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Carl Ikeme: Nigeria and Wolves goalkeeper diagnosed with acute leukaemia

It is no longer news that the Nigerian and Wolves Stopper, Carl Ikeme, was diagnosed of acute Leukemia. Ikeme, 31, had his blood test return as ‘abnormal’ earlier this month during a preseason check and was later diagnosed of acute leukemia. He has commenced chemotherapy and we wish him speedy and full recovery.

Leukemia is a cancer of the blood, with the disease occurring mostly in the bone marrow but manifesting in the blood. A good way of finding it early is blood tests – full blood count. This serves as a good screening for the disease when there are no symptoms.

Cervical Cancer -Management

We would tie up the Cervical Cancer awareness by taking a brief look at the Management.
There are a few medical terms you’ll have to get grip of in order to understand what we do and possible outcome.

 
All cancers are staged: looking at the size and spread. This informs us of how advanced the cancer is and possible ways of managing it.

 
Cervical cancer is mostly clinically or surgically staged depending on your Doctors preference. I’ll give us an international standard by FIGO (Fédération Internationale de Gynécologie et d’Obstétrique), with some explanation. Then summarize what may be done and possible outcome. The details is left for the Medical Professionals.

 

 
Just to remind us,
1. The Cervix is the gateway to the uterus
2. It has a pathway from the vagina (tube like structure)
3. Which opens to the outside.
Cervical Cancer is cancer that develops in this gateway

 
When the cancer has not gone through the foundation of the Cervical cells, also known as Basement Membrane, it is Stage 0 also known as Carcinoma in situ.

Stage 1
If it has gone beyond this but is confined to the cervix, it is Stage 1

Stage 2
If it has gone beyond the cervix but has not spread to the pelvic wall or lower third of the Vagina, it is Stage 2

Stage 3
If the cancer has spread to the pelvic wall or lower third of the vagina, Stage 3

Stage 4
If it has spread to surrounding structures and/or travelled out to other parts of the body, it is Stage 4.
3 and 4 are considered to be advanced.

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Cervical Cancer management usually has:
1. Surgical,
2. Radiological
3. Chemical (known as chemotherapy – drugs)
4. Others (supporting therapy which may include psychotherapy).
as components depending on the stage and Doctor’s preference (in some cases).

A. When it is still within its foundation (basement membrane) at Stage 0, your Doctor may want to perform the following:
1. Surgical excision (removal) of the affected area(s)
2. Cryosurgery. Use of extreme cold to surgically remove the cancer cells
3. Laser ablation. Use of focused heat
4. Loop excision
Other options may exist, but those are common. Some Doctors prefer surgical removal to the rest because they can check the removed tissue in a lab.

B. In Stage 1. Your Doctor may want to:
1. Totally take out your Womb, known as hysterectomy (uterus with the cervix too)
2. Completely remove the cervix (conization).
For more advanced forms of this stage (not mentioned due to the ambiguity), radiation may be included in the treatment.

C. For Stage 2, your Doctor may not be Surgery trigger happy. Radiation is mostly used in different forms. This is true for Stage 3 and early part of 4 (again not mentioned to avoid ambiguity).

 
D. When it has traveled far, Stage 4 proper, palliation (all that can be done to make you comfortable) is used. For this, radiation can be used to reduce bleeding, analgesics for pain, hospice care.
Your Doctor will discuss with you the options available in your Country for treatment and their risks/benefits.

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In most African Countries, Women usually come to the Hospital at 3rd to 4th stage which is sad because little can be done with resources available to keep them alive. This can be prevented by following recommended guideline for screening.
Stay alive, get screened, tell others.

Cervical Cancer Cont’d

We had an overview of Cervical Cancer last time and will dig more into this disease that is ravaging our Women. You may view the first part of this article here. Please share and comment

Today, we’ll dwell more on the practical aspect of Cervical Cancer – what you can do about it, and that will be prevention. I have stuck more to the standards and treated it to our environment (finding out what can actually work for us here in Africa).

Before the prevention, let’s look at

 Differential Diagnosis.

Some diseases look like cervical cancer, let’s briefly find out what they are

  1. Cervicitis. Inflammation of the cervix (yes, same area as that for the cancer). Usually bacterial and has discharge and bleeding (after sex and in between menstruation).
  2. Vaginitis. Inflammation of the Vagina – tube leading from the outside to the cervix. About same symptoms as vaginal discharge, very little or no bleeding and there could be itching.
  3. Pelvic Inflammatory Disease. About same with discharge and possibly bleeding but there is also lower abdominal pain.
  4. Endometrial Cancer. Cancer of the Uterus (womb) occurs mostly in women above 50. Usually has bleeding from the Vagina.

Your Doctor will help you further differentiate, but honestly, you don’t have to get to that stage with regular screening which we will discuss.

 

Prevention.

This is my favourite because people don’t have to suffer  by frequent visits to the Hospital and expenditure of time, money and energy on treatment.

Prevention can be:

  • General, and
  • Specific

General deals with:

  • Healthy lifestyle (rest, exercise, hygiene, diet, social interaction)
  • Good Health Policies.
  • Avoiding multiple sex partners
  • Use of Condom

We won’t dwell on the General Measures to prevent Cervical Cancer but on the Specific.

Specific Prevention deals with Screening.

The two widely recommended ways to screen for Cervical Cancer are:

  • Pap smear
  • HPV (human papilloma virus) test.

There are others but the above are mainly used for screening and are the recommended ones because they have been found to detect the disease early and prevent death from the disease. So, we will consider them.

  1. The Pap (Papanicolaou) Test

The Pap test is a procedure used to collect cells from the cervix so that they can be looked at under the microscope to find cancer and pre-cancer.

How the Pap test is done

The Pap test is a procedure used to collect cells from the cervix so that they can be looked at under the microscope to find cancer and pre-cancer.

The health care professional first places a speculum inside the vagina. The speculum is a metal or plastic instrument that keeps the vagina open so that the cervix can be seen clearly. Next, using a small spatula, a sample of cells and mucus is lightly scraped from the exocervix. A small brush or a cotton-tipped swab is then inserted into the opening of the cervix to take a sample from the endocervix. If your cervix has been removed (because you had a trachelectomy or hysterectomy) as a part of the treatment for a cervical cancer or pre-cancer, the cells will be sampled from the upper part of the vagina (known as the vaginal cuff). The samples are then prepared so that they can be looked at under a microscope in the lab.

 

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Although the Pap test has been more successful than any other screening test in preventing a cancer, it’s not perfect. One of the limitations of the Pap test is that the results need to be examined by the human eye, so an accurate analysis of the hundreds of thousands of cells in each sample is not always possible. Engineers, scientists, and doctors are working together to improve this test. Because some abnormalities may be missed (even when samples are looked at in the best labs), it’s not a good idea to have this test less often than guidelines recommend.

Making your Pap tests more accurate

You can do several things to make your Pap test as accurate as possible:

  1. Try not to schedule an appointment for a time during your menstrual period. The best time is at least 5 days after your menstrual period stops.
  2. Don’t use tampons, birth-control foams or jellies, other vaginal creams, moisturizers, or lubricants, or vaginal medicines for 2 to 3 days before the Pap test.
  3. Don’t have vaginal sex for 2 days before the Pap test.

A pelvic exam is not the same as a Pap test

Many people confuse pelvic exams with Pap tests. The pelvic exam is part of a woman’s routine health care. During a pelvic exam, the doctor looks at and feels the reproductive organs, including the uterus and the ovaries and may do tests for sexually transmitted disease. Pelvic exams may help find other types of cancers and reproductive problems. Pap tests are often done during pelvic exams after the speculum is placed. Sometimes a pelvic exam is done without having a Pap test, but a Pap test is needed to find early cervical cancer or pre-cancers. Ask your doctor if you had a Pap test with your pelvic exam.

How Pap test results are reported

The most widely used system for describing Pap test results is the Bethesda System (TBS). There are 3 main categories, some of which have sub-categories:

  1. Negative for intraepithelial lesion or malignancy
  2. Epithelial cell abnormalities
  3. Other malignant neoplasms.

You may need further testing if your Pap test showed any of the abnormalities .

‘1’ above means normal. So, when the result is given to you, please look out for the above and still ask your Doctor to interpret it for you

  1. The HPV Test

The most important risk factor for developing cervical cancer is infection with HPV. Doctors can now test for the HPV (high-risk or carcinogenic types) that are most likely to cause cervical cancer by looking for pieces of their DNA in cervical cells. The test can be done at the same time as the Pap test, with the same swab or a second swab. You won’t notice a difference in your exam if you have both tests.

The HPV test is most often used in 2 situations:

  1. The HPV gene test can be used in combination with the Pap test to screen for cervical cancer. The American Cancer Society recommends this combination for women 30 and older. The HPV DNA test is not recommended to screen for cervical cancer in women under 30. That is because women in their 20s who are sexually active are much more likely (than older women) to have an HPV infection that will go away on its own. For these younger women, results of this test are not as significant and may be more confusing.
  2. The HPV DNA test can also be used in women who have slightly abnormal Pap test results (ASC-US) to find out if they might need more testing or treatment.

 

Here is a summary of the recommendation :

 

Cervic

 

Screening is very important in the prevention of Cervical Cancer.

Another specific prevention is Immunization

Vaccination (immunization) has come in as another way to prevent Cervical Cancer. The three main vaccines used are:

  1. Cervarix from GSK, also called HPV2 (16 and 18 HPV subtypes)
  2. Gardasil from Merck, also called HPV4 (6, 11, 16 and 18)
  3. Gardasil 9, also from Merck, HPV9 (6, 11, 16, 18, 31, 33, 45, 52, and 58)

 

The U.S. Advisory Committee on Immunization Practices (ACIP) has issued the following recommendations for HPV vaccination:

  1. Routine vaccination of girls 11-12 years of age with three doses of HPV2, HPV4, or HPV9
  2. Routine vaccination with HPV4 or HPV9 for boys 11-12 years of age
  3. Previously unvaccinated females and males aged 13-26 years
  4. Children as young as 9 years may be vaccinated, particularly if there is a history of sexual abuse or assault
  5. Any man who has sex with a man and individuals with compromised immune systems (including people with HIV infection/AIDS), through age 26, if they were not fully vaccinated when they were younger.

 

Please check with your local listing for places to do a pap smear.

Cervical Cancer remains one of the most easily preventable Cancer in the World. We can take screening and a healthy lifestyle seriously to overcome the scourge.

 

Cervical Cancer

 

Good day Ladies and Gentlemen. Tis an honour for me to discuss with us today on Cervical Cancer. It is quietly ending the lives of our Women, but can be stopped with good information and appropriate action.
Today, we’ll just do a quick intro with emphasis on the normal. Next time will be the meat of the matter.
It will be a bit interactive, with me punctuating the talk by asking some questions. Will be glad if we reply.
Before digging in, what do we think the cervix refers to? Don’t worry, just try. Or, you could send the answer to me privately. Just make an attempt. You may pause here and answer the question personally.

  • Cervical cancer is the third cause of cancer-related death in Women worldwide
  • The Second in most African Countries (9.8 per 100,000)
    Occupies about same position in Occurrence. (17.8 per 100,000 women).
  • Globally, cervical cancer accounted for an estimated 528,000 new cancer cases worldwide and for 266,000 deaths in 2012.
  • It is one of the most easily preventable Cancer in the World through the Screening program.
  • Global incidence and mortality rates depend upon the presence of screening programs for cervical precancer and cancer and of human papillomavirus (HPV) vaccination, which are most likely to be available in developed countries. Due to these interventions, there has been a 75% decrease in the incidence and mortality of cervical cancer over the past 50 years in developed countries.
    It has now slipped to about 10th position in occurrence (prevalence) and mortality (death) in developed Countries.
  • This means if all sexually exposed Women here on this platform get screened per protocol and tell at least 5 other Ladies who do same (screen and tell 5), we may achieve same result in less than 50 years.

 

 

So, what is this cervix?
The cervix is the gateway from the vagina to the uterus (womb).

 

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It plays a critical role in pregnancy by sealing off the growing baby in the uterus from the outside world.

Cause
Human papillomavirus (HPV) is central to the development of cervical neoplasia and can be detected in 99.7 percent of cervical cancers
It is mostly transmitted via sexual intercourse. There are over 100 subtypes of this virus with 16, 18 and 45 causing cervical and anal cancers.
When one gets infected, the body has a way of clearing out the virus 90% of the time. It is the other 10% that causes cancer. It may take up to 15 years from the day one gets infected for the cancer to manifest.

Risk factors
Major risk factors identified in epidemiologic studies are as follows:

  • Sex at a young age
  • Multiple sexual partners
  • Promiscuous male partners
  • History of sexually transmitted diseases.

As a male or female, it may be your first time to have sex, or you’re in a committed relationship though having sex, if your partner has a history of multiple sexual partners, you’re at risk.
HIV infection is associated with a 5-fold increase in the risk of cervical cancer, presumably because of an impaired immune response to HPV infection.

Signs and symptoms

  • Clinically, the first symptom of cervical cancer is abnormal vaginal bleeding, usually postcoital (after sex)
  • Vaginal discomfort,
  • malodorous discharge, and dysuria are not uncommon.
    Symptoms of advanced cervical cancer may include:
  • loss of appetite,
  • weight loss,
  • fatigue,
  • pelvic pain,
  • back pain,
  • leg pain,
  • swollen legs,
  • heavy vaginal bleeding,
  • bone fractures, and
  • (rarely)leakage of urine or feces from the vagina.

‘Advanced’ means it has gone beyond the cervix and most likely affected near and distant organs.

Please stay posted for more on Cervical Cancer.

Breast Cancer Management

Once one is diagnosed of Breast Cancer, a whole lot happens. It is now time to manage that person that has the disease. The main aim is not to just rid the person of the disease but to give the person a better quality of life.

So,  management of breast cancer involves:
1. Treatment of the Disease.
2. Treatment of the Person who has the disease.

The first point is an aspect we mostly dwell on – therapies to fight the disease, but in reality, it requires more than that, we should also help the person find fulfillment in Life while combating breast cancer. Breast Cancer, like other terminal disease has physical, social, psychological and economic effects. That’s why it is very important to understand the management of breast cancer.

Please note: what would be shared here should not substitute for expert management by a Specialist in a Hospital. This should just give us an overview of breast cancer management.

Breast Cancer Management is multidisciplinary with Doctors (Surgeons and Oncologists, mostly), Nurses, Psychologists, Nutritionists/Dieticians and sometimes Physiotherapists involved.

When one is diagnosed of Breast Cancer, the Doctor would carry out further tests. Decisions about the best treatment are based on the results of these tests. The tests give information about:

• how quickly the cancer may grow.
• how likely it is that the cancer will spread through the body.
• how well certain treatments might work.
• how likely the cancer is to recur (come back).

Tests include the following:

1. On the cancer tissue itself:

• Estrogen and progesterone receptor test : A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If there are more estrogen and progesterone receptors than normal, the cancer is called estrogen and/or progesterone receptor positive. This type of breast cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing. A drug, Tamoxifen, can be administered to those with Estrogen receptor positive nodes.

• Human epidermal growth factor type 2 receptor (HER2/neu) test : A laboratory test to measure how many HER2/neu genes there are and how much HER2/neu protein is made in a sample of tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer is called HER2/neu positive. This type of breast cancer may grow more quickly and is more likely to spread to other parts of the body. The cancer may be treated with drugs that target the HER2/neu protein, such as trastuzumab and pertuzumab.

2. Radiological assessment. Computer Tomograms (CT), MRI and sometimes, X-ray and Ultrasound investigations can be done to find out the extent of the disease – has it spread?

When the management team arrives at a conclusion from the tests, then treatment can commence.

Treatment for the disease include:
1. Chemotherapy. Use of drugs
2. Radiotherapy. Use of radiation to treat the disease
3. Surgery
4. A mixture.

There are other measures like
• Pain relief
• Reduction of nausea/vomiting
• Increase of appetite.

Treatment is usually individualized and depends on several factors:
• Stage of the Cancer – from size and spread
• Extra features: Estrogen receptor positive or not
• State of health of the Individual
• Resources available – that of the Patient and the Managing team

Resource of the Managing team also includes the competence of that team.

Chemotherapy
Use of drugs in treatment of the cancer. The usual drugs used are
• Cyclophosphamide
• Methotrexate/Adriamycin
• 5-Fluorouracil
These come with side-effects which the managing Doctor would inform the Patient about. It is usually given as a course – over time. They would ensure you’re strong enough to start. Some blood tests would first be conducted to ensure this and used to monitor the progress.

Radiotherapy
This is the use of radiation in treatment of cancer. This is almost always combined with surgery. There is a special machine used which delivers the right dose to the right part of the breast helping to destroy as many cancer cells as possible. It also has side effects which the Doctor would tell you about.

Surgery
Means removal of part or whole of the affected breast. It has indications which those tests and the size of your breast would determine. For example, if I discover you have a DCIS (ductal carcinoma in situ) affecting most of the breast below the nipple and the pathologist also say it is moderate grade, and your breasts are very small (A Size), a simple mastectomy (removal of the breast without the lymph nodes and muscle beneath) would suffice. I can then reconstruct that breast using material from other parts of your body.

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Always Remember: prevention is better than cure, early detection saves. Get screened today

Ladies, please take note:
• there are ways of making you still feel like a Woman after removal of the breast. This involves reconstruction of the breast. The Nipple and areola, if unaffected can be saved for this procedure.

• Little parts of the breast can be removed – lumpectomy*
IF you have a relative or loved one that has the disease and the Doctors inform her that she needs that procedure, please encourage her to do so, it is life saving.
Some side effect of large surgeries include: lymphedema (the arm close to the site becomes enlarged), some part of the blood and lymph may accumulate in the affected breast, there could be infection post operation.

IT is a good Clinical Practice for your Doctor to discuss in detail with you before starting any management and give you time to think and plan. Please note: everyone is very important.

There are other aspects of the Management.
People with this disease require a lot of help: they may be weak (from the disease and/or the treatment) and will need people to aid them with usual life activities. They also experience depression and sadness, which will require support.
IF unchecked, it can affect how they respond to treatment – may skip their clinic and drugs.
So,

1. Support groups (one of the future goals of this platform. There are very few to none in Nigeria and most African Countries)

2. A Clinical Psychologist. May need sessions with a trained Personnel

3. Hospice – place where people are trained to take care of terminally ill people.
Close relatives should also be trained and managed.
You know, this is one area we neglect.
These people could also suffer depression from caring for the Cancer Patients.
They, the Relatives, are also humans and should be factored in the overall care of the Cancer Patient, especially if they are really close and help out
Once they understand what is really going on and also benefit from counselling et al, most will be effective in the care of the Cancer Patients.
Support groups are made up of
• Cancer Survivors
• Patients with Cancer
• Clinical psychologists
• Doctors

Read more about Breast Cancer here

Read more about Support groups here