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SEEKING MEDICAL HELP: AIDA MORRIS’S STORY

admin — Tue, 26 Jul 2011 19:30:15 +0000

In 1991, at the age of thirty-eight and with a five-year-old daughter, Aida was diagnosed with breast cancer. ‘When my GP examined my breasts he told me to go home and forget about it – that it was just a hardening of the tissue – but to come back three weeks later. At the next appointment he sent me away once again, but as I was leaving his office I had a surge of соurage and insisted on a mammogram. When I rang for the results (I had been told not to bother with an appointment as it was undoubtedly benign) he had a very different humbled and hushed tone. I had surgery within days and, once again, was at home on my own when the malignancy was confirmed over the telephone – which left me pretty devastated. Just as I was about to start radiotherapy I heard news of a friend, also thirty-eight, who had just died from breast cancer. She had also been told, a year previously, that there was nothing to worry about – but obviously there was. I was really knocked back by this news and shocked by the parallels. At some point later when I was asking some questions, having done a little research, the doctor, who had been perfectly nice in the past, actually asked me, ‘Don’t you think we know what we are doing?’ I felt like a naughty little girl who had stepped over some invisible boundary. I feel exasperated that at every turn I was not taken seriously. I feel much stronger now and am convinced that taking some control over my fate was the most important thing I could have done.’*44\240\2*

CANCER: VARIATIONS IN RATES

admin — Sat, 11 Jun 2011 09:05:59 +0000

While it is true that cancer strikes people of all ages, races, cultures, and socioeconomic levels, it is equally true that some Americans are at greater risk. Overall, blacks are more likely to develop cancer than persons of any other racial and ethnic group. In 1998, incidence rates were 443 per 100,000 blacks and 403 per 100,000 whites; 275 per 100,000 Hispanics; 279 per 100,000 Asian/Pacific Islanders; and 153 per 100,000 American Indians. Cancer sites for which blacks have significantly higher incidence and mortality rates include the esophagus, uterus, cervix, stomach, liver, prostate, and larynx. Researchers at the National Cancer Institute (NCI) believe that these differences are due more to blacks’ lower average socioeconomic status and generally more limited access to health care than to any inherent physical characteristics. Some findings indicate that some cancers may simply manifest themselves in different races.Cancer incidence and mortality rates within other minority groups, such as Hispanics, are often lower (sometimes by as much as 25 percent or more) than those of white or black Americans. Due to Hispanics’ low average socioeconomic status, we might expect that they would have cancer rates similar to those of blacks. But Hispanics seem to be “protected” from high rates. Why is this so? No one knows for sure, but the answer may lie in differences in various groups’ diets, exercise patterns, or other culturally influenced behaviors. Because cancer risk is strongly associated with lifestyle and behavior, differences in ethnic and cultural groups can provide clues to factors involved in the development of cancer. Culturally influenced values and belief systems can also affect whether or not a person seeks care, participates in screenings, or follows recommended treatment options. Socioeconomic factors such as lack of health insurance or lack of transportation to major treatment centers can lead to late diagnosis and poor survival prospects.*2/277/5*

SUPPORTIVE CARE OF CHILDREN WITH CANCER: MONITORING PATIENTS RECEIVING ANTHRACYCLINES (TESTING FOR CARDIOTOXICITY)A.

admin — Fri, 15 Apr 2011 14:09:38 +0000

The probability of abnormal cardiac function is increased when both the echocardiogram and the RNA are abnormal, rather than when just one of the two is abnormal.B. One modality, either echocardiogram or RNA, should be the consistent method of testing at every evaluation, with the other added when confirmatory testing is required.C. Perform studies before anthracycline treatment as a baseline and then preferably 2-3 weeks from the preceding dose and early enough to allow the reporting of accurate calculations before the next dose. Also obtain an electrocardiogram (ECG) as a baseline for comparison with later ECGs, which may show changes in conduction and arrhythmias.D. The patient should be normothermic and have a hemoglobin > 9 g/dL at the time of the testing.E. Frequency of testingPerform an echocardiogram (or RNA) before every other subsequent course of doxorubicin and/or daunorubicin when the total cumulative dose is < 300 mg/m2.Perform an echocardiogram (or RNA) before each subsequent course of doxorubicin and/or daunorubicin > 300 mg/m2.Perform an RNA (or echocardiogram) in addition to the consistent test modality as an optional confirmatory test, when a total dose of > 300 mg/m2 of doxorubicin or daunorubicin plus mediastinal radiation above 1000 cGy are given.Perform an RNA (or echocardiogram) in addition to the consistent test modality as an optional confirmatory test, when a total dose of > 400 mg/m2 of doxorubicin or daunorubicin is given with or without mediastinal radiation.5. For new cardiotoxic agents under investigation, perform an echocardiogram and RNA, if possible, before each course.6. The current recommendation for idarubicin is to begin more frequent monitoring at a total cumulative dose of 75 mg/m2. Confirmatory testing is suggested at 75 mg/m2 if there is mediastinal radiation and at a total dose of 100 mg/m2 of idarubicin with or without mediastinal radiotherapy.7. Follow-up after cessation of therapy is advisable.a. Obtain an echocardiogram (or RNA) at 3-6 and 12 months after therapy and repeat the ECG at 12 months after therapy.b. RNA (or echocardiogram) may be added as a confirmatory test at 12 months after therapy, especially if there is difficulty with imaging with the primary modality.c. If cardiac function is normal during the first year after therapy, then do the following.i. Obtain an echocardiogram (or RNA) and 12-lead electrocardiogram every 2 to 3 years.ii. Because of a high incidence of arrhythmias noted on late follow-up examination of patients after anthracycline therapy, a 24-hour ECG is recommended as indicated by symptoms or abnormalities of the other tests.iii. RNA (or echocardiogram) may be added as a confirmatory test less frequently, especially if there is difficulty imaging with the first testing modality.d. If cardiac function is abnormal during the first year after therapy, plan cardiac evaluation that includes an ECG and echocardiogram and, as indicated, RNA and 24-hour ECG, yearly or more often if required by symptoms.*31\168\2*

WHAT IS RADIATION TREATMENT?

admin — Mon, 18 May 2009 07:03:15 +0000

The expressions radiation treatment and radiotherapy mean the same thing: treatment with various forms of ionising radiation. The treatment is usually given by beaming the rays through the body from a machine which looks a bit like the ones they take X-rays with. Less commonly, radiation treatment is given by temporarily placing radioactive substances inside the body.

Ionising radiation is radiation that can break molecules into electrically charged particles called ions. Radiation passing through you from a machine outside the body does not make you radioactive. If your treatment involved putting radioactive substances in or on your body this would make you temporarily radioactive, but only for as long as the substance was actually present. As soon as it was removed or lost its radioactivity you would no longer be radioactive and it would be perfectly safe for anyone to come into close contact with you.

All forms of ionising radiation are invisible, travel in straight lines, can pass through the body painlessly and are capable of damaging all living cells. Radiation treatment does not burn you. You don’t feel anything while it is actually passing through you. X-rays are one form of ionising radiation. For treating cancer very, very much stronger (higher voltage) X-rays are used than for taking X-ray pictures for diagnosis. Other forms of radiation are also used to treat cancer—these are all closely related to X-rays.

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