Tag Archives: Cancer

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #17: ACTINIC KERATOSES

Red hair and freckles are associated with MCR-1 gene variants, and large areas of skin with lowered melanin protection against the adverse effects of the sun. I have red hair and freckles, for which I was teased. My response was that I had a lot of Iron in my blood, and that the freckles were Rust. This is ironic (no pun intended).

Since becoming an Octogenarian, I have had trouble keeping my Iron levels normal. I live in a beach area, where all the young ladies are sunning themselves to promote the socially desirable “bronze goddess” effect, and all of the older ladies hide their leathery skin and wear broad-brimmed hats.

The sun has a good reputation as a health-giver. Being outside does correlate with a lot of beneficial effects, such as enhancing production of Vitamin D. My recommendation, however biased, is to get your Vitamin D in capsule form, and reduce sun exposure.

SUNSHINE, however salutary, is accompanied by invisible, high energy photons capable of breaking DNA strands, and ultimately causing SKIN CANCER. Not accidentally,Visible light has insufficient energy to break bonds, although the rhodopsin in rods and cones do release electrons if stimulated by light.

Actinic Keratoses are the roughened plaques of skin, often on the face, which have a small but definite risk of turning into Cancer. I have a dermatology check every 6 months for precancerous areas to be frozen and destroyed by CO2 spray.

PREVENTION of UV Skin damage is advisable. I wear a broad brimmed hat and UV-blocking sunglasses (UV can promote cataracts and retinal damage as well) when outside in the sun. When swimming I wear a “rashguard” shirt with UV protection in the fabric.

Also, I try to limit my exposure to the Evening and Morning sun, because the light is warmer, and contains less UV. Even with these precautions, I use Sunscreen creams and lotions. I always wondered how a transparent lotion can block UV light.

The explanation lies in the chemicals contained. Such chemicals as Avobenzone and Homosalicylate actually absorb the energy of UV light. Protect yourself now for later health.

–Dr. C.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #11: “Prostate cancer”

Prostate cancer is perhaps the most common cancer in men. It increases in incidence with age, and if you live long enough, most men will contract prostate cancer. A family history of cancer and obesity are also risk factors. But many times the cancer is so slow growing that it will not kill you. In the age of modern, aggressive medicine, the treatment has often been worse than the disease.

Treating Cancer EARLY is much more successful. The PSA test was one of the first really sensitive blood tests for cancer, and it was once performed routinely, on a yearly basis, usually at the time of your annual physical.

The PSA (Prostate-Specific Antigen) test is VERY sensitive,however. In responding to an elevated PSA, very slow growing tumors would often be treated aggressively, creating more morbidity than the untreated tumor would have caused.

The treatment seemed to be worse than the disease. Many physicians stopped doing the PSA test altogether, relying on symptoms, or detecting an abnormality on RECTAL EXAM to trigger an investigation. Some years ago, a physician friend of mine elected to stop PSA testing, and two years later was discovered to have METASTATIC Prostate cancer. It had already spread to his bones, and he eventually died of that cancer.

This encouraged me to continue with PSA screening, though it is still considered optional. Very recently, a test has been developed which I think tips the scales back toward annual PSA testing. EXOSOMES are little (10-120 nm.) particles that effuse from many cells, especially cancer cells.

They contain a variety of DNA, RNA, proteins and lipids which allow the cells to communicate with one another. Recently, a company, ExoDx, was created to take commercial advantage of Exosomes in the diagnosis of various diseases, by testing body fluids.

Their test, ExoRx Prostate EPI test of urine, has been shown to be helpful in distinguishing AGGRESSIVE prostate cancer from the slower growing kind, when the PSA test is in the “grey zone” between 2 and 10 ng/ml. PSA test results above 10 ng. were always acted on, especially if the numbers were increasing. I would be surprised if the PSA did not reenter the annual testing protocol.

The annual digital rectal exam in men older than 50 years will continue to be done, although it is not very sensitive, and is often not abnormal until the cancer is more advanced. Pain in the prostate area, blood in the urine or semen, and trouble urinating are symptoms worth investigating, but if cancer is detected, it may well be advanced and harder to treat. With abnormal tests,

Risk factors or suspicious symptoms, further testing is often done. Ultrasound or biopsy may be indicated. Sometimes the biopsy is guided by MRI, to increase the likelihood that the cancer, if small, is included in the tissue sample taken. Examining the cells of the biopsy sample will yield a “gleason score” which grades the aggressiveness of the cancer.

This in turn dictates the treatment, which may include different extents of surgical removal, radiation, hormonal or chemotherapy treatment. None of this is pleasant, and you are better off, of course with prevention.

Our old friends, DIET AND EXERCISE are thought to be helpful. Although not proven, eating lots of fruits and vegetables, and maintaining a healthy weight are recommended.

–DR. C

Finasteride, one of the drugs in my medicine cabinet is mentioned as a possible aid. I will be discussing this later. I suggest that you press the green box with the magnifying glass, and type the name of the drug to see if i have discussed it. –Dr. C.

Dr. C’s Journal: A Little Bit About “Energy & Fatigue”

Sometimes I wake up in the morning with a feeling of RELAXED ENERGY. My mind is clear, I have no fatigue, and believe once more that the world is wonderful, and it’s great to be alive.

I St-re-tch, exercise my hands (I have Osteoarthritis, and they are stiff), take out my Nite guard ( I grind my teeth at night and would otherwise wear them away), take my beta blocker eye drops ( to lower my intraocular pressure) and wash down my Eliquis ( an anticoagulant to prevent stroke from my Atrial Fibrillation) with 16 oz. of water, while thinking about all of the delights awaiting me.

Yes, my body was in better shape 60 years ago; but I had much more responsibility then, and much less discretionary time. All things considered, I like to believe that I am happier now.

The KEY is to stay in GOOD HEALTH. GOOD SLEEP is critical, but it cannot be had by willpower alone. As I have discussed previously, you need a bedtime routine, good SLEEP HYGIENE.

You also need a…….. GOOD DIET. with lots of fruits, vegetables and whole grains. Fatty, spicy foods will stay in your stomach and bother you at night, particularly if you eat Late. I like to finish eating by 5 PM. Late dinner is also likely to produce GERD, and maybe Sleep Apnea.

GOOD EXERCISE is also critical. If you are not tired at the end of the day, it is hard to get good sleep. I always seem to sleep better on the day when I walk the hills for an hour, which is 3 days a week. Try not to exercise within 2 hours of bedtime. Assuming that you have a good base of SLEEP, DIET and EXERCISE, there are other mechanisms that can foul things up. INFLAMMATORY conditions often cause fatigue.

The most common inflammatory diseases are OBESITY, METABOLIC SYNDROME and DIABETES. OBESITY is the defining disease of our EXCESSIVE SOCIETY, where there is too much of everything, and excessive consumption is relentlessly advertised everywhere.

External correction is probably a pipe dream, since there is no will even to Tax Sugar-containing Beverages, the “low hanging fruit” of dietary excess. Internal correction is all that is left, and that takes WILL POWER, also in short supply.

INFECTIOUS DISEASES are a subset of inflammatory conditions. COVID 19 is the poster child of infection, and FATIGUE is one of the hallmarks of the disease. Interleukins, like TNF-alpha, IL-1, andIL-6 are some of the defense factors which cause the fatigue. AUTOIMMUNE Diseases like Rheumatoid Arthritis and Lupus are also associated with fatigue-producing interleukins.

Fatigue even has its own flagship disease, CHRONIC FATIGUE SYNDROME. Chronic viral disease has been suspected as the cause of this condition, and inflammatory cytokines may be elevated. This condition, and the similar GULF WAR SYNDROME are still poorly understood. Several CFS patients were sent to me when I was in practice, and I had some success in getting them to exercise regularly, which seemed to help. CANCER is another category of diseases where Fatigue is prominent.

Inflammation plays a role in these diseases, which also drain energy substrates from the Patients body; Cancer cells have a high metabolic requirement. MEDICATIONS, Cancer meds especially, but a variety of other Drugs are associated with FATIGUE. I went through MY MEDICATION LIST. Lo and behold, 3 of them are associated with fatigue.

Finasteride is a relic of my prostate operation, recommended to keep it from growing back. It causes fatigue, probably because of its ANTITESTOSTERONE effect. At least I can still pee, and am not bald. I take METFORMIN because of its fame in prolonging life. Its mechanism is that of interacting with the Sirtuin system, and increasing the inefficiency of mitochondria. Isn’t this surprising?

Like many other things in physiology, you place a stress on the body, and the body responds by improving its performance. If you are fatigued, you exercise. Respecting the body works with drugs as well. If you are drinking a ton of coffee and stop it, after a few weeks you will feel less fatigued.

And when you ARE FATIGUED, you drink a LITTLE coffee, and it wakes you right up. Caffeine works by displacing ADENOSINE, which causes Fatigue as it increases through the morning, peaking at SIESTA (or tea) time,at about 2 PM. OMEPRAZOLE, which I take to prevent HEARTBURN, also is related to fatigue especially if it blocks MAGNESIUM for long enough. DEPRESSION overlaps with fatigue, as does SLEEPINESS, to increase the complexity of the situation.

Many chronic LUNG, KIDNEY and LIVER diseases are associated with fatigue as a secondary concern. STAY HEALTHY!

–Dr. C

MEDICINE: LUNG CANCER DEATHS DROP AS TARGETED THERAPIES IMPROVE (NEJM)

NEJM (Aug 13, 2020) – Population-level mortality from NSCLC in the United States fell sharply from 2013 to 2016, and survival after diagnosis improved substantially. Our analysis suggests that a reduction in incidence along with treatment advances — particularly approvals for and use of targeted therapies — is likely to explain the reduction in mortality observed during this period.

“The survival benefit for patients with non-small cell lung cancer treated with targeted therapies has been demonstrated in clinical trials, but this study highlights the impact of these treatments at the population level,” said Nadia Howlader, Ph.D., of NCI’s Division of Cancer Control and Population Sciences, who led the study. “We can now see the impact of advances in lung cancer treatment on survival.”

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HEALTH: NEW STUDIES FIND “COFFEE & CAFFEINE” LOWER HEART DISEASE, CANCER RISK

NEW ENGLAND JOURNAL OF MEDICINE (JULY 23, 2020): A large body of evidence suggests that consumption of caffeinated coffee, the main source of caffeine intake in adults in the United States, does not increase the risk of cardiovascular diseases and cancers. In fact, consumption of 3 to 5 standard cups of coffee daily has been consistently associated with a reduced risk of several chronic diseases. 

Coffee and tea have been consumed for hundreds of years and have become an important part of cultural traditions and social life.5 In addition, people use coffee beverages to increase wakefulness and work productivity. The caffeine content of commonly used sources of caffeine is shown in Table 1. For a typical serving, the caffeine content is highest in coffee, energy drinks, and caffeine tablets; intermediate in tea; and lowest in soft drinks. In the United States, 85% of adults consume caffeine daily,6 and average caffeine intake is 135 mg per day, which is equivalent to about 1.5 standard cups of coffee (with a standard cup defined as 8 fluid oz [235 ml]).7 Coffee is the predominant source of caffeine ingested by adults, whereas soft drinks and tea are more important sources of caffeine ingested by adolescents,

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INFOGRAPHIC: A LOOK AT “CANCERS ASSOCIATED WITH OVERWEIGHT & OBESITY

There is consistent evidence that higher amounts of body fat are associated with increased risks of a number of cancers (6), including:

  • Endometrial cancer: Obese and overweight women are two to about four times as likely as normal-weight women to develop endometrial cancer (cancer of the lining of the uterus), and extremely obese women are about seven times as likely to develop the more common of the two main types of this cancer (7). The risk of endometrial cancer increases with increasing weight gain in adulthood, particularly among women who have never used menopausal hormone therapy (8).
  • Esophageal adenocarcinoma: People who are overweight or obese are about twice as likely as normal-weight people to develop a type of esophageal cancer called esophageal adenocarcinoma, and people who are extremely obese are more than four times as likely (9).
  • Gastric cardia cancer: People who are obese are nearly twice as likely as normal-weight people to develop cancer in the upper part of the stomach, that is, the part that is closest to the esophagus (10).
  • Liver cancer: People who are overweight or obese are up to twice as likely as normal-weight people to develop liver cancer. The association between overweight/obesity and liver cancer is stronger in men than women (1112).
  • Kidney cancer: People who are overweight or obese are nearly twice as likely as normal-weight people to develop renal cell cancer, the most common form of kidney cancer (13). The association of renal cell cancer with obesity is independent of its association with high blood pressure, a known risk factor for kidney cancer (14).
  • Multiple myeloma: Compared with normal-weight individuals, overweight and obese individuals have a slight (10% to 20%) increase in the risk of developing multiple myeloma (15).
  • Meningioma: The risk of this slow-growing brain tumor that arises in the membranes surrounding the brain and the spinal cord is increased by about 50% in people who are obese and about 20% in people who are overweight (16).
  • Pancreatic cancer: People who are overweight or obese are about 1.5 times as likely to develop pancreatic cancer as normal-weight people (17).
  • Colorectal cancer: People who are obese are slightly (about 30%) more likely to develop colorectal cancer than normal-weight people (18).A higher BMI is associated with increased risks of colon and rectal cancers in both men and in women, but the increases are higher in men than in women (18).
  • Gallbladder cancer: Compared with normal-weight people, people who are overweight have a slight (about 20%) increase in risk of gallbladder cancer, and people who are obese have a 60% increase in risk of gallbladder cancer (1920). The risk increase is greater in women than men.
  • Breast cancer: Many studies have shown that, in postmenopausal women, a higher BMI is associated with a modest increase in risk of breast cancer. For example, a 5-unit increase in BMI is associated with a 12% increase in risk (21). Among postmenopausal women, those who are obese have a 20% to 40% increase in risk of developing breast cancer compared with normal-weight women (22). The higher risks are seen mainly in women who have never used menopausal hormone therapy and for tumors that express hormone receptors. Obesity is also a risk factor for breast cancer in men (23).In premenopausal women, by contrast, overweight and obesity have been found to be associated with a 20% decreased risk of breast tumors that express hormone receptors (22).
  • Ovarian cancer: Higher BMI is associated with a slight increase in the risk of ovarian cancer, particularly in women who have never used menopausal hormone therapy (24). For example, a 5-unit increase in BMI is associated with a 10% increase in risk among women who have never used menopausal hormone therapy (24).
  • Thyroid cancer: Higher BMI (specifically, a 5-unit increase in BMI) is associated with a slight (10%) increase in the risk of thyroid cancer (25).

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COMMENTARY

Obesity increases the incidence of cancer, and complicates its treatment.
A healthy life style.,’including good sleep, diet and exercise, should prevent obesity in all but extreme genetic aberrations.

It is better to prevent problems than to grapple with them.
Stay healthy!

—Dr. C.

INFOGRAPHIC: A LOOK INTO “CANCER’S COMPLEXITY”

Technology Networks Cancer Drug Discovery-page-0

COMMENTARY

This infographic is a high-level discussion of cancer, with plenty of information to keep a Physicians’ interest.

The Human Body is a complex Community of individual cells that normally work together with admirable Harmony. Each individual cell is supplied with all its’ wants, and vigorously does its’ part for the Body.

Occasionally a ROGUE CELL escapes constraints and GOES ITS’ OWN WAY.

This has been happening from the beginning of multicellular life, and these MISCREANTS have EVOLVED to preserve themselves and have an amazing bag of TRICKS.

They are Very resourceful just like VIRUSES, which can also cause CANCER.

These twin threats give modern medical technology about all it can handle, and more.

PREVENTATIVE care offers a remedy.

Prevention is not at all complex, but of course requires thought, energy and planning. Prevention is difficult to square up with the easy, effortless, intuitive  life we yearn for.

Do you have the resolve to give SLEEP, DIET and EXERCISE a chance?

–DR. C

TELEMEDICINE: Obstetrics & Gynecology Services

The following list contains preventive services that may be done via telehealth (from ACOG.org):

General Health

  • Alcohol screening and counseling regarding alcohol use
  • Anxiety Screening and referral*
  • Counseling regarding aspirin to prevent CVD and CRC
  • Blood pressure screening (if patient has appropriate resources available such as a blood pressure cuff)
  • Contraceptive counseling, discussion of methods, and prescribing contraceptives that do not require an in-person visit such as intrauterine devices or implants*
  • Depression screening and referral
  • Fall Prevention counseling
  • Counseling regarding folic acid supplementation
  • Healthy diet and activity counseling
  • Interpersonal and domestic violence screening and discussion of available resources*
  • Obesity screening (if patient has appropriate resources available such as a scale)
  • Substance use assessment (drug use)
  • Tobacco screening and cessation counseling
  • Urinary incontinence screening*
     

Infectious disease

  • HIV risk assessment*
  • Sexually Transmitted Infection prevention counseling*

Cancer

  • Counseling and possible prescribing of medications to reduce breast cancer risk 
  • Risk assessment for BRCA testing
  • Skin cancer counseling

Pregnancy and postpartum

  • Breastfeeding services and supplies*
  • Postpartum contraceptive counseling, discussion of methods, and  prescribing contraceptives that do not require an in-person visit such as intrauterine devices or implants
  • Depression screening and referral
  • Counseling regarding folic acid supplementation
  • Interpersonal and domestic violence screening and discussion of available resources*
  • Preeclampsia prevention with low-dose aspirin
  • Preeclampsia screening (if patient has appropriate resources available)
  • Tobacco screening and cessation counseling

*WPSI recommendation. For more information about each recommendation, please see our WPSI Recommendation page.

Download Well-Woman Care Chart

ACOG.org website

Read this May 4, 2020 “Women’sHealth” article for information about what a Telemedicine Visit is like