This month's Ophthalmology, the journal of the American Academy of Ophthalmology (Academy) reports on a national study that finds cataract surgery is likely to benefit patients with age-related macular degeneration (AMD) at all stages of the disease, on a clinical trial showing that the steroid triamcinolone may be effective in advanced diabetic macular edema (DME) patients when standard treatment fails, and on the public's use of two Academy-sponsored online eye health forums.
Multicenter Study Finds AMD Patients Benefit from Cataract Surgery
Cataract surgery improved vision in patients with any stage - from mild to advanced - AMD in the first study to include an adequate number of advanced AMD patients. Data was obtained from the multicenter, prospective Age-Related Eye Disease Study (AREDS), funded by the National Eye Institute (NEI), which was organized primarily to evaluate the effects of high-dose vitamin and mineral supplements on cataract and AMD. As the American population ages AMD prevalence is expected to rise, and many patients will concurrently develop cataract; both diseases can cause blindness if untreated.
"Earlier epidemiology had suggested cataract surgery might worsen AMD, so the data from the AREDS cohort study were evaluated to answer this important question," said Emily Y. Chew, MD, who led the study for NEI.
The cohort, comprising 1,939 eyes (1,244 patients) with various stages of AMD, was evaluated for visual acuity (sharpness) after cataract surgery. On average, patients with AMD, ranging from mild to advanced, gained visual acuity after cataract surgery; the best gains were in patients with vision worse than20/40 before surgery. No difference in improvement was noted between patients with "wet" (neovascular) or "dry" (central geographic atrophy) AMD. About one year later vision gains remained statistically significant in the 865 eyes available for follow-up. Results for the primary focus of AREDS, regarding the effect of nutritional supplements, showed that high doses of vitamins C, E and beta-carotene did not affect the development or progression of cataract, but this vitamin combination plus zinc did reduce the risk of progression to advanced AMD by 25 percent in the five years of the study.
Steroids Helps Diabetic Macular Edema Patients When Other Treatment Fails
A five-year study based at the University of Sydney, Australia, found that intravitreal triamcinolone (IVTA) effectively improved vision in patients with DME, a form of diabetic retinopathy, whose eyes had continued to deteriorate despite receiving standard laser treatment.
"The majority of patients who improved with IVTA after initial treatment continued to enjoy better vision at the five year conclusion of our clinical trial, and no new safety concerns were found in these patients," said lead researcher Mark Gillies, PhD. "We believe treatment with IVTA may be considered in carefully selected advanced DME patients when standard treatment has failed to improve vision," he added.
In the first three months after treatment, the patients initially treated with both IVTA and laser showed significantly better gains in vision than control group patients, who were treated with laser only. After two years, patients in the original control group were also treated with IVTA. The beneficial effects persisted in most IVTA-treated patients throughout the five-year study; however, 80 percent of patients in the initial IVTA group developed elevated intraocular pressure and 56 percent of them required glaucoma therapy. Also, two-thirds of all patients required cataract surgery during the study period. Similar outcomes have been noted in other studies of steroid-based treatment and thus were not considered new safety concerns by Dr. Gillies' group.
What Do People Ask About in Online Eye Health Forums?
To identify the topics of highest interest to people who access eye health information on line, John C. Hagan, MD, and colleagues analyzed 4,485 questions over six months (September 1, 2008 to March 1, 2009) posted on the "Ask a Doctor: Ophthalmology" and "Eye Care Community" forums sponsored by the Academy on MedHelp (http://www.medhelp.org), one of the 10 largest health information websites. Dr. Hagan and three other ophthalmologists provide free, timely advice to a large and growing number of people with eye health and vision problems through these forums. Serious problems, such as life-threatening retinoblastomas in babies, have been caught and treated in time thanks to these forums, as have thousands of other eye and vision problems.
Concerns related to the retina topped the list at nearly 20 percent of all questions; many people asked about "flashes," "floaters," or retinal detachment. About 19 percent of questions were related to the cornea, the clear outer surface of the eye that helps focus light to make vision possible. Cataract and implanted lens questions were next in prevalence, followed by brain-eye problems (neuro-ophthalmology), children's eye alignment (strabismus), eye cancers, and general discomfort or blurry vision. Two-to-three percent of questions related to each of three vision correction topics: refractive surgery (LASIK and others), eyeglasses, or contact lenses. A smaller number were related to eye care products or medical insurance. The analysis also found many people submit postings to express their gratitude for the medical advice provided.
Source:
Mary Wade
American Academy of Ophthalmology
Oct 30, 2009
Oct 22, 2009
Research Indicates Gaps In Care For Diabetes, Cholesterol, Hypertension Among The Uninsured
A new study shows uninsured American adults with chronic illnesses like diabetes or high cholesterol often go undiagnosed and undertreated, leading to an increased risk of costly, disabling and even lethal complications of their disease.
The study, published online in Health Affairs, analyzed data from a recent national survey conducted by the Centers for Disease Control and Prevention (CDC). The researchers, based at Harvard Medical School and the affiliated Cambridge Health Alliance, analyzed data on 15,976 U.S. non-elderly adults from the National Health and Nutrition Examination Survey (NHANES), a CDC program, between 1999 and 2006.
Respondents answered detailed questions about their health and economic circumstances. Then doctors examined them and ordered laboratory tests.
The study found that about half of all uninsured people with diabetes (46 percent) or high cholesterol (52 percent) did not know they had these diseases. In contrast, about one-quarter of those with insurance were unaware of their illnesses (23 percent for diabetes, 29.9 percent for high cholesterol).
Undertreatment of disease followed similar patterns, with the uninsured being more likely to be undertreated than their insured counterparts: 58.3 percent vs. 51.4 percent had their high blood pressure poorly controlled, and 77.5 percent vs. 60.4 percent had their high cholesterol inadequately treated.
Surprisingly, being insured was not associated with a widely used measure of diabetes control (a hemoglobin A1c level below 7), a finding the authors attribute to the stringent definition of good diabetes control used in the NHANES survey. Even with excellent medical care, many diabetics fail to achieve such low hemoglobin A1c levels. Using less stringent hemoglobin A1c thresholds of 8 and 9, uninsured adults had significantly worse blood sugar control than their insured counterparts, the researchers found.
Lead author Dr. Andrew Wilper, who worked at Harvard when the study was done and who now teaches at the University of Washington Medical School, said: "Our study should lay to rest the myth that the uninsured can get the care they need. Millions have serious chronic conditions and don't even know it. And they're not getting care that would prevent strokes, heart attacks, amputations and kidney failure."
Referring to a study released in the American Journal of Public Health last month, which has been widely quoted by Sen. Max Baucus and others, he added: "Our previous work demonstrated 45,000 deaths annually are linked to lack of health insurance. Our new findings suggest a mechanism for this increased risk of death among the uninsured. They're not getting life-saving care."
Dr. Steffie Woolhandler, professor of medicine at Harvard and study co-author, said: "The uninsured suffer the most, but even Americans with insurance have shocking rates of undertreatment, in part because high co-payments and deductibles often make care and medications unaffordable. We need to upgrade coverage for the insured, as well as covering the uninsured. Only single-payer national health insurance would make care affordable for the tens of millions of Americans with chronic illnesses."
Dr. David Himmelstein, associate professor of medicine at Harvard and study co-author, said: "The Senate Finance Committee's bill would leave 25 million Americans uninsured and unable to get the ongoing, routine care that could save their lives and prevent disability. No other wealthy nation tolerates this, yet Congress is turning its back on tens of millions of Americans."
"Hypertension, diabetes and elevated cholesterol among insured and uninsured U.S. adults," Andrew P. Wilper, M.D., M.P.H.; Steffie Woolhandler, M.D., M.P.H.; Karen Lasser, M.D., M.P.H.; Danny McCormick, M.D., M.P.H.; David H. Bor, M.D.; David U. Himmelstein, M.D. Health Affairs, Oct. 20, 2009 (online).
Source:
Mark Almberg
Physicians for a National Health Program
The study, published online in Health Affairs, analyzed data from a recent national survey conducted by the Centers for Disease Control and Prevention (CDC). The researchers, based at Harvard Medical School and the affiliated Cambridge Health Alliance, analyzed data on 15,976 U.S. non-elderly adults from the National Health and Nutrition Examination Survey (NHANES), a CDC program, between 1999 and 2006.
Respondents answered detailed questions about their health and economic circumstances. Then doctors examined them and ordered laboratory tests.
The study found that about half of all uninsured people with diabetes (46 percent) or high cholesterol (52 percent) did not know they had these diseases. In contrast, about one-quarter of those with insurance were unaware of their illnesses (23 percent for diabetes, 29.9 percent for high cholesterol).
Undertreatment of disease followed similar patterns, with the uninsured being more likely to be undertreated than their insured counterparts: 58.3 percent vs. 51.4 percent had their high blood pressure poorly controlled, and 77.5 percent vs. 60.4 percent had their high cholesterol inadequately treated.
Surprisingly, being insured was not associated with a widely used measure of diabetes control (a hemoglobin A1c level below 7), a finding the authors attribute to the stringent definition of good diabetes control used in the NHANES survey. Even with excellent medical care, many diabetics fail to achieve such low hemoglobin A1c levels. Using less stringent hemoglobin A1c thresholds of 8 and 9, uninsured adults had significantly worse blood sugar control than their insured counterparts, the researchers found.
Lead author Dr. Andrew Wilper, who worked at Harvard when the study was done and who now teaches at the University of Washington Medical School, said: "Our study should lay to rest the myth that the uninsured can get the care they need. Millions have serious chronic conditions and don't even know it. And they're not getting care that would prevent strokes, heart attacks, amputations and kidney failure."
Referring to a study released in the American Journal of Public Health last month, which has been widely quoted by Sen. Max Baucus and others, he added: "Our previous work demonstrated 45,000 deaths annually are linked to lack of health insurance. Our new findings suggest a mechanism for this increased risk of death among the uninsured. They're not getting life-saving care."
Dr. Steffie Woolhandler, professor of medicine at Harvard and study co-author, said: "The uninsured suffer the most, but even Americans with insurance have shocking rates of undertreatment, in part because high co-payments and deductibles often make care and medications unaffordable. We need to upgrade coverage for the insured, as well as covering the uninsured. Only single-payer national health insurance would make care affordable for the tens of millions of Americans with chronic illnesses."
Dr. David Himmelstein, associate professor of medicine at Harvard and study co-author, said: "The Senate Finance Committee's bill would leave 25 million Americans uninsured and unable to get the ongoing, routine care that could save their lives and prevent disability. No other wealthy nation tolerates this, yet Congress is turning its back on tens of millions of Americans."
"Hypertension, diabetes and elevated cholesterol among insured and uninsured U.S. adults," Andrew P. Wilper, M.D., M.P.H.; Steffie Woolhandler, M.D., M.P.H.; Karen Lasser, M.D., M.P.H.; Danny McCormick, M.D., M.P.H.; David H. Bor, M.D.; David U. Himmelstein, M.D. Health Affairs, Oct. 20, 2009 (online).
Source:
Mark Almberg
Physicians for a National Health Program
Oct 13, 2009
What Is Testicular Cancer? What Causes Testicular Cancer?
Testicular cancer, or cancer of the testes, occurs in the testicles (testes), inside the scrotum. The scrotum is a loose bag of skin under the penis. Male sex hormones, testosterone, and sperm for reproduction are produced in the testicles. The testicles are a pair of male sex glands, also known as gonads. Testosterone controls the development of the reproductive organs, and other male physical characteristics.
Although testicular cancer is uncommon compared to other cancers (0.7% of all cancers), it is the most common cancer in males aged between 15 and 35 in North America and Europe. Just under 2,000 men are diagnosed with this type of cancer annually in the United Kingdom. About 70 British males die each year from testicular cancer. 8,000 American males are diagnosed and 390 die each year in the USA of this disease.
Testicular cancer occurs when the cells become malignant (cancerous) in either one or both testicles. White (Caucasian) males, especially those of Scandinavian descent are more susceptible to developing the disease compared to other men.
The incidence of testicular cancer in the USA has more than doubled over the last four decades among Caucasian males, and has recently started to rise among afro-American males. Experts are not sure why people of different ancestries have varying incidence rates.
What are the risk factors for testicular cancer?
Although scientists are not sure what the specific causes of testicular cancer are, there are some factors which may raise a man's risk of developing the disease. These risk factors include:
* Cryptorchidism (undescended testicle) - testicles usually descend from the inside of the abdomen into the scrotum before a baby boy is born. If a testicle has not moved down when a male is born there is a greater risk that he will develop testicular cancer later on. The increased risk applies to both testicles, and is not lowered if surgery is performed to move it down.
* Congenital abnormalities - males born with abnormalities of the penis, kidneys or testicles have a higher risk.
* Inguinal hernia - males born with a hernia in the groin area have a higher risk than others.
* Having had testicular cancer - if a male has had testicular cancer he is more likely to develop it in the other testicle, compared to a man who has never had testicular cancer.
* Family history - a male who has a close relative - sibling or father - with testicular cancer is more likely to develop it himself compared to other men.
* Abnormal testicular development - conditions, such as Klinefelter's syndrome, where the testicles do not develop normally, may increase a person's risk of testicular cancer.
* Mumps orchitis - this is an uncommon complication of mumps in which one or both testicles become inflamed. This painful complication can also raise a male's risk of developing testicular cancer later on.
* Race - testicular cancer is more common among Caucasian males, compared to men of African or Asian descent. Highest rates are found in Scandinavia, Germany and New Zealand.
Having a vasectomy does not increase a man's risk of developing testicular cancer.
What are the signs and symptoms of testicular cancer?
A symptom is something the patient feels or reports, while a sign is something other people, including a doctor, may detect. For example, pain may be a symptom while a rash could be a sign.
In most cases the patient finds the cancer himself. Sometimes they are discovered by doctors during a routine physical exam. If you notice anything unusual about your testicles you should see your doctor, especially if you detect any of the following:
* A lump or swelling in a testicle (painless)
* Pain in a testicle or scrotum
* Discomfort in a testicle or scrotum
* A sensation of heaviness in the scrotum
* A dull ache in the lower back
* A dull ache in the groin
* A dull ache in the abdomen
* A sudden accumulation of fluid in the scrotum
* Unexplained tiredness or malaise
These symptoms may not necessarily be caused by cancer. In fact, less than 4% of lumps in the testicles are found to be cancerous. You should not ignore a lump or swelling in the testicle, though. It is important to see your doctor, who can find out what the cause is.
In rare cases the man may notice that his breast area is enlarged and tender. His nipples may feel sore and tender as well. This is caused by hormonal changes occurring in his body.
Even though testicular cancer can spread to the lymph nodes, it hardly ever travels to other organs. If the cancer does spread, the patient may experience:
* Coughing
* Breathing difficulties
* Swallowing difficulties
* Swelling in the chest
How is testicular cancer diagnosed?
The doctor will interview the patient; perform a physical examination, and possibly order laboratory and diagnostic tests. These may include:
* Blood tests - the aim here is to measure levels of tumor markers. Tumor markers are substances which exist in higher-than-normal levels when cancer is present. If levels of alpha-fetoprotein (AFP), human chorionic gonadotrophin (HCG), and lactate dehydrogenase (LDH) are higher than normal it may suggest there is a testicular tumor, even if a physical exam or imaging tests did not detect it.
Not all forms of testicular cancer produce these markers. It is possible that blood tests come back normal, even though cancer is present.
* Ultrasound - this is a test that uses high-frequency sound waves that bounce off internal organs and tissues. Their echoes are processed and a picture is viewed on a monitor. An ultrasound of the scrotum can reveal the presence and also the size of a tumor. The doctor may also be able to determine the nature of any lump, whether they are solid or filled with fluid, inside or outside the testicle. This information helps the health care provider decide whether or not the lump is cancerous.
* Biopsy - a small sample of tissue is taken from the targeted area in the testicle and examined under a microscope by a pathologist to determine whether the lump is malignant (cancerous) or benign (non-cancerous).
In most cases the only way to perform a biopsy safely is to remove the whole testicle - to perform an orchidectomy. This is because the risk of the cancer spreading if a conventional biopsy is taken is high. The specialist will only remove the testicle for a biopsy if it seems very likely the lump is cancerous. If a patient has two testicles and has one removed he can still produce sperm from the other one and procreate.
Determining what type of testicular cancer it is
When the doctor has determined the type of testicular cancer the patient has, he/she can then devise a treatment plan and make a prognosis. There are two main types of testicular cancer:
* Seminoma testicular cancer - these contain only seminoma cells. All age groups can get this type of cancer. However, most older men who do develop testicular cancer will probably have this type. It is less aggressive than non-seminomas and responds well to radiation therapy.
* Non-seminoma testicular cancer - these may contain many different cancer cells. Non-seminoma tumors tend to affect younger patients and will spread more rapidly than seminoma ones. Many types of non-seminoma tumors exist, including:
o Choriocarcinoma
o Embryonal carcinoma
o Teratoma
o Yolk sac tumor
This type of cancer is also sensitive to radiation therapy, but less so compared to seminomas. Chemotherapy is usually effective for non-seminomas.
Most testicular cancers start in the germ cells - the cells in the testicles that produce immature sperm. We don't know what causes those cells to become abnormal and cancerous.
Sometimes both types of cancers may be present. If this is the case the doctor will use non-seminoma treatment.
Staging the cancer
If the doctor diagnoses testicular cancer, it is important to determine how advanced it is. In order to find out whether the cancer has left its site of origin (whether it has spread), the doctor may order an MRI (medical resonance imaging) scan, CT (computerized tomography) scan, and X-rays.
Blood tests will help determine whether cancer is still in the patient's body after the testicle was surgically removed.
After carrying out all the relevant tests, the doctor will then be able to stage the cancer. This helps determine what treatment to use.
* Stage I - the cancer is only in the testis (testicle). It has not spread outside.
* Stage II - the cancer has reached the lymph nodes in the abdomen.
* Stage III - the cancer has spread further, to other parts of the body. This could include the lungs, liver, brain and bones.
What are the treatment options for testicular cancer?
Testicular cancer treatment has a success rate of about 95% - in other words, 95% of all testicular cancer patients who receive treatment make a full recover. The sooner a patient is diagnosed and treated the better his prognosis is.
Treatment for testicular cancer may involve surgery, radiotherapy, chemotherapy, or a combination.
Surgery
* Orchidectomy - usually the first line of treatment. The testicle is surgically removed to prevent the tumor from spreading. If the patient is diagnosed and treated in Stage I, surgery may be the only treatment needed.
An orchidectomy is a straightforward operation. The patient receives a general anesthetic. A small incision is made in the groin and the whole testicle is removed through the incision. Patients have the option of having a prosthetic testicle, made of silicon, inserted into the scrotum - this will be for esthetic reasons only (not health reasons).
The patient remains in hospital for a few days.
If the man still has one testicle after the operation, his sex life and chances of reproducing should not be affected.
o Ending up with no testicles
If the male either had both testicles removed, or only had one testicle before the operation; in other words, if after the operation the patient has no testicles, he will be infertile. He will not be able to produce sperm. Males who wish to have children one day should consider banking their sperm before the operation - some sperm is kept in a sperm-bank before the testicle or testicles are removed.
o Hormone replacement therapy
The body will stop producing testosterone if the man has no testicles. Testosterone is a male hormone, which among other things, is involved in driving his libido (sex drive) and maintaining an erection. Testosterone replacement therapy involves providing the patient with testosterone. The patient either receives injections or applies patches to his skin. Injections are given every two to three weeks. Testosterone replacement therapy helps maintain a male's libido and erectile function.
* Lymph node surgery - if the cancer has reached the lymph nodes they will need to be surgically removed. This usually involves the lymph nodes in the abdomen and chest. Sometimes lymph node surgery can result in infertility. Patients who wish to have children one day should consider banking their sperm.
Nerve sparing lymph node dissection is a surgical technique which significantly lowers the risk of subsequent infertility. The procedure is carried out by very specialist surgeons who may not be available in many parts of the world. The risk of cancer recurrence is higher with this procedure because not all of the lymph node is taken out.
Radiation therapy (radiotherapy)
Radiotherapy, also known as radiation therapy, radiation oncology and XRT, is used for treating cancer, thyroid disorders and some blood disorders. Approximately 40% of patients of all types of cancer undergo some kind of radiotherapy. It involves the use of beams of high-energy X-rays or particles (radiation) to destroy cancer cells. Radiotherapy works by damaging the DNA inside the tumor cells, destroying their ability to reproduce.
Patients with seminoma testicular cancer will typically require radiotherapy as well as surgery. The radiotherapy is used to prevent cancer recurrence.
Patients whose cancer has spread to their lymph nodes will need radiation therapy.
Radiation therapy may cause the following temporary side effects:
* Tiredness
* Rashes
* Muscle stiffness
* Joint stiffness
* Loss of appetite
* Nausea
Chemotherapy
Chemotherapy is the use of chemicals (medication) to treat disease - more specifically, it usually refers to the destruction of cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing. When health care professionals talk about chemotherapy today, they generally tend to refer more to cytotoxic medication than others. Cytotoxic simply means it is toxic to cells, it kills cells, which in the case of chemotherapy refers to cancer cells.
Chemotherapy (chemo) drugs either interfere with a cancer cell's ability to divide and reproduce, or kills them.
Chemotherapy is usually given to patients with advanced testicular cancer - cancer that has spread to other parts of the body.
Chemotherapy is also used to prevent recurrence of cancer - to stop the cancer from coming back.
Most commonly, chemotherapy is used for the treatment of non-seminoma tumors.
Treatment is administered either orally (tablets by mouth) or injection.
As chemotherapy attacks healthy (good) cells as well as cancerous ones, the patient may experience the following temporary side effects:
* Nausea
* Vomiting
* Hair loss
* Mouth sores
* Tiredness
* Malaise
Most people immediately link chemotherapy with uncomfortable side effects. However, side-effect management has improved considerably over the last twenty years. Many side effects that were once inevitable can be either prevented or well controlled today. There is no reliable way to predict how patients may react to chemotherapy. Some experience very mild side-effect, others will have none at all, while some people will report various symptoms.
Prevention of testicular cancer
Preventing testicular cancer may not be possible, but making sure it does not advance before diagnosis and treatment is. In other words, if you check yourself regularly for signs and symptoms of testicular cancer you are more likely to be one of those 95% of patients who make a full recovery if you do develop testicular cancer.
How to check yourself
The best time to check yourself is when the scrotal skin is relaxed; usually after a warm shower or bath.
* Gently hold your scrotum in the palms of both your hands. Stand in front of the mirror and look for any swelling on the skin of the scrotum.
* Feel the size and weight of your testicles first.
* With your fingers and thumbs press around and be receptive for any lumps or unusual swellings. Become familiar with your own testicles. Some men have one testicle that hangs lower than the other. Some people have one testicle which is bigger than the other. This is normal.
* Each time you check yourself try to detect any significant increase in the size or weight of your testicles.
* Feel each testicle individually. Place the index and middle fingers under the testicle while your thumbs are on the top. Gently roll the testicle between the thumbs and the fingers - it should be smooth, oval shaped, and somewhat firm; there should be no lumps or swellings. The top and back of each testicle should have a tube-like section which may be slightly tender - this is where sperm is stored (epididymis). It is normal for it to feel tender.
If you are not sure what a testicle should feel like, remember this:
* They should both have a similar feel.
* As cancer in both testicles is extremely rare, you are unlikely to feel two identical testicles that have cancer.
* If one feels different from the other, tell your doctor.
* Also, tell your doctor if a testicle does not have the same feel compared to your last self-check.
Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
Although testicular cancer is uncommon compared to other cancers (0.7% of all cancers), it is the most common cancer in males aged between 15 and 35 in North America and Europe. Just under 2,000 men are diagnosed with this type of cancer annually in the United Kingdom. About 70 British males die each year from testicular cancer. 8,000 American males are diagnosed and 390 die each year in the USA of this disease.
Testicular cancer occurs when the cells become malignant (cancerous) in either one or both testicles. White (Caucasian) males, especially those of Scandinavian descent are more susceptible to developing the disease compared to other men.
The incidence of testicular cancer in the USA has more than doubled over the last four decades among Caucasian males, and has recently started to rise among afro-American males. Experts are not sure why people of different ancestries have varying incidence rates.
What are the risk factors for testicular cancer?
Although scientists are not sure what the specific causes of testicular cancer are, there are some factors which may raise a man's risk of developing the disease. These risk factors include:
* Cryptorchidism (undescended testicle) - testicles usually descend from the inside of the abdomen into the scrotum before a baby boy is born. If a testicle has not moved down when a male is born there is a greater risk that he will develop testicular cancer later on. The increased risk applies to both testicles, and is not lowered if surgery is performed to move it down.
* Congenital abnormalities - males born with abnormalities of the penis, kidneys or testicles have a higher risk.
* Inguinal hernia - males born with a hernia in the groin area have a higher risk than others.
* Having had testicular cancer - if a male has had testicular cancer he is more likely to develop it in the other testicle, compared to a man who has never had testicular cancer.
* Family history - a male who has a close relative - sibling or father - with testicular cancer is more likely to develop it himself compared to other men.
* Abnormal testicular development - conditions, such as Klinefelter's syndrome, where the testicles do not develop normally, may increase a person's risk of testicular cancer.
* Mumps orchitis - this is an uncommon complication of mumps in which one or both testicles become inflamed. This painful complication can also raise a male's risk of developing testicular cancer later on.
* Race - testicular cancer is more common among Caucasian males, compared to men of African or Asian descent. Highest rates are found in Scandinavia, Germany and New Zealand.
Having a vasectomy does not increase a man's risk of developing testicular cancer.
What are the signs and symptoms of testicular cancer?
A symptom is something the patient feels or reports, while a sign is something other people, including a doctor, may detect. For example, pain may be a symptom while a rash could be a sign.
In most cases the patient finds the cancer himself. Sometimes they are discovered by doctors during a routine physical exam. If you notice anything unusual about your testicles you should see your doctor, especially if you detect any of the following:
* A lump or swelling in a testicle (painless)
* Pain in a testicle or scrotum
* Discomfort in a testicle or scrotum
* A sensation of heaviness in the scrotum
* A dull ache in the lower back
* A dull ache in the groin
* A dull ache in the abdomen
* A sudden accumulation of fluid in the scrotum
* Unexplained tiredness or malaise
These symptoms may not necessarily be caused by cancer. In fact, less than 4% of lumps in the testicles are found to be cancerous. You should not ignore a lump or swelling in the testicle, though. It is important to see your doctor, who can find out what the cause is.
In rare cases the man may notice that his breast area is enlarged and tender. His nipples may feel sore and tender as well. This is caused by hormonal changes occurring in his body.
Even though testicular cancer can spread to the lymph nodes, it hardly ever travels to other organs. If the cancer does spread, the patient may experience:
* Coughing
* Breathing difficulties
* Swallowing difficulties
* Swelling in the chest
How is testicular cancer diagnosed?
The doctor will interview the patient; perform a physical examination, and possibly order laboratory and diagnostic tests. These may include:
* Blood tests - the aim here is to measure levels of tumor markers. Tumor markers are substances which exist in higher-than-normal levels when cancer is present. If levels of alpha-fetoprotein (AFP), human chorionic gonadotrophin (HCG), and lactate dehydrogenase (LDH) are higher than normal it may suggest there is a testicular tumor, even if a physical exam or imaging tests did not detect it.
Not all forms of testicular cancer produce these markers. It is possible that blood tests come back normal, even though cancer is present.
* Ultrasound - this is a test that uses high-frequency sound waves that bounce off internal organs and tissues. Their echoes are processed and a picture is viewed on a monitor. An ultrasound of the scrotum can reveal the presence and also the size of a tumor. The doctor may also be able to determine the nature of any lump, whether they are solid or filled with fluid, inside or outside the testicle. This information helps the health care provider decide whether or not the lump is cancerous.
* Biopsy - a small sample of tissue is taken from the targeted area in the testicle and examined under a microscope by a pathologist to determine whether the lump is malignant (cancerous) or benign (non-cancerous).
In most cases the only way to perform a biopsy safely is to remove the whole testicle - to perform an orchidectomy. This is because the risk of the cancer spreading if a conventional biopsy is taken is high. The specialist will only remove the testicle for a biopsy if it seems very likely the lump is cancerous. If a patient has two testicles and has one removed he can still produce sperm from the other one and procreate.
Determining what type of testicular cancer it is
When the doctor has determined the type of testicular cancer the patient has, he/she can then devise a treatment plan and make a prognosis. There are two main types of testicular cancer:
* Seminoma testicular cancer - these contain only seminoma cells. All age groups can get this type of cancer. However, most older men who do develop testicular cancer will probably have this type. It is less aggressive than non-seminomas and responds well to radiation therapy.
* Non-seminoma testicular cancer - these may contain many different cancer cells. Non-seminoma tumors tend to affect younger patients and will spread more rapidly than seminoma ones. Many types of non-seminoma tumors exist, including:
o Choriocarcinoma
o Embryonal carcinoma
o Teratoma
o Yolk sac tumor
This type of cancer is also sensitive to radiation therapy, but less so compared to seminomas. Chemotherapy is usually effective for non-seminomas.
Most testicular cancers start in the germ cells - the cells in the testicles that produce immature sperm. We don't know what causes those cells to become abnormal and cancerous.
Sometimes both types of cancers may be present. If this is the case the doctor will use non-seminoma treatment.
Staging the cancer
If the doctor diagnoses testicular cancer, it is important to determine how advanced it is. In order to find out whether the cancer has left its site of origin (whether it has spread), the doctor may order an MRI (medical resonance imaging) scan, CT (computerized tomography) scan, and X-rays.
Blood tests will help determine whether cancer is still in the patient's body after the testicle was surgically removed.
After carrying out all the relevant tests, the doctor will then be able to stage the cancer. This helps determine what treatment to use.
* Stage I - the cancer is only in the testis (testicle). It has not spread outside.
* Stage II - the cancer has reached the lymph nodes in the abdomen.
* Stage III - the cancer has spread further, to other parts of the body. This could include the lungs, liver, brain and bones.
What are the treatment options for testicular cancer?
Testicular cancer treatment has a success rate of about 95% - in other words, 95% of all testicular cancer patients who receive treatment make a full recover. The sooner a patient is diagnosed and treated the better his prognosis is.
Treatment for testicular cancer may involve surgery, radiotherapy, chemotherapy, or a combination.
Surgery
* Orchidectomy - usually the first line of treatment. The testicle is surgically removed to prevent the tumor from spreading. If the patient is diagnosed and treated in Stage I, surgery may be the only treatment needed.
An orchidectomy is a straightforward operation. The patient receives a general anesthetic. A small incision is made in the groin and the whole testicle is removed through the incision. Patients have the option of having a prosthetic testicle, made of silicon, inserted into the scrotum - this will be for esthetic reasons only (not health reasons).
The patient remains in hospital for a few days.
If the man still has one testicle after the operation, his sex life and chances of reproducing should not be affected.
o Ending up with no testicles
If the male either had both testicles removed, or only had one testicle before the operation; in other words, if after the operation the patient has no testicles, he will be infertile. He will not be able to produce sperm. Males who wish to have children one day should consider banking their sperm before the operation - some sperm is kept in a sperm-bank before the testicle or testicles are removed.
o Hormone replacement therapy
The body will stop producing testosterone if the man has no testicles. Testosterone is a male hormone, which among other things, is involved in driving his libido (sex drive) and maintaining an erection. Testosterone replacement therapy involves providing the patient with testosterone. The patient either receives injections or applies patches to his skin. Injections are given every two to three weeks. Testosterone replacement therapy helps maintain a male's libido and erectile function.
* Lymph node surgery - if the cancer has reached the lymph nodes they will need to be surgically removed. This usually involves the lymph nodes in the abdomen and chest. Sometimes lymph node surgery can result in infertility. Patients who wish to have children one day should consider banking their sperm.
Nerve sparing lymph node dissection is a surgical technique which significantly lowers the risk of subsequent infertility. The procedure is carried out by very specialist surgeons who may not be available in many parts of the world. The risk of cancer recurrence is higher with this procedure because not all of the lymph node is taken out.
Radiation therapy (radiotherapy)
Radiotherapy, also known as radiation therapy, radiation oncology and XRT, is used for treating cancer, thyroid disorders and some blood disorders. Approximately 40% of patients of all types of cancer undergo some kind of radiotherapy. It involves the use of beams of high-energy X-rays or particles (radiation) to destroy cancer cells. Radiotherapy works by damaging the DNA inside the tumor cells, destroying their ability to reproduce.
Patients with seminoma testicular cancer will typically require radiotherapy as well as surgery. The radiotherapy is used to prevent cancer recurrence.
Patients whose cancer has spread to their lymph nodes will need radiation therapy.
Radiation therapy may cause the following temporary side effects:
* Tiredness
* Rashes
* Muscle stiffness
* Joint stiffness
* Loss of appetite
* Nausea
Chemotherapy
Chemotherapy is the use of chemicals (medication) to treat disease - more specifically, it usually refers to the destruction of cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing. When health care professionals talk about chemotherapy today, they generally tend to refer more to cytotoxic medication than others. Cytotoxic simply means it is toxic to cells, it kills cells, which in the case of chemotherapy refers to cancer cells.
Chemotherapy (chemo) drugs either interfere with a cancer cell's ability to divide and reproduce, or kills them.
Chemotherapy is usually given to patients with advanced testicular cancer - cancer that has spread to other parts of the body.
Chemotherapy is also used to prevent recurrence of cancer - to stop the cancer from coming back.
Most commonly, chemotherapy is used for the treatment of non-seminoma tumors.
Treatment is administered either orally (tablets by mouth) or injection.
As chemotherapy attacks healthy (good) cells as well as cancerous ones, the patient may experience the following temporary side effects:
* Nausea
* Vomiting
* Hair loss
* Mouth sores
* Tiredness
* Malaise
Most people immediately link chemotherapy with uncomfortable side effects. However, side-effect management has improved considerably over the last twenty years. Many side effects that were once inevitable can be either prevented or well controlled today. There is no reliable way to predict how patients may react to chemotherapy. Some experience very mild side-effect, others will have none at all, while some people will report various symptoms.
Prevention of testicular cancer
Preventing testicular cancer may not be possible, but making sure it does not advance before diagnosis and treatment is. In other words, if you check yourself regularly for signs and symptoms of testicular cancer you are more likely to be one of those 95% of patients who make a full recovery if you do develop testicular cancer.
How to check yourself
The best time to check yourself is when the scrotal skin is relaxed; usually after a warm shower or bath.
* Gently hold your scrotum in the palms of both your hands. Stand in front of the mirror and look for any swelling on the skin of the scrotum.
* Feel the size and weight of your testicles first.
* With your fingers and thumbs press around and be receptive for any lumps or unusual swellings. Become familiar with your own testicles. Some men have one testicle that hangs lower than the other. Some people have one testicle which is bigger than the other. This is normal.
* Each time you check yourself try to detect any significant increase in the size or weight of your testicles.
* Feel each testicle individually. Place the index and middle fingers under the testicle while your thumbs are on the top. Gently roll the testicle between the thumbs and the fingers - it should be smooth, oval shaped, and somewhat firm; there should be no lumps or swellings. The top and back of each testicle should have a tube-like section which may be slightly tender - this is where sperm is stored (epididymis). It is normal for it to feel tender.
If you are not sure what a testicle should feel like, remember this:
* They should both have a similar feel.
* As cancer in both testicles is extremely rare, you are unlikely to feel two identical testicles that have cancer.
* If one feels different from the other, tell your doctor.
* Also, tell your doctor if a testicle does not have the same feel compared to your last self-check.
Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
Oct 7, 2009
Hearing Loss
Hearing Loss Risk In Men Can Be Reduced By Higher Folates, Not Antioxidants
ncreased intakes of antioxidant vitamins have no bearing on whether or not a man will develop hearing loss, but higher folate intake can decrease his risk by 20 percent, according to new research presented at the 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO, in San Diego, CA.
The study, which identified 3,559 cases of men with hearing loss, found that there was no beneficial association with increased intakes of antioxidant vitamins such as C, E, and beta carotene. However, the authors found that men over the age of 60 who have a high intake of foods and supplement high in folates have a 20 percent decrease in risk of developing hearing loss.
Hearing loss is the most common sensory disorder in the United States, affecting more than 36 million people. High folate foods include leafy vegetables such as spinach, asparagus, turnip greens, lettuces, dried or fresh beans and peas, fortified cereal products, sunflower seeds and certain other fruits and vegetables are rich sources of folate. Baker's yeast, liver and liver products also contain high amounts of folate.
The authors believe this is the largest study to delve prospectively into the relation between dietary intake and hearing loss. They used the most recent figures from the Health Professionals Follow-up Study cohort from years 1986 to 2004, a group consisting of 51,529 male health professionals. They were first enrolled into this study in 1986 and filled out detailed health and diet questionnaires every other year. The authors believe their findings can allow greater education, prevention, and screening efforts.
Title:
Vitamin Intake and Risk of Hearing Loss in Men
Author:
Josef Shargorodsky, MD; Gary Curhan, MD; Sharon Curhan, MD; Ronald Eavey, MD
Noise-Induced Hearing Loss Nearly 3 Times As Likely To Occur In Men
A comprehensive study of the prevalence and risk factors for noise-induced hearing loss (NIHL) show that men, especially those who are white and married, are significantly more at risk than women, according to new research presented at the 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO, in San Diego, CA.
The study, which analyzed the audiometric testing data from 5,290 people between the ages of 20 and 69 years indicates that more than 13 percent of subjects suffer from NIHL, which would correspond with approximately 24 million Americans suffering from the ailment. The strongest association was of gender, where men are 2.5 times more likely to develop NIHL than women. Among that group, married white (non-Hispanic) men represent the highest risk group for developing NIHL.
NIHL is a preventable and increasingly prevalent disorder that results from exposure to high-intensity sound, especially over a long period of time.
The authors believe this is the first study of its kind to delve in to the demographics of NIHL using the most recent figures from 1999-2004 National Health and Nutrition Examination Surveys (NHANES). They believe this information can allow greater education, preventative, and screening efforts.
Title:
Prevalence and Risk Factors for Noise Induced Hearing Loss
Author:
Shawn Zardouz; Hamid Djalilian, MD; Vanessa Rothholtz, MD, MSc; Mohsen Barazgan
Source:
Matt Daigle
American Academy of Otolaryngology -- Head and Neck Surgery
ncreased intakes of antioxidant vitamins have no bearing on whether or not a man will develop hearing loss, but higher folate intake can decrease his risk by 20 percent, according to new research presented at the 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO, in San Diego, CA.
The study, which identified 3,559 cases of men with hearing loss, found that there was no beneficial association with increased intakes of antioxidant vitamins such as C, E, and beta carotene. However, the authors found that men over the age of 60 who have a high intake of foods and supplement high in folates have a 20 percent decrease in risk of developing hearing loss.
Hearing loss is the most common sensory disorder in the United States, affecting more than 36 million people. High folate foods include leafy vegetables such as spinach, asparagus, turnip greens, lettuces, dried or fresh beans and peas, fortified cereal products, sunflower seeds and certain other fruits and vegetables are rich sources of folate. Baker's yeast, liver and liver products also contain high amounts of folate.
The authors believe this is the largest study to delve prospectively into the relation between dietary intake and hearing loss. They used the most recent figures from the Health Professionals Follow-up Study cohort from years 1986 to 2004, a group consisting of 51,529 male health professionals. They were first enrolled into this study in 1986 and filled out detailed health and diet questionnaires every other year. The authors believe their findings can allow greater education, prevention, and screening efforts.
Title:
Vitamin Intake and Risk of Hearing Loss in Men
Author:
Josef Shargorodsky, MD; Gary Curhan, MD; Sharon Curhan, MD; Ronald Eavey, MD
Noise-Induced Hearing Loss Nearly 3 Times As Likely To Occur In Men
A comprehensive study of the prevalence and risk factors for noise-induced hearing loss (NIHL) show that men, especially those who are white and married, are significantly more at risk than women, according to new research presented at the 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO, in San Diego, CA.
The study, which analyzed the audiometric testing data from 5,290 people between the ages of 20 and 69 years indicates that more than 13 percent of subjects suffer from NIHL, which would correspond with approximately 24 million Americans suffering from the ailment. The strongest association was of gender, where men are 2.5 times more likely to develop NIHL than women. Among that group, married white (non-Hispanic) men represent the highest risk group for developing NIHL.
NIHL is a preventable and increasingly prevalent disorder that results from exposure to high-intensity sound, especially over a long period of time.
The authors believe this is the first study of its kind to delve in to the demographics of NIHL using the most recent figures from 1999-2004 National Health and Nutrition Examination Surveys (NHANES). They believe this information can allow greater education, preventative, and screening efforts.
Title:
Prevalence and Risk Factors for Noise Induced Hearing Loss
Author:
Shawn Zardouz; Hamid Djalilian, MD; Vanessa Rothholtz, MD, MSc; Mohsen Barazgan
Source:
Matt Daigle
American Academy of Otolaryngology -- Head and Neck Surgery
231 New Genes Associated With Head And Neck Cancer Revealed By Study
A Henry Ford Hospital study has identified 231 new genes associated with head and neck cancer, one of the most deadly cancers responsible for 2.1 percent of all cancer deaths in the United States.
Previously, only 33 genes were reported associated with head and neck cancer.
"These new genes should advance selection of head and neck-specific gene targets, opening the door to promising new molecular strategies for the early detection and treatment of head and neck cancer," says study lead author Maria J. Worsham, Ph.D., director of research in the Department of Otolaryngology at Henry Ford Hospital. "It also may offer the opportunity to help monitor disease progression and a patient's response to treatment."
Results from the study were presented Sunday, Oct. 4 at the American Academy of Otolaryngology - Head & Neck Surgery Foundation Annual Meeting & OTO EXPO in San Diego.
This year alone, more than 55,000 Americans will develop head and neck cancer, which includes cancers of the mouth, nose, sinuses, salivary glands, throat and lymph nodes in the neck; nearly 13,000 of them will die from it.
According to the National Cancer Institute, 85 percent of head and neck cancers are linked to tobacco use. People who use both tobacco and alcohol are at greater risk for developing these cancers than people who use either tobacco or alcohol alone.
Treatment for head and neck cancer varies based on the location and stage of the tumor, but most often includes surgery, radiation therapy or chemotherapy.
To identify new genes that could ultimately aid in future diagnosis and treatment of head and neck cancer, Dr. Worsham's study used a whole-genome methylation approach to detect genes with altered promoter gene regions due to DNA methylation. DNA methylation - a type of chemical modification of DNA where a methyl group (CH3) can be added (hypermethylation) or removed (hypomethylation) - allows the researchers to look for genetic abnormalities within tumor samples.
Using five DNA samples from tumor tissue, the researchers looked for 1,043 possible cancer genes. Those genes were cross-examined with those already reported in PubMeth, a cancer methylation database. Of the 441 genes in the database, only 33 genes were referenced in connection with head and neck cancer.
In all, the whole-genome methylation approach revealed 231 potential new genes not previously reported in head and neck cancer. Of those, 50 percent were present in three or more of the DNA samples, and 20 percent were represented in all five samples.
"DNA methylation is emerging as one of the most promising molecular strategies for early detection of cancer, independent of its role in tumor development," says Dr. Worsham. "Abnormal methylation can result in shutting off or silencing gene function. However, treatment with more recent drugs can reverse abnormal DNA methylation patterns, reactivating silenced genes, and restoring normal gene function. Therefore, a validated head and neck cancer-specific gene panel is likely to signify potential demethylation treatment targets."
Reference: "DNA Hypermethylation Markers of Poor Outcome in Laryngeal Cancer," 2009 AAO - HNSF Annual Meeting & OTO Expo. The study was presented by Dr. Worsham Sunday, Oct. 4.
Research Support: Grant R01 NIH DE 15990
Source:
Krista Hopson
Henry Ford Health System
Previously, only 33 genes were reported associated with head and neck cancer.
"These new genes should advance selection of head and neck-specific gene targets, opening the door to promising new molecular strategies for the early detection and treatment of head and neck cancer," says study lead author Maria J. Worsham, Ph.D., director of research in the Department of Otolaryngology at Henry Ford Hospital. "It also may offer the opportunity to help monitor disease progression and a patient's response to treatment."
Results from the study were presented Sunday, Oct. 4 at the American Academy of Otolaryngology - Head & Neck Surgery Foundation Annual Meeting & OTO EXPO in San Diego.
This year alone, more than 55,000 Americans will develop head and neck cancer, which includes cancers of the mouth, nose, sinuses, salivary glands, throat and lymph nodes in the neck; nearly 13,000 of them will die from it.
According to the National Cancer Institute, 85 percent of head and neck cancers are linked to tobacco use. People who use both tobacco and alcohol are at greater risk for developing these cancers than people who use either tobacco or alcohol alone.
Treatment for head and neck cancer varies based on the location and stage of the tumor, but most often includes surgery, radiation therapy or chemotherapy.
To identify new genes that could ultimately aid in future diagnosis and treatment of head and neck cancer, Dr. Worsham's study used a whole-genome methylation approach to detect genes with altered promoter gene regions due to DNA methylation. DNA methylation - a type of chemical modification of DNA where a methyl group (CH3) can be added (hypermethylation) or removed (hypomethylation) - allows the researchers to look for genetic abnormalities within tumor samples.
Using five DNA samples from tumor tissue, the researchers looked for 1,043 possible cancer genes. Those genes were cross-examined with those already reported in PubMeth, a cancer methylation database. Of the 441 genes in the database, only 33 genes were referenced in connection with head and neck cancer.
In all, the whole-genome methylation approach revealed 231 potential new genes not previously reported in head and neck cancer. Of those, 50 percent were present in three or more of the DNA samples, and 20 percent were represented in all five samples.
"DNA methylation is emerging as one of the most promising molecular strategies for early detection of cancer, independent of its role in tumor development," says Dr. Worsham. "Abnormal methylation can result in shutting off or silencing gene function. However, treatment with more recent drugs can reverse abnormal DNA methylation patterns, reactivating silenced genes, and restoring normal gene function. Therefore, a validated head and neck cancer-specific gene panel is likely to signify potential demethylation treatment targets."
Reference: "DNA Hypermethylation Markers of Poor Outcome in Laryngeal Cancer," 2009 AAO - HNSF Annual Meeting & OTO Expo. The study was presented by Dr. Worsham Sunday, Oct. 4.
Research Support: Grant R01 NIH DE 15990
Source:
Krista Hopson
Henry Ford Health System
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