Cancer Information

Do Children have Cancers?

Children do suffer from cancers but cancers are uncommon during childhood. In the developed countries where statistical data are more complete, cancers affect 120-160 per 1,000,000 children under the age of 15 years every year. Approximately one in every 300-500 people will develop cancers before their 20th birthday.

Why do Children Get Cancers?

The answer to this question is still not resolved for most cancers. For any child who suffers from cancer, it is almost impossible to tell why he or she gets cancer.

From a statistical point, we understand that cancers in children may be related to genetic defects, chromosomal aberrations, immune deficiencies, infections like Epstein-Barr virus, Hepatitis B virus and human immunodeficiency virus infections, radiation mishaps, immunosuppressive treatments, or even anticancer treatments.
On the other hand, there is NO or insufficient evidence to associate the following with cancers in children: mother's diet during pregnancy, vitamin K injection given to the newborn infant, vaccinations, electromagnetic field, or power lines near residence.

Are Cancers in Children Similar to Those in Adults?

No, cancers in children are quite unique (see below). Even for cancers of the same type, the biological features and the responses to treatment are very different between children and adults. In general, the outcomes of cancers in children are better than adults. Therefore, it is not appropriate to apply what is known about the cancers in adult to those found in children.

What Investigations are Needed?

Investigations are needed to (a) confirm the diagnosis and classify the cancer type, and (b) define the extent of the disease (staging). The results are important to select the most suitable treatment for the child. In addition to physical evaluation, the child will have blood and urine tests, scans or imaging studies, and part of the tumour tissue will be taken out for microscopic examination (pathological diagnosis). Some children may need a bone marrow biopsy too.

How are Cancers in Children Treated?

After the diagnosis is confirmed and the cancer has been classified and staged, the doctor will decide what the best treatment or combination of treatment that the child would require. The treatment options include surgery, chemotherapy, radiotherapy, and other biologic agents.

Can Children Endure their Treatment?

The answer is yes, but they need good supportive care. The treatment of cancers in children carries both immediate and delayed complications. Some of these complications such as bleeding or infection can be dangerous. It is important that children with cancers should be treated in specialized centres where the medical team is experienced and the facilities are well established.

What are the Outcomes of Treatment?

The outcomes of anticancer treatment in children depend on the primary disease and its extent (see below). On the whole, 70-75% of children diagnosed to date are expected to be long-term survivors (and thus cured), provided that they are treated with contemporary protocols by experienced medical teams with supportive facilities.

Types of cancer

Acute Lymphoblastic Leukaemia (ALL). This is the commonest type of cancer seen in children. Almost 30% of childhood cancers are ALL. The affected child may have fever, bruises, tiring easily, and enlargement of the glands in the neck. Most children with ALL need chemotherapy only; some may require radiation treatment to the brain. On the whole, 75-80% of children can be cured after treatment.
Acute Myeloid Leukaemia (AML). This is an uncommon form of leukaemia. The affected child has symptoms that are similar to those of acute lymphoblastic leukaemia. Most children with AML need chemotherapy only. On the whole, 45-60% of children can be cured after treatment.
Non-Hodgkin Lymphoma (NHL). This is a cancer of the lymphatic glands. The affected child may have fever, tiring easily, and enlargement of the glands in the neck or inside the chest. Some children may complain of difficulty in breathing or abdominal pain. On the whole, over 80% of children can be cured with chemotherapy alone. Only a small proportion of children will need surgery or radiation treatment.
Hodgkin Lymphoma. This is another form of cancer of the lymphatic glands and the symptoms are similar to those of non-Hodgkin Lymphoma. Treatment with chemotherapy, and radiation in some children, results in cure rates of over 80% even in advanced disease.
Brain Tumours. Brain Tumours are the commonest form of solid cancer in children, accounting for 15-20% of the cases. There are different kinds of brain tumours in children and their treatments are not the same. Children with brain tumours may complain of headache, vision problems, vomiting, weakness of one side of the body, unsteadiness in walking, or epilepsy. In general, the affected children will need surgery and often radiation treatment afterwards. Medulloblastomas, a tumour commonly seen in the cerebellum of children, is treated with surgery, radiation and chemotherapy. The chance of cure is 60-70% when the tumour has not spread.

Germ cell tumours inside the brain (intracranial) are more commonly seen in Oriental children. They are peculiar because most of them can be treated with chemotherapy and radiation without the need for complicated surgery. The cure rates range from 60-90% depending on the type of germ cell tumour.
Neuroblastoma. This is a cancer of the adrenal glands inside the abdomen. Occasionally they are found in the nervous tissues inside the neck or the chest. The affected child may have fever, aches in the bones, and distended abdomen. For early disease, the outcome is excellent and more than 90% of the children can be cured. Unfortunately, most children present with advanced disease with spread to other parts of the body. Treatment with surgery, chemotherapy and sometimes radiation is needed. High-dose chemotherapy followed by stem cell transplantation is now part of the standard treatment. Only 10-30% of children can survive long-term.
Wilms Tumour. This is a cancer of the kidneys and most of the affected children present with distention of the abdomen. The standard treatment consists of surgery, chemotherapy and radiation. The outcome is excellent with 80-90% of cure even in advanced disease.
Germ Cell Tumours. This is a cancer of the testis in boys or the ovaries in girls. Sometimes they may occur inside the abdomen, the chest, the neck or at the coccyx near the anus. Some patients may need surgery alone, while others can be treated with only chemotherapy. The cure rates ranged from 75-90% even with advanced diseases.
Rhabdomyosarcoma. This is a cancer of the muscles and it commonly presents as a mass. Any part of the body may be affected. Treatment consists of surgery, chemotherapy and radiation. The long-term cure rates ranged from 70-80% when the disease has not spread.
Osteosarcoma (or Osteogenic Sarcoma). This is a cancer of the bones and commonly present as a swelling in the thigh or leg bones. Treatment consists of surgery and chemotherapy. About 60-70% of children can survive long-term after treatment when the cancer has not spread.
Ewing Sarcoma (or Primitive Neuroectodermal Tumour). This is a cancer of the nervous system that may affect the bones or the soft tissues. The symptoms are therefore similar to those of Rhabdomyosarcoma or Osteosarcoma. Treatment consists of surgery, chemotherapy and radiation. For disease that has not spread, the long-term survival rates are 70-80%.
Hepatoblastoma. This is a cancer of the liver. The affected child usually presents with a distended abdomen. With surgery and chemotherapy, the long-term survival rates are close to 90% for disease that has not spread.
Retinoblastoma. This is a cancer of the eyeball. During the early stage, parents may notice a white reflex (cat's eye reflex) in the affected eye, especially when the child's face is photographed. In early stages, the cancer can be treated by surgery or cryosurgery. For more advanced disease, radiation treatment and chemotherapy may be needed. Long-term survival rates are well above 90% unless the disease has spread beyond the eyeball.

Prostate Cancer - Other Treatment

Radiation therapy

Radiation therapy may be used alone or combined with hormone treatment or surgery to treat prostate cancer. Like surgery, it is most effective in treating cancer that has not spread outside the prostate. When combined with surgery, radiation is used to destroy any cancer cells that might be left behind and to relieve pain when the cancer has spread.

There are two main types of radiation treatment for prostate cancer:

• External beam radiation, in which a machine aims high-energy X-rays or protons at the cancer from outside the body. External radiation also includes conformal radiotherapy, intensity-modulated radiation therapy, and proton therapy.
  • Conformal radiotherapy (3D-CRT) uses a three-dimensional planning system to target a strong dose of radiation to the prostate cancer. This helps to protect healthy tissue from radiation.
  • Intensity-modulated radiation therapy (IMRT) uses a carefully adjusted amount of radiation. This provides even more protection for healthy tissue than conformal radiotherapy.
  • Proton therapy uses a different type of energy (protons) rather than X-rays. This allows a higher amount of specifically directed radiation, which offers the most protection possible to nearby healthy tissue, especially the rectum.¹³ Sometimes proton therapy is combined with X-ray therapy.
• Brachytherapy, in which tiny seeds containing radioactive material are injected directly into or near the cancer and left there. In time, the material loses its radioactivity and the seeds can remain where they are.

Side effects

Radiation treatment may cause erection problems and bladder problems. It sometimes causes diarrhea. The ability to have an erection sometimes returns or at least improves over time. So does the ability to control urination.

Side effects are common. Some men develop long-term problems that may have a big impact on the quality of their lives. Long-term problems that can be caused by radiation treatment include:

• An irritated rectum that can cause an urgent need to pass stool. This is called proctitis.
• An inflamed bladder and urination problems. This is called cystitis.
• An inflamed intestine and diarrhea. This is called enteritis.
• Being unable to have an erection. This is called impotence.
• Being unable to control urination. This is called incontinence.
• Painful urination. This is called dysuria.

Immunotherapy

Researchers also are testing many new ways to treat prostate cancer using the body's immune system to destroy the cancer cells. This type of treatment is called immunotherapy . Much has been learned in the past 20 years about the body's ability to attack prostate cancer cells with help from the outside, and research is still being done in this area. This type of treatment either stimulates your immune system or adds to it, for example, by giving you immune cells from another person.

Complementary therapy

Complementary therapies, such as acupuncture, herbs, biofeedback, meditation, yoga, and vitamins, are sometimes used along with medical treatment. Some people feel that they benefit from some of these therapies.

Before you try a complementary therapy, talk to your doctor about its possible value and side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not meant to take the place of standard medical treatment, but they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.

Clinical trials

Clinical trials are being run to find ways to prevent, detect, diagnose, and treat prostate cancer. For example, researchers are studying whether vitamin E and selenium, which is a mineral found in certain foods, can prevent prostate cancer.

Prostate Cancer - Prevention

You can take steps that may lower your chances of getting prostate cancer.¹¹

Eat more low-fat, high-fiber foods, or foods with omega-3 fatty acids, such as:

• Soy products, like tofu and soy beans.
• Tomatoes and foods that contain tomato sauce.
• Vegetables like broccoli, cauliflower, and cabbage.
• Fish, like salmon, albacore tuna, and sardines.
• Walnuts and flaxseed, and their oils.

Researchers are looking into other things that may help prevent prostate cancer. These include:

• Medicines, such as finasteride or nonsteroidal anti-inflammatory drugs (NSAIDs).
• Drinking red wine or green tea.
• Supplements, such as vitamins D and E, and selenium.

Prostate Cancer,Advanced or Metastatic - Topic Overview

Is this topic for you?

This topic is about prostate cancer that has spread or come back after treatment. For information on early cancer of the prostate gland, see the topic Prostate Cancer.

What is prostate cancer?

Prostate cancer is a group of cells that grows faster than normal in a man's prostate gland. It can spread into other areas and kill normal tissue.
The prostate gland sits just below a man's bladder. It makes part of the fluid for semen. In young men, the prostate is about the size of a walnut. It usually grows larger as you grow older.
The cancer may be one of these types:

• Locally advanced prostate cancer. This is cancer that has grown through the outer rim of the prostate and into nearby tissue.
• Metastatic prostate cancer. This is cancer that has spread, or metastasized, to the lymph nodes or other parts of the body.
• Recurrent prostate cancer. This is cancer that has come back after it was treated. The cancer can come back in the prostate, near the prostate, or in another part of the body. If it comes back in another part of the body-often the bones-it is still called prostate cancer, because it started in the prostate.

What causes prostate cancer?
Experts don't know what causes prostate cancer. But they believe that getting older and having a family history of prostate cancer raise your chance of getting it.
What are the symptoms?
Sometimes there are no symptoms of either locally advanced or metastatic prostate cancer.
When they do appear, symptoms of locally advanced prostate cancer include:

• Waking up many times during the night to urinate.
• Having trouble starting your urine stream, having a weaker-than-normal stream, or not being able to urinate at all.
• Having pain or a burning feeling when you urinate.
• Having blood in your urine.
• Having a deep pain or stiffness in your lower back, upper thighs, or hips.

Symptoms of metastatic prostate cancer may include:

• Bone pain.
• Weight loss.
• Swelling in your legs and feet.

How is prostate cancer diagnosed?
Your doctor will do a digital rectal exam, in which he or she puts a gloved, lubricated finger in your rectum to feel your prostate. You may also have a blood test called a prostate-specific antigen (PSA) test. These tests will help find out if you have prostate cancer or if your prostate cancer has come back.
Your doctor also may do a biopsy. In this test, your doctor takes a sample of tissue from your prostate gland or from the area where the cancer may have spread and sends the sample to a lab for testing. A biopsy is the only way to know for sure that you have prostate cancer.

If you have had prostate cancer before, your doctor may also order a bone scan, CT scan, or MRI to see if it has come back or spread.

Finding out that you have cancer can be scary. It may help to talk with your doctor or with other people who have had cancer. Your local American Cancer Society chapter can help you find a support group.

How is it treated?

Choosing treatment for prostate cancer can be confusing. Your choices depend on your overall health, how fast the cancer is growing, and how far it has spread.

Locally advanced prostate cancer may be treated with surgery, radiation therapy, or hormone therapy.

Treatment of metastatic cancer focuses on slowing the spread of the cancer and relieving symptoms, such as bone pain. It also can help you feel better and live longer. Treatment may include hormone therapy, radiation therapy, or chemotherapy.

Prostate Cancer Vaccine Meets Goal

Provenge, an experimental treatment vaccine for advanced prostate cancer, met researchers' goal in a key trial needed for FDA approval.

That news comes from Dendreon, the company that makes Provenge.

"We believe this is truly a breakthrough for the prostate cancer community and a testament to the promise of the field of cancer immunotherapies," Dendreon's president and chief executive officer Mitchell Gold, MD, said in a conference call today.

Provenge is a biologic drug given by infusion to spur the immune system to fight advanced prostate cancer that doesn't respond to anti-androgen treatment.

In 2007, an FDA advisory panel recommended that the FDA approve Provenge. But instead, the FDA requested more information about whether Provenge prolongs survival.

That request led to a new study of 512 men with advanced prostate cancer. Those men had metastatic, androgen-independent prostate cancer, meaning their cancer had spread and wasn't responding to anti-androgen treatment.

In that study, overall survival was significantly better for men taking Provenge than those taking a placebo.

The study's results were "unambiguous" and "very consistent" with previous Provenge trials, Gold says.

Dendreon plans to submit the study's results to the FDA in the fourth quarter of 2009; after that, the FDA will have six months to review the material, Gold says.

"This data supports Provenge being used as front-line treatment in men with metastatic, androgen-independent prostate cancer," says Gold, who notes that no new side effects from Provenge stood out in the study. In previous trials, the most common side effects in men taking Provenge were chills, fever, headache, fatigue, shortness of breath, vomiting, and tremor, mainly at a low level and for one to two days following infusion.

Gold says that those men would first have surgery or some form of local therapy, then anti-androgen therapy if their cancer recurred, and if their PSA levels rose after that, "Provenge would come into play as a potential treatment option for them."

In men with prostate cancer, PSA (prostate-specific androgen) levels are used to gauge the success of prostate cancer treatment.

Dendreon isn't releasing any further details of the study until April 28, when the findings will be presented at the American Urological Association's annual meeting in Chicago.

The technology used to make Provenge may also prove useful against other forms of cancer, Gold says.

American Cancer Society Responds

The American Cancer Society released a statement about today's Provenge news. The statement comes from Otis W. Brawley, MD, chief medical officer at the American Cancer Society.

Dendreon's announcement about the new Provenge study "is reason for optimism about a vaccine that has generated controversy for several years," Brawley says. "We have to respect the scientific process, an important part of which is a full disclosure and careful review and discussion of the data, which the company says will not be released until an upcoming medical meeting."

"One of the most important questions we'll be looking at will be the magnitude of the survival advantage; how much longer the men taking the vaccine lived compared to those on standard therapy," Brawley continues. "As with any new therapy, it will take a detailed analysis to fully understand the impact of this potential new treatment for patients with advanced prostate cancer. We look forward to the presentation of the study at the upcoming meeting."

Urine Test for Lung Cancer?

Researchers Developing Urine Test to Determine Smokers at Highest Risk for Lung Cancer

Researchers are a step closer to developing a simple urine test to identify smokers at high risk of developing lung cancer.

Although the test is still years away, the hope is to spot high-risk people earlier, when there’s still time to prevent or treat the cancer, says Jian-Min Yuan, MD, associate professor of cancer epidemiology at the University of Minnesota.

Early identification will give doctors a chance to step up smoking cessation and screening efforts, he tells WebMD.

“It might motivate smokers who are having trouble quitting” to finally kick the habit, Yuan says.

If that fails, “We can at least have them come in for lung cancer screening every six months,” he says. That way, doctors can catch cancer earlier, when there’s a higher chance it can be treated successfully with surgery, radiation, and/or chemotherapy.

The findings were presented at the annual meeting of the American Association for Cancer Research.

Smoking Causes Lung Cancer

Lung cancer is the leading cancer killer, claiming the lives of more than 160,000 Americans last year, according to the American Cancer Society. 

Smoking tobacco is the major risk factor for lung cancer. In the United States, about 90% of lung cancer deaths in men and nearly 80% of lung cancer deaths in women are from smoking, according to the CDC. People who smoke are 10 to 20 times more likely to get lung cancer or die from lung cancer than people who do not smoke.

But not every smoker develops lung cancer, and there is no way to predict exactly who will develop the disease, says Peter G. Shields, MD, deputy director of the Lombardi Comprehensive Cancer Center in Washington, D.C.

“We all know that the more you smoke, the higher your risk. But only about one in 10 heavy smokers gets lung cancer,” he tells WebMD.

“It’s really remarkable that we have tests for cholesterol and so on, but we don’t have a blood or urine test for smoking,” Shields says.

Developing a Urine Test

In an effort to develop such a test, Yuan and colleagues culled data from two large studies that began about 20 years ago. One, called the Shanghai Cohort Study, involved more than 18,000 men in Shanghai, China. The other, the Singapore Chinese Health Study, included 63,257 men and women of Chinese descent.

At the time of enrollment, urine and blood samples were collected from all the participants and frozen for future use. They were also asked to answer a battery of questions, including whether they smoked, how much they smoked, and for how long they smoked.

For the new analysis, the researchers focused on 245 smokers in the studies who developed lung cancer and 245 smokers who didn’t get cancer.

Then they thawed their urine samples and measured levels of NNAL, a byproduct of one of the most potent tobacco lung carcinogens identified to date.

“When you smoke, you suck in about 60 carcinogens. One of the most potent, called NNK, breaks down and becomes NNAL in the body,” Yuan says.

NNAL has been shown to induce lung cancer in laboratory animals, but the effect in humans had not yet been studied, he says.

Then the smokers were divided into three groups based on their levels of NNAL in the urine.

Compared with those with the lowest levels, people with a mid-range level of NNAL had a 43% increased risk of lung cancer. Those with the highest levels had more than twice the risk of lung cancer.

Then the researchers measured a byproduct of nicotine, called cotinine, in the urine.

Smokers with the highest levels of both cotinine and NNAL had an 8.5-fold increase in the risk of lung cancer compared with smokers who had the lowest levels.

The findings held true even after taking into account the number of cigarettes smoked per day, the number of years of smoking, and other factors.

The next step is to measure another tobacco-carcinogen byproduct called PAH in the participants’ urine and look at whether high levels of all three chemicals even further raises risk, Yuan says.

“The idea is to build up a risk model that incorporates many of these biomarkers as well as smoking history, so we can best identify which smokers will eventually develop lung cancer,” he says.

Male Menopause

Women may not be the only ones who suffer the effects of changing hormones. Some doctors are noticing that their male patients are reporting some of the same symptoms that women experience in perimenopause and menopause.

The medical community is currently debating whether or not men really do go through a well-defined menopause. Doctors say that male patients receiving hormone replacement therapy (testosterone) have reported relief of some of the symptoms associated with so-called male menopause.

What Is Male Menopause?

Since men do not go through a well-defined period referred to as menopause, some physicians refer to this problem as androgen (testosterone) decline in the aging male. Men do experience a decline in the production of the male hormone testosterone with aging, but this also occurs with some disease states such as diabetes. Along with the decline in testosterone, some men experience symptoms such as fatigue, weakness, depression, and sexual problems. The relationship of these symptoms to the decreased testosterone levels is still controversial.

Unlike menopause in women which represents a well-defined period in which hormone production stops completely, male hormone (testosterone) decline is a slower process. The testes, unlike the ovary, does not run out of the substance it needs to make testosterone. A healthy male may be able to make sperm well into his eighties or longer.

However, as a result of disease, subtle changes in the function of the testes may occur as early as 45 to 50 years of age, and more dramatically after the age of 70 in some men.

How Is Male Menopause Diagnosed?

To make the diagnosis, the doctor will perform a physical exam and ask about symptoms. He or she may order other diagnostic tests to rule out any medical problems that may be contributing to the condition. The doctor will then order a series of blood tests which may include several hormone levels, including a blood testosterone level.

Can Male Menopause Be Treated?

If testosterone levels are low, testosterone replacement therapy may help relieve such symptoms as loss of interest in sex (decreased libido), depression, and fatigue. But, as with hormone replacement therapy in women, testosterone replacement therapy does have some potential risks and side effects. Replacing testosterone may worsen prostate cancer, for example.

If you or a loved one is considering androgen replacement therapy, talk to a doctor to learn more. Your doctor may also recommend certain lifestyle changes, such as a new diet or exercise program, or other medications, such as an antidepressant, to help with some of the symptoms of male menopause.

Can A Vagina Be Too Big?

Faithful readers of this blog may remember that Masters and Johnson examined the vaginal sizes of 100 women who had never been pregnant. These women showed an un-stimulated vaginal length of 2 ¾-3 ¼ inches , with a ¾ inch width at the back of the vagina. During the sexual excitement phase the vaginal lengths increased to 3 ¾- 5 ¾ inches, with the width at the back of the vagina being 2 ¼-2 ½ inches. This correlates with our most common diaphragm sizes which are between 2 ½ -3 ½ inches in length.

"But I'm not worried about vaginal length," you might be thinking. "My problem is that I think my vagina is too loose - or too wide. Is that possible? If so what can I do?" Let's examine some of the medical data available to answer these questions.

Is my vagina too loose?
The vagina is like a collapsed, expandable tube lined with skin; the tissue below the skin is loose and contains large veins. Next are smaller circular muscles surrounded by stronger bands of muscle which run the length of the vagina. In addition, the lower third of the vagina is surrounded by a ring of muscles. This is covered by more connective tissue and blood vessels. Damage to these muscles, or if they become thin and weak, can allow the bladder ("cytocele") or rectum ("rectocele") to pouch into the vagina. Thus you can understand the importance of strong vaginal muscles. The ring of muscles around the vaginal opening contract during orgasm and may contribute to the intensity of an orgasm.

So what is too loose? This can be a matter of opinion based upon the input of a sexual partner, or one's observations of vaginal tone. Researchers have devised some ways to measure vaginal tone such as a pressure sensitive intravaginal balloon device, and ultrasound measurements of vaginal area ("pelvic floor") muscle thickness. A study of 30 women aged 20-42 found that better developed vaginal muscles were linked to having orgasms, and getting physical exercise. Conversely, increased age and having been pregnant were linked to decreased strength of vaginal muscles (McKey and Dougherty 1986).

A more recent study using ultrasound measurements (Bernstein,1997) found similar connections. Muscle thickness decreases with age, especially in women older than 60. Women with urinary incontinence had thinner pelvic floor muscles than women who were not incontinent.

Will exercising the vaginal muscles make my vagina tighter?
Two ultrasound studies of women who exercised their vaginal muscles did find that their muscles were thicker and stronger after pelvic floor muscle training. Among women with urine leakage, their thinner muscles became the thickness of healthy women's pelvic floor muscles. Additionally, they had less urine leakage - whether the problem was from stress or urge types of incontinence. The use of vaginal cones and/or Kegel exercises to increase muscle strength were both found to improve tone and decrease urine loss. While some of these studies did not measure vaginal tightness per se, when muscle bulk is increased, a woman can voluntarily contract those muscles to make the vaginal opening tighter.

Do tighter vaginal muscles really improve sexual response?
Despite the fact that most every discussion of Kegel exercises includes improved sex, there are not many scientific studies to back up this claim. One recent publication (Dean, 2008) reported on sexual function and pelvic muscle factors for some 2,800 women. Women who delivered only by Caesarean section (and their partners) perceived they had better vaginal tone leading to improved sexual satisfaction. Women who were currently doing pelvic muscle exercises scored much better on sexual satisfaction questions than women who did not. Women with incontinence (probably thinner muscles) scored the worst on the sex questions.

I've tried Kegel exercises but they don't work for me.
Assuming that the Kegel exercises have been done correctly, it may be time to move to other options. One low tech choice is weighted vaginal cones. This is a set of weights, shaped more like a tampon than a cone, where one inserts the lightest version then uses the vaginal muscles to hold it up inside. This is done twice daily. When this is easy the next heaviest cone is used - and so on. This is to be done while going about normal activities so that gravity provides an additional challenge to keeping the weight up inside.

More technology is involved in the electrical stimulator. A tampon shaped probe is inserted in the vagina and small electric shocks cause the muscles to contract then relax. This is done about 20 minutes up to several times a week. One patient of mine who used this device found it sexually pleasurable.

Less commonly used may be the "magnetic chair" ("Neocontrol"). This chair uses magnetic action to stimulate the muscles. I know this sounds very "woo, woo", but there is good data showing its effectiveness. This device is not for home use; treatments are given twice weekly by specially trained health care personnel.

Will plastic surgery make my vagina smaller?
Many genital plastic surgery techniques are based upon GYN surgical procedures used for medical problems such as reconstruction after cancer treatment, gender change, repair of cystocele/rectocele, etc. Unfortunately there are few good studies showing benefit where there is no overt medical problem.

One study of 53 women in Santiago, Chile (Pardo, 2006) was done specifically for complaints of wide vagina and decreased sexual satisfaction. The surgeons did two procedures. The first was inside the vagina where tissue along the roof was stitched tighter. This is similar to the type of repair done for a cystocele. Secondly, tissue around the vaginal opening and between the vagina and anus was stitched tighter. This is similar to the type of repair done for episiotomies after childbirth. Six months after surgery 94% claimed they experienced a tighter vagina, and had regained or improved orgasms. Yet some 4% of the women said they regretted the surgery.

The problem with this type of study is that sexual response can be very subjective. There is no easy way to measure sexual satisfaction in a group of diverse women. Every woman knew she got the surgical treatment so six months may not be a long enough time for any placebo response to wear off.

The American College of Obstetricians and Gynecologists (ACOG, 2007) has noted the lack of both safety and effectiveness data for genital plastic surgery. The possible complications for such surgery might include: infection, changes in sensation, pain with intercourse, and scar tissue. One GYN who has been performing genital plastic surgery for a number of years (Goodman, 2009) concluded that agreed upon terminology and training standards are still lacking.

What are you going to do, Jane?
As a big advocate of resistance/weight training to build muscles, I personally think exercise is a better place to start than surgery. As always, if a woman has concerns about sexual function, vaginal/genital structures, etc she should bring these up to her GYN. A GYN sees the wide range of "normal" in vaginal appearances. Yet, if one is having sexual problems due to genital changes, your GYN needs to know that is an issue.

All About Breasts

My Breasts Don't Look Normal. Is Something Wrong?

Given the breast centered focus of western civilization it's no surprise that many women are critical of the size and shape of their breasts. But what if something is truly abnormal about a young woman's breasts - would she know it? The purpose of this post is to try and address what is within the range of normal for breast appearance - and what may not be.

Age Matters
What is too early for the beginnings of breast development? Many mothers would be surprised to hear that breast development is not considered premature if it appears in African American girls by age of seven, or in other girls by age eight! Mothers then worry about the development of premature/precocious puberty (full breast development, menstrual periods, etc). Fortunately 80% of early-developing girls will not come fully into puberty. In fact, breast development may halt, only to reappear at the more usual time.

So what is the usual time to be "developed"? Lack of any breast development by age thirteen merits some monitoring. The small, firm breast buds usually appear about age eleven. By age thirteen a majority of girls have the beginnings of a mound-shape of breast tissue. Unless there is an overt reason for lack of development such as illness, radiation exposure, or hormonal problems there is evidence that breast development can continue until one's early 20's.

Size Might Matter
While most all of us have at least some difference in size between our two breasts, there are situations where the size difference is very apparent. Size differences which onset in teen years will likely equalize for about 75% of women.

Very large breasts can develop in teen women. This can occur on just one side or be bilateral. In this instance normalization of size is unlikely to happen. While a tumor can prompt a very large breast, most enlargement is related to a robust tissue response to normal hormonal influences. According to DeSilva (2006) there is no increased risk for breast cancer among young women with an extremely enlarged breast. Cosmetic surgery, if indicated, can be done. Reduction of a very large breast(s) is called reduction mammoplasty. Unlike breast augmentation (i.e. breast implants) there is usually more apparent scarring.

Conversely, there can be insufficient breast development on one or both breasts. One type that seems to cause particular distress creates a tall tube shaped breast. There is tissue growth under the nipple, but no rounded breast mound. Again, plastic surgery is the usual treatment.

Extra Nipples?
Having extra nipples has been reported in 1-2% of women. The line along which extra nipples are usually found extends from the armpit to the groin. Extra nipples do not usually have associated breast tissue so they may go unnoticed. A woman may think that the "accessory nipple" is a mole or other skin lesion. These do not have to be surgically removed unless, like a mole, they become inflamed by restrictive underwear or clothes.

Hormonal Medications
It has been noted that women using birth control pills may experience bilateral breast enlargement. This has been attributed to the hormone estrogen. A similar effect can occur in older women using post-menopausal hormonal therapy. Usually this is not a lasting effect, and size goes back down when the medication is stopped.

Previously, medications which block estrogen effects were tried as a treatment for too early or excessive breast development (Bloom 2008). This is not a standard treatment, however.

Breast Enlargement Options?
There are breast enlarging creams and herbal products advertised on the internet. As new products are touted, our Women's Health Board gets a spate of questions about the effectiveness of such products. The array of products includes pills, creams, devices, and even a chewing gum! I would concur with the review article written by Dr. A. Fugh-Berman (2003) published in the journal Obstetrics/Gynecology. She investigated many of the herbal ingredients touted to increase breast size. A few ingredients have the possibility of producing weak estrogen-like hormones. Yet most have no data to support their use for breast enlargement. Perhaps most concerning is there are no long term safety studies. In the real world, women may not use such products for very long when the promised 3-5 cup size increase does not appear.

Honestly, the most reliable way to get a larger breast size (short of weight gain or pregnancy) is breast augmentation done by surgically inserting a saline or silicone implant. The American Society of Plastic Surgeons reports an increase for cosmetic surgery from 14,000 in 1996 to 333,000 in 2005 for patients under age eighteen. At least 90% of those were females. Breast augmentation is one of the two most frequent plastic surgery procedures performed on teens (Zuckerman, 2008).

Since most health insurance will not cover breast augmentation, the costs have to be borne by the young woman, or her family. While the decision to do augmentation is a very personal decision it is worth understanding some of the risks. The FDA has not approved the use of saline implants in women under age 18, nor the use of silicone implants in women age 21 and younger. Surgeons can still do the procedure, but the benefits have not been demonstrated to out weigh the risks to the satisfaction of the FDA. Currently breast implants have a limited life expectancy. According to Zuckerman breast implants typically last about 10 years, and there is an increased of scar tissue formation the longer the implant is in place.

Interestingly, a study of women planning to get breast implants because of dissatisfaction with being too small, found that there was no difference in bra sizes compared to a group of women who were satisfied with their breast sizes (Didie, 2003).

Jane's Economy Breast Lift
Thus far we have moved from discussing medically focused breast issues through more self-concept, or cosmetic, concerns. Most women can think of a change in breast size, or firmness which they would prefer if the Fairy Godmother of Breast Structure was to grant them a wish. Would you be willing to develop a firmer breast profile without drugs, surgery, or any cost? OK, I was skeptical, too. But here it is-free to my readers:

Chest Exercises to Help Tone and More

If you do a few simple exercises, especially if combined with a balanced body work out, you will get better contours. As a bonus, saggy underarms (triceps flop) can improve. It will not increase or decrease your cup size by three to five sizes, but it will make what you have look better. And after all, isn't enhancing what we have been given what it's all about?

"Smart Choices" food label revealed as nutritional fraud

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NaturalNews Tip of the day (from Mike): Want to find some truly "smart choices" for kids in the grocery store? Read the ingredients on the products you buy, remembering that the first three ingredients are mostly what that item is made of. Food manufacturers often try to bury sugars deeper in the ingredients list by using multiple forms of sugar that are listed separately: Sugar, sucrose, corn syrup, high-fructose corn syrup, etc.

Get this: A prominent dean at a nationally-recognized nutritional school with Tufts University is publicly endorsing Froot Loops for children as a "Smart Choice" for healthy food.

 

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"Smart Choices" food label is marketing fraud; Tufts University involvement questioned (opinion) (NaturalNews) The big food companies have dreamed up yet another clever con to sell processed junk foods to parents and children: A "Smart Choices" label that implies the food product is a smart choice for health and nutrition. The problem is that the...

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Study Finds Breast Cancer Fighting Properties within Mushrooms A recent study published in the International Journal of Cancer found evidence supporting that mushrooms have breast cancer-fighting properties. This study was conducted at the University of Western Australia in Perth. The study...

Walnuts Found to Prevent Breast Cancer (NaturalNews) A diet high in walnuts may significantly decrease a person's risk of breast cancer, according to a study conducted by researchers from the Marshall University School of Medicine and presented at a conference of the American Association for...

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Scientists Use Post-Hypnotic Suggestion on the Stroop Effect The field of psychology uses various instrumental studies to examine cognitive processes. These processes are either controlled or automatic. Further, automatic processes can either be innate or learned. When a process is automatic, it is...

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Treatment Overview

The choice of treatment and the long-term outcome (prognosis) for women who have ovarian cancer depends on the type and stage of cancer. Your age, overall health, quality of life, and desire to have children (preserve fertility) must also be considered.

• Surgery is done to confirm and treat cancer. Removal of all cancerous tissue and taking biopsies to check for the spread of cancer (surgical staging) is important for diagnosis and treatment, because the amount of cancer remaining (residual cancer) after the initial surgery may affect your outcome.
• Chemotherapy, which uses medicines to kill cancer cells, is recommended after surgery for most stages of ovarian cancer. Recent studies show that the addition of chemotherapy after surgery improves the outcome for some early-stage ovarian cancer.¹⁵ Chemotherapy is also recommended for all other stages of ovarian cancer. Chemotherapy that is given after a surgery is called adjuvant therapy.

Initial treatment

The goal of the initial surgery is to remove all visible cancer. The type of surgery you will need depends on the stage of your cancer and if you want to be able to have children after having the surgery.

If you have early-stage (stage I and low-grade [grade 1]) cancer and you wish to have children, your surgery may include:

• Removal of your cancerous ovary and fallopian tube.
• A biopsy of your other ovary.
• Removal of fatty tissue (omentum) that is attached to some of the abdominal organs.
• Removal of lymph nodes in the pelvis and near the large blood vessel (aorta) in the belly.
• Biopsies of other tissues and peritoneal fluids (peritoneal washings) from the belly to look for cancer cells.

Your uterus and the healthy ovary will remain, so it may be possible for you to become pregnant.

If you have a more advanced stage (stage II, III, or IV) of cancer or you have stage I and do not want to have children, your surgery may include:

• A hysterectomy, which removes your uterus, and a salpingo-oophorectomy, which removes your ovaries and fallopian tubes.
• Collection of peritoneal fluid.
• Removal of pelvic and aortic lymph nodes (lymph node dissection).
• Removal of fatty tissue (omentum).
• Removal of as much cancerous tissue as possible.
• Biopsies of any tissue that may be cancerous.

Because this surgery removes all the reproductive organs, you will not be able to become pregnant after having it.

Chemotherapy is recommended after surgery for most women. The current standard of treatment is 6 cycles of paclitaxel (Taxol) and carboplatin or cisplatin. Each chemotherapy cycle is scheduled every 3 to 4 weeks, so chemotherapy may last 4 to 6 months. Studies are looking at delivering chemotherapy directly into the belly (intraperitoneal chemotherapy). One study compared women with stage III ovarian cancer who had already had surgery. In that study, one group had treatment with paclitaxel delivered into a vein (intravenous) followed by intravenous cisplatin; the other group had treatment with intravenous paclitaxel followed by intraperitoneal cisplatin and paclitaxel. Although the intraperitoneal group had more severe side effects, overall survival was better than for the intravenous group.¹⁶

Treatment Overview

continued...

Home treatment measures may help relieve some of the common side effects of cancer treatment, such as nausea, vomiting, fatigue, hair loss, stress, or sleep problems.

If both of your ovaries are removed, you are likely to experience menopausal symptoms after surgery. Home treatment measures may relieve some of these symptoms. If home treatment does not help your menopausal symptoms, talk to your doctor about other ways to manage your symptoms.

If you have recently been diagnosed with ovarian cancer, you may experience a wide variety of emotions in reaction to having cancer. Most women feel some denial, anger, and grief. There is no "normal" or "right" way to react to having cancer. You can take steps to manage your emotional reactions to learning that you have ovarian cancer. Some women find that talking with family and friends is comforting, while others may need to spend time alone to understand their feelings about their cancer.

If your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other women who have had similar feelings after being diagnosed with cancer such as yours can help you accept and deal with your cancer.

What to think about during initial treatment

In about 70% of women with ovarian cancer, the cancer has already spread (metastasized) outside the pelvis by the time it is diagnosed.¹⁷ Advanced-stage cancer spreads most commonly to the lining of the abdominal cavity, the pelvic lymph nodes, and the fatty tissue around some of the abdominal organs.

Your long-term outcome depends on your age, the stage and grade of your cancer, and the amount of cancer remaining after your initial surgery.

Your quality of life becomes a critical issue when considering your treatment choices. Be sure to discuss your personal preferences with your oncologist when he or she recommends treatment.

You may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries for all stages of ovarian cancer.

For more information about specific ovarian cancer treatments, see the topics:

Ovarian Cancer – Health Professional Information [NCI PDQ].

Ovarian Cancer – Patient Information [NCI PDQ].

Ongoing treatment

After initial treatment for ovarian cancer, it is important to receive follow-up care. Your emotional reactions may continue throughout the course of your treatment, depending on your prognosis, the treatment methods used, and your quality-of-life decisions.

Treatment Overview

(continued)

continued...

Your gynecologic oncologist or oncologist will schedule regular checkups, usually every 3 months for the first 2 years after treatment. Your doctor may then recommend checkups every 6 to 12 months depending on your stage of cancer. These checkups will include:

• A physical exam of your neck, lungs, and abdomen, and a pelvic exam to check for recurring cancer or swollen lymph nodes.
• A CA-125 blood test to see if the cancer has returned.
• An abdominal and pelvic CT scan or MRI to check to see if cancer has spread, especially when new symptoms, such as belly pain, are present or if CA-125 levels are high.

Second-look surgery, after 6 cycles of chemotherapy, may be done in research studies or clinical trials if no sign of cancer is found during a physical exam; in blood tests; or with X-ray, CT, or MRI. Additional biopsies are done at the time of second-look surgery to determine the need for more treatment. Second-look surgery is not recommended as standard treatment because of the chance of complications and because it does not clearly increase survival rates.

Treatment if the condition gets worse

The long-term outcome (prognosis) for ovarian cancer that has returned after treatment (is recurrent) depends on whether the cancer has spread. Even with no sign of cancer after treatment, between 30% and 50% of women who are treated for ovarian cancer have cancer return within 5 years.⁴ Women who have cancer return within 6 months after their initial treatment are less likely to respond to more treatment with the same chemotherapy medicines than women whose cancer has returned more than 6 months after their initial treatment. Other chemotherapy medicines may be recommended for further treatment.³
Palliative care
If your cancer gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different from care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life-not just in your body, but also in your mind and spirit. Some people combine palliative care with curative care.
Some treatments for recurrent ovarian cancer, such as chemotherapy and radiation, are considered palliative care. These treatments cannot cure your cancer, but they can extend your life, control your symptoms, reduce your pain, and make you feel more comfortable.
In addition to helping your body feel better, palliative care can help you feel better emotionally and spiritually. Talking with a palliative care provider may help you cope with your feelings about living with a long-term illness. It may also help your loved ones better understand your illness and how to support you. Or it could help you make future plans concerning your health and medical care.

Treatment Overview

(continued)

continued...

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.
For more information, see the topic Palliative Care.
Complementary therapies
In addition to conventional medical treatment, you may wish to try complementary therapies to help manage your symptoms. But complementary therapies are not a substitute for conventional medical treatment that is recommended for ovarian cancer. Complementary therapies include:

• Acupuncture.
• Herbs.
• Biofeedback.
• Meditation.
• Yoga.
• Visualization.
• Vitamins and nutritional supplements.

Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

What To Think About

Some women with ovarian cancer may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries, for all stages of ovarian cancer.
Most treatments for ovarian cancer cause side effects. The side effects that you have depend on the type of treatment used, your age, and your overall health. Your doctor can talk to you about your treatment choices and the side effects associated with each treatment.

• Side effects of chemotherapy may include loss of appetite, nausea, vomiting, diarrhea, mouth sores, or hair loss.
• Side effects of surgery depend on how much surgery was done to treat the stage of your cancer.

Nausea and vomiting are side effects of chemotherapy for ovarian cancer. Your doctor can prescribe medicines to control nausea and vomiting.Talk to your doctor about what to expect and when you should call if you are having nausea or vomiting. Home treatment measures can also help you manage other side effects of treatment.

End-of-life issues

Some women with advanced-stage cancer may choose not to have treatment focused on prolonging life because they decide that for them the time, costs, and side effects of treatment are greater than the benefits. Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to end-of-life care can be difficult. For more information, see the following topics:

Care at the End of Life

Hospice Care

When To Call a Doctor

Ovarian cancer does not cause many symptoms in its early stages. And having symptoms does not always mean you have cancer. These symptoms may be caused by other problems. It is important to talk to your doctor if you have any new symptoms, such as:

• Ongoing cramps or pain in your belly.
• Ongoing pain in your pelvis or lower back.
• Abnormal bleeding from your vagina, especially after menopause if you are not using any hormonal medicines.
• Abnormal discharge from your vagina, containing mucus that may be tinged with blood.
• Pain or bleeding during sex.
• Nausea or loss of appetite or you cannot eat normally.
• Ongoing bloating or intestinal gas that is not relieved by home treatment measures.
• Bigger belly size or a lump that can be felt in your belly.
• Decreased energy level.
• A change in your bowel habits, such as constipation or diarrhea.
• A change in your bladder habits, such as urinary frequency or urgency.
• Weight loss.

Watchful Waiting

Watchful waiting is a period of time during which you and your doctor observe your condition or symptoms without using medical treatment. Watchful waiting is not appropriate if you have symptoms that do not go away. If you are concerned about your symptoms and you have a higher risk for ovarian cancer, call and make an appointment with your doctor.