Monthly Archives: May 2013
A chest X-ray showing cancer in the right lung
Hundreds of thousands of people are diagnosed with cancer every year in the UK. It is not one disease; there are over 200 different types, each with its own symptoms, methods of diagnosis and treatment.
What is cancer?
Cancer starts when cells in our bodies start to reproduce out of control, forming new, abnormal cells. These abnormal cells form lumps, known as tumors. If the cells from tumors cannot spread, then the tumors are benign. They are not cancerous and can usually be removed. If the cells are able to invade nearby healthy tissue and organs, or spread around the body through the blood or lymphatic system causing further tumors to grow, then the tumors are malignant or cancerous. These cancer cells are likely to spread if the tumor is not treated.
What causes cancer?
Every cell in our body contains DNA. It carries our genetic code and contains the instructions for all the cell’s actions. If the DNA inside cells is damaged, these instructions go wrong. In fact damage to the DNA or “mutations” as they are known, constantly occur in our cells as they divide and reproduce. Most of the time, the cells recognize that a mutation has occurred and repair the DNA, or self-destruct and die.
When a number of mutations have occurred in the DNA of a cell, control of cell growth may be lost and the cells do not die. Instead they start to follow abnormal instructions that make them reproduce and grow, producing more and more of these mutated cells – this is the start of a cancer. Many factors such as smoking or too much exposure to the sun can also trigger DNA damage – leading to a faster accumulation of the mutations that lead to cancer.
A family history of cancer can also increase chances of getting the disease, because it usually means that person starts their life already having inherited some of the DNA mutations that take them down the path to cancer. Even when in remission, those who have had the disease have a higher risk of it developing again. In most cases however, the exact cause or sequence of events by which cancer develops, is not yet known
A recent study has found that there are more than 80 genetic markers (i.e. mutated genes) that can increase the risk of developing breast, prostate or ovarian cancer, for example. Scientists believe the results could soon lead to widespread use of DNA profiling for these cancers, though individual genetic testing for those likely to be at increased risk – such as when there is a strong family history of a type of cancer – is already in use.
Why is it so deadly?
Cancer cells are able to invade other parts of the body, where they settle and grow to form new tumors known as secondary deposits – the original site is known as the primary tumor. The cells spread by getting into the blood or lymph vessels and traveling around the body.
For example, if bowel cancer has spread through the wall of the bowel itself, it can start growing on the bladder. If cells enter the bloodstream they can travel to distant organs, such as the lungs or brain. Over time, the tumors will then replace normal tissue. The process of cancer cells spreading is called metastasis. Once a cancer has started to spread, the chances of a cure often begin to fall, as it becomes more difficult to treat for a variety of reasons. Cancer harms the body in a number of ways. The size of the tumor can interfere with nearby organs or ducts that carry important chemicals. For example, a tumor on the pancreas can grow to block the bile duct, leading to the patient developing obstructive jaundice. A brain tumor can push on important parts of the brain, causing blackouts, fits and other serious health problems. There may also be more widespread problems such as loss of appetite and increased energy use with loss of weight, or changes in the body’s clotting system leading to deep vein thrombosis.
Why is it so hard to stop?
Cancer is an extremely complex condition. Each type of cancer is biologically different from any other type. For example, skin cancer is biologically different from the blood cancer called lymphoma, of which there are then many different types. That is then coupled with genetic differences between individuals and the random nature of the DNA mutations that cause cancer. All this makes it difficult to identify the way the particular cancer cells are behaving and how they are likely to spread or damage the body. Without a full understanding of the physiology of the cancer, effective treatments are hard to develop. Early surgery to remove tumors can work. But the cancer can return if any cells are left behind. It can also return if cells have broken away from the primary tumor and formed microscopic secondary tumors elsewhere in the body before an operation to remove the primary.
And because cancer cells are our own body’s cells, many treatments to destroy them also risk destroying our healthy cells. One controversial theory of why cancer is so hard to stop is that it is rooted in the ancient traits of our genes. Prof Paul Davies from Arizona State University believes cancer may use tried-and-tested genetic pathways going back a billion years to the dawn of multi-cellular life, when unregulated cell growth would have been an advantage. He argues that this tendency was suppressed by later, more sophisticated genes, but lies dormant in all living organisms. Cancer occurs when something unlocks these ancient pathways. Other scientists disagree, saying that these pathways would not have survived millions of years of evolution. One thing is for sure – our genes hold the key to understanding cancer and how to treat it.
The future of cancer research
The field of cancer research is moving away from defining a cancer by where it is in the body, as one type of breast cancer can have more in common with an ovarian cancer than another cancer in the breast.
Instead scientists are looking deeper at what is going wrong inside cancerous cells – a tumor can have 100,000 genetic mutations and these alter over time. By pinpointing the mutations that can cause certain cancers, doctors hope to personalize treatment – choosing the drug most likely to work on a particular type of tumor.
Scientists are creating targeted cancer therapies using their latest insights into cancer at a molecular level. These treatments block the growth of cancer by interfering with genetic switches and molecules specifically involved in tumor growth and progression. Clinical trials using gene therapy are also underway. This experimental treatment involves adding genetic material into a person’s cells to fight or prevent disease.
Enzymes released by cancerous cells have a protective function and are not one of the “bad guys”, say researchers from the University of East Anglia. Their study found the MMP-8 enzyme sent a signal to the immune system to attack the tumor. Patients whose breast tumours have more of this enzyme seem to do better.
Cancer Research UK said the research provided “very early clues” as to how the enzyme might recruit cells to fight breast cancer. Scientists from UEA worked with clinicians at the Norfolk and Norwich University Hospital to look in detail at the patterns of MMPs in breast tumors from patients. Their study, published in the Journal of Biological Chemistry, reveals that the matrix metalloproteinase-8 enzyme (MMP-8) could be acting as the ‘good guy’ by alerting the immune system to the location of the tumor.
It had been thought that the production of MMPs by breast cancer cells helped to promote cancer growth. Prof Dylan Edwards, lead researcher from UEA’s School of Biological Sciences, said that if breast cancer cells produce MMP-8 it causes them to produce two other inflammatory factors (IL-6 and IL-8) that have previously been shown to promote cancer.
“They were once thought to act like ‘molecular scissors’ to snip away at the scaffolding structures outside cells and clear a path for the cancer cells to invade and spread to other organs.
“However, breast tumor cells that over-produce MMP-8 don’t survive long-term – the enzyme stops them growing,” he said.
“We now think that in tumors, MMP-8 acts as a sort of ‘find me’ signal to the immune system, which then becomes activated to attack the tumor, which may help to explain its protective function.” Drugs used to treat cancer in the 1990s, which blocked these enzymes, failed in the clinic, he said, and this new research may explain why. It is still not known exactly how MMP-8 causes IL-6 and IL-8 to be activated.
Finding this out will be an important step forward which will help direct further research. Dr Emma Smith, senior science information officer at Cancer Research UK, said: “This study provides very early clues as to how the MMP-8 protein might actually play the role of a ‘good cop’ and recruit immune cells to fight breast cancer.
“And, rather than seeing the MMP-8 protein as a ‘bad cop’ in breast cancer, recent research has shown that levels of this protein are raised in women who do relatively well.
“Yet, until now, we haven’t known why this should be the case.
“But these are early findings from cells grown in a lab, and more research is needed to see if the molecules found by the scientists alert immune cells to cancers in women.”
What is a Compression Sleeve?
How a Compression Sleeve helps with Arm Lymphedema
A compression sleeve is a stretchy elasticized garment that is custom-fitted to your arm, and helps with pain and swelling caused by arm lymphedema. Sometimes a compression sleeve is referred to as a compression garment, compression arm sleeve, lymphedema sleeve or a pressure sleeve. A compression sleeve may be worn during exercise, when traveling by air, or when you need help managing lymphedema.
During breast cancer surgery, some of your lymph nodes may be removed and tested in a procedure called axillary lymph node dissection. This is an important step in checking for metastasis, as cancer cells can break off from breast tumors and travel through your lymph system, lodging in your lymph nodes. Your lymph node status is a very important part of your comprehensive diagnosis.
However, after your lymph nodes have been removed, you are at risk for developing arm lymphedema, a condition that may cause swelling of your surgery-side hand and arm. Let your doctor know if you are experiencing lymphedema, and try to get a referral to a lymphedema therapist. A specialist can help guide you in choosing from the different types of compression sleeves. You may need a prescription from your doctor, to file a claim with your insurance company and help cover the cost of compression sleeves.
Compression sleeves are available in different weights and fabrics, as well as a variety of colors. While some sleeves cover only your arm, others extend down your palm. If you are having hand lymphedema, you can also get gauntlets and fingerless gloves that offer some compression. If your are worried about pulling on a tight sleeve, or concerned that the sleeve may slip down while you’re doing arm exercises, you can use some light adhesive to keep the sleeve in place, or a lotion that helps you slide the sleeve on more easily.
Lymphedema (PDQ®) – Treatment of Lymphedema. National Cancer Institute. Last Modified: 04/01/2009.
Lymphedema: What Every Woman With Breast Cancer Should Know. American Cancer Society. Last Revised: 07/21/2008.
What is a breast prosthesis?
A breast prosthesis (for mastectomy) or breast form (for lumpectomy) can create the appearance of a natural breast. The prosthesis is made from silicone-based material, resembles the shape and weight of a natural breast and fits into a special bra or swimsuit (many suppliers can modify existing bras and swimwear to accommodate a prosthesis).
Most prostheses can be worn in water (salt or chlorinated), require simple care, are comfortable to wear and look very natural. Wearing a prosthesis aids balance and posture and can help women feel more confident about their appearance.
Choices can be made about shape, weight and texture. It is also possible to be fitted with a self-adhesive breast form. The outer surface feels soft and smooth, and may include a nipple outline. The surface that rests against the skin varies, and you can choose one that feels most comfortable for you.
First weeks after surgery:
Your chest can be sensitive following breast surgery or radiotherapy, so wearing a silicone prosthesis can be uncomfortable until your chest has healed – about six to eight weeks.
During these weeks you should be given a light fabric-covered prosthesis known as a ‘softie’ or a ‘cumfie’. You may find that the softie tends to ride up because it is so light. It may look better if you adjust the stuffing and either pin or stitch the softie to the bottom of your bra cup and adjust your bra straps.
If you choose or want to wear a bra with your softie, try one that is quite soft and stretchy and is not wired. This may be one you already own. It needs to be easy to put on because your shoulder may be stiff at first.
Once your chest area is fully healed, you need to make sure you have a well-fitting, supportive bra before you can be successfully fitted for your permanent prosthesis. This is so that your prosthesis matches the shape and size of your natural breast, and is held comfortably and securely in place.
(CNN) — Actress Angelina Jolie announced in a New York Times op-ed article on Tuesday that she underwent a preventive double mastectomy after learning she carries a mutation of the BRCA1 gene, which sharply increases her risk of developing breast cancer and ovarian cancer. “My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman,” Jolie wrote. “Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy.”
Jolie’s mother, actress and producer Marcheline Bertrand, died of ovarian cancer in 2007 at the age of 56. Jolie is 37 years old.
In the Times op-ed, titled “My Medical Choice,” Jolie said she finished three months of medical procedures at the Pink Lotus Breast Center in California on April 27 that included the mastectomies and reconstruction.
A mastectomy is an operation that removes all or part of the breast.
“I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made,” Jolie wrote. “My chances of developing breast cancer have dropped from 87 percent to under 5 percent.” BRCA stands for breast cancer susceptibility genes — a class of genes known as tumor suppressors, according to the National Cancer Institute.
Mutation of the BRCA1 and BRCA2 genes has been linked to hereditary breast and ovarian cancer. A blood test can determine if a woman is “highly susceptible” to the cancers. Fellow actress Christina Applegate had a similar procedure in 2008. She also had a mutation of the BRCA1 gene.
Oscar-winning film star
Jolie may be best known for title role in the “Laura Croft” series of films, but also won an Academy Award as best supporting actress in “Girl, Interrupted.” She also received a Golden Globe Award and SAG Award for the same role. Jolie serves as a special envoy for the United Nations High Commissioner for Refugees and has visited refugee camps around the world. The actress has been in a relationship with actor Brad Pitt since the mid-2000s, and they are engaged. The couple has three biological and three adopted children.
In telling her story, Jolie acknowledged that surgery might not be the right choice for every woman.
“For any woman reading this, I hope it helps you to know you have options,” Jolie wrote. “I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices.” But for Jolie, the decision ultimately came down to her kids.
“I can tell my children that they don’t need to fear they will lose me to breast cancer,” she said. It’s a pain Jolie knows all too well from losing her mother to the disease.