27
June
2007
Ovarian Cancer occurs in about 22,000 American women a year. More than 16,000 of them will die from the cancer, which outnumbers both cervical and uterine cancers combined. If ovarian cancer is diagnosed in the later stages (which is usually the case), the 5 year survival is on 20-30%. On the other hand if diagnosed at Stage I, it is 90-95% 5-year survival.
Risk Factors: majority of women with ovarian cancer don’t have any risk factors. But risk factors include: older age, never pregnant, infertility, family history (10-15% of cases of ovarian cancer), and Ashkenazi Jewish. BRCA 1 or 2 gene is a genetic cause of ovarian cancer (associated with breast cancer; 20-40% lifetime risk of ovarian cancer. In women with BRCA gene, prophylactic removal of ovaries and Fallopian tubes reduces the risk of ovarian cancer down to 5% (cancer can develop in the peritoneal lining despite no ovaries, or there was already an occult – meaning hidden – cancer.)
Screening: because tests are expensive and the prevalence is too low, is not cost effective to screen. Blood test for CA-125 is not recommended because it is used only to follow the course of already diagnosed ovarian cancer. Transvaginal ultrasound is not cost-effective. Doing screening also can be very misleading because a positive test is only correct 10-23% of the time. So 90% of women would have an incorrect positive test, leading to unnecessary emotional distress and surgery. Also doing CA-125 testing with transvaginal ultrasound detects 5% of cases in stage I ovarian cancer according to the PLCO study.
Clinical: 95% women do have symptoms a few month before diagnosis but they are pretty vague – such as abdominal distention, bloating, pelvic pain, constipation, nausea, anorexia, losing appetite soon after eating, and increasing abdominal girth. Statistically it appears the most important symptoms to distinguish ovarian cancer vs. IBS (irritable bowel syndrome) are: pelvic pain, bloating, increasing abdominal girth, urinary urge and frequency,
Diagnosis: CA-125 blood test, transvaginal ultrasound, pelvic examination. Ascites (fluid in the abdominal cavity) can be drained and tested for ovarian cancer. Staging of the cancer is done during surgery – usually laparoscopy Also a complete hysterectomy is done for women who don’t want to bear kids in the future. This means removing the uterus, Fallopian tubes, and ovaries. For those who want to become pregnant in the future, if the cancer hasn’t spread or involved the other ovary, surgery is more sparing – though there is a risk of the spared ovary developing cancer.
Treatment: as mentioned above surgery is needed to remove the cancer. Chemotherapy is usually recommended, though of some controversy.
drjohnhong 
Uncategorized, women_issues, cancer 
Comments (0) » |
13
June
2007
The internet is used to search for medical information and advice by over 50% of American internet users. This has changed the way patients interact with their doctors, and it can be both positive and negative.
Older media like TV and newspapers make people recipients of medical information. However, the internet has made people active users involved in their own medical care. So internet users tend to ask more questions and demand more from their doctors.
Internet is used for medical information for 4 main reasons according to The Am J Clin Nutr 2003; 77 (suppl): 1016S-8S. 1) Lack of information during an office visit. 2) Lack of faith in their doctor’s abilities so the internet is like a 2nd opinion. 3) Avoid embarrassment on sensitive topics with their doctor 4) Research for a friend or family member.
There is a lot of misinformation about medical subjects on the internet. More so, there is a lot of misinterpretation by laypersons who seek the internet for medical information. The saying, “He knows just enough to be dangerous” can apply because medicine is a very complex field – and believing you know everything when you don’t have the whole picture can be bad.
drjohnhong patients, office visits Comments (0) » |
6
June
2007
Tuberculosis (TB): what does PPD+ test mean?
TB (tuberculosis) is a very old bacterial disease that has killed millions and millions of people in the world throughout time. However in the US, TB cases dropped between 1953 to 1985 (from 84,304 to 22,201 per year). With HIV & AIDS, the cases has increased since 1985.
PPD is something everyone hears about but don’t quit understand. It is a skin test to see if a person has been infected with TB. TB usually doesn’t cause active disease (such as the classic pneumonia) right away. In HIV negative people maybe 2-5% will have active TB in the first 3 months (this is called Primary Infection). Some studies indicated primary TB infection might be more like 10% in HIV negative people. For others, TB lays dormant and harmless but there is a 10-20% lifetime risk of it becoming very active – usually when the immune system is down (this is called LTBI-latent tuberculosis infection
So the bottom line on PPD positive skin test: yes, the person has been infected with TB. But it doesn’t mean that person is contagious if the TB isn’t active. If it is dormant, it is a question of if it will become active to cause pneumonia, or even be active in other organs like the kidneys or nervous system.
Andrew Speaker, the personal-injury lawyer, is on the news June 2007 for traveling internationally with a MDR-TB (multi-drug resistant TB). MDR-TB means it is resistant to both antimicrobial drugs, isoniazid and rifampin – the hallmark drugs to cure TB. Often MDR-TB will be resistant to other antimicrobials as well, called XDR-TB: extensively drug-resistant TB. Because people often don’t take their TB medications as instructed (meaning missing doses or ending treatment early), TB strains are becoming resistant to the medicines.
Treatment of PPD+ skin test. Traditionally if someone was over the age of 35 and PPD+, no treatment was given (meaning isoniazid and/or rifampin) because the risk of liver failure on the isoniazid was greater than the risk of developing active TB. However, things have changed and if someone is PPD tested, they need to be prepared to take medicine for 9 months.
drjohnhong infections, pulmonary Comments (0) » |
Podcast Video [2:44m]: Play Now | Play in Popup | Download | Embeddable Player | Hits (153)
Email it
