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Are The Symptoms You're Feeling Early Signs Of Cancer?

Reading the signs: Are the symptoms you’re feeling early signs of cancer? Why women ignore the signs, and what they may mean.


While women are busy caring for their children, their clients or both, there’s one important individual they tend to neglect — themselves. More frequently than not, women don’t make their own health a priority, ignoring symptoms that could be early signs of cancer.

“Women frequently ignore symptoms because they are simply busy,” says Dr. Daniel Maki, M.D., director of breast imaging at Scottsdale Medical Imaging (SMIL). “They are head of the household, often responsible for so many others that they put their own health on the back burner.”

What’s worse is some women believe the symptoms will just go away, so they ignore or deny the symptoms, according to Dr. Clayton Palowy, M.D., medical oncologist with Ironwood Cancer & Research Centers in Chandler.

“It’s human nature to ignore symptoms because you don’t want to view the worst, and you start rationalizing them as natural causes,” says Dr. Mike Janicek, M.D., medical director of the Cancer Genetic Risk Assessment Program at the Virginia G. Piper Cancer Center at Scottsdale Healthcare Medical Center. “I would say it’s the slowness of some of the symptoms that may sneak under the radar and makes it difficult for women to pay attention to symptoms, when in retrospect, it’s clear to them.”

Many symptoms such as bloating, irregular vaginal bleeding and pelvic pain seem typical, but, in reality, these and a few common symptoms that could be signs of various types of cancers.

Breast cancer

The stats:

Breast cancer is the most commonly diagnosed cancer among women and is the second-leading cause of cancer death among women, according to Centers for Disease Control and Prevention (CDC).

In the U.S. in 2012, it was estimated by the National Cancer Institute that there were nearly 227,000 new cases of breast cancer and more than 39,000 deaths.

The symptoms:

The most common complaint or symptom is a lump in the breast.

“Depending on what the lump (cancer) invades during its growth, it may cause a variety of different symptoms based on what it grows into,” says Dr. Maki.

“If the lump invades into the nipple or skin, it can begin causing retraction or dimpling,” he adds. “If the lump invades a blood vessel and milk duct, it can cause blood to be discharged from the nipple. If it invades nerve fibers, it can cause pain. If it invades the skin, it can cause thickening or change in texture of the skin itself.”

Other symptoms include:

  • Discharge from the nipple (particularly a bloody discharge)
  • Nipple inversion or retraction
  • Skin dimpling (along one edge of the breast) or retraction

“Sometimes patients even describe simply a ‘thickening’ of an area of the breast rather than a discrete lump,” says Dr. Maki.

Palowy says that breast changes such as a red breast is an early sign of inflammatory breast cancer and can be mistaken for infection.

Symptoms mistaken for:

Many of the symptoms are often attributed to cysts or one’s menstrual cycle, according to Maki. And in a large number of patients with lumps or pain, the assumption may often be correct.

“However, occasionally these symptoms do unfortunately represent early stages of breast cancer, and any new breast symptoms should always be brought to the attention of one’s doctor,” Dr. Maki says.

Prevention:

Mammograms and screenings are the best way to find breast cancer early. Also, be aware of your family history and risk factors. The National Cancer Institute has a Breast Cancer Risk Assessment Tool helps estimate a woman’s risk of developing invasive breast cancer. Visit cancer.gov/bcrisktool.

Cervical cancer

The stats:

All women are at risk for cervical (uterine cervix) cancer, which forms in the tissue of the cervix (the organ connecting the uterus and vagina) and is almost always caused by human papillomavirus (HPV) infection. However, it occurs more often in women over the age of 30.

In the U.S. in 2012, the National Cancer Institute estimated more than 12,000 new cases of cervical cancer and more than 4,000 deaths.

The symptoms:

  • Bleeding with intercourse: This is often mistaken for “just too much friction,” according to Dr. Deborah Wilson, M.D., of Scottsdale.
  • Bleeding after intercourse: Mistaken for the start of one’s period.
  • Irregular or heavy vaginal bleeding pre-menopausal: Mistaken for an abnormal period and could also be a symptom of uterine cancer.
  • Bleeding after menopause: Mistaken for an unexpected period and could also be a symptom of uterine cancer.

Prevention:

Two tests can help prevent or find cervical cancer early: a Pap test (or a pap smear) and the HPV test.

Ovarian cancer

The stats:

Ovarian cancer forms in the tissues of the ovary, with most ovarian cancers either ovarian epithelial carcinomas (cancer that begins in the cells on the surface of the ovary) or malignant germ cell tumors (cancer that begins in egg cells).

The National Cancer Institute estimates that there were more than 22,000 new cases of cervical cancer and more than 15,000 deaths in 2012 in the United States.

The symptoms:

  • Bloating: Mistaken for gas pain.
  • Pelvic pain: Mistaken for indigestion.
  • Early satiety
  • Chronic indigestion: Mistaken for food intolerance.

Prevention:

As with breast cancer, know your family history and inherited risk and changes, such as changes in the breast cancer susceptibility genes BRCA1 and BRCA2. However, according to the CDC, most breast and ovarian cancers are primarily due to aging, the environment and lifestyle.

“Ovarian cancer has no screening test, so that’s the one that most people focus on the symptoms,” says Janicek. “By the time you get bloating and some of the other symptoms, it’s often in its advanced stages.”

Know your history

The No. 1 symptom to consider? Family history, according Janicek.

“Family history is an unusual but very important symptom,” says Janicek. “And it’s not just for breast, but for ovarian and lynch syndrome. People don’t think of family history as a symptom, but it is. If you have a strong family history of breast or ovarian cancer, you may be at genetic risk for cancer.”

Compile your family’s health history, and go as far back as three generations. Janicek says to let other family members know when another family member gets cancer. Not only will you and your family be informed, but it will also help the doctor look for any patterns of disease in the family.

Visit My Family Health Portrait’s website at familyhistory.hhs.gov to help collect and track your family health history.

Collect the following information about both your mother’s and father’s sides of the family:

  • Number of close relatives with breast or ovarian cancer: mother, sister(s), daughter(s), grandmothers, aunt(s), niece(s), and granddaughter(s)
  • Ages when the cancers were diagnosed
  • Whether anyone had cancer of both breasts
  • Breast cancer in male relatives
  • Ashkenazi (Eastern European) Jewish ancestry

For more information about cancer treatment and prevention, visit:

Scottsdale Medical Imaging
Scottsdale Medical Center
3501 N. Scottsdale Rd., #130, Scottsdale
(480) 425-5081
esmil.com

Ironwood Cancer & Research Centers
695 S. Dobson Rd., Chandler
(480) 821-2838
ironwoodcrc.com

Scottsdale Healthcare Medical Center
Scottsdale Gynecologic Oncology
10197 N. 92nd St., #101, Scottsdale
(480) 993-2950
arizonaoncology.com

Deborah Wilson, M.D., Gynecology
8997 E. Desert Cove,  #105, Scottsdale
(480) 860-4791
drwilsonobgyn.com

Scottsdale Living Magazine Winter 2013

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Study reveals genomic similarities between breast cancer and ovarian cancers

One subtype of breast cancer shares many genetic features with high-grade serous ovarian cancer, a cancer that is very difficult to treat, according to researchers. The findings suggest that the two cancers are of similar molecular origin, which may facilitate the comparison of therapeutic data for subtypes of breast and ovarian cancers.

The researchers, using data generated as part of The Cancer Genome Atlas (TCGA), described new insights into the four standard molecular subtypes based on a comprehensive characterization of samples from 825 breast cancer patients.

The study, a collaborative effort funded by the National Cancer Institute (NCI) and the National Human Genome Research Institute (NHGRI), both part of NIH, was published online Sept. 23, 2012, and in print Oct. 4, 2012, in the journal Nature.

“The International Genomics Consortium provided high-quality cancer tissue samples for this critical study that is of important translational value and will lead to important new discoveries in the future,” said Dr. Robert Penny, IGC’s Chief Executive Officer and Principal Investigator of the Biospecimen Core Resource and Tissue Source Site network. “As the most common cancer in women, this study is keystone in helping to find new breast cancer treatment options.”

David Mallery, IGC’s president, said that, “The International Genomics Consortium is committed to finding better approaches to assist cancer patients and their physicians. Our expertise in overseeing top research networks and curating quality clinical data and biospecimens will enable us to continue to help advance patient care.”

“TCGA’s comprehensive characterization of their high-quality samples allows researchers an unprecedented look at these breast cancer subgroups,” said NIH Director Francis S. Collins, M.D., Ph.D.

Analyses of genomic data have confirmed that there are four primary subtypes of breast cancer, each with its own biology and survival outlooks.  These TCGA findings are based on a large number of breast cancer specimens that capture a complete view of the genomic alterations.  The four groups are called intrinsic subtypes of breast cancer: HER2-enriched (HER2E), Luminal A (LumA), Luminal B (LumB) and Basal-like.  A fifth type, called Normal-like, was observed, but because of small numbers (only eight specimens) the researchers were unable to rigorously study it.

The TCGA Research Network uncovered marked genomic similarities between the Basal-like subtype and serous ovarian cancer. The mutation spectrum, or types and frequencies of genomic mutations, were largely the same in both cancer types. Further analyses identified several additional common genomic features, such as gene mutation frequency, suggesting that diverse genomic aberrations can converge into a limited number of cancer subtypes.

Computational analyses show that Basal-like breast cancer and serous ovarian cancer might both be susceptible to agents that inhibit blood vessel growth, cutting off the blood supply to the tumor, as well as to compounds that target DNA repair, which include chemotherapy drugs such as cisplatin.

The Basal-like subgroup has also been called Triple Negative Breast Cancer because many, though not all, Basal-like tumors are negative when tested for three receptors: the estrogen receptor, the progesterone receptor and human epidermal growth factor receptor 2 (HER2). These receptors can trigger potent cell growth responses and act like a nametag, identifying the cell to the environment. The absence of these receptors means that treatments that target them will most likely be ineffective.

“The molecular similarity of one of the principal subtypes of breast cancer to that found in ovarian cancer gives us additional leverage to compare treatments and outcomes across these two cancers,” noted Harold Varmus, M.D., NCI director.  “This treasure trove of genetic information will need to be examined in great detail to identify how we can use it functionally and clinically.”

According to the World Health Organization, there are approximately 1.3 million new cases of breast cancer and 450,000 deaths worldwide annually. Breast cancer is the most common cancer among women. The majority of cases are sporadic, meaning there is not a family history of breast cancer, as opposed to genetic, where genes predispose a person to the disease.  Men can also develop breast cancer, but it accounts for less than 1 percent of breast cancer cases.

Breast cancer tumors that have the HER2 receptor are called HER2-positive, and those that don’t are called HER2-negative. When researchers analyzed the genomic findings from tumors determined to be HER2-positive by standard cellular tests, they found that only half of the samples could be characterized as belonging to the HER2E subtype. The other half were characterized as Luminal subtypes, suggesting that there are at least two types of clinically defined HER2-positive tumors.

In general, the Luminal subtypes had the lowest overall mutation rate, but by contrast, had the largest number of genes observed to be significantly mutated. This suggests that each of the genes identified as significantly mutated in the Luminal subtypes is more likely to be important in fueling cancer progression. The Luminal subtypes are characterized by the specific expression signature of multiple so-called transcription-factor genes, including ESR1, GATA3, FOXA1, XBP1 and cMYB. These genes have a complex interaction, cooperating in an orchestrated series of activations. GATA3 and FOXA1 are frequently mutated, but those mutations are mutually exclusive, meaning that mutations were observed in either GATA3 or FOXA1 but never in both. However, ERS1 and XBP1 are highly expressed but infrequently mutated.

The scale of the TCGA program allows researchers to perform the integrative analyses that detect these complex patterns of genomic changes and interactions. This close inspection of the cancer genome has led to a deeper understanding of the mutations essential for cancer progression, and several new candidates were identified in this study. The authors hope that discovery of these mutations will be a crucial step toward improving breast cancer therapies.

This publication focuses on the discoveries made through a combined analysis involving data from 825 breast cancer cases, which are freely available in the TCGA Data Portal, with several hundred more cases to come.

“The data generated by the TCGA program comprise a vast resource that investigators will be analyzing for years to come.  The resource of information about breast cancer genomes will undoubtedly fuel myriad discoveries by the cancer research community,” said Eric D. Green, M.D., Ph.D., NHGRI director.

Anne Rita Monahan Foundation

Anne Rita Monahan Foundation's Tea For Teal Event To Raise Money For Ovarian Cancer Research

The Anne Rita Monahan Foundation’s 4th annual Tea For Teal event will raise money for ovarian cancer research.


The American Cancer Society projects that 22,280 women will be diagnosed with ovarian cancer in 2012.

Statistically, 15,500 of them will die.

The Anne Rita Monahan (ARM) Foundation wants to change those numbers. The foundation is run entirely by volunteers who are dedicated to raising money for ovarian cancer research.

Anne Rita Monahan was an Arizona businesswoman. She began having physical pains in 1990 that was diagnosed as Irritable Bowel Syndrome (IBS) and repeatedly misdiagnosed for more than a decade. In 2001, an obstetrician/gynecologist found tumors on both of her ovaries. Because of the delayed proper diagnosis, her cancer had spread. She started the foundation in 2007 with the hopes of simultaneously fighting the disease and spreading awareness. After a total hysterectomy, several rounds of chemotherapy and various other surgeries, Anne lost her battle with the ovarian cancer on May 13, 2009.

This September will mark ARM’s 5th anniversary and the 4th annual Tea for Teal event.

Tea for Teal is a two-part event that will be held on September 29 at the Doubletree Paradise Valley Resort in Scottsdale. The first part is tailored towards women, but men are welcome as well. It features a silent auction and raffle, pop-up shops, purse auction and networking opportunities. The event has raised more than $70,000 over the past three years, with a goal of reaching $100,000 to be donated to the Translational Genomics Research Institute. They hope to meet the goal this year.

Money is raised through the purchase of tickets to the event. And individual ticket costs $60. A table for 10 costs $500.

Anne Rita Monahan FoundationIn addition to ticket purchases, Stella & Dot will be in attendance, donating 100 percent of its proceeds back to the foundation.

Part two of the event is a full-service English tea during which an outstanding ovarian cancer crusader will be acknowledged.

The Anne Rita Monahan Crusader Award recognizes a person who has made exceptional contributions towards cancer awareness.

Anne Rita Monahan Foundation“Are they a crusader? What have they done? [We look at] the breadth of what they have done,” says Rachel Brockway, co-chair of ARM for the last four years.

In addition, ARM has started a scholarship program.

“With the approval of our foundation, we will be giving two scholarships: one undergraduate and one graduate. [They are] for students who are interested in a healthcare field, people who are specifically looking [into] ovarian research,” says Brockway, who has been involved in the foundation since its establishment.

Brockway hopes that the fundraisers and money donated will help raise awareness and promote research.

“It’s one of the most often misdiagnosed forms of cancer,” Brockway says. “Our mission is for ovarian cancer research and awareness so women know the symptoms of ovarian cancer. A lot of times when it is diagnosed it is caught in the later stages, which is why it is so deadly.”

For more information on the Anne Rita Monahan Foundation, Tea for Teal, the 2012 Crusader Award, and signs and symptoms of ovarian cancer, visit anneritamonahan.org.