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Sunday Seven: Seven not-so-fun, oh-so-necessary rituals

On Friday, I had my annual OB/GYN appointment. It's the appointment known by all women for (1) its blood pressure check and humbling weigh-in, (2) the pee-in-a-cup ritual, (3) the get naked and change-into-a-paper-dress routine, (4) the finger-stick-iron-check, (5) the clinical breast exam, (6) the manual internal pelvic exam, and (7) the ever popular feet-in-stirrups Pap test. It's all so uncomfortable, so not fun. Yet it's all so necessary.

It was a visit with my OB/GYN that resulted in my breast cancer diagnosis two years ago this month. It was the clinical breast exam that confirmed the hard little lump I had found in the shower the previous day. It's what prompted my emergency mammogram a day later. It's what sent me on the wildest ride of my life. It's what keeps me going back for repeat yearly visits -- because I know if something goes wrong with my female parts, this doctor is likely the one who will make the discovery. He is likely the one who will save me from a late diagnosis of something terrible, the doctor who will set the wheels in motion for whatever comes after something terrible is detected.

I know already that (1) my blood pressure and weight are normal, (2) my urine is normal, (3) the paper dress is so not flattering, (4) my iron is normal, (5) my breasts are normal, and (6) my ovaries and uterus feel normal. I am only waiting on (7) the results of my Pap test that will reveal any abnormalities in the tissue of my cervix. This is the one test that can save me from cervical cancer or detect the disease in a stage that is completely curable. It's one of the best cancer screening tests around -- and I plan to receive it every year, year after year -- even if I have not one ounce of modesty left when it's said and done.

It's not so bad really. I'm accustomed to the rituals of the annual exam. I know the drill, know I will survive it all, know it's all critical for maintaining my health. So it's good really. Good -- compared to what could happen if something went undiscovered.

Tumor markers predict cancer growth -- sometimes

Cancer cells sometimes secrete specialized proteins into the bloodstream that serve as indicators of tumor growth. These tumor markers are often distinctly associated with a particular type of cancer. Like prostate cancer.

The most well-known tumor marker today is the PSA -- the prostate-specific antigen. PSA is a highly specific protein that is secreted only by cells of the prostate gland. It is one of the most widely used -- and the only widely accepted -- screening test for cancer.

There's also the tumor marker CA-125, used in the diagnosis of ovarian cancer and in the monitoring of response to treatment for the same disease. There's CEA for colon cancer, CA-19-9 for pancreatic cancer, AFP for liver and testicular cancer, beta-HCG for testicular cancer, and CA 15-3 for breast cancer. And research is under way on newer, more useful tumor markers. This is a good thing -- because some tumor markers are not specific enough or sensitive enough to accurately predict tumor growth.

This is why my oncologist does not recommend I enter the world of tumor markers, despite my status as a breast cancer survivor. He suggests I rely simply on how I feel for monitoring my chances for cancer recurrence. If I experience any worrisome symptoms, he will be the first to wage an all-out assessment of my health. But without symptoms, tumor markers are not likely to help me at all.

A peek at my breast cancer tumor markers would likely be hazy, inconclusive, and not all that helpful. Examination of tumor markers can lead to false positives. It can lead to expensive and often unnecessary follow-up testing. It can lead to worry and panic and even alarm if the numbers are not in the hoped-for range.

Although an abnormal tumor marker level may suggest cancer, this alone is typically not enough to diagnose the disease. Measurements of tumor markers are usually combined with other tests, such as a biopsy, to confirm cancer. So what would I do with an abnormal number and nothing suspicious to biopsy? I would worry. I would panic. Perhaps unnecessarily.

My doctor suggests I refrain from a wild cancer chase. And I am happy with his suggestion. Between my own awareness, follow-up oncology appointments, mammograms, annual OB/GYN check-ups, and more, I am confident any health issues that come my way will be detected early -- and can be resolved in good time. I have no need for confusing tumor marker details. Unless they are conclusively recommended, I will survive without them. More important, I will survive without worry.

Remember yearly screenings with free e-mail reminders

It can be hard to remember when it's time for check-ups and exams and screenings. Many come just once each year and with the swift passage of time, it's easy to forget our medical to-do lists. But missing an appointment -- or even delaying one -- can lead to missed and delayed diagnoses. So remembering these easy-to-forget chores is key. And perhaps reminders are the key to remembering.

The American Cancer Society offers a free mammogram reminder in the form of e-mail message sent each year to remind women to schedule their mammograms. It takes just a moment to register with an e-mail address and a preferred month and day of the year for this e-mail to arrive. To register for your yearly reminder, click here.

The College of American Pathologists offers a free reminder service for the following appointments -- blood donation, cholesterol screening, colon cancer screening, diabetes test, pap test, and mammogram. Click here to choose one or more of these options that also require just just an e-mail address and preferred month and date for delivery.

So forget that string around your finger -- reach for your computer keyboard right now. It takes just a few keystrokes to ensure prompt testing for the health issues that if detected early, can save our lives.

Mammogram, ultrasound reveal nothing to worry about

My mammogram and ultrasound today revealed nothing but normal, healthy tissue. The doctor said my pictures looked beautiful -- and she could find not one thing to worry about. She really looked for something -- because I was convinced there was something wrong when I found a lump-like bump in my left breast two weeks ago. So convinced that I was riddled with anxiety and panic and fear. But now I am happy and content once again -- and relieved that my fears were unfounded.

The explanation my doctor offered for the lumpiness I detected goes like this: my breast has been swollen and plump ever since my lumpectomy and radiation over the course of almost two years. Slowly, the swelling is disappearing and so all the tissue hidden under the plumpness is coming to the surface. It's always been there -- she could see it when she looked at my previous mammograms -- but I haven't noticed. Now, it's become more apparent as my breast returns to its normal size and shape. And so it seemed new to me. And suspicious. And wrong. But it's okay. It's normal. It's nothing to worry about.

And so I am not worried. I am settled and calm and thrilled to be surviving breast cancer, without fear that the disease is coming back. At least for today.

Colonoscopy saves woman's life from silent cancer killer

Coletta Barrett believed her stomach pains were caused by a gall bladder attack after eating greasy fried food. She excused a tightening in her lower abdomen as irritable bowel syndrome, and she explained blood in her stool as a response to stress. Only after a referral to a gastroenterologist led to a colonoscopy did she learn that the upper portion of her colon was almost completely blocked by a large tumor -- a cancerous tumor. Barrett was diagnosed with colon cancer. Her colonoscopy saved her life.

Barrett never once predicted she might have colon cancer. She thought the disease mostly struck older people. She was just 42. Screening tests are not even recommended until the age of 50. She had no family history of this cancer and had no typical risk factors associated with the disease. She did not smoke, was not overweight, and drank very little. But she did in fact have colon cancer -- shocking as it was -- and doctors believed her tumor had been growing for 18 months before detected. Fortunately, Barrett learned that her cancer had not spread. And she learned a few other things that she now shares as advice -- from her survivor point of view. These tips come from an article about Barrett in the August 1 Women's Day magazine.
  • Barrett says, "know your body." And don't ignore or dismiss any changes that occur.
  • Don't let embarrassment stop you from seeking help. Some symptoms can be difficult to discuss -- such as change in size and frequency of bowel movements, bloody stool, cramping, and bloating -- but still ask your doctor about them. Early detection is critical, she says.
  • If diagnosed with colon cancer, learn as much as you can about the disease -- a well-informed patient has a better chance at a better outcome.
Barrett offers sound advice. And I think it is global advice. Knowing your body, discussing symptoms, and education after diagnosis are key for anyone. For everyone.

Apprehension about radiation check-up turns to exhilaration

I was examined yesterday by my radiation oncologist and two medical students during a six-month follow-up appointment. And any apprehension I had prior to the visit -- about a recurrence of breast cancer or the detection of cancer somewhere else in my body -- is gone. Because I walked away with the news that I am doing just fine. No lumps or bumps or suspicious masses were found. No enlarged lymph nodes were detected. And since I did not report any pain or tenderness or sensitivity or other trouble, I was sent on my way with nothing more than a notice for a return appointment in another six months. I have other appointments hanging in the balance -- one with my medical oncologist in August and a mammogram in November -- and I am sure hesitation and worry will again sneak into my head. But for now, I can only feel the true exhilaration that comes from truly good news. Like the exhilaration that comes from a breathtaking moment at the ocean -- where the power and beauty of the sea and the sky and the sand is all it takes for one five-year-old boy to feel amazingly free.

Promising treatment found for locally advanced breast tumors

Young women sometimes are dismissed when they pursue medical attention for suspicious lumps, bumps, pains, or changes in their breasts -- because breast cancer is not so common in young women and medical professionals may assume that breast cancer is not the culprit for the complaints brought before them by young women. But young women do get breast cancer -- I did at age 34 -- and many times, the tumors found in young breasts are more aggressive than those that appear for older women. So it is critical that young women seek medical attention for anything out-of-the-ordinary. And it is critical that doctors respond with urgency so that breast cancer in young women can be detected early -- and treated appropriately.

Continue reading Promising treatment found for locally advanced breast tumors

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