Healthy Body Happy Mind

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Healthy Body Happy Mind

• Wildwood Conference Center
• Harrisburg, Pennsylvania
• September 20, 2008
• Ly-Le Tran, MD, JD, FCLM

Ly-Le Tran, MD, 20Sept2008
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Healthy Body Happy MindAgenda

• Introduction
• Discussion on 5 topics
• General health maintenance Preventive care
• General information on cancer
• Breast cancer
• Ovarian cancer
• Cervical cancer, HPV infection and vaccine

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Healthy Body Happy Mind

• Part I
• General Health Maintenance
• Preventive Care

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Prevention Current Recommendations

• Well-person check up Every year
• Immunization
• Tetanus and diptheria (Td vaccine) every 10
  years
• Hepatitis A B vaccine Once in the life time
• Rubella Once in the life time
• Varicella (chicken pox) Once in the life time,
  and if an epidemic occurs
• Flu shot Every year for age 50
• Pneumoccocus vaccine Every year for age 65

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Prevention Current Recommendations (2)

• Screening
• Blood pressure Every doctors visit
• Check for Chlamydia, gonorrhea syphyllis
  Sexually active women
• Check Cholesterol (complete lipoprotein profile,
  fasting) Every year
• Breast exam Every 3 years (Ages 19-39), and
  every year after

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Prevention Current Recommendations (3)

• Colorectal cancer Age 50, by a) hemocult every
  year, b) sigmoidoscopy every 5 years, c)
  double-contrast barium enema every 5 years or d)
  colonoscopy every 10 years
• Screening for diabetes Age 45, or earlier if
  high BP or high cholesterol every 3 years
• Hearing Age 65
• Height and weight Every visit, Body Mass Index
  (BMI) to detect obesity
• Mammogram Age 40, every year

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Prevention Current Recommendations (4)

• Test for BRCA gene to detect breast and ovarian
  cancer if positive family history of cancer with
  BRCA 1, 2
• Bone density testing Age 65
• PAP test to detect cervical cancer Age 19-64,
  every 3 years
• Snellen test for vision Age 65

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Healthy Body Happy Mind

• Part II
• General Information on Cancer

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Cancer general facts

• Lung, prostate, breast and colorectal cancers
  account for 56 all types of cancers.
• Breast cancer accounts for 16.3 of all cancers,
  and 7.8 of all deaths due to cancer
• In the US, est. of 11 million cancer survivors
  60 of whom are 65 year of age
• Breast cancer is among cancers with the highest
  survival rate

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What is cancer?

• Cell is the basic unit of life. Understanding
  cancer starts from knowing the function of cells
  
• Human body has multiple organs, each organ made
  up of tissues and several cell types
• Cell grows and divides as needed cancer occurs
  when this orderly process is disrupted. Cell
  grows, divides and accumulates forming a tumor

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What is cancer? (2)

• Tumor can be benign or malignant
• Benign tumor does not spread (metastasis), does
  not recur, and not life threatening
• Malignant tumor invades surrounding tissues,
  spread, can recur and is life-threatening
• Cancer is named by its origin, even after it has
  spread (metastasis). Ex Lung cancer (originated
  from the lung) spread to the brain being called
  lung cancer with brain metastasis

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Cancer Risk Factors

• Growing older
• Tobacco
• Sunlight
• Ionizing radiation
• Certain chemicals and other substances
• Some viruses and bacteria
• Certain hormones
• Family history of cancer
• Alcohol
• Poor diet, lack of physical activity, or being
  overweight

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Cancer Risk Factors (2)

• Not everything causes cancer.
• Cancer is not caused by an injury, such as a bump
  or bruise.
• Cancer is not contagious, no one can "catch"
  cancer from another person.
• Having one or more risk factors does not mean
  that you will get cancer. Most people who have
  risk factors never develop cancer.
• Some people are more sensitive than others to the
  known risk factors.

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Cancer Screening

• Breast Mammogram begins at age 40, and 1-2 years
  thereafter
• Cervix Pap test at age 21 or time of sexually
  active
• Colorectum Fecal occult blood test,
  sigmoidoscopy, colonoscopy, barium enema, digital
  exam

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Cancer - Early Symptoms

• A thickening or lump in the breast or any other
  part of the body
• A new mole or a change in an existing mole
• A sore that does not heal
• Hoarseness or a cough that does not go away
• Changes in bowel or bladder habits
• Discomfort after eating
• A hard time swallowing
• Weight gain or loss with no known reason
• Unusual bleeding or discharge
• Feeling weak or very tired

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Cancer Symptoms

• Most often, these symptoms are not due to cancer.
  They may also be caused by benign tumors or other
  problems. Only a doctor can tell for sure
• Early cancer does not cause pain. If you have
  symptoms, do not wait to feel pain before seeing
  a doctor.

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Cancer Diagnosis Staging

• Physical Examination
• Family History
• Laboratory tests Blood, biopsy (tissue sample)
• Imaging procedures X-Rays, CT scan, Radionuclide
  scan, Ultrasound, MRI, PET scan
• Staging Extent of the disease (local or
  metastasis), tumor size, invasion of surrounding
  tissues or lymph nodes

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Cancer Treatment

• Treatment of cancer is a comprehensive plan
  involving multiple disciplines
• Specialists surgeons, medical oncologists,
  hematologists, radiation oncologists
• Other support nutritionists, nurses, physical
  therapists, occupational therapists, patient
  support groups, family members
• Second Opinion

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Cancer Treatment (2)

• Treatment plan depends on type of cancer, stage
  of disease, patient's age, and general health.
• Treatment goal is to cure cancer. Sometimes, the
  goal is to control disease or to reduce symptoms
• Treatment plans include surgery, radiation
  therapy or chemotherapy. Some involve hormone
  therapy or biological therapy. In addition, stem
  cell transplantation
• Some cancers respond best to a single type of
  treatment. Others may respond best to a
  combination of treatments.

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Cancer Treatment (3)

• Treatments may work in a specific area (local
  therapy) or throughout the body (systemic
  therapy)
• Local therapy removes or destroys cancer in just
  one part of the body. Ex Surgery, radiation
• Systemic therapy sends drugs or substances
  through the bloodstream to destroy cancer cells
  all over the body. Ex Chemotherapy, hormone
  therapy, and biological therapy are systemic
  therapy.

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Cancer Treatment Side Effects

• Cancer treatments often damage healthy cells and
  tissues, side effects are common.
• Side effects depend mainly on the type and extent
  of the treatment.
• Side effects may not be the same for each person,
  and they may change from one treatment session to
  the next.

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Cancer Treatment Side Effects - Surgery

• Surgeon removes tumor and surrounding tissues to
  help prevent recurrence. Surgeon may also remove
  some nearby lymph nodes
• Side effects depend mainly on tumor size and
  location, and type of operation.
• It takes time to heal after surgery. The time
  needed to recover is different for each type of
  surgery. It is also different for each person. It
  is common to feel tired or weak for a while.

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Cancer Treatment Side Effects Radiation
Therapy

• Radiation therapy (also called radiotherapy) uses
  high-energy rays to kill cancer cells.
• Doctors use several types of radiation therapy.
  Some people receive a combination of treatments
• External radiation The radiation comes from
  source outside the body. Treatment 5 days a week
  for several weeks at a hospital or clinic.
• Internal radiation (implant radiation or
  brachytherapy) The radiation comes from
  radioactive material placed in seeds, needles, or
  thin plastic tubes that are put in or near the
  tissue. The patient usually stays in the
  hospital. The implants generally remain in place
  for several days.

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Cancer Treatment Side Effects Radiation
Therapy (2)

• Systemic radiation The radiation comes from
  liquid or capsules containing radioactive
  material that travels throughout the body.
• The patient swallows the liquid or capsules or
  receives an injection.
• This type of radiation therapy can be used to
  treat cancer or control pain from cancer that has
  spread to the bone. Only a few types of cancer
  are currently treated in this way
• Side effects of radiation therapy depend dose and
  type of radiation, the part of body treated. For
  example, radiation to abdomen can cause nausea,
  vomiting, and diarrhea. Skin in the treated area
  may become red, dry, and tender

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Cancer Treatment Side Effects Chemotherapy

• Use of drugs to kill cancer cells.
• Patients receive chemotherapy by mouth or through
  a vein. Drugs enter the bloodstream and can
  affect cancer cells all over the body.
• Chemotherapy is usually given in cycles Patients
  receive treatment for one or more days, then a
  recovery period (days or weeks) before next
  treatment.
• Treatment given as outpatient, doctor's office,
  or at home. Some may need to stay in the hospital
  during chemotherapy.

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Cancer Treatment Side Effects Chemotherapy (2)

• Side effects depend on specific drugs and dose.
  Drugs affect cancer cells and other cells that
  divide rapidly
• Blood cells When drugs damage healthy blood
  cells, may cause infections, easily bruised or
  bled, and very weak and tired.
• Cells in hair roots Drugs can cause hair loss.
  Hair will grow back, but can be different in
  color and texture.
• Cells on digestive tract Chemotherapy can cause
  poor appetite, nausea and vomiting, diarrhea, or
  mouth and lip sores.
• Some drugs can affect fertility Patients may
  become sterile

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Cancer Treatment Side Effects Hormone Therapy

• Some cancers need hormones to grow. Hormone
  therapy keeps cancer cells from getting or using
  the hormones they need. It is systemic therapy.
• Hormone therapy uses drugs or surgery
• Drugs stop the production of certain hormones or
  prevents the hormones from working.
• Surgery Surgeon removes organs (ovaries or
  testicles) that make hormones.
• Side effects depend on type of therapy weight
  gain, hot flashes, nausea, and changes in
  fertility. In women, hormone therapy may make
  menstrual periods stop or become irregular and
  may cause vaginal dryness. In men, hormone
  therapy may cause impotence, loss of sexual
  desire, and breast growth or tenderness

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Cancer Treatment Side Effects Biological
Therapy

• Biological therapy helps the immune system (the
  body's natural defense system) fight cancer.
• Biological therapy is usually given through a
  vein, and travel through the bloodstream.
• Side effects a rash where the therapy is
  injected, flu-like symptoms such as fever,
  chills, headache, muscle aches, fatigue,
  weakness, and nausea.
• Serious side effects changes in blood pressure
  and breathing problems.
• Biological therapy is usually given at the
  doctor's office, clinic, or hospital.

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Cancer Treatment Side Effects Stem Cell
Transplant

• Stem cells form healthy blood cells taken from
  patient before treatment, or from donor
• High doses chemotherapy, radiation, or both
  destroy cancer cells and normal blood cells in
  the bone marrow.
• After cancer treatment, patient receives healthy,
  blood-forming stem cells in the hospital.
• Side effects of cancer therapy and stem cell
  transplantation include infection and bleeding.
  In addition, graft-versus-host disease (GVHD) may
  occur in people who receive stem cells from a
  donor. In GVHD, the donated stem cells attack the
  patient's tissues. Most often, GVHD affects the
  liver, skin, or digestive tract. GVHD can be
  severe or even fatal. It can occur any time after
  the transplant, even years later.

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Cancer Treatment Nutrition and Physical
Activity

• It is important for patients to take care of
  themselves eating well and staying as active as
  possible.
• Patients need enough calories to maintain a good
  weight, enough protein to keep up strength.
• Patients feel better when they stay active.
  Walking, yoga, swimming, and other activities can
  increase energy. Exercise may reduce nausea and
  pain and make treatment easier to handle. It also
  can help relieve stress.

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Healthy Body Happy Mind

• Part III
• Breast Cancer

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Breast - Structure

• Breasts sit on the chest, over the ribs. Each
  breast is made of 15 to 20 lobes. Lobes contain
  many smaller lobules. Lobules contain groups of
  tiny glands that can produce milk. Milk flows
  from the lobules through thin tubes called ducts
  to the nipple. The nipple is in the center of a
  dark area of skin called the areola. Fat fills
  the spaces between the lobules and ducts.
• The breasts also contain lymph vessels. These
  vessels lead to small, round organs called lymph
  nodes. Groups of lymph nodes are near the breast
  in the axilla (underarm), above the collarbone,
  in the chest behind the breastbone, and in many
  other parts of the body. The lymph nodes trap
  bacteria, cancer cells, or other harmful
  substances.

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Breast Structure (2)
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Breast Cancer Risk Factors

• Age 60, uncommon before menopause.
• Personal history of breast cancer
• Family history risk is higher if got breast
  cancer before age 40.
• Certain breast changes abnormal breast cells
  such as atypical hyperplasia and lobular
  carcinoma in situ LCIS)
• Gene changes BRCA1, BRCA2, and others.

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Breast Cancer Risk Factors (2)

• Reproductive and menstrual history
• The older a woman is when she has her first
  child, the greater her chance of breast cancer.
• Women who had their first menstrual period before
  age 12 are at an increased risk of breast cancer.
  
• Women who went through menopause after age 55 are
  at an increased risk of breast cancer.
• Women who never had children are at an increased
  risk of breast cancer.
• Women who take menopausal hormone therapy with
  estrogen plus progestin after menopause also
  appear to have an increased risk of breast
  cancer.

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Breast Cancer Risk Factors (3)

• Race more often in white women than Latina,
  Asian, or African American women.
• Radiation therapy to the chest before age 30 are
  at an increased risk of breast cancer.
• Breast density Breast tissue may be dense or
  fatty on mammograms
• Taking DES (diethylstilbestrol) between 1940 and
  1971, women who took DES during pregnancy may
  have a slightly increased risk of breast cancer.

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Breast Cancer-Screening

• Mammogram
• A picture of the breast made with x-rays,
• Women age 40s, every 1 to 2 years or younger
  women with positive family history
• Mammograms can show a breast lump before it can
  be felt, a cluster of tiny specks of calcium
  (microcalcifications). Lumps or specks can be
  from cancer, precancerous cells, or other
  conditions
• Abnormal mammogram will need follow-up, more
  x-rays, and/or a biopsy.
• Mammograms are not perfect a) miss some cancers
  ("false negative."), b) show things that not a
  cancer ("false positive."), c) fast-growing
  tumors grow or spread before detection.

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Breast Cancer-Screening (2)

• Clinical breast exam during visit
• Check differences in size or shape between
  breasts rash, dimpling, or other abnormal signs
  on skin fluid from nipples.
• Using finger pads to feel for lumps in breast,
  underarm, and collarbone area. A lump is
  generally the size of a pea before anyone can
  feel it.
• Monthly breast self-exams to check for any
  changes in breasts Changes can occur because of
  aging, menstrual cycle, pregnancy, menopause, or
  taking birth control pills or other hormones. It
  is normal for breasts to feel a little lumpy and
  uneven a bit swollen and tender right before or
  during menstrual period.
• Contact doctor if any unusual changes in your
  breasts.

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Breast cancer - Symptoms

• A change in how the breast or nipple feels
• A lump or thickening in or near the breast or in
  the underarm area
• Nipple tenderness
• A change in how the breast or nipple looks
• A change in the size or shape of the breast
• A nipple turned inward into the breast
• The skin of the breast, areola, or nipple may be
  scaly, red, or swollen. It may have ridges or
  pitting so that it looks like the skin of an
  orange.
• Nipple discharge (fluid)

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Breast cancer - Diagnosis

• Breast Exam
• Mammogram
• An ultrasound device sends out sound waves which
  bounce off tissues. A computer uses the echoes to
  create a picture a lump is solid or filled with
  fluid. A cyst is a fluid-filled sac
• Magnetic resonance imaging (MRI) uses a powerful
  magnet linked to a computer. MRI makes detailed
  pictures of breast tissue.
• Biopsy
• Fine-needle aspiration Doctor uses a thin needle
  to remove fluid from lump. If fluid contains
  cells, a pathologist at a lab checks them for
  cancer.
• Core biopsy (needle biopsy) Doctor uses a thick
  needle to remove breast tissue. Pathologist
  checks for cancer cells.

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Breast cancer Diagnosis (2)

• Surgical biopsy Surgeon removes a sample of
  tissue. A pathologist checks the tissue for
  cancer cells.
• An incisional biopsy takes a sample of a lump or
  abnormal area.
• An excisional biopsy takes the entire lump or
  area.
• Hormone receptor test This test shows whether
  the tissue has certain hormone receptors.
• HER2 test This test shows whether the tissue has
  a protein called human epidermal growth factor
  receptor-2 (HER2) or the HER2/neu gene

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Breast cancer Staging

• Stage 0 carcinoma in situ.
• Lobular carcinoma in situ (LCIS) Abnormal cells
  in lining of a lobule having LCIS in one breast
  increases the risk of cancer for both breasts.
• Ductal carcinoma in situ (DCIS) Abnormal cells
  are in lining of a duct. DCIS is also called
  intraductal carcinoma, have not spread outside
  the duct.
• Stage I early stage of invasive breast cancer.
  Tumor lt 2cm, have not spread beyond the breast.
• Stage II is one of the following
• Tumor is lt 2 cm, lymph nodes under the arm.
• Tumor is 2 - 5 cm, /- lymph nodes under the arm.
  
• Tumor is gt 5 cm (2 inches), - lymph nodes under
  the arm.

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Breast cancer Staging (2)

• Stage III locally advanced cancer including
  IIIA, IIIB, and IIIC.
• Stage IIIA
• Tumor is 5 cm, underarm lymph nodes that are
  attached to each other or to other structures, or
  lymph nodes behind the breastbone.
• Tumor is gt 5 cm, underarm lymph nodes that are
  either alone or attached to each other or to
  other structures, or lymph nodes behind the
  breastbone.
• Stage IIIB Tumor of any size that invades chest
  wall or the skin of the breast, /- swelling of
  the breast, or nodules (lumps) in the breast
  skin plus underarm lymph nodes that are either
  alone or attached to each other or to other
  structures, or lymph nodes behind the
  breastbone.

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Breast cancer Staging (2)

• Inflammatory breast cancer is a rare type of
  breast cancer. The breast looks red and swollen
  because cancer cells block the lymph vessels in
  the skin of the breast. At diagnoses,
  inflammatory breast cancer is at least Stage
  IIIB, but it could be more advanced.
• Stage IIIC is tumor of any size, with lymph
  nodes behind the breastbone and under the arm, or
  lymph nodes above or below the collarbone.
• Stage IV is distant metastatic cancer.
• Recurrent cancer is cancer that has come back
  (recurred) It may recur at any site.

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Breast Cancer- Treatment

• Treatment Choices by Stage Options depend on the
  stage of disease and these factors
• Size of tumor in relation to size of breast
• Results of lab tests (such as whether the breast
  cancer cells need hormones to grow)
• Menopausal state Pre- or post menopause
• General health

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Breast cancer Treatment Breast Sparing
Surgery
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Breast cancer Treatment Surgery - Simple
Mastectomy
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Breast cancer Treatment Surgery Modified
Radical Mastectomy
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Breast Cancer TreatmentSurgery Side Effects

• Surgery causes pain and tenderness, healing time
  different for each woman.
• Feeling off balance, imbalance can cause
  discomfort in your neck and back
• Nerves may be injured or cut, causing numbness
  and tingling in chest, underarm, shoulder, and
  upper arm
• Removing lymph nodes under the arm slows the flow
  of lymph fluid cause swelling or lymphedema.

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Breast Cancer TreatmentSurgery Side Effects
(2)

• Lymphedema Need to protect arm and hand on
  treated side for life by
• Avoid wearing tight clothing or jewelry on
  affected arm
• Carry purse or luggage with the other arm
• Use an electric razor to avoid cuts when shaving
• Have shots, blood tests, and blood pressure
  measurements on the other arm
• Wear gloves to protect your hands when gardening
  and when using strong detergents
• Have careful manicures and avoid cutting cuticles
• Avoid burns or sunburns to affected arm and hand

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Breast Cancer TreatmentRadiation Therapy (RT)

• Treatment depends on tumor size and other
  factors. Radiation destroys breast cancer cells
  that may remain in the area.
• Mostly, RT given after breast-sparing surgery,
  sometime given after a mastectomy.
• Sometime, RT given before surgery to destroy
  cancer cells and shrink the tumor when tumor is
  large or may be hard to remove. Some patients
  also have chemotherapy or hormone therapy before
  surgery.

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Breast Cancer TreatmentRadiation Therapy (RT)
Side Effects

• Side effects depend on dose and type of radiation
  and area treated.
• Skin in treated area become red, dry, tender, and
  itchy, sometime weepy
• Breast may feel heavy and tight.
• Bras and some other clothing may rub skin causing
  soreness.
• Feeling weak and tired

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Breast Cancer- TreatmentChemotherapy

• Choice of chemotherapy depends on stage of
  cancer, can be given
• Before surgery (neoadjuvant),
• After surgery (adjuvant), and/or
• With or without surgery
• With or without RT
• Side effects depend on dose and type of
  chemotherapy given

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Breast Cancer- TreatmentHormone Therapy

• Some tumors need hormones to grow, estrogen and
  progesterone. Tests can show if tumor has hormone
  receptors.
• This treatment uses drugs or surgery
• Drugs A drug that can block action of natural
  hormone. Another type prevents body from making
  hormone.
• Surgery to remove your ovaries. The ovaries are
  the main source of the body's estrogen.
• A woman who has gone through menopause does not
  need surgery. (The ovaries produce less estrogen
  after menopause.)

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Breast Cancer- TreatmentHormone Therapy Side
Effects

• Side effects depend largely on the specific drug
  or type of treatment
• Symptoms of menopause most common are hot
  flashes and vaginal discharge.
• Other side effects are irregular menstrual
  periods, headaches, fatigue, nausea, vomiting,
  vaginal dryness or itching, irritation of the
  skin around the vagina, and skin rash.

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Breast Cancer- TreatmentBiological Therapy

• Biological therapy helps the immune system fight
  cancer. Immune system is the body's natural
  defense against disease.
• Current biologic for breast cancer Herceptin
  (trastuzumab). It is a monoclonal antibody, made
  in the laboratory and binds to cancer cells.
• Herceptin is given to women with tissue protein
  HER2. By blocking HER2, it can slow or stop the
  growth of cancer cells Herceptin may be given
  alone (IV) or with chemotherapy.
• Common side effects fever and chills, pain,
  weakness, nausea, vomiting, diarrhea, headaches,
  difficulty breathing, or rashes.
• Herceptin also may cause heart damage. This may
  lead to heart failure. Herceptin can also affect
  the lungs.

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Healthy Body Happy Mind

• Part IV
• Ovarian Cancer

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Ovarian Cancer
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Ovarian Cancer

• The ovaries are part of a woman's reproductive
  system. They are in the pelvis. Each ovary is
  about the size of an almond.
• The ovaries make the female hormones estrogen
  and progesterone. They also release eggs. An egg
  travels from an ovary through a fallopian tube to
  the womb (uterus).
• When a woman goes through her "change of life"
  (menopause), her ovaries stop releasing eggs and
  make far lower levels of hormones.

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Ovarian Cancer

• Benign and Malignant Cysts
• An ovarian cyst may be found on surface or inside
  of an ovary. A cyst contains fluid, sometimes
  contains solid tissue. Most ovarian cysts are
  benign (not cancer).
• Most ovarian cysts go away with time sometimes,
  a cyst does not go away or gets larger, and will
  need testing to make sure that the cyst is not
  cancer.

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Ovarian Cancer

• Ovarian cancer can invade, shed, or spread to
  other organs
• Invade Malignant tumor can grow and invade
  nearby organs fallopian tubes and uterus.
• Shed Cancer cells shed (break off) into the
  abdomen may lead to new tumors forming on surface
  of nearby organs and tissues, called seeds or
  implants.
• Spread Cancer cells spread through lymphatic
  system to lymph nodes in pelvis, abdomen, and
  chest, also may spread through the bloodstream to
  liver and lungs.

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Ovarian Cancer- Risk Factors

• Family history of ovarian cancer, breast, uterus,
  colon, or rectum caner may increase risk of
  ovarian cancer.
• If several women have ovarian or breast cancer,
  especially at a young age family history.
• If family history of ovarian or breast cancer,
  may wish to talk to a genetic counselor. The
  counselor may suggest genetic testing for women
  in the family.
• Genetic tests can sometimes show the presence of
  specific gene changes that increase the risk of
  ovarian cancer.

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Ovarian Cancer- Risk Factors (2)

• Personal history of cancer Women who had cancer
  of breast, uterus, colon, or rectum have a higher
  risk of ovarian cancer.
• Age over 55 Most women are over age 55 when
  diagnosed with ovarian cancer.
• Never pregnant Older women who have never been
  pregnant have an increased risk of ovarian
  cancer.
• Menopausal hormone therapy women who take
  estrogen by itself (estrogen without
  progesterone) for 10 or more years may have an
  increased risk of ovarian cancer.

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Ovarian Cancer- Symptoms

• Early ovarian cancer has no obvious symptoms, but
  later symptoms may include
• Pressure or pain in abdomen, pelvis, back, or
  legs
• A swollen or bloated abdomen
• Nausea, indigestion, gas, constipation, or
  diarrhea
• Feeling very tired all the time
• Less common symptoms include
• Shortness of breath
• Feeling the need to urinate often
• Unusual vaginal bleeding (heavy periods, or
  bleeding after menopause)

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Ovarian Cancer- Diagnosis

• Physical exam To check for tumors or ascites
• Pelvic exam Doctor feels the ovaries and nearby
  organs for lumps or other changes in shape or
  size.
• A Pap test is part of a normal pelvic exam, but
  it is not used to collect ovarian cells. The Pap
  test detects cervical cancer.
• Blood tests To check level of several
  substances, including CA-125.
• Ultrasound
• Biopsy a laparotomy exam to remove tissue and
  fluid from the pelvis and abdomen

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Ovarian Cancer- Staging

• Staging is to determine the extent of cancer by
  using test Chest X-Ray, CT scan, Barium enema,
  Colonoscopy
• Stage I Cancer cells found in one or both
  ovaries, on surface of the ovaries or in fluid
  in abdomen.
• Stage II Cancer spread to other tissues in
  pelvis Fallopian tubes, uterus, or others, or in
  fluid in abdomen.
• Stage III Cancer spread to tissues outside
  pelvis or to lymph nodes, or on liver.
• Stage IV Cancer spread to tissues outside
  abdomen and pelvis, inside liver, lungs, or in
  other organs.

67
Ovarian Cancer-Treatment

• Local therapy Surgery and radiation are local
  therapies, . destroying ovarian cancer in the
  pelvis. When cancer has spread, local therapy may
  be used to control the disease.
• Intraperitoneal chemotherapy Chemotherapy can be
  given directly into the abdomen and pelvis
  through a thin tube.
• Systemic chemotherapy Drug enters bloodstream
  and destroy or control cancer throughout body.

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Ovarian Cancer-TreatmentSide Effects

• Side effects depend on type, dose and extent of
  treatment
• Pain medications to relieve or reduce pain.
• Swollen abdomen Can be uncomfortable, doctor can
  remove the fluid whenever it builds up.
• Blocked intestine Blockage opened with surgery.
• Swollen legs (from lymphedema) Exercises,
  massages, or compression bandages are helpful, or
  physical therapy.
• Shortness of breath Fluid collected around the
  lungs make it hard to breathe, doctor can remove
  the fluid whenever it builds up.

69
Healthy Body Happy Mind

• Part V
• Cervical Cancer HPV Vaccine

70
Cervical Cancer
71
Cervical Cancer

• Cervix is part of reproductive system, a lower,
  narrow part of the uterus. The uterus is a
  hollow, pear-shaped in lower abdomen. Cervix
  connects the uterus to vagina.
• Cervical canal is a passageway. Blood flows from
  uterus through canal into vagina during menstrual
  period.
• Cervix also produces mucus, mucus helps sperm
  move from vagina into uterus.
• During pregnancy, cervix is tightly closed to
  help keep the baby.
• During childbirth, cervix opens to allow baby to
  pass through vagina.
• Polyps, cysts, and genital warts are benign
  growths.

72
Cervical Cancer Risk Factors

• Human papilloma viruses (HPVs) HPV infection is
  the main risk factor for cervical cancer.
• HPV is a group of viruses infecting cervix.
• HPV infections are very common.
• These viruses pass from person to person through
  sexual contact.
• Some types of HPV can cause changes in cervix.
  These changes can lead to genital warts, cancer,
  and other problems.
• Doctors may check for HPV even if there are no
  warts or other symptoms.

73
Cervical Cancer Risk Factors (2)

• If infected with HPV, doctor can discuss ways to
  avoid infecting other people.
• The Pap test can detect cell changes in cervix
  caused by HPV.
• Treatment of these changes can prevent cervical
  cancer, using several treatment methods freezing
  or burning infected tissues or medicine.
• Lack of regular Pap tests Pap test helps find
  precancerous cells. Treating precancerous
  cervical changes often prevents cancer.

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Cervical Cancer Risk Factors (3)

• Weakened immune function Women with HIV
  infection, takes drugs suppressing immune system
  have a higher risk
• Age Women over the age of 40.
• Sexual history
• Women with many sexual partners
• Woman who has had sexual intercourse with a man
  who has had many sexual partners
• Risk of developing cervical cancer is higher
  because these women have a higher-than-average
  risk of HPV infection.

75
Cervical Cancer Risk Factors (4)

• Smoking cigarettes HPV infection who smoke
  cigarettes
• Using birth control pills for 5 yrs with HPV
  infection.
• Having many children Women with many pregnancies
  and with HPV infection.
• Diethylstilbestrol (DES) may increase the risk of
  a rare form of cervical cancer and certain other
  cancers of the reproductive system in daughters
  exposed to this drug before birth.

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Cervical Cancer Screening

• Begin Pap tests 3 years after becoming sexual
  active, or at age 21 (whichever comes first).
• Have a Pap test at least once every 3 years.
• Women aged 65 - 70 who have had at least three
  normal Pap tests may stop cervical cancer
  screening.
• Women had hysterectomy do not need to have
  cervical cancer screening. However, if the
  surgery was treatment for precancerous cells or
  cancer, the woman should continue with screening.

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Cervical Cancer Screening (2)

• Some activities can hide abnormal cells and
  affect Pap test results. Doctors suggest the
  following tips
• Do not douche for 48 hours before the test.
• Do not have sexual intercourse for 48 hours
  before testing.
• Do not use vaginal medicines (except as directed
  by a doctor) or birth control foams, creams, or
  jellies for 48 hours before the test.
• Schedule Pap test for a time that is 10 to 20
  days after the first day of menstrual period.

78
Cervical Cancer Screening (3)

• Some abnormal conditions may become cancer over
  time
• Low-grade squamous intraepithelial lesion (LSIL)
  Mild cell changes on cervical surface, often
  caused by HPV infections .LSILs are common,
  especially in young women, not cancer, lesions
  stay the same or go away without Rx . Lesions
  changed may lead to cancer.
• High-grade squamous intraepithelial lesion
  (HSIL) not cancer, but without treatment they
  may lead to cancer. The precancerous cells are
  only on surface of the cervix. They look very
  different from normal cells.

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Cervical Cancer Symptoms

• Abnormal vaginal bleeding
• Bleeding between regular menstrual periods
• Bleeding after sexual intercourse, douching, or a
  pelvic exam
• Menstrual periods that last longer and are
  heavier than before
• Bleeding after menopause
• Increased vaginal discharge
• Pelvic pain
• Pain during sexual intercourse

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Cervical Cancer Diagnosis

• Colposcopy Using colposcope to look at cervix,
  done in the doctor's office or clinic.
• Biopsy To look for precancerous cells or cancer
  cells.
• Punch biopsy Doctor uses a sharp, hollow device
  to pinch off small samples of cervical tissue.
• LEEP The doctor uses an electric wire loop to
  slice off a thin, round piece of tissue.
• Endocervical curettage The doctor uses a curette
  to scrape a small sample of tissue from the
  cervical canal.
• Conization The doctor removes a cone-shaped
  sample of tissues under general anesthesia.
  Conization also may be used to remove a
  precancerous area.

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Cervical Cancer Staging

• Stage 0 Cancer found only on top layer of cells
  in the lining of cervix, also called carcinoma in
  situ.
• Stage I Cancer invaded cervix, beneath top layer
  of cells.
• Stage II Cancer extends beyond cervix, to upper
  part of vagina. Cancer does not invade the lower
  third of the vagina or the pelvic wall.
• Stage III Cancer extends to lower part of
  vagina, may spread to pelvic wall and nearby
  lymph nodes.
• Stage IV Cancer spread to bladder, rectum, or
  other parts of the body.

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Cervical Cancer Staging (2)

• Chest X-rays looks to see if cancer spread to
  lungs.
• CT scan to look for cancer in liver, lungs, or
  elsewhere in body.
• MRI can show whether cancer has spread. Sometimes
  contrast material makes abnormal areas show up
  more clearly on the picture.
• Ultrasound device is held against the abdomen or
  inserted into the vagina looking for tumor mass

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Cervical Cancer Treatment

• The choice of treatment depends mainly on tumor
  size and whether cancer has spread. If a woman is
  of childbearing age, the treatment choice may
  also depend on whether she wants to become
  pregnant someday.
• Women with cervical cancer may be treated with
  surgery, radiation therapy and/or chemotherapy.
• Doctor can describe treatment choices and the
  expected results of each. Patient and your doctor
  can work together to develop a treatment plan
  that meets individual medical needs and personal
  values.

84
Cervical Cancer Treatment -Surgery

• Surgery treats cancer in cervix and nearby areas
• Early cervical cancer Doctor remove cervix and
  uterus (total hysterectomy). However, for stage
  0, hysterectomy may not be needed. Other ways to
  remove the cancerous tissue include conization,
  cryosurgery, laser surgery, or LEEP.
• Some women need a radical hysterectomy, removing
  uterus, cervix, and part of vagina.

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Cervical Cancer Treatment -Surgery (2)

• With either total or radical hysterectomy,
  surgeon may remove both fallopian tubes and
  ovaries, (a salpingo-oophorectomy.)
• Surgeon may also remove lymph nodes near tumor to
  see if they contain cancer. If cancer cells have
  reached lymph nodes, it means disease may have
  spread to other parts of the body.

86
Cervical Cancer Treatment -Radiation Therapy
(RT)

• Two types of RT, some women receive both types
• External radiation
• Internal radiation (intracavitary radiation)
  Thin tubes (implants) containing a radioactive
  substance are left in vagina for hours - 3 days.
• Patient stays in the hospital.
• To protect others from radiation, no visitors
  permitted. Once tubes are removed, no
  radioactivity is left in body.
• Internal radiation may be repeated two or more
  times over several weeks.

87
Cervical Cancer Treatment -Chemotherapy

• Chemotherapy is generally combined with radiation
  therapy. For cancer that has spread to distant
  organs, chemotherapy alone may be used.
• Selection of chemotherapy regimen is based on the
  extent of disease
• Chemotherapy takes place at home, doctors office
  or clinic

88
Cervical Cancer Treatment -Side Effects -
Surgery

• It takes time to heal after surgery, and recovery
  time is different for each woman.
• Surgery to remove a small tumor on cervix
  cramping or other pain, bleeding, or a watery
  discharge.
• Hysterectomy tired, weak, nausea and vomiting,
  and perhaps bladder and bowel problems
• Recovery takes 4 - 8 weeks after surgery
• Menstrual periods stop, cannot become pregnant.

89
Cervical Cancer Treatment -Side Effects
Surgery (2)

• Ovaries are removed menopause occurs at once,
  hot flashes and other symptoms of menopause
  caused by surgery may be more severe compared to
  natural menopause.
• After surgery, some women may be concerned about
  sexual intimacy. Many women find that it helps to
  share these concerns with their partner. A couple
  may want to ask a counselor to help them express
  their concerns.

90
Cervical Cancer Treatment -Side Effects
Radiation Therapy

• Side effects depend dose of radiation and site
  treated.
• Radiation to abdomen and pelvis
• Nausea, vomiting, diarrhea, or urinary problems,
  hair loss in genital area.
• Skin in treated area become red, dry, and tender.
  
• Vaginal dryness, itching, or burning, narrowing
  vaginal canal.
• No intercourse during treatment, but can resume
  sexual activity within a few weeks after
  treatment ends.
• Extreme tiredness during treatment

91
Cervical Cancer Treatment -Side Effects
Chemotherapy

• Side effects depend specific drugs and dose.
  Drugs affect cancer cells and other cells that
  divide rapidly
• Blood cells causing infections, bruise or bleed
  easily, feeling very weak and tired.
• Cells in hair roots causing hair loss
• Cells lining digestive tract causing poor
  appetite, nausea and vomiting, diarrhea, or mouth
  and lip sores.
• The drugs used for cervical cancer also may cause
  skin rash, hearing problems, loss of balance,
  joint pain, or swollen legs and feet.

92
Human Papilloma Virus (HPV)-Infection in Mouth
93
Human Papilloma Virus (HPV)-Infection in Male
Genital
94
Human Papilloma Virus (HPV)-Infection in Female
Genital
95
Human Papilloma Virus (HPV)-Infection
Prevention

• HPVs are a group of 100 related viruses
• Genital HPV infection are very common and are
  sexually transmitted.
• Most HPV infections occur without any symptoms
  and go away without any treatment in a few years
• Sometimes, HPV infection sometimes persists for
  many years. Such infections are primary cause of
  cervical cancer, also play a role in cancers of
  the anus, vulva, vagina, penis, as well as
  oropharyngeal cancer.

96
Human Papilloma Virus (HPV)-Infection
Prevention (2)

• In 2006, the U.S. Food and Drug Administration
  approved Gardasil, a vaccine that is highly
  effective in preventing infections.
• Optimal protection if received between the ages
  of 9 - 26 years of age. Women of age 26 may
  benefit if never been exposed to HPV types 16,
  18, 6 and 11.
• The Gardasil HPV vaccine is a three injection
  series given over a six month period.
• The warts and other benign lesions caused by HPV
  infection can be treated.