Common Pain Killers Can Mask Signs of Prostate Cancer

Common painkillers taken on a regular basis, such as ibuprofen and aspirin, appear to lower a man's PSA level, the blood biomarker used by doctors to help gauge whether a man is at a risk of getting prostate cancer.

The authors of this new study, however, caution that men should not take the painkillers in an effort to prevent prostate cancer. An author on this study Eric A Singer M.D., M.A., a urology resident at the University of Rochester Medical Center, said, "We showed that men who regularly took certain medications like aspirin and other non-steroidal anti-inflammatory drugs, or NSAIDS, had a lower serum PSA level.... But there's not enough data to say that men who took the medications were less likely to get prostate cancer. This was a limited study, and we do not know how many of those men actually got prostate cancer."

Singer and his team studind the records of approximately 1,319 men that were over the age of 40 who took part in the National Health and Nutrition Examination Survey between the years 2001 and 2002. Singer's team looked at the men's use of NSAIDs such as ibuprofen and aspirin, as well as acetaminophen, and they looked at their PSA levels. The level of a man's PSA, or prostate-specific antigen, is one of the numerous clues that doctors watch to gauge the risk a man has of getting prostate cancer.

The researchers found that men who did use NSAIDs on a regular basis had PSA levels that were about 10 percent lower than the men who did not use them. The team then made a similar observation with the pain killer acetaminophen, but the result was not statistically significant due to the lower number of men in the study that were taking that medication.

While it might be easily assumed that if you have lower PSA levels that this automatically translates to a low risk of getting prostate cancer, the authors stress that it is still too soon to draw that kind of conclusion. The corresponding author of the study Edwin van Wijngaarden, Ph.D., and the assistant professor in the Department of Community and Preventative Medicine states that while the results of this study are consistent with other research, and indicates that certain commonly used painkillers may reduce a man's risk of getting prostate cancer, the new findings are just preliminary and do not prove a link.

Singer stated that the PSA level of a man can be elevated for many reasons that are unrelated to cancer. For instance, while inflammation is a part of cancer, sometimes it may not be, and so it is possible that the lowered level of PSA reflects the reduction of inflammation without affecting a man's risk of getting prostatism. Also, another possibility is that a PSA level that this lowered by taking NSAIDs might artificially mask a man's risk of contracting prostate cancer. The pain medications could lower the PSA, but a man's risk might stay the exact same.

Singer says, "More than anything, these findings underscore the importance for doctors to know what medications their patients are on. For instance, there are medications commonly used to treat an enlarged prostate that can result in a decreased PSA, and most physicians know that. Doctors should also be asking about patients' use of NSAIDs such as aspirin and ibuprofen."

The data is said to show much interest, but it will take more research to determine how to interpret all the findings. In the meantime, these findings should not change men's behavior and prompt them to take these pain medications to try and prevent themselves from getting prostate cancer.

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Marijuana Use May Significantly Increase Risk of Testicular Cancer

According to the National Survey on Drug Use and Health, marijuana is the most widely used illicit drug in the U.S., with 95 million Americans age 12 and older having used the drug at least once, and three out of every four illegal drugs users reporting its use within the previous 30 days. Most users perceive marijuana as a natural herb thereby believing it to be harmless.

In truth, the habitual use of marijuana has been proven to cause concentration and thinking problems, deficits in mathematical skills and verbal expression, as well as selective impairments in memory retrieval processes. It can also lead to increased anxiety, panic attacks, depression, and other mental health problems. The long-term consequences of using marijuana include poor academic performance, poor job performance, cognitive deficits, and even lung damage.

New U.S. research has now added to the ever-growing list of dangers associated with the use of marijuana. The new study has shown that people who frequently use marijuana may be at more than double the risk of developing testicular cancer.

The study included 369 men from the Seattle-Puget Sound area who had been diagnosed with testicular cancer as well as 979 men without the disease. The study participants ranged in age from 18 to 44. Each participant was asked about his history of marijuana use. The findings revealed that current marijuana users were 70 percent more likely to develop a testicular malignancy than nonusers.

The risk was shown to be highest among those who had used marijuana for at 10 years or longer or began their usage before age 18 as well as those currently using it more than once a week. In addition, the study results suggested that a specific type of testicular cancer known as nonseminoma was linked to the drug’s use. Nonseminoma is a fast-progressing testicular malignancy that accounts for approximately 40 percent of all testicular cancer cases and most often develops in people between the ages of 20 and 35. The results of the analysis were published in the journal Cancer.

Research group member Stephen Schwartz, an epidemiologist and member of the Public Health Sciences Division at the Seattle's Fred Hutchinson Cancer Research Center said, “Our study is not the first to suggest that some aspect of a man's lifestyle or environment is a risk factor for testicular cancer, but it is the first that has looked at marijuana use.”

Although experts remain uncertain as to the causes of testicular cancer, known risk factors include a family history of the disease, undescended testes and abnormal testicular development. The link between marijuana use and the disease may be attributed to a disruption of the effects of a chemical that is naturally produced by the male reproductive system believed to have a protective effect against cancer.

Approximately 8,000 men within the U.S. are diagnosed with testicular cancer annually. According to the American Cancer Society, The disease has a five-year survival rate of about 96 percent as it usually responds well to treatment. However, some patients are not diagnosed until the disease is in its advanced stages. Performing regular testicular self-examinations can help to insure successful treatment by identifying growths that are still in the early stages.

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Salmonellosis, symptoms of the Salmonellosis. Treatment of the Salmonellosis.

The salmonellosis is the pluricausal infectious disease caused various serotypes of bacteria of sort Salmonella, is characterized by various clinical displays from asymptomatic carrier state up to heavy septic forms. In most cases of the salmonellosis proceeds with primary defeat of bodies of a digestive path (gastroenteritis, colitis). The activator of the Salmonellosis - greater group of salmonellas (family Enterobacteriaceae, sort Salmonella), numbering now more than 2200 serotypes.

Sources of the Salmonellosis are basically pets and the birds, however the certain value the person (plays also the patient, the carrier) as an additional source.

The basic way of infection at a salmonellosis - alimentary, caused by the use in food of products in which a plenty of salmonellas contains. Usually it is observed at wrong culinary processing. Treatment of a salmonellosis.
The incubatory period at a food way of infection with the Salmonellosis fluctuated from 6 h up to 3 days (more often 12-24). At nosocomial flashes when the contact-household way of transfer of an infection prevails, incubation a salmonellosis about 3-8 days are extended. Allocate following clinical forms of a salmonellosis:

- The gastrointestinal (localized), proceeding in stomachal, gastroenteritis, gastroenterocolitis and coloenteritis variants;
- The generalized form of a salmonellosis in the form of typhoid and septic variants;
- The diphtheriaphor: sharp, chronic and transient;
- The subclinical form of a salmonellosis;

Clinical forms of a salmonellosis differ and on weight of current.

The gastrointestinal form (a sharp gastritis, sharp gastroenteritis or gastroenterocolitis) - one of the most widespread forms of a salmonellosis (96-98 % of cases). Begins sharply, the body temperature (raises at heavy forms up to 39С and above), there is a general weakness, a headache, a fever, a nausea, vomiting, pains in epigastric and umbilical areas, frustration of a chair later joins. At some sick the salmonellosis in the beginning marks only a fever and attributes of the general intoxication, and changes from a gastroenteric path join a little bit later. They are Most expressed by the end of the first and for the second and third day from the beginning of disease by a salmonellosis. Expressiveness and duration of displays of a salmonellosis depend on weight.

At the easy form of a salmonellosis a body temperature subfebrile, vomiting unitary, a chair liquid aqueous up to 5 times day, duration of a diarrhea 1-3 days, loss of a liquid no more than 3 % of weight of a body. At the middle form of a salmonellosis the temperature raises up to 38-39оС, duration of a fever till 4 days, repeated vomiting, a chair up to 10 times day, duration of a diarrhea till 7 days; the tachycardia, downturn the AD are marked, can develop deaquation I-II degrees, loss of a liquid up to 6 % of weight of a body. Heavy current gastrointestinal forms of a salmonellosis is characterized by a high fever (above 39оС) which lasts 5 and more days, the expressed intoxication. Vomiting repeated, is observed within several days; the chair more than 10 times day, plentiful, aqueous, fetid, can be with an impurity of slime. The diarrhea proceeds till 7 days and more.

The increase in a liver and spleen is marked, is possible icteritiousness leather and sclera. The tachycardia, significant downturn the AD are observed cyanosis leather. Changes from kidneys come to light: oligohydruria, albuminuria, erythrocyte and cylinders in urine, the maintenance of residual nitrogen raises. Can develop sharp nephritic insufficiency. The water-salt exchange (deaquation II-III degrees) is broken, that is shown in dryness of a leather, blue disease, aphonia, spasmes. Losses of a liquid reach 7-10 % of weight of a body. In blood the level of hemoglobin and erythrocyte raises, is characteristic moderated leukocytosis with shift leukocytic formulas to the left.

The most frequent clinical variant at gastrointestinal a salmonellosis gastroenteritis. Destructive changes at a salmonellosis in a thick gut are registered only in 5-8 % of cases. Gastroenterology and colitis variants of a salmonellosis should be diagnosed only if in a clinical picture of disease displays colitis prevail and is available bacteriological or serologic acknowledgement of the diagnosis as these variants of a salmonellosis are rather similar on current to a sharp dysentery.

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Tuberous sclerosis

Definition

Tuberous sclerosis is a group of two genetic disorders that affect the skin, brain/nervous system, kidneys, and heart, and cause tumors to grow. The diseases are named after a tuber- or root-shaped growth in the brain.

Alternative Names

Adenoma sebaceum

Causes

Tuberous sclerosis is inherited. Changes (mutations) in two genes, TSC1 and TSC2, are responsible for the condition.

Only one parent needs to pass on the mutation for the child to get the disease. However, most cases are due to new mutations, so there usually is no family history of tuberous sclerosis.

This condition is one of a group of diseases called neuro-cutaneous syndromes. Both the skin and central nervous system (brain and spinal cord) are involved.

There are no known risk factors, other than having a parent with tuberous sclerosis. In that case, each child has a 50% chance of inheriting the disease.

Symptoms

Skin symptoms include:

• Caf-au-lait spots
• Red patches on the face containing many blood vessels (adenoma sebaceum)
• Raised patches of skin with an orange-peel texture (shagreen spots), often on the back
• White areas of skin that look like an ash leaf (ash leaf spots)

Brain symptoms include:

• Developmental delays
• Mental retardation
• Seizures

Other symptoms:

• Heart tumors (rhabdomyoma)
• Kidney tumors
• Pitted dental enamel
• Rough growths under or around the fingernails and toenails
• Rubbery non-cancerous tumors on or around the tongue

The symptoms of tuberous sclerosis vary from person to person. Some people have normal intelligence and no seizures. Others have severe retardation, serious tumors, or difficult-to-control seizures.

Exams and Tests

Signs may include:

• Abnormal heart rhythm (arrhythmia)
• Calcium deposits in the brain
• Non-cancerous "tubers" in the brain
• Rubbery growths on the tongue or gums
• Tumor-like growth (hamartoma) on the retina, pale patches in the eye
• Tumors

Tests may include:

• CT scan of the head
• MRI of the head
• Ultrasound of the kidney
• Ultraviolet light examination of the skin

DNA testing for either of the two genes that can cause this disease (TSC1 or TSC2) is available.

Regular ultrasound checks of the kidneys are an important screening tool, to make sure there is no tumor growth.

Treatment

There is no specific treatment for tuberous sclerosis. Because the disease can differ from person to person, treatment is based on the symptoms.

Medications are needed to control seizures, which is often difficult. Depending on the severity of the menal retardation, the child may need special education.

Small growths (adenoma sebaceum) on the face may be removed by laser treatment. These growths tend to come back, and repeat treatments will be necessary.

Rhabdomyomas commonly disappear after puberty, so surgery is usually not necessary.

Support Groups

For additional information and resources, contact the Tuberous Sclerosis Alliance at 800-225-6872.

Outlook (Prognosis)

Children with mild tuberous sclerosis usually do well. However, children with severe retardation or uncontrollable seizures usually do poorly. Occasionally when a severely affected child is born, the parents are examined, and one of them is found to have had a mild case of tuberous sclerosis that was not diagnosed.

The tumors in this disease tend to be non-cancerous (benign). However, some tumors (such as kidney or brain tumors) can become cancerous.

Possible Complications

• Brain tumors (astrocytoma)
• Heart tumors (rhabdomyoma)
• Severe mental retardation
• Uncontrollable seizures

When to Contact a Medical Professional

Call your health care provider if:

• Either side of your family has a history of tuberous sclerosis
• You notice symptoms of tuberous sclerosis in your child

Call a genetic specialist if your child is diagnosed with cardiac rhabdomyoma. Tuberous sclerosis is the leading cause of this tumor.

Prevention

Genetic counseling is recommended for prospective parents with a family history of tuberous sclerosis. Prenatal diagnosis is available for families with a known DNA mutation. However, tuberous sclerosis often appears as a new mutation, and these cases are not preventable.

References

Haslam RHA. Neurocutaneous Syndromes. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 596.

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Bunions

Definition

A bunion is when your big toe points toward the second toe. This causes a bump on the edge of your foot, at the joint of your big toe.

Alternative Names

Hallux valgus

Causes

Bunions occur more commonly in women and sometimes run in families. People born with abnormal bones in their feet are more likely to form a bunion. Wearing narrow-toed, high-heeled shoes may lead to a bunion. The condition may become painful as extra bone and a fluid-filled sac grow at the base of the big toe.

Symptoms

• Red, calloused skin along the foot at the base of the big toe
• A bony bump at this site
• Pain over the joint, aggravated by pressure from shoes
• Big toe turned toward the other toes

Exams and Tests

A doctor can usually diagnose a bunion by looking at it. A foot x-ray can show an abnormal angle between the big toe and the foot and, in some cases, arthritis.

Treatment

When a bunion first begins to develop, take good care of your feet and wear wide-toed shoes. This often solves the problem and prevents the need for any further treatment. It may help to wear felt or foam pads on the foot to protect the bunion, or devices to separate the first and second toes at night. These are available at drugstores. You can also try cutting a hole in a pair of old, comfortable shoes to wear around the house.

If the bunion gets worse -- resulting in severe deformity or pain -- surgery to realign the toe and remove the bony bump (bunionectomy) can be effective. There are over 100 different surgical techniques that have been described to treat this condition.

Outlook (Prognosis)

The outlook depends on your age and activities, and the severity of the bunion. Teenagers may have more trouble treating a bunion than adults. Many adults do well by caring for the bunion when it first starts to develop, and wearing different shoes. Surgery reduces the pain in many, but not all, people with bunions.

Possible Complications

• Chronic foot pain
• Foot deformity
• Stiff foot
• Hallux varus (occurs with surgical over-correction, where the toe points away from the second toe)

When to Contact a Medical Professional

Call for an appointment with your doctor if the bunion:

• Continues to cause pain even after self care, such as wearing wide-toed shoes
• Prevents you from doing your usual activities
• Has any signs of infection (like redness or swelling), especially if you have diabetes

Prevention

Avoid compressing the toes of your foot with narrow, poor-fitting shoes.

References

Vanore JV. Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 1: Hallux valgus. J Foot Ankle Surg. 2003; 42(3): 112-123.

King DM. Associated deformities and hypermobility in hallux valgus: an investigation with weightbearing radiographs. Foot Ankle Int. 2004; 25(4): 251-255.

Ferrari J, Higgins JP, Prior TD. Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database Syst Rev. 2004.

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Donovanosis. Venereal granuloma

Except for the name «donovanosis» this venereal illness also refers to venereal granuloma, the fifth venereal illness, is simple granuloma or granulomatosis, tropical inguinal granuloma, granuloma ulcer genitals, inguinal granuloma. The name «granuloma» occurs from a latin word granulum – "kernel", and there was it of that the basic symptoms of venereal granuloma are really reminding grains papule – small pimples on genitals.

Speaking about classical venereal diseases, venereologists, as a rule, keep in mind five diseases. Two of them – a syphilis and a gonorrhoea – are widely widespread worldwide. Other three concern to type of rare infections in Russia, transferred by sexual contact. It is soft chancre («the third venereal illness»), inguinal megakaryoblastoma («the fourth venereal illness»), and, finally, venereal granuloma («the fifth venereal illness»).

In comparison with "counterparts", especially with a syphilis, donovanosis looks a harmless sore. However harmless venereal illnesses does not happen, and venereal granuloma is not exception. Complications granulomatosis if they are reached with business, can be more than serious and dangerous to human life.

Venereal granuloma is the chronic infection transferred, similarly to other venereal illnesses, first of all sexual by and slowly progressing in an organism of the infected person. Adults are ill venereal granuloma only, it is not transferred children.

The activator of venereal granuloma (donovanosis) owing to which illness has received this name, – bodies Donovan which refers to also Calymmatobacterium granulomatis or stick Aragan-Vianne. It is fine (1-2 microns) a bacterium bean-like or ovoid forms. At contact to patients, bacteria take root into a leather of genitals, perineum and other sites, causing disease.

In Russia cases venereal granuloma – a huge rarity as this illness is specific to the tropical countries with a warm and damp climate. Especially widely venereal granuloma it is widespread in Papua-new Guinea, Southern India, Southern Africa, the countries of Caribbean basin, in separate areas of Australia and Brazil. In America and in the Europe "brought in" cases venereal granuloma are registered only. There are scattered instances venereal granuloma and in Russia. Among our compatriots basically the people going in tropics on rest and interested persons to try of local "exotic" including in intimate relations catch.

Certainly, sick venereal granuloma the person can transfer an infection to the constant partner, but such cases – an even greater rarity, as venereal granuloma, on medical terminology, «rather less contagious». It means, that in difference, we shall tell from a gonorrhoea who is almost always transferred the healthy partner from the patient at the first not protected contact, venereal granuloma at sexual contact is transferred seldom enough.

According to statistics, the risk to catch venereal granuloma at the unitary not protected sexual contact to patients can change from 1 up to 50 %. Thus it is necessary to consider, that the damp climate and enough heat of an environment is necessary to a bacterium. Hence, arrived of tropics to Russia infected venereal granuloma "holidayer" is practically safe for constant partners, both at sexual attitudes, and at household contacts. And still it is better to not risk, because even 1 % of probable infection for one person can be quite enough.

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Cervical Cancer

Description An in-depth report on the causes, diagnosis, treatment, and prevention of cervical cancer.

Alternative Names Dysplasia; Human Papillomas Virus; Pap Smear

Treatment for Invasive Cervical Cancer Radiation therapy and surgery are about equally effective as a single option for treating very small cervical cancers in their earliest stages, with survival rates of up to 85% to 90% in appropriate patients. Factors influencing the choice between radiation therapy and surgery in women with invasive cancer include the patient's age and health and the extent of the disease. Both surgery and radiation therapy eliminate the possibility of having children in premenopausal women. Although treatments for cervical cancer have several potentially severe side effects, they are usually well-tolerated. Women undergoing any of these treatments should feel free to seek support groups and counseling, which can be as important for their outlook as medical therapies.

Surgery

In the early stages of cervical cancer, surgery is often the preferred primary treatment approach since it preserves normal sexual function. Surgery for invasive cancer is nearly always hysterectomy. Some patients desiring fertility who have early stage I cancer may be candidates for cervical cone biopsy.

Hysterectomy. A hysterectomy attempts to eliminate the cancerous tissue by removing the uterus. There are several variations of this operation, depending on the location of the tumor. In women of childbearing age, the ovaries can usually be left intact. Although a woman who has a hysterectomy but retains her ovaries cannot bear children, she will not go into premature menopause. (Studies indicate that leaving the ovaries intact is safe for most women and does not pose any greater risk for cervical cancer recurrence.)

A simple hysterectomy involves the removal of the uterus and the cervix, but leaves the parametrium (tissue surrounding the uterus) and vagina intact. Lymph nodes in the pelvis are not usually removed.

Click the icon to see an illustrated series detailing a hysterectomy.

A radical hysterectomy removes not only the uterus and the cervix but also the parametrium, the supporting ligaments, the upper vagina, and some or all of the local lymph nodes (a procedure called lymphadenectomy).

If the cancerous tumor recurs within the pelvis after primary treatment, a more extreme procedure may be performed called a pelvic exenteration, which combines radical hysterectomy with removal of the bladder and rectum. (In such cases, plastic surgery may be needed afterward to recreate an artificial vagina.) Patients undergoing this procedure are physically and psychologically screened in advance to determine whether it is an appropriate choice. The success rate for pelvic exenteration in halting the progression of the disease is approximately 25% to 45%.

Any form of hysterectomy is major surgery and requires at least a three to five day hospital stay. Although hysterectomy typically uses a wide abdominal incision, less invasive techniques that allow shorter recovery time may be possible for some women with early stage cancers if performed by experienced surgeons.

Side effects include difficulty emptying the bladder or bowels and a painful lower abdomen. Urinary tract infections are very common. Complications include fistulas (abnormal channels within the pelvis, which in this case are a result of surgery), bladder dysfunction, and cysts.

Normal activity, including intercourse, can be resumed in about four to eight weeks. Once the uterus is removed, menstruation will cease. If the ovaries are removed, the symptoms of menopause will begin. These symptoms are likely to be more severe in surgical menopause than in the course of a natural passage to menopause. Hormone replacement therapy should be considered. [For more information on hysterectomy see the Well-Connected Report #73, Fibroids: Uterineor Report #74, Endometriosis.]

Trachelectomy.An experimental procedure called trachelectomy is being investigated for preserving fertility in certain women in early stage cancer, but it is highly controversial and appropriate in only about 5% of cervical cancer patients. In the procedure, only the cancerous portion of the cervix is removed, while the uterus and the rest of the cervix are left intact. The cervix is closed with a suture.

Small, early studies suggest it may be effective for early stage 1 patients with no risk factors for aggressive cancer. In two small 1999 and 2000 studies, conception rates were between 27% and 37%, and survival rates after two years were over 95%. The procedure is primarily performed outside the US, and few American surgeons are skilled in this surgery at this time. Throughout the world, in fact, only about a few hundred of these procedures have been performed to date. Women should also realize that conception rates are still lower than normal. And even if they can get pregnant, there is a very high risk for miscarriage because the cervix is weakened. Larger and longer-term studies are needed to confirm its long-term safety.

Radiation

Radiation therapy is an alternative approach for early stage cervical cancer. Radiation with concurrent with cisplatin-based chemotherapy is now the standard treatment for locally advanced cervical cancer. Radiation therapy employs high-energy rays aimed at the body from an outside machine (external beam radiation) and radioactive materials placed inside the body against the cervix (intracavitary radiation).

• External beam radiation is given first and aimed at the lymph nodes along the pelvic wall. It usually involves a short period of direct-radiation five days a week for about six weeks in an outpatient setting.
• Intracavitary radiation (also called brachytherapy) follows and is designed to deliver high doses of radiation to the local tumor area. Radioactive material, typically cesium-137, is encapsulated in both gold and platinum. These capsules are inserted in a long stainless steel tube, called a tandem, which is inserted in the uterus and in small stainless steel cylinders, called colpostats, which are placed against the cervix as close to the cancerous cells as possible. Commonly, two or more radiation treatments are administered for about 35 hours each time. Radiation implants may also be inserted directly into the tumor using a needle.

In order to be effective, radiation therapy must be powerful enough to destroy the cancer cells' capacity to grow and divide. This means that normal cells are also affected, which may cause significant side effects. Fortunately, healthy cells usually recover quickly from the damage, whereas abnormal cells do not.

Advanced methods for targeting radiation more precisely are now available that limit the damage to healthy tissue. They include 3-D conformal radiation and intensity-modulated radiation therapy (IMRT):

• 3-D conformal techniques use computers and a three-dimensional image of the cervix to provide precise targeting of the tumor using multiple high-dose radiation beams.
• IMRT also uses 3-D techniques and employs very thin and precise beam at various intensities.

Side Effects. Side effects of radiation therapy include fatigue, redness or dryness in the treated area, diarrhea, frequent or uncomfortable urination, and vaginal dryness, itching, or burning. After treatment, side effects usually disappear.

Long-Term Complications. Complications include proctitis (inflammation of the rectum) and cystitis (inflammation of the bladder). Bowel obstruction is an uncommon complication. Radiation therapy may also cause vaginal scarring, sexual difficulties, and premature menopause in younger women. Occasionally an abnormal tunnel between the bladder and the vagina, known as a vesicovaginal fistula, will develop and may require surgery.

Click the icon to see an image of the female anatomy.

Investigative temporary silicone implants or a noninvasive device called the belly board may protect the small intestine during radiation therapy and help reduce complications.

Radiation itself may increase the risk for later development of cancer in the area surrounding the treated tissue. Although newer more precise radiotherapy approaches should reduce this risk, there is some concern that IMRT may double the incidence of secondary cancers over time compared to 3-D conformal techniques. This is of particular concern in younger patients.

Radiation and Hyperthermia. Investigators are studying hyperthermia (use of high heat often provided by ultrasound) in combinations with radiation therapy. This approach has shown some promise in achieving significant response rates in small studies. Comparison studies are important to determine if this approach would be as beneficial with radiation therapy as concurrent chemotherapy.

Chemotherapy

Chemotherapy employs cell-killing drugs, known as cytotoxic agents, to destroy widespread cancer cells that have spread from their point of origin (the primary tumor) and are, therefore, no longer treatable by surgery or radiation.

For many years, chemotherapy was only used with very advanced disease to reduce symptoms. Platinum-based chemotherapy agents (usually cisplatin) are now being used in many situations for cervical cancer including the following:

• In combination with radiation therapy to improve survival rates in certain women, including some with locally advanced cancer.
• In some women with locally advanced cancer to reduce tumors to the point where the cancer may be operable.
• When cancer has spread (metastasized), mostly to reduce symptoms such as pain.

Chemotherapy Agents Used.

• Platinum-Based Agents. One of the most active chemotherapeutic agents for cervical cancer is cisplatin, which enhances the effectiveness of radiation in the treatment of patients with more advanced disease stages. Cisplatin and carboplatin are known as platinum-based drugs. In general, platinum-based agents are the standard drugs used for this disease. Concurrent platinum-based agents and radiotherapy are important treatments for many later cancer stages. Even in treating metastatic disease, cisplatin used alone has been more helpful than even combinations of agents. There is some evidence that a combination of platinum plus paclitaxel with possibly other single agents may be more effective than platinum alone in the treatment of metastatic disease. Other platinum agents, such as nedaplatin, are under investigation.
• Drugs that Enhance Radiation. Some drugs being investigated appear to increase tumor response to radiation therapy, and so are known as radiation sensitizers or enhancers. Topotecan, a radioenhancer, for example, is showing some promise in early studies, although toxicity is high.
• Other Agents. Other drugs, mostly used in combinations, have also been investigated with some promise. They include with epirubicin, irinotecan, paclitaxel, bleomycin, mitomycin, vinorelbine, gemcitabine, and doxifluridine.

For cancer that has spread to other areas from its original source (metastatic disease), chemotherapy regimens may use single cytotoxic agents or several agents in combination.

Administration. Cytotoxic agents may be given orally or as injections. Treatment may be administered at a medical center, physician's office, or even a patient's home. Some patients receiving chemotherapy may need to remain in the hospital for several days so the effects of the drugs can be monitored. The drugs are often administered in cycles with a period of rest following a period of treatment in order to allow a recovery from the side effects.

Side Effects. Chemotherapy affects all fast-growing cells, including healthy ones, so some side effects are inevitable. Side effects occur with all chemotherapeutic drugs. They are more severe with higher doses and increase over the course of treatment.

Common side effects include the following:

• Nausea and vomiting. Drugs known as serotonin antagonists, especially ondansetron (Zofran), can relieve these side effects in nearly all patients given moderate drugs and most patients who take more powerful drugs. In one study, a combination of dexamethasone (a corticosteroid) with ondansetron taken within 24 hours of chemotherapy achieved either a major or complete reduction in nausea and vomiting.
• Diarrhea.
• Temporary hair loss.
• Weight loss.
• Fatigue.
• Anemia.
• Depression.

Complications. Serious short- and long-term complications can also occur and may vary depending on the specific agents used. They include the following:

• Increased chance for infection from suppression of the immune system.
• Severe drops in white blood cells (neutropenia). Certain agents, such as taxanes, pose a higher risk for this than other chemotherapeutic drugs. White blood cell count may be improved with the addition of a drug called granulocyte colony-stimulating factor (either filgrastim and lenograstim).
• Liver and kidney damage.
• Abnormal blood clotting (thrombocytopenia).
• Allergic reaction, particularly to platinum-based agents. (A simple skin test in under investigation that may identify people with a potential allergic response.).
• Menstrual abnormalities are common and premature menopause occurs in about 30% of women, particularly in those over 40.
• Rarely, secondary cancers such as leukemia.
• Between a quarter and a third of women report problems in concentration, motor function, and memory, which may be long-term. This effect may be due to reductions in estrogen levels after treatments.

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