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DO YOU WORRY ABOUT CANCER?

NHS England has ordered an independent taskforce to develop a five-year action plan with the aim of improving cancer survival rates and services.
The taskforce includes cancer specialist doctors, clinicians, patient groups and charity leaders, who will collectively look at ways to improve cancer prevention, first contact with services, diagnosis, treatment and support for those living with and beyond cancer and end of life care.

Early diagnosis of cancer:

The problem UK has relatively poor track record when compared with other European countries. It is estimated there are probably an additional 5-10,000 deaths each year most of which can be attributed to diagnostic delay.

Later diagnosis due to mixture of

  • late presentation by patient (alack awareness)

  •  Late recognition by GP

  • Delays in secondary care

In the last 18 moths new research from the National CANCER Intelligence Network has published the startling findings that in England 25% of cancers are diagnosed as emergencies. The figure rises with age implying that older people with symptoms are less likely to be investigated or referred early. More easily diagnosed cancers such as breast, uterine or melanoma are less likely to present in A&E but more difficult ones such as brain or pancreas are more likely to present in A&E .

58% brain tumours

39% of lung cases

25% colorectal cases

present as emergencies. Older women, women and people from ethnic minorities were more likely to present late.

If if a patient presents to their GP with symptoms we have the facility to refer under a 2 week rule which the patient is informed of at the consultation and an immediate referral is made to secondary care and they are contracted to see the patient within 2 weeks. However, it has been found that under half of current cancers are diagnosed with the 2 week urgent referral system.

For many years we as GP’s have used a risk stratification tool to establish a patient’s risk of a cardiovascular event( heart attack or stroke) and high risk patients are seen and treated and given relevant health education and this has resulted in a significant fall in cardiovascular events. One tool which is started to be used for cancer is QCancer  based on the QResearch database and pioneered at Nottingham university

It is a single tool to look at multiple cancers.

It has asymptomatic based approach but also takes into account risk factors such as age, smoking, alcohol, family history and weight.

90% of patients with cancer present with symptoms

Symptoms that  can be significant 

Key symptoms in model (identified from studies including NICE guidelines 2005)

 coughing up blood  vomiting blood  blood in the urine(painless)

Rectal bleeding  Unexplained bruising  Constipation, cough for >l 3 weeks

Vaginal bleeding (women) after intercourse or after menopause

  Testicular lump (men)  Loss of appetite  Unintentional weight loss

 Indigestion +/- heart burn  Difficulty swallowing

 Abdominal pain or swelling  Breast lump, pain, skin  Night sweats

Neck lump  Urinary symptoms (men)

We have started to use this in the practice and some of you may be aware of being handed a questionnaire in reception if not please ask for one. We will then create a score in the format of Cates Plot and relative risk which is entered in the records.

An example of a result showing an individual’s risk of having a cancer and a further breakdown of the results demonstrates which is the most likely cancer at risk – in this example it is a colorectal cancer. 

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If the score suggests  you have a risk of cancer  you will be asked to make an appointment to discuss this to arrange appropriate referral and investigations.

 It will also be updated if new symptoms occur. 

Hopefully during the next 12 months this will be fully integrated into our computer system rather than relying on paper questionnaires so that alerts can be triggered during regular consultations.

The following 12 types of cancer will be considered :-

Cancer

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A TREASURE OF RICHES

What better way of eating tomatoes but by picking them straight from the vine and immediately devouring them especially when they are grown without any chemical intervention. The next best is slicing them and topping them with fresh basil and a drizzle of olive oil, light seasoning and eating them as a starter or snack. image Anyone can grow tomatoes on a windowsill, on a balcony or in a garden and after careful nurturing you also can have that pleasure. When I bought my plants I was advised by an elderly couple who were buying a plant each to put on their windowsill. I was surprised when I ended up with a red variety and a yellow variety. But research showed me that the yellow variety is richer in antioxidants than the red. image Lycopene is a carotenoid pigment that has long been associated with the deep red colour of many tomatoes. A small preliminary study on healthy men and women has shown that the lycopene from orange- and tangerine-colored tomatoes may actually be better absorbed than the lycopene from red tomatoes. This is because the lycopene in deep red tomatoes is mostly trans-lycopene, and the lycopene in orange/tangerine tomatoes is mostly tetra-cis-lycopene. In a recent study, this tetra-cis form of lycopene turned out to be more efficiently absorbed by the study participants. image

I didn’t realise the antioxidant protection as being important for bone health, but according to a study carried out whereby Lycopene was withdrawn from postmenopausal women’s diet for 4 weeks and after this short period of time there were increased signs of oxidative stress in their bones and unwanted changes in their bone tissue implying that tomato lycopene (and other tomato antioxidants) may have a special role to play in preventing osteoporosis.

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Intake of tomatoes has long been linked to heart health. Fresh tomatoes and tomato extracts have been shown to help lower total cholesterol, LDL cholesterol, and triglycerides. In addition, tomato extracts have been shown to help prevent unwanted clumping together (aggregation) of platelet cells in the blood – a factor that is especially important in lowering risk of heart problems like atherosclerosis. Dietary intake of tomatoes, consumption of tomato extracts, and supplementation with tomato phytonutrients (like lycopene) have all been shown to improve the profile of fats in our bloodstream. Specifically, tomato intake has been shown to result in decreased total cholesterol, decreased LDL cholesterol, and decreased triglyceride levels. It’s also been shown to decrease accumulation of cholesterol molecules inside of macrophage cells. (Macrophage cells are a type of white blood cell that gets called into action when oxidative stress in the bloodstream gets too high, and the activity of macrophages—including their accumulation of cholesterol—is a prerequisite for development of atherosclerosis.)

imageAnti-Cancer Benefits

Tomatoes have repeatedly been show to provide us with anti-cancer benefits. The track record for tomatoes as a cancer-protective food should not be surprising, since there is a very large amount of research on tomato antioxidants and a more limited but still important amount of research on tomato anti-inflammatory nutrients. Risk for many cancer types starts out with chronic oxidative stress and chronic unwanted inflammation. For this reason, foods that provide us with strong antioxidant and anti-inflammatory support are often foods that show cancer prevention properties.

image Prostate cancer is by far the best-researched type of cancer in relationship to tomato intake. The jury verdict here is clear: tomatoes can definitely help lower risk of prostate cancer in men. One key tomato nutrient that has received special focus in prostate cancer prevention is alpha-tomatine. Alpha-tomatine is a saponin phytonutrient and it’s shown the ability to alter metabolic activity in developing prostate cancer cells. It’s also been shown to trigger programmed cell death (apoptosis) in prostate cancer cells that have already been fully formed. Research on alpha-tomatine has also been conducted for non-small cell lung cancer, with similar findings. Along with prostate cancer and non-small cell lung cancer, pancreatic cancer and breast cancer are the two best-studied areas involving tomatoes and cancer risk. Research on tomatoes and breast cancer risk has largely focused on the carotenoid lycopene, and there is fairly well documented risk reduction for breast cancer in association with lycopene intake.

In multiple studies other health benefits associated when tomatoes included in the diet include reduced risk of some neurological diseases (including Alzheimer’s disease). Tomato-containing diets have also been linked in a few studies with reduced risk of obesity and age-related macular degeneration.
And it could boost the skins ability to protect itself against UV rays.

I think that covers many of the dreaded diseases we all fear so tomatoes eaten raw or cooked in many different ways are a must in our diet.
That’s why before leaving my garden to return to London I harvested the ripe tomatoes and those I didn’t dry in the sun I roasted in the oven with garlic, fresh basil, seasoning then whizzed the mixture in a food mixer, stored in the freezer to make a sauce ready for soups and sauces to welcome me on my return.
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Posted by on September 3, 2013 in Training and Advice

 

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How can Yew help?

Recently I posted a blog talking about the history of yew and its use in medicine but I didn’t complete the story

This remarkable tree, the Yew in the Central Himalayas, is used as a treatment for breast and ovarian cancer. But western medicine in order to satisfy their criteria had to find a way of isolating the drug from the natural source.
Pacific yew’s bark were first collected in 1962 by researchers from the U.S. Department of Agriculture (USDA) who were under contract to NCI to find natural products that might cure cancer.
When this was found to be a potential anti-cancer drug there was outcry from the environmentalists including Al Gore as when collecting the bark this led to destruction of the tree.It was then found that the leaves of European yew (Taxus Baccata)were also an appropriate source which is a more renewable source than the bark of the Pacific yew (Taxus brevifolia). This ended a point of conflict in the early 1990’s. Docetaxel (another taxane) can then be obtained by semi-synthetic conversion from the precursors.

The precursors of chemotherapy drug Paclitaxel can be derived from the leaves or needles of the European Yew Taxus Baccata
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Paclitaxel is a chemotherapy drug. It is also known by its original brand name, Taxol. The drug is made from the needles of a particular type of yew tree. It works by stopping cancer cells separating into two new cells, so it blocks the growth of the cancer. It is a treatment for various types of cancer, including

Ovarian cancer
Breast cancer
Non small cell lung cancer.
AIDS related Kaposi’s sarcoma
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We know that clippings from the Hampton Court Yews have already been used along with those from many other sources to help many hundreds of cancer patients. However it is my opinion that we need to be clear about the exact location of the batches of clipping that are used. At Hampton Court there are also avenues of yews, which are more important a source of origin than a yew hedge or maze. This is because yews in an avenue can be more readily identified as being female or male and, if it is not already becoming apparent in taxol research, it will become increasingly important to separate clippings into their gender origin. At present such attention is not given in the collection of clippings and if gathered from hedges or mazes, which are also to be found at Hampton Court, then the task of establishing gender is extremely difficult as both sexes of the yew grow so close to each other in such environments. Thus the yew avenue offers a better chance of gender selection at the outset and consequently vastly improves further research potential.

But how can you help?
If you or someone you know has a Yew hedge or tree the annual clippings can be used to produce this important anti-cancer medicine. When I lived in Isleworth those of us who had Yew trees/ hedges did this each year.
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Lime hurst Ltd offer cut-and-collect service for Yew clippings ( tel : +44(0)1243 555110. )http://limehurst.co.uk/v2/
Limehurst are involved in the harvesting and processing of medicinal & cosmetic plants and have been collecting Yew hedge clippings in the UK since 1992 for use as a cancer treatment.
Or
Another organisation offering similar service is Friendship Estates
Tel:+44(0)1302 700220
http://www.friendshipestates.co.uk/
Between July and September his company come and collect the clippings of one years hedge growth , which are then used as raw material for the production of ant- cancer drugs
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Breast cancer, mastectomy and Angelina Jolie

Angelina Jolie

Many of you may have been following the news regarding Angelina Jolie and her disclosure of her double mastectomy. If you haven’t then please have a look at this article.

http://www.guardian.co.uk/film/2013/may/14/angelina-jolie-double-mastectomy

If any of our patients have a strong family history of breast cancer they can be referred to a special clinic that will address this.

In the meantime, in response to the news of Angelina Jolie having a recent double mastectomy, this website Cancer Research UK might be a useful place to seek some information:

http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/

You can also click on this very helpful TLC guide which holds a wealth of information related to breast screening with a useful guide to self screening with helpful videos.

http://www.breakthrough.org.uk/about-breast-cancer

Written by Sangeeta Kathuria

 
Comments Off on Breast cancer, mastectomy and Angelina Jolie

Posted by on May 16, 2013 in Current affairs

 

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