Monday, January 26, 2015

Why are certain cancers so hard to diagnose?

Medical science has made tremendous strides in the diagnosis and treatment of cancer.  Screening tests including mammograms for breast cancer, Pap smears for cervical cancer, and colonoscopies for colon cancer have allowed these cancers to be detected at an earlier stage when treatment is generally more effective. Treatment of several types of cancer including breast, testicular, skin and colon, if started early in their course, can result in a “cure” in a high percentage of cases.  Also, many people whose risk of developing cancer is increased can be identified by assessing risk factors, exploring family history or performing genetic testing.

Despite these advances, there are certain types of cancer that defy diagnosis and often carry a particularly grim prognosis. Pancreatic, ovarian, and lung cancers fall into this category.  Reasons for a delay in the diagnosis of cancer include:

  • Inadequate access to medical care

  • Lack of noticeable signs or symptoms in the early stages of certain cancers

  • Failure to seek medical attention for signs or symptoms suggesting cancer

  • Delayed diagnosis because of cancer signs or symptoms mimicking another illness

  • Absence of effective screening tests for certain cancers

  • Cancers “hidden” in organs that are not easily examined
When the diagnosis is delayed, the likelihood of the cancer progressing to a more serious stage or spreading to other areas of the body increases. This typically results in poorer treatment outcomes and higher cancer-related mortality. Pancreatic cancer is a classic example of this. Fewer than 20% of patients with pancreatic cancer are diagnosed while the tumor is confined to the pancreas.  In cases in which the cancer has spread away from the pancreas at the time of diagnosis, only 1 patient in 100 remains living 5 years later.

What can be done to improve early detection?  All of the cancers mentioned above can be diagnosed through physical exams and medical tests such as CT scans, MRIs, blood tests and ultrasounds. The specific diagnostic tests will vary depending on the type of cancer.

In regard to ovarian cancer, two tests, the transvaginal ultrasound and a blood test called CA-125, have been used to detect ovarian cancer. Currently, however, they are not recommended as a screening test for women in the general population since they have not been shown to reduce mortality. Women are encouraged to report symptoms associated with ovarian cancer to their doctor for further evaluation. These symptoms include abdominal swelling or bloating (due to a mass or a buildup of fluid), pelvic pressure or abdominal pain, difficulty eating or feeling full quickly, and/or urinary symptoms (having to go urgently or often).

Approximately 85% of lung cancer develops in former or current smokers. Screening for lung cancer is also not recommended for the general population. In high risk individuals (adults aged 55 to 80 years who have a significant smoking history and currently smoke or have quit within the past 15 years), however, the US Preventive Services Task Force recommends annual screening for lung cancer with low-dose computed tomography (CT scan).

Pancreatic cancer remains one of the most deadly forms of cancer with very little improvement in mortality rate over the past several decades. There are two cancer “markers” that can be detected with blood tests (CA19-9 and CEA). These tests, however, are not consistently positive even when pancreatic cancer is present and are not recommended as a screening test. Typically only vague symptoms that could be associated with several different gastrointestinal conditions are present when pancreatic cancer is suspected. These include pain (usually abdominal or back pain), weight loss, jaundice (yellowing of the skin and eyes), loss of appetite, nausea, and changes in stool.

With most of these difficult-to-diagnose cancers it appears that the best way toward early diagnosis is to be aware of changes in your body and discuss any troubling signs or symptoms with your doctor. More often than not, these new complaints will have nothing to do with cancer and can be treated or will resolve on their own. When persistent symptoms suggest cancer, however, making the diagnosis as early into its course as possible can lead to a much improved outcome.

If you have any questions about cancer diagnosis, please log into your account and send us your question. We are here to help.

Thursday, January 15, 2015

Influenza treatment recommendations - 2015 Flu season

This year, one strain of influenza A (H3N2) virus is being reported as the most common cause for the flu. This strain of virus has been particularly serious in the past, causing more hospitalizations and deaths than many other strains of the flu virus.  Even though a H3N2 virus was used in the production of this year’s flu vaccine, the strain that is causing most of the infections is somewhat different than the type used in making the vaccine so it is not providing complete protection.

For most healthy individuals, the flu is an uncomfortable, but temporary illness.  For certain groups of people including the elderly, chronically ill, and infants, the flu can be life threatening.  With the knowledge that this year’s flu vaccine is not providing complete protection, this week, the Centers for Disease Control (CDC) released recommendations for the treatment of influenza. These recommendations apply primarily to the categories of people in whom influenza represents the most serious threat and pertains primarily to the use of anti-viral (neuraminidase inhibitor) medications.
  

 In this year’s flu outbreaks, the CDC recommends that individuals who should receive anti-viral medication are:
  1. Any patient with flu who requires hospitalization
     
  2. Any patient with severe or complicated flu, including those who remain as outpatients but may have a complication such as pneumonia.
     
  3. Anyone who is at higher risk for flu complications including:
    • Children younger than 2 years (although all children younger than 5 years are considered at higher risk for complications from influenza, the highest risk is for those younger than 2 years);
    • Adults aged 65 years and older;
    • Persons with chronic illnesses. This includes chronic lung diseases (asthma, emphysema), heart or vascular disease (except hypertension alone), chronic kidney disease, chronic liver disease (e.g. chronic hepatitis), blood disorders (e.g. sickle cell disease, leukemia, etc.)  and metabolic disorders (including diabetes mellitus). Others include those with neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury);
    • Persons whose immune system is compromised, including that caused by medications (e.g. corticosteroids) or by HIV infection;
    • Women who are pregnant or have recently delivered (within 2 weeks after delivery);
    • Persons aged younger than 19 years who are receiving long-term aspirin therapy;
    • American Indians/Alaska Natives;
    • Persons who are morbidly obese (i.e., body-mass index is equal to or greater than 40); and
    • Residents of nursing homes and other chronic-care facilities.
Three anti-viral medications have been approved by the U.S. Food and Drug Administration (FDA) for treating influenza during this season. These are: oseltamivir (Tamiflu®), zanamivir (Relenza®), and peramivir (Rapivab®).  Oseltamivir is an oral medication that has been approved for treatment of the flu in individuals aged 2 weeks and older.  Zanamivir is an inhaled medication approved for treatment of the flu in persons 7 years of age and older.  Peramivir is given intravenously and used in persons aged 18 years and older. Anti-viral treatment is most beneficial when administered early in the illness, ideally within 48 hours of the onset of symptoms. The CDC advises that treatment in those groups that are at highest risk should begin even before laboratory confirmation of the infection is made.

In spite of being somewhat off the mark in regard to protection against the H3N2 strain of influenza A this year, the current vaccine does provide protection against other strains of the flu virus in this year’s outbreak. In those not yet immunized, there is still time to receive this protection.  Recognizing the seriousness of the predominant flu strain this season, those who are at high-risk for complications should additionally seek treatment with an anti-viral medication if the flu is suspected.

If you have any questions about influenza treatment recommendations for this year, please log into your account and send us your question. We are here to help.

Friday, January 9, 2015

Staying Active This Winter

Wintertime does not have to bring your exercise routine to a grinding halt.  Getting outside to exercise gives you a chance to breath fresh air and helps burn those excess calories consumed during the holidays. Working out in cold or inclement conditions, however, does require attention to issues that don’t come into play during warmer seasons. Here are some tips to address some of those concerns so that you can exercise safely and enjoyably.
  1. Dress the Part.  An old Norwegian saying sums it up: “there is no such thing as bad weather, just bad clothing”.  Wintertime can be a wonderful time to get outside, but not if your clothing is not up to the task. Instead of wearing a single heavy garment, dressing in layers of clothing will provide more warmth and protection from the elements. Layering also allows you to control your temperature more effectively. Should you become overheated or begin to sweat during activity or exercise, you can remove or open up a layer to ventilate. As you cool down, zip up or add a layer.   A base layer made from a synthetic fabric, such as Capilene or Coolmax, should be worn next to the body. It keeps the skin dry by “wicking” moisture away.   Next, an insulating layer of wool or synthetic fleece traps air to keep you warm.  When conditions dictate, an outer shell layer that is both windproof and waterproof can be worn.  Ideally, this garment also “breathes” to allow moisture to escape from the body.  Gore-Tex is the trade name for one of the most popular fabrics with these characteristics.  Wear a hat and gloves or mittens with the thermometer plunges. Consider buying exercise shoes a half-size or one size larger than usual to allow for thick thermal socks or an extra pair of regular socks.
     
  2. Warm up first.  It easier to go out into the cold if you warm up inside first. Try jogging in place or doing jumping jacks for 5 to 10 minutes prior to going outside. Stop your warmup before you start sweating in order to avoid evaporative heat loss once outside.
     
  3. Don’t push it.  Inclement weather conditions can make exercising outside risky.  If there is ice or snow on the ground don’t worry about how fast or far that you are going.  Walking can be made safer from a traction standpoint if using a more heavily lugged trail running shoe or a product designed for traction on ice or snow such as Yaktrax.
       
  4. Be noticed.  The shorter days of winter means that you may be working out in the dark.  Find well-lit locations to work out, preferably away from traffic.  A lighted track at a nearby school is ideal.  By wearing brighter, reflective clothing, motorists will be able to see you better. Carry a flashlight or a headlamp so that you can see where you’re going.  Leave the ear buds and your favorite music at home. Losing your ability to hear clearly as well having your sight restricted by the dark increases your vulnerability.
     
  5. Find a Friend.   Making a commitment to work out with a friend can help to keep you from finding excuses to not exercise as well as making the workout more of a social experience.  In particularly bad weather conditions having a friend to “share the misery” can make the experience seem less onerous and can provide a margin for safety. Ironically, sometimes the most challenging experiences can end up being the most memorable.
     
  6. Go indoors.  In certain weather conditions, it’s better to work out indoors rather than risking injury, hypothermia, or frost bite.  Most gyms offer a variety of exercise equipment that will cross over to outdoor activities. Walkers or runners should feel at home on a treadmill.  Cyclists can spin on a stationary bike.  Going to the gym also offers the opportunity to lift weights or participate in an exercise class.  If you stay at home, exercising to a workout DVD or home exercise equipment can substitute for an outdoor work out.  Another option is to walk in an indoor mall or shopping center.  Just make sure to avoid the candy store!
For most people, winter is not the best time to try to achieve new levels of fitness or to prepare for a major athletic event. By the same token, winter should not be seen as the time to rest on one’s laurels until the days get longer and warmer.  Extra attention may need to be paid to clothing, weather conditions, and the mode of exercise but the benefits of staying active will far exceed any inconvenience. As the Nike ad says, “Just Do It”.

If you have any questions about staying active this winter, please log into your account and send us your question. We are here to help.