Archive for cancer

Jan
12

Escape the Code!

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Think it is impossible to escape your genetics? Are you destined and resigned to end up looking just like one of your parents, or Aunt Sally or Uncle Benny?

An interesting study looking at just that was recently released to the news. This research is centered on the genetic risk of breast cancer, and possible explanations for healthy members within clusters of families with strong histories of cancer.

Having a family history of  the BRCA1 and BRCA 2 gene mutation significantly increases a woman’s risk for developing breast cancer. This specific gene mutation is only responsible for some of the incidences of breast cancer. Researchers have been looking at other factors explaining this cluster of familial cancers. This has led to the exciting research regarding epigenetics!

It just may be possible to some degree, to escape your genetic code!

Genetic code is in all of our cells and it is the blueprint from which our cells, organs and bodies will work. Epigenetics is the machinery that actually turns on or turns off this blueprint. It can, and will determine what happens within your cells and your body.

Researchers and scientists are talking about something called methylation. This methylation process can prevent cancer from growing in certain situations, or help it to grow in other situations. It depends on the where in the body it is working, how much methylation is happening, and what is actually making it work.

It turns out that a decrease in the healthy methylation process may be responsible for aging. This decrease of healthy methylation can lead to hyper or hypomethlyation, which can then promote growth of cancer cells. This type of decrease is considered a somewhat natural process associated with normal aging. It then seems that certain life style habits can cause the wrong type of over methylation, leading to problems with glucose metabolism and also to cancer.

Getting back to the study I mentioned above. Unaffected women from high risk families with breast cancer were found to have different methylated blood cells when compared to affected family members. Researchers are not sure yet what this means, but it suggests a changed expression in the genetic code.

Another recent study regarding the incidence of breast cancer in British women revealed another surprising difference. White women residing in the UK were noted to have a higher incidence of breast cancer compared to South Asian women and black women, also residing in the UK. This difference was attributed to a higher consumption of alcohol and decreased amount of breast feeding by white women as compared to women of other ethnicity. When these habits were removed from the equation, the rate of breast cancer was equal throughout the different groups of women.

Diet has been shown to affect the expression of cells, specifically a diet low in folic acid is associated with gastrointestinal malignancies. Use of opiates, nicotine, and over use of alcohol have all shown  changes in cells leading to cancer through abnormal cell repair and DNA expression. This is the route believed to allow cancer cells to grow. Exercise has shown to elevated protective chemicals within our bodies which help prevent this abnormal methylation process.

Why are we talking about this? Researchers are beginning to identify the different affects healthy and unhealthy habits have on the incidence of disease. This empowers us to make decisions that allow us to take more control of our health and hopefully, longevity.

You may not be destined to develop diabetes or heart disease as you age, you may not be at risk for cancers. It may be possible to escape your genetic code by choosing certain habits that are beneficial to your epigenetics.

Think back on all the good advise from our mothers or fathers regarding healthy habits. Teachings such as eat your vegetables, get enough sleep, no drinking to excess or smoking at all; they were talking epigenetics!

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Oct
26

More On Telomeres

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I mentioned in the last post that Telomere length is not all there is to anti aging process and I will explore this more in this post. It may seen a little scientific but here it goes.

Telomere length is an important factor in the healthy replication of our DNA. The machinery performing this function is not perfect and sometimes gets it wrong. These cells are often destroyed through other protective mechanisms of our bodies. With each DNA division, the telomeres at the ends of the DNA get shorter and shorter until eventually the length is too short to allow replication. It is this process that is felt to cause aging, and the progression of chronic disease.

Telomerase is an enzyme that is present to protect the telomeres but it is often dormant within the cell. When we are growing within the womb, and as young being, telomerase is switched on and very active. At some point of a cells growth process, this enzyme is switched off the guard against run away cell growth. When telomerase becomes active, it protects telomere length and therefore makes the cell “immortal”. This may sound great but this immortality often means increased cell growth which often means tumor, or cancer.

Scientists have identified all these compounds, but not the secret to longevity and immortality. As I mentioned in the previous post, preserving telomere length may be achieved through exercise and meditation.

What are the recognized factors which trigger telomerase, resulting in cellular overgrowth and cancer formation? No one really knows quite yet, but this is an area of exciting research. Many cancer treatments being studied deal with inactivating telomerase in the cancer cells. There is a suspicion that certain viruses can help activate telomerase in certain cancers.

A recent study which evaluated telomere length and life style intervention attributed the increased length to increased telomerase activity in the circulating blood cells.

The life style interventions included adopting a plant based diet, moderate activity/exercise, stress reduction and increased social support.

In other words, this study showed increased health of cells after 5 years of eating fruits and vegetables, exercising at least 150 minutes a week, working on relieving stress and interacting with friends and loved ones in a meaningful way. This sounds like a healthy prescription for living your life!

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Aug
27

OVARIAN CYST-DO YOU NEED AN OPERATION?

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Management of Ovarian Cysts is primarily dependent on the type of cyst, the size of the cyst,  and how long it has been present. So when do you need to have surgery and what type of surgery will be done?

Antique Medical Illustration of Female Genitals

As mentioned in previous posts, most cysts resolve after several weeks to months. Most commonly, an ultrasound has been done to look at several factors including size, characteristics and in some cases placement.

What is an ultrasound? This is a way of visualizing a mass using sound waves which bounce off of organs and other tissues. It is performed through a transducer which is placed on top of the skin of the abdomen and it is also placed into the vagina for better visualization of the ovaries. Neither of these procedures hurt. The Radiologist is looking for the ovaries, they will evaluate and characterize this cyst as

  • cystic- there is one circular wall containing fluid only
  • biloculated- a fluid filled cyst with one thin wall
  • multiloculated- there are several walls within the cyst cavity
  • complex- contains walls, debris such as cells and blood
  • solid- contains solid elements, thick or irregular walls, these are most predictive of malignancy.

All of these factors help to determine whether watchful waiting is appropriate or whether surgery is indicated. The reasons to perform ultrasounds also include the need to determine whether a palpated mass or nodule in the pelvis is even associated with the ovary. Occasionally these masses can represent a problem with the gastrointestinal tract or with the uterus.

How do the specialist further evaluate an ovarian cyst after the ultrasound has determined it to be complex?

A CA-125 is often ordered. This is a blood test which measures a substance in the blood stream that an ovarian cancer may be producing. It is actually not intended to be a screening test as many things can cause elevations. It is used in conjunction with the ultrasound characteristics of a cyst.

Color Doppler Velocimetry studies have been looked at in terms of whether a cancer has a different blood flow than a benign cyst. This is a study where the blood is given a color image and used to evaluate the amount of blood flow to the ovary. Studies have shown there is no specific pattern differentiating ovarian cancers from cysts, therefor this is felt to be of little value.

Cyst Aspiration is a procedure where a long needle is placed through the skin of the abdomen, through all the layers of the abdomen, and then into the cyst itself. The fluid within the cyst is then drawn up through the needle, then removed and studied by pathologist. They look at the cells within the fluid as well as perform different tests on the fluid to determine whether any cancer is present. This procedure has many problems and is no longer a recommended procedure in the vast majority of cases. The main issue is that of potentially pulling cancer cells out from a cyst, through the abdominal cavity and accidentally spilling those cancer cells within the abdomen thus facilitating potential spread of a cancer that had been confined to the ovary.

When do the specialists recommend surgery?

In premenopausal women, surgery will be recommended if:

  • the cyst has not resolved within a few months
  • the cyst is enlarging over a period of roughly 6 weeks
  • a CA-124 is elevated with an enlarging cyst
  • Pain is also a reason to operate as these cysts can be quite painful as they enlarge.

In post menopausal women, indications for surgery include the above plus

  • cyst is solid or complex
  • ascites (fluid in the belly) is present-this can be a sign of cancer
  • fixed mass in the cul-de-sac

It is estimated that 15% of asymptomatic pre-menopausal women and 5% of menopausal women will have a cystic ovarian mass of greater that 2.5 cm in their life time. By characterizing a cyst through ultrasound and following it for a designated period of time, many operations can be avoided.

The type of operation often depends on the size of the cyst and the suspicion for malignancy. A small cyst, the size of a plum or less, can often be removed through a laparoscope. This is a tube which is placed through the abdominal wall, air is used to inflate the wall away from the organs in the abdominal cavity. This allows the surgeon to see and operate on the ovaries, as well as remove the cyst from the abdominal cavity. There has been tremendous advances in laparoscopic surgeries in the last several years. If the cyst is larger than this, or if there is a high degree of suspicion for malignancy, a laparotomy will be performed. This is a more invasive surgery where a larger incision into the abdominal cavity is made for better visualization of the cyst and surrounding organs.  This allows better evaluation of the potential of involvement of fallopian tubes, uterus, bowel as well as lymph nodes.

Ovarian cysts are most often benign and asymptomatic, having been found by accident. It is important to realize  that surgery is not necessary in many cases. It takes  an experienced radiologist  to evaluate these cysts through ultrasound, coupled with a gynecologic specialist who is also experienced in following ovarian cysts to determine when and if surgery is needed.

Anne Vaillancourt PAC

This is my final installation about ovarian cysts.  I would love to hear your opinions, comments and your stories about ovarian cysts and your experiences. Please leave me a comment below.

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May
03

BREAST CANCER-Are you at risk for a certain type?

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White spot is Breast Cancer seen on a Mammogram

White spot is Breast Cancer seen on a Mammogram

Breast Cancer is a very frightening illness for a woman to contemplate.  Our breasts are one of the symbolic parts of our anatomy which define us as women. The diagnosis of cancer is hard enough to hear, but when it is breast cancer, it strikes to the heart and soul of a woman.

There are many types of breast cancer and each of them carries a different prognosis and cure potential. There is much research into causes, treatments and prevention currently ongoing. Now more than ever there are better treatments for breast cancer, and many women who have received this diagnosis live for decades following diagnosis and treatment.

To understand the different types of breast cancer, it is important to know the anatomy and different parts of the breast. The breast is made up of glandular, fatty and fibrous tissue.

The glandular tissue includes lobules which lie deep in the breast and are the milk producing glands; and the ducts which are responsible for carrying milk to the nipple.

The fibrous tissue surrounds the glandular tissue and adds some support to breast tissue.

The fatty tissue surrounds the glandular and fibrous tissue and gives the breast the soft consistency.

Within all of this are the lymph system and the blood vessel system. When a woman goes through menopause, the glandular tissue shrinks, the fibrous tissue looses some of its support and the breast increases the amount of fatty tissue. This decreases the density of the breast and aids in mammogram detection of abnormalities.

What types of cancer can affect the breast?

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DCIS: this stands for Ductal Carcinoma in Situ. This is the most common type of noninvasive breast cancer; it is confined to the ducts of the breast and has not spread into surrounding tissue or distant organs. It is detected on mammogram, 1:5 cases (20%) of breast cancer will be DCIS and it is felt to be almost completely curable. If necrosis is present on biopsy however, this signals the cancer is more aggressive and may be capable of spreading. A sub type of DCIS is Papillary Cancer.

LCIS: this is Lobular Carcinoma in situ. This cancer begins in the lobules which are the milk producing glands of the breast. It does not extend beyond the wall of the lobule, hence the term “in situ”. It is felt to have a low likelihood of becoming a metastatic (spreading) cancer however statistically its’ presence raises the risk of invasive cancer in the same or opposite breast. Researchers are not sure why this is the case.

Both of the above types of breast cancer are felt to have a low malignant potential. This means that they are unlikely to spread or invade surrounding healthy breast tissue, or spread by the lymph system and blood stream to other organs and cause a cancer in those organs.

The types of breast cancer discussed below are all types with a malignant aspect to them, meaning they will grow into surrounding breast tissue and interfere with normal functioning, and can spread to other organs and cause the same diseased activity. Women die from breast cancer when the organs the cancer has invaded can no longer work normally to sustain life. Treatments are aimed at both preventing spread to other organs, as well as trying to  destroy the cancerous breast tissue and any metastatic cancer tissue.

Invasive/Infiltrating Ductal Carcinoma: this is the most common invasive breast cancer. It accounts for 8 out of 10 invasive breast cancers diagnosed. It begins in the ducts and spreads through the walls into the fatty tissue. It is able to metastasize through the lymph system to other organs. A few additional subtypes are Tubular and Paget’s disease.

Invasive Lobular Carcinoma: as the name suggests, this begins in the lobules or milk glands and can spread locally as well as metastasize to other organs. It is more rare and only accounts for 1:10 diagnosis of invasive breast cancer. It is difficult to find on mammogram

Inflammatory Breast Cancer: This type is more uncommon than the above types and the cancer’s DNA behaves differently than other types of cancers. Its’ presentation is different in that there is no specific lump or cluster of calcifications as seen with the above types of breast cancer. Rather, it causes blockage of lymph vessels in the skin which in turn causes a redness and warmth to the skin of an area of the breast. Along with this redness and warmth is a thickening and pitted appearance likened to the peel of an orange. It accounts for 1-3% of breast cancers and usually occurs in younger women and there is a slightly higher incidence in African American women. The breast becomes larger and this is what is seen on mammogram, it is often mistaken for mastitis. MRI is the more sensitive imaging technique for evaluating this cancer. This is a very aggressive cancer and it is difficult to treat successfully as it is usually advanced when discovered. The 5-year survival rate is 40% as compared to 87% for other types of breast cancer.

Triple Negative Breast Cancer: this will be further explained below, but these cancers are usually very invasive ductal cancers with no protein receptors which make them amenable to treatment. They are usually present in younger women and slightly higher incidence in African American women. They are rapidly growing cancers.

When a breast cancer is diagnosed, biopsied and/or removed, several tests are done on the tissue to determine how the specific cancer will respond to therapies. This helps to determine a treatment course and to some extend predict the response and potential survival rate for the patient. These tests are also used to additionally categorize the type of cancer. There are receptors on the walls of the cancer cells which are proteins which can turn on growth when triggered.

The common receptors tested are for estrogen and progesterone. These proteins (receptors) allow these hormones which are naturally occurring in a woman’s body to attach to the cancer cell and fuel its growth. A breast cancer which has these receptors will be called ER + or PR+, or both ER/PR+, and likewise ER-, PR- or ER/PR-. ER or PR positive breast cancers actually have a better prognosis because they can respond to treatment. 2/3’s of breast cancers will contain at least one of these proteins.

HER2: this is a growth promoting protein. There are genes within the breast cell that when “turned on” will instruct the cell to make this protein. HER2 cancers have increased amounts of HER2 genes which leads to increased amounts of this protein. This type of cancer can spread and be more aggressive, however certain chemotherapy agents have been developed which can effectively treat this type of  breast cancer. Any of the above cancers discussed with the exception of the IN-SITU cancers can be determined to be ER or PR + or -; and they may or may not have HER2 protein.

BRCA1  AND BRCA2: many of you have heard about this type of genetic testing. These terms do not relate to a specific cancer but rather a genetic tendency or risk factor for developing breast cancer.

This would be a gene that is passed down within families. BRCA 1 and 2 genes are the most common causes of hereditary breast cancer. Normally, the BRCA1 and BRCA2 genes help prevent cancer by making proteins that prevent abnormal cell growth. When there is an inherited mutation on these genes, they are unable to prevent this abnormal growth. The risk of developing breast cancer with these gene mutations is as high as 80%. These cancers usually occur earlier in life of the women with these genetic mutations. The cancer often occurs bilaterally or in both breasts but not necessarily at the same time.  There is an increased risk of ovarian cancer with these gene mutations. In the US, there is an increased risk of BRCA1 and BRCA2 in women of Ashkenazi Jewish descent.

There are other gene mutations that are not as common.

ATM is a gene which helps repair DNA when functioning normally. It controls cell division. Researchers have yet to discover why a mutation of this gene causes cancer.

P53 is a tumor suppressor gene which plays a role in cell growth when functioning normally. When damaged, it looses the ability to block cell growth. 50% of all cancers of all types will have a p53 mutation. This mutation carries increased risk of brain cancer, leukemia, sarcoma as well as breast cancer when a mutation exists.

PTEN is a gene which regulates cell growth. It is felt by researchers to be the most important tumor suppressor gene yet discovered. When functioning normally, it protects a cell from progressing to a cancer. It may cause cell death if such a precancerous change in the cell occurs. Mutations of this gene are associated with large numbers of cancer types, including breast.

CHEK2 is an inherited genetic marker for breast cancer similar to BRCA1 and BRCA2. The CHEK2 gene normally produces a protein which prevents cells from growing uncontrollably. When mutated, it cannot regulate cell growth and carries a 3 fold increased risk of breast cancer .

The good news about breast cancer is that we know more about it.

Diagnosis and tissue typing have become more sophisticated resulting in improved therapy and improved survival.

Now more than ever women are surviving breast cancer and living long and productive lives.

It is a very frightening diagnosis to consider, and women often delay getting screening tests and exams to aid in early diagnosis because of this fear.

It is vitally important for a woman to identify her risk factors for breast cancer and improve her lifestyle to reduce risk factors which can be controlled.(risk factor is anything, genetic or lifestyle, that increases the risk for a particular disease)

These risk factors have been discussed in a prior posting on our website. I encourage readers to familiarize themselves with those risk factors and begin a program which helps you to reduce them.

I also encourage readers talk with their medical providers about their concerns regarding mammograms and screening tests.

Remember-most breast cancers caught in  early stages carry an excellent prognosis for long survival.

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Mar
22

5 REASONS TO BETTER CARE FOR YOUR SKIN DURING MENOPAUSE

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How could she have protected her skin better?

How could she have protected her skin better?

As you read this article on 5  reasons to care for your skin during menopause, think about this woman and what she could have done differently.

Anne Vaillancourt

Anne Vaillancourt

Starting in the spring where I live in North Carolina, we all  spend more time outdoors. This increases our chance of harmful effects from Ultraviolet sun radiation (UVR) on our skin, especially as we age.  Starting in peri-menopause, it is more important than ever to take extra precautions to protect from and at the same time lessen the damage sun exposure has had on the skin.

When Menopause occurs, Five things can happen to a woman’s skin:

  1. The lower estrogen levels cause less collagen production; collagen maintains the thickness of skin and the healthy glow.
  2. The lessened collagen in skin is also the reason wrinkles occur.
  3. Oil production lessens and this can cause some benefits with smaller pore size and less likelihood of acne, but it can also facilitate rashes and cause dryness.
  4. There can be a discoloration, also called Melasma, which occurs with estrogen usage. Melasma can occur with pregnancy, oral contraceptive use, and with hormone replacement during menopause.
  5. Last and most importantly is skin cancer. While menopause does not cause skin cancer, the cumulative effect of the aging process and  how the skin has been cared for can help determine or cause skin cancer.

So what can or should a woman do as she enters menopause to care properly for her skin?

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  • The most important thing that  dermatologists  advise is USE SUNSCREEN DAILY! Why? The harmful radiation (UVR) that comes from sunlight will break down collagen, which helps to cause wrinkles; can trigger abnormal pigment formation in the skin which leads to melasma. Sunlight radiation in skin that has suboptimal DNA repair can lead to 1 of the 3 forms of skin cancer. Most makeup and moisturizers have some sunscreen formulated into the product to help with daily exposure to the sun. This is a double edged sword, as sunlight is needed for Vitamin D production in our skin. If you wear a sunscreen regularly, you probably should ask your doctor about taking a Vitamin D3 supplement daily. Vitamin D is involved with cancer prevention ( and bones, and brain, and muscles)  and low levels can make us more susceptible to malignancies of all kinds.
  • MOISTURIZE! Aging skin is almost always synonymous with drying skin and moisturizing with a good product will help with dryness and skin turnover to create healthy new skin This can also reduce inflammation. Many moisturizers have products included in the lotion or cream which help to build collagen, increase cell turnover and prevent or lessen wrinkles. There is a wide range of products and prices, but there are many good affordable creams in the drug stores.
  • SLEEP! How does this help the skin? Skin renewal is an ongoing process which occurs 24 hours a day, however researchers feel   the skin works harder at cellular regeneration at night. It is also felt that the stress hormones that are released due to sleep deprivation may slow collagen production as well as alter regulation of blood vessel tone leading to puffiness and irritation.
  • HAVE YOUR PROVIDER EXAMINE YOUR SKIN YEARLY! There are not many people who can look at their own backs to check for new moles, it is important to have someone do this for you. Skin cancer is most often treatable or even preventable with removal of pre-cancer lesions, or early and small lesions. Some skin cancer is more serious than other types and if you have a family history, smoke, or have had a lot of sun exposure; it is extremely important to get a good skin evaluation. Some dermatologists feel it can only take one bad sunburn in your life to place you at serious risk for skin cancer.

So remember this list to have healthy skin:

  • SUNSCREEN- daily
  • HEALTHY DIET- lots of fresh fruits and vegetables and a good protein source that contains vitamin  A
  • SLEEP – Keep the stress hormones low
  • HYDRATION – one quart of water for every 50 pounds of lean body weight per day
  • MOISTURIZE – use a good product that is reasonably priced
  • STOP SMOKING -  inhaling tobacco smoke is your enemy
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Nov
29

Vitamin D3 – 12 benefits for you

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Friendly doctor or Pharmacist with pillThis article was published previously but I thought you would benefit from reading it.

Vitamin D3 is something we can make in our skin and use in many different cells within our body. The problem is that many of us do not get the hour of prime-time sunshine we need per week. Even when we are sun exposed, many of us are wearing sun screen, have pigmented skin that decreases our production or are advanced in age and even with enough sun, may not produce enough Vitamin D. This article is to help you understand the benefits of Vitamin D3 so you will be motivated to take a supplement and to possibly have your 25 OH vitamin D levels checked.

The 12 benefits of adequate Vitamin D3 (CHOLECALCIFEROL) are easily identified from the medical literature. These benefits appear in enough different places that it can be assumed the studies are valid.

  1. Adequate levels of Vitamin D3 protect against Breast Cancer. One problem with cancer cells is that they don’t destruct when they are supposed to. They keep dividing and reproducing. Vit. D receptors are present on most cells in our body and help to trigger appropriate cell death, and identify to the immune system the correct cells it should eliminate.
  2. Ditto for Cancer of the Colon (large bowel). Both colon cancer and breast cancer are increased in people of color.  The same people most likely to have lower levels of Vitamin D3 in their blood. People who have more pigment in their skin need 30% more sun exposure to produce enough cholecalciferol.  Anyone and especially dark skinned individuals need to supplement if they live in northern latitudes that have more months of reduced sunshine per year.
  3. Vitamin D regulates absorption of calcium and phosphorus which are needed for healthy bones. Low levels of D3 are associated with poor bone development in children and bone softening in adults called osteopenia if mild or osteoporosis if advanced.
  4. Vitamin D3 is associated with proper immune function. It is no coincidence that the “cold season” is during winter months when there is less sunshine.
  5. The Brain’s health is dependent upon a number of factors and one of them is adequate levels of Vitamin D3.
  6. Keeping adequate levels of Vitamin D3 in our blood and tissues is associated with decreased aging changes in our body. Want to keep your vitality longer?  Make sure you get enough Vitamin D in your diet or enough sunshine in your life.
  7. Certain female gynecologic infections are associated with inadequate blood levels of Vitamin D3. Bacterial Vaginosis is the most common of these and hardest to control. If you have vaginitis and it won’t clear, check your 25OH Vitamin D blood levels.
  8. Insulin is a very important hormone but it can be over or under secreted. Vitamin D helps regulate insulin secretion.
  9. Many patients, especially women complain of joint pain and fatigue. Some of them have been given the diagnosis of Fibromyalgia. Inadequate blood levels of  D3 are associated with these aches, pains and fatigue. Get your 25OH vit D levels checked or take a therapeutic trial of 1000IU/day and keep a journal of your symptoms.
  10. Auto-immune disorders wreak havoc with tissues in our body. Common diseases that are caused by auto immune dysfunction are diabetes, rheumatoid arthritis, and hypo-thyroidism.  Adequate levels of Vit. D3 in the blood and tissues decreases the risk and severity of such diseases.
  11. Hypertension is associated with inadequate blood and tissue levels of several minerals and vital substances like potassium, calcium, selenium, and you guessed it Vit. D3.
  12. Vitamin D3 if kept at adequate levels in the blood is associated with a decreased risk of death from any cause. It isn’t a  panacea, but it obviously plays a more important role in our health than was realized for any years.
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