Monday, 31 October 2016

Can Ovarian Cancer Be Prevented?

ref: American Cancer Society
Most women have one or more risk factors for ovarian cancer. But most of the common factors only slightly increase your risk, so they only partly explain the frequency of the disease. So far, what is known about risk factors has not translated into practical ways to prevent most cases of ovarian cancer.
There are several ways you can reduce your risk of developing epithelial ovarian cancer. Much less is known about ways to lower the risk of developing germ cell and stromal tumours of the ovaries. The remainder of this section refers to epithelial ovarian cancer only. It is important to realize that some of these strategies reduce the risk only slightly, while others decrease it much more. Some strategies are easily followed, and others require surgery. If you are concerned about your risk of ovarian cancer, you may want to discuss this information with your health care professionals. They can help you consider these ideas as they apply to your own situation.
Oral contraceptives
Using oral contraceptives (birth control pills) decreases the risk of developing ovarian cancer, especially among women who use them for several years. Women who used oral contraceptives for 5 or more years have about a 50% lower risk of developing ovarian cancer compared with women who never used oral contraceptives. Still, birth control pills do have some serious risks and side effects. Women considering taking these drugs for any reason should first discuss the possible risks and benefits with their doctor.
Gynaecologic surgery

Both tubal ligation and hysterectomy may reduce the chance of developing ovarian cancer, but experts agree that these operations should only be done for valid medical reasons -- not for their effect on ovarian cancer risk.

If you are going to have a hysterectomy for a valid medical reason and you have a strong family history of ovarian or breast cancer, you may want to consider having both ovaries and fallopian tubes removed (called a bilateral salpingo-oophorectomy) as part of that procedure.

Even if you don’t have an increased risk of ovarian cancer, some doctors recommend that the ovaries be removed with the uterus if a woman has already gone through menopause or is close to menopause. If you are older than 40 and you are going to have a hysterectomy, you should discuss the potential risks and benefits of having your ovaries removed with your doctor.

Prevention strategies for women with a family history of ovarian cancer or BRCA mutation
If your family history suggests that you (or a close relative) might have a syndrome linked with a high risk of ovarian cancer, you might want to consider genetic counseling and testing. During genetic counseling (by a genetic counselor or other health care professional with training in genetic risk evaluation), your personal medical and family history is reviewed. This can help predict whether you are likely to have one of the gene mutations associated with an increased ovarian cancer risk.
The counselor will also discuss the benefits and potential drawbacks of genetic testing with you. Genetic testing can help determine if you or members of your family carry certain gene mutations that cause a high risk of ovarian cancer. Still, the results are not always clear cut, and a genetic counselor can help you sort out what the results mean to you.
For some women with a strong family history of ovarian cancer, knowing they do not have a mutation that increases their ovarian cancer risk can be a great relief for them and their children. Knowing that you do have such a mutation can be stressful, but many women find this information very helpful in making important decisions about certain prevention strategies for them and their children.
Using oral contraceptives is one way that many women can reduce their risk of developing ovarian cancer. Oral contraceptives also seem to reduce this risk for women with BRCA1 and BRCA2 mutations. But birth control pills can increase breast cancer risk in women without these mutations. This increased risk continues for some time after these pills are stopped. Studies that have looked at this issue in women with BRCA mutations haven’t agreed about what effect birth control pills have on breast cancer risk. Some studies have shown an increased risk of breast cancer, while some have not. Research is continuing to find out more about the risks and benefits of oral contraceptives for women at high ovarian and breast cancer risk.
It isn’t clear if tubal ligation effectively reduces the risk of ovarian cancer in women who have BRCA1 or BRCA2 mutations. Studies that have looked at this issue haven’t agreed about this. Researchers do agree that removing both ovaries and fallopian tubes (salpingo-oophorectomy) helps protect women with BRCA1 or BRCA2 mutations against ovarian (and fallopian tube) cancer.
Sometimes a woman has this surgery to reduce her risk of ovarian cancer before cancer is even suspected. If the ovaries are removed to prevent ovarian cancer, the surgery is called risk-reducing or prophylactic. Generally, salpingo-oophorectomy is recommended only for very high-risk women after they have finished having children. This operation lowers ovarian cancer risk a great deal but does not entirely eliminate it. That’s because some women who have a high risk of ovarian cancer already have a cancer at the time of surgery. These cancers can be so small that they are only found when the ovaries and fallopian tubes are looked at under the microscope (after they are removed). Also, women with BRCA1 or BRCA2 gene mutations have an increased risk of primary peritoneal carcinoma. Although the risk is low, this cancer can still develop after the ovaries and fallopian tubes are removed.
The risk of fallopian tube cancer is also increased in women with mutations in BRCA1 or BRCA2. Sometimes early fallopian tube cancers are found unexpectedly when the fallopian tubes are removed as a part of a risk-reducing surgery. In fact, some cancers that were thought to be ovarian or primary peritoneal cancers may have actually started in the fallopian tubes. That is why experts recommend that women at high risk of ovarian cancer who are having their ovaries removed should have their fallopian tubes completely removed as well (salpingo-oophorectomy).
Research has shown that premenopausal women who have BRCA gene mutations and have had their ovaries removed reduce their risk of breast cancer as well as their risk of ovarian cancer. The risk of ovarian cancer is reduced by 85% to 95%, and the risk of breast cancer cut by 50% or more.
Another option for women who do not wish to have their ovaries removed because they don’t want to lose ovarian function (and go through menopause early) is to have just the fallopian tubes removed (a salpingectomy). They may choose to have their ovaries removed later. This has not been studied as well as removing both the ovaries and fallopian tubes at the same time, so it isn’t clear how much this affects the risk of cancer. It is clear that to have the greatest effect on breast cancer risk, the ovaries need to be removed by the time the woman is 35.
Some women who have a high risk of ovarian cancer due to BRCA gene mutations feel that having their ovaries and fallopian tubes removed is not right for them. Often doctors recommend that those women have screening tests to try to find ovarian cancer early. These tests are discussed in the next section.

Monday, 24 October 2016

Genital HPV Infection – What should you know?

What is HPV? Should I get the HPV vaccine?
HPV is the most common sexually transmitted infection (STI). HPV is a different virus than HIV and HSV (herpes). HPV is so common that nearly all sexually active men and women get it at some point in their lives. There are many different types of HPV. Some types can cause health problems including genital warts and cancers. But there are vaccines that can stop these health problems from happening.
How is HPV spread?
You can get HPV by having vaginal, anal, or oral sex with someone who has the virus. It is most commonly spread during vaginal or anal sex. HPV can be passed even when an infected person has no signs or symptoms.
Anyone who is sexually active can get HPV, even if you have had sex with only one person. You also can develop symptoms years after you have sex with someone who is infected making it hard to know when you first became infected.
Does HPV cause health problems?
In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer.
Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area.
Does HPV cause cancer?
HPV can cause cervical and other cancers cancers including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer).
Cancer often takes years, even decades, to develop after a person gets HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers.
There is no way to know which people who have HPV will develop cancer or other health problems. People with weak immune systems (including individuals with HIV/AIDS) may be less able to fight off HPV and more likely to develop health problems from it.
How can I avoid HPV and the health problems it can cause?
You can do several things to lower your chances of getting HPV.
Get vaccinated.
HPV vaccines are safe and effective. They can protect males and females against diseases (including cancers) caused by HPV when given in the recommended age groups (see “Who should get vaccinated?” below). HPV vaccines are given in three shots over six months; it is important to get all three doses.
Get screened for cervical cancer.
Routine screening for women aged 21 to 65 years old can prevent cervical cancer.
If you are sexually active
Use latex condoms the right way every time you have sex. This can lower your chances of getting HPV. But HPV can infect areas that are not covered by a condom - so condoms may not give full protection against getting HPV;
•Be in a mutually monogamous relationship – or have sex only with someone who only has sex with you.
Who should get vaccinated?
All boys and girls ages 11 or 12 years should get vaccinated.
Catch-up vaccines are recommended for males through age 21 and for females through age 26, if they did not get vaccinated when they were younger.
The vaccine is also recommended for gay and bisexual men (or any man who has sex with a man) through age 26. It is also recommended for men and women with compromised immune systems (including people living with HIV/AIDS) through age 26, if they did not get fully vaccinated when they were younger.
How do I know if I have HPV?
There is no test to find out a person’s “HPV status.” Also, there is no approved HPV test to find HPV in the mouth or throat.
There are HPV tests that can be used to screen for cervical cancer. These tests are recommended for screening only in women aged 30 years and older. They are not recommended to screen men, adolescents, or women under the age of 30 years.
Most people with HPV do not know they are infected and never develop symptoms or health problems from it. Some people find out they have HPV when they get genital warts. Women may find out they have HPV when they get an abnormal Pap test result (during cervical cancer screening). Others may only find out once they’ve developed more serious problems from HPV, such as cancers.
How common is HPV and the health problems caused by HPV?
HPV (the virus): About 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that most sexually-active men and women will get at least one type of HPV at some point in their lives.
Health problems related to HPV include genital warts and cervical cancer.
Genital warts: Before HPV vaccines were introduced, roughly 340,000 to 360,000 women and men were affected by genital warts caused by HPV every year.* Also, about one in 100 sexually active adults in the U.S. have genital warts at any given time.

Cervical cancer: More than 11,000 women in the United States get cervical cancer each year.
There are other conditions and cancers caused by HPV that occur in persons living in the United States. Every year approximately 17,600 women and 9,300 men are affected by cancers caused by HPV.
*As these figures only look at the number of people who sought care for genital warts, this could be an underestimate of the actual number of people who get genital warts.
I'm pregnant. Will having HPV affect my pregnancy?
If you are pregnant and have HPV, you can get genital warts or develop abnormal cell changes on your cervix. Abnormal cell changes can be found with routine cervical cancer screening. You should get routine cervical cancer screening even when you are pregnant.
Can I be treated for HPV or health problems caused by HPV?

There is no treatment for the virus itself. However, there are treatments for the health problems that HPV can cause:
1. Genital warts can be treated by you or your physician. If left untreated, genital warts may go away, stay the same, or grow in size or number.
2. Cervical precancer can be treated. Women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment. For more information visit
3. Other HPV-related cancers are also more treatable when diagnosed and treated early.

Friday, 21 October 2016

HPV (Human Papillomavirus) & HPV Vaccine : What You Need to Know

ref. : CDC, USA.

What is HPV?

Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. More than half of sexually active men and women are infected with HPV at some time in their lives.
About 20 million Americans are currently infected, and about 6 million more get infected each year. HPV is usually spread through sexual contact.
Most HPV infections don’t cause any symptoms, and go away on their own. But HPV can cause cervical cancer in women. Cervical cancer is the 2nd leading cause of cancer deaths among women around the world. In the United States, about 12,000 women get cervical cancer every year and about 4,000 are expected to die from it.
HPV is also associated with several less common cancers, such as vaginal and vulvar cancers in women, and anal and oropharyngeal (back of the throat, including base of tongue and tonsils) cancers in both men and women. HPV can also cause genital warts and warts in the throat.
There is no cure for HPV infection, but some of the problems it causes can be treated.

HPV vaccine: Why get vaccinated?

The HPV vaccine you are getting is one of two vaccines that can be given to prevent HPV. It may be given to both males and females.
This vaccine can prevent most cases of cervical cancer in females, if it is given before exposure to the virus. In addition, it can prevent vaginal and vulvar cancer in females, and genital warts and anal cancer in both males and females.
Protection from HPV vaccine is expected to be long-lasting. But vaccination is not a substitute for cervical cancer screening. Women should still get regular Pap tests.

Who should get this HPV vaccine and when?

HPV vaccine is given as a 3-dose series
•1st Dose - Now
•2nd Dose - 1 to 2 months after Dose 1
•3rd Dose - 6 months after Dose 1
Additional (booster) doses are not recommended
Routine vaccination
• This HPV vaccine is recommended for girls and boys 11 or 12 years of age. It may be given starting at age 9.

Why is HPV vaccine recommended at 11 or 12 years of age?

HPV infection is easily acquired, even with only one sex partner. That is why it is important to get HPV vaccine before any sexual contact takes place. Also, response to the vaccine is better at this age than at older ages.

Catch-up vaccination


This vaccine is recommended for the following people who have not completed the 3-dose series:
•Females 13 through 26 years of age.
•Males 13 through 21 years of age.
This vaccine may be given to men 22 through 26 years of age who have not completed the 3-dose series.
It is recommended for men through age 26 who have sex with men or whose immune system is weakened because of HIV infection, other illness, or medications.
HPV vaccine may be given at the same time as other vaccines.


Some people should not get HPV vaccine or should wait.

•Anyone who has ever had a life-threatening allergic reaction to any component of HPV vaccine, or to a previous dose of HPV vaccine, should not get the vaccine. Tell your doctor if the person getting vaccinated has any severe allergies, including an allergy to yeast.
•HPV vaccine is not recommended for pregnant women. However, receiving HPV vaccine when pregnant is not a reason to consider terminating the pregnancy. Women who are breast feeding may get the vaccine.
•People who are mildly ill when a dose of HPV vaccine is planned can still be vaccinated. People with a moderate or severe illness should wait until they are better.

What are the risks from this vaccine?

This HPV vaccine has been used in the U.S. and around the world for more than six years and has been very safe.
However, any medicine could possibly cause a serious problem, such as a severe allergic reaction. The risk of any vaccine causing a serious injury, or death, is extremely small.
Life-threatening allergic reactions from vaccines are very rare. If they do occur, it would be within a few minutes to a few hours after the vaccination.

Several mild to moderate problems are known to occur with this HPV vaccine.

These do not last long and go away on their own.
Ø  Reactions in the arm where the shot was given:
Ø  Pain (about 8 people in 10)
Ø  Redness or swelling (about 1 person in 4)
Ø  Fever: ◦Mild (100° F) (about 1 person in 10)
Ø  Moderate (102° F) (about 1 person in 65)
Ø  Headache (about 1 person in 3)
Ø  Fainting: Brief fainting spells and related symptoms (such as jerking movements) can happen after any medical procedure, including vaccination. Sitting or lying down for about 15 minutes after a vaccination can help prevent fainting and injuries caused by falls. Tell your doctor if the patient feels dizzy or light-headed, or has vision changes or ringing in the ears.
Like all vaccines, HPV vaccines will continue to be monitored for unusual or severe problems.

What if there is a serious reaction?

What should I look for?
•Look for anything that concerns you, such as signs of a severe allergic reaction, very high fever, or behaviour changes.
Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination.
What should I do?
•If you think it is a severe allergic reaction or other emergency that can’t wait, call 999 or get the person to the nearest hospital. Otherwise, call your doctor.
•Afterward, the reaction should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your doctor might file this report.




Monday, 17 October 2016

Coping With Cancer

REF.:  The American Society of Clinical Oncology (ASCO)
Coping With Uncertainty
Many people with cancer may feel a lack of certainty about what the future holds. After a cancer diagnosis, you may feel that your life is less secure than it once was. It is important to ask for support when you are feeling this way. There are many resources to help you.
Causes of uncertainty
Both newly diagnosed patients and long-term survivors have common worries, which are listed below.
  • Having to put plans on hold. You may feel like you are unable to look to the future. Making plans is difficult for many practical reasons. For instance, it may be hard to plan a family vacation when you may not know exactly when you will have treatment. You may not be able to commit to a lunch date because you cannot predict how you will be feeling. Some people feel unable to make any plans. One approach that works well for many people with cancer is to remain flexible and accept that plans may change.
  • Fear about cancer treatments and their side effects. You may be apprehensive or even scared of the side effects of treatment, such as pain, nausea, or fatigue. Or, you may fear becoming dependent on others during cancer treatment or missing activities that you enjoy. Learn more about coping with the fear of treatment side effects.
Long-term cancer survivors may worry about having late effects. These are side effects of cancer treatment that occur months or years after treatment ends. Talk with your health care team about what you can expect from late effects. There are resources that are available if you need help.
  • The treatment won’t work. No treatment works the same for every patient, even those with the same type of cancer. Some treatments are more effective for some people. Other treatments may work but cause side effects. Understanding what your treatment options are today and in the future may help you know what to expect next.
  • The treatment will stop working. Many times, people continue to receive a cancer drug until it stops working. This is especially true for those with cancer that has spread or those with cancer that is controlled with drugs for a long time. It is scary to think the drug could stop working, even if you know there are other treatments you can take.  
  • The cancer will come back. A cancer recurrence is when the cancer returns after treatment. It is a top fear of many cancer survivors. If you worry about this, you may find yourself paying attention to every new symptom in the body. In turn, this too can increase your general level of anxiety. Learn more about coping with the fear of recurrence.
  • Fear of dying or losing someone you love. Confronting the idea of dying can be difficult. Feeling fear is natural when you face the prospect of dying or losing someone you love. It’s normal to struggle with a fear of death. Yet, if these feelings become severe, talk with your health care team about resources to help you cope.
Dealing with the “what ifs” of cancer
Acknowledging the unknowns of cancer may lead to other feelings, such as anxiety, anger, sadness, or fear. It may even manifest itself as physical sensations. For instance, it may interrupt sleep or decrease your ability to concentrate at work. Learning to manage the uncertainty is an important part of staying healthy. Follow these tips to help you cope:
  • Recognize there are situations you can control and those you can’t. As hard as it sounds, many people find it helpful to let go of those things that they can’t change and focus on their reaction to events.
  • Talk with your health care team if your feelings of uncertainty are affecting your daily life. They can help you find the resources you need to feel better.
  • Talk with a counselor or social worker at the hospital. They may recommend a support group in your area. A group may help you share with others who are going through a similar cancer experience. There are also support communities online.
  • Talk with friends and family members. Tell them how you are feeling and how they can help.
  • Learn as much as you can about cancer and its treatment. Having the right information can help you know what to expect.