Odysseys of George

Well as in the banner above, October is the official breast awareness month. In accordance, Selayang Hospital is holding a month long campaign with its official successful launch was on the 4th of October 2006. The campaign, led by our Breast & Endocrine Surgeon, Ms Azlina Firzah, was the first of its kind in Selayang Hospital.

According to the National Cancer Registry Report 2003, 31% of all cancer occuring among females were of breast cancer making it the leading cancer in women. In Selayang, women of above 30 have been reported to have breast cancer. Just today, a lady in her late 20′s were diagnosed to have breast cancer. There is no race predilection as breast cancer is the leading cancer in women of all races. If not mistaken the risk of a women getting breast cancer at present is 1 in 18. It could be higher than that as many cases are not reported.

Who is in charge? Women! Self breast examination is the single most important screening tool to pick up any lumps early. Sadly, many still feel reluctant to examine themselves and those who do and do find a lump, becomes worried and fearful of seeing a doctor. Some resign from examining themselves because they are worried they may find a lump. Breast cancer like most other cancers if diagnosed early has a better outcome. But yet, fear appears to be a dominant deterrent.

Once a lump is detected, triple assessment is performed to confirm and secure the diagnosis.
This consist of Clinical Assessment(history and breast examination), Radiological Assessment in the form of ultrasound or mammogram maybe both, and lastly a pathological assessment (Fine Needle Aspiration Cytology or Core Needle Biopsy).

Upon confirmation of the diagnosis, clinical staging is performed into Stage 1,2,3 or 4. In Stages 1,2 and some stage 3, the primary treatment is surgery. If possible, breast conservation surgery(BCS) maybe an option but post-operative radiotheraphy is a must. In all whether BCS or mastectomy, an axillary dissection is also performed. This is because axillary nodal status is the single most important prognostic factor in breast cancer.

After surgery, systemic treatment is usually required as even in early breast cancer, some cancer cells could have already travelled away from the primary source and these are called micrometastases. These may not show up until much later when they are reactivated and present themselves as secondary deposits in the lung, bone or liver. Thus, breast cancer is looked upon as a systemic disease and can be very challenging. Active after treatment monitoring and follow-up is therefore of importance.

Sites to check out:

http://www.radiologymalaysia.org/breasthealth

http://www.radiologymalaysia.org/breasthealth/BCWA/aboutbcwa.htm

http://www.radiologymalaysia.org/breasthealth/MBCC/index.htm

http://www.cancer.org.my/can_det_centre.htm

Strange? No, it actually looks like a butterfly from the front. The wings being the two right and left lobes, the body – the isthmus and the antenna – the pyramidal lobe, all of which are parts of an important structure in the body called the thyroid gland. It secretes a hormone for daily bodily functions called thyroxine. So?? Such a beautiful organ can go wrong in 3 ways:
1. Function — too active or too passive ( hyperthyroid / hypothyroid )
2. Size — it can just swell up and press onto the trachea or esophagus causing difficulty in breathing or swallowing
3. Combination of both
Medications can be used to control the function but surgery is usually the option for size or when medical treatment fails to control the dysfunction.Problem? — Surgery has a risk of injuring the nerve that supplies the vocal cords and in a case of one sided damage it causes hoarseness of voice and if both sides are damaged then it can cause loss of voice and difficulty and noisy breathing. thus the worry for both patients and surgeons though the risk is actually very small.

Well, there was this lovely 60 year old lady who came to see me for an swelling over the neck which had increased in size significantly over the last 6 months. A fine needle biopsy, an ultrasound and a CT scan all pointed to a non cancerous origin and made me more worried because clinically this looked and felt malignant.

So, after explaining in depth and a trip to redang, I came back to wiggle my scaple along the lady’s neck. So off I went chop!chop! swish! .. oops! maybe not! continue…… as the hours passed a huge 10cm by 8cm by 6cm left lobe mass was removed together with the nodular right lobe and isthmus. Total thyroidectomy done. At the end, it was a lesson in anatomy as all the structures were very visible.

Well, surgery went well. Though exhausted I was happy that her voice was salvaged.The butterfly gland was sent to pathology for reporting.

Probably will have a part 2 for the later outcome. Interested??

Just got this from a friend. Well just to alert all my friends and visitors.

Cancer update
Johns Hopkins
Cancer News from Johns Hopkins:

1. No plastic containers in micro.
2. No water bottles in freezer.
3. No plastic wrap in microwave.

Johns Hopkins has recently sent this out in its newsletters. This information is being circulated at Walter Reed Army MedicalCenter as well.

Dioxin chemicals causes cancer, especially breast cancer. Dioxins are highly poisonous to the cells of our bodies. Don’t freeze your plastic bottles with water in them as this releases dioxins from the plastic.

Recently, Dr. Edward Fujimoto, Wellness Program Manager at Castle Hospital, was on a TV program to explain this health hazard. He talked about dioxins and how bad they are for us.

He said that we should not be heating our food in the microwave using plastic containers. This especially applies to foods that contain fat. He said that the combination of fat, high heat, and plastics releases dioxin into the food and ultimately into the cells of the body.

Instead, he recommends using glass, such as Corning Ware, Pyrex or ceramic containers for heating food. You get the same results, only without the dioxin. So such things as TV dinners, instant ramen and soups, etc., should be removed from the container and heated in something else. Paper isn’t bad but you don’t know what is in the paper. It’s just safer to use tempered glass, Corning Ware, etc.

He reminded us that a while ago some of the fast food restaurants moved away from the foam containers to paper. The dioxin problem is one of the reasons.

Also, he pointed out that plastic wrap, such as Saran, is just as dangerous when placed over foods to be cooked in the microwave. As the food is nuked, the high heat causes poisonous toxins to actually melt out of the plastic wrap and drip into the food. Cover food with a paper towel instead.

NOOR V. GILLANI, D.Sc
Principal Research Scientist
Adjunct Professor
Nat’l Space Science & Technol Ctr.
Atmospheric Science Department
(NSSTC, NASA-AL)
U. of AL in Huntsville(UAH)
Tel. 256 961-7942
email:gillani@nsstc.uah.edu
Fax. 256 961-7755

Checked in the medical literature :

Diry, M. Tomkiewicz, C. Koehle, C. Coumoul, X. Bock, K Walter. Barouki, R. Transy, C.
UMR-S 490 INSERM, UFR Biomedicale des Saints Peres, Paris, Cedex, France.
Activation of the dioxin/aryl hydrocarbon receptor (AhR) modulates cell plasticity through a JNK-dependent mechanism
Oncogene. 25(40):5570-4, 2006 Sep 7.

Abstract:
Environmental chemicals such as dioxin adversely affect immune, neurological and reproductive functions and have been implicated in cancer development. However, the mechanisms responsible for dioxin toxicity are still poorly understood……Dioxin-induced effects occur 48 h post-treatment initiation, a time scale, which argues for a genomic effect of the AhR, linked to induction of target genes. This novel Ahr action on cell plasticity points to a role in cancer progression.