Perchlorate in Drinking Water Associated with Thyroid Function Abnormalities

The Associated Press is reporting that Federal Regulators do not have any plans to try and regulate the amount of perchlorate that is in public drinking water, which has been found to pose a risk to individuals' thyroid function. The chemical can also cause developmental health risks, especially for babies and fetuses.

The decision made by the Environmental Protection Agency is not final, however, and the agency will collect public comments for thirty days before concluding the decision process as to whether or not the chemical in drinking water should be regulated.

What is Perchlorate?

The Department of Defense used perchlorate in the testing of rockets and missiles. It is estimated that the drinking water of nearly twenty million Americans is contaminated with the chemical. Perchlorate is the main ingredient of rocket and missile fuel and is an explosive element. The chemical has contaminated the drinking water supplies of many states, particularly Texas and California.

How does Perchlorate Affect the Thyroid?

Perchlorate affects human health by inhibiting iodine uptake into the thyroid gland. The thyroid gland helps to regulate the metabolism in adults and releases thyroid hormones. In children, the thyroid gland is important in proper development. Perchlorate is becoming an urgent threat to human health and water resources.

Perchlorate and Children

Toddlers are particularly vulnerable to perchlorate in their drinking water because they eat and drink a significant amount of food and water in relation to their tiny size.  

A research study conducted by the Environmental Working Group analysis of FDA data discovered that perchlorate levels even as low as four parts per billion in drinking water could possibly expose the average two year old toddler to a dangerous amount of rocket fuel contamination in their every day lives.

Cleanup of Drinking Water

The research findings of the FDA highlight the importance of the cleanup of drinking water so that small children are not exposed to rocket fuel in their drinking water. Perchlorate in drinking water can be minimized through filtration and clean up. The cleanup of perchlorate in food is more difficult because the origination of the chemical is more difficult to pin point.

Importance of Cleanup of Drinking Water

The National Academy of Sciences, also referred to as the NAS, research finding found that the health effects of perchlorate are severe.

Researchers at the Centers for Disease Control and Prevention, which is also referred to as the CDC, have released research conclusions that indicate thatAmerican women, especially those with low iodine intake, could possibly have reduced thyroid function as a result of perchlorate exposure. Similar thyroid function effects were not found for men.

Filter Drinking Water at Home to Protect Your Thyroid

Many people are asking the question as to whether tap water or bottled water is better for health. Because of cost, many families prefer tap water as it is more readily available than bottled water. And many prefer tap water because of environmental issues relating to the use of plastic containers that are associated with bottled water.

The standard faucet filter that many people have in their kitchen is not sufficient. Reverse osmosis drinking water treatment systems have been shown to filter out the dangerous perchlorate chemical in drinking water and aid in the protection of thyroid health.

Consult a Professional

If you have questions about your drinking water, perchlorate and the effect that it has on your thyroid health, consult a thyroid health professional.

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

Depression and Chronic Illness

Studies suggest that at least one in four individuals who have a chronic illness also has a certain degree of depression during the course of their illness. While it may seem natural to feel depressed and frustrated by persistent or chronic illness, depression is a serious medical condition that can be treated effectively in most people.

The chronic emotional and intellectual stress associated with prolonged health problems is believed to initiate changes in the brain's stress response system that may set the stage for depression. People who have suffered a stroke or heart attack, those who have had heart surgery and cancer patients and survivors are particularly at risk.

Effective treatments are available to manage depression such as psychotherapy (talk therapy), art therapy, music therapy, behavior modification therapy, support groups, spiritual counseling, exercise and medications. Yet for many reasons some people never receive adequate care to help them overcome depression as a co-existing disorder in association with their chronic illness.

Ten Warning Signs of Depression

Depression is often complicated and compounded by other emotional, intellectual (mental) and physical symptoms, which may range from mild to severe, and may wax and wane over time. If you notice any of these warning signs, and they interfere with normal day to day activities in excess of and beyond what the usual limitations of your physical/biological chronic health issue talk with your doctor.

1. Prolonged feelings of desperation, hopelessness and unexplained crying spells.

2. Significant changes in appetite and sleep patterns.

3. Irritability, angry explosions, agitation, anxiety, pessimism, worry and/or continued indifference.

4. Loss of energy and enthusiasm, persisten feelings of guilt, worthlessness, hopelessness, helplessness.

5. Loss of enjoyment from once pleasurable activities such as reading, art appreciation, music or movies for example.

6. Inability to concentrate of make decisions.

7. Withdrawal from social contacts and isolation.

8. Unexplained aches and pains

9. Persistent significant changes in thinking, memory or other mental abilities such as confusion or cognitive function which can be caused by illnesses and medication side effects but could also be due to persistent insomnia and/or depression.

10. Recurring thoughts of death and suicide.

Things you can do or help your loved one with:

• Watch for signs of depression and talk to your doctor if you have any question about your medication side effects, physical limitations and the possibility of depression as an unrecognized co-existing disorder.

• Exercise your mind. Regular mental activity - specially things that are intellectually challenging-- can help keep the brain sharp as we age or limit our physical activities.

• Manage Stress. Chronic stress can damage nerve cells and increase forgetfulness.

• Stay involved in activities that you enjoy and stay socially connected with friends and family as much as possible. These are important predictors of quality of life issues that will help prevent depression.

• Join a support group early on in your journey through chronic illness. The sooner you are able to express the wide range of emotions and sort through them the sooner you will be able to move into learning effective coping skills and adjusting to your life with a chronic illness.

• Seek out a professional therapist or counselor express your emotions, learn coping skills and behavior modification strategies that can help you manage stress and deal with emotional and behavioral issues in a private setting.

If you or someone you love has a chronic illness such as post surgical hypothyroidism after thyroid cancer or any other chronic illness and is struggling with persistent depression talk to your doctor about support groups in your area or a referral to mental health services professional. There is help in your local community. 

Could it be thyroid cancer? When To Call The Doctor

When To Call a Doctor

Call your doctor if you have any of these signs of thyroid nodules:

• Swelling in your neck for more than 2 weeks
• A hoarse or scratchy voice that is not caused by a cold or throat infection and lasts longer than 1 month
• A hard time swallowing or breathing
• Symptoms of a thyroid problem such as feeling tired, weak, or nervous, losing weight, having trouble sleeping, or having a fast heartbeat

If you have had part of your thyroid gland removed because of noncancerous thyroid nodules, you will need regular medical checkups to make sure your thyroid gland is working well.

Watchful Waiting

For some kinds of health problems, you can wait and see what happens for a while before you and your doctor decide what kind of treatment you should have. This is called watchful waiting.

Because of the small risk of cancer, watchful waiting is not recommended for people with thyroid nodules.

Call your doctor if you have swelling in your neck that does not go away, problems swallowing, a hoarse or scratchy voice that has lasted several weeks, or any other symptoms of a thyroid problem.

Who To See

Different types of health professionals can help treat a thyroid problem.

• Family medicine doctor or general practitioner
• Internist
• Pediatrician
• Your doctor may also refer you to an endocrinologist for further tests and treatment.

If you need a special exam or treatment, you may see one of these types of doctors:

• Nuclear medicine physician (a doctor who specializes in medicine using different types of radioactive substances)
• Surgeon and/or Otolaryngologist (an ear, nose, and throat specialist)

Risk Factors Associated with Thyroid Nodules or Tumors

You are more likely to develop a thyroid nodule if:

• You are older. Thyroid nodules are more common in older people.
• You are female. Women are more likely than men to develop thyroid nodules.
• You have been exposed to radiation. Exposure to environmental radiation or past radiation treatment to your head, neck, and chest (especially during childhood) increases your risk for thyroid nodules.
• You do not get enough iodine. Iodine deficiency is rare in the United States but it is common in areas where iodine is not added to salt, food, and water. An iodine deficiency may result in an enlarged thyroid gland (goiter), with or without nodules.
• You have Hashimoto's thyroiditis. Hashimoto's thyroiditis can cause an underactive thyroid gland (hypothyroidism).
• One or both of your parents have had thyroid nodules.

Most thyroid nodules are not cancerous. But a nodule is more likely to be cancerous if:

• You have had radiation treatment, or you were exposed to radiation in the environment. In rare cases, thyroid cancer could appear up to 20 years after radiation exposure.
• You have family members who have had cancer in their endocrine glands, including the thyroid gland.
• You are younger than 30 or older than 60.
• You are male.
• The nodule grows quickly over a period of weeks or months. But just because a nodule has changed in size does not mean it is cancerous.
• You develop a nodule while you are pregnant.
• You have Graves' disease.
• You have Hashimoto's thyroiditis. Hashimoto's thyroiditis can cause an underactive thyroid gland (hypothyroidism).
• One or both of your parents have had thyroid nodules.

Most thyroid nodules are not cancerous, but a thyroid nodule is more likely to be cancerous if:

You have had radiation treatment, or you were exposed to radiation in the environment. 

In rare cases, thyroid cancer could appear up to 20 years after radiation exposure.

You have family members who have had cancer in their endocrine glands, including the thyroid gland.

You are younger than 30 or older than 60.

You are female (Women and girls are three times more likely to be diagnosed with thyroid cancer)

The thyroid nodule grows quickly over a period of weeks or months. 

You develop a thyroid nodule while you are pregnant.

You have Graves' disease.

You have Hashimoto's thyroiditis.

Seeking a Second Opinion

A diagnosis of cancer can be scary and agreeing to a treatment plan confusing. It is wise to seek a second opinion or advice from another qualified cancer specialist or group of specialists before or even after you begin treatment.

"We need to let our intuition guide us, and then be willing to follow that guidance directly and fearlessly." - Shakti Gawain

Newly diagnosed cancer patients are often overwhelmed with uncertainty, disbelief, and fear and look to cancer specialists for hope and direction. Some are looking for proof of their diagnosis before beginning treatment , while others are looking for support and guidance to sort out difficult choices. Getting a second opinion involves asking another physician or group of specialists to review your medical records and confirm your doctor's diagnosis and treatment plan as well as answer questions you may have not thought of when you first heard the news of your cancer diagnosis.

Never feel foolish or uncomfortable seeking a second opinion, regardless of the existing qualifications your current doctor has. Many doctors welcome another doctor's opinion because another specialist can in fact confirm that you have cancer or agree with the recommended treatment plan your existing relationship with your doctor may very well become stronger. On the other hand a second opinion doctor may suggest changes or advise you of additional options to the existing or proposed treatment plan you otherwise never know about at the onset of your journey.

There are lots of reasons for seeking a second opinion. Some doctors are cautious in their approach to treatment, while others might suggest a more aggresive approach. You need to hear argument for ALL of your treatment options. A second opinion is a way to make sure you are getting the latest and most effective treatments treatments and that you are made aware of clinical trials that you may want to consider participation in.

Your primary care doctor or specialist may be able to offer the name of a qualified specialist if you ask or refer you to a team of cancer specialists to give you another point of view to help you decide on the best course of treatment. A second opinion is specially important if your doctors has little or no experience with your type of cancer or if he/she offers you little hope that treatment will benefit you. Look at all your options with an open mind and do your homework (or assign a trusted family member or friend who can do it for you) by following up on references and clinical outcomes reports, it could save your life or better protect your quality of life !

Remember another doctor's opinion may change the diagnosis or reveal a treatment your doctor was not aware of. One surgeon may find that your tumor is inoperable (cannot be succesfully operated on), while another may be able to remove it ! If you are asked to consider alternatives, such as surgery, radiation, chemotherapy, hormone therapy or immunosuppressant therapy you may want to hear from each type of oncologist who provides that treatment.

Second opinions are also valuable if you live in a small town or rural area where there may not be many oncology specialists. If so, you may want to get an opinion from specialists at a large academic medical center with expertise in treating your particular type of cancer. In addition another opinion is important if you have a rare cancer and you can identify a noted expert in that cancer to give you advice or consult with your doctor.

Remember: you must tell your doctor you are seeking a second opinion because he /she must make available your clinical history and latest diagnosis, all tests results (blood work and pathology reports) copies of relevant diagnostic testing originals such as radiological films (ultrasound, x-ray, cat scan or mri) and surgical reports; including your treatment plan to the doctor or doctors giving the second opinion.

Additional Sources of Information

• The R.A. Bloch Cancer Foundation, Inc., lists institutions across the United States that provide second opinions from multidisciplinary groups of cancer specialists at their website.

• The Second Opinion Source  is a San Francisco based service provided by the Regional Cancer Foundation that offers second opinions from multidisciplinary team of physicians to California adults diagnosed with new or recurring cancers.

Early Detection of Recurrent Thyroid Cancer

By Ernest L. Mazzaferri, MD MACP Adjunct Professor of Medicine, University of Florida; Emiritus Professor & Chairman of Internal Medicine The Ohio State University

In the past few decades, thyroid cancer has been diagnosed earlier, providing an opportunity for treatment before the cancer has spread beyond the thyroid and improving survival rates. Proper therapy – in most cases this means surgical removal of the tumor along with the entire thyroid gland, followed by radioactive iodine (I-131) ablation and thyroid hormone therapy – has the potential to reduce recurrence and mortality rates.

Recurrence rates and the need for follow-up

Although the long-term prognosis for survival with Well Differentiated Thyroid Cancer (WDTC) is generally quite good, tumor recurrence is common, affecting 20% to 35% of patients with the disease. Recurrence can occur any time, even decades after initial therapy.

[1] Studies now show that many late cancer “recurrences” may actually be cases of persistent tumor that had fallen below our testing detection limits for as long as decades.

[2]Given the potential for this type of persistent “recurrence” and the percentage of thyroid cancer deaths caused by WDTC, there can be a great risk associated with delay of diagnosis, even in recurrent thyroid cancers.

We know that delaying the initial diagnosis of thyroid cancer longer than 1 year increases mortality rates significantly.

The mortality risk worsens as the delay becomes longer, eventually imparting a risk comparable with that of advanced age. One study, based on regression modeling of 1510 patients without distant metastases at the time of initial therapy who had undergone surgery and I-131 therapy, found that the likelihood of death from WETC was increased by multiple factors:

[1] These included age of over 40 years, a tumor size of more than 1.0 cm, local tumor invasion or regional lymph node metastases, follicular histology, and a delay of therapy for more than 12 months and the extent of surgery and use of I-131 therapy.

[2]There are compelling reasons to believe that delay-related risks also exist with persistent, unrecognized thyroid cancers. For example, respiratory insufficiency due to pulmonary metastases is the most common cause of death from thyroid cancer.

Additionally, tumor bulk of distant metastases ranks second only to patient age as a predictor of death from thyroid cancer. The longer the tumor remains, the greater its bulk. However, early diagnosis and treatment substantially enhance survival.

These facts lead us to two important possible conclusions:

(1) that delay of diagnosis and treatment can be directly related to a higher mortality rate, and, conversely,

(2) that early identification and treatment of recurrent and/or persistent WDTC can lower mortality rates. Meticulous initial therapy coupled with rigorous follow-up can have very favorable effects on patients with WDTC.

Thus, early identification of recurrent or persistent disease is important, yet patients are reluctant to go through frequent and rigorous cycles of follow-up. These cycles usually require hypothyroidism and its associated signs and symptoms; however, an elevated serum TSH level is an essential, which are key to a successful management of the identification of persistent disease.

Summary: As with delaying the initial diagnosis, delaying the detection of persistent or recurrent thyroid cancer can increase mortality rates significantly. Mortality risk increase as the delay becomes longer. As discussed above, the tumor bulk of distant metastases ranks second only to a patient’s age as a predictor of death from thyroid cancer.

Additionally, all therapeutic modalities seem to be more effective when the tumor bulk is smallest. In fact, the larger the tumor mass, the less likely that it will be ablated with I-131 therapy and the higher the mortality rate.

Given all these facts, it follows that early detection and treatment are important goals in improving long-term outcome. To support these goals, any steps that can be safely taken to encourage patients to comply with a regular follow-up routine should be taken.

References: 

1. Ries, LAG, Eisner MP, Kosary CL, et al. 2000 SEER cancer statistics review, 1973-1997. Bethesda, MD: National Cancer Institute.

2. Hundahl, SA, Fleming Id, Fremgen, AM, Mench, HR. 1998 A National Cancer Data Base Report on 53,856 cases of thyroid carcinoma treated in the US, 1985-1995. Cancer. 83:2638-2648.

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.

Exercise and Cancer Prevention

The observations were compelling, to say the least. First it was breast cancer, then colorectal cancer: 40 to 50 percent reductions in the risk of cancer-related death and cancer recurrence.The apparent cause was not a new targeted agent or a novel combination therapy, but rather, frequent trips back and forth in heavily chlorinated water, regular bouts with yard mulch and garden weeds, striding through the neighborhood for 30 minutes every morning. In other words, old-fashioned exercise.

Five large observational studies have now linked reports of regular post-treatment physical activity with superior outcomes compared with patients who remained sedentary after treatment. And now the first prospective, randomized clinical trial is nearly set to test whether physical activity can indeed influence cancer's course after treatment.

Results from the observational studies "are certainly compelling enough to warrant a randomized trial of physical activity," says Dr. Kerry Courneya, of the University of Alberta, who will lead the trial in patients who have been treated for colon cancer.

The trial represents a shift of sorts, because most cancer-related physical activity research to this point has not focused on recurrence or survival.

Studies That Got the Ball Rolling Physical activity and survival after colorectal cancer diagnosis - Meyerhardt et al., Journal of Clinical Oncology, August 2006  Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer - Meyerhardt et al., Journal of Clinical Oncology, August 2006Physical activity and survival after breast cancer diagnosis - Holmes et al., JAMA, May 2005

"There is extensive evidence [from prospective studies] that post-treatment activity improves cancer patient-reported outcomes such as quality of life or fatigue," explains Dr. Rachel Ballard-Barbash, associate director of the Applied Research Program in NCI's Division of Cancer Control and Population Sciences. Although there isn't much evidence to indicate which specific types of activities might be most beneficial from a recurrence or survival standpoint, Dr. Ballard-Barbash continues, "We do have good evidence on how to get cancer patients physically active."

The level of activity required for a measurable benefit varied, but the cancer mortality risk reductions reported from the large observational studies of physical activity - two of which came from the long-running Nurses' Health Study - have been fairly consistent.

"It's certainly intriguing data," says Dr. Wendy Demark-Wahnefried, from the Department of Behavioral Science at the University of Texas M.D. Anderson Cancer Center, who has been studying the impact of diet and exercise on long-term cancer survivors for more than a decade. "One of the questions now is whether the clinical trials [of physical activity] can be done, because I think there is tremendous interest."

NCI sponsored a workshop 2 years ago on how best to design such trials, notes Dr. Ballard-Barbash, and NCI has been fielding proposals to conduct them.

Dr. Lee W. Jones, director of the Tug McGraw Research Center at the Duke University Medical Center, says data to help inform optimal trial design (e.g., type of activity, intervention delivery strategies, etc.) is coming, as well as data on the potential biological mechanisms by which exercise may inhibit tumor growth.

Researchers, Dr. Jones says, have speculated that physical activity might influence post-treatment outcomes in breast cancer patients by dampening levels of estrogen or insulin, elevated levels of which are associated with poor outcomes. Several studies involving breast cancer patients, for instance, have consistently found a threefold increased risk of death among women with the highest insulin levels.

Meanwhile, studies involving patients with a range of problems, including diabetes and heart disease, have shown that physical activity can reduce insulin levels. Last year, researchers from Dana-Farber Cancer Institute (DFCI), led by Dr. Jennifer Ligibel, showed that a regimen of cardiovascular and strength training lowered insulin levels in sedentary women who had completed adjuvant therapy for early stage breast cancer.

"We're very interested in what happens biologically with physical activity," explains Dr. Ligibel, from DFCI's Breast Cancer Program. "We think it has to be modification of hormone levels.…And the data suggest that estrogen is not the whole story." The data, however, are far from consistent.

"In our preclinical studies, we've found that the hypoxia/angiogenic pathways are really upregulated with exercise, but that insulin doesn't change much," says Dr. Jones. (This does not necessarily mean that exercise doesn't alter insulin signaling in the tumor, he cautions.) And in one animal model study of prostate cancer, Dr. Jones adds, voluntary exercise actually accelerated tumor growth.

The trial Dr. Courneya is leading, dubbed CHALLENGE, is set to launch by the end of this year in Canada, and will investigate whether increased physical activity can improve disease-free survival (DFS) in patients treated for high-risk stage II and III colon cancer. (Another Canadian clinical trial that is already underway, called LISA, is testing whether a dietary and physical activity regimen focused on weight loss can improve DFS in overweight or obese women who have been treated for early stage breast cancer.)

The physical activity intervention in the trial follows from a similar - and highly successful - trial, the Diabetes Prevention Program. "The activity in this trial will be a mix," Dr. Courneya explains. "The literature doesn't point to a specific type of exercise that has the most benefit. So we're going to promote aerobic exercise, assuming that most participants will walk, but expecting that others will do things like biking or swimming."

The physical activity component will include in-person or phone-based meetings with exercise consultants for 3 years, with more frequent meetings for the first year. "This isn't like taking a drug," Dr. Courneya acknowledges. "These types of lifestyle interventions are difficult and have to be delivered over a longer period of time."

Dr. Ligibel agrees that delivery of the intervention is a challenge. "The data suggest there is better compliance with dietary modifications than physical activity modifications," she says. Even so, small studies and trials of the influence of exercise on cancer outcomes are multiplying and expanding to other cancer types. Dr. Jones' group at Duke, for example, has been conducting studies in patients before and after lung cancer surgery, as well as in patients with primary brain tumors.

"I'm very confident that anybody, regardless of where they are in the cancer survivorship continuum, can exercise," Dr. Jones says. "It's just a matter of what type of exercise, the frequency, and the intensity."

SOURCE: National Cancer Institute's Report - Some Exercise a Day May Keep Cancer at Bay by Carmen Phillips

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.

Thyroid Awareness Month Facts Review

The thyroid is a small gland, shaped like a butterfly, located in the lower part of your neck. The function of a gland is to secrete hormones. The main hormones released by the thyroid are triiodothyronine, abbreviated as T3, and thyroxine, abbreviated as T4. These thyroid hormones deliver energy to cells of the body.

The most common problems that develop in the thyroid include: hypothyroidism (an underactive thyroid), hyperthyroidism (an overactive thyroid), goiter (an enlarged thyroid), thyroid nodules (lumps in the thyroid gland), thyroid cancer (malignant thyroid nodules or tissue), and thyroiditis.

You have a higher risk of developing thyroid disease if, among a variety of factors:

…You have a family member with a thyroid problem

…You have another pituitary or endocrine disease

…You or a family member have another autoimmune disease

…You've been diagnosed with Chronic Fatigue Syndrome

…You've been diagnosed with Fibromyalgia

…You're female

…You're over 60

…You've just had a baby

…You're near menopause or menopausal

…You're a smoker

…You've been exposed to radiation

…You've been treated with lithium

…You've been exposed to certain chemicals (i.e., perchlorate, fluoride)

Thyroid Cancer Incidence - The state of New Jersey tabulates these statistics on thyroid cancer incidence.