A Family Doctor's Tale - CANCER SCREENING 3

DOC DO I NEED TO GO CANCER SCREENING 3

Cancer Screening:

C. Breast cancer

Breast Cancer is the most common cancer in women.
Women who are at high risk are those with:
1.family history of breast cancer
A gene has been identified which indicates high incidence of breast cancer.


2.family history of other cancers such as ovary and colon


3.women of age 55 years and above

Cancer screening procedures includes:
1.monthly breast self examination(BSE) is recommended for all women from the age of 30 to detect breast lumps which may be early cancer


2.Mammography once every 2 years from the age of 50 years can help to detect breast cancer.


3.Ultrasound of the breasts together with mammogram  also helps in the detection of breast cancer.


4.Blood test-tumor markers such as CEA, CA 125 and CA 15.3 may be raised in cancer of the breast but are not significant in making a diagnosis.

D.Liver Cancer

Liver Cancer is the 4th most common cancer in men in Singapore.


Men are more often 4 times affected than women.


People who are at risk of developing liver cancer are:
1.Chronic hepatitis B carriers and infections


2.Hepatitis C liver cirrhosis and infection


3.Liver cirrhosis from other causes (eg alcohol)

Screening for hepatitis B is recommended for:
1.Healthcare workers because they are exposed to hepatitis patients


2.Pregnant women because the hepatitis infection can spread to her baby at birth


3.Dialysis patients because the fluid or plasma used in dialysis may contain the hepatitis B infection


4.Those people with a history of hepatitis B infection or liver cancer in the family


5.Those people with high risk behaviour having unprotected sex, multiple sex partners, drug addicts who share needles.

Cancer screening procedures includes:
1.Blood test-tumor marker alpha feto-protein level should be done every 3-6 months.


Patients with hepatitis and liver cancer has been found to have raised levels of serum alpha feto-protein.


However patients with germ cell cancers of the testes and ovary also have raised level of alpha feto-protein.

Pregnant women may also have raised alpha feto-protein at certain stage of their pregnancy.

2.Ultrasound of the liver including the gallbladder and bile ducts
should be done every 6 to 12 months.

E.Ovarian Cancer

Ovarian Cancer is the fifth commonest cancer in Singapore and can be potentially fatal if not detected early.

Early ovarian cancer may not have any symptoms and may be undetected unless screening is done.

Women who are at high risk are those with:
1.family history of ovarian cancer


2.abnormal menses

Cancer screening procedures includes:
1.Annual pelvic examination


2.pelvic ultrasound


3.Blood test-tumor markers CA125 and alpha feto-protein level should be done yearly for those with high risk of ovarian tumors

 

A Simple Guide to Hepatitis B

A Simple Guide to Hepatitis B
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What is Hepatitis B?-
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Hepatitis B is a serious chronic inflammatory liver disease caused by a virus which is called hepatitis B virus (HBV).

What are the Symptoms of Hepatitis B?
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Most of the time a person with HBV infection has no symptoms at all.
Older people are more likely to have symptoms.

If you have symptoms, they might include :
1.jaundice (yellowing of the skin and white of eye)

2.dark coloured urine

3.pale stools

4.prolonged tiredness

5.nausea and vomiting.

6.loss of appetite

7.abdominal pain

8.fever and joint pains

How is the diagnosis of Hepatitis made?
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A blood test is the only way to diagnose hepatitis B.
You may be infected with HBV and may even spread it to others without knowing it.

HBV can be spread from an infected mother to her infant during birth.
To prevent spread of HBV from infected mothers to their infants, every woman should have her blood tested for hepatitis B surface antigen (HBsAg) during each pregnancy.

What is the treatment of Hepatitis B?
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There are no medications available for recently acquired (acute) HBV infection. There are antiviral drugs eg interferon which may be able to treat chronic HBV infection.

Who is at risk of getting Hepatitis B?
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For those who has never been immunised or do not have antibodies from having a previous Hepatitis B infection, you are at risk of Hepatitis B infection.

The Hepatitis B virus is is not spread through food or water, sharing eating utensils, breastfeeding, hugging, coughing, sneezing, or skin contact.

HBV is spread by exposure to infected blood from skin puncture or contact with mucous membranes.

It is spread by:
1.sexual contact with an infected person

2.an infected mother to her newborn during childbirth

3.a Hepatitis B infected person's blood during blood transfusion

4.sharing of injection needles among drug abusers

5.accidental cuts to the skin by a nail clipper, shaving blade or other instruments that are contaminated with a Hepatitis B infected person's blood

6.contact with an infected person's saliva or blood through cuts or sores in the mouth or skin. Kissing by itself do not spread HBV unless there is a cut in the lips.

7.during acupuncture, body or ear piercing and tattooing if the needles used are contaminated with Hepatitis B infected person's blood

8.have a job that involves contact with human blood or body fluids

What is the best prevention for Hepatitis B?
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Hepatitis B vaccine is the best prevention against hepatitis B.
If you do not have antibodies from a previous infection and if you are not a Hepatitis B carrier, you can get vaccinated against Hepatitis B and protect yourself from its complications.
Hepatitis B vaccine is recommended for all infants, for children and adolescents who were not vaccinated as infants, and for all unvaccinated adults who are at risk for HBV infection as well as any adult who wants to be protected against HBV infection.
The vaccine is safe.
It is also extremely effective provided you complete all 3 doses:
1st dose - at the appointed date
2nd dose - 1 month after the 1st dose
3rd dose - 5 months after the 2nd dose
A booster vaccination may be necessary after 5 years if the blood test showed a drop in immunity.

Infants born to infected mothers need to get hepatitis B vaccine and another shot call HBIG (hepatitis B immune globulin) soon after birth to prevent infection.

Besides vaccination, other ways to prevent transmission of HBV are:
1.avoid multiple sexual partners; keep to one sexual partner

2.Latex condoms, when used consistently and correctly, may reduce the risk of sexually transmitted HBV transmission.

3.Do not inject illegal drugs. Never share needles, syringes or drugs.

4.Do not share personal items like razors, toothbrushes or any other instruments that may cause tears to the skin and hence spread of any blood borne infection.

5.seek reliable operators for ear or body piercing, tattooing or acupuncture.

What happens if I am a Hepatitis B carrier?
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A simple blood test can tell if you are a carrier, are immune or need immunisation.
If you are found to be a carrier, then:
1.you will need to see your doctor every 6 months to a year for tests to check your liver function and blood alpha-foetoprotein which is a cancer marker for liver cancer

2.your immediate family members should go for blood tests.
They should get immunised if they are not immune.
If they are carriers too, they should go for regular follow up with the doctor.

3.you should take precautions to prevent the spread of hepatitis B to your family and loved ones

4.you should avoid smoking and drinking alcohol as they may further increase the risk of damage to your liver

5.inform your doctor and dentist that you are a carrier

6.do not donate blood, organs or sperm

7.know the symptoms and signs of the various complications and see your doctor at once if you experience any of them.

What are the Complications of Hepatitis B ?
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Hepatitis B can lead to complications like:
1.acute hepatitis (episode of liver inflammation)

2.chronic hepatitis (permanent liver inflammation)

3.liver cirrhosis (permanent scarring and hardening of the liver)

4.liver failure (liver is unable to function,
resulting in toxins accumulating in body)

5.liver cancer

Those who recover completely from Hepatitis B infection become immune to the disease.
1 in 10 people who get infected with the virus become carriers who then carries the Hepatitis B virus permanently in his body.

Hepatitis B carriers seldom show any symptoms but they can:

1.spread the disease to others
2.develop serious liver complications such as those mentioned above.

About 15%-25% of people with chronic HBV infection die prematurely from these complications.

A Simple Guide to Liver Cancer

A Simple Guide to Liver Cancer
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What is Liver Cancer?
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Liver Cancer develops when the liver cells undergo abnormal changes to form cancer cells.
Most Primary cancer of the liver begins as mutated hepatocytes(liver cells).
Secondary cancer of the liver is due to spread from the stomach, colon, breast, lungs, ovaries etc

What is the incidence of Liver Cancer?
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Liver cancer is one of the most common cancer.
It occurs in men more than women.
It is more common in the 40s and 50s age groups.

What are the Risk Factors of Liver Cancer?
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The main risk factor for liver cancer is
1.Hepatitis B infection.

Other important risk factors include
2.Hepatitis C infection

3.alcoholic liver disease (disease of the liver caused by heavy alcohol consumption).

4.family history of liver cancer

5.Chemicals exposures such as nitrites,solvents, hydrocarbons,viny chloride

6.poisons (e.g. aflatoxin present in some spoilt or mouldy peanuts).

7.inherited liver diseases (alpha-1 anti-trypsin deficiency)

8.Drug abuse eg heroin


What are the Signs and Symptoms of Liver Cancer?
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During the early stages, most people with liver cancer do not show any signs or symptoms.
Signs and symptoms, when they do appear, include:

1.loss of appetite and weight

2.discomfort or swelling in the upper part of the abdomen on the right side

3.weakness and fatigue

4.nausea and vomiting

5.jaundice - yellowness of the skin and eyes

6.dark color urine

7.Persistent or swinging fever

How is the Diagnosis of Liver Cancer confirmed?
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1. full medical history especially history of Hepatitis B and alcohol

2. full examination especially of the liver

3.an ultrasound scan of the liver and gallbladder, if possible the whole abdomen.
4.CT scan or MRI of the liver and surrounding tissues


5.blood tests (a protein present in blood called the alpha- fetoprotein or AFP may be found to be raised in liver cancer)

6.needle liver biopsy into the liver swelling as detected by ultrasound or MRI (to confirm the liver cancer).

With the diagnosis confirmed, the doctor will proceed with further tests to find out how advanced the liver cancer is. This will help the doctor to plan the treatment.

What is the Treatment of Liver Cancer?
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As in all cancers, treatment includes surgery, radiation therapy, chemotherapy.

In Liver cancer percutaneous ethanol (alcohol) injection is injected directly into the tumour, by means of a small needle, to kill the cancerous cells.

Liver transplant can also be carried out in selected cases where the size of the cancer is not too massive but surgery is not feasible due to the patient's limited liver reserve(provided a suitable liver donor can be found).

Treatment depends on the the stage of the cancer as well as health of the affected person.

The goal of treatment is complete cure.

However, where this is not possible, treatment is aimed at
preventing the tumour from spreading or growing.
Helping to eliminate uncomfortable symptoms is also an important aspect of liver cancer treatment.

How to Protect yourself from Liver Cancer?
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Prevention from getting liver cancer is by taking steps to reduce your risk factors.

1. Reduce your risk of Hepatitis B by getting vaccinated. The Hepatitis B vaccine is safe and effective.
Both Hepatitis B and C are spread through infected blood or sexual fluids as well as intravenous drug abuse. It is therefore important to avoid activities that put you at risk:

2.Avoid multiple sex partners and having sex with commercial sex workers, strangers or anyone with multiple sex partners.

3.Do not abuse drugs or share injection needles.

4.Never share personal items like razors, toothbrushes or other items that may cause breaks in the skin.

5.Visit only reliable operators for ear/body piercing, tattooing or acupuncture.

6.It is also important that you limit your consumption of alcohol as excessive drinking can give rise to liver disease and increase your risk of liver cancer.

The liver is one of the largest and most important organs in your body. It performs many essential functions including:
making and storing of essential nutrients
making important hormones and enzymes
breaking down harmful substances.

Do not abuse Your LIVER by excessive drinking or taking drugs!