CANCER IN FEMALE REPRODUCTIVE ORGANS: UTERUS CANCER

June 1, 2011

The main function of the body of the uterus is to provide a suitable environment for a growing embryo and fetus. Under the influence of a huge increase in the amount of oestrogen and progesterone the uterus grows from an organ of approximately 7-8 cm long in the non-pregnant stage, to an organ that reaches from the floor of the pelvis to the diaphragm when carrying a fetus. It surely is one of the miracles of nature that this hugely increased size goes back to normal within a week or two following delivery of the baby!
Cancer of the Uterine LiningCancer of the body of the uterus can develop in the lining of the uterus (‘endometrium’) or in the muscle (‘myometrium’.) Endometrial cancer is the most common gynecological cancer in women worldwide. There seems to be two types of cancers that can affect the uterine lining. The first – being the more common and found in up to 70% of cases – is due to an excess of oestrogen or to oestrogen which is not balanced by progesterone which takes place when ovulation does not occur. The second type, which is oestrogen independent, is much more aggressive and spreads more commonly to lymph glands and elsewhere.Type I Endometrial Cancer (a cancer that affects the lining of the uterus) occurs particularly in women who are overweight. Over 80% of endometrial cancers occur in women who have entered the menopause.When the ovaries eventually give up growing follicles and producing eggs at menopause, the amount of oestrogen and progesterone falls to between one-tenth and one-twentieth of that seen in younger women. Furthermore, the oestrogen in the menopause is ‘oestrone’ which is much less powerful than the oestrogen produced by the pre-menopausal ovary. The source of this oestrone in women following menopause is mainly from body fat. The body fat converts prehormones, particularly male hormones, into oestrone. Therefore the more fat a woman has, and then the more conversion of these hormones to oestrone takes place. So that, if a woman is double her ideal body weight, she produces more than double the amount of oestrogen. Since there is little or no progesterone around to counteract this oestrogen, then the oestrogen acts on the lining of the uterus to cause it to grow, to become thicker (‘hyperplasia’) and to eventually develop a cancer. These cancers are usually similar when seen under the microscope to the normal lining of the uterus and only in about 10% of cases do they invade deeply into the muscle.The other causes of this excess oestrogen situation include tumours of the ovary; taking oestrogen for hormone replacement without the addition of progesterone, and diabetes mellitus – in which more of the precursors are converted to oestrogen. The use of Tamoxifen, although an anti-oestrogen commonly used in breast cancer, also has paradoxically oestrogen-like effects on the uterine lining and doubles the risk of uterine cancer developing.The second type of uterine cancer, when seen under the microscope looks quite different to the normal uterine lining. These cancers, which may be confusing to understand, but which doctors may refer to as ‘poorly differentiated cancers’, ‘papillary serous cancers’, ‘adenosquamous cancers’, and ‘clear cell cancers’ can spread very rapidly, and often invade deeply into the muscle or spread outside the uterus. These Type 2 cancers are stimulated by abnormalities in the genes that control the growth of the uterine lining, but what causes these gene changes is currently unknown.*1/144/5*

YOUR CANCER YOUR LIFE – RIGHT TO HAVE QUESTIONS ANSWERED (DIFFERENT PATIENTS)

May 12, 2009

Remember that, because every patient is different, and because no one can look with certainty into the future, many of the answers can only be educated guesses—what is average or likely. No one can tell you exactly how you will react to a certain treatment or how long you will live. The best anyone can do is tell you what is likely to happen. It is important to know this, and also to know what could happen if you are not an ‘average’ patient, that is both the best and worst that could happen.

Remember you cannot make the best decisions for yourself without this information. Getting it will not be easy. Most of the answers should come from your practitioner. You can ask other practitioners as well as the first one you see. You will find many of the answers in this book. You can go to a library or bookshop and find other books. You can get information from other patients, other hospital staff, friends, or relatives.

Much of this information will not be offered, you will have to ask and often ask more than once. If you find it hard to push for all the information, some of the following will help.

*5/40/1*

AFTER CANCER: STAYING IN THE MEDICAL SYSTEM. ONCOLOGIST

March 12, 2009

If I Was Treated by an Oncologist, Do I Still Need an Oncologist after Completion of My Treatments?

At least for a while, you need an oncologist to

• oversee your reevaluation

• advise you regarding the appropriateness of stopping treatment •advise you regarding follow-up (which tests and procedures need to be done when, where, and how)

• advise you regarding measures to prevent recurrent or new cancer or other medical problems.

•evaluate and treat any cancer-related and treatment-related complications, aftereffects, or side effects

• evaluate and treat early any future problems that may indicate recurrent problems with your cancer.

Will I Need to Be Followed by an Oncologist for the Rest of My Life?

Depending on your type of cancer and your personal cancer situation, after completion of cancer treatments you may need to be followed by your oncologist for a few more visits, a few more months, a few years, or the rest of your life.

If your oncologist advises that you no longer need to follow up with him or her, you are “dismissed.” This means that you now can do without the expertise of a cancer specialist involved in your routine care. Under these circumstances, your oncologist feels that follow-up with your internist or family practitioner will be just as good. Since you have to see him or her anyway for routine care unrelated to your history of cancer, it will be more convenient for you to see one doctor instead of two. Even if you are dismissed, your oncologist will keep your medical file and be available for questions, problems, or reevaluations at your request or if the need arises.

If you are involved in a clinical trial, you may need to proceed with follow-up with your oncologist for the rest of your life for the sake of monitoring and data collection. This follow-up will be nothing more than an inconvenience.

Can I Switch Oncologists Now?

You can switch doctors at any time. If you feel the need to switch oncologists, now is a good time because

• your treatment is complete

• you need to be reevaluated anyway

•you are about to start a new phase of cancer follow-up

Why Would I Switch Oncologists Now?

There are a number of common reasons why you might feel the need to switch oncologists after completing your cancer treatments:

•Your oncologist is very far from your home.

•Your oncologist does not participate in your insurance plan, and your insurance will not cover your current oncologist’s bills.

•You were not comfortable, confident, or satisfied with your oncologist, despite sincere attempts to make it work during treatment. You can be going to the most famous, well-respected oncologist in the world for your type of cancer. If his or her style or personality makes it difficult for you to communicate your needs, then this oncologist is not the best person to be caring for you.

•You feel that your oncologist is not interested in your care now that your treatment is complete.

*97/32/5*

AFTER CANCER: POSTCANCER FATIGUE (SYMPTOM, CAUSE)

Is Postcancer Fatigue the Same As Chronic Fatigue or Chronic Fatigue Syndrome?

No. Postcancer fatigue is a symptom distinct from chronic fatigue and that seen in chronic fatigue syndrome. “Postcancer fatigue” applies only to weariness that occurs in people in remission following treatment, that is due to the prior cancer or its treatment, and that persists after all treatable causes of fatigue have been ruled out or been corrected.

In contrast, “chronic fatigue” is a term that describes a symptom but conveys nothing about its cause, course, or treatment. “Chronic fatigue syndrome,” still a somewhat controversial concept, is defined not only by its unique symptom complex but also by the supposed causative agents, the usual course it takes, and the treatment.

What Causes Postcancer Fatigue?

Although the exact mechanism remains unknown, the scientific community accepts the view that residual effects of radiation, chemotherapy, or other cancer therapy can cause fatigue long after the completion of treatment. Since the definition of postcancer fatigue demands that all treatable causes of tiredness have been ruled out or corrected, as-yet-unidentified changes or abnormalities are the probable culprits. Three possible causes are

•the circulation of fatigue-causing substances released by dead, dying, or repairing cells

• changes in the parts of the brain that affect energy level, changes caused by prior cancer or treatment

• the residual inefficiency of otherwise normal cells and organs (e.g., muscles may appear normal on examination and with diagnostic tests but may be functioning subnormally as a result of changes on the cellular level, detectable only with sophisticated research technology)

Fatigue is a nonspecific symptom. It is difficult, if not impossible, to determine which of the hard-to-quantify possible causes are playing a role. You may have been treated optimally for depression; yet some residual refractory depression (depression unresponsive to treatment) persists. Or you may have a high risk of recurrent cancer, and chronic subclinical anxiety (it is present, but there is little sign of it) may be contributing to your fatigue. We need further study of the mechanisms of this symptom. The hope is that research will lead to effective means of prevention, detection, and treatment of postcancer fatigue.

*69/32/5*

AFTER CANCER: FEELINGS. READING THE OBITUARIES

What If I Feel Differently about Reading the Obituaries?

If you read the obituaries before your cancer diagnosis, reading them now is just the continuation of an old habit that satisfies certain needs for you. You may find the stories in the obituaries interesting. If you tend to check the age and cause of death, you are satisfying a somewhat morbid curiosity common to many people. It helps some to keep the perspective that life is short and not to be wasted.

If you never read the obituaries before your cancer diagnosis and now catch yourself reading them, it can be an uncomfortable, anxiety-provoking, and embarrassing self-revelation. Reading obituaries is a common behavior after cancer treatment, with many possible roots. Part of you wants to deny your recent brush with a life-threatening disease. To balance your denial and reach a realistic yet comfortable balance, you read the obituaries. This allows the other side of you to reassert that you are mortal and that many people do die of cancer. This process takes place on a subconscious level.

Seeing reports of others’ demise perhaps bolsters your sense of accomplishment when you are feeling low in other areas. “I survived. That is the important thing.” Or perhaps you still find it so hard to grasp the enormity of your cancer experience that you look to the obituaries for some sense of reality. This is similar to looking at the wreckage of a car after an accident, as if by looking at the crumpled metal you could understand the event.

Should I Avoid Reading the Obituaries?

Do not worry about it. Do not give yourself more anxiety by worrying about your behavior. You do not have to control everything. If you feel like reading obituaries, read them. If it bothers you to read them, turn the page. If you dwell on the obituaries and cannot stop thinking about death, get some professional help to sort out your fears and feelings.

*156/32/5*

AFTER CANCER: FEELINGS. DENIAL AND REPRESSION

What Is the Difference between Denial and Repression?

Denial is an abnormal refusal to acknowledge the known truth. If you refuse to believe that there is any reason to have follow-up or if you deny the presence of a new lump, you are said to be in denial.

Repression is the rejection of painful or frightening ideas from conscious thought. You may have a high chance of recurrence, but you are doing well now. You are said to be repressing thoughts of recurrence if, while you are enjoying an activity, you put out of your mind thoughts about potential future problems. You know and accept all the truths, but you do not let yourself think about them all the time.

Many people use the term “denial” when they are really referring to repression.

Is Denial Healthy?

Denial is unhealthy if it keeps you from doing the right thing. Denial that prevents you from taking steps to avoid or minimize problems is harmful. If you were treated for malignant melanoma (a type of skin cancer), and you continue to spend hours in the sun with your skin unprotected, you are denying your vulnerability. Consequently, you are missing one important and easy way to help keep yourself healthy. Using sunscreen does not mean that you are vulnerable and afraid; it means that you are taking control of your situation as much as possible.

Healthy denial can bring you physical and/or emotional comfort in painful or hopeless circumstances. The story of a young woman with aggressive cancer who was deteriorating rapidly illustrates how denial can be healthy. She was bald and jaundiced (yellow from liver failure). She had done everything possible to fight her cancer and had accepted that her death was near. She shared her sadness about dying. The interesting thing was that she always acted as if she looked wonderful, referring to her pretty skin and thick hair. She knew exactly what her situation was, but her physical appearance was so abhorrent to her that her mind protected her. Her denial did not change any of her decisions. It simply shielded her from the pain of acknowledging her physical deterioration and helped her to live fully within the severe constraints of her terminal condition.

Is Repression Healthy?

Repression can be a healthy, adaptive way of dealing with a painful reality. Repression can allow you to take steps to recover or stay healthy, while minimizing the negative impact of these actions.

Fear of recurrence can be a debilitating problem, destroying your quality of life even when things are going well. Understanding and sharing this fear will diminish it, but not make it disappear completely. Repression of any remaining fear will free you to live your life most fully. Effective repression enables you to minimize your fear of recurrence between checkups, but it does not misguide you into believing you no longer need them or can ignore symptoms. Repression allows you to forget when it is safe to forget.

Repression is a dynamic process. When you are due for a checkup or develop a worrisome symptom, you will be less able to repress your fears. Accept the anxiety as part of a mechanism that is working well.

Repression is a healthy way of coping with physical and emotional pain as long as it does not prevent you from doing the right thing.

As you can see, repression and denial can be good or bad, adaptive or maladaptive, depending on how they are used. Repression is not inherently good or bad, any more than a drug is inherently good or bad; it depends on how it is used.

*129/32/5*

AFTER CANCER: VACCINATION. PNEUMONIA SHOT. FLU VACCINE

Why Is the Timing of Vaccination Important?

The timing of the administration of vaccines is important for several reasons:

•Your body must be able to mount an immune response to the vaccine in order for it to be effective. If a vaccine is given too soon after cancer therapy, your body may not mount an effective response.

• It takes a few weeks after vaccination to build up immunity. If you are vaccinated just prior to exposure to the illness, your body may not have had enough time to build an effective immunity.

•The resultant immunity lasts for a specified length of time. For short-lived vaccine-induced immunity, the timing of the administration of the vaccine should be such that your peak immunity will occur at the expected time of exposure to illness. If you are vaccinated too early before exposure, your immunity may have waned and become less effective when you need it.

Do I Need a Pneumonia Shot?

The pneumonia vaccine is a safe and effective vaccine that helps build your immunity to the most common cause of pneumonia, the pneumococcus. You are a candidate for the pneumonia vaccine if you

•are sixty-five or older

• have diabetes

• have chronic lung disease

• have kidney failure

•are taking drugs that suppress your immune system

• have multiple myeloma

If you are in close contact with those who need the pneumonia vaccine (flatmates, children, other close associates) ask your doctor about also getting vaccinated. This will minimize the chance that a contact person will bring the infection to a person at risk.

Receiving the pneumonia vaccine does not guarantee that you will never get pneumonia. It merely offers some protection against the most common cause of pneumonia. You can still develop pneumonia from one of the many other causes of pneumonia not covered by the vaccine.

Do I Need a Flu Vaccine?

In general, it is a good idea to minimize your chance of getting sick, including catching the flu (influenza). After cancer treatment, there are additional physical and emotional benefits to preventing illness such as influenza. If you do not have a history of egg allergy or some other reason for not taking it, you should probably receive the flu vaccine. Discuss with your doctor the risks to you of influenza.

When large numbers of people receive the flu vaccine, it is effective in decreasing the overall incidence and severity of flu in the group. But many factors determine how effective the flu vaccine is for each individual. Taking the flu vaccine does not guarantee that you will not get the flu.

The flu vaccine is given every autumn, around April, to those who need it. It is also available to people who simply hope to avoid the inconvenience of the flu (workers and homemakers for whom a few days “out of commission” would be a hardship).

Flu vaccines protect for only one season. You need to be revaccinated in every year in which you wish to boost your immunity to influenza.

*103/32/5*

Related Posts:

• YOUR CANCER YOUR LIFE – RIGHT TO HAVE QUESTIONS ANSWERED (DIFFERENT PATIENTS)
• AFTER CANCER: STAYING IN THE MEDICAL SYSTEM. ONCOLOGIST
• AFTER CANCER: POSTCANCER FATIGUE (SYMPTOM, CAUSE)
• AFTER CANCER: FEELINGS. READING THE OBITUARIES
• AFTER CANCER: FEELINGS. DENIAL AND REPRESSION