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Breast Cancer Diagnosis and Treatment

Posted by Monday, 2 January 2017

Breast Cancer Awareness

The outlook for women with breast cancer is improving constantly. Due to increased awareness, opportunities for early detection, and treatment advances, survival rates continue to climb. In the U.S., October is Breast Cancer Awareness Month and the campaign is designed to increase breast cancer awareness. There are many organizations that support Breast Cancer Awareness Month and provide assistance within early detection plans. Organizations also put together breast cancer fundraisers such as walks and events that support breast cancer research and help fund patients with socio-economic disadvantages.

Breast Cancer Symptoms

Breast cancer may or may not cause symptoms. Some women may discover the problem themselves, while others may have the abnormality first detected on a screening exam. Common breast cancer symptoms include the following:
  • Non-painful lumps or masses
  • Lumps or swelling under the arms
  • Nipple skin changes or discharge
  • Noticeable flattening or indentation of the breast
  • Change in the nipple
  • Unusual discharge from the nipple
  • Changes in the feel, size, or shape of the breast tissue

Types of Breast Cancer

Inflammatory Breast Cancer

Inflammatory breast cancer is a rare type of cancer that often does not cause a breast lump or mass. As seen in this photo, it often causes thickening and pitting of the skin, like an orange peel. The affected breast may also be larger or firmer, tender, or itchy. A skin rash or reddening of the skin is common. These changes are caused by cancer cells blocking lymph vessels in the skin. Inflammatory cancer of the breast typically has a fast growth rate.

Causes of Breast Cancer

Certain genes control the life cycle the growth, function, division, and death of a cell. When these genes are damaged, the balance between normal cell growth and death is lost. Normal breast cells become cancerous because of changes in DNA structure. Breast cancer is caused by cellular DNA damage that leads to out-of-control cell growth.

Causes of Breast Cancer: Genetics & Mutations

Inherited genes can increase the likelihood of breast cancer. For example, mutations of genes BRCA1 and BRCA2 (linked to an increased risk of breast and ovarian cancers) can inhibit the body s ability to safe-guard and repair DNA. Copies of these mutated genes can be passed on genetically to future generations, leading to a genetically-inherited increased risk of cancer.

Causes of Breast Cancer: Environment

Breast cancer may be caused by environmental exposure. Sunlight can cause DNA damage that leads to breast cancer through ultraviolet radiation. So can air pollutants like soot, wood dust, asbestos, and arsenic, to name just a few.

Causes of Breast Cancer: Lifestyle

Lifestyle choices can lead to breast cancer as well. Eating a poor diet, inactivity, obesity, heavy alcohol use, tobacco use including smoking, and exposure to chemicals and toxins are all associated with a greater breast cancer risk.

Causes of Breast Cancer: Medical Treatment

Medical treatment with chemotherapy, radiation, or immunosuppressive drugs used to decrease the spread of cancer throughout the body can also cause damage to healthy cells. Some second cancers , completely separate from the initial cancer, have been known to occur following aggressive cancer treatments.

Mammograms and Breast Cancer Prevention

Early detection of breast cancer is the key to survival. Mammograms are X-rays of the breast that can detect tumors at a very early stage, before they would be felt or noticed otherwise. During a mammogram, your breasts are compressed between two firm surfaces to spread out the breast tissue. Then an X-ray captures black-and-white images of your breasts that are displayed on a computer screen and examined by a doctor who looks for signs of cancer. Women at average risk have are recommended to have a mammogram every year starting at age 45. Starting at age 54, women are recommended to have a screening mammogram every 2 years as long as they remain healthy.

3D mammograms, or breast tomosynthesis, is a breast imaging procedure that also uses X-rays to produce images of breast tissue in order to detect abnormalities.

Breast Cancer Prevention: Breast MRI and Ultrasound
Breast MRI

MRI (magnetic resonance imaging) is a technology that uses magnets and radio waves to create detailed, 3D images of the breast tissue. Before the test you may be injected through an intravenous line, in the arm, with a contrast solution (dye). The contrast solution will allow potential cancerous breast tissue to show more clearly. Radiologists are able to see areas that could be cancerous because the contrast tends to be more concentrated in areas of cancer growth.

During a breast MRI the breasts are exposed as the patient lies flat on a padded platform with cushioned openings for the breasts. A breast coil surrounds each opening and works with the MRI unit to create the images. MRI imaging is a painless diagnostic tool. The test takes between 30 and 45 minutes.

Ultrasound

Sometimes a breast ultrasound is ordered in addition to a mammogram. An ultrasound can demonstrate fluid-filled cysts that are not cancerous. Ultrasounds may also be recommended for routine screening tests in some women at a higher risk of developing breast cancer. During a breast ultrasound a small amount of water-soluble gel is applied to the skin over the area to be examined. Then, a probe is gently applied against the skin. You may be asked to hold your breath, briefly several times. The breast ultrasound takes about 10 minutes to complete.

Breast Cancer Prevention: Breast Self-Exams

Experts recommend that women be aware of their breasts and notice any changes, rather than performing checks on a regular schedule. Women who choose to do self-exams should be sure to discuss the technique with their doctor.

What is a Breast Self-Exam?

A breast self-exam is a way to check your breasts for changes such as lumps or thickenings. Early breast cancer detection can improve your chances of surviving the disease. Any unusual changes discovered during the breast self-exam should be reported to your doctor.

Lump in Breast: Could it be Cancer?

Remember that the majority (about 80%) of breast lumps are not due to cancer. Cysts, benign tumors, or changes in consistency due to the menstrual cycle can all cause benign breast lumps. Still, it's important to let your doctor know about any lumps or changes in your breast that you find.

Breast Cancer Biopsy

A biopsy is the most certain way to determine whether a breast lump is cancerous. Biopsies may be taken through a needle or through a minor surgical procedure. The results can also determine the type of breast cancer that is present in many cases (there are several different types of breast cancers). Treatments are tailored to the specific type of breast cancer that is present.

Needle Biopsies

A needle biopsy uses a hollow needle to remove tissue or cell samples from the breast. A pathologist studies the samples under a microscope to see if they contain cancer. There are two types of needle biopsies: core need biopsy and fine needle aspiration (fine needle biopsy).
  1. Core Needle Biopsy: If a lump can be felt in the breast (palpable mass), a core needle biopsy may be performed. The doctor will use a small amount of local anesthetic to numb the skin and the breast tissue around the area. The doctor will insert the needle and remove a small amount of tissue to be examined.
  2. Ultrasound-Guided Core Needle Biopsy: This is one type of biopsy for lumps or abnormalities that cannot be felt (nonpalpable mass). A core needle is placed into the breast tissue and ultrasound helps confirm the exact location of the potential cancer so the needle is placed correctly. Tissue samples are then taken through the needle. Ultrasound can see the difference between cysts and solid lesions.
  3. MRI-Guided Core Needle Biopsy: For this test, you will be given a contrast agent through an IV. Your breast will be numbed and compressed and several MRI images will be taken. The MRI images will guide the doctor to the suspicious area. A needle will be used in the biopsy device to remove tissue samples with a vacuum assisted probe.
  4. Stereotactic Biopsy: If the lump is nonpalpable you could be also given a stereotactic biopsy. Using a local anesthetic, the radiologist makes a small opening in theskin. A needle is placed into the breast tissue, and imaging studies help confirm the exact placement. Tissue samples are taken through the needle.
Surgical Biopsies

A surgeon makes a cut (incision) in the breast to remove tissue.
  1. Open Excisional Biopsy: This surgery removes an entire lump and the issue is examined under a microscope. If a section of normal breast tissue is taken all the way around a lump, it is called a lumpectomy. In this procedure, a wire is put through a needle into the area to be biopsied. The X-ray helps to make sure it is in the right location and a small hook at the end of the wire keeps it in position. The surgeon uses the wire as a guide to locate the suspicious tissue.
  2. Incisional Biopsy: An incisional biopsy is very similar to an excisional biopsy, but less tissue is removed. Local anesthetic will be used and you will also get IV sedation. An incisional biopsy removes part of the tumor, which means that more surgery may be needed to remove the remaining cancer.
Biopsy Results: Hormone-Sensitive Breast Cancer

A biopsy can tell whether the breast cancer has receptors for estrogen (ER-positive) and/or progesterone (PR-positive), indicating which hormone stimulates tumor growth. About two-thirds of breast cancers are hormone receptor-positive. Medications can be given that act to help prevent growth of the tumor from stimulation by these hormones.

ER-positive breast cancer is sensitive to estrogen, whereas PR-positive breast cancer is sensitive to progesterone. Both ER-positive and PR-positive breast cancers may respond to hormone therapy. Hormone receptor (HR) negative is a type of cancer that does not have hormone receptors and will not be affects by hormone blocking treatments.

Biopsy Results: HER2-Positive Breast Cancer

HER-2 (human epidermal growth factor receptor 2) is a protein that is expressed at a high level by about 20% of breast cancers. Having this receptor means the cancer tends to grow and spread faster than other forms of breast cancer. There are special targeted treatments available for this type of tumor.

Treatments specifically for HER2-positve breast cancer include:
  • Herceptin (trastuzumab)
  • Kadcyla (ado-trastuzumab emtansine)
  • Perjeta (pertuzumab)
  • Tykerb (lapatinib)
Breast Cancer Stages

Breast cancer stages are classified according to cancer tumor size, location, and extent of spread. Staging helps doctors determine the prognosis and treatment for cancer. The TNM staging system classifies breast cancers according to:
  1. Tumor (T): Primary tumor size and/or extent
  2. Nodes (N): Spread of cancer to lymph nodes in the regional area of the primary tumor
  3. Metastasis (M): Spread of cancer to distant sites away from the primary tumor
TNM Breast Cancer Classification

The TNM classification of a cancer usually correlates to one of the following five stages:
  • Stage 0 Breast Cancer (Tis, N0, M0): This refers to cancer that is "in situ," meaning that cancerous cells are confined to the breast. This type of breast cancer has not spread and is not invading other tissues.
  • Stage I Breast Cancer: Stage I invasive breast cancer is broken up into subcategories known as IA and IB.
  • Stage IA breast cancer (T1, N0, M0) refers to the tumor measuring up to 2 centimeters and no cancer has spread outside the breast.
  • Stage IB breast cancer (T0 or T1, N1mi, M0) includes no tumor in the breast, but small groups of cancer cells in the lymph nodes. Stage IB could also be a tumor in the breast that is no larger than 2 centimeters and small groups of cancer cells in the lymph nodes.
Stage II Breast Cancer

Stage II invasive breast cancer is broken up into two subcategories known as IIA and IIB.
  • Stage IIA breast cancer (T0 or T1 or T2, N0 or N1, M0) includes no tumor in the breast, but cancer (larger than 2 millimeters) in 1 to 3 axillary lymph nodes or lymph nodes near the breast bone. Stage IIA can also include a tumor measuring 2 centimeters or smaller and cancer has spread to the axillary lymph nodes or a tumor 2-5 centimeters that has not spread to the axillary lymph nodes.
  • Stage IIB breast cancer (T2 or T3, N0 or N1, M0) refers to a tumor 2-5 centimeters and small groups (0.2-2.0 millimeters) of breast cancer cells in the lymph nodes or a tumor 2-5 centimeters with cancer in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone. Stage IIB breast cancer can also include a tumor larger than 5 centimeters with no affected lymph nodes.

Stage III Breast Cancer

Stage III invasive breast cancer is broken up into subcategories IIIA, IIIB, and IIIC.
  • Stage IIIA (T0 to T3, N1 or N2, M0) refers to the tumor ranging from nonexistent to any size and cancer is found in 4 to 9 axillary lymph nodes or in lymph nodes near the breastbone. Stage IIIA can also include a tumor larger than 5 centimeters with small groups of breast cancer cells (0.2 to 2 millimeters) in the lymph nodes or a tumor larger than 5 centimeters with cancer in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone.
  • Stage IIIB (T4, N0 to N2, M0) refers to a tumor of any size and has spread to the chest wall and/or skin of the breast in addition to cancer that has spread to up to 9 axillary lymph nodes or lymph nodes near the breastbone.
  • Stage IIIC (any T, N3, M0) refers to a tumor of any size and possible spreading to the chest wall and/or the skin of the breast as well as the cancer in 10 or more axillary lymph nodes or spread to lymph nodes above or below the collarbone or near the breastbone.
  • Stage IV Breast Cancer (any T, any N, M1): Stage IV breast cancer refers to breast cancer that has spread to other organs such as the lungs, distant lymph nodes, skin, bones, liver, or brain.
Breast Cancer Survival Rates

Breast cancer survival depends upon a number of factors. Cancers that are found early are often localized to the breast. Statistics on the survival rate of breast cancer are often given as 5-year survival rates. The 5-year survival rate is the percentage of people who live at least 5 years after being diagnosed with breast cancer. According to the American Cancer Society, women with early stage (stage 1) breast cancer have a 5-year survival rate of 100%. Women with breast cancer that has spread to distant sites in the body (stage 4) have only a 20% chance of surviving 5 years; but this rate can improve as treatment advances are made.

Breast Cancer Treatments: Surgery

Breast-conserving surgery removes the cancer and some healthy tissue around it, but not the breast. Some lymph nodes under the arms may be removed for biopsy. If the cancer is near the chest wall, part of it may be removed. Breast-conserving surgery is also known as breast-sparing surgery, lumpectomy, partial mastectomy, quadrantectomy, and segmental mastectomy.

Mastectomy

Mastectomy is the removal of the entire breast and all the surrounding tissue and possibly nearby tissues. There are different mastectomy surgeries available, depending on how much additional tissue is removed. The following are different types of mastectomies:
  1. Simple mastectomy includes removal of the entire breast, but does not remove lymph nodes or muscle tissue.
  2. Double mastectomy is when both breasts are removed.
  3. Skin-sparing mastectomy includes keeping the skin over the breast intact. Breast reconstruction surgery is typically planned immediately after the mastectomy.
  4. Nipple-sparing mastectomy keeps the breast skin and nipple intact and breast reconstruction surgery immediately follows.
  5. Modified radical mastectomy combines a simple mastectomy with the removal of the lymph nodes under the arm.
  6. Radical mastectomy includes the removal of the entire breast, lymph nodes, and the pectoral muscles under the breast.
Breast Cancer Treatments: Radiation Therapy

High-energy beams of localized radiation are used to kill targeted cancer cells. Radiation therapy can be used after breast cancer surgery, or it may be used in addition to chemotherapy for widespread cancer. This treatment does have side effects, which can include swelling of the area, tiredness, or a sunburn-like effect. There are two ways to administer radiation therapy.

External Beam Radiation

A beam of radiation is focused onto the affected area by an external machine. The treatment is usually given five days a week for five to six weeks.

Brachytherapy

This form of radiation involves radioactive seeds or pellets that are implanted into the breast next to the cancer.

Breast Cancer Treatments: Chemotherapy

Chemotherapy drugs are given to kill cancer cells that are located anywhere in the body. It can be administered by a slow IV infusion, by pill, or by a brief IV injection, depending upon the drug. Sometimes chemotherapy is given after surgery to help prevent the cancer from recurring (adjuvant therapy). Side effects of chemotherapy can include an increased risk of infection, nausea, fatigue, and hair loss.

Chemotherapy drugs are given to kill cancer cells that are located anywhere in the body. It can be administered by a slow IV infusion, by pill, or by a brief IV injection, depending upon the drug. Sometimes chemotherapy is given after surgery to help prevent the cancer from recurring. Usually, chemotherapy drugs are given in cycles with certain treatment intervals followed by a period of rest. The cycle length and rest intervals differ from drug to drug.

Adjuvant Chemotherapy

If all visible cancer has been removed, there is still the possibility that cancer cells have broken off or are left behind. Adjunct chemotherapy is given to assure that these small amounts of cells are killed. Since some women have a very low risk of recurrence even without chemotherapy, it is not given in all cases.

Neoadjuvant Chemotherapy

Neoadjuvant chemotherapy is given before surgery. There is no correlation between neoadjuvant chemotherapy and long-term survival, but there are advantages to see if the cancer responds to the chemotherapy before surgical removal. This can also reduce the size of the cancer and allow for a less extensive surgery in some patients.

Chemotherapy for Advanced Breast Cancer

Chemotherapy can be used if the cancer has metastasized to distant sites in the body. In this case, doctors will determine the most appropriate treatment.

Chemotherapy Side Effects

Different drugs cause different side effects. Certain types of chemotherapy have specific side effects, but each patient s experience is different. The following are common side effects of chemotherapy:
  1. Fatigue
  2. Pain (headaches, muscle pain, stomach pain, and pain from nerve damage)
  3. Mouth and throat sores
  4. Diarrhea
  5. Nausea and vomiting
  6. Constipation
  7. Blood disorders
  8. Changes in thinking and memory
  9. Sexual and reproductive issues
  10. Appetite loss
  11. Hair loss
  12. Permanent damage to the heart, lung, liver, kidneys, or reproductive system
Breast Cancer - Hormone Therapy

Some breast cancer cells are activated by female hormones estrogen and/or progesterone (ER- and PR-positive breast cancers). Hormone therapy can stop or slow the growth of hormone receptor-positive tumors by blocking the cancer cells from receiving the hormones they need to grow. Hormone therapy is usually given after surgery, but it can also be given to reduce the chance of developing breast cancer in women at high risk.

Breast Cancer - Hormone Therapy

Some breast cancer cells are activated by female hormones estrogen and/or progesterone (ER- and PR-positive breast cancers). Hormone therapy can stop or slow the growth of hormone receptor-positive tumors by blocking the cancer cells from receiving the hormones they need to grow. Hormone therapy is usually given after surgery, but it can also be given to reduce the chance of developing breast cancer in women at hiTargeted Drug Therapies for Breast Cancer

Targeted therapies are newer treatments for breast cancer patients. They utilize specific proteins within cancer cells, like the HER-2 protein. Targeted therapies can stop the HER-2 protein from stimulating tumor growth in cancer cells that have this protein. Targeted therapies have fewer side effects than traditional chemotherapy because they only target cancer cells. They are often used in combination with chemotherapy.gh risk.

Breast Cancer Recovery

Breast cancer treatment can be both physically and emotionally exhausting. There are many changes taking place that may be difficult to cope with. Chemobrain is a term coined to describe the mental changes caused by chemotherapy treatment. Patients have experienced memory deficits and the inability to focus. Breast cancer treatments can also leave patients fatigued, which is normal.

It can be difficult to keep up with activities of daily life, and make patients feel isolated or overwhelmed. Friends and family can be invaluable sources of support and assistance during this time. Some people choose to join a local or an online support group to share their experiences and spread breast cancer awareness.

Breast Reconstructive Surgery

Many women opt to have reconstructive surgery after breast cancer surgery. Reconstructive procedures use implants or tissues obtained from other locations in the body. These procedures can be done at the time of mastectomy, or they may be performed months or even years later.

Implants

A tissue expander will be inserted un the skin, for a few weeks, to stretch the skin and allow a silicone-gel or saline implant to be inserted. Each week preceding the implant insertion, the tissue expander is filled to a desired volume until the patient is satisfied with their new breast size.

Tissue Flap Procedure

A women s own tissue is taken from the abdomen or back to create a mound to reconstruct the breast. The tissue is sometimes kept attached to its original blood supply or it is disconnected and reconnected to a blood supply near the new location. Some patients also have nipple reconstruction, which is created using tissue from the back or abdomen flap. The nipple is then tattooed in order to resemble the color of a nipple. A prosthetic nipple is also an option and can be created by making a copy of your natural nipple.

Alternative to Reconstructive Surgery: Prosthesis

A prosthesis, or breast form, is an alternative to reconstructive surgery. A prosthesis offers the appearance of breasts without surgery. This is a device that is worn inside a bra or bathing suit to permit a balanced appearance when clothed. Breast prostheses come in many shapes, sizes, and materials (silicone gel, foam, or fiberfill interior). Breast prosthetic devices are often covered by insurance plans.

Is Breast Cancer Genetic?

Breast cancer occurs in both men and women, but it is about 100 times more likely to affect women than men. Women over age 55 and those with a close relative who have had the condition are at greatest risk for developing breast cancer. Still, up to 80% of women who do get breast cancer do not have a relative with the disease. Certain inherited genetic mutations dramatically increase a women s risk of breast cancer. The most common of these are genes known as BRCA1 and BRCA2. Women who inherit mutations in these genes have up to an 80% chance of developing breast cancer.

The Breast Cancer (BRCA) Gene Test

Several tests are available to look for the Breast Cancer (BRCA) gene. A blood test can be given to analyze DNA mutations in BRCA1 and BRCA2. Women who have inherited mutations have a much higher risk of developing breast cancer. The BRCA test is typically only offered to people who may have inherited the mutation. You may be a candidate for the BRCA gene test if you have the following:
  • Personal history of breast cancer
  • Personal history of ovarian cancer
  • Family history of breast cancer in parents, siblings, and/or children
  • A male relative with breast cancer
  • A family member with both breast and ovarian cancers
  • A family member with bilateral breast cancer
  • Two or more relatives with ovarian cancer
  • A relative with known BRCA1 or BRCA2 mutation
  • Ashkenazi Jewish ancestry with a close relative with breast or ovarian cancer
  • Ashkenazi Jewish ancestry and a personal history of ovarian cancer
Breast Cancer Prevention

Factors that can raise the risk of getting breast cancer include not getting enough exercise, drinking more than one alcoholic drink per day, and being overweight. Breast cancer prevention also includes avoiding exposure to carcinogens, chemicals, and radiation from medical imaging. Some kinds of hormone therapy and birth control pills can also elevate risk, but the risk returns to normal after stopping these medications. Some studies have shown that regular physical activity may help lower the risk of recurrence in women who have survived breast cancer.

Preventative surgery (prophylactic mastectomy) may also prevent breast cancer. Bilateral prophylactic mastectomy is the removal of both breasts in order to prevent breast cancer. Women with a strong family history of BRCA1 or BRCA2 mutations may choose to have bilateral prophylactic mastectomy in order to lower their risk of developing breast cancer.

Breast Cancer Research

Doctors continue to search for more effective and tolerable treatments for breast cancer. The funding for this research comes from many sources, including advocacy groups throughout the country. Many of the 2.5 million breast cancer survivors and their families choose to participate in walk-a-thons and other fundraising events. This links each individual fight against cancer into a common effort for progress.

Additional Information on Breast Cancer
For more information about Breast Cancer, please consider the following:
  • American Cancer Society
  • National Breast Cancer Foundation, Inc.
  • BreastCancer.org
  • Susan G. Komen
  • National Cancer Institute

Diabetes and Foot Problems

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How can diabetes affect my feet?
Chronically high blood sugar (glucose) levels can be associated with serious complications in people who have diabetes. The feet are especially at risk. Two conditions called diabetic neuropathy and peripheral vascular disease can damage the feet (and other areas of the body) in people who have diabetes.

What is diabetic neuropathy?
Chronically high sugar levels associated with uncontrolled diabetes can cause nerve damage that interferes with the ability to sense pain and temperature. This so-called "sensory diabetic neuropathy" increases the risk a person with diabetes will not notice problems with his or her feet. Nearly 10% of people with diabetes develop foot ulcers due to peripheral vascular disease and nerve damage. People with diabetes may not notice sores or cuts on the feet, which in turn can lead to an infection. Nerve damage can also affect the function of foot muscles, leading to improper alignment and injury.

What is peripheral vascular disease?
Diabetes is associated with poor circulation (blood flow). Inadequate blood flow increases the healing time for cuts and sores. Peripheral vascular disease refers to compromised blood flow in the arms and legs. Poor blood flow increases the risk that infections will not heal. This, in turn, increases the risk of ulcers and gangrene, which is tissue death that occurs in a localized area when there is an inadequate blood supply.

What are common foot problems of people with diabetes?

The following images show common foot problems that anyone can get; however, those with diabetes are at increased risk for serious complications associated with these conditions, including infection and even amputation.

Athlete's foot
Fungal infection of the feet is called athlete's foot. Cracked skin, itching, and redness are associated with the condition. Fungus enters cracks in the skin causing an infection that must be treated with antifungal medications. Oral medications or topical creams may be used to treat athlete's foot.

Fungal nail infection
Thick, brittle, yellow-brown, or opaque nails are common with fungal nail infections. The infected area may crumble or seem to pull away from the rest of the nail. Fungus thrives in the warm, moist, dark environment created by wearing closed-toed shoes. Nail injury also increases the risk of fungal nail infection. These infections are difficult, but not impossible, to treat. Oral medications work best to treat fungal nail infections. Topical treatments are only effective for a few types of fungal nail infections. Sometimes, surgery is necessary to remove infected areas of the nail.

Calluses 
Calluses are hard areas of thickened skin that build up on the bottom of the feet. Uneven weight distribution, a skin abnormality, or ill-fitting shoes may cause calluses. Use these tips to care for calluses:
  • Rub the area with pumice stone after a shower or bath. Ask your doctor the best way to do this.
  • Place cushioned insoles or pads in shoes.
  • Ask your doctor about prescription medication to soften calluses.

It's normal to have some calluses. It's important to never try to cut a callus using a sharp object. Doing so can cause serious injury.

Can these foot problems be prevented?

Taking good care of your feet can prevent problems before they start! Use the following tips to reduce your risk of common foot problems and serious complications associated with them.

Diabetes and Foot Problems
Prevention Tip #1

Living with diabetes requires you to pay special attention to your health and your condition. Follow your doctor's instructions regarding diet, exercise and medication. Keeping your blood sugar (glucose) levels within the recommended range is one of the best things you can do to control your condition and protect your feet.

Diabetes and Foot Problems
Prevention Tip #2

Carefully inspect your feet daily for redness, blisters, sores, calluses, and other signs of irritation. Daily foot checks are especially important if you have inadequate blood flow.

Diabetes and Foot Problems
Prevention Tip #3

Follow these foot care tips to properly care for your feet:

  1. Wash your feet daily with non-irritating soap and warm water.
  2. Avoid soaking your feet.
  3. Dry your feet completely after bathing, paying special attention to the areas between the toes.
  4. Avoid applying lotion to the areas between the toes.
  5. Ask your doctor which lotion is best for your skin type and health condition.

What is the treatment for mesothelioma?

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There are three traditional kinds of treatment for patients with malignant mesothelioma. Often two or more of these are combined in the course of treatment:

surgery (taking out the cancer),
radiation therapy (using high-dose X-rays or other high-energy rays to kill cancer cells), and
chemotherapy (using drugs to fight the cancer).
Additional information

Surgery: There are several types of surgery used in treating mesothelioma.

  • A pleurectomy is the removal of part of the chest or abdomen lining and some of the tissue around it.
  • Depending on how far the cancer has spread, a lung also may be removed in an operation called a pneumonectomy.
  • In an extrapleural pneumonectomy, the lung is removed along with the lining and diaphragm (the muscle that helps you breathe) on the affected side. In this surgery, the lining around the heart is also removed.
  • Sometimes a pleurectomy/decortication is performed. In this surgery, the lining of the lung is removed along with as much of the tumor as possible.

Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

If fluid has collected in the chest or abdomen, your doctor may drain the fluid out of your body by putting in a needle into the chest or abdomen and using gentle suction to remove the fluid. If fluid is removed from the chest, this is called thoracentesis. If fluid is removed from the abdomen, this is called paracentesis. Your doctor may also put drugs through a tube into the chest to prevent more fluid from accumulating.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be administered by pill, or it may be put into the body by a needle in the vein or muscle.

Chemotherapeutic agents can be administered either systemically (through the bloodstream) or intrapleurally (in the pleural cavity). When it is administered intrapleurally, the treatment is localized at the site of the tumor. These drugs are generally very toxic and you should discuss their use very carefully with your physician.

Mesothelioma

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What is mesothelioma?

Mesothelioma is a rare form of cancer (malignancy) that most frequently arises from the cells lining the sacs of the chest (the pleura) or the abdomen (the peritoneum). Pleural mesothelioma is the most common form, often presenting with symptoms in the chest area. Peritoneal mesothelioma is much less common. This can affect the organs in the abdomen, and its symptoms are related to this area of the body, that is, abdominal swelling, nausea, vomiting, and bowel obstruction. The rarest form of mesothelioma is pericardial mesothelioma, which involves the sac surrounding the heart.

There are two major cell types of mesothelioma, epithelial and sarcomatoid. Sometimes both of these cell types can be present. The sarcomatoid type is rarer and occurs in only about 15% of cases; it portends a poorer prognosis. In very rare cases, mesothelioma can originate from benign, non-malignant cells. This so-called benign mesothelioma can be cured surgically.

What are the symptoms of mesothelioma?

Most people present with complaints of shortness of breath. They also can have complaints of chest pain and cough. Patients may also be asymptomatic, with the disease discovered by physical exam or an abnormal chest X-ray.

As the disease progresses, shortness of breath increases, and weight loss, decreased appetite, and night sweats can develop. Local invasion by the tumor can result in changing of voice, loss of function of the diaphragm, and symptoms specific to the area and involvement of adjacent structures.

What causes mesothelioma?

Most people with malignant mesothelioma have worked on jobs where they breathed asbestos. Usually, this involves men over 40 years of age. Others have been exposed to asbestos in a household environment, often without knowing it. The number of new cases of mesothelioma has been relatively stable since 1983, the same time that the restrictions on asbestos were instituted by the U.S. Occupational Safety and Health Administration (OSHA). In Europe, the number of new cases of mesothelioma continues to rise.

How much asbestos exposure does it take to get mesothelioma?

An exposure of as little as one or two months can result in mesothelioma 30 or 40 years later and in some cases, as much as 70 years later.

How long does it take after asbestos exposure for mesothelioma to show up?

People exposed in the 1940s, '50s, '60s, and '70s are now being diagnosed with mesothelioma because of the long latency period of asbestos disease.

How is mesothelioma diagnosed?

Mesothelioma is diagnosed by pathological examination from a biopsy. Tissue is removed, placed under the microscope, and a pathologist makes a definitive diagnosis and issues a pathology report. This is the end of a process that usually begins with symptoms that send most people to the doctor: a fluid buildup around the lungs (pleural effusions), shortness of breath, pain in the chest, or pain or swelling in the abdomen. The doctor may order an X-ray or CT scan of the chest or abdomen. If further examination is warranted, the following tests may be done:

Thoracoscopy: For pleural mesothelioma, the doctor may look inside the chest cavity with a special instrument called a thoracoscope. A cut will be made through the chest wall and the thoracoscope will be put into the chest between two ribs. This test is usually done in a hospital using an anesthetic. If fluid has collected in your chest, your doctor may drain the fluid out of your body by putting a needle into your chest and using gentle suction to remove the fluid. This is called thoracentesis.
Peritoneoscopy: For peritoneal mesothelioma, the doctor may also look inside the abdomen with a special tool called a peritoneoscope. The peritoneoscope is put into an opening made in the abdomen. This test is usually done in the hospital under an anesthetic. If fluid has collected in your abdomen, your doctor may drain the fluid out of your body by putting a needle into your abdomen and using gentle suction to remove the fluid. This process is called paracentesis.
Biopsy: If abnormal tissue is found, the doctor will need to cutout a small piece and have it looked at under a microscope. This is usually done during the thoracoscopy or peritoneoscopy, but can be done during surgery. Unfortunately, in some cases, tumor cells can grow along the tract where the biopsy is taken. This can be minimized with the use of radiation to the area.

What is the prognosis for mesothelioma?

Like most cancers, the prognosis for this disease often depends on how early it is diagnosed and how aggressively it is treated. Unfortunately, mesothelioma is often found at a stage in which a cure is unobtainable. Many will succumb to the disease within one year of diagnosis.

Mesothelioma treatment options (traditional and new treatments being studied)

Treatment options are determined by the stage of mesothelioma (the extent to which the tumor has spread in the body). There are three staging systems currently in use, and each one measures somewhat different variables.

The oldest staging system and the one most often used is the Butchart system, which is based mainly on the extent of primary tumor mass and divides mesotheliomas into four stages.

Butchart system extent of primary tumor mass
  • Stage I: Mesothelioma is present in the right or left pleura and may also involve the diaphragm on the same side.
  • Stage II: Mesothelioma invades the chest wall or involves the esophagus, heart, or pleura on both sides. Lymph nodes in the chest may also be involved.
  • Stage III: Mesothelioma has penetrated through the diaphragm into the lining of the abdominal cavity or peritoneum. Lymph nodes beyond those in the chest may also be involved.
  • Stage IV: There is evidence of metastasis or spread through the bloodstream to other organs.

The Brigham system is the latest system and stages mesothelioma according to resectability (the ability to surgically remove the tumor) and lymph node involvement.

Brigham system: variables of tumor resectability and nodal status
  • Stage I: resectable mesothelioma and no lymph node involvement
  • Stage II: resectable mesothelioma but with lymph node involvement
  • Stage III: unresectable mesothelioma extending into chest wall, heart, or through diaphragm, peritoneum; with or without extrathoracic lymph-node involvement
  • Stage IV: distant metastatic disease

10 SURPRISING FACTS ABOUT MESOTHELIOMA

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Mesothelioma is a rare type of cancer that affects the protective lining around the chest, abdominal or cardiac cavity. Mesothelioma usually results from exposure to asbestos. Asbestos is a natural mineral that has been used in many products. It is a known human carcinogen.

Asbestos becomes extremely dangerous when its microscopic fibers are released into the air. Asbestos fibers are invisible to the naked eye, so most people are unaware they are inhaling or ingesting these particles.

Many construction workers, shipyard workers, miners, textile workers, factory workers, auto mechanics, first responders and others may have been exposed to asbestos over the years, through direct or second-hand exposure. Veterans are one of the most at-risk groups.

The following are some surprising facts about mesothelioma.

1. The primary cause of mesothelioma is inhalation of airborne asbestos particles.
The primary cause of mesothelioma is inhalation or ingestion of asbestos particles that have become airborne. An estimated 2-10 percent of individuals who are heavily exposed to asbestos particles for long periods of time will be diagnosed with pleural mesothelioma.

2. An estimated 11 million people were exposed to asbestos between 1940 and 1978.
The National Institutes of Health estimates that during the height of asbestos mining and use, which occurred between 1940 and 1978, close to 11 million people were exposed to asbestos fibers.

3. The majority of mesothelioma patients go without symptoms for 25-50 years after being exposed to asbestos.
Most mesothelioma patients experience a significant gap between the date of exposure and the onset of symptoms. The mean latency period for men is 47.9 years and 53.3 years for women. Doctors can have difficultly diagnosing mesothelioma due to the fact that early symptoms tend to be either quite mild or completely nonexistent.

4. Approximately 2,000-3,000 new mesothelioma cases are diagnosed each year.
Due to the long latency period and continued exposure to materials containing asbestos, approximately 2,000-3,000 new mesothelioma cases are diagnosed each year.

5. Men are four times more likely than women to be diagnosed with mesothelioma.
Men were more likely to be exposed to asbestos in the jobs and industries in which they traditionally worked. As a result, men are about 4.6 times more likely than women to be diagnosed with mesothelioma.

6. Dose and duration are not the only factors affecting the risk of developing an asbestos-related disease.
There is no question that the amount of asbestos an individual is exposed to and the length of time he or she is exposed are both key factors affecting the risk of that individual developing an asbestos-related disease. These are not the only factors, however. The source of the exposure, as well as the size, shape and chemical makeup of the fiber itself may also affect a person s risk.

If an individual smokes or already has a pre-existing lung condition, this can also increase his or her chances of being diagnosed with this type of cancer. Race and age may also play a role. The majority of patients who receive a mesothelioma diagnosis are white and over the age of 60.

7. Mesothelioma most commonly occurs in the pleura.
While mesothelioma can affect the lining of the chest, lungs, abdomen or heart, it most commonly occurs in the pleura the membranes surrounding and enveloping the lungs. Between 70 to 90 percent of all mesothelioma cases occur in the pleura, 10 to 30 percent occur in the peritoneum (lining of the abdominal cavity) and 1 percent occur in the pericardium (membrane surrounding the heart).

8. Symptoms of mesothelioma vary depending on where the cancer is located.
Patients with pleural mesothelioma may experience symptoms such as:

  1. Abdominal swelling
  2. Anemia
  3. Loss of appetite
  4. Chest pain
  5. Chills or night sweats
  6. Cough (which sometimes can involve coughing up blood)
  7. Breathing problems
  8. Fatigue and shortness of breath
  9. Fever
  10. Fluid buildup
  11. Lumps under abdominal skin or skin on the chest
  12. Vomiting
  13. Weight Loss

Peritoneal mesothelioma affects the lining of the abdomen or stomach (peritoneum). Symptoms for this type of mesothelioma can be similar to those for pleural mesothelioma, however can also include:

  1. Abdominal distention
  2. Bowel obstruction
  3. Feeling of being full
  4. Hernias

Pericardial mesothelioma affects the membrane surrounding the heart. Symptoms for this type of cancer can also be similar to the other types of mesothelioma, and may also include:

  1. Heart palpitations
  2. Irregular heartbeat
  3. Murmurs
  4. Pressure on the heart
  5. Heart failure

9. There is hope for mesothelioma patients.
The current five-year survival rate for mesothelioma patients is around 30 percent. Fortunately there is hope for longer-term survival in those diagnosed with mesothelioma. Surgery, chemotherapy, radiation therapy and clinical trials are some of the treatments available to people fighting this type of cancer.

10. More than half of all mesothelioma patients are included in clinical trials.
Although there is no definitive cure for mesothelioma at this time, more than 175 clinical trials have been conducted since 2011. At least half of the patients diagnosed with mesothelioma will be involved in a clinical trial at some point in their lives.

Foods That Cause Acne

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Foods That Cause Acne. Acne is one of the most hated enemy by everyone, especially women. Acne is not including a dangerous disease. But its presence is very annoying, though acne is not harmful but should we treat and handle well.
Acne is caused by clogged pores due to overactive oil glands. Although many medical experts who denied any connection between acne with the food we eat, there's no harm in avoiding some foods that supposedly can trigger acne.

Here are some foods can cause Acne:

1. Sugar and Chocolate
Chocolate may be one of the most food trigger acne. Archives of Dermatology published a study which explains that the food has a high Glycemic Index scale, usually in processed carbohydrates such as sugar can cause the appearance of acne due to increased hormone levels.

2. Milk
Some studies show a high milk intake may be associated with the appearance of acne. A Harvard study found that teens who drink milk more than two servings a day are more likely to suffer from severe acne. That is because the increase in growth hormone which causes the sebaceous glands in the skin become clogged.

3. Iodine
Iodine may be one factor in the appearance of acne, such as skin oil glands which can irritate skin that is prone to acne. Iodine can be found in fish and shellfish because sea water contains iodine. In addition other sources comes from iodized salt which is a component of several types of canned food.

4.Caffeine and Alcohol
Caffeine is considered to trigger the appearance of acne because it can affect hormone levels produced by the body. Some sources of caffeine are coffee, tea, soft drinks, and chocolate. In addition, alcohol also causes an increase in hormones, particularly testosterone can cause acne more often.

5. Food Allergy Triggers
Skin problems often arise due to food allergies, especially milk and eggs. Acne appears due to the immune system tries to fight the poison that is felt. An allergist has diagnosed and confirmed the relationship of food allergy with severe acne.

6. Fruit and Vegetable Characteristically Acid
Some fruits and vegetables that are acidic can cause the appearance of acne, such as carrots, cucumbers, oranges, and lettuce. The acidity of the body can cause the appearance of acne, because it should be avoided.

Those are some foods that can trigger the onset of Acne. シ

Acyclovir Pharmacology and Indication

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Acyclovir is acyclic purine nucleoside analogue active against herpes simplex virus, varicella zoster, Epstein-Barr virus and cytomegalovirus. In the cell, undergo phosphorylation acyclovir acyclovir triphosphate into an active form that inhibit the herpes simplex virus DNA polymerase and viral DNA replication, thereby preventing viral DNA synthesis without affecting normal cell processes.

Acyclovir Pharmacology
Acyclovir is an antiviral agent highly active in vitro against herpes simplex virus (HSV) types I and II, and varicella zoster virus. Upon entry into the infected cell, the phosphorylated form of the active compound Acyclovir Acyclovir trifosfate. The initial phase of the process depends on the enzyme thymidine kinase viral-coded. Acyclovir trifosfate act as inhibitors and as a false substrate for the herpes-specified DNA polymerase which prevents viral DNA synthesis without affecting normal cellular processes.

Treatment of herpes simplex virus infections of the skin and mucous membranes including initial and recurrent genital herpes / recurrent, herpes zoster (shingles / shingles / shingles). Preventing recurrence of herpes simplex infections in patients with strong immune systems. Preventing herpes simplex infection in patients with poor immune systems.

Another acyclovir pharmacology is a treatment of herpes simplex virus infections of the skin and mucous membranes including initial and recurrent genital herpes / recurrent, herpes zoster (shingles / shingles / shingles); preventing recurrence of herpes simplex infections in patients with strong immune systems; preventing herpes simplex infection in patients with poor immune systems.

Acyclovir Indication
Acyclovir indication such as treatment of herpes simplex virus on the skin and mucus membranes, including initial and recurrent genital herpes; treatment of herpes zoster and varicella infections; treatment of infections caused by the herpes simplex of the skin and mucous membranes including initial and recurrent genital herpes, herpes simplex infection prevention in immuno-compromised patients; treatment of herpes zoster infection.

Vitamins For A Healthy Heart

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As we all know, vitamins are very important when it comes to keeping your heart healthy.  You need to eat the right foods of course, although you also need to supplement the food you eat with the necessary vitamins your body needs to stay in shape and keep your heart working healthy for a long time to come.  If you don’t consume the right nutrients, you won’t be doing your heart any favors - and may end up having problems later on in life.

The first vitamin that comes to mind for most people is vitamin E, a vitamin that is essential to improving the overall health of your heart.  When taken correctly, vitamin E will stop the cholesterol in the body from harming the arteries that surround the heart.  Anytime cholesterol oxidizes, it sticks to the sides of the arteries and can lead to blockages which can cause heart attacks or other serious problems with the heart. 

To help you keep your heart healthy, most doctors recommend that you take additional supplements that contain vitamin E.  They may also suggest that you eat foods that are naturally rich in vitamin E, such as nuts.  Nuts have high amounts of vitamin E, and most of them taste great.  You can find other foods that contain vitamin E as well, although nuts have the highest amounts.

In the past, research has shown Vitamin E to help those who have already suffered the wrath of a heart attack.  This vitamin helps to prevent heart attacks in the future by opening up the arteries and eliminate blockage.  Those who have had a heart attack in the past are always encouraged to add more vitamin E to their diet.

What many aren’t aware of, is the fact that you can use vitamin C to boost the effects of vitamin E.  Vitamin C is known as an antioxidant, which prevents the damaging effects that cholesterol has on the body.  Along with preventing cholesterol from damaging the body, vitamin C also helps vitamin E with it’s functions - such as protecting your arteries and your heart.

By taking both vitamin C and E as a combination, you’ll be well on your way to a healthier heart.  Overall, this is the easiest way that you can be sure you aren’t damaging your heart, especially if you have had a heart attack in the past.  If you have a history of heart disease or heart problems in your family, these vitamins are essential to your diet.  Even if you are just concerned about the health of your heart, these vitamins will give you the peace of mind in knowing that you are eating for a healthy heart.

As far as your dosage goes, it will vary from person to person, although 400 international units of vitamin E and C are the recommended amounts for most people.  On it’s own, vitamin C can be tolerated in large doses, without imposing any harmful effects.  You can take around 500 mg of it twice a day, and ensure that your heart remains healthy.

To be on the safe side, you should always make sure that you get the proper amount of vitamins in your daily diet.  Taking additional vitamins and supplements isn’t a bad idea either, especially if you are trying to boost the health of your heart.  Your heart is one of the most important organs in your body, which is why you should always take care of it.  If you eat the proper diet and take the necessary vitamins - you’ll be well on your way to keeping your heart healthy.