Cervical cancer, breast, ovarian cancer
High cervical cancer rates sign of larger problems
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High cervical cancer rates sign of larger problems
July 22, 2005 06:08:26 PM PST
Despite overall declines in cervical death rates in the U.S., certain groups of women are significantly more likely to die from the disease, which is likely due to underlying disparities access to health care, according to a new report from the National Cancer Institute.
The investigators found that women living in areas with high death rates from cervical cancer were less likely to have a usual source of health care or to use preventive services, such as cancer screening.
These women also tended to have low income and education levels, and experienced relatively high rates of other diseases such as breast cancer, colorectal cancer and heart disease.
High rates of cervical cancer "are markers for a lot of other events," according to study author Dr. Harold P. Freeman, director of the National Cancer Institute's Center to Reduce Cancer Health Disparities in Rockville, Maryland.
Freeman added that all of the above diseases, like cervical cancer, can be screened for and treated.
In the case of cervical cancer, annual Pap smears help diagnose cervical cancer in its very early stages, when it can be very effectively treated, he said. It's a "cancer from which, presumably, no woman should die."
However, 4,000 women still die every year from cervical cancer, Freeman said, probably because, in part, they have limited access to services to detect the cancer in its early stages.
But to help reduce cervical cancer rates, experts also need to educate women about why it's important to be screened, and how to do it. "We need to couple education to access," Freeman told Reuters Health.
In their analysis, Freeman and his team reviewed the available study findings on cervical cancer rates in the U.S. and the circumstances of women living in areas where death rates remain high.
They found that cervical cancer death rates are generally declining in the U.S., but remain high among African-American women in the south, women living along the Mexican border, white women in Appalachia, American Indians in the Northern Plains, Vietnamese-American women, and Alaska Natives.
"These women tend to have a fragmented health care system," Freeman noted.
Freeman and his team summarize their findings in the NCI report Excess Cervical Cancer Mortality: A Marker for Low Access to Health Care in Poor Communities.
Previous research, also out of the National Cancer Institute, has shown that cervical cancer rates trended downward between 1975 and 2000, but women in high poverty counties had at least a one-third higher incidence than women in low poverty counties.
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Cervical Cancer Resources and Information
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National Cervical Cancer Coalition
http://www.nccc-online.org/
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Cervical Cancer - MedlinePlus
Information and Links Page
http://www.nlm.nih.gov/medlineplus/cervicalcancer.html
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Cervical cancer information centre
CancerBacup - UK
http://www.cancerbacup.org.uk/Cancertype/Cervix
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What Is Cervical Cancer?
American Cancer Society
http://www.cancer.org/docroot/CRI/conte ... ncer_8.asp
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Cervical Cancer
eMedicine
http://www.emedicine.com/med/topic324.htm
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Leg Swelling After Cancer
With the advent of better and more effective cancer treatments, the survival rate for all cancers has risen dramatically. With this progress, a new and often misunderstood and misdiagnosed complication has arisen.
Many cancer survivors , having overcome cancer, find themselves with sudden and often unexplained swelling, usually of the arms or of the legs.
This swelling occurs because of one of several factors.
First, the swelling begins after lymph nodes have been removed for cancer biopsies.
Second, the swelling may start as a result of radiation damage to either the lymph nodes and/or the lymph system.
Due to either the removal of lymph nodes or damage to the lymph system, your body is no longer able to rid itself of excess fluids. The fluids collect in the limbs effected and swelling beings.
This swelling is called lymphedema. The swelling that occurs is permanent, and while it is not curable it is treatable.
Permanent Leg Swelling
****In the situation of any permanent leg swelling whether the cause is known or unknown, the diagnoses of lymphedema must be considered****
There are several groups of people who experience leg swelling from known causes, but it doesn't go away or unknown causes where the swelling can actually get worse as time goes by.
Group One
This group includes those who have had the injuries, infections, insect bites, trauma to the leg, surgeries or reaction to a medication. When this swelling does not go away, and becomes permanent it is called secondary lymphedema.
Group Two
Another extremely large group that experiences permanent leg swelling are cancer patients, people who are morbidly obese, or those with the condition called lepedema. What causes the swelling to remain permanent is that the lymph system has been so damaged that it can no longer operate normally in removing the body's waste fluid.
In cancer patients this is the result of either removal of the lymph nodes for cancer biopsy, radiation damage to the lymph system, or damage from tumor/cancer surgeries.
This is also referred to as secondary lymphedema.
Group Three
Group three consists of people who have leg swelling from seemingly unknown reasons. There may be no injury, no cancer, no trauma, but for some reason the leg simply is swollen all the time.
The swelling may start at birth, it may begin at puberty, or may begin in the 3rd, 4th or even 5th decade of life or sometimes later.
This type of leg swelling is called primary lymphedema. It can be caused by a genetic defect, malformation or damage to the lymph system while in the womb or at birth or be part of another birth condition that also effects the lymph system.
This is an extremely serious medical condition that must be diagnosed early, and treated quickly so as to avoid painful, debilitating and even life threatening complications. Treatment should NOT include the use of diuretics.
What is Lymphedema?
Lymphedema is defined simply as an accumulation of excessive protein rich fluid in the tissues of the leg. The accumulation of fluid causes the permanent swelling caused by a defective lymph system.
A conservative estimate is that there may be 1-2 million people in the United States with some form of primary lymphedema and two to three million with secondary lymphedema.
What are the symptoms of Lymphedema?
If you are an at risk person for leg lymphedema there are early warning signs you should be aware of. If you experience any or several of these symptoms, you should immediately make your physician aware of them.
1.) Unexplained aching, hurting or pain in the leg.
2.) Experiencing "fleeting lymphedema." This is where the limb may swell, even slightly, then return to normal. This may be a precursor to full blown leg lymphedema.
3.) Localized swelling of any area. Sometimes lymphedema may start as swelling in one area, for example the foot, or between the ankle and knee. This is an indication of early lymphatic malfunction.
4.) Any arm inflammation, redness or infection.
5.) You may experience a feeling of tightness, heaviness or weakness of the leg.
How is Lymphedema Treated?
The preferred treatment today is decongestive therapy. The forms of therapy are complete decongestive therapy (CDT) or manual decongestive therapy (MDT), there are variances, but most involve these two type of treatment.
It is a form of massage therapy where the leg is very gently massaged to actually move the fluid out of the leg and into an area where the lymph system still functions normally.
With these massage treatments, swelling is reduced and then the patient is fitted with a pre-measured custom pressure garment to keep the swelling down and/or is taught to use compression wraps to maintain the leg size.
What are some of the complications of lymphedema?
1. Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphodemous limbs are localized immuno-deficient.
2. Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.
3. Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids.
4. Loss of Function due to the swelling and limb changes.
5. Depression - Psychological coping as a result of the disfigurement and debilitating effect of lymphedema.
6. Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections.
7. Sepsis, Gangrene are possibilities as a result of the infections.
8. Possible amputation of the limb.
9. Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids.
10. Skin complications such as splitting, plaques, susceptibility to fungus and bacterial infections.
11. Chronic localized inflammations.
Can lymphedema be cured?
No, at the present time there is no cure for lymphedema. But it can be treated and managed and most of the complications can be avoided. Life with lymphedema can still be active and full, with proper treatment, patient education, and patient life style adaptation.
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Your Body After Cancer Treatment
Lymphedema: Arm or Leg Swelling
Lymphedema is a swelling of a part of the body, usually an arm or leg, that is caused by the buildup of lymph fluid. It can be caused by cancer or the treatment of cancer. There are many different types of lymphedema. Some types happen right after surgery, are mild, and don't last long. Other types can occur months or years after cancer treatment and can be quite painful. Lymphedema can also develop after an insect bite, minor injury, or burn.
People who are at risk for lymphedema are those who have had:
Breast cancer--if you had radiation therapy or had your underarm lymph nodes removed. Your risk is even higher if you had radiation in the underarm area after your lymph nodes were removed.
Melanoma of the arms or legs--if you had lymph nodes removed and/or had radiation therapy.
Prostate cancer--if you had surgery or radiation therapy to the whole pelvis.
Cancer of the female or male reproductive organs--if you were treated with surgery to remove lymph nodes or had radiation therapy.
Other cancers that have spread to the lower abdominal area. The pressure from the growing tumor can make it hard for your body to drain fluid.
Full article: http://www.nci.nih.gov/cancertopics/lif ... ment/page5
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Cancer Resources and Information:
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Your Body After Cancer Treatment
http://www.nci.nih.gov/cancertopics/lif ... ment/page5
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Cancer Information on the Internet
http://www.hackley.org/medical_services ... _links.htm
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Cancer Resource Center
http://patient.cancerconsultants.com/li ... x?id=32333
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Cancer Lynx
http://www.cancerlynx.com/
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Cancer Information & Support International
http://www.cancer-info.com/
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Lymphedema
WHAT IS IT?
Lymphedema is a buildup of a fluid called lymph and protein in the tissues under the skin. Lymph accumulates when there is an obstruction to normal flow causing swelling, usually in an arm or leg. The lymph system is similar to the blood system in its network of vessels that carry lymph fluid throughout the body.
Trauma to lymphatic tissue by surgery or radiotherapy is the main cause of lymphedema in the context of cancer. It can result from surgery and/or radiation therapy during treatment for cancers of the breast, abdomen, melanoma, connective tissues (sarcomas) and the pelvic area, as well as lymphomas, in both men and women. Lymphedema may also be the result of infection, such as dermatophytosis in the foot.
Cancer tumors also can block the lymph vessels, especially in people with prostate cancer or lymphoma.
IF I HAVE CANCER WILL I DEVELOP LYMPHEDEMA?
Not necessarily. The most frequent cases occur in women with breast cancer; 10% to 25% of breast cancer patients will develop lymphedema. While most cases are mild, approximately 400,000 women cope daily with some degree of disfigurement, discomfort, and sometimes disability because of arm and hand swelling.
Because of improvements in radiation and surgical techniques (such as removing smaller samples of lymph nodes), lymphedema is less common today than it use to be. Lymphedema develops in about one in four breast cancer patients who have a mastectomy with lymph-node dissection. The risk doubles for those who also receive radiation treatments to the underarm area.
Radical prostatectomy, a procedure that removes the prostate gland, seminal vesicles and sometimes the nearby pelvic lymph nodes, can lead to lymphedema .One type of Kaposi’s sarcoma is called the lymphadenopathic form that can spread throughout the body and may aggressively involve lymph nodes, viscera, and occasionally the GI tract – resulting in a kind of lymphedema.
SENTINEL LYMPH NODE BIOPSY
If breast cancer spreads, it first goes to the lymph nodes under the arm. That's why women with breast cancer have these nodes examined. Until recently, surgeons would remove as many lymph nodes as possible, but this greatly increased the risk of lymphedema. More recently, a growing number of physicians have begun focusing on finding the sentinel nodes — the first nodes to receive the drainage from breast tumors and therefore the first to show evidence of cancer’s spread. Experts believe that if a sentinel node is removed and found to be healthy, then the chance of finding cancer in any of the remaining nodes is very small and no other nodes need to be removed. This spares as many as 75% of women who have no evidence of tumor spread to the axillary nodes the risk of complications, especially lymphedema.
WHEN DOES IT DEVELOP?
Lymphedema can appear any time after surgery or radiation treatment including many years later.
When the condition develops very soon after surgery, it is usually mild, and goes away within one to two weeks. It can also develop six to eight weeks after surgery or radiation. Again, this type of lymphedema usually goes away in a few weeks.
Unfortunately, the more common form of lymphedema in cancer survivors develops slowly over time. It may show up many months or even years after treatment ends and swelling can range from mild to severe. In most cases however, lymphedema appears between six and 12 months after treatment. While people who have many lymph nodes removed and radiation therapy have the highest risk of developing lymphedema, some high-risk patients won’t develop the condition.
WHEN TO CALL A PROFESSIONAL
Patients should contact a physician if they had a mastectomy, lower abdominal surgery or radiation treatments in the past, and the affected limb becomes red, painful or hot, or if it develops open sores or areas of broken skin. Doctors should be consulted especially if there is a fever in addition to swelling.
Diagnostic Tests
Usually, no specific testing is necessary to diagnose lymphedema, but tests may be done such as a blood count that can identify signs of infection. Ultrasound may be ordered to look for blood clots, which can cause swelling. Computed tomography (CT) may be used to find a tumor that could be blocking lymph vessels. In addition, there are more specialized tests that can identify lymph flow and lymph vessel abnormalities.
Symptoms
The first signs of lymphedema can be a change in a patient’s arms or legs or other affected area such as the groin. Initially, skin will remain soft, but if the problem continues, the limb may become hot and red and the skin hard and stiff. The lymph fluid that collects in the tissues can be very uncomfortable, but pain is not always present. Early symptoms of lymphedema may include:
A feeling of tightness around the arm on the area that was treated for cancer,
Decreased flexibility in a hand, elbow, wrist, fingers, or leg,
Difficulty fitting into clothing,
Tight fit of a ring, wristwatch, bracelet, or shoe,
Weakness, pain, aching or heaviness in the arm, legs, or feet,
Skin that looks shiny, has fewer folds, and feels stiff or taut,
A dull ache in the affected limb,
A feeling of tightness in the skin of the affected limb,
Difficulty moving a limb or bending at a joint because of swelling and skin tightness,
Pitting (small indentations left on the skin after pressing on the swollen area)
In most cases, only one arm or leg is affected. If the leg is involved, swelling usually begins at the foot, then progresses upward toward the ankle, calf and knee.
Severity
The severity is directly related to the extent of surgery and radiation treatment to the lymph nodes. Severity and general risk of developing lymphedema seems to increase with obesity, weight gain and infection in the affected area.
TREATMENTS
Lymphedema has no cure so treatment focuses on reducing the symptoms. Treatment has varied from virtually no treatment to surgery, but there are various practical methods to deal with the condition, including elevation of the limb (in the first year only), compression garments (no greater than 20-30 mm Hg), certain types of massage and exercises, pneumatic compression devices (controversial), and other types of physical therapy. Experts also recommend keeping the affected limb clean, dry and lubricated.
The National Lymphedema Network (www. Lymphnet.org) encourages massage by an specially certified expert in lymphedema massage.. In many cases, patients can also be trained to massage themselves to improve the flow of lymph fluids.
Medications
There are no medications to treat lymphedema. Diuretics have been found to be ineffective and may actually exacerbate the condition. Other medicines have been tried, but there is no clear evidence of significant effectiveness with any particular drug.
MILD LYMPHEDEMA:
Elevating the arm or leg above the level of the heart(during the first year) and flexing it frequently are basic methods to manage the condition. Since elevation is impractical except for short periods, patients should be fitted with an elastic sleeve, covering the arm or leg.
A significant reduction in edema (swelling) has been reported after wearing elastic sleeves for 6 consecutive hours per day. Using these garments during exercise, physical activity, and especially air travel is recommended, since air travel seems to exacerbate the condition.
If the legs are affected, avoid periods of prolonged standing. If working or standing a lot, a doctor may prescribe special graduated compression stockings to wear throughout the day. A doctor may also suggest a protein-rich, low-salt diet for those who are over-weight or obese.
MODERATE TO SEVERE:
For people with moderate to severe lymphedema in the legs, doctors prescribe pneumatic compression devices to be used at home to help reduce limb swelling. The “pneumatic stockings” are worn every day for an hour or two to reduce the swelling. Once the swelling has been reduced, a person may still need to wear elastic stockings up to the knee every day from the moment of rising until bedtime.
For lymphedema in the arm, pneumatic sleeves--like pneumatic stockings--can be used every day to reduce the swelling; elastic sleeves may also be needed.
Others recommend a special type of massage therapy called manual lymph drainage. Antibiotics also may be prescribed to prevent or treat infection in the affected limb. Since skin infections can be more serious in people with lymphedema, a person may need to have antibiotics administered intravenously in the hospital during an infection.
Complex Decongestive Therapy
More serious cases of lymphedema can be treated with Complex Decongestive Therapy by a physical therapist or other health care professional, who has special training. Complex Decongestive Therapy consists of skin care, massage, special bandaging, exercise, and fitting for a compression sleeve. Seeking and getting treatment early should lead to a shorter course of treatment to get the lymphedema under control. While most insurance companies will pay for this treatment, some do not.
Someone certified in the procedure should perform Manual Lymph Drainage (MLD).
In the case of lymphedema of the arm, the procedure involves a type of massage that moves built up fluid around the blocked vessels and across the chest to the other side of the body where the lymphatic system is still in tact. Usually the healthy area will be “worked” first. After each treatment, the effected area is carefully bandaged with a special layered wrap that looks like an ace bandage but is made of a different fabric. The wrap is important for keeping the effected limb de-congested. An average course is 15 daily treatments of 60 to 90 minutes each. After a MLD course of treatments, the patients will wear a compression garment every day. The patient should be measured for a new compression sleeve every six months or so. Sometimes a yearly MLD treatment course is recommended as a kind of “tune up.”
PREVENTING COMPLICATIONS
Because lymphedema development may occur even after several decades, patients should monitor themselves for signs of lymphedema and report any changes to their physicians.
Prevention is important and can require daily attention to manage the symptoms of swelling in particular. Arm and hand precautions are based on two key ideas: (1) Do not increase lymph production, which is directly proportional to blood flow, and (2) do not increase blockage to lymph system. Therefore, patients should avoid excessive heat, infections, and overly-strenuous arm exercises which would increase blood flow in the arm and thereby increase lymph production.
MANAGING LYMPHEDEMA
Patients should follow these suggestions to manage their lymphedema:
Avoid puncturing or injuring the skin in any way. Use first aid care if there is a break in the skin.
Avoid vaccinations, injections, blood pressure monitoring, blood drawing, and intravenous administration in the arm affected.
Avoid tight-fitting clothing or jewelry.
Avoid heat, such as with sunburns or tanning, baths, and saunas.
Avoid strenuous exertion, but do exercise while wearing compression garments.
Exercise, But Avoid Muscle Strain
It is important to use your affected limb for normal everyday activities, yet overuse can cause lymphedema to occur in some people. Follow these suggestions whenever possible:
Use affected arm or leg as normally as possible until fully healed, about 4 to 6 weeks after surgery or radiation treatment.
Exercise regularly but do not strain the arm or leg. Before any strenuous exercise, such as weightlifting or tennis, talk with a doctor, nurse, or physical therapist about specific goals and limitations to decide what level of activity is right. Ask if a fitted sleeve or stocking should be worn during strenuous activities or while flying.
If an arm or leg starts to ache, lie down and elevate it.
Avoid vigorous, repeated activities, heavy lifting, or pulling.
Watch for early signs of infection: rash, red blotches, swelling, increased heat, tenderness, or fever. Call a doctor right away if there are signs of infection.
Experts also recommend that those with lymphedema avoid any trauma to the area affected.
Trauma includes extreme temperature changes, repetitive movements against resistance (pushing or pulling), heavy lifting, and excessive exercise.
For More Information
American Cancer Society
The American Cancer Society held an international conference on lymphedema in 1998 in New York City. It involved 60 of the world’s leading experts and included a forum of more than 250 breast cancer survivors, leaders of breast cancer advocacy groups, and others. The conference report plus a lymphedema resource guide are available as a book from the ACS at cancer.org. (See below for title.)
National Lymphedema Network
The National Lymphedema Network is a charitable organization with an international scope. Founded in 1988, the Network’s mission is to provide education and guidance to patients and health care professionals. The Network promotes standardizing quality treatment for lymphedema patients. In addition, the organization supports research into the causes and possible alternative treatments for this “often incapacitating, often-neglected condition.”
Sources:
Current Trends in Lymphedema Management, Esther Muscari Lin, RN, MSN, CS, ACNP, AOCN, November 7, 2002.
American Cancer Society, Cancer (Vol. 92, No. 4: 748-752). http://www.cancer.org/
Cancer Principles and Practices of Oncology, Lippincott Williams &
Wilkins, 6th Edition, 2001. http://www.lww.com/productdetailresults ... 60,00.html
Harvard Medical School, Intelihealth.com, http://www.intelihealth.com/IH/ihtIH?t= ... SIHW000|~b, |
Lymphatic Research Foundation, http://www.lymphaticresearch.org/
Lymphedema Online Support Group, http://www.acor.org/.
Lymphology Association of North America, offers professional certification. http://www.clt-lana.org/main.html
Merck Manual, 17th Edition, 1999. http://www.merck.com/pubs/mmanual_home/contents.htm
National Lymphedema Network,
http://www.lymphnet.org/
https://www.cancerpage.com/centers/Side ... hedema.asp
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