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Sunday, 2 February 2014

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Thursday, 2 January 2014

8 Ways to Lower Your Cancer Risk

1. Be Smoke Free.

Lung cancer kills more women and men in the U.S. than any other cancer -- 28% of all cancer deaths, or about 160,000 people every year. The vast majority of those deaths are due to smoking.

And that’s just lung cancer. Smoking has also been linked to more than a dozen other cancers and accounts for 30% of all cancer deaths overall.

That's why many doctors will tell you that the biggest anti-cancer step you can take is to stop smoking, or never start. But even if you’re having trouble quitting entirely, you can reduce your cancer risk significantly by just cutting back.

A study that appeared in the Journal of the American Medical Association in 2010 found that smokers who cut back from about 20 cigarettes per day to less than 10 per day reduced their lung cancer risk by 27%. It’s a good first step, but don't stop there; quit completely for your health's sake.

Even if you’re a nonsmoker, don’t assume smoke isn’t permeating your life. About 3,000 cases of lung cancer each year occur as a result of exposure to secondhand smoke, and there are strong indicators that other cancers may be linked to secondhand smoke as well.

“If you’re in a closed bar or nightclub and 100 people in there are smoking, you might as well be,” says Mack Ruffin IV, MD, MPH, a professor in the department of family medicine at the University of Michigan and an expert in preventive oncology. “If you leave a bar and your clothes are smelling of tobacco, you’ve inhaled a lot of cigarette smoke.”

So think twice before spending regular nights out in smoke-filled clubs, or letting your child ride home regularly with someone who smokes in the car.

2. Don't Weight.

Many people probably know that carrying too much weight around isn’t good for your heart, but did you know that it’s a major risk factor for cancer as well? Obesity is the culprit behind some 14% of cancer deaths, and more than 3% of new cancer cases, every year.

“Our No. 1 recommendation for cancer risk reduction is to stay as lean as possible within a healthy weight range. This may be one of the most important ways to prevent cancer,” says Alice Bender, MS, RD, manager of nutrition communications at the American Institute for Cancer Research (AICR).

In November 2007, the AICR put out an expert report summarizing how food, nutrition, and physical activity affect cancer and cancer prevention. Being overweight, according to the AICR report, is linked to a wide variety of cancers, including esophageal, pancreatic, gall bladder, breast, endometrial, and kidney cancers.

3. Bust a Move.

All forms of physical activity help to prevent many forms of cancer, according to the AICR Expert Report. You may not get six-pack abs with 30 minutes of moderate exercise every day, but a number of studies have found evidence that just this much physical activity can cut your risk of many common cancers by 30% to 50%.

“It doesn’t matter that much what kind of exercise you do, or when -- just do it,” Ruffin says. “Let’s correlate it to smoking. If you can cut your weight down to a healthy range, increase your physical activity, and increase your fruit and vegetable intake. That’s the equivalent to stopping smoking if you were a smoker. People don’t understand how important these factors are, because they creep up over your life span.”

4. Plant Your Plate.

There are a number of different foods that may help to prevent certain types of cancer. “For example, tomatoes, watermelon, and other foods containing lycopene have evidence showing that they probably reduce the risk of prostate cancer,” Bender says.

But if you’re aiming to slice your risk of many cancers across the board, load your plate with plants, particularly non-starchy vegetables and fruits. That’s why the AICR report’s No. 4 recommendation is to eat mostly foods that come from plants -- at least 14 ounces every day. The Mediterranean diet, St. Tropez diet, and the green diet all are based on a diet rich in fruits and vegetables. Diets that tend to prevent cancer are rich in plant-based foods.

AICR’s “new American plate” plan offers an easy cheat sheet on eating to prevent cancer. Fruits, vegetables, beans, and whole grains should cover two-thirds of your plate; the other one-third should contain lean meats, fish, and low-fat dairy.

5. Drop the Drink.

When it comes to health, alcohol wields a double-edged sword. There is plenty of evidence to suggest that light alcohol consumption, especially red wine,may be beneficial for heart health.

But on the other hand, it appears that any alcohol consumption can raise your risk of cancer.

“For cancer, there is no safe level of alcohol,” Bender says. “It’s a dose response: The more you drink, the greater the risk, especially for certain cancers like those of the mouth, throat, and esophagus.” And if you smoke, too, the combined effects of drinking and smoking shoot your risk for these up even higher.

What to do? Both the AICR expert report and the American Cancer Society recommend that women limit alcohol consumption to no more than one drink per day, and men no more than two.

6. Shake Off Stress.

“People always want to know if stress can raise your cancer risk,” Ruffin says. “There’s no convincing evidence that, by itself, stress is an independent risk factor for cancer. But what it cando is lead people to engage in unhealthy behavior in an effort to cope with stress. If you’re overeating, drinking, or smoking to self-medicate your stress away, those behaviors all raise your cancer risk.”

So instead, Ruffin recommends finding healthy ways of coping with stress, like exercise (which helps to reducecancer risk), meditation, and journaling.

7. Pull Down the Screens.

Many screening tests for various cancers, like mammograms and prostate-specific antigen (PSA) testing, don’t actually prevent cancer -- they just catch it at a very early stage, when it may be more treatable.

But other tests, like Pap tests and colonoscopies, can help detect precancerous changes that, if left untreated, can turn into cervical cancer or colon cancer.

There are many confusing messages about what screening tests different people should use, and when. Instead of trying to figure it out on your own, Ruffin says, talk to your doctor about your individual situation.

Take screening mammograms, for instance. The question isn’t “Should women under 50 get mammograms?” but “Should I,given my own personal situation and family health history, start mammograms before 50?”

“And don’t think one conversation is enough,” Ruffin says. “Things about your health situation change, and so does our knowledge about cancer and screening. Ask your doctor about it this year, and next year, and the year after that.

. Dig Your Roots.

Ruffin advises all of his patients to learn their family health histories in detail. “Family history is where we can really create a personalized strategy for cutting cancer risk and catching it early,” he says. “But it’s a piece I don’t think people bring up nearly often enough.”

So next time you have a family reunion, make it a project to gather information on who’s had what health condition and when. “Gather on Skype or Facebook or face to face and talk about this,” Ruffin says.

The Surgeon General’s Family Health History Initiative lets you create a personalized diagram that you can download to keep on your own computer, or copy and share with other family members to keep the info flowing.

9. Aspirin -- Maybe, and with a Dose of Caution.

Should you take aspirin to prevent cancer? The jury’s still out, but at least some evidence points that way. A large study published in 2010 found that daily use of low-dose aspirin can cut the risk of death due to certain cancers (primarily lung, colorectal, and esophageal cancer) by as much as 21%.

But regular aspirin use can come with side effects, especially stomach bleeding and irritation. Most experts say it’s way too soon to recommend a cancer-fighting aspirin a day.

“We’d all like preventing cancer to be as easy as taking a little pill, but the fact is that you’ll reduce your cancer risk much more by maintaining a healthy weight, exercising, and eating fruits and vegetables than you will by taking aspirin,” Ruffin says.

Talk to your doctor before you start taking aspirin on a regular basis for any reason.

Chemotherapy, radiation, and other cancer treatments can be hard on your body. Fortunately, making healthy food choices can help you feel better and speed your recovery.

Choose Healthy Foods

"When you're being treated for cancer, it's important to avoid extreme diets that may leave you short on key nutrients," says Veronica McLymont, PhD, RD, director of food and nutrition services at Memorial Sloan-Kettering Cancer Center. Instead, focus on eating a balanced diet. Ask your oncologist or a nutritionist if you need extra calories and protein to keep your strength up during treatment.

Choose whole grain breads and cereals.
Drink 100% fruit or vegetable juices. (Make sure they are pasteurized because you may be more susceptible to germs while you’re getting cancer treatment.)
Fill half of your plate with vegetables and fruits.
A few times a week, choose meatless meals such as vegetarian lasagna or vegetable stir-fry.
Snack on carrot sticks, sweet pepper slices, and fresh or dried fruits.
Have a leafy green salad with dinner.
Limit sugary foods -- the kind with lots of calories but very little nutrition.
Pick lean meats and fish more often than red meat and processed meats.

Try to Eat, Even If You Don't Have an Appetite

Lack of appetite is common during cancer treatment. Some treatments can even make food taste unpleasant. "Even though you don't feel like eating, it's important to get adequate nutrition," says Sarah Rafat, RD, a senior dietitian at MD Anderson Cancer Center. Here’s what to do:

Choose high-calorie, nutrient-rich foods such as avocados, nuts, beans, seeds, puddings, and cooked cereals.
Eat small meals throughout your day.
Don’t wait until you're hungry to eat. Instead, eat at certain times of day.
Keep your favorite foods close at hand.
Make your meals look appealing. Add parsley, lemon slices, cherry tomatoes, and other colorful garnishes to your plate.

Ease Side Effects With Food

Certain foods can help ease the common discomforts from cancer treatment.

Conquer constipation by drinking water and eating high-fiber foods like beans, lentils, vegetables, and fresh or dried fruit.
Drive away diarrhea with bland foods such as rice, bananas, and apples. Drink water to stay hydrated.
Protect mouth sores and avoid dry mouth by grinding or pureeing foods to make them easier to swallow. Or eat foods that are already soft and mostly liquid, like soups and milk or yogurt shakes.
Nix nausea by choosing bland foods and foods without strong odors. Steer clear of greasy foods. Go easy on your stomach by eating small meals throughout the day. Drink plenty of water even if you are vomiting.

Focus on Food Safety

Some cancer treatments temporarily weaken your immune system. So it’s important to avoid germs that you can pick up from food. Contaminated food can make you quite sick. Here are some guidelines to help keep you safe.

Avoid cracked or unrefrigerated eggs.
Check expiration dates to avoid food spoilage, and throw away any moldy foods.
Cook all your meats until they're well done.
Don't buy bulk foods from open bins, like salad greens.
Keep all perishable foods in the fridge until you're ready to prepare them.
Prep your food on surfaces that are cleaned with soapy, hot water.
Use a separate cutting board for raw meat, fish, or poultry. Wash it thoroughly after each use.
Scrub and rinse fruits and vegetables thoroughly. Don’t eat any fruits or vegetables that you can’t wash easily, such as raspberries. Scrub the outsides, even if you don’t eat them, like the rind of a melon.

source:webmd

Monday, 30 December 2013

Miscarriage (Spontaneous Abortion)

Miscarriage facts

Spontaneous miscarriage is the loss of a pregnancy that ends spontaneously before the fetus can survive.
Exercise, working, and intercourse do NOT increase risk of miscarriage for women without underlying specific medical conditions that place them at risk.
Causes for miscarriage include genetic abnormalities, infection, medications, hormonal effects, structural abnormality of the uterus, and immune abnormalities.
After an isolated miscarriage, the probability of having a normal term pregnancy in the future is high.
Treatment of recurrent miscarriage is directed toward the underlying cause.

What is a miscarriage?

A miscarriage is any pregnancy that ends spontaneously before the fetus can survive. A miscarriage is medically referred to as a spontaneous abortion. The World Health Organization defines this unsurvivable state as an embryo or fetus weighing 500 grams or less, which typically corresponds to a fetal age (gestational age) of 20 to 22 weeks or less. Miscarriage occurs in about 8% to 20% of all recognized pregnancies, and usually occurs before the 13th week of pregnancy. With the development of highly sensitive assays for hCG levels that can detect an early pregnancy even prior to the expected next period (menstruation), researchers have been able to show that around half of all pregnancies (recognized and unrecognized) are lost. Because the loss occurs so early, many miscarriages occur without the woman ever having known she was pregnant. Of those miscarriages that occur before the eighth week, a portion have no fetus associated with the sac or placenta. This condition is called blighted ovum, and many women are surprised to learn that there was never an embryo inside the sac.

Chances of miscarriage decrease significantly once fetal heart function is detected in a given pregnancy.

A woman who may be showing the signs of a possible miscarriage (such as vaginal bleeding) may have her pregnancy referred to as a "threatened abortion."

What causes a miscarriage, and what are the tests for the different causes?

The cause of a miscarriage cannot always be determined. The most common known causes of miscarriage in the first third of pregnancy (1st trimester) are chromosomal abnormalities, collagen vascular disease (such as lupus), diabetes, other hormonal problems, infection, and congenital (present at birth) abnormalities of the uterus. Chromosomal abnormalities of the fetus are the most common cause of early miscarriages, including blighted ovum (see above). Each of the causes will be described below.

Chromosomal abnormalities

Chromosomes are microscopic components of every cell in the body that carry all of the genetic material that determines hair color, eye color, and our overall appearance and makeup. These chromosomes duplicate themselves and divide many times during the process of development, and there are numerous points along the way where a problem can occur. Certain genetic abnormalities are known to be more prevalent in couples that experience repeated pregnancy losses. These genetic traits can be screened for by blood tests prior to trying to conceive.

Half of the fetal tissue from 1st trimester miscarriages contain abnormal chromosomes. This number drops to 24% with 2nd trimester miscarriages. In other words, abnormal chromosomes are more common with 1st trimester than with 2nd trimester miscarriages. First trimester miscarriages are so very common that unless they occur more than once, they are not considered "abnormal" per se. They do not prompt further evaluation unless they occur more than once. In contrast, 2nd trimester miscarriages are more unusual, and therefore may trigger evaluation even after a first occurrence. It is therefore clear that causes of miscarriages seem to vary according to trimester.

Chromosomal abnormalities also become more common with aging, and women over age 35 have a higher rate of miscarriage than younger women. Advancing maternal age is the most significant risk factor for early miscarriage in otherwise healthy women.

Collagen vascular diseases

Collagen vascular diseases are illnesses in which a person's own immune system attacks their own organs. These diseases can be potentially very serious, either during or between pregnancies. In these diseases, a woman makes antibodies to her own body's tissues. Examples of collagen vascular diseases associated with an increased risk of miscarriage are systemic lupus erythematosus, and antiphospholipid antibody syndrome. Blood tests can confirm the presence of abnormal antibodies and are used in the diagnose of these conditions.

Diabetes

Diabetes generally can be well managed during pregnancy, if a woman and her health care professional work closely together. However, if the diabetes is insufficiently controlled, not only is the risk of miscarriages higher, but the baby can have major birth defects. Other problems can also occur in relation to diabetes during pregnancy. Good control of blood sugars during pregnancy is very important.

Hormonal factors

Hormonal factors may be associated with an increased risk of miscarriage, including Cushing's Syndrome, thyroid disease, and polycystic ovary syndrome (PCOS). It also has been suggested that inadequate function of the corpus luteum in the ovary (which produced progesterone necessary for maintenance of the very early stages of pregnancy) may lead to miscarriage. Termed "luteal phase defect," this is a controversial issue, since several studies have not supported the theory of luteal phase defect as a cause of pregnancy loss.

Infections

Maternal infection with a large number of different organisms has been associated with an increased risk of miscarriage. Fetal or placental infection by the offending organism then leads to pregnancy loss. Examples of infections that have been associated with miscarriage include infections byListeria monocytogenes, Toxoplasma gondii, parvovirus B19, rubella, herpes simplex, cytomegalovirus, and lymphocytic choriomeningitis virus.

Abnormal structural anatomy

Abnormal anatomy of the uterus can also cause miscarriages. In some women there can be a tissue bridge (uterine septum), that acts like a partial wall dividing the uterine cavity into sections. The septum usually has a very poor blood supply, and is not well suited for placental attachment and growth. Therefore, an embryo implanting on the septum would be at increased risk of miscarriage.

Other structural abnormalities can result from benign growths in the uterus called fibroids. Fibroid tumors (leiomyomata) are benign growths of muscle cells in the uterus. While most fibroid tumors do not cause miscarriages, (in fact, they are a rare cause of infertility), some can interfere with the embryo implantation and the embryo's blood supply, thereby causing miscarriage.

Other causes

Invasive surgical procedures in the uterus, such as amniocentesis and chorionic villus sampling, also slightly increase the risk of miscarriage.

What does NOT cause miscarriage?

It must be emphasized that exercise, working, and sexual intercourse do not increase the risk of pregnancy loss in routine (uncomplicated) pregnancies. However, in the unusual circumstance where a woman is felt by her physician to be at higher risk of spontaneous abortion, she may be advised to stop working and refrain from having sexual intercourse. Women with past history of premature delivery and other specific obstetrical conditions might fall under this category.

Are there lifestyle factors associated with miscarriage?

Smoking more than 10 cigarettes per day is associated with an increased risk of pregnancy loss, and some studies have even shown that the risk of miscarriage increases with paternal smoking. Other factors, such as alcohol use, fever, use of nonsteroidal anti-inflammatory drugs around the time of embryo implantation, and caffeine use have all been suggested to increase the risk of miscarriage, although more studies are needed to fully clarify any potential risks associated with these factors. Of course, alcohol is a known teratogen (a chemical that can damage the developing fetus), so pregnant women are advised to abstain from drinking alcoholic beverages.

What are the symptoms of a miscarriage?

Cramping and vaginal bleeding are the most common symptoms noticed with spontaneous abortion. The cramping and bleeding may be very mild, moderate, or severe. There is no particular pattern as to how long the symptoms will last.

Vaginal bleeding during early pregnancy is often referred to as a "threatened abortion." The term threatened abortion is used since miscarriage does not always follow vaginal bleeding in early pregnancy, even after repeated episodes or large amounts of bleeding. Studies have shown that most pregnancies with demonstrated fetal cardiac activity that have vaginal bleeding at 7 to 11 weeks of gestation will result in an ongoing pregnancy.

What will the doctor look for during an examination with suspected miscarriage?

A woman's cervix might have some bloody discharge, but nothing else unusual will be characteristic of threatened abortion. Some women will have mild uterine tenderness during the manual examination of the uterus. The doctor may look to see if the cervix is dilated and will check to see if the uterus is enlarged to an extent appropriate for gestational age of the pregnancy.

How is threatened abortion evaluated?

Pelvic ultrasound is used to visualize fetal heartbeat and to determine whether a pregnancy is still viable. The ultrasound examination can also distinguish between intrauterine and ectopic pregnancies. The doctor may also order blood levels of serial human chorionic gonadotrophin (HCG) to help determine the viability of a pregnancy if the ultrasound examination is not conclusive. During the evaluation, the woman may be advised to rest and avoid sexual intercourse (activity).

What are common terms a woman might hear during evaluation for miscarriage?

"Miscarriage" (spontaneous abortion) is termination of pregnancy before the fetus is viable (able to survive).
"Complete abortion" describes spontaneous (not intentionally induced by medication or procedures) passage of all fetal and placental tissue. This is common prior to 12 weeks' gestation.
"Incomplete abortion" is when some, but not all, the fetal and placental tissue is expelled.
"Products of conception" refers to the combination of fetal and placental tissue.
"Threatened abortion" is when a miscarriage does not actually occur, but there is vaginal bleeding from the uterus. The cervix will not be dilated and does not show signs of imminent passage of fetal and placental tissue.
"Missed abortion" describes a fetal death in the uterus prior to viability, but the products of conception are not passed.
A "septic (infectious) abortion" is caused by bacterial infection and accompanied by fever, chills, pain, and a pus-containing discharge.

What treatment can a woman expect when she has had a miscarriage?

The central goal of the doctor in this situation will be to try to figure out whether the woman has passed all of the tissue from the fetus and placenta. If she has passed all the tissue, she may only require observation by medical personnel. On the other hand, a woman who has not passed all of the tissue (incomplete abortion) will usually need suction dilation and curettage (D&C) of the uterus to remove any retained products of the pregnancy. This procedure is done with local anesthesia, and sometimes antibiotics may be prescribed for the woman to prevent infection.

When should a woman receive evaluation for underlying causes of pregnancy loss?

Currently, most practitioners will not initiate an extensive medical evaluation for a single pregnancy loss, because a woman has a high probability of having a normal pregnancy even after two consecutive miscarriages.

Recurrent pregnancy loss (RPL) has been inconsistently defined. When defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period, it affects approximately 1% to 2% of women. Because of the risk of subsequent miscarriages is similar among women that have had 2 versus 3 miscarriages, and the probability of finding a treatble etiology is similar among the two groups, most experts agree there is a role for evaluation after two losses.

For women with recurrent pregnancy loss, an evaluation will focus on the pattern and history of the prior miscarriages. Three consecutive miscarriages would suggest a woman should receive further evaluation.

Thus, the following tests are considered for women with three consecutive miscarriages.

Blood testing can be ordered to identify chromosomal abnormalities in the couple that could be transmitted to the fetus. The couple can each appear completely normal but still carry chromosomal defects, which, when combined, can be lethal to the embryo. This type of testing is called karyotyping, and it is performed on both members of the couple. A hysterosalpingogram (HSG) can identify anatomical abnormalities within the uterus.

Antinuclear antibody, anticardiolipin antibody, VDRL, RPR, and lupus anticoagulant are some of the blood tests used to diagnose autoimmune diseases that can cause recurrent miscarriage.

As described above, some of these illnesses will already by apparent to the woman and her doctor, but not all cases. Other antibody tests may be performed as well.

Can something be done to prevent future miscarriages?

The treatment of recurrent miscarriage depends on what is believed to be the underlying cause. This often is not as simple as it sounds. Careful evaluation may turn up several potential factors which alone or together may be responsible for the pregnancy losses. If a chromosomal problem is found in one or both persons, then counseling as to future risks is the only option for the couple, since there is currently no method to correct genetic problems.

If a structural problem is encountered with the uterus, surgical correction could be contemplated. It should be emphasized that just because a structural abnormality is found, it does not necessarily mean that it caused the miscarriage. Removal of a fibroid or uterine septum does not guarantee a future successful pregnancy, since the fibroid or uterine septum may not have been the cause of miscarriage in the first place.

Adequate control of diabetes and thyroid disease is critical in trying to prevent recurrent pregnancy loss in women with those conditions. For women with immunologic problems, such as such as systemic lupus erythematosus and antiphospholipid antibody syndrome, certain medications are being studied that may be useful in achieving successful pregnancy outcomes. Blood thinners such as aspirin and heparin can, in some cases, prevent further pregnancy loss.

The use of progesterone to increase the blood levels of this hormone is sometimes used for patients with recurrent pregnancy loss, although large-scale controlled studies that confirm the utility of progesterone supplementation have not been carried out. However, many physicians report success with progesterone therapy. Progesterone may be given as vaginal suppositories, or in tablet or gel form.

In dealing with recurrent pregnancy loss, it is important to realize that even though apparently obvious problems can be corrected, a miscarriage can still occur. This is not to say that attempts should not be taken to correct identified abnormalities that have been historically associated with miscarriage. However, no treatment can be guaranteed. Even with repeated miscarriages, there is still a very good chance of achieving a successful pregnancy. Early pregnancy and pre-pregnancy counseling can help identify risk factors and allow the practitioner to provide any special care that may be needed.

source:medicinenet.com