Cancer  Some Referred To Specialists Laters

A recent study, published Online First in The Lancet Oncology, reveals that although 77% of cancer patients who have strange symptoms are usually sent to the hospital after 1 or 2 consultations, non-white patients, young people, women, and people with uncommon cancers often see their doctors 2 to 3 times before being referred to a cancer specialist.

The study also shows the large differences in the speed of doctors in England when it comes to diagnosing different types of cancer. This is due to the fact that patients with symptoms showing possible multiple melanoma, lung, and pancreatic cancer need many more consultations to determine what is really going on compared to patients with common cancers, such as melanoma, testicular, and breast cancer.

Georgios Lyratzopoulos, lead author of the study, from Cambridge University in the UK commented:

    "These findings highlight limitations in current scientific knowledge. Medical research in recent decades has prioritized improving cancer treatments, but knowledge about the 'symptom signature' of common cancers and practical solutions on how best to diagnose them is still emerging. We hope our research can help to generate support for further research into the diagnosis of those cancers where the challenge of section is greatest. This will improve the patients experience of cancer diagnosis and can also lead to earlier and more effective treatment."



Researchers explain that the number of visits a patient has with their doctor before being referred to the hospital can greatly impact the patient experience.

To determine their findings, the researchers collected data from over 41,000 patients who had 24 different types of cancer and who were being treated at 158 different hospitals in England. They analyzed the patients cancer type, sex, age, ethnicity, and socioeconomic status, as well as how many times patients went to their physician with symptoms before their doctor gave them a hospital referral.

The authors determined that the patients who had Hodgkin's lymphoma, multiple myeloma, stomach cancer, lung cancer, ovarian cancer, colon cancer, and pancreatic cancer were much more likely to have seen their doctors more than 3 times before their doctors referred them to the hospital. According to the authors, this may be because of the various symptoms in certain patients, which makes it harder for the patients' doctors to diagnose immediately. On the other hand, cancers which are seen often and have easy-to-diagnose symptoms, such as an obvious lump, probably receive referrals faster, due to the fact that it is more known what is causing these symptoms.

Researchers believe that patients who are from ethnic minority groups and younger patients probably see there doctor more times than others before being referred to the hospital because of communication problems, or the fact that doctors may not expect cancer in someone young.

The authors say there needs to more efficient use of new technologies in order to find symptoms earlier, and therefore start treatment sooner.

In the article's accompanying comment, by Martin Gulliford from King's College London, UK, he states:

    "These findings raise several questions.. that deserve to be tested prospectively in future research.. Do modes of cancer presentation vary systematically between different groups of patients? Are GP's more reluctant to refer young or non-white patients for investigation of possible cancer? Are participants in these groups less willing to accept a referral to investigate possible cancer?"

What Is Breast Cancer? How common is breast cancer? Why do some women get breast cancer? Zometa

What Is Breast Cancer?

Breast cancer is a tumor that has become malignant - it has developed from the breast cells. A 'malignant' tumor can spread to other parts of the body - it may also invade surrounding tissue. When it spreads around the body, we call it 'metastasis'.

A woman's breast consists of lobules. Lobules are milk-producing glands. The breast is also full of ducts - milk passages that connect the lobules to the nipple. There is also fatty and connective tissue surrounding the ducts and lobules - this is called stroma.

The most common breast cancers start in the cells around the ducts. Others can start in the cells that line the lobules. A smaller number of breast cancers can start in other parts of the breast.

The human body has two ways of moving fluid about. One is through the blood stream, which carries plasma, red and white blood cells and platelets. Lymphatic vessels carry tissue fluid, waste products and infection fighting cells (immune system cells). Immune system cells are located in the lymph nodes - the nodes are shaped like a bean.

It is common for cancer cells to grow in the lymph nodes. They get there via the lymphatic vessels.

The lymphatic system of the breasts connect to the lymph nodes in three areas: Under the arm (axillary lymph node), in the chest (internal mammary node) and by the collarbone (supra or infraclavicular node).

Doctors guess that if cancer cells are in the lymphatic system, they are most likely to be in the bloodstream and will spread to other organs in the body. It is very hard to test for breast cancer cells in the bloodstream.

If breast cancer cells have got to the nodes under the arm (axillary), it will most likely swell. Whether or not it has swollen there, will decide what type of treatment a patient should have. If cancer cells are found in more lymph nodes, then the likelihood of it turning up in different parts of the body is greater. However, there is no hard and fast rule here. Women have had swellings in many nodes and did not develop metastases, while some women with no swellings in their nodes did.

Most breast lumps are benign (harmless)

Although most breast lumps do not develop into anything dangerous (benign) some will need to be biopsied (doctor takes a piece out and tests it). Most lumps are harmless cysts - sacs filled with fluid.

A benign tumor cannot spread to other parts of the body - it stays inside the breast. They pose no threat to the patient's life. They are not cancer. Some of them, however, can increase the woman's chance of developing breast cancer later on. Tumors such as papillomas and atypical hyperplasia are examples of this.

How common is breast cancer?

Breast cancer is the most common cancer for women. About one in every nine women will develop breast cancer in her lifetime. 99% of all breast cancers are diagnosed in women, 1% affect men.

In the USA there were 100,000 new cases in 1985. In 1994 the number rose to 180,000. The main reason for the increase is better awareness leading to more diagnostic tests.

Why do some women get breast cancer?

We don't know the answer to that yet. We know that heredity plays a part. The more close relatives a woman has who had breast cancer, the higher is her risk of developing it.

 Breast Cancer Survival In Younger Breast Cancer Patients Improves With Bone Drug

 Zometa

Zometa (zoledronic acid), used to protect bone health in pre-menopausal ER-Positive breast cancer patients, has been found to improve survival considerably. In fact, it had as beneficial an effect on survival as chemotherapy, researchers from the University of Vienna, Austria, reported in the 2011 CTRC-AACR San Antonio Breast Cancer Symposium this week.

The scientists reported that not only did zoledronic acid reduce death risk by 36%, but also that the risk of breast cancer recurrence dropped 28%. Patients were administered zoledronic acid along with adjuvant endocrine treatment, including ovarian function suppression.

The researchers presented data after 48, 62 and 84 months of follow-up. At 7 years there were "drastically" fewer breast cancer recurrences and better survival rates - and no reports of toxic side effects.


    "We have confirmed what this trial showed initially, which was both exciting and surprising. The continued success of this treatment means we can intervene early and still observe persistence of the benefit of treatment."

 Blood Mystery Solved

You probably know your blood type: A, B, AB or O. You may even know if you're Rhesus positive or negative. But how about the Langereis blood type? Or the Junior blood type? Positive or negative? Most people have never even heard of these.

Yet this knowledge could be "a matter of life and death," says University of Vermont biologist Bryan.

While blood transfusion problems due to Langereis and Junior blood types are rare worldwide, several ethnic populations are at risk,he notes. "More than 50,000 Japanese are thought to be Junior negative and may encounter blood transfusion problems or mother-fetus incompatibility," he writes.

But the molecular basis of these two blood types has remained a mystery - until now.

In the February issue of Nature Genetics, he and his colleagues report on their discovery of two proteins on red blood cells responsible for these lesser-known blood types.

he identified the two molecules as specialized transport proteins named ABCB6 and ABCG2.

"Only 30 proteins have previously been identified as responsible for a basic blood type," he notes, "but the count now reaches 32."

The last new blood group proteins to be discovered were nearly a decade ago, he says, "so it's pretty remarkable to have two identified this year."

Both of the newly identified proteins are also associated with anticancer drug resistance, so the findings may also have implications for improved treatment of breast and other cancers.

Cross-border science

As part of the international effort, he, assistant professor in the biology department, used a mass spectrometer at UVM funded by the Vermont Genetics Network. With this machine, he analyzed proteins purified by his longtime collaborator, Lionel Arnaud at the French National Institute for Blood Transfusion in Paris, France.

Ballif and Arnaud, in turn, relied on antibodies to Langereis and Junior blood antigens developed by Yoshihiko Tani at the Japanese Red Cross Osaka Blood Center and Toru Miyasaki at the Japanese Red Cross Hokkaido Blood Center.

After the protein identification in Vermont, the work returned to France. There Arnaud and his team conducted cellular and genetic tests confirming that these proteins were responsible for the Langereis and Junior blood types. "He was able to test the gene sequence," he says, "and, sure enough, we found mutations in this particular gene for all the people in our sample who have these problems."

Transfusion troubles

Beyond the ABO blood type and the Rhesus (Rh) blood type, the International Blood Transfusion Society recognizes twenty-eight additional blood types with names like Duffy, Kidd, Diego and Lutheran. But Langereis and Junior have not been on this list. Although the antigens for the Junior and Langereis (or Lan) blood types were identified decades ago in pregnant women having difficulties carrying babies with incompatible blood types, the genetic basis of these antigens has been unknown until now.

Therefore, "very few people learn if they are Langereis or Junior positive or negative," Ballif says.

"Transfusion support of individuals with an anti-Lan antibody is highly challenging," the research team wrote in Nature Genetics, "partly because of the scarcity of compatible blood donors but mainly because of the lack of reliable reagents for blood screening." And Junior-negative blood donors are extremely rare too. That may soon change.

With the findings from this new research, health care professionals will now be able to more rapidly and confidently screen for these novel blood group proteins, Ballif wrote in a recent news article. "This will leave them better prepared to have blood ready when blood transfusions or other tissue donations are required," he notes.

"Now that we know these proteins, it will become a routine test," he says.

A better match

This science may be especially important to organ transplant patients. "As we get better and better at transplants, we do everything we can to make a good match," Ballif says. But sometimes a tissue or organ transplant, that looked like a good match, doesn't work - and the donated tissue is rejected, which can lead to many problems or death.

"We don't always know why there is rejection," he says, "but it may have to do with these proteins."

The rejection of donated tissue or blood is caused by the way the immune system distinguishes self from not-self. "If our own blood cells don't have these proteins, they're not familiar to our immune system," Ballif says, so the new blood doesn't "look like self" to the complex cellular defenses of the immune system. "They'll develop antibodies against it," he says, and try to kill off the perceived invaders. In short, the body starts to attack itself.

"Then you may be out of luck," says Ballif, who notes that in addition to certain Japanese populations, European Gypsies are also at higher risk for not carrying the Langereis and Junior blood type proteins.

"There are people in the United States who have these challenges too," he says, "but it's more rare."

Other proteins

Ballif and his international colleagues are not done with their search. "We're following up on more unknown blood types," he says. "There are probably on the order of 10 to 15 more of these unknown blood type systems - where we know there is a problem but we don't know what the protein is that is causing the problem."

How is cancer treated? Surgery Radiation Chemotherapy

How is cancer treated?


Cancer treatment depends on the type of cancer, the stage of the cancer (how much it has spread), age, health status, and additional personal characteristics. There is no single treatment for cancer, and patients often receive a combination of therapies and palliative care. Treatments usually fall into one of the following categories: surgery, radiation, chemotherapy, immunotherapy, hormone therapy, or gene therapy.

Surgery

Surgery is the oldest known treatment for cancer. If a cancer has not metastasized, it is possible to completely cure a patient by surgically removing the cancer from the body. This is often seen in the removal of the prostate or a breast or testicle. After the disease has spread, however, it is nearly impossible to remove all of the cancer cells. Surgery may also be instrumental in helping to control symptoms such as bowel obstruction or spinal cord compression.

Radiation

Radiation treatment, also known as radiotherapy, destroys cancer by focusing high-energy rays on the cancer cells. This causes damage to the molecules that make up the cancer cells and leads them to commit suicide. Radiotherapy utilizes high-energy gamma-rays that are emitted from metals such as radium or high-energy x-rays that are created in a special machine. Early radiation treatments caused severe side-effects because the energy beams would damage normal, healthy tissue, but technologies have improved so that beams can be more accurately targeted. Radiotherapy is used as a standalone treatment to shrink a tumor or destroy cancer cells (including those associated with leukemia and lymphoma), and it is also used in combination with other cancer treatments.

Chemotherapy

Chemotherapy utilizes chemicals that interfere with the cell division process - damaging proteins or DNA - so that cancer cells will commit suicide. These treatments target any rapidly dividing cells (not necessarily just cancer cells), but normal cells usually can recover from any chemical-induced damage while cancer cells cannot. Chemotherapy is generally used to treat cancer that has spread or metastasized because the medicines travel throughout the entire body. It is a necessary treatment for some forms of leukemia and lymphoma. Chemotherapy treatment occurs in cycles so the body has time to heal between doses. However, there are still common side effects such as hair loss, nausea, fatigue, and vomiting. Combination therapies often include multiple types of chemotherapy or chemotherapy combined with other treatment options.



Immunotherapy


Immunotherapy aims to get the body's immune system to fight the tumor. Local immunotherapy injects a treatment into an affected area, for example, to cause inflammation that causes a tumor to shrink. Systemic immunotherapy treats the whole body by administering an agent such as the protein interferon alpha that can shrink tumors. Immunotherapy can also be considered non-specific if it improves cancer-fighting abilities by stimulating the entire immune system, and it can be considered targeted if the treatment specifically tells the immune system to destroy cancer cells. These therapies are relatively young, but researchers have had success with treatments that introduce antibodies to the body that inhibit the growth of breast cancer cells. Bone marrow transplantation (hematopoetic stem cell transplantation) can also be considered immunotherapy because the donor's immune cells will often attack the tumor or cancer cells that are present in the host.

Hormone therapy



Several cancers have been linked to some types of hormones, most notably breast and prostate cancer. Hormone therapy is designed to alter hormone production in the body so that cancer cells stop growing or are killed completely. Breast cancer hormone therapies often focus on reducing estrogen levels (a common drug for this is tamoxifen) and prostate cancer hormone therapies often focus on reducing testosterone levels. In addition, some leukemia and lymphoma cases can be treated with the hormone cortisone.

Gene therapy


The goal of gene therapy is to replace damaged genes with ones that work to address a root cause of cancer: damage to DNA. For example, researchers are trying to replace the damaged gene that signals cells to stop dividing (the p53 gene) with a copy of a working gene. Other gene-based therapies focus on further damaging cancer cell DNA to the point where the cell commits suicide. Gene therapy is a very young field and has not yet resulted in any successful treatments.


How can cancer be prevented?


Cancers that are closely linked to certain behaviors are the easiest to prevent. For example, choosing not to smoke tobacco or drink alcohol significantly lower the risk of several types of cancer - most notably lung, throat, mouth, and liver cancer. Even if you are a current tobacco user, quitting can still greatly reduce your chances of getting cancer.


Skin cancer can be prevented by staying in the shade, protecting yourself with a hat and shirt when in the sun, and using sunscreen. Diet is also an important part of cancer prevention since what we eat has been linked to the disease. Physicians recommend diets that are low in fat and rich in fresh fruits and vegetables and whole grains.

Certain vaccinations have been associated with the prevention of some cancers. For example, many women receive a vaccination for the human papillomavirus because of the virus's relationship with cervical cancer. Hepatitis B vaccines prevent the hepatitis B virus, which can cause liver cancer.

Some cancer prevention is based on systematic screening in order to detect small irregularities or tumors as early as possible even if there are no clear symptoms present. Breast self-examination, mammograms, testicular self-examination, and Pap smears are common screening methods for various cancers.

What are the symptoms of cancer? How is cancer classified? How is cancer diagnosed and staged?

What are the symptoms of cancer?

Cancer symptoms are quite varied and depend on where the cancer is located, where it has spread, and how big the tumor is. Some cancers can be felt or seen through the skin - a lump on the breast or testicle can be an indicator of cancer in those locations. Skin cancer (melanoma) is often noted by a change in a wart or mole on the skin. Some oral cancers present white patches inside the mouth or white spots on the tongue.

Other cancers have symptoms that are less physically apparent. Some brain tumors tend to present symptoms early in the disease as they affect important cognitive functions. Pancreas cancers are usually too small to cause symptoms until they cause pain by pushing against nearby nerves or interfere with liver function to cause a yellowing of the skin and eyes called jaundice. Symptoms also can be created as a tumor grows and pushes against organs and blood vessels. For example, colon cancers lead to symptoms such as constipation, diarrhea, and changes in stool size. Bladder or prostate cancers cause changes in bladder function such as more frequent or infrequent urination.

As cancer cells use the body's energy and interfere with normal hormone function, it is possible to present symptoms such as fever, fatigue, excessive sweating, anemia, and unexplained weight loss. However, these symptoms are common in several other maladies as well. For example, coughing and hoarseness can point to lung or throat cancer as well as several other conditions.

When cancer spreads, or metastasizes, additional symptoms can present themselves in the newly affected area. Swollen or enlarged lymph nodes are common and likely to be present early. If cancer spreads to the brain, patients may experience vertigo, headaches, or seizures. Spreading to the lungs may cause coughing and shortness of breath. In addition, the liver may become enlarged and cause jaundice and bones can become painful, brittle, and break easily. Symptoms of metastasis ultimately depend on the location to which the cancer has spread.

How is cancer classified?

There are five broad groups that are used to classify cancer.

    Carcinomas are characterized by cells that cover internal and external parts of the body such as lung, breast, and colon cancer.

    Sarcomas are characterized by cells that are located in bone, cartilage, fat, connective tissue, muscle, and other supportive tissues.
    Lymphomas are cancers that begin in the lymph nodes and immune system tissues.
    Leukemias are cancers that begin in the bone marrow and often accumulate in the bloodstream.
    Adenomas are cancers that arise in the thyroid, the pituitary gland, the adrenal gland, and other glandular tissues.

Cancers are often referred to by terms that contain a prefix related to the cell type in which the cancer originated and a suffix such as -sarcoma, -carcinoma, or just -oma. Common prefixes include:

    Adeno- = gland

    Chondro- = cartilage

    Erythro- = red blood cell

    Hemangio- = blood vessels

    Hepato- = liver

    Lipo- = fat

    Lympho- = white blood cell

    Melano- = pigment cell

    Myelo- = bone marrow

    Myo- = muscle

    Osteo- = bone

    Uro- = bladder

    Retino- = eye

    Neuro- = brain

How is cancer diagnosed and staged?

Early detection of cancer can greatly improve the odds of successful treatment and survival. Physicians use information from symptoms and several other procedures to diagnose cancer. Imaging techniques such as X-rays, CT scans, MRI scans, PET scans, and ultrasound scans are used regularly in order to detect where a tumor is located and what organs may be affected by it. Doctors may also conduct an endoscopy, which is a procedure that uses a thin tube with a camera and light at one end, to look for abnormalities inside the body.
Cancer testing

Extracting cancer cells and looking at them under a microscope is the only absolute way to diagnose cancer. This procedure is called a biopsy. Other types of molecular diagnostic tests are frequently employed as well. Physicians will analyze your body's sugars, fats, proteins, and DNA at the molecular level. For example, cancerous prostate cells release a higher level of a chemical called PSA (prostate-specific antigen) into the bloodstream that can be detected by a blood test. Molecular diagnostics, biopsies, and imaging techniques are all used together to diagnose cancer.

What is Cancer? What Causes Cancer? What causes cancer? What are the symptoms of cancer?

What is Cancer? What Causes Cancer?

Cancer is a class of diseases characterized by out-of-control cell growth. There are over 100 different types of cancer, and each is classified by the type of cell that is initially affected.

Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer prohibits normal blood function by abnormal cell division in the blood stream). Tumors can grow and interfere with the digestive, nervous, and circulatory systems, and they can release hormones that alter body function. Tumors that stay in one spot and demonstrate limited growth are generally considered to be benign.

Cancer cell

More dangerous, or malignant, tumors form when two things occur:

    a cancerous cell manages to move throughout the body using the blood or lymph systems, destroying healthy tissue in a process called invasion
    that cell manages to divide and grow, making new blood vessels to feed itself in a process called angiogenesis.

When a tumor successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a serious condition that is very difficult to treat.

What causes cancer?

Cancer is ultimately the result of cells that uncontrollably grow and do not die. Normal cells in the body follow an orderly path of growth, division, and death. Programmed cell death is called apoptosis, and when this process breaks down, cancer begins to form. Unlike regular cells, cancer cells do not experience programmatic death and instead continue to grow and divide. This leads to a mass of abnormal cells that grows out of control.

Genes - the DNA type

Cells can experience uncontrolled growth if there are damages or mutations to DNA, and therefore, damage to the genes involved in cell division. Four key types of gene are responsible for the cell division process: oncogenes tell cells when to divide, tumor suppressor genes tell cells when not to divide, suicide genes control apoptosis and tell the cell to kill itself if something goes wrong, and DNA-repair genes instruct a cell to repair damaged DNA.

Cancer occurs when a cell's gene mutations make the cell unable to correct DNA damage and unable to commit suicide. Similarly, cancer is a result of mutations that inhibit oncogene and tumor suppressor gene function, leading to uncontrollable cell growth.

Carcinogens

Carcinogens are a class of substances that are directly responsible for damaging DNA, promoting or aiding cancer. Tobacco, asbestos, arsenic, radiation such as gamma and x-rays, the sun, and compounds in car exhaust fumes are all examples of carcinogens. When our bodies are exposed to carcinogens, free radicals are formed that try to steal electrons from other molecules in the body. Theses free radicals damage cells and affect their ability to function normally.

Genes - the family type

Cancer can be the result of a genetic predisposition that is inherited from family members. It is possible to be born with certain genetic mutations or a fault in a gene that makes one statistically more likely to develop cancer later in life.
Other medical factors
Holding hands

As we age, there is an increase in the number of possible cancer-causing mutations in our DNA. This makes age an important risk factor for cancer. Several viruses have also been linked to cancer such as: human papillomavirus (a cause of cervical cancer), hepatitis B and C (causes of liver cancer), and Epstein-Barr virus (a cause of some childhood cancers). Human immunodeficiency virus (HIV) - and anything else that suppresses or weakens the immune system - inhibits the body's ability to fight infections and increases the chance of developing cancer.