Thursday, 4 July 2013

Spot Cancer Early

Today brought the sad news that Bernie Nolan has sadly passed away at the age of fifty two after a battle with breast cancer. She left a fourteen year old daughter, her husband and of course her sisters.

Cancer is a cruel disease and can strike anyone at anytime. It is so important to know your body and be vigilant with your health as cancer is so much easier to treat when it is found early.

Cancer survival rates have doubled since the 1970’s and twice as many people today with survive their cancer for more then ten years. This is down to a number of things such as better targeted drugs, more advanced treatments and more ways to spot cancer early.

However, there is still a lot of work to be done, for example 9/10 people diagnosed with early bowel cancer will survive at least five years after diagnosis BUT only 1/10 cases are currently being diagnosed at this early stage. We all need to take more care to be aware of our bodies, be aware of the symptoms and visit the doctor when we notice any changes in our bodies usual habits. This could save your life.

I am going to list the most important symptoms for both men and women but please don't panic if you look through the list and think a few apply to you. This doesn't mean you definitely have cancer, in fact it usually isn't anything as serious as cancer but it may be worth going to your GP to have a chat and a check up :).

Signs of cancer for both men and women:
* Usual lump or swelling anywhere on your body - Men should pay particular attention to any lumps in their testicles and women should pay particular attention to any breast lumps. Everyone should watch out for lumps on your neck, armpit, abdomen, groin or chest area. The best time to have a check is probably when having a bath or shower. Have a good feel and know how your body feels so if any lumps do appear you can detect them easily.
* A mole that has changed shape, size or colour - most moles are harmless. However be aware of them because if a new mole appears or one changes colour, shape or size then it will need to be checked. If any mole begins or ooze, bleed or become crusty then please make an appointment with your GP ASAP.
* A sore that hasn't healed after several weeks - our skin is usually able to repair itself easily (within a week or so) If a spot, wart or sore isn't able to heal itself after three weeks then please go to your doctor.
* An ulcer in your mouth or on your tongue that has been there more then three weeks - most people get mouth ulcers when they are feeling run down. Usually they are nothing to worry about. Usually the lining of your mouth will renew itself every two weeks so an ulcer won't last much longer then that. However is an ulcer does last long then three weeks please visit your doctor or dentist.
* A cough or croaky voice that lasts longer then three weeks - these are symptoms of a cold. Usually they disappear after a week or so and are not signs of anything serious. But if they do last for longer then three weeks or if they get persistently worse then please do go to your doctor. ESPECIALLY if you are a smoker or have been a smoker.
* Persistent difficulty swallowing - Lots of medical conditions can affect your ability to swallow. If you are having difficulty and it lasts longer then a week or so then you should go to your doctor.
* Indigestion - There are lots of foods, especially fatty or spicy ones that can make you feel uncomfortable after eating them. If this is happening to you a lot or is really painful then it should be checked out.
* Blood in your urine - This should ALWAYS be reported to your doctor. It might not mean cancer but it should always be looked at.
* Problems passing urine - It is common for men to have difficulty passing urine as they get older. You may need to pee more often then you used to and it can sometimes be painful. Usually it is caused by a common condition causing your prostate to enlarge. It it not often cancer but if you are having trouble please visit a doctor. Most women experiencing problems with urine are suffering from an infection but if you need to pass urine more urgently then normal or are in pain whilst doing so, please get yourself checked out.
* Blood in your bowel movements - This is usually caused by piles which is caused by straining when you are going to the toilet. It can also be a sign of cancer so please stay vigilant.
* A change in your bowel movements that lasts longer then six weeks (diarrhoea) - this is usually caused by stomach bugs or food poisoning. If it lasts longer then a few weeks please get yourself to the doctors.
* Unexpected weight loss - It is normal for your weight to fluctuate slightly. However if you are not on a diet but are losing lots of weight please get a check up.
* Heavy night sweats - these are usually brought on by infections and some types of medications. They are also common in women going through the menopause. They can also be caused by some cancers so please take care if you are experiencing them regularly.
* Unexplained pain or ache that lasts longer then four weeks - Pain is our bodies telling us something is not right. Take notice of any pain and if it is persistent or getting worse then go see your doctor as soon as you can.
* Coughing up blood - ALWAYS go to see your doctor as soon as this happens.

Signs of cancer in women specifically:
* An usual change in your breast - lumps are not the only sign of breast cancer. Changes to your breast's appearance, shape or feel are also signs as are changes to the texture of the skin, any redness or changes to your nipples. Pain in your breast is also a sign. If you experience any of these, don't panic but visit your GP ASAP.
* Bleeding from the vagina after the menopause or in between periods - Spotting (bleeding between periods) is common for females taking the contraceptive pill. However if you are bleeding during or after sex, between periods or after going through the menopause then it should be check out straight away.
Persistent bloating - Bloating is the blight of lots of women's lives. If it happens persistently please have a check up.

Some of these symptoms may seem embarrassing or silly. Don't ever feel embarrassed to see your doctor - they have seen it all and do not judge. Don't ever feel like you're bothering your doctor or wasting a time slot - if you have a concern or symptom, they are there to listen, to check and to reassure. If you are worried or think you may need to see a doctor then please don't deliberate, make the appointment as soon as you can. Early diagnosis saves lives. It also puts your mind at rest if nothing is actually wrong with you.

Cancer Screening
Certain cancer types have screening tests in place to detect the disease in the early stages:

Breast Cancer - Mammograms
What is a Mammogram?
A mammogram is an x-ray of breast tissue and is used to identify early breast cancer. You have to remove all clothing on your upper body, including your bra to have a mammogram and are positioned so that both breasts are x-rayed individually. This means your breasts are gently squashed with a clear, flat plastic plate. This means you can get a clear picture whilst having a minimal amount of radiation. It can be uncomfortable but it doesn’t take very long. Most radiographers aim for two mammograms, at different angles, for both breasts.

A new technique is currently being introduced. This is known as digital mammogram and this uses computer imaging. This new technique has been shown to be better at picking up breast cancer in younger women and those with denser breast tissue.

Some Important Facts about Mammograms:
*Mammograms do not prevent cancer but they can discover a cancer that has already developed.
*Mammograms can be uncomfortable but this does not usually last long. Some women may be a little sore afterwards
*Mammograms involve x-rays which mean you will be exposed to a small amount of radiation, although it is not likely to be a harmful amount and as you only need a mammogram every three years it is unlikely to have a large effect in the long run.
*Can sometimes produce false positives which can cause a huge amount of unnecessary worry. Sometimes mammograms pick up on an abnormal area in the breast which later proves to be non cancerous.
*Occasionally mammograms need to be repeated due to blurry images, equipment failure or parts of the breast being missed by the original images.
*Mammograms are the most effective way of detecting early breast cancer but it is not 100% accurate at all times. Sometimes cancers are too small to be detected on a mammogram or the person reading it may miss a cancer, although this risk is reduced by having at least two people check the mammogram
*Women taking part of the programme may still develop breast cancer between mammograms. This is called interval cancer and the patient will have a mammogram done at the time of diagnosis so it can be compared to previous ones to notice any patterns. It is important to note that cure rates for women with interval cancer are a lot better then those for women that have never had screening.

Cervical Cancer – Smear Tests
Smear Tests:
It is hugely important to have cervical screening as preventing cervical cancer from developing is vital. Cervical cancer is actually one of the only cancers that is preventable because if pre cancerous cells are detected through screening then they can be treated before they have a chance to become cancerous.
Women between the ages of twenty five and sixty are encouraged to have smear tests every three to five years to detect any changing cells in their cervix. During a smear test, a doctor or nurse will insert a speculum into your vagina and scrape anyway a sample of cells from your cervix. These cells are then placed into a small pot of liquid and send to be analysed. You will then be contacted with your results and any abnormal smears will require further investigation.

You don’t have to be over the age of twenty five to develop cervical cancer; some younger women do develop it as well. However, in the UK, smear tests are not encouraged until twenty five because your cervix is still developing in your teens and early twenties. This means the likelihood of you getting an abnormal result is more common but usually nothing to worry about. After Jade Goody’s horrifically young death, a campaign was launched to lower the smear test age limit but medical professionals do not agree with this. If you are under twenty five and are concerned about your cervical cancer risk – please do speak to your GP and get some advice. A private gynaecologist may allow you to have a smear test but it would depend on your individual circumstances.


It is also important to note that an abnormal smear result does not mean you have cervical cancer. If you are contacted and told your test was abnormal then please do not ignore it, go and see what your doctors have to say.

I’m approaching my twenty third birthday so I am not entitled to smear tests yet. I’ve heard horror stories about them and I am slightly worried about them. However, I will be forcing myself to attend my smear tests appointment when they are available to me. If I do develop pre cancerous cells – I will be finding them and I will be stopping them from developing.

Points to Consider:
You can have a smear test at several different places:
* Your GP’s surgery should offer them
* A family planning clinic
* A genito-urinary clinic
* An antenatal clinic
* A private health clinic
* Marie Stopes

You are well within your rights to request a female doctor or nurse performs your test but any male doctors will be chaperoned by a female staff member anyway. It is important to state if you require a female at the time of booking your appointment. 

A smear test should be scheduled whilst you are in the middle of your menstrual cycle (between periods) as it will be very difficult to see your cervix and get a cell sample whilst you are bleeding.

Age Limits:
There are varying age limits for women in the four nations of the UK.
* Women between the ages of twenty five and sixty four are screened every three to five years in England and Northern Ireland.
* In Scotland, cervical screening is offered to women aged between twenty and sixty.
* Wales offers cervical screening to women aged between twenty and sixty four.

Research has shown that screening every three years prevents 84/100 cases of cervical cancer that would develop if they weren’t caught by the smears. So getting a smear test every three years is recommended by the NHS up until you are fifty years old. Abnormal cells develop at a much slower rate in women over fifty so screening is recommended after five years for women in that age group. Your local primary care trust will contact you whenever it is time for a screening for you. I cannot stress the importance of attending these appointments enough – it could save you from a battle with cancer.

The Screening Process:

Cervical cancer is preventable. This is because pre cancerous cell changes can be picked up before they have a chance to develop. A cervical cancer screening test is known as a smear test. This involves a doctor or a nurse using a speculum to take a small sample of cells from the surface of your cervix. It sounds horrific and it can be very uncomfortable but I am going to try and explain it as clearly as I can!
You will need to take off your underwear and lie back on the couch/bed. Being as relaxed as you possibly can be will make the procedure less uncomfortable. 

Occasionally, the person doing the test will perform a vaginal examination first. This means they will place two gloved fingers inside your vagina to make sure your womb is in the correct position and that it feels like it’s a normal size. They will use their other hand to press down on your abdomen and gently feel your womb.

Then comes the actual smear test: The speculum is placed inside your vagina and has two arms which are used to spread the sides of your vagina apart so the cervix can be clearly seen. A small brush is then inserted and used scraped along the surface of your cervix to collect a sample of your cells. The brush and the cells are then sent to a lab in a pot of liquid and examined under a microscope. Any abnormal cells are reported and further investigation on these cells will be needed. 

Bowel Cancer – Colonoscopy
A colonoscopy is usually performed in the outpatients department of a hospital and the procedure itself usually lasts around an hour. The bowel needs to be completely empty for the colonoscopy so the patient will need to follow a very careful diet for a few days before the test. Laxatives may also be needed and may be prescribed. The department carrying out the procedure will give you careful instructions regarding your diet and laxatives.
It may be possible for you to have a sedative to relax you a little before the procedure. You will be told to lie on your side whilst the nurse or doctor passes a thin flexible tube called a colonoscope into your back passage. There are flexible fibres in the tube which pass around the bowel easily. There is a light and camera on the end of the tube and these show any abnormal areas of the bowel.
It may be that photographs and biopsies of the cells in the large bowel are taken during the colonoscopy. Usually any polyps can be removed using a wire loop that is passed through the colonoscope. This can be done painlessly normally.
Sometimes the whole bowel can’t be seen during the colonoscopy. This may be due to the bowel not being completely empty or because the colonoscopy can’t get round a bend in the bowel or reach the end of t. You may be asked to have a repeat or a CT colonoscopy in this situation.
Most patients are ready to go home within a few hours of the test but someone will need to come and collect you, especially if you have had a sedative. Someone should be around to keep an eye on you for around twelve hours after the procedure.
 Potential Complications:
Usually a colonscopy is a fairly straightforward procedure and patients do not have any side effects. However, very rare side effects do include:
*Fluid Loss – Taking laxatives may cause you to lose lots of fluids as you are visiting the toilet frequently. It is important to let the people carrying out your colonoscopy know if you have any heart problems before taking laxatives as this can worsen your condition.
*Breathing or Heart Problems – You may have a reaction to the laxatives which may cause you to have temporary problems breathing or temporary problems with your heart.
*Heavy Bleeding – Around 1/150 people having a colonoscopy suffer from heavy bleeding after the procedure. If biopsies are taken or polyps are removed then there is a chance of bleeding. If you do notice heavy bleeding then you should seek medical advice immediately.
*Perforated Bowel – The colonoscopy can VERY RARELY make a hole in the bowel wall. This happens about 1/1000 but an operation may need needed to mend the hole.
*Death – Around 1/10,000 people having a colonscopy die as a result. A very very small percentage of those having the procedure.
The specialist performing your colonoscopy will let you know if they take any biopsies or remove any polyps during your procedure. The results of these can take up to three weeks, which can be a very anxious time for you.
Possible results include:
*A Normal Result – this means no polyps or cancerous cells were found in your bowel. About 50% of colonoscopies have a normal result and it is rare that a colonoscopy will miss cancer. If your result is normal then you will probably be offered screening every two years.
*Benign Polyps – If one or more polyps are found during the procedure then they are usually all removed at the same time in a procedure known as a polypectomy. This can help prevent bowel cancer developing. Around 40% of people having colonoscopies following an abnormal FOB test have polyps  The removed polyps are studied in a lab and the next steps are determined by the results. Polyps can sometimes reoccur after being removed.
*Cancer – Around 10% of people having colonoscopies after an abnormal FOB test are diagnosed with bowel cancer. That is 1/10. If the cancer is found at an early stage then there is a very good chance of survival as around 90% of early stage bowel cancer cases are successfully treated.
*Other Benign Causes – Colonoscopies can also indicate other conditions such as Crohn’s disease or ulcerative colitis and you are usually referred to a gastroenterologist.

Abnormal Tests Results:Abnormal results are usually reported like this:
Mild Dyskaryosis or CIN 1(mild or slight cell changes)If you are told that you have mild cell changes then you will probably be told to get a colposcopy straight away or to wait and have another smear in six months. Sometimes mild cell changes will go back to normal by themselves but it is important to monitor them and go back for any tests advised by your medical team. If a second test shows abnormal cells then a colposcopy is definitely needed to assess the situation. 

Moderate Dyskaryosis or CIN 2 (moderate cell changes)Treatment will be needed if you have moderate cell changes but you only usually need it once. Then you will have follow up tests to monitor the cells in your cervix. If you have successful treatment after an abnormal smear and carry on having regular smears then you are unlikely to get cervical cancer. If you do not have treatment then you are at real risk of developing cervical cancer
Severe Dyskaryosis or CIN 3 (severe cell changes)This is also sometimes known as carcinoma in situ (CIS) which sounds like cancer but it isn’t. This means some cells in your cervix look cancerous but are all found in the skin layer which covers your cervix. It won’t be “true” cancer until it breaks through the layer and starts to spread into the surrounding tissue. Urgent treatment is needed for this kind of smear result but if it is moved ASAP then cancer can be prevented.
All these results mean the cells found are pre cancerous meaning if they are left to go untreated, they could develop into cancer of the cervix. YOU DO NOT HAVE CERVICAL CANCER IF YOU ARE TOLD YOU HAVE ABNORMAL CELLS.
9/10 smears come back normal. 1/20 shows a borderline or mild cell change. Most of the time these cells will return to normal by themselves. 1/100 shows moderate cell changes whilst 1/200 show severe changes. Less than 1/1000 shows cancer. 
First Steps:If you have mild cell changes then you may be told to wait six months and have a repeat test. This is because mild cell changes usually sort themselves out. If you have moderate to severe cell changes then you will probably be referred to your local hospital for a colposcopy. This is an outpatient procedure and it is basically a close examination of your cervix which doesn’t actually go inside your vagina. The doctor or nurse specialist uses something like a magnifying glass to look at the cells on your cervix in more detail and takes a biopsy to send to the lab for further examination.

Types of Treatment:Laser Therapy (Laser Ablation): some cells can be burned away by a laser in an outpatient procedure. For this kind of treatment you will lie on a bed with your legs in stirrups whilst a doctor places a speculum into your vagina to hold it open whilst they point a laser beam at the abnormal areas. You will be given local anaesthetic to numb the area and prevent pain. The laser is a very strong and hot beam of light and it burns away the abnormal cells. This can cause a slight burning smell whist you are having the treatment but that just means the laser is working so try not to worry. You should be able to go home as soon as the treatment is finished. You may experience period type pains but they should go away with the normal paracetamol or ibuprofen and some bed rest.
Cold Coagulation: This name is a little misleading as the treatment isn’t cold at all! You lie on a bed with your legs in stirrups whilst a doctor inserts a speculum to hold your vagina open. A hot probe is then used to burn away the abnormal cells. You shouldn’t be able to feel the probe but it can cause some period type pains which should go away a few hours after the treatment has finished.
Cryotherapy: This is basically cold coagulation but with a cold probe instead of a hot one. The cold probe freezes the abnormal cells. The procedure is exactly the same as the cold coagulation.
Diathermy: This is done under local anaesthetic. An electronic current is used to cut away the tissue that contains the abnormal cells. It is a fairly quick procedure and it usually done as an outpatient case which means you should be able to go home afterwards. It can cause bleeding or discharge for about four weeks after the treatment but sanitary towels will have to be used as tampons have to be avoided for four weeks. Sex must also be avoided for four weeks following a diathermy procedure.
Cone Biopsy: This is a minor operation that can be used to diagnose cervical cancer or to treat abnormal cells. The entire area containing possible abnormal cells is removed. It is called a cone biopsy because a cone shaped area of tissue is removed from the cervix. This is called the transformation zone. This can be done under general or local anaesthetic.
Hysterectomy: If you are past menopause, or have had all your children, then your doctor may suggest removing your uterus. This is usually suggested if you have had abnormal cells more then once or if the cells are severely abnormal.
These treatments do sound rather uncomfortable and scary but it is massively important to have abnormal cells treated to prevent them developing into cervical cancer. Please do remember to book yourself in for a smear if you are due one. As I’ve said before, a little discomfort is nothing compared to a battle with cervical cancer.

I hope this blog post is interesting and informative for you. Please do visit your doctor if anything is bothering you healthwise. Please look into screening if you have a family history of any cancer type. We need to look after ourselves and make sure we catch cancer early enough to treat it.

If you have any questions about early diagnosis, cancer screening or symptoms please visit


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