Endometrial cancer

Cancer of the endometrium has increased in incidence, partly because people are living longer than before and reporting such cases more accurately. The word endometrium generally means the uterine endometrium which is the fundus or the corpus of the uterus. About 32,000 cases are reported every year with 5900 deaths. After breast, colorectal, and lung cancer, endometrial cancer is the fourth most common cancer in women and the most common pelvic neoplasm. Awareness about endometrial cancer is very less which is the reason for endometrial cancer to be in the fourth place. Hence, all women should be encouraged to have annual check ups, including the gynecological examination.

History plays an important role in diagnosing endometrial cancer. One third of the women with post menopausal bleeding have cancer of the uterus, mainly endometrial. Obese women have slightly higher risk of endometrial cancer because of the increased levels of estrone related to excess weight. To explain in detail, there is conversion of androstenedione to estrone in body fat, which exposes the uterus to unopposed estrogen. Obese women should be taken extra care by the medical professionals to evaluate the risk of having cancer of the endometrium.

Women who are on hormone replacement therapy (HRT) are at the potential risk of having endometrial cancer. Unopposed estrogen administered in HRT is the reason for putting the women on HRT at risk. Currently, progesterone is added to the HRT regimen to offset this risk. Hence, a good history and a proper physical examination plays a vital role in diagnosing endometrial cancer.

Investigations like endometrial aspiration and biopsy confirms the presence of endometrial cancer. The median age of having cancer of endometrium is 61, and most women are at least 55 when they are diagnosed with endometrial cancer. Women over 50 years with any potential risks (post menopausal bleeding, on HRT, obesity) are encouraged to undergo endometrial biopsy. Women who are on HRT without progesterone should undergo regular endometrial aspiration or biopsy to rule out hyperplasia, which is a precursor of endometrial cancer.Other factors that put the women at risk are nulliparity (those women with no children) and late menopause (who attain menopause after the age of 52).

Ultrasound is a painless way of measuring the thickness of the endometrium that will give an idea about the changes that has occured in the same. However, ultrasonography does not confirm the presence of endometrial cancer. Endometrial smears (aspiration) and biopsy are the direct ways of diagnosis of cancer of the endometrium. A tissue sample from the endometrium is obtained and analysed. It is a common out patient procedure performed during the gynecological pelvic examination.

Treatment is based on the stage of the cancer but its always total abdominal hysterectomy with bilateral salpingo oopherectomy (removal of uterus and the uterine tubes) which is suggested. External radiation and brachy therapy are suggested for those with risk of recurrence. Recurrent cancer usually occurs in the vagina. These lesions are treated with surgery and radiation, and in some cases with HRT and chemotherapy.

Early diagnosis with endometrial smears and biopsy once a year helps women to identify the cancer of the endometrium and treat them effectively without leaving any complications. Hence, an annual gynecological examination is a must for every woman.

Candidiasis

Thrush is a fungal or yeast infection affecting the mouth, esophagus, stomach and vagina. It is otherwise called as Candidiasis. It is caused by an organism called Candida albicans. Vagina is a susceptible host to the organism because Candida flourishes in airless, moist and warm areas. This organism Candida is normally present in our body and does not cause any problem, but when there is any other infection in the body like HIV or any AIDS related disease the infection becomes obvious. Vaginal thrush is generally related with sexually transmitted disease (STD) but can even present without a STD.

Women with vaginal thrush present with the complaint of a watery discharge or thick curdy white discharge which is usually itchy, painful and reddish in the vaginal region. The discharge is odorless and mostly patchy giving an appearance of cottage cheese. Some women complain of a burning sensation, bad odor, swelling, painful urination, painful intercourse and ulcers caused by scratching.

The cause is unknown. Conditions like HIV infection, uncontrolled diabetes, pregnancy induced diabetes, stress, long term steroids therapy, chemotherapy, birth control pills, certain antibiotics tend to increase the risk of having vaginal thrush. It is not difficult to diagnose a vaginal thrush because of its cottage cheese appearance, but some STD's like gonorrhea, chlamydia mimic the same signs and symptoms of a vaginal thrush (that should not be missed). Hence, it's always better to consult a doctor when symptoms appear (especially for the first time and if you are pregnant).

Diagnosis is made by collecting a history about the presence of any chronic illness or on any treatment that compromises the immune system and inspecting the vaginal area and discharge. A vaginal swab is collected by doing a pelvic examination and is sent to the lab to confirm the presence of the organism. The presence of candida in culture confirms the presence of infection.

Vaginal thrush subsides on its own. But unfortunately not always. Untreated vaginal thrush has a high chance of recurrence. Sometimes the woman may find itching and pain beyond control and seek some treatment. Antifungal creams and suppositories are generally used in its treatment. Some of the antifungal topical agents that can be bought over the counters are nystatin, miconazole, butoconazole, tioconazole, terconazole, and clotrimazole. If the infection does not subside with the topical agents, then oral antifungal agents are started. Some of the oral antifungal agents are fluconazole and ketoconazole. As vaginal thrush is common during pregnancy, it is always good to consult your treating doctor for safe medication.

Though infections like this cannot be prevented, there are certain steps that can be taken to avoid or be more careful from getting these types of infection. Wearing cotton panties, wearing loose panties and pants to make the vaginal area more airy, keeping the vaginal area clean and dry by simple washing and wiping after urination and while changing pads during periods, changing pads often before it overflows during periods, changing clothes after exercise or swimming and avoiding douches.

Vaginal thrush is not a sexually transmitted disease, so don't hesitate to visit a doctor and seek treatment while you have any of these symptoms. Studies show that it is normal for a woman to have three to four episodes of this yeast infection every year. Taking appropriate treatment avoids recurrences and unnecessary complications.

How to prevent breast cancer with sulforaphane?

Breast cancer is a major health problem in women. It has risk factors, some of which are preventable and some cannot be prevented. Just like any cancer, breast cancer does not have a complete cure. Some of the ways through which it can be prevented and be treated early to save life are described below.

The factors that cause breast cancer in a woman are genetic factors (certain genes BRCA-1 or BRCA-2), normal aging (over 50 years), family history and personal history of any other cancer, early menarche (before 12 years of age), nulliparity (women who have never borne any children), late maternal age at first birth (first child after 30 years of age), late menopause (over 55 years of age), history of benign breast diseases, habits like smoking and alcohol intake, hormones (taken as oral contraception, hormone replacement therapy), obesity (high fat diet) and breast implants.

Among these factors, genes, normal aging, family history of cancers or benign breast diseases, early menarche, and late menopause cannot be prevented but habits like alcohol intake and smoking, nulliparity, late maternal age at first birth, obesity, and breast implants can be prevented. Luckily, researchers have proved that cancers caused by hormones can be prevented by adding sulforaphane to the diet which is present in cruciferous vegetables like cabbage, cauliflower and broccoli.

It has been studied and proved that the cruciferous vegetables contain a natural photochemical compound known as glucosinolates. This is broken down in the body into sulforaphane which is a strong cancer cell killer. It is proved that it acts only on the cancer cells and it is specific to those cancers that are caused by hormones (breast cancer and prostate cancer). Adding slightly steamed cruciferous vegetables 3-4 ounces a week can prevent breast cancers. Adding broccoli sprouts, radish, wasabi and arugula with broccoli can double the anti-cancer effect. Too much cooking or using a microwave to steam destroys 90 percent of glucosinolates, an enzyme that is caused to produce sulforaphane that fights and kills cancer stem cells. Thus sulforaphane not only kills the existing cancer cells but also prevents the formation of cancer stem cells.

It is always better to eat healthy. Vegetables and fruits, and folate rich foods must be included in the diet and fatty foods should be avoided. Avoiding alcohol consumption reduces the risk of getting breast cancer. Though smoking is not related to breast cancer, smoking tends to cause lung cancers which soon affect the breast. Obesity and fat deposition in the breast are believed to cause cancers. Exercise is a good idea to keep cancers at bay. Exercising keeps the body fit and also produces good hormones and decreases the hormone levels that have cancer risk. Avoiding unnecessary treatments like breast implants can reduce the chance of cancers

Many prefer settling financially first and then get married and think that the age of 30 is ideal for getting married which is incorrect. Getting married in early twenties and having babies and breast feeding them will help to prevent breast cancer.

Though these are certain measures that can prevent breast cancer, steps like self-breast examination from the age of 20, breast examination by health care professionals every 3 years from 20 years and every year over 40 years, mammograms every 3 years over 30 years and annually over 40 years can help in early diagnosis of breast cancers. The earlier the diagnosis and earlier the treatment, the better the prognosis.

How to care for your age spots?

Age spots commonly called as liver spots or solar lentigo is not a disease but a common sign of ageing. They start to show when you turn 40. They are small, raised or flat hyper pigmented area usually brown, starts appearing on the sun exposed areas like face, back, shoulders, arms, legs and feet. This is not considered as a medical condition that needs any active treatment but it is better to bring them to your physicians notice.

Protecting and caring for your skin since childhood is the best way to prevent age spots. Mothers and grandmothers who already have this should take extra caution for their children and grandchildren. There is no treatment which works a magic on them. Applying sun screen creams is the only way you could have protected your skin from age spots. Hydroquinone, retinoids and vitamin C are medically used to treat age spots apart from cryotherapy and laser treatment in worse case. It takes months and even years to disappear.

HOME REMEDIES:
1. Vitamin C rich substances which has antioxidic property plays a role in minimising age spots. Peels of lemon and oranges can be applied to these areas for about 20 min followed by a warm bath will reduce pigmentation and make the skin more smoothe.

2. Vitamin E also has antioxident property and as well as blocks the formation of nitrosamines which causes cancers. A dietry intake of vitamin E rich foods like spinach, broccoli, almonds and sunflower oil is good. They can also be taken in the form of tablets.

3. Lemon juice with honey, lemon juice with yogurt, lemon juice with a pinch of turmeric powder, fresh pineapple juice, boiled warm potatoes, mashed cucumber can be tried. Each one can be tried each day for atleast half an hour. You will definitely be able to make the difference in few weeks.

4. Apply sunscreens regularly and liberally while going out. Avoid going out in peak hours that is between 10am to 6pm. Shades and cloudy days also emits suns rays as other days.

5. Make use of your hat, umbrella, full sleeved tops, sunglasses etc.

6. Also protect your house and car glasses from the entry of sun's rays by sheilding them.

7. Avoid using tube lights which emits ultraviolet rays same as sun. Instead use bulbs.

8. Eat healthy food and take vitamin supplements with your doctor's permission.

Sun's rays are harmful rays, there is no place on earth to hide away from it. So, take appropriate measures to care for yourself and hide your age.

Cervical cancer

Cervial cancer is a worry to all women, and this article is written in an attempt to help address those worries, giving full details of what cervical cancer is, and what to look out for. Do visit your general practitioner if you have worries about whether this is affecting your life.

Cervical cancer is one of the two main types of primary uterine cancers. The rate of cervical cancers has been decreased from 45 cases per 100,000 to 15 cases per 100,000 women because of early detection by pap smear. However, it is still the third most common female reproductive cancers.

Cervical cancers occur between the ages 30 to 45, but can also occur as early as 18. Sexual activity has influence over cervical cancers under the age of 25. It is more prevalent in those with the history of multiple sexual partners and several early pregnancies. Studies suggest that this type of cancer may even be sexually transmitted. Invasive cervical cancer has been identified as an HIV-defining condition.

Apart from first intercourse at early age, early childbearing and multiple partners, the risk factors of having cervical cancer may include exposure to human papillomavirus (HPV), HIV infection, smoking and exposure to diethylstilbestrol (DES) in utero. Diagnosis is made with the history, signs and symptoms, and results of pap smear followed by biopsy.

Symptoms of cervical cancer are vaginal discharge, irregular bleeding, or bleeding after sexual intercourse. But many women have no symptoms of the disease and are identified to have cervical cancer during the routine pap smear test.

In advanced stages of cervical cancer, women usually complain of increasing vaginal discharge that are watery, and finally become dark and foul smelling because of necrosis and infection of the tumor. Bleeding, which occur at irregular intervals between periods (metrorrhagia), or after menopause, may be slight (just enough to spot in the undergarments), and occurs usually after mild trauma (such as intercourse, douching or defecation). As the disease continues, bleeding may persist and increase.

Chronic cervical infection also play a significant role in cervical cancer. The chronic cervical infection soon turns to become a cervical cancer. The symptoms of chronic cervical infection are similar to the signs and symptoms of cervical cancer. The clinical signs of the disease include a large, reddish growth or a deep, ulcerating crater before the woman notices any obvious symptoms.

As the cancer advances, it may invade the tissues outside the cervix, including the lymph glands anterior to the sacrum. The cervical cancer also accompanies the cancer involving the fundus of the uterus in almost one-third of all women with cervical cancers. The nerves in the region may be affected, producing excruciating pain in the back and the legs that is relieved only by large doses of opioid analgesics.

In the final stage, when the cancer is left untreated, it may present with symptoms of extreme emaciation and anemia, which is usually accompanied by fever due to secondary infection and abscesses in the ulcerating mass, and fistula formation.

It is better to seek treatment if any of the above mentioned symptom is present. Earlier the detection, better the prognosis. Pap smear done once every year for all women in reproductive age as a part of general check up can identify the early symptoms. Any infection of the reproductive system should be treated immediately. Lead a healthy sexual life and prevent yourself from acquiring any killer disease.

Syphilis

Sexually transmitted diseases (STDs) are the most common infections in the United States and are epidemic in most parts of the world. Portals of entry of STD microorganisms and sites of infection include the skin, mucosal linings of the urethra, cervix, vagina, rectum and oropharynx. Syphilis is a sexually transmitted diseases caused by Treponema pallidum. Syphilis is an acute and chronic infectious disease acquired through sexual contact or may be congenital in origin.

The risk of acquiring syphilis increases proportionately with the number of sexual partners. Sexual activity of adolescence accounts an increased incidence of syphilis in that age group. Oral and anal sexual practice exposes a potentially great risk of the disease.

Because of perceived stigma and possible threat to emotional relationships, those with symptoms of syphilis or any other STDs often are reluctant to seek timely health care. In an untreated person, the course of syphilis can be divided into three stages: primary, secondary, and tertiary. These stages reflect the time from infection and clinical manifestations observed in that period.

Primary syphilis occurs 2 to 3 weeks after the initial exposure with the organism. A painless lesion is noted at the site of infection called a chancre. If they are untreated, these lesions usually resolve spontaneously within about 2 months.

Secondary syphilis occurs when the organism spreads from the original chancre to produce a generalized infection. The rash of secondary syphilis occurs approximately 2 to 8 weeks after the chancre, and involves the trunk, and the extremities, including the palms of the hand and the soles of the feet.

Transmission of organisms usually occurs at this stage when there is contact with the lesions. The symptoms may include lymphadenopathy, arthritis, fever, malaise, hair loss, and weight loss. Secondary stage is followed by a period of latency in which the infected person is free of the signs and symptoms of syphilis.

Tertiary syphilis is the final stage which presents as a slowly progressive inflammatory disease with the potential to affect multiple organs. 20% to 40% of those infected with syphilis may not reach this stage.

Venereal Disease Research Laboratory (VDRL) or rapid plasma reagin circle card test (RPR-CT) are used for screening and diagnosing. Penicillin G benzathine, an antibiotic is the current treatment of all stages of syphilis. People who are allergic to penicillin are usually treated with doxycycline.

Genital herpes

Genital herpes or herpes genitalis is a viral infection that causes herpetic lesions (blisters) on the cervix, vagina and external genitalia. It is also called herpesvirus Type-2 infection. Genital herpes is a sexually transmitted disease but also may be transmitted asexually from wet surfaces or by self-transmission (touching a cold sore and then touching the genital area).

The initial infection is very painful and lasts about a week. The infection can re-occur. Some people have few or no recurrences whereas others may have frequent attacks. The recurrences are less painful and usually produce itching and burning. Symptoms may occur with sunburn, dental work, stress, or inadequate rest and food. Close human contact by mouth, oropharynx, mucosal surface, vagina and cervix seems necessary to acquire the infection. Other susceptible sites are skin lacerations and conjunctivae.

The infected area becomes red and swollen with severe itching and pain. It starts as a blister, which later coalesces, ulcerates and encrusts. In females, the labia is the primary site, although cervix, vagina and perineal skin may also be affected. In males, the glans penis, foreskin, or penile shaft are usually affected. Flu like symptoms may occur 3 or 4 days after the lesions appear. Inguinal lymph adenopathy (swelling of the lymph nodes in the groin), slight temperature elevation, myalgia (muscle aches) and dysuria (pain while urinating) are often noted.

In the female, a purulent discharge may develop from secondary bacterial infection. Pain is severe in the first week and then decreases. The lesions subside in about 2 weeks unless they become secondarily infected. Rarely, complications may arise from extragenital spread, such as to the buttocks, upper thighs, or even to the eyes as a result of touching lesions. Other potential problems are aseptic meningitis and severe emotional stress related to the diagnosis.

Herpes simplex virus type 2 (HSV-2) appears to be the cause of about 80% of genital and perineal lesions. This virus causing herpes genitalis is usually killed at room temperature by drying. Any stress can lead to an outbreak of this infection in a susceptible host. In pregnant women with active herpes, babies delivered vaginally may become infected with the virus. There is a risk of fetal mortality and morbidity if this occurs. Hence, a cesarean section may be performed if the virus recurs near the time of delivery.

There is no cure for genital herpes, but treatment is aimed at relieving the symptoms. The goals of management are to relieve pain and discomfort, prevent the spread of infection, relieve anxiety, decrease the potential health risks, initiate counseling, and transfer knowledge to the affected person regarding treatment regimen, self care and implications for the future.

Acyclovir (Zovirax), an antiviral agent is the first drug of choice for the genital herpes. It is helpful in altering the course of infection by reducing the duration of infection and by preventing its recurrences. It is available for topical, oral and intravenous use.

Pain is relieved by keeping the lesion clean, and by following proper hygienic practices. Taking sitz bath will ease discomfort. Wearing clean, loose, soft, and absorbent clothing can increase comfort. Aspirin and other analgesics are effective in controlling pain. Avoid use of occlusive ointments and powders because they tend to prevent the lesions from drying.

Bed rest is encouraged for those who have considerable pain and malaise. Contact of urine with herpes lesions may cause pain which often makes the affected person reluctant to void. Voiding can be assisted by pouring warm water over the vulva or sitz bath. Taking more fluids and consciously voiding every 4 to 6 hours will prevent other complications.

Education about Genital herpes:
1. Woman can have children; The obstetrician should be informed if you are pregnant.
2. Lesions should be washed gently with soap and running water and lightly dried.
3. Avoid exposure to prolonged sunlight.
4. Obtain information from HELP (Herpectics Engaged in Living Productivity).
5. Precautions are unnecessary in the absence of active lesions.
6. For a partner with no history of genital herpes, a condom should be used.

The problems of genital herpes are both physical and psychological. Stress is relieved by counseling and proper explanation by the health care professionals. To prevent transmission, intercourse should be avoided until the lesions heals.

Breast cancer

Breast cancer is a major health problem in the United States. Mortality rate from breast cancer has remained unchanged for the last 50 years, suggesting that the current treatments with surgery, radiation therapy and chemotherapy have produced only modest improvements in overall survival. At present, there is no cure for breast cancer but if it is identified and treated early the results are better.

Current statistics show that the lifetime risk of developing breast cancer is 1 in 8 women. If you have any of the following risk factors, make sure you do regular breast examination and go for regular mammograms.

1. A personal history of breast cancer.
2. First degree relatives of women with breast cancer.
3. Early menarche.
4. Nulliparity and late maternal age at first birth.
5. Late menopause.
6. History of benign breast disease.
7. Exposure to ionizing radiation.
8. Obesity.
9. Usage of Oral contraceptives.
10.Hormone replacement therapy.
11.Alcohol intake.

Breast cancers can occur anywhere in the breast, but the majority occur in the upper outer quadrant and more commonly in the left breast. The lesions are usually painless, fixed rather than mobile and are hard with irregular borders. Dimpling of the breast and nipple retraction are other symptoms that are noted during the initial stage. However, pain with nipple discharge is the classical symptom of breast cancer in later stage. Metastasis to skin is manifested by ulcerating and fungating lesions.

Diagnosis is made by fine needle aspiration or open biopsy of the breast tissue. Breast cancers are staged depending upon the tumor size, nodal involvement and metastasis. The different types of breast cancers are infiltrating ductal carcinoma, infiltrating lobular carcinoma, medullary carcinoma, mucinous carcinoma, tubular ductal cancer, inflammatory carcinoma, Paget's disease and in situ breast carcinoma.

Treatment of breast cancer includes surgical management (partial mastectomy, quadrantectomy, modified radical mastectomy, radical mastectomy), radiation therapy, chemotherapy (adriamycin, cytoxan, methotrexate, 5-flurouracil, vinblastine, vincistine) and hormonal therapy (halotestin, diethylstilbesterol, prednisone, cytadren, megace, tamoxifen). There are reconstructive breast surgeries like breast hypertrophy, reduction mammoplasty, breast uplift procedures like augmentation mammoplasty and prophylactic mastectomy.