We still don't fully understand what triggers cells to start dividing uncontrollably to form a tumour, but we have been able to observe certain patterns in people with cancer that tell us about risk factors.
Infection plays a major role in cervical cancer. The number one risk factor for cervical cancer is infection by the sexually transmitted human papillomavirus (HPV). Infection with HPV rarely leads to cervical cancer; infection is a common occurrence and the virus usually goes away by itself. However, it can remain and lead to cancer - and most cervical cancers are related to HPV. When cancer appears in the cervix, it's usually located at a site that's actively inflamed due to infection by this virus. Viruses insert their own DNA into human cells, altering their code. This may be what causes cells to multiply uncontrollably in cervical cancer.
It's been shown repeatedly that women who are young when they lose their virginity and women who have had many sexual partners are at higher risk of the disease. However, most people have been exposed to HPV in their lifetime.
People who smoke are at higher risk of this disease, as with most cancers. The risk also increases steadily with age. Women over age 65 are the most likely to develop cervical cancer. In Canadian studies, people with low incomes had consistently higher rates of cervical cancer. The most dramatic risk elevation was found in First Nations women, who are 2 to 6 times as likely to develop cervical cancer as non-Native women.
There's limited evidence that certain families have a higher risk of developing cervical cancer. It's likely that some cell types are more susceptible to HPV than others. Like many diseases, cervical cancer is probably caused by a combination of genetic and environmental factors.
Cervical dysplasia is a term that describes new growths of abnormal tissue that often appear in the cervix and sometimes forewarn of cancer. Today, a classification system called the Bethesda system is used to describe abnormalities on the Pap test. Although it is much more complicated than the previous system, it is more specific and exact with its details.
The Facts on Cervical Cancer
Posteado en en por
Cervical cancers are among the most common cancerous (malignant) tumours. Fortunately, a large majority of women diagnosed with this disease are completely cured. This is because the tumours tend to grow slowly. Women are encouraged to have regular Pap tests, as this allows for early detection of tumours in most cases, and therefore plenty of time to treat them.
Girls and women aged 9 to 26 can also reduce their risk of cervical cancer by having the cervical cancer vaccine. Recommendations for Pap tests vary from province to province. All provincial programs target women between the ages of 18 and 69.
In a typical year, about 1,450 Canadian women are diagnosed with cervical cancer, and about 430 will not survive it. Most of those who die are in the oldest age groups, and almost all of them are people whose cancer had already spread before it was detected. This is only likely to happen if you don't have regular Pap smears done. The death rate from cervical cancer is now 90% lower than it was before the Pap smear was invented in 1941. The Pap test can actually tell in advance which people are likely to develop cervical cancer in the near future, allowing doctors to act to prevent the disease from appearing.
The tissues of the cervix are very prone to undergo abnormal changes, and many women have tumours or neoplasms (new growths) in these areas of the reproductive system. Only a minority of these changes are actually cancerous. Some are benign, which means that they won't multiply and spread to other organs, and therefore aren't cancerous. Others are considered precancerous, and may require surgical treatment similar to that used to cure cancer itself. Many women who don't actually have cancer still need to be treated by an oncologist (a doctor who treats cancer).
Preventing cancer may require a time-consuming series of diagnostic and surgical procedures. Similarly, women who have been cured of cervical cancer often need further treatment, especially if radiation was used. The latest prevention method is a vaccination against 4 common types of HPV. HPV, or human papillomavirus, is a sexually transmitted virus that can cause cervical cancer and other health problems. The vaccine prevents against the types of HPV that cause about 70% of all cervical cancers. It is a highly effective way to reduce the likelihood of developing a number of conditions caused by the human papillomavirus. The vaccination is available for girls and women 9 to 26 years of age.
Girls and women aged 9 to 26 can also reduce their risk of cervical cancer by having the cervical cancer vaccine. Recommendations for Pap tests vary from province to province. All provincial programs target women between the ages of 18 and 69.
In a typical year, about 1,450 Canadian women are diagnosed with cervical cancer, and about 430 will not survive it. Most of those who die are in the oldest age groups, and almost all of them are people whose cancer had already spread before it was detected. This is only likely to happen if you don't have regular Pap smears done. The death rate from cervical cancer is now 90% lower than it was before the Pap smear was invented in 1941. The Pap test can actually tell in advance which people are likely to develop cervical cancer in the near future, allowing doctors to act to prevent the disease from appearing.
The tissues of the cervix are very prone to undergo abnormal changes, and many women have tumours or neoplasms (new growths) in these areas of the reproductive system. Only a minority of these changes are actually cancerous. Some are benign, which means that they won't multiply and spread to other organs, and therefore aren't cancerous. Others are considered precancerous, and may require surgical treatment similar to that used to cure cancer itself. Many women who don't actually have cancer still need to be treated by an oncologist (a doctor who treats cancer).
Preventing cancer may require a time-consuming series of diagnostic and surgical procedures. Similarly, women who have been cured of cervical cancer often need further treatment, especially if radiation was used. The latest prevention method is a vaccination against 4 common types of HPV. HPV, or human papillomavirus, is a sexually transmitted virus that can cause cervical cancer and other health problems. The vaccine prevents against the types of HPV that cause about 70% of all cervical cancers. It is a highly effective way to reduce the likelihood of developing a number of conditions caused by the human papillomavirus. The vaccination is available for girls and women 9 to 26 years of age.
Cervical Cancer
Posteado en en por
"Cancer" is an umbrella term that denotes a group of more than 100 different diseases. They all affect the body's basic unit, the cell. Cancer occurs when cells become abnormal and divide without control.
All of the organs of the body are made up of many types of cells. Normally, cells divide to produce more cells only when the body needs them. This orderly process helps keep us healthy. If cells keep dividing when new cells are not needed, a mass of tissue forms. This mass of extra tissue, called a growth or tumor, can be either benign or malignant.
Benign tumors are not cancerous. They can usually be removed, and in most cases, they do not come back. The most important distinction is that cells from benign tumors do not spread to other parts of the body. Benign tumors are not a threat to life. Polyps, cysts and genital warts are types of benign growths of the cervix.
Malignant tumors are cancerous. Cancer cells can invade and damage tissues and organs near the tumor. Cancer cells can also break away from a malignant tumor and enter the lymph system or the bloodstream. This is how cancer of the cervix can spread to other parts of the body, such as nearby lymph nodes, the rectum, the bladder, the bones of the spine and the lungs. The spread of cancer is called metastasis.
Like all other organs of the body, the cervix is made up of many types of cells. Normally, cells divide to produce more cells only when the body needs them. This orderly process helps keep us healthy. Ninety percent of cervical cancers arise from the flattened or "squamous" cells covering the cervix. Most of the remaining 10 percent arise from the glandular, mucus-secreting cells of the cervical canal leading into the uterus.
Each year, about 15,000 women in the United States learn that they have cancer of the cervix.
The development of cervical cancer is gradual and begins as a pre-cancerous condition called dysplasia. In this form, it is 100 percent treatable, usually without the need for a hysterectomy.
Dysplasia, depending on its severity, can often resolve without treatment. More often, it eventually progresses to actual cancer--called “carcinoma in situ” (CIS) when it has not yet spread and “microinvasive” when it has spread only a few millimeters into the surrounding tissue and has not yet penetrated blood vessels and lymph channels.
This process may take many years, but once the cancer is established, it quickly spreads further into the nearby tissues or to other organs--usually the intestines, liver and lung. There are often no symptoms of cervical cancer until the disease is advanced.
The majority of women today diagnosed with cervical cancer have either not had regular Pap smears or have not followed up after having an abnormal smear. Not having regular Pap smears is the single greatest risk factor for a bad outcome in women who develop cervical cancer.
Risk factors for cervical cancer include:
--infection with human papilloma virus or HPV, the cause of genital warts (Not all women who have HPV infection develop cervical cancer. Scientists believe that certain other factors they call co-factors are involved in its development. One co-factor is smoking. Tobacco use damages the immune system and interferes with the body's ability to resist HPV infection in the cervix);
--multiple sexual partners and/or partners who have multiple partners;
--beginning sexual intercourse at an early age.
In the early 1970's, it was discovered that women whose mothers took an estrogen drug called DES (diethylstilbestrol) during pregnancy are at risk of a rare form of cervical and vaginal cancer. This drug was used from 1938 until 1971, and was sometimes combined with prenatal vitamins in the mistaken belief that it prevented miscarriages. If you are old enough to be a “DES baby,” ask your mother if she was ever given this drug. For more information, go to the DES Action web page.
There is a small increased risk of abnormal Pap smears among women who take birth-control pills. It is thought that this is because such women are more sexually active, are less likely to use condoms and have more frequent Pap smears in order to be prescribed the birth-control pill.
Women whose immune systems are weakened--such as those with HIV infection or women who have received organ transplants and are taking drugs to suppress the immune system--may be at a higher risk.
Infections with genital herpes or chronic Chlamydia infections, both STDs, may increase risk.
Poor women may be at higher risk because they are not able to afford regular Pap smears. Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the U.S., where it has been declining. This is due almost entirely to the use of the Pap smear, which has reduced the death rate from this disease by 70 percent since it was introduced in 1941. Yet according to the American Cancer Society, 12,800 women were diagnosed with cervical cancer in the year 2000, and there were 4,600 deaths from this disease.
Symptoms
Precancerous changes of the cervix usually do not cause pain. In fact, they generally do not cause any symptoms, and are not detected unless a woman has a pelvic exam and a Pap test.
Symptoms usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue. When this happens, the most common symptom is abnormal bleeding. Bleeding may start and stop between regular menstrual periods, or it may occur after sexual intercourse, douching or a pelvic exam. Menstrual bleeding may last longer and be heavier than usual. Bleeding after menopause may also be a symptom of cervical cancer, as is Increased vaginal discharge.
These symptoms may be caused by cancer or by other health problems; only a doctor can tell for sure. It is important for a woman to see her doctor if she is experiencing any of these symptoms.
Prevention
The vast majority of cervical cancers can be prevented. Since the most common form of cervical cancer starts with preventable and easily detectable precancerous changes, there are ways to prevent this disease.
All of the organs of the body are made up of many types of cells. Normally, cells divide to produce more cells only when the body needs them. This orderly process helps keep us healthy. If cells keep dividing when new cells are not needed, a mass of tissue forms. This mass of extra tissue, called a growth or tumor, can be either benign or malignant.
Benign tumors are not cancerous. They can usually be removed, and in most cases, they do not come back. The most important distinction is that cells from benign tumors do not spread to other parts of the body. Benign tumors are not a threat to life. Polyps, cysts and genital warts are types of benign growths of the cervix.
Malignant tumors are cancerous. Cancer cells can invade and damage tissues and organs near the tumor. Cancer cells can also break away from a malignant tumor and enter the lymph system or the bloodstream. This is how cancer of the cervix can spread to other parts of the body, such as nearby lymph nodes, the rectum, the bladder, the bones of the spine and the lungs. The spread of cancer is called metastasis.
Like all other organs of the body, the cervix is made up of many types of cells. Normally, cells divide to produce more cells only when the body needs them. This orderly process helps keep us healthy. Ninety percent of cervical cancers arise from the flattened or "squamous" cells covering the cervix. Most of the remaining 10 percent arise from the glandular, mucus-secreting cells of the cervical canal leading into the uterus.
Each year, about 15,000 women in the United States learn that they have cancer of the cervix.
The development of cervical cancer is gradual and begins as a pre-cancerous condition called dysplasia. In this form, it is 100 percent treatable, usually without the need for a hysterectomy.
Dysplasia, depending on its severity, can often resolve without treatment. More often, it eventually progresses to actual cancer--called “carcinoma in situ” (CIS) when it has not yet spread and “microinvasive” when it has spread only a few millimeters into the surrounding tissue and has not yet penetrated blood vessels and lymph channels.
This process may take many years, but once the cancer is established, it quickly spreads further into the nearby tissues or to other organs--usually the intestines, liver and lung. There are often no symptoms of cervical cancer until the disease is advanced.
The majority of women today diagnosed with cervical cancer have either not had regular Pap smears or have not followed up after having an abnormal smear. Not having regular Pap smears is the single greatest risk factor for a bad outcome in women who develop cervical cancer.
Risk factors for cervical cancer include:
--infection with human papilloma virus or HPV, the cause of genital warts (Not all women who have HPV infection develop cervical cancer. Scientists believe that certain other factors they call co-factors are involved in its development. One co-factor is smoking. Tobacco use damages the immune system and interferes with the body's ability to resist HPV infection in the cervix);
--multiple sexual partners and/or partners who have multiple partners;
--beginning sexual intercourse at an early age.
In the early 1970's, it was discovered that women whose mothers took an estrogen drug called DES (diethylstilbestrol) during pregnancy are at risk of a rare form of cervical and vaginal cancer. This drug was used from 1938 until 1971, and was sometimes combined with prenatal vitamins in the mistaken belief that it prevented miscarriages. If you are old enough to be a “DES baby,” ask your mother if she was ever given this drug. For more information, go to the DES Action web page.
There is a small increased risk of abnormal Pap smears among women who take birth-control pills. It is thought that this is because such women are more sexually active, are less likely to use condoms and have more frequent Pap smears in order to be prescribed the birth-control pill.
Women whose immune systems are weakened--such as those with HIV infection or women who have received organ transplants and are taking drugs to suppress the immune system--may be at a higher risk.
Infections with genital herpes or chronic Chlamydia infections, both STDs, may increase risk.
Poor women may be at higher risk because they are not able to afford regular Pap smears. Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the U.S., where it has been declining. This is due almost entirely to the use of the Pap smear, which has reduced the death rate from this disease by 70 percent since it was introduced in 1941. Yet according to the American Cancer Society, 12,800 women were diagnosed with cervical cancer in the year 2000, and there were 4,600 deaths from this disease.
Symptoms
Precancerous changes of the cervix usually do not cause pain. In fact, they generally do not cause any symptoms, and are not detected unless a woman has a pelvic exam and a Pap test.
Symptoms usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue. When this happens, the most common symptom is abnormal bleeding. Bleeding may start and stop between regular menstrual periods, or it may occur after sexual intercourse, douching or a pelvic exam. Menstrual bleeding may last longer and be heavier than usual. Bleeding after menopause may also be a symptom of cervical cancer, as is Increased vaginal discharge.
These symptoms may be caused by cancer or by other health problems; only a doctor can tell for sure. It is important for a woman to see her doctor if she is experiencing any of these symptoms.
Prevention
The vast majority of cervical cancers can be prevented. Since the most common form of cervical cancer starts with preventable and easily detectable precancerous changes, there are ways to prevent this disease.
Metastatic Disease to the Spine and Related Structures
Posteado en en por
Introduction
Background
Spinal metastasis is common in patients with cancer. The spine is the third most common site for cancer cells to metastasize, following the lung and the liver. Approximately 60-70% of patients with systemic cancer will have spinal metastasis; fortunately, only 10% of these patients are symptomatic. Approximately 94-98% of these patients present with epidural and/or vertebral involvement. Intradural extramedullary and intramedullary seeding of systemic cancer is unusual; they account for 5-6% and 0.5-1% of spinal metastases, respectively.
Metastatic disease to the neuraxis other than the brain parenchyma and the spinal column is uncommon. The incidence of cancer cells invading the leptomeninges is as high as 8-13%. In autopsy studies, the rate has been estimated to be 25%.
Pathophysiology
Spread from primary tumors is mainly by the arterial route. Retrograde spread through the Batson plexus during Valsalva maneuver is postulated. Direct invasion through the intervertebral foramina also can occur. Besides mass effect, an epidural mass can cause cord distortion, resulting in demyelination or axonal destruction. Vascular compromise produces venous congestion and vasogenic edema of the spinal cord, resulting in venous infarction and hemorrhage.
About 70% of symptomatic lesions are found in the thoracic region of the spine, particularly at the level of T4-T7. Of the remainder, 20% are found in the lumbar region and 10% are found in the cervical spine. More than 50% of patients with spinal metastasis have several levels of involvement. About 10-38% of patients have involvement of several noncontiguous segments. Intramural and intramedullary metastases are not as common as those of the vertebral body and the epidural space. Isolated epidural involvement accounts for less than 10% of cases; it is particularly common in lymphoma and renal cell carcinoma. Most of the lesions are localized at the anterior portion of the vertebral body (60%). In 30% of cases, the lesion infiltrates the pedicle or lamina. A few patients have disease in both posterior and anterior parts of the spine.
Primary sources for spinal metastatic disease include the following:
•Lung - 31%
•Breast - 24%
•GI tract - 9%
•Prostate - 8%
•Lymphoma - 6%
•Melanoma - 4%
•Unknown - 2%
•Kidney - 1%
•Others including multiple myeloma - 13%
Frequency
United States
The spine is the most common site for metastatic disease. About 30-70% of patients with a primary tumor have spinal metastatic disease at autopsy. Spinal metastases are slightly more common in men than in women and adults aged 40-65 years than in others.
Mortality/Morbidity
•Median survival of patients with spinal metastatic disease is 10 months.
•The morbidity of spinal metastatic disease is important, especially in patients with paralysis and/or bowel and bladder involvement. The latter compromises the quality of life of patients with cancer and puts an additional burden on their caregivers. Cord compression is normally seen as preterminal event. Median survival at that stage is about 3 months.
Clinical
History
Spinal metastasis may be the initial presentation in 10% of patients with systemic cancer. About 2% of symptomatic patients have no identifiable systemic disease.
Approximately 90% of patients present with bone and/or back pain followed by radicular pain. About 50% of these patients have sensory and motor dysfunction, and more than 50% have bowel and bladder dysfunction.
About 5-10% of patients with cancer present with cord compression as their initial symptom. Among those who present with cord compression, 50% are nonambulatory at diagnosis, and 15% are paraplegic.
Bone pain at night in a patient with systemic cancer is always an ominous symptom. In fact, it is the most ominous symptom in patients with metastatic disease to the spine.
Background
Spinal metastasis is common in patients with cancer. The spine is the third most common site for cancer cells to metastasize, following the lung and the liver. Approximately 60-70% of patients with systemic cancer will have spinal metastasis; fortunately, only 10% of these patients are symptomatic. Approximately 94-98% of these patients present with epidural and/or vertebral involvement. Intradural extramedullary and intramedullary seeding of systemic cancer is unusual; they account for 5-6% and 0.5-1% of spinal metastases, respectively.
Metastatic disease to the neuraxis other than the brain parenchyma and the spinal column is uncommon. The incidence of cancer cells invading the leptomeninges is as high as 8-13%. In autopsy studies, the rate has been estimated to be 25%.
Pathophysiology
Spread from primary tumors is mainly by the arterial route. Retrograde spread through the Batson plexus during Valsalva maneuver is postulated. Direct invasion through the intervertebral foramina also can occur. Besides mass effect, an epidural mass can cause cord distortion, resulting in demyelination or axonal destruction. Vascular compromise produces venous congestion and vasogenic edema of the spinal cord, resulting in venous infarction and hemorrhage.
About 70% of symptomatic lesions are found in the thoracic region of the spine, particularly at the level of T4-T7. Of the remainder, 20% are found in the lumbar region and 10% are found in the cervical spine. More than 50% of patients with spinal metastasis have several levels of involvement. About 10-38% of patients have involvement of several noncontiguous segments. Intramural and intramedullary metastases are not as common as those of the vertebral body and the epidural space. Isolated epidural involvement accounts for less than 10% of cases; it is particularly common in lymphoma and renal cell carcinoma. Most of the lesions are localized at the anterior portion of the vertebral body (60%). In 30% of cases, the lesion infiltrates the pedicle or lamina. A few patients have disease in both posterior and anterior parts of the spine.
Primary sources for spinal metastatic disease include the following:
•Lung - 31%
•Breast - 24%
•GI tract - 9%
•Prostate - 8%
•Lymphoma - 6%
•Melanoma - 4%
•Unknown - 2%
•Kidney - 1%
•Others including multiple myeloma - 13%
Frequency
United States
The spine is the most common site for metastatic disease. About 30-70% of patients with a primary tumor have spinal metastatic disease at autopsy. Spinal metastases are slightly more common in men than in women and adults aged 40-65 years than in others.
Mortality/Morbidity
•Median survival of patients with spinal metastatic disease is 10 months.
•The morbidity of spinal metastatic disease is important, especially in patients with paralysis and/or bowel and bladder involvement. The latter compromises the quality of life of patients with cancer and puts an additional burden on their caregivers. Cord compression is normally seen as preterminal event. Median survival at that stage is about 3 months.
Clinical
History
Spinal metastasis may be the initial presentation in 10% of patients with systemic cancer. About 2% of symptomatic patients have no identifiable systemic disease.
Approximately 90% of patients present with bone and/or back pain followed by radicular pain. About 50% of these patients have sensory and motor dysfunction, and more than 50% have bowel and bladder dysfunction.
About 5-10% of patients with cancer present with cord compression as their initial symptom. Among those who present with cord compression, 50% are nonambulatory at diagnosis, and 15% are paraplegic.
Bone pain at night in a patient with systemic cancer is always an ominous symptom. In fact, it is the most ominous symptom in patients with metastatic disease to the spine.
Cancer in the Spine: Comprehensive Care
Posteado en en por
When a plant goes to seed, its seeds are carried in all directions; but they can only live and grow if they fall on congenial soil." This analogy, in an article by the English surgeon Steven Paget published in the Lancet in 1889, was an attempt to explain the predilection of certain types of cancer to spread to bone and other tissues. More than a century later, the "seed and soil" theory is still being debated, and the discourse has expanded to include the biologic effect that the seed has on the soil after implantation. In an early chapter of this book, Cancer in the Spine, David G. Hicks outlines what is known about the biology of metastatic disease. In addition to the "congenial" environment of the spine, regional venous drainage, angiogenesis, cell adhesion, and growth factors are all responsible for disseminating tumor cells. One of the initial steps in metastasis to bone is the stimulation of osteoclastic resorption. The resultant osteolysis is responsible for many of the clinical sequelae of metastatic disease — bone pain, pathologic fractures, spinal deformity, and spinal cord compression. The recognition of these molecular mechanisms has led to new forms of treatment, including bisphosphonate therapy, to inhibit the activity of osteoclasts.
Approximately 500,000 patients present with spinal metastases each year, and symptomatic spinal cord compression will develop in nearly 20,000 of them. Improved cancer-survival rates, combined with an aging population, will increase the prevalence of spinal metastases in the future. Major advances in the diagnosis and treatment of spinal neoplasms have led to an improved quality of life for these patients and to cures for the small group of patients with primary spinal malignant tumors.
Interdisciplinary collaboration is the key to managing the care of patients with spinal tumors. Treatment often involves multiple methods, including chemotherapy, radiation therapy, and surgery. The editor of this book, Robert F. McLain, has assembled an excellent resource for practitioners and students of all the disciplines involved in the care of patients with cancer of the spine. Although the book does not delve sufficiently into detail to serve as a stand-alone resource for any specialty, it does an excellent job of providing an overview of the field. Readers will gain an appreciation of numerous treatment options and an understanding of how they relate to one another. The book has clinically relevant chapters on pathophysiology and a section on the diagnostic evaluation of spinal tumors. The types of primary tumors that most commonly spread to bone are discussed in separate chapters and followed by a section in which each treatment method is discussed individually. One of the final chapters includes a helpful list of clinical practice guidelines for cancer surveillance and screening after initial treatment. The book ends with a cogent discussion by Edward C. Benzel and others, entitled "When Is Enough, Enough?" in which hospice care and the role of palliative surgery are discussed. The authors stress the importance of multidisciplinary collaboration and the involvement of the patient and his or her family in the complex and emotionally charged decision-making process.
I do not find fault with anything about this book. McLain practices at the Cleveland Clinic Foundation, as do 4 of the 5 section editors and 33 of the 65 contributors. Although having contributions by so many persons from one institution could be seen as detracting from the book, each chapter is well referenced, the recommendations are evidence based, and there is no hint of institutional bias. The book is also balanced, with excellent chapters by authors from other high-quality institutions, including the Memorial Sloan-Kettering Cancer Center, Massachusetts General Hospital, the University of Texas M.D. Anderson Cancer Center, Johns Hopkins University, and others. Cancer in the Spine is a compact gem of succinct chapters that provide a multidisciplinary overview of this complex topic.
Bradford L. Currier, M.D.
Mayo Clinic
Rochester, MN 55905
Approximately 500,000 patients present with spinal metastases each year, and symptomatic spinal cord compression will develop in nearly 20,000 of them. Improved cancer-survival rates, combined with an aging population, will increase the prevalence of spinal metastases in the future. Major advances in the diagnosis and treatment of spinal neoplasms have led to an improved quality of life for these patients and to cures for the small group of patients with primary spinal malignant tumors.
Interdisciplinary collaboration is the key to managing the care of patients with spinal tumors. Treatment often involves multiple methods, including chemotherapy, radiation therapy, and surgery. The editor of this book, Robert F. McLain, has assembled an excellent resource for practitioners and students of all the disciplines involved in the care of patients with cancer of the spine. Although the book does not delve sufficiently into detail to serve as a stand-alone resource for any specialty, it does an excellent job of providing an overview of the field. Readers will gain an appreciation of numerous treatment options and an understanding of how they relate to one another. The book has clinically relevant chapters on pathophysiology and a section on the diagnostic evaluation of spinal tumors. The types of primary tumors that most commonly spread to bone are discussed in separate chapters and followed by a section in which each treatment method is discussed individually. One of the final chapters includes a helpful list of clinical practice guidelines for cancer surveillance and screening after initial treatment. The book ends with a cogent discussion by Edward C. Benzel and others, entitled "When Is Enough, Enough?" in which hospice care and the role of palliative surgery are discussed. The authors stress the importance of multidisciplinary collaboration and the involvement of the patient and his or her family in the complex and emotionally charged decision-making process.
I do not find fault with anything about this book. McLain practices at the Cleveland Clinic Foundation, as do 4 of the 5 section editors and 33 of the 65 contributors. Although having contributions by so many persons from one institution could be seen as detracting from the book, each chapter is well referenced, the recommendations are evidence based, and there is no hint of institutional bias. The book is also balanced, with excellent chapters by authors from other high-quality institutions, including the Memorial Sloan-Kettering Cancer Center, Massachusetts General Hospital, the University of Texas M.D. Anderson Cancer Center, Johns Hopkins University, and others. Cancer in the Spine is a compact gem of succinct chapters that provide a multidisciplinary overview of this complex topic.
Bradford L. Currier, M.D.
Mayo Clinic
Rochester, MN 55905
Cancer of the Spine
Posteado en en por
While primary tumors of the vertebrae (e.g., multiple myeloma) are uncommon, metastases to the spine are frequent. The spine is the most common site for skeletal metastases.22 At autopsy, 70% of patients who die from cancer demonstrate vertebral metastases,23 and more than 5% have evidence of metastatic compression of the spinal cord.24 This is usually an extradural anterior mass that involves bone. Intradural extramedullary tumors are usually histologically benign meningiomas or neurofibromas. Gliomas (i.e., ependymomas, astrocytomas, and medulloblastomas) are usually intramedullary, although occasionally they are also found in an extramedullary site. Although the response to treatment is quite different for all of these histologically distant tumors, the neurologic symptoms, signs, and rehabilitation interventions are quite similar.
Injury to the spinal cord and peripheral nerves is a recognized risk of therapeutic radiation that may not become manifest for many months, or even years.25 A transient radiation myelopathy primarily involving sensory neurons may occur in 10 to 15% of patients receiving mantle radiation for Hodgkin's disease.26 This condition is usually associated only with sensory symptoms, such as paresthesias and Lhermitte's sign, and resolves in 1 to 9 months.26 Delayed radiation myelopathy is an irreversible and progressive neurologic condition that may affect motor, sensory, and sphincter functions and has a reported incidence of 1 to 12%.27
Clinical Presentation
By far the most frequent presenting symptom of a tumor of the spine is pain. The pain may be localized, diffuse, or radicular in nature. It is characteristically made worse by activity and by straining. Different from more benign back pain, the pain caused by tumors tends to be persistent, to be present or even worse at night, and is not relieved by rest. Additional symptoms at presentation may be weakness of the legs, difficulty in walking, and urinary sphincteric problems leading to incontinence.
Neurologic deficits may develop insidiously or occur suddenly, depending on the tumor's rate of growth and location, or on the occurrence of a sudden pathologic fracture. Slowly progressive neurologic dysfunction is often seen with tumors of the lower spine that encroach on the cauda equina, whereas tumors of the thoracic spine may cause the sudden collapse of a vertebral body with direct compression of the spinal cord or of its blood supply. Although only half of all tumors of the spine are located in the thoracic region, these cause 70% of all spinal cord compressions that result in paraplegia. Such paraplegia may be neurologically complete, that is, with total paralysis and sensory loss below the level of the lesion. More frequently, however, the neurologic lesion is incomplete, with sensation and motor function preserved to varying degrees, as may be rated by the ASIA Impairment Scale,28 which is a modified version of the Frankel Scale.29,30 Impaired bladder and bowel control at first may present clinically as urinary urgency or hesitancy, but with progressive cord compression, urinary retention or bowel and bladder incontinence may occur.
Treatment
Proper rehabilitation management planning and intervention depend on an accurate diagnosis and staging of the tumor, just as does the medical and surgical management. Most patients with spinal metastases can and should be managed nonsurgically with radiation, chemotherapy, and orthotic stabilization of the spine, since it has been demonstrated that radiation alone provides results that are similar to those of surgery followed by radiation.31 In general, laminectomy with decompression has been found to be of limited use as compared with radiation, since the compressive lesion is usually located anteriorly to the cord, and the surgical procedure itself contributes to spinal instability. However, profound neurologic deficits, especially when occurring rapidly, may warrant surgical decompression, which preferably should be done by an anterior approach followed by surgical stabilization of the spine. Surgical decompression of the spinal cord is not very effective once the patient has become completely paraplegic. Surgical stabilization may often be indicated when gross spinal instability is present, as two of the three “columns” (anterior, middle, and posterior) of the spine have been destroyed by the tumor.32 The extent of surgical stabilization varies, depending on the patient's anticipated life expectancy. Patients with short life expectancy (less than 1 year) benefit most from a relatively simple procedure employing methylmethacrylate, which allows immediate spinal stability and rapid mobilization of the patient, whereas patients with a more favorable prognosis may be better served by vertebrectomy, spinal instrumentation, and bony fusion in conjunction with methylmethacrylate.32
Spinal metastases and myelomatous lesions, even when accompanied by compression fractures and minor or modest spinal instability, can be successfully managed by spinal orthotic support and radiation. Both modalities may significantly decrease pain. Lesions in the cervical spine are most rigidly immobilized by a halo brace (Fig. 71.1) but also may be adequately supported by a SOMI brace (sternal-occipital-mandibular immobilizer) (Fig. 71.2). When such lesions are present in the upper thoracic spine, spinal orthoses may not be necessary, as this part of the spine is stabilized inherently by the rib cage. Lesions in the more mobile lower thoracic and lumbar spine are often associated with severe pain. An adjustable thoracolumbar sacral (TLS) orthosis (Fig. 71.3) with posterior stays may provide sufficient support for less severe lesions, decrease pain, and allow greater mobility. The soft anterior portion of the corset, the apron, should fit snugly over the entire abdomen for optimal support. Larger lesions and postoperative conditions may require fabrication of a custom-molded plastic TLS brace, a two-piece removable orthosis (Fig. 71.4) that firmly grabs the pelvis below and the chest above.
When neurologic loss has occurred, the rehabilitation therapy must be carefully individualized, on the basis of the extent of the neurologic dysfunction, the medical/surgical condition, and the patient's life expectancy. Spinal cord dysfunction with severe or complete paralysis and sensory loss, and perhaps bladder and bowel dysfunction, warrants a comprehensive but relatively short-term rehabilitation program involving as many members of the rehabilitation team as judged appropriate by the physiatrist. The rehabilitation programs should be designed to address each of the many clinical complications and conditions that may be seen in individuals with spinal cord dysfunction of traumatic origin (Table 71.6). Early intervention should include bedside physical and occupational therapy, establishment of bowel and bladder training programs, and the application of nursing principles to prevent complications, such as pressure sores and joint contractures, that increase morbidity, worsen the functional prognosis, and prolong the rehabilitation phase. Proper positioning of the patient in bed and turning at least every 2 hours is of paramount importance in this regard. The patient and family are given emotional support and are educated in the medical aspects of spinal cord dysfunction and management. If the prognosis is poor (i.e., less than 6 months) the patient is instructed early in the ADL skills, which he or she can quickly learn to perform, and provided with the necessary assistive devices, such as a wheelchair, nursing supplies, and personal assistance. As soon as medically appropriate, discharge from the hospital to the home or a nursing facility can be accomplished. When life expectancy is greater and the general criteria for admission to the inpatient rehabilitation service are met, the patient may be transferred there for a more comprehensive and intensive rehabilitation program
Injury to the spinal cord and peripheral nerves is a recognized risk of therapeutic radiation that may not become manifest for many months, or even years.25 A transient radiation myelopathy primarily involving sensory neurons may occur in 10 to 15% of patients receiving mantle radiation for Hodgkin's disease.26 This condition is usually associated only with sensory symptoms, such as paresthesias and Lhermitte's sign, and resolves in 1 to 9 months.26 Delayed radiation myelopathy is an irreversible and progressive neurologic condition that may affect motor, sensory, and sphincter functions and has a reported incidence of 1 to 12%.27
Clinical Presentation
By far the most frequent presenting symptom of a tumor of the spine is pain. The pain may be localized, diffuse, or radicular in nature. It is characteristically made worse by activity and by straining. Different from more benign back pain, the pain caused by tumors tends to be persistent, to be present or even worse at night, and is not relieved by rest. Additional symptoms at presentation may be weakness of the legs, difficulty in walking, and urinary sphincteric problems leading to incontinence.
Neurologic deficits may develop insidiously or occur suddenly, depending on the tumor's rate of growth and location, or on the occurrence of a sudden pathologic fracture. Slowly progressive neurologic dysfunction is often seen with tumors of the lower spine that encroach on the cauda equina, whereas tumors of the thoracic spine may cause the sudden collapse of a vertebral body with direct compression of the spinal cord or of its blood supply. Although only half of all tumors of the spine are located in the thoracic region, these cause 70% of all spinal cord compressions that result in paraplegia. Such paraplegia may be neurologically complete, that is, with total paralysis and sensory loss below the level of the lesion. More frequently, however, the neurologic lesion is incomplete, with sensation and motor function preserved to varying degrees, as may be rated by the ASIA Impairment Scale,28 which is a modified version of the Frankel Scale.29,30 Impaired bladder and bowel control at first may present clinically as urinary urgency or hesitancy, but with progressive cord compression, urinary retention or bowel and bladder incontinence may occur.
Treatment
Proper rehabilitation management planning and intervention depend on an accurate diagnosis and staging of the tumor, just as does the medical and surgical management. Most patients with spinal metastases can and should be managed nonsurgically with radiation, chemotherapy, and orthotic stabilization of the spine, since it has been demonstrated that radiation alone provides results that are similar to those of surgery followed by radiation.31 In general, laminectomy with decompression has been found to be of limited use as compared with radiation, since the compressive lesion is usually located anteriorly to the cord, and the surgical procedure itself contributes to spinal instability. However, profound neurologic deficits, especially when occurring rapidly, may warrant surgical decompression, which preferably should be done by an anterior approach followed by surgical stabilization of the spine. Surgical decompression of the spinal cord is not very effective once the patient has become completely paraplegic. Surgical stabilization may often be indicated when gross spinal instability is present, as two of the three “columns” (anterior, middle, and posterior) of the spine have been destroyed by the tumor.32 The extent of surgical stabilization varies, depending on the patient's anticipated life expectancy. Patients with short life expectancy (less than 1 year) benefit most from a relatively simple procedure employing methylmethacrylate, which allows immediate spinal stability and rapid mobilization of the patient, whereas patients with a more favorable prognosis may be better served by vertebrectomy, spinal instrumentation, and bony fusion in conjunction with methylmethacrylate.32
Spinal metastases and myelomatous lesions, even when accompanied by compression fractures and minor or modest spinal instability, can be successfully managed by spinal orthotic support and radiation. Both modalities may significantly decrease pain. Lesions in the cervical spine are most rigidly immobilized by a halo brace (Fig. 71.1) but also may be adequately supported by a SOMI brace (sternal-occipital-mandibular immobilizer) (Fig. 71.2). When such lesions are present in the upper thoracic spine, spinal orthoses may not be necessary, as this part of the spine is stabilized inherently by the rib cage. Lesions in the more mobile lower thoracic and lumbar spine are often associated with severe pain. An adjustable thoracolumbar sacral (TLS) orthosis (Fig. 71.3) with posterior stays may provide sufficient support for less severe lesions, decrease pain, and allow greater mobility. The soft anterior portion of the corset, the apron, should fit snugly over the entire abdomen for optimal support. Larger lesions and postoperative conditions may require fabrication of a custom-molded plastic TLS brace, a two-piece removable orthosis (Fig. 71.4) that firmly grabs the pelvis below and the chest above.
When neurologic loss has occurred, the rehabilitation therapy must be carefully individualized, on the basis of the extent of the neurologic dysfunction, the medical/surgical condition, and the patient's life expectancy. Spinal cord dysfunction with severe or complete paralysis and sensory loss, and perhaps bladder and bowel dysfunction, warrants a comprehensive but relatively short-term rehabilitation program involving as many members of the rehabilitation team as judged appropriate by the physiatrist. The rehabilitation programs should be designed to address each of the many clinical complications and conditions that may be seen in individuals with spinal cord dysfunction of traumatic origin (Table 71.6). Early intervention should include bedside physical and occupational therapy, establishment of bowel and bladder training programs, and the application of nursing principles to prevent complications, such as pressure sores and joint contractures, that increase morbidity, worsen the functional prognosis, and prolong the rehabilitation phase. Proper positioning of the patient in bed and turning at least every 2 hours is of paramount importance in this regard. The patient and family are given emotional support and are educated in the medical aspects of spinal cord dysfunction and management. If the prognosis is poor (i.e., less than 6 months) the patient is instructed early in the ADL skills, which he or she can quickly learn to perform, and provided with the necessary assistive devices, such as a wheelchair, nursing supplies, and personal assistance. As soon as medically appropriate, discharge from the hospital to the home or a nursing facility can be accomplished. When life expectancy is greater and the general criteria for admission to the inpatient rehabilitation service are met, the patient may be transferred there for a more comprehensive and intensive rehabilitation program
Metastatic Liver Cancer
Posteado en en por
Metastatic liver cancer is a cancer that has spread to the liver from elsewhere in the body.
Weight loss and a poor appetite may be the first symptoms.
Doctors base the diagnosis on results of blood tests and usually biopsy.
Chemotherapy drugs and radiation therapy may help relieve symptoms but do not cure the cancer.
Metastatic liver cancer most commonly originates in the lungs, breasts, large intestine, pancreas, or stomach. Leukemia (a cancer of white blood cells) and lymphoma (a cancer of the lymph system), especially Hodgkin's disease, may involve the liver. Cancers spread to the liver because the liver filters most of the blood from the rest of the body, and when cancer cells break away from a primary cancer, they often enter and travel through the bloodstream. Sometimes the discovery of metastatic liver cancer is the first indication that a person has cancer.
Symptoms
Often, the first symptoms are vague. They include weight loss, poor appetite, and sometimes fever. Typically, the liver is enlarged and hard. It may feel tender and often lumpy. Occasionally, the spleen is enlarged, especially if the cancer originated in the pancreas. At first, unless the cancer is blocking the bile ducts, the person has mild or no jaundice (a yellowish discoloration of the skin and the whites of the eyes). Later, the abdominal cavity may become swollen (distended) with fluid (a condition called ascites—see Manifestations of Liver Disease: Ascites). In the weeks before death, jaundice progressively worsens. People may become confused and drowsy as toxins accumulate in the brain because the liver is too damaged to remove them from the blood. This condition is called liver encephalopathy (see Manifestations of Liver Disease: Hepatic Encephalopathy).
Did You Know...
Sometimes the discovery of metastatic liver cancer is the first indication of cancer.
Diagnosis
Doctors often have difficulty diagnosing the cancer until it is advanced. Liver function tests, which are simple blood tests, are done. Results may be abnormal, as they are in many disorders. Thus, this finding cannot confirm the diagnosis. Ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) of the liver may detect the cancer, but these tests cannot always detect small tumors or distinguish cancer from cirrhosis or other abnormalities.
Metastatic Liver Cancer
A liver biopsy (removal of a sample of liver tissue with a needle for examination under a microscope—see Diagnostic Tests for Liver, Gallbladder, and Biliary Disorders: Biopsy of the Liver) is done if the diagnosis is unclear after imaging tests or if more information is needed to help with treatment decisions. To improve the chances of obtaining cancerous tissue, a doctor uses ultrasonography or CT to guide the placement of the biopsy needle. Alternatively, doctors may insert a flexible viewing tube (laparoscope) through a tiny incision in the abdomen to better identify and obtain cancerous tissue.
Treatment
Treatment depends on how far the cancer has spread and what the primary cancer is. Options include the following:
Chemotherapy drugs: These drugs may be used to temporarily shrink the tumor and prolong life, but they do not cure the cancer. Chemotherapy drugs may be injected into the liver's main artery (the hepatic artery), providing a high concentration of the drugs directly to the cancer cells in the liver.
Radiation therapy to the liver: Sometimes this treatment reduces severe pain, but it has little other benefit.
Surgery: If only a single tumor or a few tumors are found in the liver, they may be surgically removed, especially if they originated in the intestines. However, not all experts consider this surgery worthwhile.
If cancer has spread extensively, usually all a doctor can do is relieve the symptoms (see Death and Dying: Symptoms During a Fatal Illness). People may prepare an advance directive (see Legal and Ethical Issues: Advance Directives) to specify the type of care they desire if they become unable to make decisions about care
Weight loss and a poor appetite may be the first symptoms.
Doctors base the diagnosis on results of blood tests and usually biopsy.
Chemotherapy drugs and radiation therapy may help relieve symptoms but do not cure the cancer.
Metastatic liver cancer most commonly originates in the lungs, breasts, large intestine, pancreas, or stomach. Leukemia (a cancer of white blood cells) and lymphoma (a cancer of the lymph system), especially Hodgkin's disease, may involve the liver. Cancers spread to the liver because the liver filters most of the blood from the rest of the body, and when cancer cells break away from a primary cancer, they often enter and travel through the bloodstream. Sometimes the discovery of metastatic liver cancer is the first indication that a person has cancer.
Symptoms
Often, the first symptoms are vague. They include weight loss, poor appetite, and sometimes fever. Typically, the liver is enlarged and hard. It may feel tender and often lumpy. Occasionally, the spleen is enlarged, especially if the cancer originated in the pancreas. At first, unless the cancer is blocking the bile ducts, the person has mild or no jaundice (a yellowish discoloration of the skin and the whites of the eyes). Later, the abdominal cavity may become swollen (distended) with fluid (a condition called ascites—see Manifestations of Liver Disease: Ascites). In the weeks before death, jaundice progressively worsens. People may become confused and drowsy as toxins accumulate in the brain because the liver is too damaged to remove them from the blood. This condition is called liver encephalopathy (see Manifestations of Liver Disease: Hepatic Encephalopathy).
Did You Know...
Sometimes the discovery of metastatic liver cancer is the first indication of cancer.
Diagnosis
Doctors often have difficulty diagnosing the cancer until it is advanced. Liver function tests, which are simple blood tests, are done. Results may be abnormal, as they are in many disorders. Thus, this finding cannot confirm the diagnosis. Ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) of the liver may detect the cancer, but these tests cannot always detect small tumors or distinguish cancer from cirrhosis or other abnormalities.
Metastatic Liver Cancer
A liver biopsy (removal of a sample of liver tissue with a needle for examination under a microscope—see Diagnostic Tests for Liver, Gallbladder, and Biliary Disorders: Biopsy of the Liver) is done if the diagnosis is unclear after imaging tests or if more information is needed to help with treatment decisions. To improve the chances of obtaining cancerous tissue, a doctor uses ultrasonography or CT to guide the placement of the biopsy needle. Alternatively, doctors may insert a flexible viewing tube (laparoscope) through a tiny incision in the abdomen to better identify and obtain cancerous tissue.
Treatment
Treatment depends on how far the cancer has spread and what the primary cancer is. Options include the following:
Chemotherapy drugs: These drugs may be used to temporarily shrink the tumor and prolong life, but they do not cure the cancer. Chemotherapy drugs may be injected into the liver's main artery (the hepatic artery), providing a high concentration of the drugs directly to the cancer cells in the liver.
Radiation therapy to the liver: Sometimes this treatment reduces severe pain, but it has little other benefit.
Surgery: If only a single tumor or a few tumors are found in the liver, they may be surgically removed, especially if they originated in the intestines. However, not all experts consider this surgery worthwhile.
If cancer has spread extensively, usually all a doctor can do is relieve the symptoms (see Death and Dying: Symptoms During a Fatal Illness). People may prepare an advance directive (see Legal and Ethical Issues: Advance Directives) to specify the type of care they desire if they become unable to make decisions about care
Metastatic Cancer
Posteado en en por
When a cancer spreads (metastasizes) from its original site to another area of the body, it is termed metastatic cancer. Virtually all cancers have the potential to spread this way. Whether metastases develop depends on the complex interaction of many tumor cell factors, including the type of cancer, the degree of maturity (differentiation) of the tumor cells, the location and how long the cancer has been present, as well as other incompletely understood factors.
The treatment of metastatic cancer depends on where the cancer started. When breast cancer spreads to the lungs, for example, it remains a breast cancer and the treatment is determined by the tumor's origin within the breast, not by the fact that it is now in the lung. About 5 percent of the time, metastases are discovered but the primary tumor cannot be identified. The treatment of these metastases is dictated by their location rather than their origin
Although the presence of metastases generally implies a poor prognosis, some metastatic cancers can be cured with conventional therapy.
Types
Virtually all cancers can develop metastases.
How It Spreads
Metastases spread in three ways - by local extension from the tumor to the surrounding tissues, through the bloodstream to distant sites or through the lymphatic system to neighboring or distant lymph nodes. Each kind of cancer may have a typical route of spread.
What Causes It
The characteristics of each tumor are different, and it is not known what factors make the metastasis develop in particular places.
Common Signs and Symptoms
Many patients have no or minimal symptoms related to the tumor and their metastases are found during a routine medical evaluation. If there are symptoms, they depend on the site involved.
The treatment of metastatic cancer depends on where the cancer started. When breast cancer spreads to the lungs, for example, it remains a breast cancer and the treatment is determined by the tumor's origin within the breast, not by the fact that it is now in the lung. About 5 percent of the time, metastases are discovered but the primary tumor cannot be identified. The treatment of these metastases is dictated by their location rather than their origin
Although the presence of metastases generally implies a poor prognosis, some metastatic cancers can be cured with conventional therapy.
Types
Virtually all cancers can develop metastases.
How It Spreads
Metastases spread in three ways - by local extension from the tumor to the surrounding tissues, through the bloodstream to distant sites or through the lymphatic system to neighboring or distant lymph nodes. Each kind of cancer may have a typical route of spread.
What Causes It
The characteristics of each tumor are different, and it is not known what factors make the metastasis develop in particular places.
Common Signs and Symptoms
Many patients have no or minimal symptoms related to the tumor and their metastases are found during a routine medical evaluation. If there are symptoms, they depend on the site involved.
Hepatocellular Carcinoma
Posteado en en por
What is liver cancer (hepatocellular carcinoma, HCC)?
Liver cancer (hepatocellular carcinoma) is a cancer arising from the liver. It is also known as primary liver cancer or hepatoma. The liver is made up of different cell types (for example, bile ducts, blood vessels, and fat-storing cells). However, liver cells (hepatocytes) make up 80% of the liver tissue. Thus, the majority of primary liver cancers (over 90 to 95%) arises from liver cells and is called hepatocellular cancer or carcinoma.
When patients or physicians speak of liver cancer, however, they are often referring to cancer that has spread to the liver, having originated in other organs (such as the colon, stomach, pancreas, breast, and lung). More specifically, this type of liver cancer is called metastatic liver disease (cancer) or secondary liver cancer. Thus, the term liver cancer actually can refer to either metastatic liver cancer or hepatocellular cancer. The subject of this article is hepatocellular carcinoma, which I will refer to as liver cancer.
What is the scope of the liver cancer problem?
Liver cancer is the fifth most common cancer in the world. A deadly cancer, liver cancer will kill almost all patients who have it within a year. In 1990, the World Health Organization estimated that there were about 430,000 new cases of liver cancer worldwide, and a similar number of patients died as a result of this disease. About three quarters of the cases of liver cancer are found in Southeast Asia (China, Hong Kong, Taiwan, Korea, and Japan). Liver cancer is also very common in sub-Saharan Africa (Mozambique and South Africa).
The frequency of liver cancer in Southeast Asia and sub-Saharan Africa is greater than 20 cases per 100,000 population. In contrast, the frequency of liver cancer in North America and Western Europe is much lower, less than five per 100,000 population. However, the frequency of liver cancer among native Alaskans is comparable to that seen in Southeast Asia. Moreover, recent data show that the frequency of liver cancer in the U.S. overall is rising. This increase is due primarily to chronic hepatitis C, an infection of the liver that causes liver cancer.
Liver cancer (hepatocellular carcinoma) is a cancer arising from the liver. It is also known as primary liver cancer or hepatoma. The liver is made up of different cell types (for example, bile ducts, blood vessels, and fat-storing cells). However, liver cells (hepatocytes) make up 80% of the liver tissue. Thus, the majority of primary liver cancers (over 90 to 95%) arises from liver cells and is called hepatocellular cancer or carcinoma.
When patients or physicians speak of liver cancer, however, they are often referring to cancer that has spread to the liver, having originated in other organs (such as the colon, stomach, pancreas, breast, and lung). More specifically, this type of liver cancer is called metastatic liver disease (cancer) or secondary liver cancer. Thus, the term liver cancer actually can refer to either metastatic liver cancer or hepatocellular cancer. The subject of this article is hepatocellular carcinoma, which I will refer to as liver cancer.
What is the scope of the liver cancer problem?
Liver cancer is the fifth most common cancer in the world. A deadly cancer, liver cancer will kill almost all patients who have it within a year. In 1990, the World Health Organization estimated that there were about 430,000 new cases of liver cancer worldwide, and a similar number of patients died as a result of this disease. About three quarters of the cases of liver cancer are found in Southeast Asia (China, Hong Kong, Taiwan, Korea, and Japan). Liver cancer is also very common in sub-Saharan Africa (Mozambique and South Africa).
The frequency of liver cancer in Southeast Asia and sub-Saharan Africa is greater than 20 cases per 100,000 population. In contrast, the frequency of liver cancer in North America and Western Europe is much lower, less than five per 100,000 population. However, the frequency of liver cancer among native Alaskans is comparable to that seen in Southeast Asia. Moreover, recent data show that the frequency of liver cancer in the U.S. overall is rising. This increase is due primarily to chronic hepatitis C, an infection of the liver that causes liver cancer.
Treatment of Bone Cancer
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The treatment of cancer of the bone, especially metastatic cancer, has two goals: management of the neoplasm and management of the symptoms produced by the local lesion. Prognosis is affected by a patient's age, the size of the primary tumor, grade and stage, degree of lymphatic and blood vessel invasion, the duration of symptoms and the location of the tumor on the arm, leg or trunk.
There are two ways bone metastasis is treated. Systemic therapy, aimed at cancer cells that have spread throughout the body, includes chemotherapy, hormone therapy, and immunotherapy. Local therapy, aimed at killing cancer cells in one specific part of the body, includes radiation therapy and surgery.
Surgery often has to be extensive, with a wide margin of tissue around the tumor being removed. Sarcomas involving muscles require removal of the entire affected muscle group.
Radiation therapy is used to prevent local recurrences of radiosensitive tumors and may be given either before or after surgery.
Chemotherapy - a number of drugs have proven to be effective in treating bone and soft tissue sarcomas. The dosages required to provide a good chance for cure often produce significant side effects. Effective single agents may include doxorubicin (Adriamycin), cyclophosphamide, high-dose methotrexate (with leucovorin rescue), ifosfamide, dacarbazine, vincristine, dactinomycin (Actinomycin D), etoposide and investigational agents. Combinations of these drugs are often used.
Hormone therapy is either the removal of the organs which produce hormones which can promote the growth of certain types of cancer (such as testosterone in males and estrogen in females), or drug therapy to keep the hormones from promoting cancer growth.
Biphosphonates are drugs that can be used to reduce bone pain and slow down bone damage in people who have cancer that has spread to their bones.
Even if a bone or soft tissue sarcoma is appears to be localized and could apparently be completely removed, there is still significant risk that tumor cells too small to detect have already spread to other places in the body. Additional treatment with chemotherapy (adjuvant chemotherapy) attempts to eliminate these tumor deposits.
There are also safe and effective ways to treat pain. Medications can allow people to be free of pain so that they can continue the activities that are important to them.
There are two ways bone metastasis is treated. Systemic therapy, aimed at cancer cells that have spread throughout the body, includes chemotherapy, hormone therapy, and immunotherapy. Local therapy, aimed at killing cancer cells in one specific part of the body, includes radiation therapy and surgery.
Surgery often has to be extensive, with a wide margin of tissue around the tumor being removed. Sarcomas involving muscles require removal of the entire affected muscle group.
Radiation therapy is used to prevent local recurrences of radiosensitive tumors and may be given either before or after surgery.
Chemotherapy - a number of drugs have proven to be effective in treating bone and soft tissue sarcomas. The dosages required to provide a good chance for cure often produce significant side effects. Effective single agents may include doxorubicin (Adriamycin), cyclophosphamide, high-dose methotrexate (with leucovorin rescue), ifosfamide, dacarbazine, vincristine, dactinomycin (Actinomycin D), etoposide and investigational agents. Combinations of these drugs are often used.
Hormone therapy is either the removal of the organs which produce hormones which can promote the growth of certain types of cancer (such as testosterone in males and estrogen in females), or drug therapy to keep the hormones from promoting cancer growth.
Biphosphonates are drugs that can be used to reduce bone pain and slow down bone damage in people who have cancer that has spread to their bones.
Even if a bone or soft tissue sarcoma is appears to be localized and could apparently be completely removed, there is still significant risk that tumor cells too small to detect have already spread to other places in the body. Additional treatment with chemotherapy (adjuvant chemotherapy) attempts to eliminate these tumor deposits.
There are also safe and effective ways to treat pain. Medications can allow people to be free of pain so that they can continue the activities that are important to them.
What Is Bone Cancer?
Posteado en en por
Bone is the supporting framework of the body. Most bones are hollow. The outer part of bones consists of a network of fibrous tissue called matrix onto which calcium salts are laid down. The soft tissue inside hollow bones is called bone marrow. At each end of the bone is a zone of, a softer form of bone-like tissue called cartilage.
Cartilage is made of a fibrous tissue matrix mixed with a gel-like substance that does not contain much calcium. Cartilage is softer than bone but more firm than most tissues.
Most bones start out as cartilage. The body then lays calcium down onto the cartilage to form bone. After the bone is formed, some cartilage may remain at the ends to act as a cushion between bones. This cartilage, along with ligaments and some other tissues connect bones to form a joint. In adults, cartilage is mainly found at the end of some bones as part of a joint. It is also seen at the place in the chest where the ribs meet the sternum (breastbone) and in parts of the face. The trachea (windpipe), larynx (voicebox), and the outer part of the ear are other structures that contain cartilage.
Bone itself is very hard and strong. Some bone is able to support as much as 12,000 pounds per square inch. It takes as much as 1,200 to 1,800 pounds of pressure to break the femur (thigh bone). The outside of the bone is covered with a layer of fibrous tissue called periosteum. The bone itself contains 2 kinds of cells. The osteoblast is the cell that lays down new bone, and the osteoclast is the cell that dissolves old bone. Although bone often looks like it doesn't change much, the truth is that it is very active. Throughout our bodies, new bone is always forming while old bone is dissolving.
Inside hollow bones is a space called the medullary cavity where bone marrow is found. In some bones the marrow is only fatty tissue. The marrow in other bones is a mixture of fat cells and blood-forming cells. The blood-forming cells produce red blood cells, white blood cells, and blood platelets. Other cells in the marrow include plasma cells, fibroblasts, and reticuloendothelial cells.
Cells from any of these tissues can develop into a cancer.
Types of bone cancers
Most of the time when someone with cancer is told they have cancer in the bones, the doctor is talking about a cancer that spread there from somewhere else. This is called metastatic cancer. It can be seen in many different types of advanced cancer, such as breast cancer, prostate cancer, and lung cancer. When these cancers in the bone are looked at under a microscope, they resemble the tissue they came from. For example, if someone has lung cancer that has spread to bone, the cells of the cancer in the bone still look and act like lung cancer cells. They do not look or act like bone cancer cells, even though they are in the bones. Since these cancer cells still act like lung cancer cells, they still need to be treated with drugs that are used for lung cancer. For more information about metastatic bone cancer, please see the American Cancer Society document Bone Metastases, as well as the document on the specific place where the cancer started (Breast Cancer, Lung Cancer, Prostate Cancer, etc.).
Other kinds of cancers that are sometimes called "bone cancers" start in the blood forming cells of the bone marrow -- not in the bone itself. The most common bone cancer is called multiple myeloma. Another cancer that starts in the bone marrow is leukemia, although it is generally considered a "blood cancer" rather than a "bone cancer." Sometimes, lymphomas, which more often start in lymph nodes, can start in bone marrow. Multiple myeloma, lymphoma, and leukemia are not discussed in this document. For more information on these cancers, refer to the individual document for each.
A primary bone tumor is a tumor that starts in the bone itself. The main type of cancers that are true (or primary) "bone" cancers are called sarcomas. This is a term that describes the type of tissue that the cancer started in. Sarcomas are cancers that start in bone, muscle, fibrous tissue, blood vessels, fat tissue, as well as some other tissues. They can develop anywhere in the body.
There are several different types of bone tumors. Their names are based on the area of bone or surrounding tissue that is affected and the kind of cells forming the tumor. Some primary bone tumors are benign (not cancerous), and others are malignant (cancerous). Most bone cancers are called sarcomas.
Benign bone tumors
Benign tumors do not spread to other tissues and organs and so are not usually life threatening. They are generally cured by surgery. Types of benign bone tumors include:
osteoid osteoma
osteoblastoma
osteochondroma
enchondroma
chondromyxoid fibroma.
These benign tumors are not discussed further in this document, which is limited to bone cancers.
Malignant bone tumors
Osteosarcoma: Osteosarcoma (also called osteogenic sarcoma) is the most common primary bone cancer. This cancer starts in the bone cells. It most often occurs in young people between the age of 10 and 30, but about 10% of osteosarcoma cases develop in people in their 60s and 70s. It is rare during middle age, and is more common in males than females. These tumors develop most often in bones of the arms, legs, or pelvis. For more information, see the American Cancer Society document, Osteosarcoma.
Chondrosarcoma: Chondrosarcoma is a cancer of cartilage cells. It is the second most common primary bone cancer. This cancer is rare in people younger than 20. After age 20, the risk of getting a chondrosarcoma goes up until about age 75. Women get this cancer as often as men.
Chondrosarcomas can develop in any place where there is cartilage. Most develop in bones such as the pelvis, leg bone or arm bone. Occasionally, chondrosarcoma will develop in the trachea, larynx, and chest wall. Other sites are the scapula (shoulder blade), ribs, or skull.
Benign (non-cancerous) tumors of cartilage are more common than malignant ones. These are called enchondromas. Another type of benign tumor that has cartilage is a bony projection capped by cartilage called an osteochondroma. These benign tumors rarely turn into cancer. There is a slightly higher chance of cancer developing in people who have many of these tumors, but this is still not common.
Chondrosarcomas are classified by grade, which measures how fast they grow. The grade is assigned by the pathologist (a doctor specially trained to examine and diagnose tissue samples under a microscope) after looking at the tumor under the microscope. The lower the grade, the slower the cancer grows. When a cancer is slow growing, the chance that it will spread is lower and so the outlook is better. Most chondrosarcomas are either low grade (grade I) or intermediate grade (grade II). High grade (grade III) chondrosarcomas, which are the most likely to spread, are less common.
Some chondrosarcomas have distinctive features under a microscope. These variants of chondrosarcoma can have a different prognosis (outlook) than usual chondrosarcomas.
Dedifferentiated chondrosacromas start out as typical chondrosarcomas but then some parts of the tumor change into cells like those of an osteosarcoma or fibrosarcoma. This variant of chondrosarcoma tends to occur in older patients and is more aggressive than usual chondrosarcomas.
Clear cell chondrosarcoma is a rare variant that grows slowly. It rarely spreads to other parts of the body unless it has already come back several times in the original location.
Mesenchymal chondrosarcomas can grow rapidly, but like Ewing tumor, are sensitive to treatment with radiation and chemotherapy.
Ewing tumor: Ewing tumor is the third most common primary bone cancer. This cancer (also called Ewing sarcoma) is named after the doctor who first described it in 1921, Dr. James Ewing. Most Ewing tumors develop in bones, but they can start in other tissues and organs. The most common sites for this cancer are the pelvis, the chest wall (such as the ribs or shoulder blades), and the long bones of the legs or arms. This cancer is most common in children and teenagers and is rare in adults over age 30. Ewing tumors occur most often in white people and are rare among African Americans and Asian Americans. More detailed information about this cancer can be found in the American Cancer Society document, Ewing Family of Tumors.
Malignant fibrous histiocytoma: Malignant fibrous histiocytoma (MFH) more often starts in "soft tissue" (connective tissue such as ligaments, tendons, fat, and muscle) than in bones. When MFH occurs in bones, it usually affects the legs (often around the knees) or arms. This cancer most often occurs in elderly and middle-aged adults and is rare among children. MFH tends to grow quickly and often spreads to other parts of the body, like the lungs and lymph nodes. MFH mostly tends to grow locally, but it can spread to distant sites
Fibrosarcoma: This is another type of cancer that develops more often in "soft tissues" than it does from bones. Fibrosarcoma usually occurs in elderly and middle-aged adults. Leg, arm, and jaw bones are the ones most often affected.
Giant cell tumor of bone: This type of primary bone tumor has benign and malignant forms. The benign (non-cancerous) form is most common. Giant cell bone tumors typically affect the leg (usually, near the knees) or arm bones of young and middle-aged adults. They don't often spread to distant sites, but tend to come back where they started after surgery (this is called local recurrence). This can happen several times. With each recurrence, the tumor becomes more likely to spread to other parts of the body. Rarely, a giant cell bone tumor spreads to other parts of the body without first recurring locally. This happens in the malignant (cancer) form of the tumor.
Chordoma: This primary tumor of bone usually occurs in the base of the skull and bones of the spine. It develops most often in adults older than 30 years, and is about twice as common in men than in women. Chordomas tend to grow slowly and often do not spread to other parts of the body, but they often come back in the same area if they are not removed completely. When they do spread, lymph nodes, the lungs, and the liver are the most common areas for secondary tumors.
Other cancers that develop in bones
Non-Hodgkin lymphoma
Non-Hodgkin lymphoma generally develops in lymph nodes but sometimes starts in the bone. Primary non-Hodgkin lymphoma of the bone is often a widespread disease because multiple sites in the body are usually involved. The outlook is similar to other non-Hodgkin lymphomas of the same subtype and stage. Primary lymphoma of the bone is given the same treatment as lymphomas that start in lymph nodes -- it is not treated like a primary bone sarcoma. For more information see the American Cancer Society document, Non-Hodgkin Lymphoma.
Multiple myeloma
Multiple myeloma is almost always found in bones, but doctors do not consider it a bone cancer because it develops from the plasma cells of the bone marrow (the soft inner part of some bones). Although it causes bone destruction, it is no more a bone cancer than is leukemia. It is treated as a widespread disease. At times, myeloma can be first found as a single tumor (called a plasmacytoma) in a single bone, but most of the time it will go on to spread to the marrow of other bones. For more information see the American Cancer Society document, Multiple Myeloma.
Cartilage is made of a fibrous tissue matrix mixed with a gel-like substance that does not contain much calcium. Cartilage is softer than bone but more firm than most tissues.
Most bones start out as cartilage. The body then lays calcium down onto the cartilage to form bone. After the bone is formed, some cartilage may remain at the ends to act as a cushion between bones. This cartilage, along with ligaments and some other tissues connect bones to form a joint. In adults, cartilage is mainly found at the end of some bones as part of a joint. It is also seen at the place in the chest where the ribs meet the sternum (breastbone) and in parts of the face. The trachea (windpipe), larynx (voicebox), and the outer part of the ear are other structures that contain cartilage.
Bone itself is very hard and strong. Some bone is able to support as much as 12,000 pounds per square inch. It takes as much as 1,200 to 1,800 pounds of pressure to break the femur (thigh bone). The outside of the bone is covered with a layer of fibrous tissue called periosteum. The bone itself contains 2 kinds of cells. The osteoblast is the cell that lays down new bone, and the osteoclast is the cell that dissolves old bone. Although bone often looks like it doesn't change much, the truth is that it is very active. Throughout our bodies, new bone is always forming while old bone is dissolving.
Inside hollow bones is a space called the medullary cavity where bone marrow is found. In some bones the marrow is only fatty tissue. The marrow in other bones is a mixture of fat cells and blood-forming cells. The blood-forming cells produce red blood cells, white blood cells, and blood platelets. Other cells in the marrow include plasma cells, fibroblasts, and reticuloendothelial cells.
Cells from any of these tissues can develop into a cancer.
Types of bone cancers
Most of the time when someone with cancer is told they have cancer in the bones, the doctor is talking about a cancer that spread there from somewhere else. This is called metastatic cancer. It can be seen in many different types of advanced cancer, such as breast cancer, prostate cancer, and lung cancer. When these cancers in the bone are looked at under a microscope, they resemble the tissue they came from. For example, if someone has lung cancer that has spread to bone, the cells of the cancer in the bone still look and act like lung cancer cells. They do not look or act like bone cancer cells, even though they are in the bones. Since these cancer cells still act like lung cancer cells, they still need to be treated with drugs that are used for lung cancer. For more information about metastatic bone cancer, please see the American Cancer Society document Bone Metastases, as well as the document on the specific place where the cancer started (Breast Cancer, Lung Cancer, Prostate Cancer, etc.).
Other kinds of cancers that are sometimes called "bone cancers" start in the blood forming cells of the bone marrow -- not in the bone itself. The most common bone cancer is called multiple myeloma. Another cancer that starts in the bone marrow is leukemia, although it is generally considered a "blood cancer" rather than a "bone cancer." Sometimes, lymphomas, which more often start in lymph nodes, can start in bone marrow. Multiple myeloma, lymphoma, and leukemia are not discussed in this document. For more information on these cancers, refer to the individual document for each.
A primary bone tumor is a tumor that starts in the bone itself. The main type of cancers that are true (or primary) "bone" cancers are called sarcomas. This is a term that describes the type of tissue that the cancer started in. Sarcomas are cancers that start in bone, muscle, fibrous tissue, blood vessels, fat tissue, as well as some other tissues. They can develop anywhere in the body.
There are several different types of bone tumors. Their names are based on the area of bone or surrounding tissue that is affected and the kind of cells forming the tumor. Some primary bone tumors are benign (not cancerous), and others are malignant (cancerous). Most bone cancers are called sarcomas.
Benign bone tumors
Benign tumors do not spread to other tissues and organs and so are not usually life threatening. They are generally cured by surgery. Types of benign bone tumors include:
osteoid osteoma
osteoblastoma
osteochondroma
enchondroma
chondromyxoid fibroma.
These benign tumors are not discussed further in this document, which is limited to bone cancers.
Malignant bone tumors
Osteosarcoma: Osteosarcoma (also called osteogenic sarcoma) is the most common primary bone cancer. This cancer starts in the bone cells. It most often occurs in young people between the age of 10 and 30, but about 10% of osteosarcoma cases develop in people in their 60s and 70s. It is rare during middle age, and is more common in males than females. These tumors develop most often in bones of the arms, legs, or pelvis. For more information, see the American Cancer Society document, Osteosarcoma.
Chondrosarcoma: Chondrosarcoma is a cancer of cartilage cells. It is the second most common primary bone cancer. This cancer is rare in people younger than 20. After age 20, the risk of getting a chondrosarcoma goes up until about age 75. Women get this cancer as often as men.
Chondrosarcomas can develop in any place where there is cartilage. Most develop in bones such as the pelvis, leg bone or arm bone. Occasionally, chondrosarcoma will develop in the trachea, larynx, and chest wall. Other sites are the scapula (shoulder blade), ribs, or skull.
Benign (non-cancerous) tumors of cartilage are more common than malignant ones. These are called enchondromas. Another type of benign tumor that has cartilage is a bony projection capped by cartilage called an osteochondroma. These benign tumors rarely turn into cancer. There is a slightly higher chance of cancer developing in people who have many of these tumors, but this is still not common.
Chondrosarcomas are classified by grade, which measures how fast they grow. The grade is assigned by the pathologist (a doctor specially trained to examine and diagnose tissue samples under a microscope) after looking at the tumor under the microscope. The lower the grade, the slower the cancer grows. When a cancer is slow growing, the chance that it will spread is lower and so the outlook is better. Most chondrosarcomas are either low grade (grade I) or intermediate grade (grade II). High grade (grade III) chondrosarcomas, which are the most likely to spread, are less common.
Some chondrosarcomas have distinctive features under a microscope. These variants of chondrosarcoma can have a different prognosis (outlook) than usual chondrosarcomas.
Dedifferentiated chondrosacromas start out as typical chondrosarcomas but then some parts of the tumor change into cells like those of an osteosarcoma or fibrosarcoma. This variant of chondrosarcoma tends to occur in older patients and is more aggressive than usual chondrosarcomas.
Clear cell chondrosarcoma is a rare variant that grows slowly. It rarely spreads to other parts of the body unless it has already come back several times in the original location.
Mesenchymal chondrosarcomas can grow rapidly, but like Ewing tumor, are sensitive to treatment with radiation and chemotherapy.
Ewing tumor: Ewing tumor is the third most common primary bone cancer. This cancer (also called Ewing sarcoma) is named after the doctor who first described it in 1921, Dr. James Ewing. Most Ewing tumors develop in bones, but they can start in other tissues and organs. The most common sites for this cancer are the pelvis, the chest wall (such as the ribs or shoulder blades), and the long bones of the legs or arms. This cancer is most common in children and teenagers and is rare in adults over age 30. Ewing tumors occur most often in white people and are rare among African Americans and Asian Americans. More detailed information about this cancer can be found in the American Cancer Society document, Ewing Family of Tumors.
Malignant fibrous histiocytoma: Malignant fibrous histiocytoma (MFH) more often starts in "soft tissue" (connective tissue such as ligaments, tendons, fat, and muscle) than in bones. When MFH occurs in bones, it usually affects the legs (often around the knees) or arms. This cancer most often occurs in elderly and middle-aged adults and is rare among children. MFH tends to grow quickly and often spreads to other parts of the body, like the lungs and lymph nodes. MFH mostly tends to grow locally, but it can spread to distant sites
Fibrosarcoma: This is another type of cancer that develops more often in "soft tissues" than it does from bones. Fibrosarcoma usually occurs in elderly and middle-aged adults. Leg, arm, and jaw bones are the ones most often affected.
Giant cell tumor of bone: This type of primary bone tumor has benign and malignant forms. The benign (non-cancerous) form is most common. Giant cell bone tumors typically affect the leg (usually, near the knees) or arm bones of young and middle-aged adults. They don't often spread to distant sites, but tend to come back where they started after surgery (this is called local recurrence). This can happen several times. With each recurrence, the tumor becomes more likely to spread to other parts of the body. Rarely, a giant cell bone tumor spreads to other parts of the body without first recurring locally. This happens in the malignant (cancer) form of the tumor.
Chordoma: This primary tumor of bone usually occurs in the base of the skull and bones of the spine. It develops most often in adults older than 30 years, and is about twice as common in men than in women. Chordomas tend to grow slowly and often do not spread to other parts of the body, but they often come back in the same area if they are not removed completely. When they do spread, lymph nodes, the lungs, and the liver are the most common areas for secondary tumors.
Other cancers that develop in bones
Non-Hodgkin lymphoma
Non-Hodgkin lymphoma generally develops in lymph nodes but sometimes starts in the bone. Primary non-Hodgkin lymphoma of the bone is often a widespread disease because multiple sites in the body are usually involved. The outlook is similar to other non-Hodgkin lymphomas of the same subtype and stage. Primary lymphoma of the bone is given the same treatment as lymphomas that start in lymph nodes -- it is not treated like a primary bone sarcoma. For more information see the American Cancer Society document, Non-Hodgkin Lymphoma.
Multiple myeloma
Multiple myeloma is almost always found in bones, but doctors do not consider it a bone cancer because it develops from the plasma cells of the bone marrow (the soft inner part of some bones). Although it causes bone destruction, it is no more a bone cancer than is leukemia. It is treated as a widespread disease. At times, myeloma can be first found as a single tumor (called a plasmacytoma) in a single bone, but most of the time it will go on to spread to the marrow of other bones. For more information see the American Cancer Society document, Multiple Myeloma.
How to Build Leg Muscle in your Fifties and Sixties
Posteado en en por
When, we get older our joints, hips and lower back start to show signs of wear. They become more fragile and susceptible to injuries. Joints, hips and lower back all have taken their toll over the years, especially if you were involved in sports or a job that required manual labor.
At 60 I still wanted to be able to train my legs using heavier weights. I started to think about what if something would happen and I injure myself!
I am a very active person with various types of activities requiring me mobile. What would I do, if I were to lose that mobility? Suddenly, I found that free weights and squatting with 400 plus pounds did not make sense anymore! One wrong move or losing my balance could result in a serious injury. To avoid hip replacement, bad knees or having lower back problems, I had to find a safer method for building legs.
This article I will explain how to make training legs safer with less of a chance of injuries. The workout that I will be explaining will have your back supported and with a more controlled range of motion. I have completed this workout routine, with variations, for over a year now. My legs are growing and stronger than ever, but without the fear of injury.
If you still want to do squats with using free weights, then it would be better to use the Smith Machine. The Smith Machine is defiantly a safer piece of equipment than loading weights on a barbell. If you are unfamiliar with this equipment, it mimics squats using the barbell with plates, but with cables and safety devises on both sides. The main difference with this equipment, you do not have to worry about balancing the weight.
Muscles Used
Quadriceps
Hamstrings
Glutes
Calves
The Equipment
Gyms have various types of equipment and brand names that will be similar to the ones that I will be mentioning. Hammer Strength, Universal, Pro Fitness, Maximus, Flex, LifeFitness, Nautilus, Power Strength, Body Solid, FreemMotion, Smith Machine, are some good examples of plate loading and cable gym equipment.
Leg Building Strategy
Your legs have very strong muscles. You'll find that you can lift heavier weights during your leg workouts than with other routines, and for that reason proper form is important so not to injure your back and/or your other joints.
With that being said, you'll often find that you can make bigger and quicker gains with your leg workouts. For example, over the course of a few months, you might find that you're increasing your weights on a weekly basis. When this happens, you really notice your legs taking shape!
The key to staying injury free and making gains is to use good form, and not to over train your muscles. You need to let your muscles rest in between workouts. Give them 3 or 4 days to rest before training them again. Follow up each workout with a protein shake and your legs will never be the same.
My Leg Building Workout
I train legs once a week in the middle of the week. This way it gives my upper body a day to rest before resuming. You can perform the leg work twice a week if you can or able to. I have found that it takes me a minimum of 3 days to recover from the workout I am about to discuss.
Warming up
Over a year ago I found out that it takes more time for my legs to warm up. To start with squats, like I use to, did not work for me anymore. Now I start with my calves, a little unorthodox I know but it works for me. My theory behind this is that your calve muscles are one the most used muscles in your body.
From the time you crawl out of bed in the morning until you are back in bed that night your calves are being use. With this theory in mind, when I get to the gym I work my calves first. My calves have already warmed up from using them throughout the day. I work them hard and burn them out before I attack the larger muscle groups. By now my heart is pumping, body has warmed up and blood is circulating. Now I am ready for my larger leg muscles.
The Leg Workout
Your calves along with your quads have three muscle groups each inner, outer and medial. Make sure your workout hits all muscle groups. The workout that I use and will explain below, will do that either individually or as a group.
The leg and calve workout along with most of my other workouts is done once per week.
All reps mentioned here after are to failure, which means you cannot lift anymore weight after completing the last rep.
Quads, complete 4 sets each exercise, between 8 to 10 reps.
Hamstrings, 3 sets each exercise, between 8 to 10 reps.
Calves, 4 sets each exercise, between 10 to 12 reps.
Calve Workout
With all calve exercises, it is not the weight being use that is as important as using proper form. You want your heels to go down as far as they can for the stretch. Next, rise up on ball and toes of your feet as high as you can. Too much weight can prevent you from accomplishing this movement.
Seated calve press: Start by using a calve press machine. I like using the LifeFitness Machine for this. You are in a seated position with the ball of you feet resting on the bar with legs slightly bent. With the ball of your feet you push forward until your toes end up on bar and then back down. Repeat. If your gym does not have similar equipment, you can use a leg press machine. Put just the ball of your feet on the leg press machine with your heels hanging off. Follow the same motion of movement as you would with the calve press machine.Standing calve raise: I use the LifeFitness Calve Raise Machine for this. There are other machines that are the same. This machine has pads for your shoulders press up against and bars for your hands to hold on to. Adjust the shoulder pad height then start with your legs slightly bent and heels hanging off the platform. Drop your heels down as far as they will go for the stretch, then up on ball and toes of your feet as high as you are able. Repeat.
Seated calve raise: Now, we will finish our calves off will seated calve raises. I use the Hammer Strength plate loading equipment for this. I like completing this exercise last. It hits the medial calve muscle, a smaller muscle, the most. With the pads on top of your legs near your knees and your heels down from the bar as far as they will go. Now, left up until you are on ball and toes of your feet. Repeat.
Quadricep (thigh) Workout
There are lot theories in the order for which to complete your quad exercises. Find out which one works for you and follow it or change them up. Below I will be explaining one order of performing these exercises.
Squats: There are many pieces of equipment at the gym that are made for squats, with hand grips and where your back is supported. With weight added, back against the pad and hands on the grips, squat down to where your legs are at a 90 degree angle and then back up. Do not go below a 90 degree angle, this will put strain on your knees and may cause knee damage. When you are standing do not lock your knees keep your legs slightly bent and weight on your quads.
Leg Press: I like the Hammer Strength plate loading equipment for this. In a sitting position with your back against the pad, push your legs forward, stop before locking your knees with keeping the weight on your quads. Now lower the weight until your legs are at a 90 degree angle then push back up. Repeat.
Seated leg extensions: All gyms have seated leg extension equipment. With weight added, adjust the pad height on your shins to where it sits just above your ankle. In a seated position with back supported lift your lower legs up to just before full extension and then back down. Repeat.
Hamstring Workout
I use two pieces of equipment for my hamstrings.
Lying reverse leg curl: Lay down with pad adjusted to where it rest on the back of your legs just above your ankles. Grab the hand grips by your head now curl your legs up to where the pad just about reaches your hamstrings. Now slowly straighten your legs and lower the pad back down. Repeat.
Seated reverse leg curl: Sit down with the pad adjusted behind your legs just above your ankles. With your back supported against the pad bring your legs to a 90 degree angle then slowly back to the starting position with legs slightly bent. Repeat.
In conclusion
Most of these exercises your back is supported, hands are on grips for balance and performed with a controlled range of motion. Be sure not to hyperextend your legs or bend your legs more than a 90 degree angle. You can complete these leg exercises indefinitely with only some weight modifications.
Leg Cramps
Posteado en en por
Leg cramps or spasms are a painful tightening of the muscles in the leg. Staying in bed for long periods of time sometimes can cause muscles in the leg or foot to cramp. Dehydration, certain drugs, and brain or nerve diseases can also cause cramps. Other causes of cramping are pressure on the calf muscles or on the back of the knee, too much phosphorus, too little calcium, low blood sugar, or too little potassium in the body. All of these are chemistry imbalances in the blood.
What to look for
Sudden pain or discomfort in a leg or foot and a tight or stiff feeling
Trouble moving the foot or pain when moving the foot or leg
What the patient can do
Change position often.
If you are bed-bound, use a bed cradle to protect the legs and feet from the weight of the bed clothes. A bed cradle is a support at the end of the bed that holds the sheets and blanket up off the legs and feet.
Exercise your legs in bed by bending and straightening them 10 times twice a day or as many times as you can. A family member can move your legs for you if you can't.
Tell your doctor or nurse about the cramps. They may be able to help prevent them. For example, they may prescribe a muscle relaxant.
Apply heat to legs when they cramp if it's allowed by your doctor. Talk to your doctor or nurse about what kind of heat to use and how long you should use it.
Massage the leg if allowed by your doctor.
Keep warm.
Contract the opposite muscle group to stretch the tight muscle as much as you can without hurting it. For example, for a calf muscle cramp, try pointing the toes upward toward the knees, or walk around.
Follow your doctor's instructions for correcting imbalances in calcium, potassium, or phosphorus.
What caregivers can do
Help the patient stretch the tight muscle if he can't.
Use ice or a cold washcloth to gently rub the cramped muscle.
If muscle relaxers are prescribed, watch for dizziness or stumbling.
Call the doctor if the patient:
Has cramping that is not relieved by heat, massage, or by stretching the cramped muscle (as described above)
Has cramping that lasts for more than 6 to 8 hours
Has a cramped leg that becomes red, swollen, or hot
What to look for
Sudden pain or discomfort in a leg or foot and a tight or stiff feeling
Trouble moving the foot or pain when moving the foot or leg
What the patient can do
Change position often.
If you are bed-bound, use a bed cradle to protect the legs and feet from the weight of the bed clothes. A bed cradle is a support at the end of the bed that holds the sheets and blanket up off the legs and feet.
Exercise your legs in bed by bending and straightening them 10 times twice a day or as many times as you can. A family member can move your legs for you if you can't.
Tell your doctor or nurse about the cramps. They may be able to help prevent them. For example, they may prescribe a muscle relaxant.
Apply heat to legs when they cramp if it's allowed by your doctor. Talk to your doctor or nurse about what kind of heat to use and how long you should use it.
Massage the leg if allowed by your doctor.
Keep warm.
Contract the opposite muscle group to stretch the tight muscle as much as you can without hurting it. For example, for a calf muscle cramp, try pointing the toes upward toward the knees, or walk around.
Follow your doctor's instructions for correcting imbalances in calcium, potassium, or phosphorus.
What caregivers can do
Help the patient stretch the tight muscle if he can't.
Use ice or a cold washcloth to gently rub the cramped muscle.
If muscle relaxers are prescribed, watch for dizziness or stumbling.
Call the doctor if the patient:
Has cramping that is not relieved by heat, massage, or by stretching the cramped muscle (as described above)
Has cramping that lasts for more than 6 to 8 hours
Has a cramped leg that becomes red, swollen, or hot
Soft tissue sarcoma
Posteado en en por
Risk factors
Most soft tissue sarcomas are not associated with any known risk factors or identifiable etiology. There are some exceptions:
Studies suggest that workers who are exposed to Phenoxy herbicide in herbicides and chlorophenols in wood preservatives may have an increased risk of developing soft tissue sarcomas. An unusual percentage of patients with a rare blood vessel tumor, angiosarcoma of the liver, have been exposed to vinyl chloride in their work. This substance is used in the manufacture of certain plastics, notably PVC.[citation needed]
In the early 1900s, when scientists were just discovering the potential uses of radiation to treat disease, little was known about safe dosage levels and precise methods of delivery. At that time, radiation was used to treat a variety of noncancerous medical problems, including enlargement of the tonsils, adenoids, and thymus gland. Later, researchers found that high doses of radiation caused soft tissue sarcomas in some patients. Because of this risk, radiation treatment for cancer is now planned to ensure that the maximum dosage of radiation is delivered to diseased tissue while surrounding healthy tissue is protected as much as possible.[citation needed]
It is believed that a retrovirus plays an indirect role in the development of Kaposi's sarcoma, a rare cancer of the cells that line blood vessels in the skin and mucus membranes. Kaposi's sarcoma often occurs in patients with AIDS (acquired immune deficiency syndrome). AIDS-related Kaposi's sarcoma, however, has different characteristics to and is treated differently from typical soft tissue sarcomas.[citation needed]
In a very small fraction of cases, sarcoma may be related to a rare inherited genetic alteration of the p53 gene and is known as Li-Fraumeni syndrome. Certain other inherited diseases are associated with an increased risk of developing soft tissue sarcomas. For example, people with neurofibromatosis type I (also called von Recklinghausen's disease associated with alterations in the NF1 gene) are at an increased risk of developing soft tissue sarcomas known as malignant peripheral nerve sheath tumors. Patients with inherited retinoblastoma have alterations in the RB1 gene, a tumor suppressor gene, and are likely to develop soft tissue sarcomas as they mature into adulthood.
[edit] Frequency
Soft tissue sarcomas are relatively uncommon cancers. They account for less than 1% of all new cancer cases each year. This may be because cells in soft tissue, by contrast with other tissues, are not constantly fast dividing cells.[citation needed]
In 2006, about 9,500 new cases were diagnosed in the United States.[2] Soft tissue sarcomas are more commonly found in older patients (>50 years old) although in children and adolescents under age 20, certain histologies are common (rhabdomyosarcoma, synovial sarcoma).[citation needed]
[edit] Symptoms
In their early stages, soft tissue sarcomas usually do not cause symptoms. Because soft tissue is relatively elastic, tumors can grow rather large, pushing aside normal tissue, before they are felt or cause any problems. The first noticeable symptom is usually a painless lump or swelling. As the tumor grows, it may cause other symptoms, such as pain or soreness, as it presses against nearby nerves and muscles. If in the abdomen it can cause abdominal pains commonly mistaken for menstrual cramps, indigestion, or cause constipation.[citation needed]
[edit] Diagnosis
The only reliable way to determine whether a soft tissue tumor is benign or malignant is through a biopsy. Therefore, all soft tissue lumps that persist or grow should be biopsied. A biopsy can be obtained via needle biopsy or with surgical biopsy. During this procedure, a doctor makes an incision or uses a special needle to remove a sample of tumor tissue. A pathologist examines the tissue under a microscope. If cancer is present, the pathologist can usually determine the type of cancer and its grade. The grade of the tumor is determined by how abnormal the cancer cells appear when examined under a microscope. The grade predicts the probable growth rate of the tumor and its tendency to spread. Low-grade sarcomas, although cancerous, are unlikely to metastasize. High-grade sarcomas are more likely to spread to other parts of the body.[citation needed]
The most common site of spread is to the lungs.[citation needed]
[edit] Treatment
In general, treatment for soft tissue sarcomas depends on the stage of the cancer. The stage of the sarcoma is based on the size and grade of the tumor, and whether the cancer has spread to the lymph nodes or other parts of the body (metastasized). Treatment options for soft tissue sarcomas include surgery, radiation therapy, and chemotherapy.[citation needed]
Surgery is the most common treatment for soft tissue sarcomas. If possible, the doctor will remove the cancer and a safe margin of the healthy tissue around it. It is important to obtain a margin free of tumor to decrease the likelihood of local recurrence and give the best chance for eradication of the tumor. Depending on the size and location of the sarcoma, it may, rarely, be necessary to remove all or part of an arm or leg.[citation needed]
Radiation therapy may be used either before surgery to shrink tumors or after surgery to kill any cancer cells that may have been left behind. In some cases, it can be used to treat tumours that cannot be surgically removed. In multiple studies, radiation therapy has been found to improve the rate of local control, but has not had any influence on overall survival.[citation needed]
Chemotherapy may be used with radiation therapy either before or after surgery to try to shrink the tumor or kill any remaining cancer cells. The use of chemotherapy to prevent the spread of soft tissue sarcomas has not been proven to be effective. If the cancer has spread to other areas of the body, chemotherapy may be used to shrink tumors and reduce the pain and discomfort they cause, but is unlikely to eradicate the disease.
Most soft tissue sarcomas are not associated with any known risk factors or identifiable etiology. There are some exceptions:
Studies suggest that workers who are exposed to Phenoxy herbicide in herbicides and chlorophenols in wood preservatives may have an increased risk of developing soft tissue sarcomas. An unusual percentage of patients with a rare blood vessel tumor, angiosarcoma of the liver, have been exposed to vinyl chloride in their work. This substance is used in the manufacture of certain plastics, notably PVC.[citation needed]
In the early 1900s, when scientists were just discovering the potential uses of radiation to treat disease, little was known about safe dosage levels and precise methods of delivery. At that time, radiation was used to treat a variety of noncancerous medical problems, including enlargement of the tonsils, adenoids, and thymus gland. Later, researchers found that high doses of radiation caused soft tissue sarcomas in some patients. Because of this risk, radiation treatment for cancer is now planned to ensure that the maximum dosage of radiation is delivered to diseased tissue while surrounding healthy tissue is protected as much as possible.[citation needed]
It is believed that a retrovirus plays an indirect role in the development of Kaposi's sarcoma, a rare cancer of the cells that line blood vessels in the skin and mucus membranes. Kaposi's sarcoma often occurs in patients with AIDS (acquired immune deficiency syndrome). AIDS-related Kaposi's sarcoma, however, has different characteristics to and is treated differently from typical soft tissue sarcomas.[citation needed]
In a very small fraction of cases, sarcoma may be related to a rare inherited genetic alteration of the p53 gene and is known as Li-Fraumeni syndrome. Certain other inherited diseases are associated with an increased risk of developing soft tissue sarcomas. For example, people with neurofibromatosis type I (also called von Recklinghausen's disease associated with alterations in the NF1 gene) are at an increased risk of developing soft tissue sarcomas known as malignant peripheral nerve sheath tumors. Patients with inherited retinoblastoma have alterations in the RB1 gene, a tumor suppressor gene, and are likely to develop soft tissue sarcomas as they mature into adulthood.
[edit] Frequency
Soft tissue sarcomas are relatively uncommon cancers. They account for less than 1% of all new cancer cases each year. This may be because cells in soft tissue, by contrast with other tissues, are not constantly fast dividing cells.[citation needed]
In 2006, about 9,500 new cases were diagnosed in the United States.[2] Soft tissue sarcomas are more commonly found in older patients (>50 years old) although in children and adolescents under age 20, certain histologies are common (rhabdomyosarcoma, synovial sarcoma).[citation needed]
[edit] Symptoms
In their early stages, soft tissue sarcomas usually do not cause symptoms. Because soft tissue is relatively elastic, tumors can grow rather large, pushing aside normal tissue, before they are felt or cause any problems. The first noticeable symptom is usually a painless lump or swelling. As the tumor grows, it may cause other symptoms, such as pain or soreness, as it presses against nearby nerves and muscles. If in the abdomen it can cause abdominal pains commonly mistaken for menstrual cramps, indigestion, or cause constipation.[citation needed]
[edit] Diagnosis
The only reliable way to determine whether a soft tissue tumor is benign or malignant is through a biopsy. Therefore, all soft tissue lumps that persist or grow should be biopsied. A biopsy can be obtained via needle biopsy or with surgical biopsy. During this procedure, a doctor makes an incision or uses a special needle to remove a sample of tumor tissue. A pathologist examines the tissue under a microscope. If cancer is present, the pathologist can usually determine the type of cancer and its grade. The grade of the tumor is determined by how abnormal the cancer cells appear when examined under a microscope. The grade predicts the probable growth rate of the tumor and its tendency to spread. Low-grade sarcomas, although cancerous, are unlikely to metastasize. High-grade sarcomas are more likely to spread to other parts of the body.[citation needed]
The most common site of spread is to the lungs.[citation needed]
[edit] Treatment
In general, treatment for soft tissue sarcomas depends on the stage of the cancer. The stage of the sarcoma is based on the size and grade of the tumor, and whether the cancer has spread to the lymph nodes or other parts of the body (metastasized). Treatment options for soft tissue sarcomas include surgery, radiation therapy, and chemotherapy.[citation needed]
Surgery is the most common treatment for soft tissue sarcomas. If possible, the doctor will remove the cancer and a safe margin of the healthy tissue around it. It is important to obtain a margin free of tumor to decrease the likelihood of local recurrence and give the best chance for eradication of the tumor. Depending on the size and location of the sarcoma, it may, rarely, be necessary to remove all or part of an arm or leg.[citation needed]
Radiation therapy may be used either before surgery to shrink tumors or after surgery to kill any cancer cells that may have been left behind. In some cases, it can be used to treat tumours that cannot be surgically removed. In multiple studies, radiation therapy has been found to improve the rate of local control, but has not had any influence on overall survival.[citation needed]
Chemotherapy may be used with radiation therapy either before or after surgery to try to shrink the tumor or kill any remaining cancer cells. The use of chemotherapy to prevent the spread of soft tissue sarcomas has not been proven to be effective. If the cancer has spread to other areas of the body, chemotherapy may be used to shrink tumors and reduce the pain and discomfort they cause, but is unlikely to eradicate the disease.
Build Aerobic Capacity by Strengthening Leg Muscles
Posteado en en por
Aerobic capacity is a measure of your ability to use oxygen to do work. If your body can process more oxygen than that of another person, usually you will be able to run faster, walk or work longer, and have more energy than that person.
The loss of aerobic capacity with aging explains why older people cannot compete effectively against younger ones in endurance events. The good news is that a regular exercise program can help you compensate for this loss by strengthening skeletal muscles and increasing your maximum heart rate.
Tasks that you did without effort when you were younger can become major ordeals that leave you exhausted when you are older. It takes more effort and time to walk up stairs, mow the lawn, fix a faucet or wash the dishes. Dr. Jerome Fleg, a cardiologist at the National Heart, Lung, and Blood Institute, tested 800 men and women over several years and found that their ability to sustain exercise decreased rapidly as they aged. The older they became the faster they lost aerobic capacity.
The men and women lost three to six percent per decade in their 20's and 30's, and 20 percent per decade in their 70's. The men lost aerobic capacity faster than the women. The men lost 8.3 percent of aerobic capacity in their 40's and 23 percent per decade in their 70's. This study was done with people who were healthy enough for vigorous exercise on a treadmill that measured their exercise capacity. People who have had heart attacks, strokes, diabetes or other wasting diseases would lose aerobic capacity much faster than healthy people. Journal reference
A regular exercise program can increase exercise capacity by up to 25 percent, which would give the older participants the same exercise capacity as you would expect in people who are twenty years younger.
With vigorous exercise, you develop stronger skeletal muscles. When you contract your leg muscles, they squeeze against the veins in your legs and pump blood toward your heart. When your leg muscles relax, the veins dilate and fill with blood. This alternate contacting and relaxing pumps extra blood toward your heart. The extra blood returned to the heart stretches and strengthens the heart muscle, causing it to beat faster and with more force. So strengthening your leg muscles increases your maximum heart rate, even as you age.
Smoking and cancer: Second-hand smoke
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Breathing in other people's smoke can cause cancer. Second-hand smoke can increase a non-smoker's risk of getting lung cancer by a quarter.
Second-hand smoke can cause other health problems too, including heart disease, stroke and breathing problems. Even 30 minutes of exposure to second-hand smoke can reduce blood flow in a non-smoker’s heart. Every year, second-hand smoke kills about 11,000 people in the UK from lung cancer, heart disease and strokes.
For more information about the evidence that links second-hand smoke to cancer, go to our How do we know section.
Second-hand smoke and children
Second-hand smoke is particularly dangerous for children because their bodies are still developing. Smoking when you are with your children can increase their risk of cot death, glue ear, respiratory illnesses such as asthma and chest infections, and possibly cancer later on in life.
A study by the Royal College of Physicians showed that about 17,000 children in the UK are admitted to hospital every year because of illnesses caused by second-hand smoke.
Over forty percent of children in the UK live in a household where at least one person smokes. If you are a smoker, try not to expose your child to your smoke.
The chemicals in second-hand smoke
There are two types of tobacco smoke:
•mainstream smoke, which is directly inhaled through the mouth end of the cigarette, and
•sidestream smoke, which comes from the burning tip of the cigarette.
Second-hand smoke consists mainly of sidestream smoke, which is about four times more toxic than mainstream smoke, although people inhale it in a more diluted form. This is because sidestream smoke contains much higher levels of many of the poisons and cancer-causing chemicals in cigarettes, including:
•up to three times as much carbon monoxide
•five times more cadmium
•3-10 times more polycyclic aromatic hydrocarbons
•10-40 times more nitrosamines
•about 15 times more benzene
•40-70 times more ammonia
Smoking in the workplace
Over half of employees in the UK are exposed to tobacco smoke at work. Their health is being put at risk even though employers have a duty to maintain a safe working environment. Find out more about smoking at work on our public policy pages.
Smoking in public places
In February 2006, MPs voted by a massive majority to make public spaces, including pubs and private members' clubs, smokefree. This move will help to protect workers from the harmful effects of second-hand smoke and has been hailed as a large advance in public health.
Since the ban was brought into place, England has seen the largest ever fall in smoking rates. In the first year of the ban, about 400,000 people quit smoking and scientists have estimated that the new laws will prevent about 40,000 deaths from smoking-related diseases over the next decade
Cancer Awareness Month: “My Left Hand
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Today I received an e-mail containing a copy of the news story below about a man’s personal battle with cancer in his left hand. Joshua Isaac, a young husband, father and writer, documents his experience dealing withe re-occurrence of epithelioid sarcoma—a rare, cancerous tumor. I’d read about Joshua’s story ages ago and remembered being moved by it. So when I got the e-mail today, it prompted me to share his story as part of Cancer Awareness Month. It’s a film well worth watching. There is a link to the trailer at the bottom of the page.
Cancer fight on film
Seattle’s Joshua Isaac used a camera to chronicle his battle with a rare cancer in the documentary ‘My Left Hand.’
SERENA AU; For The News Tribune – Published: August 20th, 2007:
Joshua Isaac enjoys an afternoon with his son, Jacob, 6, at their home in Seattle. Joshua’s film “My Left Hand” recently premiered and tells the story of his battle with cancer that eventually led to amputation of his left hand.
Joshua Isaac had three things going for him as he battled a rare form of cancer: his faith, his family and his film.
Epithelioid sarcoma, which comprises less than 1 percent of all cancers in this country, appeared as a tumor in the center of Isaac’s left hand. Nobody knows what causes it, and no cure has been found. The one-year survival rate is about 50 percent, but rather than surrender to the disease, Isaac approached his cancer with camera in hand.
In his documentary film, “My Left Hand,” Isaac, 34, chronicles his experience dealing with the re-occurrence of his cancer, a rare tumor initially found as a distracting lump in his hand in 1998. He documents his emotions, setbacks, fears and faith while undergoing chemotherapy, radiation and the eventual amputation of his left hand.“I did it because I thought this was a very personal event in my life,” said Isaac.
“One of my first jobs was doing documentary work with the Shoah Foundation down in Los Angeles. I did think in undergraduate school about doing a documentary on my family history, so that tied in with the film.
”Born and raised in North Seattle, Isaac and his family’s lives had always been steeped in Judaism. He met his wife, Kim Haas, a 1989 graduate of Tacoma’s Bellarmine Preparatory School, when they worked as camp counselors together in a Jewish summer camp in 1995.
Judaism and its traditions were a crucial component of Isaac’s battle and recovery. “Oddly, I questioned faith less,” said Isaac. “I embraced Judaism. I was taking comfort in the idea that there possibly is meaning in all of this, maybe for proliferating my life and my principles.”
This did not mean that Isaac was exempt from moments of weakness.“There was definitely disbelief, anger, depression. Psychologically, I could be at an event where my kids were playing and sometimes I would just think about everything that was happening and actually start crying. (I would think), how much longer do I have?”
“But I knew that thinking ‘Why me?’ wasn’t a healthy thing to do,” Isaac said. “Who knows what happens to anyone? Tomorrow I could walk out and get hit by a bus.”Diagnosis came at a difficult time for the family as both Isaac’s parents had recently died. Faced with that devastating news, Isaac entered his cancer treatment with a determination to remain positive with the support of his family and his synagogue.
After an unsuccessful round of chemotherapy, Isaac underwent surgery to amputate his left hand. He later learned that the cancer had metastasized to his lymph nodes, and so he began radiation treatment.
Emboldened by his film and inspired by his two young sons, Sam and Jacob, Isaac persevered, even after the loss of his hand.
In 2005, Isaac received news that rejuvenated his life – the cancer was gone. Isaac has been in remission for 25 months.
Following his battle with cancer, Isaac rejoices in the opportunities available to him, even with the loss of his hand.“I never was a guitar player, so that’s OK,” he said. “Jacob (his older son) has gotten into T-ball, that’s one sport I can’t go do with him. Even tying shoes for me is tough. But being able to coach their soccer team, that’s still something I can do. So I do it.”
Isaac, who works as a media producer at Microsoft, continues to write using the aid of voice recognition software. Today, Isaac wears his wedding ring on his right hand. For him, removing the ring from his left hand was a source of strength. “It was kind of a symbolic moment,” said Isaac. “For me, it was like ‘I’m losing my hand, but this is something stronger than my hand.”
There is a another chapter to the story. Isaac, who had been told that a possible side-effect of the chemotherapy was sterility, saw the birth of his daughter Sophie on May 25.“I’d been rushing to get home because the Sears guy had to fix the fridge,” said Isaac, beaming. “She was really healthy and beautiful. That was a good day. It was a triumphant day.”
Isaac’s first venture into film-making, “My Left Hand” was directed and produced by him and edited by another Seattle native, Stephen Sadis. The film has been submitted in the documentary category at local and national film festivals, including the recent Seattle True and Independent Film Festival.
Cancer fight on film
Seattle’s Joshua Isaac used a camera to chronicle his battle with a rare cancer in the documentary ‘My Left Hand.’
SERENA AU; For The News Tribune – Published: August 20th, 2007:
Joshua Isaac enjoys an afternoon with his son, Jacob, 6, at their home in Seattle. Joshua’s film “My Left Hand” recently premiered and tells the story of his battle with cancer that eventually led to amputation of his left hand.
Joshua Isaac had three things going for him as he battled a rare form of cancer: his faith, his family and his film.
Epithelioid sarcoma, which comprises less than 1 percent of all cancers in this country, appeared as a tumor in the center of Isaac’s left hand. Nobody knows what causes it, and no cure has been found. The one-year survival rate is about 50 percent, but rather than surrender to the disease, Isaac approached his cancer with camera in hand.
In his documentary film, “My Left Hand,” Isaac, 34, chronicles his experience dealing with the re-occurrence of his cancer, a rare tumor initially found as a distracting lump in his hand in 1998. He documents his emotions, setbacks, fears and faith while undergoing chemotherapy, radiation and the eventual amputation of his left hand.“I did it because I thought this was a very personal event in my life,” said Isaac.
“One of my first jobs was doing documentary work with the Shoah Foundation down in Los Angeles. I did think in undergraduate school about doing a documentary on my family history, so that tied in with the film.
”Born and raised in North Seattle, Isaac and his family’s lives had always been steeped in Judaism. He met his wife, Kim Haas, a 1989 graduate of Tacoma’s Bellarmine Preparatory School, when they worked as camp counselors together in a Jewish summer camp in 1995.
Judaism and its traditions were a crucial component of Isaac’s battle and recovery. “Oddly, I questioned faith less,” said Isaac. “I embraced Judaism. I was taking comfort in the idea that there possibly is meaning in all of this, maybe for proliferating my life and my principles.”
This did not mean that Isaac was exempt from moments of weakness.“There was definitely disbelief, anger, depression. Psychologically, I could be at an event where my kids were playing and sometimes I would just think about everything that was happening and actually start crying. (I would think), how much longer do I have?”
“But I knew that thinking ‘Why me?’ wasn’t a healthy thing to do,” Isaac said. “Who knows what happens to anyone? Tomorrow I could walk out and get hit by a bus.”Diagnosis came at a difficult time for the family as both Isaac’s parents had recently died. Faced with that devastating news, Isaac entered his cancer treatment with a determination to remain positive with the support of his family and his synagogue.
After an unsuccessful round of chemotherapy, Isaac underwent surgery to amputate his left hand. He later learned that the cancer had metastasized to his lymph nodes, and so he began radiation treatment.
Emboldened by his film and inspired by his two young sons, Sam and Jacob, Isaac persevered, even after the loss of his hand.
In 2005, Isaac received news that rejuvenated his life – the cancer was gone. Isaac has been in remission for 25 months.
Following his battle with cancer, Isaac rejoices in the opportunities available to him, even with the loss of his hand.“I never was a guitar player, so that’s OK,” he said. “Jacob (his older son) has gotten into T-ball, that’s one sport I can’t go do with him. Even tying shoes for me is tough. But being able to coach their soccer team, that’s still something I can do. So I do it.”
Isaac, who works as a media producer at Microsoft, continues to write using the aid of voice recognition software. Today, Isaac wears his wedding ring on his right hand. For him, removing the ring from his left hand was a source of strength. “It was kind of a symbolic moment,” said Isaac. “For me, it was like ‘I’m losing my hand, but this is something stronger than my hand.”
There is a another chapter to the story. Isaac, who had been told that a possible side-effect of the chemotherapy was sterility, saw the birth of his daughter Sophie on May 25.“I’d been rushing to get home because the Sears guy had to fix the fridge,” said Isaac, beaming. “She was really healthy and beautiful. That was a good day. It was a triumphant day.”
Isaac’s first venture into film-making, “My Left Hand” was directed and produced by him and edited by another Seattle native, Stephen Sadis. The film has been submitted in the documentary category at local and national film festivals, including the recent Seattle True and Independent Film Festival.
Cancer-Healthcare
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Breast cancer symptoms vary widely from lumps to swelling to skin changes and many breast cancers have no obvious symptoms at all. Symptoms that are similar to those of breast cancer may be the result of non-cancerous conditions like infection or a cyst.Early breast cancer usually does not cause pain. In fact, when it first develops, breast cancer may cause no symptoms at all. But as the cancer grows, it can cause these changes:
* a lump or thickening in the breast or armpit
* a change in the size or shape of the breast
* discharge from the nipple
* a change in the color or texture of the skin of the breast or areola (such as dimpling, puckering, or scaliness).
Note: any changes in the breast should be reported to a doctor without delay. Symptoms can be caused by cancer or by a number of less serious conditions. Early diagnosis is especially important for breast cancer because the disease responds best to treatment before it has spread. The earlier breast cancer is found and treated, the better a woman's chance for complete recovery.
Posted by chandrasekar at 6:59 AM 0 comments
Tuesday, July 14, 2009
causes of cancer
Most people don't realize that cancer is preventable in many cases. Learning what causes cancer and what the risk factors are is the first step in cancer prevention.
Tobacco
According to the National Cancer Institute, smoking causes 30% of all cancer deaths in the U.S. and is responsible for 87% of cases of lung cancer. Not only does it affect the lungs, it can cause kidney, pancreatic
Physical Activity
Exercising at least 30 minutes a day, 5 days a week greatly reduces your cancer risk. Exercise like yoga, aerobics, walking and running are great activities to lower your cancer risk factor.And other factors such as sunexposure,environmentalfactors etc...
Does Sex Protect You Against Cancer?
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Sex is more than physical pleasure: it may bring benefits on a long term. Many philosophies plead for total abstinence and preservation of the sexual energy for a prolonged life, but science comes up with another story.
In fact, many researches have showed that sex has a rather healing effect, on both psychical and physical levels. Of course, sex must be healthy, clean as on the other hand there is a wide array of sexually transmitted diseases. Frequent orgasms (about 100 per year) have been linked to an increase of 3-8 years in a person's lifespan and a decrease of death risk of 50%.
Perhaps nobody would have expected this, but sex decreases cancer rates. And in both sexes!
Researches found that sexually active women have a lower risk of developing breast cancer. When it comes to men, numerous researches have shown that a high ejaculation frequency and sexual activity are linked to a lower risk of prostate cancer later in life. A study found out that men who ejaculated 13 to 20 times monthly presented a 14% lower risk of prostate cancer than men who ejaculated on average, between 4 and 7 times monthly during most of their adult life. Those ejaculating over 21 times a month presented a 33% decreased risk of developing prostate cancer than those on the baseline.
Many cancers can be boosted by impairments of the hormonal balance, and perhaps sex and orgasm can fix this. Indeed, increased estrogen levels have been linked with higher risk of many cancers and increased testosterone levels in men has been linked to greater risk for prostate cancer.
But too much sex can be harmful for your health. In fact, over sexual partners increase the risk of infection with papillomavirus (HPV), a common genital virus, which can be transmitted even through anal and oral sex, by 8.6 times.
The human papillomavirus (HPV) is the leading cause of cervical cancer (in uterus) (95 % of the cases). Due to oral sex, HPV can provoke larynx, esophagus and oropharyngeal cancer (cancer of the throat, tonsils and back of the tongue), in a rate higher than heavy smoking or alcoholism. This virus can also provoke periungual skin, vulva, vagina, penis, perianal and anus cancer and it is also suspected to provoke breast cancer
Everything You Want to Know About Sex and Cancer
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How does your sex life affect the chances of your getting cancer? Does the sensuous woman have more or less cancer than the celibate? And how about the man? Does circumcision help; and whom does it help? And what about orgasmic frequency? There is very little need to answer these questions, because an increase or decrease in cancer is not likely to deter those who are enjoying sex, nor encourage those who aren't. Nevertheless, with a "modern" book, we have to have something about sex in it. I will deal with women and men separately because, although their sexual interaction is a thing in common, the types of cancer that are related to it are not.
Cancer of the breast appears to be influenced to some degree by reproduction. It has been known for some time that there is a relatively high incidence of breast cancer among nuns, and that marriage, having children, and nursing them appears to reduce the incidence. Since marriage, having children and nursing are interrelated, it is very difficult to separate these factors. The early work suggested that long-term nursing reduced the incidence of breast cancer. This has never been substantiated, but we can still say that having children reduced the chances of getting breast cancer, and having children at a relatively early age appears to reduce the chances of getting breast cancer even more. It is also reasonably certain that having children and nursing them does not, as it does in mice, increase the incidence of breast cancer. In mice, the more pregnancy, the more breast cancer. No one has ever satisfactorily explained this discrepancy.
Cancer of the uterine cervix has its highest incidence in prostitutes, and its lowest in nuns. That ought to tell you something.
You can't win, ladies, because what increases the risk of breast cancer decreases the risk of cancer of the uterine cervix: pregnancy reduces the incidence of cancer of the breast and increases the incidence of cancer of the cervix, while celibacy increases the incidence of cancer of the breast and reduces the incidence of cancer of the cervix. You might as well do what you enjoy, because in the long haul it makes little difference in terms of cancer risk.
Cancer of the penis is very rare in circumcised men and, interestingly enough, cancer of the uterine cervix has a very low incidence in women married to circumcised men. It has not been determined whether this represents a cause and effect relationship, or whether these observations are both due to a common factor, such as a high level of marital fidelity in wives of circumcised men.
The lowest incidence of cancer of the prostate is found in Japanese men. This has been attributed to the early and regular sex habits of the Japanese male; an orgasm a day keeps the urologist away. J. D. Ferguson says that "Exemption both from baldness and gout has been credited to eunuchs since Hippocratic times. More recently it was suggested that such individuals likewise enjoy immunity from prostatic cancer. Convincing proof of this is hard to obtain, but, as yet, no instances of the disease have been reported in such circumstances. From an experimental aspect, however, there is no doubt that in domestic animals subjected to early castration, the prostate remains permanently underdeveloped, and it seems logical to suppose that a similar state in man might reduce any subsequent risk of malignant change. Despite this, it is obvious that prepubertal emasculation cannot be accounted an acceptable method of prophylaxis." Incidentally, castration is guaranteed to prevent cancer of the testicle.
There is a very very old joke that goes something like this: A salesman comes to the big city for a convention and is accosted at the train station by a woman who approaches him and says "I'm selling" and he replied "I'm buying," and they go off together. When he returns home, he finds that he has acquired gonorrhea. The following year, on his trip to the big city, he meets the same woman who says "I'm selling" and he replied "I'm buying" and again they go off together. On his return home, he finds that he has acquired syphilis. The following year he returns to the big city and meets the same woman at the station. She says "I'm selling," and he replies "What are you selling now, cancer?" Well, it looks as if this little dirty joke might well have been prophetic. A recent study, which has not been confirmed, indicates that people with cancer of the prostate tend to have had both venereal disease and a larger number of sexual partners than a control population that did not have cancer of the prostate. This appears to be a well-controlled study, but the samples are relatively small, and the conclusions drawn have to be tentative until the work has been repeated.
Some scientists have postulated that both cancer of the uterine cervix and cancer of the prostate might be caused by a herpes virus (a first cousin of the virus that causes cold sores). If this were so, one would expect some correlation between the national incidence of cancer of the uterus and the incidents of cancer of the prostate. There doesn¹t seem to be any such correlation, with a country like Australia ranking in the top ten with cancer of the prostate and the bottom ten for cancer of the uterus. South Africa ranks first in cancer of the prostate and fifteenth in cancer of the uterus; while Venezuela ranks first in cancer of the uterus and twenty-fifth in incidence of cancer of the prostate. At the present time, I know of no satisfactory explanation for these conflicting findings. If a man wanted to play it safe, he would stick to one woman. He might have less fun, but he might also have considerably less trouble.
After reading this chapter, a woman told me that she thought that she would get neither cancer of the cervix nor cancer of the breast because she had had children at an early age, nursed them all, and had remained reasonably faithful to a series of circumcised men.
In summary, it appears as if people might reduce their chances of getting cancer a bit by having frequent sexual intercourse with the same partner and having children at a reasonably early age (now, doesn't that make you happy, Doctor Ruben?). To avoid cancer of the uterine cervix, celibacy can be recommended; but that is the only thing that it has to recommend it.
Cancer of the breast appears to be influenced to some degree by reproduction. It has been known for some time that there is a relatively high incidence of breast cancer among nuns, and that marriage, having children, and nursing them appears to reduce the incidence. Since marriage, having children and nursing are interrelated, it is very difficult to separate these factors. The early work suggested that long-term nursing reduced the incidence of breast cancer. This has never been substantiated, but we can still say that having children reduced the chances of getting breast cancer, and having children at a relatively early age appears to reduce the chances of getting breast cancer even more. It is also reasonably certain that having children and nursing them does not, as it does in mice, increase the incidence of breast cancer. In mice, the more pregnancy, the more breast cancer. No one has ever satisfactorily explained this discrepancy.
Cancer of the uterine cervix has its highest incidence in prostitutes, and its lowest in nuns. That ought to tell you something.
You can't win, ladies, because what increases the risk of breast cancer decreases the risk of cancer of the uterine cervix: pregnancy reduces the incidence of cancer of the breast and increases the incidence of cancer of the cervix, while celibacy increases the incidence of cancer of the breast and reduces the incidence of cancer of the cervix. You might as well do what you enjoy, because in the long haul it makes little difference in terms of cancer risk.
Cancer of the penis is very rare in circumcised men and, interestingly enough, cancer of the uterine cervix has a very low incidence in women married to circumcised men. It has not been determined whether this represents a cause and effect relationship, or whether these observations are both due to a common factor, such as a high level of marital fidelity in wives of circumcised men.
The lowest incidence of cancer of the prostate is found in Japanese men. This has been attributed to the early and regular sex habits of the Japanese male; an orgasm a day keeps the urologist away. J. D. Ferguson says that "Exemption both from baldness and gout has been credited to eunuchs since Hippocratic times. More recently it was suggested that such individuals likewise enjoy immunity from prostatic cancer. Convincing proof of this is hard to obtain, but, as yet, no instances of the disease have been reported in such circumstances. From an experimental aspect, however, there is no doubt that in domestic animals subjected to early castration, the prostate remains permanently underdeveloped, and it seems logical to suppose that a similar state in man might reduce any subsequent risk of malignant change. Despite this, it is obvious that prepubertal emasculation cannot be accounted an acceptable method of prophylaxis." Incidentally, castration is guaranteed to prevent cancer of the testicle.
There is a very very old joke that goes something like this: A salesman comes to the big city for a convention and is accosted at the train station by a woman who approaches him and says "I'm selling" and he replied "I'm buying," and they go off together. When he returns home, he finds that he has acquired gonorrhea. The following year, on his trip to the big city, he meets the same woman who says "I'm selling" and he replied "I'm buying" and again they go off together. On his return home, he finds that he has acquired syphilis. The following year he returns to the big city and meets the same woman at the station. She says "I'm selling," and he replies "What are you selling now, cancer?" Well, it looks as if this little dirty joke might well have been prophetic. A recent study, which has not been confirmed, indicates that people with cancer of the prostate tend to have had both venereal disease and a larger number of sexual partners than a control population that did not have cancer of the prostate. This appears to be a well-controlled study, but the samples are relatively small, and the conclusions drawn have to be tentative until the work has been repeated.
Some scientists have postulated that both cancer of the uterine cervix and cancer of the prostate might be caused by a herpes virus (a first cousin of the virus that causes cold sores). If this were so, one would expect some correlation between the national incidence of cancer of the uterus and the incidents of cancer of the prostate. There doesn¹t seem to be any such correlation, with a country like Australia ranking in the top ten with cancer of the prostate and the bottom ten for cancer of the uterus. South Africa ranks first in cancer of the prostate and fifteenth in cancer of the uterus; while Venezuela ranks first in cancer of the uterus and twenty-fifth in incidence of cancer of the prostate. At the present time, I know of no satisfactory explanation for these conflicting findings. If a man wanted to play it safe, he would stick to one woman. He might have less fun, but he might also have considerably less trouble.
After reading this chapter, a woman told me that she thought that she would get neither cancer of the cervix nor cancer of the breast because she had had children at an early age, nursed them all, and had remained reasonably faithful to a series of circumcised men.
In summary, it appears as if people might reduce their chances of getting cancer a bit by having frequent sexual intercourse with the same partner and having children at a reasonably early age (now, doesn't that make you happy, Doctor Ruben?). To avoid cancer of the uterine cervix, celibacy can be recommended; but that is the only thing that it has to recommend it.
Oral sex can cause throat cancer
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People who have had more than five oral-sex partners in their lifetime are 250% more likely to have throat cancer than those who do not have oral sex, a new study suggests.
The researchers believe this is because oral sex may transmit human papillomavirus (HPV), the virus implicated in the majority of cervical cancers.
The new findings should encourage people to consistently use condoms during oral sex as this could protect against HPV, the team says. Other experts say that the results provide more reason for men to receive the new HPV vaccine.
Maura Gillison at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, US, and colleagues collected blood and saliva samples from the throats of 100 patients diagnosed with cancers of the tonsils or back of the throat. The scientists also took samples from 200 healthy people for comparison.
By combining the blood and saliva samples with antibody molecules, Gillison's team could tell whether a person had ever had an HPV infection.
Cancer traps
All of the study participants provided information about their sexual history, including the number of people with whom they had engaged in oral sex.
After controlling for other risk factors for throat cancer, such as drinking and smoking, the analysis revealed that people who had prior infection with HPV were 32 times as likely to have this cancer as those with no evidence of ever having the virus. And those who tested positive for a particularly aggressive strain of the virus, called HPV-16, were 58 times more likely to have throat cancer.
By comparison, either smoking or drinking increases the risk of such cancer by about threefold.
The throat cancers analysed in the new study mostly started in the "crypts" of the throat - the grooves at the base of the tonsils. This might be because the tonsil grooves trap infectious particles, suggests Mark Stoler of the University of Virginia in Charlottesville, US, who was not involved in the study.
High risk levels
The study also revealed a link between oral sex and throat cancer caused by HPV. People who had one to five oral-sex partners in their lifetime had approximately a doubled risk of throat cancer compared with those who never engaged in this activity - and those with more than five oral-sex partners had a 250% increased risk.
There was an even stronger link between oral sex and throat cancers clearly caused by HPV-16 (those tumours that tested positive for the strain). People with more than five oral sex partners had a 750% increased risk of these HPV-16-caused cancers.
"This study is important because it is putting all of the pieces together," says Gillison. "We need to add oral HPV infection to the list of risks for oral cancer," she adds.
Virus vaccine
A vaccine against several of the most aggressive strains of HPV linked to cervical cancer received approval from the US Food and Drug Administration in 2006. However the plan to vaccinate adolescent girls with this vaccine developed by Merck, called Gardasil, has received some criticism.
There have been no studies investigating whether the vaccine can also protect against throat cancer, but the new evidence linking HPV to throat cancer could lead to broader vaccination with Gardasil. "We will see a push for vaccination in men," says Stoler, who has been involved in the development of the vaccine.
Tonsil and throat cancers affect about two in every 100,000 adults in the US. The new results could promote the development of spit tests for HPV infection to help identify people at high risk for these cancers, researchers say
The researchers believe this is because oral sex may transmit human papillomavirus (HPV), the virus implicated in the majority of cervical cancers.
The new findings should encourage people to consistently use condoms during oral sex as this could protect against HPV, the team says. Other experts say that the results provide more reason for men to receive the new HPV vaccine.
Maura Gillison at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, US, and colleagues collected blood and saliva samples from the throats of 100 patients diagnosed with cancers of the tonsils or back of the throat. The scientists also took samples from 200 healthy people for comparison.
By combining the blood and saliva samples with antibody molecules, Gillison's team could tell whether a person had ever had an HPV infection.
Cancer traps
All of the study participants provided information about their sexual history, including the number of people with whom they had engaged in oral sex.
After controlling for other risk factors for throat cancer, such as drinking and smoking, the analysis revealed that people who had prior infection with HPV were 32 times as likely to have this cancer as those with no evidence of ever having the virus. And those who tested positive for a particularly aggressive strain of the virus, called HPV-16, were 58 times more likely to have throat cancer.
By comparison, either smoking or drinking increases the risk of such cancer by about threefold.
The throat cancers analysed in the new study mostly started in the "crypts" of the throat - the grooves at the base of the tonsils. This might be because the tonsil grooves trap infectious particles, suggests Mark Stoler of the University of Virginia in Charlottesville, US, who was not involved in the study.
High risk levels
The study also revealed a link between oral sex and throat cancer caused by HPV. People who had one to five oral-sex partners in their lifetime had approximately a doubled risk of throat cancer compared with those who never engaged in this activity - and those with more than five oral-sex partners had a 250% increased risk.
There was an even stronger link between oral sex and throat cancers clearly caused by HPV-16 (those tumours that tested positive for the strain). People with more than five oral sex partners had a 750% increased risk of these HPV-16-caused cancers.
"This study is important because it is putting all of the pieces together," says Gillison. "We need to add oral HPV infection to the list of risks for oral cancer," she adds.
Virus vaccine
A vaccine against several of the most aggressive strains of HPV linked to cervical cancer received approval from the US Food and Drug Administration in 2006. However the plan to vaccinate adolescent girls with this vaccine developed by Merck, called Gardasil, has received some criticism.
There have been no studies investigating whether the vaccine can also protect against throat cancer, but the new evidence linking HPV to throat cancer could lead to broader vaccination with Gardasil. "We will see a push for vaccination in men," says Stoler, who has been involved in the development of the vaccine.
Tonsil and throat cancers affect about two in every 100,000 adults in the US. The new results could promote the development of spit tests for HPV infection to help identify people at high risk for these cancers, researchers say
Cancer - renal pelvis or ureter - Overview
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Alternative Names
Transitional cell cancer of the renal pelvis or ureter
Definition of Cancer - renal pelvis or ureter:
Cancer of the renal pelvis or ureter is cancer that forms in the pelvis or the tube that carries urine from the kidney to the bladder.
Causes, incidence, and risk factors:
Cancer can grow in the urine collection system, but is uncommon. As a group, renal pelvis and ureter cancers account for no more than 5% of all cancers of the kidney and upper urinary tract. They affect men more often than women and are more common in people older than 65.
Tumors of the renal pelvis and ureter are usually transitional cell cancers. Approximately 10% are squamous cell carcinomas.
The causes of this cancer are not completely known. Long-term (chronic) irritation of the kidney from harmful substances removed in the urine may be a factor. This irritation may be caused by:
•Analgesic nephropathy
•Exposure to certain dyes and chemicals used to manufacture leather goods, textiles, plastics, and rubber
•Smoking
Patients with a history of bladder cancer are also at risk.
Kidney anatomy
•Reviewed last on: 6/10/2008
•David C. Dugdale III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Transitional cell cancer of the renal pelvis or ureter
Definition of Cancer - renal pelvis or ureter:
Cancer of the renal pelvis or ureter is cancer that forms in the pelvis or the tube that carries urine from the kidney to the bladder.
Causes, incidence, and risk factors:
Cancer can grow in the urine collection system, but is uncommon. As a group, renal pelvis and ureter cancers account for no more than 5% of all cancers of the kidney and upper urinary tract. They affect men more often than women and are more common in people older than 65.
Tumors of the renal pelvis and ureter are usually transitional cell cancers. Approximately 10% are squamous cell carcinomas.
The causes of this cancer are not completely known. Long-term (chronic) irritation of the kidney from harmful substances removed in the urine may be a factor. This irritation may be caused by:
•Analgesic nephropathy
•Exposure to certain dyes and chemicals used to manufacture leather goods, textiles, plastics, and rubber
•Smoking
Patients with a history of bladder cancer are also at risk.
Kidney anatomy
•Reviewed last on: 6/10/2008
•David C. Dugdale III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Cancer of the ureter and renal pelvis
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This information is about primary cancer of the ureter or renal pelvis. This means cancer that has started in the ureter or renal pelvis.
The ureters and the renal pelvis
Cancer of the ureter and renal pelvis
Causes
Signs and symptoms
How it is diagnosed
Further tests
Staging and grading
Treatment
Follow up
Your feelings
References
The ureters and the renal pelvis
The ureters are hollow muscular tubes that carry urine from the kidneys to the bladder. The renal pelvis is the lower part of each kidney that connects to each ureter.
Structure of the kidneys
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Cancer of the ureter and renal pelvis
Cancers affecting the ureter and renal pelvis are rare. Approximately 400 people are diagnosed with this type of cancer in the UK each year. Cancer of the ureter and renal pelvis tends to affect more men than women, and is rare under the age of 65.
The main type of cancer affecting the ureter and renal pelvis is called transitional cell carcinoma (TCC). This type of cancer develops in cells, known as transitional cells, which form the lining of the bladder, ureters and renal pelvis. Usually only one ureter or renal pelvis is affected.
Another, more common, type of cancer that can affect the kidney, is known as renal cell cancer (RCC). The tests, investigations and treatment of RCC are very different. This information is only about TCC. Our general information on kidney cancer covers the treatment of renal cell cancer.
Very rarely, other types of cancer can start in the ureter or renal pelvis. These include some types of lymphoma (a cancer that starts from the cells of the lymphatic system) and sarcoma (a cancer that develops from the supporting tissues of the body, such as muscle or cartilage).
Cancer that starts in the ureter or renal pelvis is known as primary cancer. When cancer spreads from another part of the body to the ureter it is known as secondary or metastatic cancer in the ureter or renal pelvis.
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Causes
The exact causes of cancer of the ureter and renal pelvis is unknown. It is thought that smoking may increase the risk of developing these types of cancer. People who have been exposed to certain chemicals used in dye factories and chemical industries are also at a slightly increased risk.
There may also be an increased risk in people who have papillary necrosis, a condition where parts of the kidney are damaged or have died off. Papillary necrosis can occur because of overexposure to certain painkillers, and sometimes in people who have conditions affecting the kidney, such as diabetes or repeated infections.
Cancer of the ureter and renal pelvis, like other cancers, is not infectious and so cannot be passed on to other people. It is not caused by an inherited faulty gene, so other members of your family are not likely to develop it.
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Signs and symptoms
The symptoms of cancer of the ureter and renal pelvis may include any of the following:
blood in the urine (haematuria)
passing blood clots in the urine
unexplained weight loss
having to pass urine frequently
pain when passing urine
back pain or cramps
fatigue (tiredness and lack of energy)
anaemia (if you have been passing blood in the urine for some time), but this is rare.
Sometimes the ureter may become blocked, either by cancer cells or by a blood clot. If this happens, the above symptoms may develop more quickly and may be more severe, often accompanied by a high temperature. This is known as a ureteric obstruction.
The above symptoms may be caused by a number of conditions other than cancer of the ureter or renal pelvis. Symptoms which are severe, get worse, or that last for a few weeks, should always be checked by your doctor.
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How it is diagnosed
Your GP will examine you and organise a series of urine and blood tests. The urine sample will be sent to a laboratory to be checked under a microscope for any cancer cells. Samples of blood will also be taken to check your general health, the number of cells in your blood (blood count), and to see how well your kidneys and liver are working.
Your GP will refer you to a urologist (a doctor who specialises in diseases of the urinary system) if further tests are needed. These tests will help to make the diagnosis and, if cancer is found, to check how far, if at all, the disease has spread.
Cystoscopy and biopsy A small, flexible, fibre-optic telescope (cystoscope) is passed up the urethra to enable the doctor to look at the bladder. The doctor can also extend the tip of the cystoscope up into the ureter: this procedure, known as ureteroscopy, can be done under a local or a general anaesthetic. In most cases it is done under a local anaesthetic because this is the quickest and simplest way.
If any abnormality that could be a cancer is seen, it has to be examined while you are under a general anaesthetic. The doctor will then take a sample of abnormal cells, and these are examined in a laboratory under a microscope by a pathologist (biopsy).
Intravenous urogram or pyelogram (IVU or IVP) This test shows up abnormalities in the urinary system. It is done in the hospital x-ray department and takes about an hour. A dye is injected into a vein, usually in the arm, that travels through the bloodstream to the kidneys. The doctor can watch the passage of dye on an x-ray screen and pick up any abnormalities.
The dye will probably make you feel hot and flushed for a few minutes, but this feeling gradually disappears. You may feel some discomfort in your abdomen, but this will only be temporary. You should be able to go home as soon as the test is over.
Ultrasound scan Sound waves are used to build up a picture of the inside of your body. You may have scans of your bladder and pelvis. The scan will be done in the hospital scanning department. Before your test, you will be asked to drink plenty of fluid so that your bladder is full and a clear picture can be seen. Once you are lying comfortably on your back, a special gel is spread over your abdomen. A small device, like a microphone, is rubbed over the area. The echoes are converted into a picture by a computer. This is a completely painless procedure and takes about 15–20 minutes. Once the scan is over, you will be allowed to empty your bladder.
Retrograde pyelography This is a special x-ray which involves inserting a catheter into the ureter at the time of ureteroscopy. Dye is then passed up the catheter to highlight the ureter and renal pelvis.
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Further tests
If a cancer is found, you may be referred for other tests to find the size of the cancer and whether or not it has spread beyond the ureter or renal pelvis. These may include either of the following:
CT (computerised tomography) scan A CT scan takes a series of x-rays and puts these together to give a 3-D picture of the inside of your body. The scan is painless and takes between 10 and 30 minutes.
You may be asked not to eat or drink anything for several hours before your appointment. Most people who have a CT scan are given a drink or injection of dye before the scan. This helps the doctor to see particular areas more clearly. People who are allergic to iodine or have asthma may be at higher risk of reacting to the dye. If you are allergic to iodine or have asthma, tell the doctor and the person doing the test before you have the injection or drink. After having the injection, most people feel hot and flushed, but this only lasts for a few minutes. You will probably be able to go home as soon as the scan is over.
MRI (magnetic resonance imaging) scan This test is similar to a CT scan, but uses magnetism instead of x-rays to build up cross-sectional pictures of your body. During the test, you will be asked to lie very still on a couch inside a long tube for about 30 minutes. It can be slightly uncomfortable and some people feel claustrophobic during the scan. It is also very noisy, but you will be given earplugs or headphones to wear.
The combination of tests will help the specialist to find out the stage and grade of the cancer. This will help the doctors to decide on the most appropriate treatment for you.
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Staging and grading
Staging
Staging refers to the size of the cancer and whether or not it has spread beyond the ureter or renal pelvis.
The following stages are used for transitional cell cancer of the renal pelvis and ureter:
Localised The cancer is only in the area where it started and has not spread outside the kidney or ureter.
Regional The cancer has spread to the tissue around the kidney or to nearby lymph nodes. Lymph nodes are bean-shaped structures that are found throughout the body. They produce cells that fight infection.
Metastatic The cancer has spread to other parts of the body.
Grading
Grading refers to how abnormal the cancer cells look under the microscope, and can give an idea of whether or not the cancer cells are slow-growing (low-grade) or faster-growing (high-grade).
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Treatment
Treatment will depend on a number of factors, including your age, general health and the position, type, stage and grade of the cancer.
Surgery is the most common treatment for cancer of the ureter and renal pelvis. The extent of surgery will depend on many factors, such as the stage and the grade of the cancer.
After surgery, sometimes further treatment will be recommended, such as radiotherapy or chemotherapy. This is known as adjuvant treatment. The aim of adjuvant treatment is to get rid of any remaining cancer cells and to reduce the chance of the cancer coming back. The effectiveness of adjuvant treatment for cancer of the ureter and renal pelvis is unknown.
If surgery is not possible, other treatments may be more appropriate. These may include chemotherapy or radiotherapy. The aim of these treatments is to reduce the size of the tumour and help control symptoms.
Surgery
Nephro-ureterectomy means the removal of the kidney, ureter and top part of the bladder. Sometimes the surrounding lymph glands, fat and tissue may also be removed.
Segmental ureterectomy resection is the removal of the affected part of the ureter. The remaining parts are then rejoined. This procedure is usually only possible if the tumour is small, low-grade and contained within the ureter.
Ureteroneocystomy (or reimplantation) is the removal of the lower part of the ureter, and sometimes a small part of the bladder. The remaining part of the ureter is then connected to the bladder. This is usually done if the tumour is only in the lower part of the ureter.
Occasionally, a tumour may affect just the surface of the ureter. The cancer may be removed either by laser treatment or electrosurgery. These two surgical treatments are in the early stages of development.
Laser therapy A ureteroscope is passed through the bladder and into the ureter. A narrow beam of intense laser is then passed through the tube to destroy the tumour.
Electrosurgery An electric current is used to remove the cancer. The tumour and surrounding area can be burned away.
Radiotherapy
Radiotherapy treats cancer by using high-energy rays, which destroy the cancer cells and shrink the tumour while doing as little harm as possible to normal cells.
Chemotherapy
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy the cancer cells. They work by disrupting the growth and division of cancer cells. The chemotherapy may be given directly into the vein (intravenously).
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Follow up
After treatment, you will have regular follow-up appointments with your specialist to monitor how you are recovering after treatment. Follow-up will usually include a physical examination. It may also involve taking some urine or blood samples. You will also have regular cystoscopies to detect any changes in the ureter. If you have any problems, or notice any new symptoms between these times, let your doctor know as soon as possible.
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Your feelings
During your diagnosis and treatment of cancer, you are likely to experience a number of different emotions, from shock and disbelief to fear and anger. At times, these emotions can be overwhelming and hard to control. It is quite natural, and important, to be able to express them. Each individual has their own way of coping with difficult situations; some people find it helpful to talk to friends or family, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available if you need it.
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