Directory of health resources for healthcare professionals.

Cancer patients have vitamin deficiencies (in particular, folic acid, vitamin C, and pyridoxine) as well as other nutritional deficiencies.200 There have been a number of studies of patients with proven cancer who are being treated with vitamin therapy alone. Many of these vitamin-therapy studies have recently been reviewed by Bertino, who concludes that such treatment is without proven benefit to the cancer patient—and I agree with him. The cancer patient should be thoroughly worked up by an oncology specialist. I am advocating simple common sense: an apparently healthy person should take steps to avoid or eliminate risk factors that could potentially cause cancer and atherosclerosis. This includes eating the right foods and taking the right amount of those vitamins and minerals shown to have anticancer and antioxidant effects, and shown to be needed for the immune system to function well. By eliminating all known risk factors of cancer and atherosclerosis and practicing good nutrition supplemented with vitamins and minerals, your overall risk of developing cancer or atherosclerosis will be kept to a minimum.Richard S. Schweiker, then Secretary of Health and Human Services, said in a policy statement given at a symposium on cancer research at Rockefeller University that he and the Reagan Administration endorse the research focus on cancer prophylaxis and the protective potential of vitamins and trace minerals in both normal and high-risk populations. As reported by the Medical Tribune on June 30, 1982, he said that enough new data have emerged in recent basic, clinical, and epidemiological studies to justify support for the hypothesis that micronutrients may prevent the initiation or development of cancer. The National Cancer Institute in Bethesda, Maryland, has allocated several million dollars for this purpose.Schweiker stated, “This new strategy holds promise for reducing the incidence of cancer more successfully than an attempt to remove from the environment all substances which may initiate the cancer process—an approach which is not always possible or practical.” In addition, he said that laboratory studies of vitamin A precursors, vitamins С and E, selenium, and certain chemicals demonstrate that these “act as preventive agents.”I recommend taking the combination of vitamins and minerals in Table 6.8 as a food supplement. These nutrients could be taken daily unless otherwise specified by your physician. Pregnant or lactating women should not follow this program unless it has been approved by their physician. The formula for younger children is also shown.*37\360\2*

The time between diagnosis and surgery or the start of treatment can often seem like the longest period of a lifetime. The news of a cancer diagnosis wreaks mayhem with our usually routine and ordered minds, and often women are poorly physically, emotionally and psychologically prepared to start the process of recovery. Thinking through the important issues that have to be dealt with over the next two to three months, and planning the practical issues that need to be dealt with will often ease the worry and allow you to focus on the process of healing body and mind and getting totally well again.
For many, this will be a mammoth task that will require the help of others. It is really important at this stage to surround yourself with people you trust. These might include your doctor, carer, partner or someone you have identified among your networks that is prepared to be your key support person. But whilst we trust these people, we need to identify what the primary role of each will be.
For instance, the doctor’s role would be to lead the medical treatment program; your partner or carer, to attend appointments with you and clarify questions and emotionally connect with you; the key support person may look after the practical aspects of household and professional needs.
Reflect on what is the most important priority in your life, not anybody else’s life; not even your loved one’s life. Your life. For most it will be to continue living a full and healthy normal life after the tumour has gone. The challenge is, then ‘How will I achieve this?’ Thinking through what the most important issues are that need to be dealt with, and knowing the rest does not really matter is a start for many. Many will map out a plan from ideas presented in this book, and put things in order beforehand.
*18/144/5*

Fallopian Tube Cancer
Fallopian tube cancers usually present in a similar fashion to cancers of the ovary and may be indistinguishable at the time of surgery. In other words, the symptoms responsible for presentation again are non-specific and are outlined above.
The aims of surgery are identical and chemotherapy following surgery is always undertaken.
The cure rate for fallopian tube cancer is similar to that of ovarian cancer.

Tumours of the Placenta
Tumours of the placenta usually present with abnormal bleeding in early pregnancy and the diagnosis is made on ultrasound.
It was my third pregnancy after a full term pregnancy two and a half years before, and a miscarriage. I had no bleeding but was very large for my stage of pregnancy.
I also felt extremely nauseated and extremely tired. The diagnosis of ‘no fetus’ at the tenth week and six months later, of a malignancy requiring chemotherapy came as a huge shock, as my obstetrician had underplayed the incidence of Trophoblast disease.
Clara
There are two premalignant tumours of the placenta seen in early pregnancy . . . complete hydatidiform mole and partial hydatidiform mole. In the complete type, a fetus does not develop. The afterbirth becomes abnormal with the capability of invading the muscle of the womb and/or invading into blood vessels and spreading elsewhere, usually the lungs or top of the vagina. With a partial molar pregnancy, the chance of this happening is present but very rare, perhaps less than 1/1000.
Complete hydatidiform mole in almost all cases only contains chromosomes from the father, whereas with a partial molar pregnancy, there is an extra set of chromosomes.
When a diagnosis of hydatidiform mole is made then a chest x ray is done since this is the most common site of spread of invasive moles and the pregnancy removed by ‘suction curettage’ … A general anesthetic is given and the cervix opened; a plastic tube is then introduced into the womb cavity and the tissue removed.
Once the diagnosis of complete mole is confirmed, then the woman is followed up by measuring the pregnancy hormone either in the blood or urine. If the molar pregnancy continues to grow then the pregnancy hormone (‘HCG’) will rise and chemotherapy commence.
If a partial molar pregnancy is confirmed then a follow up with blood or urine tests are done in some centers but not in others since problems are so rare.
If a cancer occurs following delivery then this is a ‘choriocarcinoma. This is a serious condition, but with chemotherapy the cure rate is very high. Kate who had this condition survived extensive treatment and is living a very fulfilling and healthy life.
Cure rates approximating 100% are now possible in women following a rising hormone level after a hydatidiform mole. The cure rate for choriocarcinoma is also very high.
*17/144/5*

Sarah is 36 years old, married, with two children aged 11 and 12.

Two and a half years ago, she was relaxing after a bath when she felt a lump in the upper part of her breast. Although she was not very concerned about it, she went to see her doctor the following day. Sarah’s G.P agreed that the lump was probably nothing to worry about, and was likely to be related to the fact that her period was soon due. She suggested Sarah return a week later. As the lump was still there the following week, Sarah was referred to a consultant.

There was some delay in arranging an appointment with the consultant, and Sarah was eventually seen by a hospital doctor about 4 weeks later. The doctor did a needle biopsy to remove some cells from the lump, and Sarah returned the following week for the results of this test. Unfortunately, the biopsy had failed to provide any conclusive evidence about the nature of the lump, apart from indicating that it was not a cyst and contained no fluid. Another needle biopsy was done and another appointment made for the following week. This time she saw the consultant, who told her that the second needle biopsy had also failed to provide any useful information. He then did a Tru-Cut biopsy to remove a piece of tissue from the lump. Sarah was due to return to the hospital to receive the results of this biopsy a week later, but in the meantime the consultant rang her to suggest that she should take a suitcase with her to her next appointment as, whatever the results of the biopsy, he felt that the lump should be removed.

It was only then that Sarah began to feel concerned about the possibility that the lump could be cancer.

At her next clinic visit, Sarah and her husband learned that the tissue biopsy had revealed cancer, and the consultant asked if she would like to go home for a few days to consider whether she would prefer to have a lumpectomy or a mastectomy. He himself was in favour of a mastectomy, and they all agreed that she should have this operation the following day.

The breast care nurse took Sarah and her husband to the ward and explained to them what was going to happen.

The next morning, Sarah’s breast was removed, together with several lymph glands from under her arm. The lump was between 2 and 3 cm in width (about 1 inch). She was in hospital for about 4 days, and before she left she was fitted by the breast care nurse with a temporary soft prosthesis to put in her bra. While she was in hospital, a physiotherapist also showed her how to do some exercises to help her regain the movement in her arm.

She felt shocked and exhausted for the first few days she was at home. Her wound was quite painful for several days, but regular painkillers helped. She was given sleeping tablets which she took for the next 10 nights, while awaiting her follow-up appointment with the consultant. When she returned to the clinic, she was told there had been no evidence of spread of the cancer beyond her breast, and she would not need to have further treatment.

About 10 days after her operation, the stitches were removed from Sarah’s wound at her local health centre, and 4 weeks after her mastectomy, she was fitted with a permanent external silicone prosthesis.

A few weeks later, having watched a television programme about cancer, Sarah developed a fear of her breast cancer recurring. During the next few months she had a bone scan after developing back ache and headaches, as well as a variety of other tests to investigate the causes of various aches and pains. About 3 months after her operation, she started having dizzy spells and her doctor, who felt that anxiety could be the cause of some of Sarah’s problems, started her on anti-depressants. She continued taking the anti-depressants for about a year, gradually stopping when she felt better able to cope.

Sarah had a great deal of support from her breast care nurse, as well as from her GP and consultant, all of whom took her worries seriously. She also saw a counselor for a while when her anxiety was becoming difficult for her to deal with. However, for 18 months after her operation, every ache or pain Sarah suffered added to her terror of the cancer returning. She feels that it has taken her about two and a half years to recover completely psychologically, although it was only about 4 to 6 weeks before she had recovered physically from the operation. She now feels able to live her life without constantly thinking about what she will do if the cancer recurs, and has decided to face any problems if and when they arise.

Her breast care nurse arranged for pockets to be sewn into her bras (and her swimsuit) following an embarrassing experience at her daughter’s sports day. She did try an adhesive prosthesis, but found the strips that stick to the skin, and to which the prosthesis itself attaches, uncomfortable.

Sarah returned to her consultant for check-ups every 3 months to begin with, and then every 6 and she will now see him once a year. She wishes that there was some test that could be done so that she could be told categorically that there is no more cancer in her body, but realizes that this is not possible. Since her operation, she examines herself regularly to check for any breast abnormality.

Sarah and her husband have not told their children that she has had breast cancer, only that she had to have a lump removed from her breast. They will do so when they feel their daughters are old enough to cope with this knowledge.

*71/39/5*