The very fact that a person is diagnosed with breast cancer can certainly have
an adverse effect on the mind of that person. But what is more frightening is
when the person learns that it is advance stage of breast cancer. However,
cancer patients can now be given a relief of hope due to the availability of
advanced breast cancer treatments. If the patient is made to realize that there
are treatments available towards those types of cancers then this fact will
bring increase hope of survival to these cancer patient victims and their mental
state of mind will become positive and the treatment will be thus be effective
enough.
It is a known fact that the survival chances towards advanced
breast cancer is much lower than a breast cancer that is detected at stage one.
Mostly, cancer patients who undergo first diagnosis (SEER) are found to have
advance breast cancer which has spread to distant tissue. This type of situation
is common among poverty based people and who have lack of health insurance. A
patient suffering form advance breast cancer (Stage 4 breast cancer) has less
chances of the body to have the ability to fight off the diseases. This is
because by now the disease have spread far away into the body and the natural
defense system is thus weakened breast cancer at stage , the survival rate is
very high, about 98% to 100%. However, a woman who is diagnosed with advance
breast cancer, the survival rate may come down to sixteen to twenty percent
approximately.
These days we have advance breast
cancer treatments which are being used. Also, more new treatments towards
advance breast cancer are being developed. However, one should understand that
stage 4 is the most deadly category of breast cancer. Advance breast cancer has
metastasized to other distant organs of the body which include the bone tissue,
lung tissue and the liver too. The test done to detect is in the form of chest X
Rays, CT and bone scans. Almost all types of breast cancer victims have to
undergo some type of surgery in order to remove the cancerous growth as much as
possible. They also undergo chemotherapy too. This is done in order to kill of
any microscopic scraps of the disease that may have left behind and if it is
left untreated, it can then grow again and will lead to full fledged cancer
again. Thus, advance techniques are also been used towards breast cancer
treatment. The treatment is done in such a way so that it not only eliminates
cancer but also prevents re-occurring of cancer.
There is yet another
type of advance breast cancer and it is called as inflammatory breast cancer.
Initially, there is some redness and warmth like thing in the skin of the cancer
affected breast, often without any lump. The skin turns red because the cancer
lies in the lymph vessels of the skin. Hence, the patient along with the doctor
might consider it as a simple infection and thus may try to treat with
antibiotics. But as time passes, it neither gets better nor worse too. Hence,
the doctor now decides for a biopsy of the underlying tissue to detect if it is
cancer. Even when mastectomy is done, there are chances of recurrence in the
skin. Hence, chemotherapy should be the treatment that should be opted before
any local treatment is administered. Inflammatory breast cancer is a serious
disease. Usually in advance breast cancer, chemotherapy is suggested with three
or four rounds of Adriamcin and Cytoxan. Also, Taxol or Taxotere can be used .
After this, local treatment can be followed in the form of mastectomy.
One of the advance breast cancer treatments is in the form of a drug
called Herceptin (Trastuzumab). This drug has been very effective towards
certain types of advance breast cancers. A patient who has HER2 positive is
suffering from a type of advance cancer, can be treated by Herceptin along with
the chemotherapy drug called paclitaxel. HERZ is defined as human epidermal
growth factor receptor 2. HERZ is located on the surface of cells and it is
responsible for maintaining the growth of the cell in check. When HERZ starts to
malfunction, it will then lead to cancer which starts working in an aggressive
manner. People who are suffering from advance breast cancer and who undergoes
such advance treatments, can hope for survival. However, I would like to advice
people that earlier detection of cancer can help a patient to recover
completely.
Monday 23 April 2012
Thursday 19 April 2012
Breast Cancer - Inflammatory Breast Cancer
Inflammatory breast cancer, or IBC, is a rare form of breast cancer. It is
estimated to occur in only 1 - 3% of all breast cancer patients. It usually
occurs in post-menopausal women, but cases have been found in girls as young as
12 and in men. IBC is usually diagnosed at an earlier age than other forms of
breast cancer and is more common in African American women than in Caucasian
women. This cancer has a higher mortality rate because it is often misdiagnosed
in the early, more treatable stages. However, advances in cancer research have
improved the survival rate.
This cancer grows rapidly; your symptoms will appear in a matter of days or weeks. Women with inflammatory breast cancer often have no idea that they have breast cancer because IBC does not usually form a lump in the breast. Instead, this cancer forms 'sheets' of cancer cells making your breast feel thicker or heavier than usual. Other symptoms of IBC include swelling and tenderness of the breast, discoloration (usually red to purple) of the breast, itching or pain in the breast, dimpled or rough looking skin on the breast, swelling or crusting of the skin on the nipple and flattening or retraction of the nipple. Many of these symptoms mimic those of a breast infection, or mastitis. Mastitis usually causes a fever and usually occurs in younger breast-feeding mothers. Mastitis will respond to antibiotics. IBC, which has been documented in breast-feeding women, does not cause a fever nor respond to antibiotics.
Because the symptoms of IBC are so similar to mastitis and because inflammatory breast cancer is so rare, many doctors misdiagnose this cancer as mastitis. Patients are often prescribed multiple rounds of antibiotics because it doesn't clear up after the first round. If you have these symptoms and your doctor wants you to take more than one round of antibiotics, ask for a biopsy or referral to a breast specialist. You may have to be very aggressive to get the proper diagnosis. This is vital because the earlier this is diagnosed, the sooner you can begin treatment and the better your survival chances.
A proper cancer diagnosis usually results from elimination of mastitis as a culprit, with the symptoms still present and possibly getting worse. Your doctor may schedule you for a mammogram or a breast sonogram to confirm the diagnosis, but these are not very reliable with this cancer because the affected area may not show up. A biopsy is the most effective way to confirm diagnosis of this cancer, however it may still be wrong if your doctor biopsies the wrong area of your breast. Because this cancer does grow very rapidly, your doctor may also schedule other tests to determine if your cancer has spread to other organs in your body. This will affect your course of treatment.
Your treatment depends largely upon whether your cancer has spread to other organs of your body. You will most likely have a team of doctors talking with you, trying to determine the best course of treatment for you. You will receive aggressive treatment because inflammatory breast cancer is a late stage cancer. This means you will most likely receive chemotherapy, surgery and radiation therapy. You will most likely receive chemotherapy first because this cancer makes performing surgery first risky due to the skin changes it causes. Chemotherapy also works to shrink the size of the cancer, making it more likely that surgery will remove all of it. The surgery that most women choose with this cancer is a mastectomy, or complete removal of the affected breast. This is because the cancer is often widespread throughout the breast, making a surgery that preserves breast tissue highly unlikely.
During surgery, your surgeon will probably remove the lymph nodes under your arm to examine them for cancer. After surgery, you will most likely receive radiation therapy. Radiation therapy is used to kill any cancer cells that the surgeon may have missed and to help prevent the cancer from returning. Inflammatory breast cancer has a high incidence of recurrence, so your doctor may prescribe additional rounds of chemotherapy if you responded well to the previous rounds or hormone therapy if your cancer was the type that grew in the presence of estrogen.
This cancer grows rapidly; your symptoms will appear in a matter of days or weeks. Women with inflammatory breast cancer often have no idea that they have breast cancer because IBC does not usually form a lump in the breast. Instead, this cancer forms 'sheets' of cancer cells making your breast feel thicker or heavier than usual. Other symptoms of IBC include swelling and tenderness of the breast, discoloration (usually red to purple) of the breast, itching or pain in the breast, dimpled or rough looking skin on the breast, swelling or crusting of the skin on the nipple and flattening or retraction of the nipple. Many of these symptoms mimic those of a breast infection, or mastitis. Mastitis usually causes a fever and usually occurs in younger breast-feeding mothers. Mastitis will respond to antibiotics. IBC, which has been documented in breast-feeding women, does not cause a fever nor respond to antibiotics.
Because the symptoms of IBC are so similar to mastitis and because inflammatory breast cancer is so rare, many doctors misdiagnose this cancer as mastitis. Patients are often prescribed multiple rounds of antibiotics because it doesn't clear up after the first round. If you have these symptoms and your doctor wants you to take more than one round of antibiotics, ask for a biopsy or referral to a breast specialist. You may have to be very aggressive to get the proper diagnosis. This is vital because the earlier this is diagnosed, the sooner you can begin treatment and the better your survival chances.
A proper cancer diagnosis usually results from elimination of mastitis as a culprit, with the symptoms still present and possibly getting worse. Your doctor may schedule you for a mammogram or a breast sonogram to confirm the diagnosis, but these are not very reliable with this cancer because the affected area may not show up. A biopsy is the most effective way to confirm diagnosis of this cancer, however it may still be wrong if your doctor biopsies the wrong area of your breast. Because this cancer does grow very rapidly, your doctor may also schedule other tests to determine if your cancer has spread to other organs in your body. This will affect your course of treatment.
Your treatment depends largely upon whether your cancer has spread to other organs of your body. You will most likely have a team of doctors talking with you, trying to determine the best course of treatment for you. You will receive aggressive treatment because inflammatory breast cancer is a late stage cancer. This means you will most likely receive chemotherapy, surgery and radiation therapy. You will most likely receive chemotherapy first because this cancer makes performing surgery first risky due to the skin changes it causes. Chemotherapy also works to shrink the size of the cancer, making it more likely that surgery will remove all of it. The surgery that most women choose with this cancer is a mastectomy, or complete removal of the affected breast. This is because the cancer is often widespread throughout the breast, making a surgery that preserves breast tissue highly unlikely.
During surgery, your surgeon will probably remove the lymph nodes under your arm to examine them for cancer. After surgery, you will most likely receive radiation therapy. Radiation therapy is used to kill any cancer cells that the surgeon may have missed and to help prevent the cancer from returning. Inflammatory breast cancer has a high incidence of recurrence, so your doctor may prescribe additional rounds of chemotherapy if you responded well to the previous rounds or hormone therapy if your cancer was the type that grew in the presence of estrogen.
Friday 13 April 2012
Breast Cancer Facts
The breast cancer signs and symptoms can be widely different for every woman.
Some experience lumps, some experience skin changes that appear quite drastic
and other women get no definite signs of breast cancer.
Some women experience similar signs and symptoms of breast cancer when it may just be a simple infection or maybe a cyst. All women of all ages – from teens upwards – should check their breasts for unusual lumps and bumps. If you think you find a lump or your breasts feel and look different, it is best to get an appointment with a doctor as soon as possible.
The prognosis of a diagnosis for breast cancer can sometimes take many weeks and can include many different types of testing to undergo. This can be extremely frustrating and quite an upsetting time in any woman’s life. The up side of it is that once the prognosis has been made, you can start looking at the bigger picture. You can sit down with your doctors and formulate some kind of plan for treatment which will be specifically tailored just for you.
There are a few myths surrounding breast cancer and the breast cancer facts. Let’s look at some of the myths that you may or may not have heard before.
Some people believe that breast cancer only becomes a risk when you are older. This in some ways is true. However, younger women do get breast cancer as well.
Some people also believe that if breast cancer doesn’t run in the family they won’t actually get breast cancer. This isn’t true at all. It is thought that nearly 80 percent of women who have had breast cancer have no family history of the disease.
It was reported years ago that antiperspirants can put women at risk of developing breast cancer. This is unfounded and has never been proved that a link between using antiperspirants and breast cancer even exists. It has also been reported that using birth control pills can contribute to a woman’s risk of developing breast cancer. There are many studies done over time that show no founded link between the two. One of the studies combined all the information received from all of the other studies and found a very slight increase. This increase was over time, but was not significant enough actually prove the link.
There has also been a lot of press about the association of high fat foods and the risk of breast cancer. While eating high fat foods isn’t good for health, there is no definitive research that the link between eating fatty foods and breast cancer actually exists. This could be a misinterpretation of the link between obesity and breast cancer which does actually exist and has been proven many times. If you make a lifestyle choice and eat lots of high fat foods, you will eventually become overweight and possibly obese. This will then in turn, increase your risk of developing breast cancer at a later date.
Some women experience similar signs and symptoms of breast cancer when it may just be a simple infection or maybe a cyst. All women of all ages – from teens upwards – should check their breasts for unusual lumps and bumps. If you think you find a lump or your breasts feel and look different, it is best to get an appointment with a doctor as soon as possible.
The prognosis of a diagnosis for breast cancer can sometimes take many weeks and can include many different types of testing to undergo. This can be extremely frustrating and quite an upsetting time in any woman’s life. The up side of it is that once the prognosis has been made, you can start looking at the bigger picture. You can sit down with your doctors and formulate some kind of plan for treatment which will be specifically tailored just for you.
There are a few myths surrounding breast cancer and the breast cancer facts. Let’s look at some of the myths that you may or may not have heard before.
Some people believe that breast cancer only becomes a risk when you are older. This in some ways is true. However, younger women do get breast cancer as well.
Some people also believe that if breast cancer doesn’t run in the family they won’t actually get breast cancer. This isn’t true at all. It is thought that nearly 80 percent of women who have had breast cancer have no family history of the disease.
It was reported years ago that antiperspirants can put women at risk of developing breast cancer. This is unfounded and has never been proved that a link between using antiperspirants and breast cancer even exists. It has also been reported that using birth control pills can contribute to a woman’s risk of developing breast cancer. There are many studies done over time that show no founded link between the two. One of the studies combined all the information received from all of the other studies and found a very slight increase. This increase was over time, but was not significant enough actually prove the link.
There has also been a lot of press about the association of high fat foods and the risk of breast cancer. While eating high fat foods isn’t good for health, there is no definitive research that the link between eating fatty foods and breast cancer actually exists. This could be a misinterpretation of the link between obesity and breast cancer which does actually exist and has been proven many times. If you make a lifestyle choice and eat lots of high fat foods, you will eventually become overweight and possibly obese. This will then in turn, increase your risk of developing breast cancer at a later date.
The www.a1breastcancertips.com/ could help you to educate
pertaining to breast cancer, from the symptoms, statistics and facts on how to
treat and prevent Breast Cancer.
Wednesday 11 April 2012
Can Caffeinated Beverages Reduce Your Breast Cancer Risk?
Women today are more concerned than ever about preventing breast
cancer. There is much speculation about how our lifestyle and habits affect our
chances of contracting this and other cancers. Well, there are many risk
factors that can make you more prone to breast cancer, but there are also
things you can do to prevent breast cancer.
First, it’s important to have a healthy diet. Avoiding processed foods and eating a diet that is low in saturated fats and high in fruits, vegetables and fish. These foods can keep your weight in check and protect your health by providing vitamins and fiber.
In addition to these foods being healthy and fiber rich, they also provide significant ant-oxidants. Anti-oxidants are extremely important to slowing down the aging process and preventing disease.
Each day as our body converts food to energy, it creates oxygen carrying molecules called free radicals. If free radicals are not eliminated from the body, they damage our cells and our DNA. This cell damage is partially responsible for a multitude of diseases, including cancer.
Anti-oxidants are important because they rid the body of free radicals. Since free radicals are created daily, they should be eliminated daily, too. But, because our diets have become so laden with processed food, many of us don’t consume enough anti-oxidants each day.
So, protecting our health means we have to make changes in our lifestyle. Watching what we eat and drink can put us in the best position to combat aging as it creeps up on us.
While you’re taking stock of what’s in your pantry, don’t forget to include looking at what you drink. You need a good dose of anti-oxidants each day, and many of us just don’t consume enough fruits and vegetables to get our daily requirement.
Well, it turns out that drinking tea and coffee can be a great way to increase your anti-oxidants and improve your health- particularly your resistance to breast cancer. There have been many studies that have reported the benefits of green tea, but one recent study suggested that there may be benefits to drinking black tea and coffee, too.
The study I’m referring to was conducted at the Gifu School of Medicine in Japan. The study was conducted on pre-menopausal women. This study looked at the hormone level of 50 Japanese women during different days of their menstrual cycle. They found that in women who consumed tea, coffee and even caffeinated cola had a higher level of the sex hormone binding globulin on critical days of their cycle than the women who did not consume these beverages.
Why Is This Important?
The level of binding globulin is important because low levels of this hormone in pre-menopausal women have been associated with a higher risk of developing breast cancer. So, it appears that drinking your daily intake of caffeine may help your body produce a higher level of binding globulin and help protect you from breast cancer.
Which of These Beverages Should I Drink?
In this particular study, researchers found no difference in the binding globulin level between those who drank coffee, tea or even cola. It seemed to be the consumption of caffeinated beverages of any kind that caused the level of binding globulin to rise.
However, many other studies have shown that in addition to having caffeine, green tea has many other health protecting qualities, as well. Remember how important we just said that anti-oxidants are to our diet?
Well, it just so happens that green tea has an extraordinary level of very potent anti-oxidants. Black tea and coffee have anti-oxidants, too; but nothing to compare to the level and potency you’ll find in green tea. (Cola, by the way, does not contain anti-oxidants.)
Though green and black tea both come from the camellia sinensis plant, green tea is healthier because of the way it’s processed. Black tea is fermented, which changes the structure of the anti-oxidants, making them less effective and potent. Green tea is not fermented (nor is white), so it retains anti-oxidants in their most natural and potent state.
And, for those of you who might be sensitive to caffeine; you’ll be happy to know that green tea has less caffeine than coffee or black tea. But, clearly it has enough caffeine to increase your level of binding globulin sufficiently. Remember, the study cited above showed no difference between green tea drinkers and other caffeinated beverage drinkers in terms of the level of binding globulin.
Making Changes You Can Continue
So, if you’re interested in reducing your breast cancer risk, you need to make some changes to your lifestyle to help protect your health. Watch your diet; be sure you’re getting the recommended amount of fresh fruits and vegetables each day.
You should also be sure to add some sort of caffeinated beverage to your diet, if you’re not already drinking some. And, to boost both your anti-oxidants and get your caffeine at the same time, make that beverage green tea.
Make lifestyle changes that you can commit to- otherwise you’ll be unlikely to keep up with them. It might not be realistic for you to say that you’re going to immediately increase your intake of vegetables from none each day to five servings. But, if you can consistently eat two servings each day, then you’ve still made an improvement. And, perhaps later you can work up to five servings.
Small changes over time are the best way to ensure that you’ll continue your new healthy habits. Reduce your number of processed foods and increase your intake of fruits, vegetables and green tea slowly over time. This way, you won’t feel overwhelmed and be tempted to quit.
Smoking can also increase your risk for cancer. We all know that smoking makes us likely candidates for lung cancer, but what many people don’t know is that smoking increases your overall risk for cancer. Smoke is toxic to your body, and can increase your risk of any cancer, including breast cancer.
Breast cancer is the second most common cancer among women in the US. This year, over 200,000 women will be diagnosed with breast cancer, and over 40,000 will die from it.** It pays to understand how to protect your health and reduce your risk of contracting this disease.
**Statistics from American Cancer Society
First, it’s important to have a healthy diet. Avoiding processed foods and eating a diet that is low in saturated fats and high in fruits, vegetables and fish. These foods can keep your weight in check and protect your health by providing vitamins and fiber.
In addition to these foods being healthy and fiber rich, they also provide significant ant-oxidants. Anti-oxidants are extremely important to slowing down the aging process and preventing disease.
Each day as our body converts food to energy, it creates oxygen carrying molecules called free radicals. If free radicals are not eliminated from the body, they damage our cells and our DNA. This cell damage is partially responsible for a multitude of diseases, including cancer.
Anti-oxidants are important because they rid the body of free radicals. Since free radicals are created daily, they should be eliminated daily, too. But, because our diets have become so laden with processed food, many of us don’t consume enough anti-oxidants each day.
So, protecting our health means we have to make changes in our lifestyle. Watching what we eat and drink can put us in the best position to combat aging as it creeps up on us.
While you’re taking stock of what’s in your pantry, don’t forget to include looking at what you drink. You need a good dose of anti-oxidants each day, and many of us just don’t consume enough fruits and vegetables to get our daily requirement.
Well, it turns out that drinking tea and coffee can be a great way to increase your anti-oxidants and improve your health- particularly your resistance to breast cancer. There have been many studies that have reported the benefits of green tea, but one recent study suggested that there may be benefits to drinking black tea and coffee, too.
The study I’m referring to was conducted at the Gifu School of Medicine in Japan. The study was conducted on pre-menopausal women. This study looked at the hormone level of 50 Japanese women during different days of their menstrual cycle. They found that in women who consumed tea, coffee and even caffeinated cola had a higher level of the sex hormone binding globulin on critical days of their cycle than the women who did not consume these beverages.
Why Is This Important?
The level of binding globulin is important because low levels of this hormone in pre-menopausal women have been associated with a higher risk of developing breast cancer. So, it appears that drinking your daily intake of caffeine may help your body produce a higher level of binding globulin and help protect you from breast cancer.
Which of These Beverages Should I Drink?
In this particular study, researchers found no difference in the binding globulin level between those who drank coffee, tea or even cola. It seemed to be the consumption of caffeinated beverages of any kind that caused the level of binding globulin to rise.
However, many other studies have shown that in addition to having caffeine, green tea has many other health protecting qualities, as well. Remember how important we just said that anti-oxidants are to our diet?
Well, it just so happens that green tea has an extraordinary level of very potent anti-oxidants. Black tea and coffee have anti-oxidants, too; but nothing to compare to the level and potency you’ll find in green tea. (Cola, by the way, does not contain anti-oxidants.)
Though green and black tea both come from the camellia sinensis plant, green tea is healthier because of the way it’s processed. Black tea is fermented, which changes the structure of the anti-oxidants, making them less effective and potent. Green tea is not fermented (nor is white), so it retains anti-oxidants in their most natural and potent state.
And, for those of you who might be sensitive to caffeine; you’ll be happy to know that green tea has less caffeine than coffee or black tea. But, clearly it has enough caffeine to increase your level of binding globulin sufficiently. Remember, the study cited above showed no difference between green tea drinkers and other caffeinated beverage drinkers in terms of the level of binding globulin.
Making Changes You Can Continue
So, if you’re interested in reducing your breast cancer risk, you need to make some changes to your lifestyle to help protect your health. Watch your diet; be sure you’re getting the recommended amount of fresh fruits and vegetables each day.
You should also be sure to add some sort of caffeinated beverage to your diet, if you’re not already drinking some. And, to boost both your anti-oxidants and get your caffeine at the same time, make that beverage green tea.
Make lifestyle changes that you can commit to- otherwise you’ll be unlikely to keep up with them. It might not be realistic for you to say that you’re going to immediately increase your intake of vegetables from none each day to five servings. But, if you can consistently eat two servings each day, then you’ve still made an improvement. And, perhaps later you can work up to five servings.
Small changes over time are the best way to ensure that you’ll continue your new healthy habits. Reduce your number of processed foods and increase your intake of fruits, vegetables and green tea slowly over time. This way, you won’t feel overwhelmed and be tempted to quit.
Smoking can also increase your risk for cancer. We all know that smoking makes us likely candidates for lung cancer, but what many people don’t know is that smoking increases your overall risk for cancer. Smoke is toxic to your body, and can increase your risk of any cancer, including breast cancer.
Breast cancer is the second most common cancer among women in the US. This year, over 200,000 women will be diagnosed with breast cancer, and over 40,000 will die from it.** It pays to understand how to protect your health and reduce your risk of contracting this disease.
**Statistics from American Cancer Society
About
the Author
Jon
Stout is Chairman of the Golden Moon Tea Company. For more information about
tea, black tea and wholesale tea go to www.goldenmoontea.com
Saturday 7 April 2012
Pregnancy After Breast Cancer Treatment
After treatment of breast cancer to the satisfaction of her oncologist, should a women who desire to get pregnant be discouraged from doing so? A very critical question considering the fact that there are close to half a million breast cancer survivors living in the US and are in the childbearing age.
For a very long time, counseling of women regarding pregnancy was dependent on the fact that estrogen increases during pregnancy and because estrogen has some effects on both estrogen receptor positive and estrogen receptor negative tumors, its probably better if women avoid pregnancy-unless of course another woman is carrying for them, a gestational carrier.
A woman might not conceive after breast cancer treatment. This usually happens if the radiation treatment was done on the ovaries. This could be as a result of the disease spreading to the ovaries. Infertility may also be as a result of some of the chemotherapy treatments.
When this happens, the woman is unable to conceive and may have to consider other options such as adoption. Another problem associated with the available treatment options is that they could result in early menopause. This also results in a woman being unable to conceive.
A number of treatments for breast cancer, like certain chemo drugs, might have an effect on a woman's fertility. Still, lots of women are able to become pregnant after treatment. Women concerned in relation to their fertility ought to converse to their doctors regarding this prior to beginning treatment.
Generally speaking, tamoxifen, chemotherapy, radiation, and other drug-related therapies are avoided if the woman is pregnant because of their associated risks with birth defects. Tamoxifen, especially, is considered very unsafe because it is a hormonal therapy and is never recommended if the woman is pregnant or planning on conceiving.
Appearance of first menses before the age of 12 significantly increases (by about 40%) the risk of breast cancer. Natural menopause appearing after age 55 increases risk of breast cancer twofold. Thus, the most important factor is the total number of years of ovulation activity.
Breast cancer accounts for one third of new cancers in women. If it is detected early, it is better supported. Women with breast cancer benefit from treatment tailored to their pathology. Four technologies are mainly used. In order of importance: surgery, radiotherapy, chemotherapy and hormone therapy.
About the Author
Read About week by week pregnancy
Also About first aid
for children and pregnancy
after breast cancer
Friday 6 April 2012
New mutation behind breast cancer identified.
Washington, Feb 23 ( ANI ): Scientists have discovered a new gene that may
increase the risk of breast cancer.
In the study from Finland, mutations in this gene, called Abraxas, were linked to cases of hereditary breast cancer.
Researchers have now identified more than 10 genes that increase breast cancer risk; perhaps the most well-known of these are the BRCA BRCA
One of two genes (designated BRCA1 and BRCA2) that help repair damage to DNA, but when inherited in a defective state increase the risk of breast and ovarian cancer. 1 and BRCA2 genes.
But only about 20 percent of women with a family history of breast cancer have mutations in BRAC1 or BRAC2 - meaning in many cases, it's likely other genes are at work.
The mutation does not appear to be common - it was found in 2.4 percent of families with a history of breast cancer. But importantly, the mutation was not found in anyone without breast cancer in the study.
Because the study was conducted in Finland, future studies will need to investigate how common the mutation is in other countries, said study researcher Roger Greenberg, an associate professor of cancer biology at the University of Pennsylvania School of Medicine The University of Pennsylvania's School of Medicine, presently located in the University City section of Philadelphia, Pennsylvania, was the United States's first school of medicine, founded at the College of Philadelphia, as the University was then called. .
In the future, women with a family history of breast cancer might be tested for the Abraxas mutation, Greenbergsaid.
Greenberg and colleagues found the Abraxas mutation in three of 125 breast cancer patients from families with a history of the condition.
This gene had been suspected to play a role in breast cancer risk because it interacts with BRCA1.
When the researchers looked at an additional 991 breast cancer patients, they found the Abraxas mutation in one woman, who also turned out to have breast cancer in her family.
None of the 868 healthy patients in the study had the Abraxas mutation.
The mutated Abraxas gene prevents cells from fixing damaged DNA: see nucleic acid.
DNA
or deoxyribonucleic acid
One of two types of nucleic acid (the other is RNA); a complex organic compound found in all living cells and many viruses. It is the chemical substance of genes. , increasing the risk that a cell will become cancerous. The gene may increase the risk of other cancers as well.
Indeed, one patient in the study was diagnosed with both breast and endometrial cancer, and some patients with the Abraxas mutation had family members with lung cancer, lip cancer and lymphoma.
More research is needed to know exactly how much of an increase in breast cancer risk the Abraxas mutation brings. But Greenberg noted women in the study with this mutation were diagnosed around the same age as those with BRCA1 and BRCA2 mutations - in their mid-40s.
Women with a mutation in BRCA1 or BRCA2 are about five times more likely to develop breast cancer in their lifetimes compared with women who do not have this mutation, according to the National Cancer Institute.
"Identifying more of these mutations will make it easier for patients to know their risk of developing breast cancer," said Dr. Kristin Byrne, chief of breast imaging at Lenox Hill Hospital Lenox Hill Hospital, on Manhattan's Upper East Side, is a 652-bed, acute care hospital and a major teaching affiliate of NYU Medical Center. Founded in 1857 as the German Dispensary, today's 10-building Lenox Hill Hospital complex has occupied its present site since 1868 when it in New York City New York City: see New York, city.
New York City
City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. , who was not involved in the study.
Such genetic information may even help doctors better diagnose breast cancer. Most patients with the Abraxas mutation in the study had a type of breast cancer called lobular carcinoma, which is harder to detect on a mammogram. Knowing that a patient has this mutation might mean doctors use additional screening methods, such as MRI 1. (application) MRI - Magnetic Resonance Imaging.
2. MRI - Measurement Requirements and Interface. , Dr Byrne added.
The study has been published in the journal Science Translational Medicine. ( ANI )
]]>
In the study from Finland, mutations in this gene, called Abraxas, were linked to cases of hereditary breast cancer.
Researchers have now identified more than 10 genes that increase breast cancer risk; perhaps the most well-known of these are the BRCA BRCA
One of two genes (designated BRCA1 and BRCA2) that help repair damage to DNA, but when inherited in a defective state increase the risk of breast and ovarian cancer. 1 and BRCA2 genes.
But only about 20 percent of women with a family history of breast cancer have mutations in BRAC1 or BRAC2 - meaning in many cases, it's likely other genes are at work.
The mutation does not appear to be common - it was found in 2.4 percent of families with a history of breast cancer. But importantly, the mutation was not found in anyone without breast cancer in the study.
Because the study was conducted in Finland, future studies will need to investigate how common the mutation is in other countries, said study researcher Roger Greenberg, an associate professor of cancer biology at the University of Pennsylvania School of Medicine The University of Pennsylvania's School of Medicine, presently located in the University City section of Philadelphia, Pennsylvania, was the United States's first school of medicine, founded at the College of Philadelphia, as the University was then called. .
In the future, women with a family history of breast cancer might be tested for the Abraxas mutation, Greenbergsaid.
Greenberg and colleagues found the Abraxas mutation in three of 125 breast cancer patients from families with a history of the condition.
This gene had been suspected to play a role in breast cancer risk because it interacts with BRCA1.
When the researchers looked at an additional 991 breast cancer patients, they found the Abraxas mutation in one woman, who also turned out to have breast cancer in her family.
None of the 868 healthy patients in the study had the Abraxas mutation.
The mutated Abraxas gene prevents cells from fixing damaged DNA: see nucleic acid.
DNA
or deoxyribonucleic acid
One of two types of nucleic acid (the other is RNA); a complex organic compound found in all living cells and many viruses. It is the chemical substance of genes. , increasing the risk that a cell will become cancerous. The gene may increase the risk of other cancers as well.
Indeed, one patient in the study was diagnosed with both breast and endometrial cancer, and some patients with the Abraxas mutation had family members with lung cancer, lip cancer and lymphoma.
More research is needed to know exactly how much of an increase in breast cancer risk the Abraxas mutation brings. But Greenberg noted women in the study with this mutation were diagnosed around the same age as those with BRCA1 and BRCA2 mutations - in their mid-40s.
Women with a mutation in BRCA1 or BRCA2 are about five times more likely to develop breast cancer in their lifetimes compared with women who do not have this mutation, according to the National Cancer Institute.
"Identifying more of these mutations will make it easier for patients to know their risk of developing breast cancer," said Dr. Kristin Byrne, chief of breast imaging at Lenox Hill Hospital Lenox Hill Hospital, on Manhattan's Upper East Side, is a 652-bed, acute care hospital and a major teaching affiliate of NYU Medical Center. Founded in 1857 as the German Dispensary, today's 10-building Lenox Hill Hospital complex has occupied its present site since 1868 when it in New York City New York City: see New York, city.
New York City
City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. , who was not involved in the study.
Such genetic information may even help doctors better diagnose breast cancer. Most patients with the Abraxas mutation in the study had a type of breast cancer called lobular carcinoma, which is harder to detect on a mammogram. Knowing that a patient has this mutation might mean doctors use additional screening methods, such as MRI 1. (application) MRI - Magnetic Resonance Imaging.
2. MRI - Measurement Requirements and Interface. , Dr Byrne added.
The study has been published in the journal Science Translational Medicine. ( ANI )
]]>
Tuesday 3 April 2012
Diet, exercise help prevent cancer.
WASHINGTON -- A new comprehensive evidence-based report issued by an
international expert panel provides an unprecedented analysis supporting the
preventability of cancer via diet, exercise, and avoidance of obesity.
Developed over a 5-year period by a multinational team of 21 experts, the 517-page report updates a report issued in 1997. The new document, entitled Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective, is a joint publication of two independent research funding organizations, the American Institute for Cancer Research ( AICR American Institute for Cancer Research (Washington, DC)
AICR Association for International Cancer Research
AICR American International Club of Rome
AICR Atlantic Institute of Clinical Research ) and the London-based World Cancer Research Fund. The report was unveiled at an AICR press briefing.
The panel analyzed data from more than 7,000 studies to come up with 10 basic recommendations for cancer prevention:
* Be as lean as possible within the normal range of body weight.
* Be physically active as part of everyday life.
* Limit consumption of energy-dense foods. Avoid sugary drinks.
* Eat mostly foods of plant origin.
* Limit intake of red meat and avoid eating processed meat.
* Limit alcoholic drinks.
* Limit consumption of salt. Avoid moldy
animal feed overgrown with fungus; the feed may be harvested and stored or be still in the ground.
moldy corn disease
see leukoencephalomalacia, fusariummoniliforme. cereals (grains) or pulses ( Legumes
A family of plants that bear edible seeds in pods, including beans and peas.
Mentioned in: Cholesterol, High
legumes (l ). (The second point is aimed at minimizing exposure to aflatoxins aflatoxins (ăf`lətäk'sĭnz), a group of secondary metabolites that are cancer-causing byproducts of a mold that grows on nuts and grains, particularly peanuts. .)
* Aim to meet nutritional needs through diet alone (rather than supplements).
* Mothers should breast-feed; children should be breast-fed breast·feed or breast-feed
v. breast-fed , breast-feed·ing, breast-feeds
v.tr.
To feed (a baby) mother's milk from the breast; suckle.
v.intr.
To breastfeed a baby. .
* Cancer survivors Cancer survivors are those individuals with cancer of any type, current or past, who are still living. The National Coalition for Cancer Survivorship (NCCS) pioneered the definition of survivor as from the time of diagnosis and for the balance of life, a person diagnosed with should follow the recommendations for cancer prevention.
With each recommendation, the report adds specific public health goals and personal recommendations, many of them including target numbers. And although the report does not address the issue of smoking, it does include this italicized statement: And always remember--do not smoke or chew tobacco.
"This report gives a complex perspective that puts in context all the messages you've been hearing about over the last 10 years.... This is not simply a collection and a sifting by experts. This is a very studied collation COLLATION, descents. A term used in the laws of Louisiana. Collation -of goods is the supposed or real return to the mass of the succession, which an heir makes of the property he received in advance of his share or otherwise, in order that such property may be divided, together with the , with mathematically rigorous analyses, that takes account a whole host of different things," said panel member Dr. W. Philip T. James, chairman of the International Obesity Task Force The International Obesity Task Force (IOTF) is an organization designed to combat obesity. It is part of the International Association for the Study of Obesity. External links
The report comes on the heels of "an enormous explosion of research in the last 10 years," Dr. James added. In particular, although the 1997 report did cite evidence for a link between excess body weight and cancer, now "there's such coherence in that evidence and it's clear that being fat induces and causes more cancers than we thought last time."
If all 10 of the recommendations were to be adopted, cancer rates could be reduced by at least a third. Throw in the no-smoking goal, and more than half of all cancer cases could be prevented. "This is not a message of misery at all. It's a challenge for all individuals, for policy makers, for governments, and [for] people involved in the community," Dr. James said.
Another expert panelist, Dr. Walter C. Willett, said the report "shows that overweight and obesity [come] not too far behind smoking as an avoidable cause of cancer."
Dr. Willett, professor of medicine at Harvard University, Boston, and a renowned epidemiologist specializing in the role of dietary factors and disease, pointed out that while cigarette smoking has been declining, rates of overweight and obesity have continued to rise. "If these trends continue, it will not be too far in the future that overweight and obesity become the No. 1 cause of cancer," he said during the briefing.
The report also reflects a new emphasis on early growth and development as factors that influence a person's cancer risk later in life. "For the first time, we see how our body grows and develops over a lifetime plays a role in cancer. This is a new way of thinking," Dr. Willett said.
He explained that the forces that guide uncontrolled growth and lead to cancer are a combination of nutrition, hormones, and genes. Hormonal influences that begin in the womb, combined with early-life nutritional influences, help determine the way cells grow throughout life. Carrying excess body fat makes it more likely that cells undergo the kind of abnormal growth that leads to cancer.
"What we've learned is this: Events that take place early in life strongly influence our risk of cancer for the rest of our lives," Dr. Willett said.
For example, women who were born with a high birth weight are more likely to develop premenopausal pre·me·no·paus·al
adj.
Of or relating to the years or the stage of life immediately before the onset of menopause.
premenopausal adjective breast cancer later in life. Conversely, breast-feeding reduces cancer risks for both the mother and baby, most likely as a result of hormonal factors. But one shouldn't despair about early life influences that can't be changed. "Reducing the amount of fat in our bodies has a protective effect, even late into life," by reducing levels of circulating hormones linked to cancer risk, Dr. Willett explained.
The American Institute for Cancer Research and the World Cancer Research Fund will issue a second report next year that will focus on how to implement the panel's recommendations. The follow-up report will offer guidance for individuals and the medical community, and is expected to influence international government policies regarding food, agriculture, and related issues, Dr. James said.
"Previously, the cancer prevention game has only been [focused] on smoking," Dr. James said in an interview after the briefing. "We now need to bring in this other dimension.... It's a huge opportunity to amplify the prevention strategies."
The full report is available online at www.dietandcancerreport.org.
BY MIRIAM E. TUCKER
Senior Writer
Developed over a 5-year period by a multinational team of 21 experts, the 517-page report updates a report issued in 1997. The new document, entitled Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective, is a joint publication of two independent research funding organizations, the American Institute for Cancer Research ( AICR American Institute for Cancer Research (Washington, DC)
AICR Association for International Cancer Research
AICR American International Club of Rome
AICR Atlantic Institute of Clinical Research ) and the London-based World Cancer Research Fund. The report was unveiled at an AICR press briefing.
The panel analyzed data from more than 7,000 studies to come up with 10 basic recommendations for cancer prevention:
* Be as lean as possible within the normal range of body weight.
* Be physically active as part of everyday life.
* Limit consumption of energy-dense foods. Avoid sugary drinks.
* Eat mostly foods of plant origin.
* Limit intake of red meat and avoid eating processed meat.
* Limit alcoholic drinks.
* Limit consumption of salt. Avoid moldy
animal feed overgrown with fungus; the feed may be harvested and stored or be still in the ground.
moldy corn disease
see leukoencephalomalacia, fusariummoniliforme. cereals (grains) or pulses ( Legumes
A family of plants that bear edible seeds in pods, including beans and peas.
Mentioned in: Cholesterol, High
legumes (l ). (The second point is aimed at minimizing exposure to aflatoxins aflatoxins (ăf`lətäk'sĭnz), a group of secondary metabolites that are cancer-causing byproducts of a mold that grows on nuts and grains, particularly peanuts. .)
* Aim to meet nutritional needs through diet alone (rather than supplements).
* Mothers should breast-feed; children should be breast-fed breast·feed or breast-feed
v. breast-fed , breast-feed·ing, breast-feeds
v.tr.
To feed (a baby) mother's milk from the breast; suckle.
v.intr.
To breastfeed a baby. .
* Cancer survivors Cancer survivors are those individuals with cancer of any type, current or past, who are still living. The National Coalition for Cancer Survivorship (NCCS) pioneered the definition of survivor as from the time of diagnosis and for the balance of life, a person diagnosed with should follow the recommendations for cancer prevention.
With each recommendation, the report adds specific public health goals and personal recommendations, many of them including target numbers. And although the report does not address the issue of smoking, it does include this italicized statement: And always remember--do not smoke or chew tobacco.
"This report gives a complex perspective that puts in context all the messages you've been hearing about over the last 10 years.... This is not simply a collection and a sifting by experts. This is a very studied collation COLLATION, descents. A term used in the laws of Louisiana. Collation -of goods is the supposed or real return to the mass of the succession, which an heir makes of the property he received in advance of his share or otherwise, in order that such property may be divided, together with the , with mathematically rigorous analyses, that takes account a whole host of different things," said panel member Dr. W. Philip T. James, chairman of the International Obesity Task Force The International Obesity Task Force (IOTF) is an organization designed to combat obesity. It is part of the International Association for the Study of Obesity. External links
- Official website
- Overeaters Anonymous website
The report comes on the heels of "an enormous explosion of research in the last 10 years," Dr. James added. In particular, although the 1997 report did cite evidence for a link between excess body weight and cancer, now "there's such coherence in that evidence and it's clear that being fat induces and causes more cancers than we thought last time."
If all 10 of the recommendations were to be adopted, cancer rates could be reduced by at least a third. Throw in the no-smoking goal, and more than half of all cancer cases could be prevented. "This is not a message of misery at all. It's a challenge for all individuals, for policy makers, for governments, and [for] people involved in the community," Dr. James said.
Another expert panelist, Dr. Walter C. Willett, said the report "shows that overweight and obesity [come] not too far behind smoking as an avoidable cause of cancer."
Dr. Willett, professor of medicine at Harvard University, Boston, and a renowned epidemiologist specializing in the role of dietary factors and disease, pointed out that while cigarette smoking has been declining, rates of overweight and obesity have continued to rise. "If these trends continue, it will not be too far in the future that overweight and obesity become the No. 1 cause of cancer," he said during the briefing.
The report also reflects a new emphasis on early growth and development as factors that influence a person's cancer risk later in life. "For the first time, we see how our body grows and develops over a lifetime plays a role in cancer. This is a new way of thinking," Dr. Willett said.
He explained that the forces that guide uncontrolled growth and lead to cancer are a combination of nutrition, hormones, and genes. Hormonal influences that begin in the womb, combined with early-life nutritional influences, help determine the way cells grow throughout life. Carrying excess body fat makes it more likely that cells undergo the kind of abnormal growth that leads to cancer.
"What we've learned is this: Events that take place early in life strongly influence our risk of cancer for the rest of our lives," Dr. Willett said.
For example, women who were born with a high birth weight are more likely to develop premenopausal pre·me·no·paus·al
adj.
Of or relating to the years or the stage of life immediately before the onset of menopause.
premenopausal adjective breast cancer later in life. Conversely, breast-feeding reduces cancer risks for both the mother and baby, most likely as a result of hormonal factors. But one shouldn't despair about early life influences that can't be changed. "Reducing the amount of fat in our bodies has a protective effect, even late into life," by reducing levels of circulating hormones linked to cancer risk, Dr. Willett explained.
The American Institute for Cancer Research and the World Cancer Research Fund will issue a second report next year that will focus on how to implement the panel's recommendations. The follow-up report will offer guidance for individuals and the medical community, and is expected to influence international government policies regarding food, agriculture, and related issues, Dr. James said.
"Previously, the cancer prevention game has only been [focused] on smoking," Dr. James said in an interview after the briefing. "We now need to bring in this other dimension.... It's a huge opportunity to amplify the prevention strategies."
The full report is available online at www.dietandcancerreport.org.
BY MIRIAM E. TUCKER
Senior Writer
Sunday 1 April 2012
Yes, breast cancer related lymphoedema can be managed.
Introduction
Setting
Background
Lymphoedema is a chronic inflammatory lymphostatic disease that is caused by the body's inability to drain lymph fluid from the tissues, which results in the swelling of a body part, most commonly the extremities. Lymphoedema occurs when the lymphatic load exceeds the transport capacity of the lymphatic system, resulting in an abnormal accumulation of protein-rich fluid in the interstitium (Norton School of Lymphatic Therapy 2004; Zuther 2005; Lawenda, Mondry & Johnstone 2009). Primary lymphoedema is the result of developmental dysplasia of the lymph vessels or lymph nodes (Foldi & Foldi 2006) and may be present at birth, or develop later with no obvious cause (Norton School of Lymphatic Therapy 2008). Secondary lymphoedema is more common than primary lymphoedema and is caused by known factors such as surgery, radiation, infection, malignant tumours, immobility and chronic venous insufficiency (Zuther 2005).
It is unknown how many people in Africa live with lymphoedema. The unavailability of statistics is merely part of a worldwide phenomenon as, according to Zuther (2005), no specific studies have been conducted on the incidence of lymphoedema. In 1984, the World Health Organisation (Norton School of Lymphatic Therapy 2008) estimated that 113 million people suffered from lymphoedema, with 90 million caused by parasites, 20 million caused by breast cancer and with 2-3 million people with primary lymphoedema. Foldi and Foldi (2006) are, however, of the opinion that 140-250 million people worldwide suffer from lymphoedema and that breast cancer treatment is one of the most common causes of secondary lymphoedema.
The lack of epidemiological data are also related to the fact that lymphoedema is not a reportable condition (Foldi & Foldi 2006). Secondary lymphoedema is, furthermore, commonly viewed as being less important than the eradication and detection of recurrent breast cancer (Petreck & Heelan 1998). In 1998, Petreck and Heelan (1998) undertook a review of the medical literature and found that the incidence of breast cancer related lymphoedema ranged between 6% and 30%; however, Clark, Sitzia and Harlow (2005) state that the incidence of breast cancer related lymphoedema ranges between 6% and 83%.
Lymphoedema is incurable because of permanent damage to, or absence of, the various lymphatic components (Lawenda et al. 2009). People do not die of lymphoedema, but their quality of life is severely impaired. Surgical procedures such as debulking operations, amputations and other unsuccessful or outdated surgical procedures can have disastrous effects on the patient (Foldi & Foldi 2006). Complete Decongestive Therapy is the gold standard treatment for lymphoedema (Lawenda et al. 2009) with the main goal of returning the lymphoedema to a stage of latency by using the remaining lymph vessels and other lymphatic pathways. Additional goals of Complete Decongestive Therapy, which have shown an average lymphoedema reduction of the upper extremity of 59.1% (Lawenda et al. 2009), are the reduction and removal of fibrotic tissue and the prevention and elimination of infections (Zuther 2005).
Complete Decongestive Therapy is a specialised conservative treatment comprising two phases: an induction phase and a lifelong maintenance phase (Norton School of Lymphatic Therapy 2008; Zuther 2005; Foldi & Foldi 2006; Lawenda et al. 2009). During the induction phase, the patient is seen and treated on a daily basis. Induction treatment consists of manual lymph drainage of 30-60 minutes at least once a day, 5 days per week and the application of compression bandages. Short stretch bandages are preferred because of their high working and low resting pressure qualities. Before the bandages are applied, the affected limb is moisturised with a moisturiser specifically formulated for a sensitive skin and patients are instructed not to remove the bandages at home. During the induction phase the patient, or a family member, is taught self-bandaging as the patient's lymphoedematous limb needs to be bandaged during weekends and nights for the maintenance phase. The patient receives instructions on decongestive exercises and has to perform these for 10-15 minutes twice a day whilst wearing the bandages (Zuther 2005). Skin and nail care forms part of patient education as well as the signs, symptoms and management of skin infection. The duration of the induction phase varies with the severity of the lymphoedema, or by the patient's response to therapy (Lawenda et al. 2009), and ends when a plateau, indicated by the results of the circumferential or volumetric measurements on the affected extremity, is reached. During the maintenance phase, the patient assumes responsibility for the management of the lymphoedema by maintaining and improving the results of the previous phase. The maintenance phase comprises skin and nail care, self-manual lymph drainage and decompression exercises. During the day, compression garments are worn whilst the patient continues to apply compression bandages at night. Follow-ups are conducted on patients and additional treatment sessions are carried out should the patient be unable to maintain decongestion, or experiences swelling (Zuther 2005).
Problem Statement
The researcher is of the opinion that health professionals in South Africa commonly regard cancer related lymphoedema as a 'normal' complication of cancer and the treatment of cancer. Should a woman develop lymphoedema, she simply has to accept and live with this complication, as there is no permanent solution available. It is true that there is no cure for lymphoedema, but unfortunately it tends to progress without adequate treatment, which leads not only to body image disturbances and the accompanying decrease in quality of life, but also to health related complications such as inflammatory conditions and even malignant tumours (Foldi & Foldi 2006).
Purpose of the study
The purpose of the study was to demonstrate that breast cancer related lymphoedema is manageable by means of Complete Decompression Therapy, thereby improving the quality of life of the patient.
Research significance
It is not clear how many people worldwide live with lymphoedema, but it is estimated that the number can be as high 250 million. Breast cancer is considered to be the most common cause of secondary lymphoedema. Breast cancer related lymphoedema is not new to oncology nursing; however, oncology nursing research is extremely sparse. Only one South African study that addresses this problem could be found. In South Africa, we have no evidence of the incidence, the self-management attempts, lived experience or suffering of women living with breast cancer related lymphoedema or the management thereof. This study attempted to provide evidence that lymphoedema caused by cancer and its treatment can be managed to improve the patient's quality of life.
Literature review
As this study involved nursing practice, Dorothea Orem's Self-care Deficit Nursing Theory was selected as the theoretical framework (Berbiglia 2010). Self-care refers to the activities individuals initiate and perform on their own behalf to maintain life, health and well-being. The ability to engage in self-care is influenced by various factors such as age, health state, health care system factors and the availability and adequacy of resources. A self-care deficit arises when the individual's self-care demands exceed his acquired ability or power to engage in self-care. An adult requires nursing in the absence of the ability to maintain the amount and quality of self-care needed to sustain life and health continuously, to recover from disease or injury, or to cope with their effects. Orem (1995) identified three nursing systems in patient care. The first system, the wholly compensatory system, is applicable to the person who is socially dependent on others for the continuation of their existence (Foster & Bennett 2002); here nurse action is intense and patient action limited. The second system is the partially compensatory system, where the patient has a limited ability to meet his self-care needs and the nurse and patient share the actions of self-care. The third system, the supportive-educative system, is applicable in situations where the patient is able to accomplish self-care but needs support in terms of learning new self-care activities; here the patient action is intense whilst the nurse action is limited to support (Edmond 2003). Both the partially compensatory and the supportive-educative system were applied in the care of the patient. The patient had limited ability to apply the self-care needed to manage her lymphoedema and had to be assisted by the researcher, a registered nurse. The supportive-educative system was used to teach and support the patient in applying self-care during the induction therapy and to prepare her for the self-care needed throughout the lifelong maintenance phase.
Orem (1995) urges nurses to ask and answer the questions, 'What is?' and 'What can be?', as a departure point in nursing practice situations. Nursing practice, guided by the Self-care Deficit Nursing Theory, is characterised by a caring approach where the nurse uses experiential and specialised scientific knowledge to design and produce the art of nursing care (Berbiglia 2010). Experiential and specialised knowledge of oncology nursing and Complete Decongestive Therapy were applied to assess the patient in answering the question 'What is?', as well as to design and implement a care plan to answer 'What can be?'
Definition of concepts
Quality of life: Quality of life is an ill-defined term and means different things to different people (Fayers & Machin 2007). In 1993 the World Health Organisation Quality of Life Group (Bowling 1996) defined quality of life as 'an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the person's physical health, psychological state, level of independence, social relationships and their relationships to salient features of their environment.'
Complete Decongestive Therapy: Complete Decongestive Therapy is specialised, conservative, long-term therapy consisting of skin and nail care, manual lymph drainage, application of bandages, decongestive exercise and medical compression garments (Weissleder & Schuchhardt 2008).
Research design and methods
Research design
The design used was a mixed method, descriptive instrumental single case study. An instrumental case study design is used when insight into an issue is pursued or when a generalisation is challenged (Barroso 2010) and allows researchers to focus on their concerns as highlighted by the case (Luck, Jackson & Usher 2006). The research design was applicable to the study as the researcher wished to present the uniqueness of the participant's situation and challenged her own concerns, namely the perception of health professionals that 'nothing can be done for women living with breast cancer related lymphoedema'.
Context of the study
The context for the study was Tshwane, a municipal area in South Africa's smallest province, Gauteng Province. The total population of Gauteng is 8.8 million, which represents approximately 20% of the total South African population. More than 60% of the research and development of South Africa takes place in Gauteng, which also has the hightest per capita income in South Africa. Tshwane hosts a population of approximately 2 million (SouthAfrica.info 2010), but it is unknown how many women in Tshwane have breast cancer or breast cancer related lymphoedema, as no statistics are available.
Population and sample
The target population was all women living with breast cancer related lymphoedema in Tshwane. The accessible population, from which the sample was obtained (Burns & Grove 2005), was all women who had entered a specific lymphoedema project in Tshwane. Scholars differ in terms of sample selection in case studies as some are of the opinion that a 'typical' case should be presented, whilst others indicate that the extraordinary case should be presented (Barroso 2010). However, the patient with the most severe breast cancer related lymphoedema in terms of volume, was selected for the study.
Data collection methods
Mixed methods were used to gather data. Self-report data were gathered using a structured interview to explore the patient's general characteristics, her history of health and illness and quality of life, whilst the use of structured observation gathered data on the condition of the patient's affected arm and progress during treatment. During the first consultation, the researcher measured both the patient's arms with a measuring tape and the Four Centimetre Method (Norton School of Lymphatic Therapy 2008), and calculated the volume of each arm using the standard formula for a cylinder. This enabled the researcher to estimate the lymphoedema volume of the affected arm. To monitor progress, the researcher measured the affected arm on a weekly basis or when an increase in volume was suspected. Daily inspections of the patient's skin were conducted for signs of dryness, infection, maceration or any other abnormality. Findings were documented on the patient's treatment record which was reviewed periodically. The researcher gathered data from May to August 2009, whilst treating the patient.
Three data gathering instruments were used:
* A questionnaire gathered data on the patient's general characteristics and history of health and illness, with the Numerical Rating Scale of Cancer Pain Intensity. This scale was adapted to determine the patient's quality of life with the lowest number (0) a 'bad life that cannot get worse' and the highest number (10) a 'good life that cannot get better'.
* An Excel spreadsheet served to document the circumference measurements of the patient's arm and to calculate the lymphoedema volume. The treatment record of the patient also served as a data gathering instrument as field notes were made before or immediately after the patient's treatment.
* Photographs were taken as well.
Data analysis
Content analyses were used to review the treatment record of the patient, and a template, guided by the layout of the case report (McCarthy & Reilly 2000), was used to categorise the data. Descriptive statistics were used to determine the progress of the patient's arm in terms of volume reduction and the quality of life measured by means of the Numerical Scale.
Case report
The case report will be presented using the guidelines of McCarthy and Reilly (2000). The induction treatment of the patient's lymphoedematous left arm is presented. A pseudonym is used to ensure her anonymity and confidentiality.
Description of the patient
Bertha was 61 years old, living in a township in Tshwane, married with three children. Bertha was self-employed and part of the informal business sector.
History of the presenting condition
Bertha was diagnosed with breast cancer of her left breast in 2002. According to the patient, she was initially misdiagnosed and only diagnosed with breast cancer once the lump in her breast 'was as big as a fist'. She was scheduled to receive six cycles of neoadjuvant chemotherapy but only received four as her finger and toe nails became loose and 'smelled terrible'. After the four cycles of neoadjuvant chemotherapy, a mastectomy, presumably a modified radical mastectomy was performed, followed by radiotherapy. Bertha was unsure of when her left arm started to swell but reported that her arm started swelling significantly 5 years after her breast cancer treatment. She described the swelling as follows:
My arm started swelling little by little ... it started swelling up a little and it would go down, but not everything ... and then it swelled again and go down but not completely ... and so it went on an on ... slowly, slowly ... it was not sore.Bertha reported the swelling during one of her follow-up visits to the oncology clinic. She was referred to the occupational therapy department and had a compression garment made for her, but she only wore it 'for a short time ... it did not fit nicely'. In 2009, a member of the public referred Bertha to a private health-care practitioner for the treatment of her lymphoedema but she could not afford private health care and was referred to the researcher after approximately 10 Complete Decongestive Therapy treatments over a period of 1 month.
According to Bertha, she never had cellulites, one of the common lymphoedema related problems, or took any medication for the lymphoedema. She reported suffering from hypertension and visited a primary health clinic every month for the management thereof and attended the oncology clinic annually.
Assessment and care plan
The general impression of Bertha was one of an overweight person with a huge left arm. Skin inspection revealed a surgical scar on her left anterior chest wall. Radiation fibrosis with telangiectasia was also present; her left arm and hand were enlarged and had various abnormal skin folds; skin changes were present on her hand and forearm (Figure 1) and skin maceration was present between her second and third, third and fourth, and fourth and fifth fingers. No papillomas or lymphoree were detected and no shoulder range of motion impairment was observed. With palpation, no temperature differences between her arms were detected. Pitting could not be induced and fibrotic areas were found on her lymphoedematous forearm. Stemmer's sign was negative. The estimated volume of Bertha's right arm totalled 4615 mL, whilst her left arm totalled 8456 mL; the estimated lymphoedema volume was therefore 3841 mL. Bertha gave her quality of life 10 out of 10 and stated, 'My life is good ... this arm does not prevent me from doing what I want...'.
Four weeks of induction therapy was planned, comprising manual lymph drainage, 24-hour compression bandages, nail and skincare and patient education 5 days per week with self-bandaging during weekends.
Results
Expected outcomes
The expected outcomes were as follows:
* a 60% reduction in lymphoedema volume in the planned 4-week induction therapy
* no macerated skin at the end of induction treatment
* a positive influence on the patient's quality of life.
[FIGURE 1 OMITTED]
Outcomes achieved
The following outcomes were achieved:
* The lymphoedema volume decreased by 33% decrease after 4 1/2 weeks of therapy, with a 2-week interruption after the first 12 treatments. A 57.2% reduction was achieved after an induction period of 10.5 weeks of therapy.
* No skin maceration was present at the end of the induction treatment.
* There was a positive influence on the patient's quality of life. She stated:
This arm still does not prevent me from doing what I want... it is much lighter ... so light that I can fly (raising her arms above her head)... I do not wear a towel over my arm any more ... I did that to stop people for looking and asking what happened ... (Patient)Ethical considerations
The ethical principles, as outlined in the Belmont Report (Polit & Beck 2010), namely beneficence, respect for human dignity and justice, supported the researcher in conducting the study. Firstly, the researcher explained to the participant what lymphoedema was; what Complete Decongestive Therapy consisted of; and the self-care that would be required during the treatment and maintenance phase. After receiving the participant's co-operation, informed consent was obtained. Anonymity and confidentiality were ensured by interviewing and treating the participant in private. The views of the participant were respected and during each treatment session, time was allowed for queries to be raised. The research proposal was peer reviewed by the Departmental and Faculty Research and Innovations Committees of the Tshwane University of Technology and approved by the Ethics Committee of the same university.
Trustworthiness
Validity and reliability
Validity and reliability were ensured by using a recognised method, the Four Centimetre Method, to estimate the volume of the patient's affected arm. Only the researcher took the circumferential measurements of the patient's arms to ensure that the same tension was applied on the measuring tape and that the positions of measurement were consistent. The validity and reliability of the Numerical Rating Scale of Cancer Pain Intensity has been supported by literature (Jensen 2003) and adapted to allow the patient to quantify her quality of life. Trustworthiness was ensured by means of three strategies, namely credibility, dependability and confirmability (Krefting 1991). Shenton (2004) questions whether producing truly transferable results is a realistic aim for a single study as it has the potential to disregard the importance of the context, which is a key factor in qualitative research. Transferability was therefore not a priority. Shenton (2004) guided the researcher with specific requirements to ensure that the strategies were applicable. Credibility was ensured by the researcher's prolonged engagement with the patient which created trust. Sampling was random, as all patients treated by the researcher had an equal probability of being selected. Triangulation was achieved by using different data gathering methods namely, individual interviews, a scale, structured observation, photographs and volumetric measurements. The research proposal for the study was peer reviewed. Member checks were also carried out as the researcher reflected on the self-report data and asked the participant whether the data were documented and understood as intended. Dependability was ensured as a research proposal was written to outline what was planned. The research report serves as evidence of the implementation of the plan, with confirmability ensured by developing an audit trail.
Discussion
The expected 60% limb volume reduction could not be achieved. Unfortunately, it was unknown how much the limb volume was reduced during Bertha's treatment at the private health-care practitioner. It might be possible, therefore, that the total reduction was more than 60% and maybe as high as 68% which is the highest reduction percentage reported in the literature (Norton School of Lymphatic Therapy 2004). However, a 35% reduction in lymphoedema volume was achieved after 12 treatments. This compares positively with the findings of Thomas et al. (2007) who found a median lymphoedema reduction of 36% after 12 treatments. Mondry, Riffenburgh and Johnstone (2004) reported a median reduction of 138 mL after a median treatment period of 2 weeks (10 treatments). Bertha's volume reduction after 12 treatments was 1095 mL. The median duration of treatment before reaching a measurement plateau is reported to be 2 weeks (Mondry et al. 2004) and 12 treatments (Thomas et al. 2007). Bertha's measurements did not reach a plateau but went up and down. After 6.5 weeks of treatment, a 56.2% volume reduction was achieved as the lymphoedema volume was 1686 mL, but could not be maintained and the lymphoedema volume increased during the next 2 weeks to 1912 mL. It took another 2 weeks of treatment to reduce the limb volume to 1639 mL, a 57.2% reduction. It was then decided to end the induction treatment phase (Figure 2 illustrates Bertha's left arm at the end of the induction phase) and to start the maintenance phase.
Compliance was a challenge and it affected Bertha's hand. Circumferential measurements were taken on a Friday before treatment; however, the following Monday, when the patient returned for treatment, her hand would be swollen visibly more and painful. It was only after 7.5 weeks of treatment that Bertha confessed that she did not bandage her arm during weekends but wore a compression garment 'that fits like a worm, going in and out ...' in the skin folds. Bertha further explained that the garment was short and ended above her elbow resulting in her upper arm 'hanging loose'. When inspecting the garment, it was found the garment was a sleeve without a glove or gauntlet. The garment was much too small for Bertha's arm and consequently it formed a tourniquet at her wrist and above her elbow which resulted in the swelling of her hand and forearm, and it was impossible for her upper arm to fit in the compression garment. It also became clear that she may not have had the trained social support to assist her with the bandaging at home that she said she had. Bertha's non-compliance is however not unique, because Mondry et al. (2004) found that an increased number of treatments resulted in a marked improvement in volume and girth, but poorer compliance. Foldi and Foldi (2006) are very pragmatic about patient compliance and state that patient compliance to compression therapy in many cases is poor, similar to that of taking prescribed drugs. As experienced with Bertha, noncompliance with decompression therapy automatically leads to relapse.
[FIGURE 2 OMITTED]
Despite the fact Bertha rated her quality of life to be 'a good life that cannot get better', the limb volume reduction improved her quality of life. It was unknown if her quality of life would have improved if her lymphoedema did not drastically reduce. Weiss and Spray (2002) found that the quality of life of patients with lymphoedema improves significantly after Complete Decongestive Therapy, irrespective of the limb volume decrease, but Howell and Watson (2005) found the exact opposite. These authors (Howell & Watson 2005) report that despite a limb volume reduction, the quality of life of most women in their study worsened as they realised that their lymphoedema would require lifelong management and would therefore serve as a reminder of their breast cancer experience.
Limitations of the study
The study has various limitations. Case studies lead to familiarity with the participant, which limits objectivity, especially if the data were gathered by means of observation with the researcher as the primary or sole observer (Polit & Beck 2010). Case studies have also been criticised for lacking rigour (Jensen & Rodgers 2001 in Luck, Usher & Jackson 2005). Luck et al. (2001), however, advise researchers to address objectivity and rigour issues by planning the case study research and applying the usual requirements for rigour applicable to their chosen methods. Generalisation is also a limitation (Polit & Beck 2010), as the study reflects the findings applicable to one person in a specific context.
Conclusion
The study demonstrated and confirmed that despite imperfect patient compliance, breast cancer related lymphoedema can be managed with Complete Decongestive Therapy, with a resultant improvement of the quality of life of women living with breast cancer.
http://www.hsag.co.za doi: 10.4102/hsag.v16i1.578
Acknowledgements
The study was funded by the Tshwane University of Technology.
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Johanna E. Maree (1)
Affiliation:
(1) Adelaide Tambo School of Nursing Science, Tshwane University of Technology, South Africa
Correspondence to:
Johanna Maree
Email:
lize.maree@wits.ac.za
Postal address:
Private Bag X680, Pretoria 0001, South Africa
Dates:
Received: 26 Aug. 2010
Accepted: 08 July 2011
Published: 17 Oct. 2011
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