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Primary & Secondary Prevention

By admin on June 10th, 2009

In medical parlance, Primary Prevention means doing things to prevent ever getting a disease, whileSecondary Prevention means keeping a watchful eye for the first signs and symptoms of disease, to catch it early when chances for cure are greatest. Regarding cancer prevention, a combination of both of these strategies is advocated. The precise degree of how much prevention strategy is appropriate will depend on the the person’s “pre-prevention likelihood” of getting a particular cancer. Thus, if breast cancer runs in the family, it is more important to be vigilant in preventing it than if no cases have occured in the family. It obviously makes no sense for a man to take steps to prevent cervical cancer, or a woman penile cancer or even a male child prostate cancer, since the “pre-prevention likelihood” of these diseases is zero. There is little justification is performing rectal exams on symptomless children to look for rectal cancer, since the disease is vanishingly rare in them. Common sense is key! 

Examples of Primary Prevention include:

1) Avoiding Excess Carcinogens- Cigarette smoking causes the same yearly illness that would occur if one nuclear reactor underwent a complete meltdown in every major city every 4 months! (From Manual of Clinical Oncology 3rd ed.) Again, while a rare puff on a cigar or pipe is unlikely to be harmful to health, the practice of daily smoking (or being in close proximity of heavy smokers) carries danger for cancer, heart disease, emphysema, visual deterioration, ear damage in children, and stunted fetal growth if women smoke while pregnant. Also, since tobacco is high in radioactive Polonium, it can cause cancer by this mechanism. Avoiding frequent marijuana smoking is also important to reduce risk of cancer to the mouth, lungs and and voicebox (“larynx”). While one or two 4 ounce glasses of red wine per day may be beneficial in lowering heart disease risk and alleviating stress, excess hard liquor consump- tion (more than one shot per day) raises digestive cancer risk, especially if one also smokes tobacco. Esophagus, liver and pancreas cancer are particularly raised with heavy liquor consumption; 25% of patients who develop cancer of the mouth area will ultimately develop another cancer (“metachronous”) else- where in the respiratory or digestive tracts. About 10% will have another cancer (“simultaneous”) found at the time of their initial evaluation! Dietary fat has been a controversial area regarding cancer development. The newer studies (1999) have disclaimed the old dogma that high fat (over 30% fat in the diet) itself is a major increasor of breast and colon cancer. This was initially based on the theories that fat consumption raises harmful free radicals, and that it slows the movement of stool through the digestive tract allowing more “contact time” between other possible dietary carcinogens (like soot and nitrites) and the bowel wall. While this has been mostly disproven, people who eat lots of fat also tend to eat less fresh fruits and vegetables, and get less fiber. These help reduce free radicals (see below) and also help keep the bowel walls clean. It makes sense for a prudent person to eat a well balanced diet, but not to be fanatical about avoiding dietary fat. After all, it is fat (not sugar!) that makes our diet taste smooth, soft and palatable. We want to avoid excessive burnt foods, pickled foods high in nitrites, and artificial flavors and dyes. This does not mean such foods should never be eaten; merely that they should not be a staple. It is advisable to well wash plant foods to help remove organophosphate pesticides and herbicides that may be linked to increased lymphoma risk. Flushing out our body and bladder with 6 to 8 glasses of water a day halves bladder cancer risk!

2) Vitamins and “Antioxidants”- These are much in vogue in the prevention and popular health magazines. Scientific research has shown we all need to get enough vitamin A and E. These are thought to “scavenge” free radicals that normally accumulate in cells, especially as they age. Recall that these chemicals are thought to damage DNA and increase mutation and cancer risk. Excess vitamin A is poisonous, leading to liver damage, dizziness and senility. It is very important to get enough vitamin C to help cartilage production; however too much is damaging by making the blood too acidic (“ascorbic acidemia”). Vitamin D is necessary for proper bone growth and calcium metabolism, and the B vitamins are crucial for making the insulation material (“myelin”) which surrounds nerves. The “fat soluble” vitamins are A, D, E and K, which is made by intestinal bacteria and necessary for proper blood clotting. Vitamins B and C are “water soluble” so easily flushed out in the urine; they must be constantly replaced. Excess vitamins B and E are less toxic than excesses of other types. Nonetheless, unless a person has a documented deficiency of any of these and is under medical instruction, vitamins should only be taken in moderation. In general, vitamins act as “co-factors” for chemical reactions in the body, but in themselves are not sufficient. We also need to take in carbohydrates, protein, some fat, water, and trace minerals (like chromium, magnesium, and nickel) for vitamins to be absorbed and effective. Standard vitamin pills like Centrum, One- A-Day and Geritol provide these essential trace minerals. Interestingly, we can help prevent certain squamous cells cancers (e.g. of the mouth or vulva) in those predisposed to them by prescribing topical vitamin A (“Tretinoin”) which is known as the popular anti-wrinkle cream. This is called “chemoprophylaxis” and must be done under strict medical supervision. It cannot be used in pregnancy owing to increased risk for birth defects. In some patients with internal cancers, this vitamin A derivative can be given as pills (“Accutane”); this is more risky for side- effects like body swelling and liver damage. Also, Hairy Cell leukemia often will respond to this drug, and new derivatives are being developed for other cancers. Anti-oxidants are an exciting are of research, they are not yet proven to prevent or cure cancer. However, as mentioned vitamins A and E are thought to work (in part) by an anti-oxidant strategy, accounting for there protective effects against aero-digestive tract and other squamous cancers. Free radicals are thought to be a key factor in cell aging and DNA mutation. Normally, we have a mechanism within cells to help scavenge excess free radicals, called the “glutathione reduc- tase” system. This enzyme is lacking (by heredity) in certain people, who seem to have more rapid cellular aging. Glutathione is a sulfur-based enzyme within the cell that looks for free radicals floating in the cellular fluid (“cytoplasm”) and “reduces” them chemically to a harmless state. Interestingly, sulfur-based drugs have been developed as “radioprotectants” to help protect against the damaging effects of cosmic radiation; astronauts carry these on space missions in case of solar flares. Patients who have Glutathione deficiencies have fragile and easily bursting blood cells; the compounds apparently help strengthen cell membranes. A new type of broccoli has recently been developed at Johns Hopkins that has over 20 times the amount of SGA (sulforaphane glucosinolate), you can seen the prominent sulfur base of this compound which scavenges free radicals. It is to be sold under the name “Brocco Sprouts”; it is the first food ever grown specifically to prevent malignancy. Tablets of “SuperOxide Dismutase” are available in Health Food stores, this dietary supplement putatively helps capture excess Free Radical molecules. Tomatoes are high in “Lycopenes” which are thought to help prevent prostate cancer, and possibly other types. Certainly a salad a day may be helpful in preventing cancer, and Alternative Health writings mention many more foods. 

3) Avoiding Excess Radiation is always advisable given the strong mutagenic capability of ionizing radiation, and the DNA damaging capability of Ultraviolet rays from the sun. We avoid unnecessary medical exposures from X-rays unless they can be justified as their benefits outweighing their risks. Over time, living at high elevations or in areas with high natural background radiation may raise risk, although this has never been proven by any study. It is important to check base- ments for Radon leaks, especially in the Midwest U.S.A. and properly vent the basement if these are detected. It is advisable not to sleep in basements in areas with high Radon levels. Tobacco smoke is high in radioactive Polonium, and is another reason why frequent smoking should be avoided. It is prudent, although not of proven danger, to not live very close by power plants or power distribution junctions, especially if there are young children in the home. Electromagnetic fields from power plants, coal emissions (which can have radioactive isotopes), and slow nuclear power plant emissions are all good reasons to avoid living by these generators. The most common type of clearly damaging radiation is from the sun’s Ultraviolet (UV) rays; exposure is directly related to most skin cancer cases. One should avoid whole body exposure to strong sunlight, and use an SPF (“Solar Protectant Factor”) sunscreen rated at least 20. This is especially important for children or those of fair complexion. Recall that excess tanning is is also associated with decreased general immunity and internal cancers too. 

4) Avoiding Industrial Exposures can mean balancing income prospects with safety considerations. An Occupational Safety and Health Administration (OSHA) in the U.S.A. helps prevent debacles seen in the past, like rampant lung cancer in unprotected talc factory workers and leukemias in power plant workers. Recall that while merely living by power lines or plants remains unproven as a cause for malignancy, cancer rates are definitely higher for actual workers in these plants. Workers in the petroleum and organic chemical industries have higher rates of bladder, lung and skin cancers. Pipefitters and Shipbuilders exposed to asbestos have much higher rates of lung cancer, especially if they also smoke cigarettes. Agricultural workers exposed to herbicides and pesticides have higher leukemia and non-Hodgkin’s lymphoma rates. Many examples were given earlier, and the OSHA has done much to help correct this is America. There is an interesting rule of “diminishing returns” in spending money to improve safety. It has been found that 90% of improved safety can be attributed to the first 10% of money spent, and that spending ten times as much will still not completely eliminate the remaining 10% of risk! It is important to try to work in a fundamentally safe industry, and if one must work in a more dangerous vocation, to minimize collateral risks (like tobacco and excess alcohol) to help ensure overall well-being.

5) Regular Exercise and stress reduction are crucial in preventing heart attacks, strokes, obesity, adult onset diabetes, infections, bone density loss, cancer, and other health problems. Exercising to target levels (heart rate of 200 minus age in years) for at least 20 minutes at least three times per weeks is sufficient to confer great health benefits. Among these is immune system stimulation; it is ultimately the immune system which detects and destroys fledgling or residual cancers.

Again, Secondary Prevention is looking for the first signs of a fledgling cancer, and this can either be accomplished by the patient themselves seeing something concerning, this is called “Self Exam”. They can also undergo standard “Screening Tests” as appropriate. While no particular symptom proves cancer (only analyzing a tissue specimen can) there are “warning signs” that should motivate a person to see their doctor, either for cancer or another possible disease. This is especially true if the person it at increased risk for cancer (as described above). For instance, a heavy smoker develops a chronic cough,
or if someone who’s mother died of breast cancer notices a new breast lump, they shouldn’t delay in seeking treatment. Delay in getting diagnosed and treated is the leading reason for cancer deaths, since the majority of cancers can be cured if caught early enough! The “ten warning signs of cancer” listed below are all more likely to be caused by some non-cancerous medical condition, but they all militate for a medical checkup to confirm or deny a possible cancer.

This is just an excerpt from our Complete Cancer Treatment Transcript. Much more, including latest treatments, can be sent to you by email when you order the complete transcript at a nominal cost.



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Vulvar Cancer

By admin on June 10th, 2009

What is the Vulva?

The vulva is the external female genital organ composed of 3 portions- the “Labia Majora,” “Labia Minora,” and “Clitoris.” The skin between the vagina and anus (“Perineum”) is considered an extension of the vulva. The urethral opening for urination is close to the clitoris, in the upper vulvarregion. Thus, the vulva is the vaginal “lips” and surrounding area. A cancer of the vulva is not considered “vaginal” cancer, since it arises outside of the vagina proper and behaves differently, tending to spread to different areas. There is a system of draining channels (“lymph channels”) to drain blood serum from the vulva. The drained blood serum is purified by glands (“lymph nodes”), which are normally pea-sized but swell (“lymphadenopathy”) when invaded by infection or cancer. Specifically, the vulva usually drains first to lymph nodes in either upper thigh (“inguinal nodes”), it afterward may drain to lymph nodes in the pelvis proper (“pelvic nodes”). These pelvic nodes then interconnect (via lymph channels) to those in the abdomen (“paraaortic nodes”); the filtered blood serum is finally rejoins the bloodstream above the level of the heart (via the “left thoracic duct”). The lymph glands, which are normally filled with White Blood Cells, are important as they can act as a conduit for the spread of infections or cancer . Initially, at least, disease of the right half or the vulva spreads to the right inguinal nodes, and that of the left vulva to left inguinal nodes. A cancer is the midportion of the vulva spreads equally to both right and left inguinal nodes. There is some “interconnection” between the right and left lymph nodes, so this rule is not steadfast, but it is useful “clinically” to doctors. Furthermore, the vulva has a rich blood supply and venous drainage, which can also promote spread of disease to anywhere in the body. However, this distant spread tends to occur only long after the areas(“regional”) lymph nodes are involved. The vulva can be removed (“vulvectomy”) which interferes with sexual function, but it is not considered a “vital organ” (necessary to live).

What is Vulvar Cancer?

The vulva is composed of various “cells,” which are intricately combined together into “tissues” which form the “organ” . The vulva contains fat, muscle and skin cells. These cells divide to produce new ones, and grow very rapidly during womb life, early childhood and puberty. In adulthood, new cells are produced only to replace those that die of old age, injury or disease. Normally, division of cells is under very tight control. This control is exerted by the “genes” inside each cell, which are housed in long clumps forming“chromosomes,” which are visible under a light microscope. The genes themselves are made up ofDNA, the master genetic code material. If the genes are damaged, say by chemicals or radiation, the control over cell division may be lost in one particular cell. Ultimately, cancer is considered a disease of the DNA. Vulvar cancer starts in a single cell . That cell starts dividing haphazardly, making millions and billions of copies of itself. It takes up the nourishment needed by other cells, depriving them so the cancer can continue to grow. Quickly growing cells can clump up to form a “tumor” . A tumor simply means a swelling, it can be caused by inflammation or infection. A “benign” tumor only grows in it’s local area (although it may get quite large)– it cannot spread and is not cancer. By contrast, a tumor which can spread to other body areas is called “malignant” and this is cancer . The process of cancer spread to other areas is called “metastasis,” so only malignant tumors (i.e. cancer) can metastasize. Theoretically, cancer can spread to any area of the body, and it often grows better in it’s area of spread than in it’s area of origin (“primary site”) . It is this capacity for spread that makes cancer so dangerous. If not treated successfully, vulvar cancer ultimately kills by urinary blockage, debility, anemia, infection, and damage to distant organs like the liver and brain.

How Does Vulvar Cancer Spread?

The most common area for vulvar cancer to start is on the Labia Majora, it is three times more common here than on the Labia Minora. Only about 10% of cases initially involve the Clitoris. When a cell turns pre-cancerous, it may start dividing but stay localized for many years, or even many decades. This is called“Vulvar Intraepithelial Neoplasia (“VIN”) . A portion of “VIN” cases progress to“Carcinoma in Situ” (“CIS”), which is technically the first stage of actual cancer. Only about 5% of VIN cases progress all the way to“Invasive Cancer,” but we don’t know in advance which ones will or won’t. Once Invasive Cancer manifests, it tends to grow for month to years in it’s local area. It then spreads to the Inguinal lymph nodes(“lymphogenously”), usually to one side first. Then it spreads to deep pelvic lymph nodes. Only 4% of patients have pelvic lymph nodes involved(“positive”) in the absence of Inguinal lymph node involvement. The cancer may then track up through the lymph channels to invade Paraaortic lymph nodes in the abdomen. It continue to grow locally to invade the skin, urethra, bladder, perineum, rectum, and pelvic bone . It tends to spread through the bloodstream (“hematogenously”) only late in the disease, mostly to the liver, lung, bone and brain.

How Common is Vulvar Cancer?

There are about 3200 new cases of invasive vulvar cancer each year in the U.S.A., it accounts for1200 deaths annually. Vulvar cancer represents 4% of the total cancers involving the female genital tract (“gynecologic malignancies”). Overall, gynecologic malignancies account for 13% of new cancer cases in American women. Patients with the precancerous VIN condition have are an average of 44 years old. Frank cancer (but not VIN) is rare before age 50, and the average patient is 61 years old. The overall incidence (number of new cases annually) of vulvar cancer is steady. Over 90% of cases are “Squamous Cell Carcinoma,” which originates from the “epithelial” (skin and lining cells) of the vulva (the ones overlying the fat and muscle). About 7% of cases are“Melanoma,” arising from“melanocyte” pigment cells; this has more predilection for spread in the bloodstream.“Paget’s Disease of the Vulva” is a pre-cancerous condition showing on the vulvar skin a red and velvety area, it has an underlying “invasive cancer” in about 2% of cases. Paget’s is a “marker” for the development of another gynecological malignancy (e.g. cervix or uterine cancer) which eventually occurs in 25% of patients with it. “Bartholin’s Gland Cancer” is an “adenocarcinoma” (arises from gland cells) seen exclusively in post-menopausal women (over about age 50) it makes up less than 1% of vulvar cancer cases. Other rare possibilities are“Sarcoma” (from the underlying muscle or fat), “Lymphoma” (from the immune cells in the vulva) or“Basal Carcinoma” (a skin cancer) The treatment for these follows that in other body areas where they are more common.

What Causes, or Increases the Risk for Vulvar Cancer?

As for any cancer, the exact reason why one woman gets vulvar cancer and another does not remains unknown. However, these “risk factors” are often present:

1) Vulvar Intraepithelial Neoplasia (VIN) or Carcinoma in Situ (CIS) may exist for several decades before manifesting as Invasive Cancer, which they only go on to less in less than 5% of patients.
2) Viruses of the Genital Tract — Specifically Human Papillomavirus (“HPV”) which causes genital warts (“condyloma acuminatum”). Around 5% of patients with vulvar cancer have genital warts. Also Herpes Simplex II is also associated with VIN and later Invasive Cancer. These viruses are sexually transmitted(“STD’s”) .
3) Nulliparity means never having had children, about 25% of American women are “nulliparous.” This is a risk factor for breast, uterus, and ovarian cancer too. Menopause at an early age (i.e. the mid 40′s) has a higher risk also.
4) Lower Socioeconomic Status means being poor, especially as a member of a generally poorer group (Blacks, Hispanics, Native Americans). Some feel that the higher incidence is explained by more promiscuity in these groups (more chance of getting a Sexually Transmitted Disease from multiple male partners). It is probable that the poor don’t get medical attention until the disease is further advanced, and have other medical problems associated with this cancer.
5) Other Medical Problems associated with vulvar cancer include being obese, having high blood pressure, heart disease, diabetes, and kidney problems. All of these conditions are related to each other. 
6) Occupation and Environmental Exposure — Women who worked in the Laundry or Custodian (cleaning) Industries have a greater risk, reason unknown.

What are the Symptoms of Vulvar Cancer?

Very early vulvar cancer has no symptoms, as it is too small to cause problems.
1) A Lump or Bump (“Mass”) on the vulva is the most common first sign, it can become a sore(“lesion”) which will not heal and grows slowly over months.
2) Itching (“Pruritis”) and Pain will occur as the cancer grows in it’s local area.
3) Bleeding will occur as the cancer breaks through the skin. It may be scant.
4) Lymph Gland Swelling (“lymphadenopathy”) in the pelvis; this does not prove that the glands are involved since infection will also swell them. On the other hand, non-swollen glands may still be microscopically involved with cancer.
5) Urinary and Bowel Problems can occur as the cancer invades the urethra, bladder and rectum respectively.
6) Signs of Distant Spread include back pain (from spread to para-aortic lymph nodes), bone pain from spread there, or nervous system problems from brain spread. Vulvar cancer tends to grow large in it’s local area prior to spreading.
***20% of patients have no previous symptoms when their disease is detected.

Is Vulvar Cancer Preventable?

There is no sure way of preventing vulvar cancer . Being careful to avoid getting a Sexually Transmitted Disease will lower the risk, as will good vulvar hygiene. If a woman has the risk factors for this disease, she should be especially vigilant about doing vulvar“self-exam” on a monthly basis to look for any new suspicious areas, and bring them to a doctor’s attention without delay.

The vulva is the genital organ area between the vagina and upper thighs in a women. The vulva includes the mound of tissue on pelvic surface (mons), the vaginal lips (labia), and clitoris. Infections of the vulva, including sexually transmitted diseases, are the main problems women have with this area.Rarely, the vulva gets cancer. It is critical to get prompt diagnosis and proper treatment of a vulvar cancer problem; this can literally make the difference between life and death. In the past, radical and mutilating surgery was all that could be done, and it was often unsuccessful. Fortunately, improved treatments are now available which often maintain sexual function and give better survival than ever before. Understanding your options will give you the peace-of-mind of knowing you have done everything possible to ensure a successful outcome for yourself or a loved one.

CancerAnswersÕs material explains, in plain English, the definition, types, risk factors, frequency, evaluation, historical and latest effective treatments for vulvar cancer. We describe surgery, radiation, and chemotherapy along with their side-effects and results. While we don’t promise a cure, we tell you everything you need to know to help you make the right choices today in dealing with a vulvar cancer problem.

This is just an excerpt from our Complete Cancer Treatment Transcript. Much more, including latest treatments, can be sent to you by email when you order the complete transcript at a nominal cost.