ultraviolet (or UV) radiation from the sun.

• According  to the National Center for Chronic Prevention and Health Promotion, melanoma accounts for less than 5% of skin cancer cases, but it causes more than 75% of skin cancer deaths.

• The World Health Organization reports that 10 minutes in a tanning bed is equal to the skin cancer causing effects of 10 minutes in the Mediterranean  summer sun.

To learn more about skin cancer, visit the Skin Cancer Foundation at http://www.skincancer.org/

Suggestions to Cope with Sexual Problems during and after Cancer Treatment

It is important to let your partner know if you do not feel interested in sex. It can be helpful to explain how you feel, so that they do not feel rejected. You can also suggest what you are happy to offer as an alternative – such as, 'I don’t want to have sex but would love to give you a cuddle’.

If your partner is feeling frustrated it may be helpful for them to reduce the frustration through masturbation, either with you or alone.

If you have fatigue (continual tiredness that is not relieved by rest) and don’t have much energy, it might help to make love differently. Less energetic positioning, where your weight is well supported, can reduce strain. You may prefer quicker sexual contact rather than longer sessions. These are things you can talk about together.

If the tension is building between you, you may find it helpful to get support from a counsellor who specialises in offering help in these circumstances. It is not unusual for a person diagnosed with cancer to feel uninterested sexually and you should never feel pressured to have sex if you are not emotionally or psychologically ready to do so as a result of your cancer diagnosis, treatment or changes to your hormonal functioning or body image as a result of it.

Pain During Intercourse

Pain during intercourse can occur after pelvic surgery or radiation to the area. It may also occur if medicines reduce the production of natural lubrication or in cases of thyroid cancer treatment when hormonal function is disrupted and/or imbalanced.

Pain can reduce sexual feelings and reduce desire. Often, an experience of pain can lead to a fear of pain, which can in turn lead to tension. This tension can then distract the person from achieving arousal, prevent lubrication and cause further pain.

There are many reasons for pain. It is important to let your partner know what is painful so that you can explore other positions or ways of making love. Often, the cause can be treated simply. If you have pain, it is important to tell your doctor, who can examine you to find out why and suggest solutions.

If you have pain or are worried about pain, it may helpful if you take control over the depth and speed of penetration try to ensure your partner, and/or you, are close to orgasm before penetration make love after pain medicines have been taken use pillows and cushions to help you feel more comfortable and supported make love side by side, to reduce body weight on a sore scar area.

Vaginal Problems

Cancer treatments, such as chemotherapy, hormonal therapy, or radiotherapy to the pelvic area, may cause changes to the vagina that can lead to dryness, narrowing, ulcers and infection. These changes may lead to pain during intercourse.

1) Vaginal Dryness: This can be helped by a number of creams and gels that can be put directly into the vagina.

• Replens® is a non-hormonal cream available from most chemists. It is applied 2–3 times per week and works for about three days at a time. The cream binds to the vaginal wall and the water held within it reduces dryness and boosts the blood flow in the vagina.

• Ovestin®, Ortho-gynest®, and Premarin® are available on prescription from your doctor. They contain very small amounts of oestrogen and can be used as a cream or a pessary. The effect in the vagina is short lasting. The amount of oestrogen in this product is considered to be so small that it does not cause any hormonal influences elsewhere in the body.

• Vagifem®, also on prescription, is a gel which contains a small amount of oestrogen. It can be used twice a week. A small research study has shown that Vagifem can increase the amount of oestrogen circulating in the body. Because of this risk, Vagifem may not be recommended for women who are taking aromatase inhibitors, such as anastrozole (Arimidex®), exemestane (Aromasin®), or letrozole (Femara®). Your specialist or breast care nurse can give you further advice and information about this.

• Water based lubricants such as KY Jelly, Senselle®, Astroglide® and SYLK® which can be bought at a pharmacy or most major supermarkets, can help to increase moisture levels, making sex easier. Some women prefer to use glycerine as it is cheap and not embarrassing to buy due to its many uses.

2) Vaginal narrowing:  This may happen after radiotherapy to the pelvis and sometimes after surgery. After your treatment you will usually be advised to use vaginal dilators. These are plastic tubes of varying sizes which you can be inserted by yourself or as part of joint sexual touch. The dilators prevent the two side-walls of the vagina sticking together, and are used with lubricants. They are available from your doctor or specialist nurse at the hospital. An alternative way to prevent vaginal narrowing is to have regular intercourse or to use a vibrator.

3) Vaginal Ulceration: Radiotherapy can also cause sore areas (vaginal ulcers) which may bleed slightly. These can take weeks, or sometimes months, to heal. If you have any unusual bleeding after intercourse, you should to tell your doctor and ask for an examination.

4) Vaginal Infection: Some women find that they are prone to getting vaginal thrush infections while having radiotherapy or chemotherapy. This is because there are changes in the acidity in the vaginal area, which allow the normal organisms in the vagina to overgrow. You may have thrush if you notice a creamy-white discharge, or an itchiness in the vaginal area which gets worse if you scratch. This is easily treated. The medicines can be bought from your chemist. If you have had sexual contact, your partner may also need to have treatment.

Penetrative sex is perfectly safe during radiotherapy or chemotherapy if you are not affected by any of these vaginal side effects. You should use effective contraception if there is any risk that you could become pregnant, and your doctor can advise you on the best method for your situation.

Lowered Sex Drive in Women

• Sildenafil (Viagra®) and similar drugs can be used to raise women’s sex drive. They may also increase vaginal lubrication leading to reduced pain during sex, more arousal and increased ability to achieve orgasm.

Erectile Dysfunction After Cancer Surgery

Many men have erection difficulties after cancer surgery or radiotherapy to the pelvic area, but the treatment may not be the only factor. Studies have found that men commonly find they have sexual problems after operations that have nothing at all to do with their genital area. Your cancer operation, therefore, may not be the cause of all your sexual difficulties.

There may be psychological factors involved, which you are not consciously aware of. Some men find that they can have full erections with time. Even if they cannot, a half-erect penis can still be effective for making love. The positioning for this may be better with the partner on top guiding the penis inside.

If you have had an operation that has damaged the nerves that control erection, this need not be the end of your sexual life. You do not need to have a hard penis to give your partner pleasure. You may find it helpful to increase your range of sexual activity to include oral sex, mutual touching, increased masturbation, or use of a dildo or vibrator to increase your pleasure and that of your partner.

1) Medicines, pumps, implants and injections: If you have problems getting or maintaining an erection there are many options to help you. Remember that these will give you a hard penis, but will not necessarily increase your feelings of arousal.

• Tablets of sildenafil (Viagra®) help to produce an erection by increasing and restricting the blood supply in the penis. They are usually taken an hour before lovemaking, and then, following direct sexual stimulation, an erection will occur. These tablets should be prescribed by your GP. However, they may not be recommended for you if you have heart problems and/or are taking certain drugs, such as nitrates. They can cause side effects for some people which include heartburn, headaches, dizziness and visual changes. A possible side effect is that occasionally the erection lasts for more than a couple of hours and there is a danger of damage to the tissues of the penis.

• Vardenafil (Levitra®)tablets are similar to Viagra. They normally work within 25–60 minutes. The most common side effects are headaches and flushing of the face.

• Tadalafil (Cialis®) tablets can be used. They can be taken up to 36 hours before lovemaking. Your doctor may be able to prescribe them on the NHS. Tadalafil works by increasing the effects of one of the chemicals produced in the body during sexual arousal. It should not be taken by people who are taking certain heart medicines.

• Injection of a drug such as alprostadil (Caverject®, Viridal®) or papaverine directly into the penis, using a small needle, causes an erection. The drug restricts blood-flow and traps blood in the penis, causing an instant erection. Some experimentation is often needed at first to get the dose right.

One of the possible side effects is that if too much of the drug is given, the erection stays for too long and there is a danger of damaging the tissues. Some men who use these injections say that the head of the penis is not as hard as the shaft. The injections are prescribed by your GP. Usually this method is recommended to be only used once a week, which may not be enough for some men or their partners.

• Pellets of alprostadil (MUSE®) can be inserted into the penis. The pellet melts into the surrounding area and, after some rubbing to distribute it into the nearby tissues, produces an erection. Some men find that the pellet is initially uncomfortable.

• Vacuum pumps (sometimes called vacuum constriction devices) can also be used to produce an erection. The pump is a simple device with a hollow tube that you put your penis into. Pumps are either operated by hand or battery, and draw blood into the penis by creating a vacuum in the tube. Once the penis is full of blood, a rubber ring is placed around the base to keep the erection. The vacuum is released and the pump removed. The erection can be maintained for about 30 minutes. Once you have finished making love the ring is taken off and the blood flows normally again.

The advantage of vacuum pumps is that they don't involve inserting anything into the penis, but it does take a couple of weeks or so to get used to using one. It is particularly helpful for people who are not able to take other medicines. Your penis may feel slightly colder than usual to your partner because the blood is not moving around. The other important thing is to wear the ring for only half an hour at a time. The pump can be used as many times as you want, providing you allow a half hour between each use so that the blood can flow properly.

• Penile implants  are sometimes used after all other methods have been tried. There are two main types that have to be inserted during an operation. The first type uses semi-rigid rods that keep the penis fairly rigid all the time, but allow it to be bent down when an erection isn’t needed. The second type involves a hydraulic device that, when activated, causes an erection. Your doctor can discuss penile implants with you.

If you think any of these options might be useful to you, your doctor can give more information or you can contact an organisation.

Support Self Image and Physical Changes

Body image is the mental picture we have of our own appearance. This image is drawn from what our body actually looks like, and also from how we think we look. Throughout life, our body image is constantly changing. Our body image can be altered whether or not a cancer or its treatment causes change to our appearance.

Changes in body image can cause feelings of distress that go far beyond the physical effects of a cancer and its treatment. When there has been a change in body image which is sudden and dramatic, you may feel abnormal. You may also have feelings of shame, embarrassment, inferiority and anger. When the change is a visible one, these feelings can be reinforced by the reactions of other people.

1) Hiding changes: If the change can be hidden under clothes, for example, a colostomy or mastectomy, it is common to react by trying to pass as normal. You might hide the change, avoid looking at it, and conceal it from others. This avoidance can lead to you feeling increasingly anxious about the thought of someone finding out.

Having a stoma, or having a breast removed, is likely to cause a significant change in the way you feel about your body. If this is true for you then you could try making love in underwear or partly-dressed rather than completely naked. Changing the lighting level during sex can also help to build your confidence about how your body looks. It may help to lie on your side for lovemaking to prevent pressure on scars or stomas. Facing away from your partner, not towards, may also help.

2) Talking about your feelings around body image: The most important thing is to tell someone your fears, rather than hiding them and letting them grow into something bigger. The more able you are to face the things you have been avoiding, the better. However, it might be very important to have spent some time thinking through your worst fears, and planning a way of managing this to help build your confidence.

If you are the partner of someone who has changes in their real or perceived body image, it may also take you time to adjust to and accept the changes. You may need to talk through your own fears.

REMEMBER YOUR DOCTOR IS THE BEST SOURCE OF INFORMATION FOR YOUR INDIVIDUAL SITUATION

Voice Problems Should Never Be Ignored

Hoarseness is an annoyance that many people tend to ignore, but any persistent abnormal change in the voice—including a breathy, raspy, or strained quality—should be evaluated by a doctor, experts say. And the onus may be on you to ask for a voice evaluation, as a new study finds that primary care doctors often don't examine their patients for voice problems.

"What people should know is that a little hoarseness can be the sign of a big problem," says Richard Rosenfeld, professor and chairman of otolaryngology at Long Island College Hospital in Brooklyn, N.Y., and one of the authors of clinical practice guidelines for treating hoarseness that were published in September in Otolaryngology-Head and Neck Surgery. 

Voice problems affect about 30 percent of people in their lifetimes, and these issues can limit productivity in the workplace and damage quality of life. In the new study, researchers asked primary care physicians how often they routinely evaluate patients for problems with their voices. Just a third of the 271 primary care doctors surveyed reported doing regular evaluations for voice problems, and about 1 in 5 said they never evaluate patients for voice disorders.

Hoarseness can have many different causes, including the perfectly benign cold, allergy, or gastroesophageal reflux. But hoarseness that lasts for more than three weeks can be a sign of serious problems such as laryngeal, thyroid, or lung cancer, cautions Seth Cohen, assistant professor of otolaryngology-head and neck surgery at the Duke Voice Care Center at Duke Medical Center and the researcher presenting the new study at a meeting this week. "It's not something to take lightly."

Here are five tips for dealing with hoarseness:

Speak up. One reason primary care doctors don't address hoarseness is that "patients don't complain about it," Cohen says. "Patients have to advocate for themselves." Listen to your voice. Does it feel different? Are you able to do your job? Do your family members tell you that your voice doesn't sound quite right? If so, make sure your doctor knows all of your symptoms after the three-week mark, Cohen says, and consider having an exam of your larynx, also known as the voice box. Some family physicians perform this exam, but if yours doesn't, ask for a referral to an otolaryngologist.

Protect your voice. Your voice needs water much as an automobile needs oil, Cohen says, to "help keep mucus thin and as lubricating as possible." Don't smoke if you're hoarse, and avoid secondhand smoke as well as throat clearing, coughing, shouting, and yelling. "You need to take care of your voice at least as [well] as you take care of your car," Rosenfeld says.

Don't take decongestants. The medications dry out the mucus membranes, and you want to keep the membranes and your vocal cords moist.

Don't equate degree of hoarseness with seriousness. "It's not the amount of hoarseness that you have," Rosenfeld says. "Simply because you're a little hoarse doesn't mean you can ignore it."

Consider voice training, a "vastly underutilized and underappreciated type of therapy that can help you recover your voice quickly," Rosenfeld says. These sessions, done with a speech-language pathologist, usually last from four to eight weeks. "Voice training teaches you how to use your voice in a safer and more effective way," Rosenfeld says.

Cancer Symptons Women Ignore

As women routine tests like pap smears and mammograms are important, but don't rely on tests alone to protect you from cancer. It's just as important to listen to your body and notice anything that's different, odd, or unexplainable. You don't want to join the ranks of cancer patients who realize too late that symptoms they'd noticed for a long time could have sounded the alarm earlier, when cancer was easier to cure.

Here, some signs that are commonly overlooked:

1. Wheezing or shortness of breath. One of the first signs lung cancer patients remember noticing when they look back is the inability to catch their breath. "I couldn't even walk across the yard without wheezing; I thought I had asthma, but how come I didn't have it before?" is how one woman described it.

2. Chronic cough or chest pain. Several types of cancer, including leukemia and lung tumors, can cause symptoms that mimic a bad cough or bronchitis. One way to tell the difference: The problems persist, or go away and come back again in a repeating cycle. Some lung cancer patients report chest pain that extends up into the shoulder or down the arm.

3. Frequent fevers or infections. These can be signs of leukemia, a cancer of the blood cells that starts in the bone marrow. Leukemia causes the marrow to produce abnormal white blood cells, which crowd out healthy white cells, sapping the body's infection-fighting capabilities. Often, doctors finally catch leukemia in older adults after the patient has been in a number of times complaining of fever, achiness, and flu-like symptoms over an extended period of time.

4. Difficulty swallowing. Most commonly associated with esophageal or throat cancer, having trouble swallowing is sometimes one of the first signs of lung cancer, too.

5. Swollen lymph nodes or lumps on the neck, underarm, or groin. Enlarged lymph nodes indicate changes in the lymphatic system, which can be a sign of cancer. For example, a lump or an enlarged lymph node under the arm is sometimes a sign of breast cancer. A painless lump on the neck, underarm, or groin can be an early sign of leukemia.

6. Excessive bruising or bleeding that doesn't stop. This symptom usually suggests something abnormal happening with the platelets and red blood cells, which can be a sign of leukemia. One woman with leukemia described bruising in strange places, such as on her fingers and hands, as well as red spots on her face, neck, and chest. Another noticed bleeding gums. The explanation: Over time, leukemia cells crowd out red blood cells and platelets, impairing the blood's ability to carry oxygen and clot.

7. Weakness and fatigue "I kept having to sit down at work, and one night I was too tired to drive home," said one woman in describing the fatigue that led her to discover she had leukemia. Generalized fatigue and weakness is a symptom of so many different kinds of cancer that you'll need to look at it in combination with other symptoms. But any time you feel exhausted without explanation and it doesn't respond to getting more sleep, talk to your doctor.

8. Bloating or abdominal weight gain—the "my jeans don't fit" syndrome. While this might sound too common a phenomenon to be considered a cancer symptom, consider this: Women diagnosed with ovarian cancer overwhelmingly report that unexplained abdominal bloating that came on fairly suddenly and continued on and off over a long period of time (as opposed to for a few days each month with PMS) is one of the main ways they knew something was wrong.

9. Feeling full and unable to eat. This is another tip-off to ovarian cancer; women say they have no appetite and can't eat, even when they haven't eaten for some time. Any woman who experiences noticeable bloating or weight gain numerous times (the diagnostic criteria is more than 13 times over the period of a month)—especially if it's accompanied by pelvic pain or feeling overly full—should call her doctor and ask for a pelvic ultrasound.

10. Pelvic or abdominal pain. Taken by itself, pelvic pain can mean a lot of things. In fact, because it's a common symptom of fibroids, ovarian cysts, and other reproductive tract disorders, doctors don't always think of cancer when you describe pelvic pain. Make sure your doctor looks at all possible explanations and does a full exam, since pain and cramping in the pelvis and abdomen can go hand in hand with the bloating that often signals ovarian cancer. Leukemia can also cause abdominal pain resulting from an enlarged spleen.

11. Rectal bleeding or blood in stool. "I thought it was hemorrhoids" is one of the most common things doctors hear when diagnosing colorectal cancer. Blood in the toilet alone is reason to call your doctor and schedule a colonoscopy.

12. Unexplained weight loss. If you notice the pounds coming off and you haven't made changes to your diet or exercise regime, you need to ask why. Weight loss is an early sign of colon and other digestive cancers; it's also a sign of cancer that's spread to the liver, affecting your appetite and the ability of your body to rid itself of wastes.

13. Recurrent upset stomach or stomachache. As simple as it sounds, a good old-fashioned bellyache is what tipped off a number of lucky folks, whose doctors ordered ultrasounds and discovered early that they had tumors on their livers. Stomach cramps or frequent upset stomachs may indicate colorectal cancer; many cancer patients say their doctors thought they had ulcers.

14. A red, sore, or swollen breast. Everyone knows to check for lumps in the breasts, but too often overlooked are symptoms closer to the surface, which can indicate inflammatory breast cancer. Some women described noticing cellulite-like dimpled skin on an area of the breast. Others noticed that a breast felt swollen, hot, or irritated. Red or purplish discoloration is also cause for concern. Call your doctor about any unexplained changes to your breasts.

15. Nipple changes. One of the most common changes women remember noticing before being diagnosed with breast cancer is a nipple that began to appear flattened, inverted, or turned sideways. "My nipple started looking like it was turned inside out," said one woman. In addition, inflammatory breast cancer also causes nipple problems, such as itchy, scaly, or crusty skin on the nipple— so take any nipple changes seriously.

16. Unusually heavy or painful periods or bleeding between periods. Many women reported this as the tip-off to endometrial or uterine cancer. Unfortunately, many women also said their doctors weren't responsive, overlooking or misdiagnosing their complaints as normal perimenopause. Ask for a transvaginal ultrasound if you suspect something more than routine heavy periods.

17. Swelling of facial features. Some patients with lung cancer report noticing puffiness, swelling, or redness in the face. The explanation for this is that small cell lung tumors commonly block blood vessels in the chest, preventing blood from flowing freely from the head and face.

18. A sore or skin lump that doesn't heal, becomes crusty, or bleeds easily. Most of us know to watch moles for changes that might indicate skin cancer. But other signs, such as small waxy lumps or dry scaly patches, are easier to miss. Familiarize yourself with the different types of skin cancer—melanoma, basal cell carcinoma, and squamous cell carcinoma—and be vigilant about checking skin all over the body for odd-looking growths or spots.

19. Changes in nails. Unexplained changes to the fingernails can be a sign of several types of cancer. A brown or black streak or dot under the nail can indicate skin cancer, while newly discovered "clubbing"— enlargement of the ends of the fingers, with nails that curve down over the tips—can be a sign of lung cancer. Pale or white nails can be an indication that your liver is not functioning properly, sometimes a sign of liver cancer.

20. Pain in the back or lower right side. As vague as this sounds, many cancer patients say this was the first sign of liver cancer, known as one of the "silent killers" (another is ovarian cancer). Breast cancer is also often diagnosed via back pain, which can occur when a breast tumor presses backward into the chest, or when the cancer spreads to the spine or ribs.

IF YOU HAVE ANY OF THESE SYMPTOMS PLEASE TALK TO YOUR DOCTOR.

Understanding Prognosis and Cancer Statistics

Patients and their loved ones face many uncertainties when dealing with cancer. It is natural for anyone facing cancer to be concerned about what the future holds. Understanding the nature of cancer and what to expect can help patients and their loved ones plan treatment, anticipate lifestyle changes, and make quality of life and financial decisions. Cancer patients frequently ask their physicians or search on their own for statistics to answer the question:

"What is my prognosis?"

Prognosis of cancer patients - the prediction of the future course and outcome of a cancer and an indication of the likelihood of recovery from that cancer. The doctor may speak of a favorable prognosis, if the cancer is expected to respond well to treatment, or an unfavorable prognosis, if the cancer is difficult to achieve cancer control. However, prediction is a prediction. When Oncologists discuss a cancer patient's prognosis, they are attempting to project what is likely to occur for that individual patient based on available data on record and past experience with patients in very similar circumstances.

Many factors affect a person’s prognosis. Some of the most important are the type and location of the cancer, the stage of the disease (the extent to which the cancer has metastasized, or spread if at all), and its grade (how abnormal the cancer cells look and how quickly the cancer is likely to grow and spread). In addition, for hematologic cancers (cancers of the blood or bone marrow) such as leukemias and lymphomas, the presence of chromosomal abnormalities and abnormalities in the patient’s complete blood count (CBC) can affect a person’s prognosis. Other factors that may also affect the prognosis include the person’s age, general health, and response to treatment.

You must remember and be very clear because we cannot stress this enough; when doctors discuss a person’s prognosis, they carefully consider all factors that could affect that person’s disease and treatment and then try to predict what might happen. The doctor bases the prognosis on information researchers have collected over many years about hundreds or even thousands of people with cancer but one can predict with 100% certainty what will happen in your care.

Whenever possible, the doctor uses statistics based on groups of people whose situations are most similar to that of an individual patient. Several types of statistics might be used to discuss prognosis. Some commonly used statistics are described below:

• Survival rate indicates the percentage of people with a certain type and stage of cancer who survive for a specific period of time after their diagnosis. For example, 55 out of 100 people with a certain type of cancer will live for at least 5 years, and the other 45 people will not. Survival statistics may further categorize the people who die by cause of death because some will die from unrelated causes. For example, of the 45 people mentioned above, 35 may die from their cancer and 10 may die from other causes.

• The 5-year survival rate indicates the percentage of people who are alive 5 years after their cancer diagnosis, whether they have few or no signs or symptoms of cancer, are free of disease, or are having treatment. Five-year survival rates are used as a standard way of discussing prognosis as well as a way to compare the value of one treatment with another. It does not mean that a patient can expect to live for only 5 years after treatment or that there are no cures for cancer.

• Disease-free or recurrence-free survival rates represent how long one survives free of the disease, rather than until death.

Because survival rates are based on large groups of people, they cannot be used to predict what will happen to a particular patient. No two patients are exactly alike, and treatment and responses to treatment vary greatly.

The doctor may speak of a favorable prognosis if the cancer is likely to respond well to treatment. The prognosis may be unfavorable if the cancer is likely to be difficult to control. It is important to keep in mind, however, that a prognosis is only a prediction. Again, doctors cannot be absolutely certain about the outcome for a particular patient.

Is it helpful to know the prognosis?

Cancer patients and their loved ones face many unknowns. Understanding cancer and what to expect can help patients and their loved ones plan treatment, think about lifestyle changes, and make decisions about their quality of life and finances. Many people with cancer want to know their prognosis. They find it easier to cope when they know the statistics. They may ask their doctor or search for statistics such as survival rates on their own. Other people find statistical information confusing and frightening, and they think it is too impersonal to be of use to them.

The doctor who is most familiar with a patient’s situation is in the best position to discuss the prognosis and to explain what the statistics may mean for that person. At the same time, it is important to understand that even the doctor cannot tell exactly what to expect. In fact, a person’s prognosis may change if the cancer progresses or if treatment is successful.

Seeking information about the prognosis is a personal decision. It is up to each patient to decide how much information he or she wants and how to deal with it.