Cancer Care News and Events - Baptist Health System

Twins Tell Their Story of Surviving Prostate Cancer

Tue, 26 Aug 2008 00:00:00 GMT

Randy and Rusty Coward are 46 year old identical twins from Victoria, Texas who recently shared a frightening medical diagnosis. When Rusty was diagnosed with prostate cancer, his brother Randy decided to get checked and found that he too had prostate cancer. The twins both underwent robotic prostatectomies - performed on the same day here in San Antonio at St. Luke's Baptist Hospital by surgeon Naveen Kella, M.D. Robotic surgery for prostate cancer results in smaller incisions and scarring, faster recovery, less blood loss and reduced chance of side effects like incontinence and impotence. Both Randy and Rusty have made complete recoveries.

September is Prostate Cancer Month. The twins wanted to share their story so that other men will know the symptoms of prostate cancer, the importance of getting a PSA test which can detect prostate cancer, and the treatment options like robotic surgery that are available today. For more information call 210-297-7005.

Dr. Naveen Kella is a member in good standing of the medical staff at St. Luke's�Baptist Hospital. Physicians are independent contractors who are neither employees nor agents of St. Luke's Baptist Hospital or of Baptist Health System and, as a result, Baptist Health System is not responsible for the acts of Dr. Naveen Kella in her medical practice.

Breast Cancer Self Exams: Which Lumps Are Normal?

Tue, 22 Apr 2008 00:00:00 GMT

Fibrocystic Breast Changes: Lumps That Are Normal

by Elaine Gottlieb

En Espa�ol (Spanish Version)

Do your breasts feel lumpy? It may be that you're experiencing fibrocystic breast changes-a benign condition that occurs in at least 60% of all women of childbearing age.

It sounds very unglamorous, but the human breast is no more than a lumpy gland made up of milk glands and ducts and the tissues that separate and support them. Most breasts have at least one or two lumps; however, if your breast feels especially lumpy and uncomfortable, you're probably experiencing fibrocystic breast changes.

"The vast majority of women have [fibrocystic changes]...and are no worse for it," reports Dr. Carolyn Kaelin, a gynecologist and director of the breast clinic at Brigham & Women's Hospital in Boston.

What Are Fibrocystic Changes?

Fibrocystic changes are benign breast changes. The medical literature used to refer to them as "fibrocystic disease." That was before fibrocystic changes were found to be no more a disease than menstruation or menopause. The breast tissue may feel dense with an irregular area of thicker tissue having a lumpy or ridge-like surface. You might also feel tiny bead-like masses scattered throughout the breasts.

Your breasts may feel tender, swollen, and full with a dull, heavy pain. They may be sensitive to touch with a burning sensation. This discomfort is normal and does not indicate the presence of disease. For some women the pain is so severe that they cannot exercise or lie on their stomachs. Fibrocystic changes usually occur in both breasts. Most often in the upper outer quadrant and the underside of the breast where most of the milk-producing glands are located.

Why Does This Happen?

Fibrocystic changes are associated with hormonal shifts in estrogen and progesterone, which affect the breast tissue. During the menstrual cycle, the breasts swell as the milk glands and ducts enlarge and the breasts retain water. After menstruation, the breast swelling goes down and the breasts return to normal.

Fibrocystic changes generally begin when women are in their twenties or thirties and usually last until menopause. For a small number of women, the condition worsens over the years, causing constant pain and lumpiness. In general, some of the lumps become permanent and may or may not shrink after menopause.

Breast Cysts

Some women with fibrocystic changes develop cysts in their breasts. A cyst is a fluid-filled sac that is usually smooth, firm, movable, and sometimes tender-like a water balloon without the water. The cyst will generally enlarge before the menstrual period and shrink afterwards. A large cyst may be round and feel like an eyeball when pressed with the eyelid closed.

If you are concerned about a lump, your healthcare provider can determine whether or not it warrants further attention. Determining whether a lump is a cyst or something more serious can be determined by a simple office procedure known as fine needle aspiration. A fine-gauge needle is inserted into the lump and fluid is withdrawn.

If the lump is a cyst, as is the case 95% of the time, it will collapse once the fluid is removed. If it's a complex cyst, the next step is an ultrasound-guided fine needle aspiration that would likely cause the cyst wall to collapse.

"If we were concerned that there was something in the cyst wall, we would proceed with a biopsy," says Kaelin.

Treatment

While there is no definitive, medically proven treatment for breast pain caused by fibrocystic changes, there are various remedies that can be helpful.

Foods and Supplements
For some women, avoiding foods and beverages containing caffeine, such as coffee, tea, chocolate, and soft drinks, may decrease water retention and help to alleviate the discomfort. Reducing fat in the diet may also be helpful. However, this has not been proven in clinical trials.
In clinical trials, the herb chasteberry has shown promise for reducing cyclic breast pain. Other natural treatments commonly proposed include evening primrose oil, vitamin B6, and vitamin E. However, the two vitamins lack supporting evidence, and studies suggest that evening primrose is not effective. Before you embark on a self-prescribed regimen of supplements, you should discuss your plans with your doctor.
Women who stop smoking may notice that their lumps decrease.
Medication
Aspirin and other pain relievers, as well as heat application can relieve uncomfortable symptoms, as does wearing a bra that provides firm support. In worse case scenarios, oral contraceptives-which change the hormonal balance in your body-can lessen fibrocystic changes. For severe cases, Danazol, a synthetic form of the hormone androgen, may be prescribed. However, many women find that the side effects of Danazol, including weight gain, hair growth, and voice changes, are more distressing than the fibrocystic discomfort.

"Finding out what works for individual women is a trial and error process. If there was one good way to treat the discomfort, everyone would be treated that way. Not every remedy works for everyone but hopefully, at least something works for everyone," Kaelin observes.

Fibrocystic Changes and Breast Cancer

There is no correlation between fibrocystic changes and breast cancer. However, fibrocystic changes can make it more difficult to detect breast cancer. The best way to alleviate concerns about these cyclic changes is to examine your breasts every month seven days after your period when hormone levels are lowest and there is less texture (lumpiness). That way you'll know what degree of texture and lumpiness is normal for your breasts and be able to detect changes. It's also a good idea to keep a diagram of the more textured or lumpy areas, says Kaelin.

Kaelin strongly advises women to have a clinician examine their breasts once a year; this should be done in addition to mammograms.

How to Examine Your Breasts

It is normal to have some lumpiness or thickening in the breasts. By examining your breasts once each month, you will learn what is normal for you and notice when any changes do occur. Some women find that doing a weekly self-exam works better for them. They learn how their breasts feel at all phases of their menstrual cycles. The more regularly you can examine your breasts, the better you can learn what is normal for you. Your job isn't just to find lumps, but to notice if there are any changes.

In the Shower
With your fingers flat, move gently over every part of each breast. Use your right hand to examine the left breast and your left hand to examine the right breast. Check for any thickening, hard lumps, or knots.
In Front of a Mirror
Check your breasts with your arms at your sides. Then raise your arms overhead. Look for any changes in the shape of each breast, swelling, dimpling, or changes in the nipples.
Lying Down
To examine your right breast, put a pillow under your right shoulder. Place your right hand behind your head. Then with the flat fingers of your left hand, press gently in small circular motions around an imaginary clock face. Begin at the outermost top of your right breast for 12 o'clock, then move to 10 o'clock, etc. until you get back to 12 o'clock. Each breast will have a normal ridge of firm tissue. Then move in one inch toward the nipple. Repeat this process until you have examined every part of your breast including the nipple.
Move the pillow so that it's under your left shoulder, place your left hand behind you head, and repeat the procedure on the left breast. Finally, squeeze the nipple of each breast gently between the thumb and index finger. Any clear or bloody discharge should be reported to your physician immediately.

RESOURCES:

Womens health
http://www.4woman.gov

Y-ME National Breast Cancer Organization
http://www.y-me.org/index.php

CANADIAN RESOURCES:

The Canadian Women's Health Network
http://www.cwhn.ca/indexeng.html

Health Canada
http://www.hc-sc.gc.ca/index_e.html

REFERENCES:

Fibrocystic breasts: a non-disease. American Cancer Society website. Available at: http://www.fwradiology.com/fibrobrst.htm.

Love, SM, Gelman, RS, Silen, W. Sounding board. Fibrocystic "disease" of the breast--a nondisease?. N Engl J Med 1982; 307:1010.

Smith, RL, Pruthi, S, Fitzpatrick, LA. Evaluation and management of breast pain. Mayo Clin Proc 2004; 79:353.

Understanding fibrocystic changes of the breast. College of American Pathologists website. Available at: http://www.cap.org/apps/cap.portal.

What is Breast Cancer?

Tue, 23 Oct 2007 00:00:00 GMT

Breast cancer is a disease in which cancer cells grow in the breast tissue.

Cancer occurs when cells in the body (in this case breast cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor.

The term cancer refers to malignant tumors, which can invade nearby tissue and spread to other parts of the body. A benign tumor does not invade or spread. Although most people think of breast cancer as affecting women, men can develop breast cancer as well, and breast cancer in men can be much more aggressive than in women.

Breast Cancer

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Causes

The cause of breast cancer is unknown, but research shows that certain risk factors are associated with the disease.

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Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for breast cancer include:

Sex: Female, although men can also get breast cancer
Age: 50 or older
Personal history of breast cancer
Family members with breast cancer
Changes in breast tissue, such as atypical ductal hyperplasia, radial scar formation, and lobular carcinoma in situ (LCIS)
Changes in certain genes (BRCA1, BRCA2, and others)
Race: Caucasian
Increased exposure to estrogen over a lifetime through:
- Early onset of menstruation
- Late onset of menopause
- No childbearing or late childbearing
- Absence of breastfeeding
- Taking hormone replacement therapy for long periods of time (Prempro for more than four years)
- Tobacco use
Increased breast density (more lobular and ductal tissue and less fatty tissue)
Radiation therapy before the age of 30 years old
Overuse of alcohol

Note: Studies show that most women with known risk factors do not get breast cancer. And many women who get breast cancer have none of the risk factors listed above, other than the risk that comes with growing older.

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Symptoms

When breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause the following changes:

A lump or thickening in or near the breast or in the underarm area or in the neck
A change in the size or shape of the breast
Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast
Ridges or pitting of the breast skin (like the skin of an orange)
A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly)

Note: These symptoms may also be caused by other, less serious health conditions. Anyone experiencing these symptoms should see a doctor.

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Diagnosis

The doctor will ask about your symptoms and medical history and perform a physical exam.

Tests may include:

Clinical Breast Exam -The doctor carefully feels the breast lump and the tissue around it. The size and texture of the lump is examined to determines whether the lump moves easily. The doctor will examine both breasts, since the tissue can be very "lumpy" throughout the breast in some patients.

Mammography - x-rays of the breast used to see lumps or other changes in breast tissue

Ultrasonography- the use of high-frequency sound waves to see whether a lump is a fluid-filled cyst (usually not cancer) or a solid mass (which may or may not be cancer)

Biopsy - removal of tumor tissue to be tested for cancer cells. Types of biopsies for breast cancer include:

Fine-needle aspiration-removal of fluid and/or cells from a breast lump using a thin needle
Needle biopsy-removal of tissue with a needle from an area that looks suspicious on a mammogram but cannot be felt
Surgical biopsy:
- Incisional biopsy-cutting out a sample of a lump or suspicious area
- Excisional biopsy-cutting out all of a lump or suspicious area and an area of healthy tissue around the edges

Hormone Status Evaluation -Breast cancer tissue is tested for the presence of estrogen and progesterone receptors, which are used to help plan therapy.

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Treatment

Once breast cancer is found, staging tests are performed to find out if the cancer has spread and, if so, to what extent.

Treatments include:

Surgery

Surgery is the removal of the cancerous tumor and nearby tissue, and possibly nearby lymph nodes. The most common procedures performed today are the lumpectomy (which may be called a tylectomy, segmentectomy, or quadrantectomy) and the modified radical mastectomy.

Lumpectomy - removal of the breast cancer and some normal tissue around it. Often, some of the lymph nodes under the arm are removed

Segmentectomy- removal of the cancer and a larger area of normal breast tissue around it

Simple Mastectomy- removal of the breast, or as much of the breast as possible, without the intentional removal of the lymph nodes

Radical Mastectomy- removal of the breast, both chest muscles, the lymph nodes under the arm, and some additional fat and skin. This procedure is only considered in rare cases if the cancer has spread to the chest muscles, and is rarely performed in the United States at this time.

Modified Radical Mastectomy- removal of the whole breast, the lymph nodes under the arm and, often, the lining over the chest muscles

Axillary Lymph Node Dissection- removal of the lymph nodes under the arm to help determine whether cancer cells have entered the lymphatic system

Sentinel Lymph Node Biopsy -the placement, by the surgeon, of a small amount of blue dye and/or a radioactive tracer in the area where the tumor was located. The dye or tracer is then followed into the armpit and only those lymph nodes picking up the substance are removed. The accuracy rate for this procedure exceeds 95% in experienced hands and reliably identifies those lymph nodes that may contain cancer. Presently, those remaining lymph nodes should be removed if any sentinel nodes contain cancer. This method is usually done in women who do not have lymph nodes that can be felt in the armpit. The potential side effects are far less than seen after a standard lymph node dissection.

Radiation Therapy

Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. Two main types of radiation may be used:

External Radiation Therapy- radiation directed at the breast from a source outside the body

Internal Radiation Therapy- radioactive materials placed into the breast in or near the cancer cells

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.

Biologic Therapy

Biologic therapy is the use of medications or substances made by the body to increase or restore the body's natural defenses against cancer. It is also called biologic response modifier (BRM) therapy.

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Prevention

Because the cause of breast cancer is unknown, finding it early and treating it is the best way to prevent dying from the disease. And because it does not cause symptoms in the early stages, it is important to have screening examinations and tests to find the cancer before symptoms appear.

Women age 20 or older should perform a breast self-exam (BSE) every month.
Women between the ages of 20-39 should have a clinical breast exam by a health professional every three years. A breast exam should be performed more regularly if there is a family history or there have been previous breast biopsies.
Women age 40 and older should have a screening mammogram every year. Some advocate that a mammogram should be given sooner for patients with a strong family history or whom have had previous breast biopsies performed.
After age 40, women should have a breast exam by a healthcare professional every year.

All of these recommendations are reasonable; however, research evidence showing that these steps actually lower the risk of dying from breast cancer is far from conclusive. The only exception is regular mammograms beginning at age 50, which clearly does decrease breast cancer mortality. A recent study involving 160,921 women recruited at age 39-41 showed that annual screening mammograms up to age 48 did decrease breast cancer mortality over an average of 10.7 years. This reduction, however, was not statistically significant, meaning it could have been due to chance. According to these findings, about 2,500 women would need to be screened to prevent one breast cancer death during this time period. *

�RESOURCES:

American Cancer Society
http://www.cancer.org

CancerCare
http://www.cancercare.org

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* Updated Prevention section on 12/21/2006 according to the following study, as cited by
http://www.ebscohost.com/dynamed/what.php Moss SM, Cuckle H, Evans A, Johns L, Waller M, Bobrow L; Trial Management Group. Effect of mammographic screening from age 40 years on breast cancer mortality at 10 years' follow-up: a randomised controlled trial. Lancet . 2006 Dec 9;368(9552):2053-60.

The Baptist Health System Cancer Support Group

Fri, 19 Oct 2007 00:00:00 GMT

The Baptist Health System�Cancer Support Group is here for you.

If you, a member of your family or someone you love is coping with cancer this support group is for you.

Meetings are held at Northeast Baptist Hospital and offer valuable information, encouragement, and useful tips for patients, family, and friends of cancer. Some of the items covered include;

Cancer diagnosis and treatment
Side effects of treatment
Emotions and self-esteem
Cancer and intimacy
Community resources
Pain management
Nutrition and fatigue
Financial concerns

When: The 3rd Tuesday of every month
Time: 6:00 p.m to 7.30 p.m.
Where:
Northeast Baptist Hospital
1st Floor (East Wing) Cancer Resource Room
8811 Village Drive
SA, TX
78217
Map & Directions

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If you would like to register to attend call �(210) 297-7005.

Cancer Resource Center Volunteers Needed

Wed, 30 Jan 2008 00:00:00 GMT

Are you looking for a great place to volunteer? The Northeast Baptist Hospital cancer resource team needs compassionate and caring volunteers.

Some of your duties will include:

Learning about American Cancer Society (ACS) programs and services and community resources.
Listening, supporting, and educating cancer patients and caregivers.
Distributing ACS literature as needed.

Download:
Job Description
Application

Location:

Northeast Baptist Hospital
Cancer Resource Center
8811 Village Drive
San Antonio, Texas
78217-5440
Map & Directions
For More Information Contact:�
Stacy Aniol, American Cancer Society at (210) 595-0258�or complete the online volunteer form below.

Tips and Facts for Breast Self-Examination

Tue, 25 Sep 2007 00:00:00 GMT

A�breast self-exam is an examination of your breasts that you do yourself. It's a way for you to notice any changes, lumps, or abnormalities in your breasts. It's also a chance for you to become familiar with what is normal for your breasts.�

When breast cancer first develops, there may be no symptoms at all but as the cancer grows, it can cause the following changes:

Lumps: The breast is naturally lumpy and regular. Monthly breast checks allow you to become familiar with the natural lumps and changes in the breast. A new lump or change or a hard, firm lump, not noticed before, is the kind of change to check for and if this is found and persists you should be bring this to the attention of your doctor immediately. Cancer changes can occur throughout the breast but common sites/areas for breast cancer is the upper outer quadrant of the breast and underneath the nipple of the breast.
Nipple discharge or thickening can be a sign of breast cancer. If discharge from the nipple is new and is only coming from one breast and is bloody or occurs for the first time in an individual who is post-menopausal, prompt evaluation by a provider is recommended. Some discharge from the nipple is due to benign causes including certain medications such as birth control pills. Infections can be another cause of breast discharge and you should check with your doctor.
A new thickness or fullness may be another indicator of breast cancer.
A change in the breast size or shape may be another indicator of a breast change that should lead to an evaluation by your provider.

When should I�conduct a breast self-examination?
If you are still having monthly cycles/periods, the best time to perform this examination is during day 1-5 of the cycle.

If you are older or have stopped having cycles/periods, it is suggested that you select one day out of each month (a day that you know you routinely perform some task on such as the day that you pay your electric bill) and perform the examination on that day.

Mammography�is a type of imaging that is designed to find changes in the breast that might suggest cancer. It is currently recommended that women of average risk should begin undergoing screening mammograms annually starting at age 40. Mammograms are pictures of the breast and usually 2 pictures/images are taken during a screening evaluation.

What do radiologists look for?
When evaluating a mammogram for breast cancer, a radiologist carefully inspects the pictures/images for differences between your breasts and studies them carefully for signs of densities/lumps and/or calcifications.

Some breast cancers will appear as a density on an x-ray with a rounded or an irregular spot that shows up as a white area on the film. To better characterize these changes, another mammogram and/or ultrasound will be requested to determine if this changes is one that should be removed or tested with a biopsy.

Calcifications are deposits of calcium in the breast-they appear as small white spots on a mammogram. In the early development of mammograms, calcifications with certain features were found to occur more commonly with changes that suggest breast cancer. There are several forms of calcifications that can occur and be seen on mammography, however, not all calcifications suggest cancer but may require more testing.

By: Dr.�Sharon T. Wilks, MD, FACP�
Cancer Committee Chair, Baptist Health System

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While Dr. Sharon T. Wilks, M.D, FACP, is a member of the medical staff of one or more of Baptist Health System's hospitals, she is an independent contractor who is self-employed. As a result, Dr. Wilks is neither an employee nor an agent of those hospitals nor of Baptist Health System; and none of these hospitals nor Baptist Health System is responsible for any actions that Dr. Wilks takes in her medical practice.

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A Support Group for those with Cancer

Thu, 20 Dec 2007 00:00:00 GMT

Going through a major illness can be more than just physically taxing. There can be an emotional toll on the individual coping with the illness, as well as on their family members and friends. The Baptist Health System Cancer Support Group offers an invaluable resource of emotional and educational support for families with a loved one who is experiencing a cancer diagnosis, going through treatment or recovery.

"There is strength in sharing and learning from those who have experienced the fear, the pain and the stress of dealing with cancer," said Susan Lake, RN, OCN, AMSRN, a clinical nurse specialist in oncology and support group facilitator.

The American Cancer Society facilitates the support group allowing attendees to benefit from the considerable resources and knowledge offered by the non-profit organization. At each meeting educational information is given to attendees on subjects related to cancer. Among the topics discussed are; Cancer diagnosis and treatment, Side effects of treatment, Emotions and self-esteem, Cancer and intimacy, Community resources, Pain management, Nutrition and fatigue, Financial concerns, and more.

2 Meeting Locations:

Baptist Medical Center

When:
4^th Tuesday of each month (except public holidays)

Time: 6 p.m. to 7.30 p.m.

Where:
Baptist Medical Center
Musselman Chapel�1^st Floor
111 Dallas Street
San Antonio, TX 78205
Maps & Directions

Northeast Baptist Hospital

When:
3^rd Tuesday of each month (except public holidays)

Time:
6 p.m. to 7.30 p.m.

Where:
Northeast Baptist Hospital
8811 Village Drive
on the 1^st floor in the East Wing Cancer Resource Room
San Antonio, TX 78217
Map & Directions

Calcium: Good For Bone Health and May Reduce Colon Cancer Risk

Thu, 20 Mar 2008 00:00:00 GMT

Calcium for Preventing Colon Cancer

by Steven Bratman, MD

En Espa�ol (Spanish Version)

Colorectal adenomas are precancerous polyps that occur in the lower digestive tract. Various kinds of evidence indicate use of calcium supplements can help prevent colon polyps and also reduce colon cancer risk.

An article published in the Journal of the National Cancer Institute in 2007 adds weight to this hypothesis. A total of 930 people with a history of a previous colon polyp were given either placebo or calcium carbonate (three grams daily) for four years. At the end of the four-year trial period, people given calcium showed a significantly lower rate of polyp recurrence compared to those given placebo. Treatment was then stopped, but researchers continued to follow the participants. Remarkably, the protective effect of calcium was maintained for as long as five years after the end of the active part of the study. Even if people did not continue to take calcium supplements, they remained relatively less likely to develop polyps simply on the basis of having had taken it.

There are two caveats, however. First, this dose of calcium supplementation is very high, and should not be undertaken without a doctor's supervision. Furthermore, there is weak but still potentially worrisome evidence that, when taken by men, calcium supplements may raise risk of cancer of the prostate.

REFERENCES:

Grau MV, Baron JA, Sandler RS, et al. Prolonged effect of calcium supplementation on risk of colorectal adenomas in a randomized trial. J Natl Cancer Inst . 2007;99:129-36.

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