Staring Cancer in the Face

I’m not an expert on Cancer. In fact, I am far from being one. I am just a son who lost his mother to Endometrial Cancer, and I am hoping that less family will have to experience what my mother and my family had gone through in the course of my mom's year-long battle with the big C. Mom was the first cancer patient in the family - and definitely will be the last!

A Woman Named Jocelyn

Why – you might ask – would a guy like me advocate something which he is totally and physiologically exempt from? Yes, Endometrial Cancer is a silent killer of women, and I could support other causes; however, this issue is particularly close to my heart and let me tell you why. It’s about a woman named Jocelyn.

Sunday, October 28, 2012

How Chemotherapy Can Affect Your Weight

There are many ways that cancer can affect your life, and being prepared for them may help make the journey a little easier. For instance, you're probably aware that chemotherapy can cause your hair to fall out and may have readied yourself for that by doing some wig or hat shopping.

However, did you know that chemo can cause weight gain or loss? It's an unpredictable thing, but knowing why these fluctuations occur may help you prepare for a rise or fall in your body weight.

Weight loss associated with chemotherapy

Certain side effects of chemotherapy, such as low appetite, diarrhea, vomiting, nausea and dehydration, may cause a drop in body fat. As a result, it's important to monitor your weight, and notify your health care provider if you lose more than five pounds. (Seek emergency care if you experience sudden rapid heartbeat or breathing, confusion, blue lips or excessive fatigue.)

To maintain your body weight, you may need to change your diet to preserve the muscle mass you need to heal. This can include eating more protein and healthy fats—think olive oil, nuts and fish. Other palatable and easy-to-keep-down foods may include bean soups, milkshakes, smoothies, whole milk, yogurt and ice cream. Additionally, consuming smaller, more frequent meals may be easier on your stomach than three traditional meals per day.

Finally, talk to your health care provider about medications that may be causing your appetite loss, and find out if they're necessary. There also may be prescriptions that can help spark hunger.
Chemo-associated weight gain

If you fall into the camp of people who put on pounds in response to cancer treatment, there could be a number of reasons. For example, it's not uncommon for people to get less physical activity due to chemo-related fatigue or to eat more because of side effects from certain medications. Additionally, some cancer drugs can increase water retention and fatty tissue. The latter is largely associated with steroids, and this type of weight gain usually shows most in the face or between the shoulder blades.

If you or your health care provider think your weight gain is due to a poor diet or lack of activity, you may want to consider changing your lifestyle habits. Eating more fruits and vegetables can satisfy your appetite while keeping you hydrated and well-nourished.

While feelings of weakness or nausea can certainly hinder physical activity, some exercises may actually alleviate these symptoms. Swimming is a great low-impact, calming activity, as is walking. Many cancer patients find yoga to be soothing to both the body and the mind. Yoga can help tone muscles while reducing stress, which is great for your overall well-being.

Weight gain from fluid retention requires different action. If your doctor determines that your chemo meds are causing bloat and puffiness, try not to stand or walk too much at one time. Additionally, avoid wearing tight clothes, crossing your legs and consuming excessive sodium. To cut down on sodium, stay away from savory snacks, canned foods, cured meat, added salt and soy sauce.

If your weight gain goes higher than five pounds within a week, contact your health care provider. If you experience shortness of breath, contact your physician immediately.

Source: Healthy Women
Image: Spire Healthcare

How You Can Prevent Uterine Cancer

Most women assume that ovarian cancer is the most common gynecologic cancer. They are surprised when I tell them that uterine cancer – also known as endometrial cancer – is actually the most common gynecologic malignancy and the fourth most common cancer in women.

The reason uterine cancer is not the first to come to mind is that, unlike ovarian cancer, most uterine cancer is diagnosed in its early stages so relatively few women die from it. The five-year survival rate for women diagnosed when their cancer is still in stage I is 96%. That’s why it is so important to evaluate abnormal bleeding sooner rather than later so that if a cancer is present it will be diagnosed in its earliest, most curable stage.

In a premenopausal or perimenopausal woman, abnormal bleeding is anything that varies from a normal monthly flow. Heavy bleeding, constant spotting or irregular cycles may all indicate a problem. Any bleeding in a postmenopausal woman should be evaluated. The overwhelming majority of abnormal bleeding is not an indication of uterine cancer, but still needs to be checked out.

The only thing better than early detection of uterine cancer is to prevent it from developing in the first place. Since most uterine cancer is caused by an excess of estrogen compared to progestin, this is a potentially preventable cancer. Here are five steps that may dramatically reduce your risk:

1. A Pill a Day…
The use of birth control pills for at least 12 months decreases the risk of uterine cancer by a whopping 50-80 percent. This protection lasts for 15 years after pill use is discontinued.

2. Choose an IUD
You may be familiar with an intrauterine device as a method of contraception, but the progestin in the Mirena ™ IUD also has a number of non-contraceptive benefits. A little known fact is that the Mirena ™ IUD decreases the risk of hyperplasia (an abnormal thickening of the uterine lining), which in many cases is a precursor to uterine cancer.

3. Question Your Kin
If you have multiple family members with colon cancer and/or uterine cancer, genetic testing could be lifesaving, not only for you, but also for your entire family. Carriers of hereditary nonpolyposis colorectal cancer, known as Lynch syndrome, have a 27-71% chance of developing uterine cancer as opposed to the 3% in the general population.

4. Lower Your Weight to Lower Your Risk
Fat cells produce estrogen, so obese women are at an increased risk for uterine and breast cancer. Higher BMI not only increases the rate of developing endometrial cancer, but is associated with an increased death rate as well.

5. Pick Your Progestin
It has been known since the 1970s that taking estrogen therapy without adequate progestin increases the risk of uterine cancer almost tenfold. If you are taking estrogen for relief of menopausal symptoms (and have a uterus), it is crucial to take an appropriate progestin to protect the lining of the uterus. “Bioidentical” progestin creams have not been shown to offer adequate protection in spite of claims by compounding pharmacies. The progestin molecule is too large to be absorbed through the skin, which is why all the FDA-approved progestins are in pill form. (Note: A progestin is not necessary if you are using vaginal estrogen.)

Added to Women's Health, Anatomy, Smart Patient, Illness Prevention, Gynecology on Sun 11/20/2011

Source: The Dr. Oz Show
Image: Find Feeling

Thursday, October 25, 2012

Hospice & Palliative Care in Metro Manila

Written by Asia Pacific Hospice Palliative Care Network 2007 Directory 


Ayala Alabang Hospice Care Foundation Inc.
Haven for Children
Alabang-Zapote Road, Alabang, Muntinlupa City
Metro Manila, Luzon, Philippines
Tel: (63) 2 401-1018
Fax: (63) 2 887-2124
Atty. Asuncion B. Kalalo, President
Home Care Service

National Hospice & Palliative Care Council of the Philippines (Hospice Philippines)c/o Ayala Alabang Hospice Care Foundation Inc.

Haven for Children
Alabang-Zapote Road Alabang, Muntinlupa City, Metro Manila, Luzon Philippines
Tel: (63) 2 401- 1018
Fax: (63) 2 887-2124
Atty. Asuncion B. Kalalo, President

*** MAKATI ***

Alay Kapwa Kilusang Pankalusugan (AKAP)
2226 Paraiso Street, Dasmarinas Village,
Makati City, Luzon, Philippines
Tel: (63) 2 893-9072
Fax:  (63) 2 843-0502
Liza Ganlanza, National Training Co-ordinator
Home Care Service 

(Hospice of Manila Empowerment Inc)
7th Floor Builders Centre
170 Salcedo Street, Legaspi Village
Makati, Manila, Luzon, Philippines
Tel: (63) 2 750 5143
Dr. Susan D. Reyes, Managing Director
Home Care Service 

*** MANILA ***

Jose R Reyes Memorial Medical Center
Rizal Avenue, Sta. Cruz Manila, Philippines
Tel: (63) 2 711-6930
Fax: (63) 2 711-6930
Ms. Delia B. dela Cruz, Secretary
Support Group for Cancer Survivors 

Children’s Hospital of the Philippines Foundation Inc.
Philippines Children’s Medical Center
Private Clinic Rm 11, Quezon Avenue
Manila, Luzon, 1100, Philippines
Tel: (63) 2 924 6601
Fax: (63) 2 924 0840
Ms. Maria S. Rafael
Palliative Care In-patient

PALCARE Volunteer Group
3/F Unit 308, 1336 West East Center Bldg.
Taft Ave., Malate, Manila, Luzon, Philippines
Tel: (63) 2 727 8110
Fax: (63) 2 527 8810
Dr. Agnes Bausa, Program Director
Home Care Service
Training & Counselling

Philippine Cancer Society Inc.
310 San Rafael Street
San Miguel, Manila, Luzon 1005 Philippines
Tel: (63) 2 733 3485
Fax: (63) 2 735 2707
Dr. Kelly Salvador, Executive Director
Outpatient Clinic

Starfish Palliative Care Program
San Lazaro Hospital
Quiricata St., Sta. Cruz, Manila 1014
Tel: (63) 2 732 3776
Fax: (63) 2 711 6979
Dr. Cirena R. Cabanban, Chairman
Palliative Care Consultancy
Quarterly Workshops

Supportive Palliative & Hospice Care Program
Dept. of Family & Community Medicine
Philippine General Hospital
3rd Floor Room 304, OPD Building Avenue
Taft Ave., Manila, Luzon 1000, Philippines
Tel: (63) 2 521 8450
Fax: (63) 2 523 2358
Dr. Agnes Bausa, Program Co-ordinator

University of Santo Tomas Hospital Hospice
UST Hospital, Pain Clinic, 3rd Floor
Espana Blvd., Manila 1008, Luzon, Philippines
Tel: (63) 2 732 3001
Dr. Corazon Arcangel, Chairman


At Home Hospice Foundation Inc.
Room 513, Medical Arts Bldg.
St. Luke’s Medical Center
279 E Rodriguez Sr. Ave, New Manila
Quezon City, Luzon, 2795, Philippines
Tel: (63) 2 723-1023
Fax: (63) 2 723-1023
Dr. Cenon R. Cruz, President

FEU-NRMF Medical Center Hospice &
Palliative Care Service
Dept. of Community & Family Medicine,
NRMF Medical Center
Regalado Avenue, West Fairview
Quezon City, Luzon, Philippines
Tel: (63) 2 427 0213
Fax: (63) 2 427 0213
Dr. Agnes Bausa, Palliative Care Consultant
In-patient Service
Palliative Care Consultancy
Home Care Service

Kythe Inc.
Room 303, 3rd Floor, Korben Place
91 Roces Ave., Corner Scout Tobias St.
Quezon City, Luzon, Philippines
Tel: (63) 2 376 3454
Ms. Girlie Garcia, CEO
Palliative Care Unit
Day Care Centre & Outpatient Clinic for Children

*** PASIG CITY ***

Cancer Center Palliative Care Service
The Medical City
Ortigas Avenue, Pasig City
Metro Manila, Luzon, Philippines
Tel: (63) 2 6356789
Dr. Maria Fidelis Manalo,
Palliative Care Consultant
In-patient Service
Palliative Care Consultancy
Home Care Service


St. Michael’s Hospice Foundation
135 Capricorn St., Cinco Hermanos Subd.
IVC, Marikina City, Metro Manila, Philippines
Tel: (63) 2 681 8510
Fax: (63) 2 413 4968
Dr. Amado M. San Luis, President
Home Care Service


UPHRMC Home Care Program
7th Floor, Medical Arts Building
UPHRMC medical Centre Compound
Alabang-Zapote Road, Pamplona, Las Pinas City
Metro Manila, Luzon, Philippines
Tel: (63) 2 874 8515
Dr. Rumalie Corvera

Wednesday, October 24, 2012

Staring Cancer in the Face

I’m not an expert on Cancer. In fact, I am far from being one. I am just a son who lost his mother to Endometrial Cancer, and I am hoping that less family will have to experience what my mother and my family had gone through in the course of my mom's year-long battle with the big C. Mom was the first cancer patient in the family - and definitely will be the last!

A couple of weeks ago, I posted an entry about my Mom’s battle with Endometrial Cancer. It was just one of those posts that I occasionally churn out in hopes of getting people to notice something. I blogged about how wonderful my mom was and how na├»ve I was about Endometrial Cancer. Heck, I didn’t know what an ‘endometrium’ was.

As soon as the post went live, I invited some friends to read it and I subsequently decided to go on with my daily routine. A few days after that, someone named Kaz commented on the post and an emotional light bulb exploded. It turns out Kaz is one of the amazing women behind Womb Cancer Support UK. And after a few correspondences with her and her comrade Debbie, I knew that I have to do something myself.

To tell you the truth, like most people (my age) that I talked to, I was clueless. I didn’t know where to begin or where to start. I realized afterwards that I don’t need to be an expert on Endometrial Cancer. Otherwise, I could just go back to school and study Oncology. We don’t need to be experts. We just need to be aware that Endometrial Cancer exists and that it kills people. Awareness drives us to take action, to take the first step, to know the risk factors and symptoms of Endometrial Cancer, and to educate ourselves on how we can cope if one of our family members is at risk or is battling this disease.

We can lie supinely on our backs and say ‘no, it’s not going to happen to my family’. But you know what, I was in that same position a couple years back. I thought Cancer couldn’t happen to anyone. And a person must be really, I mean really, unhealthy to be able to contract that disease. I guess not. And do you know what sucked? I realized this when it got my Mom in 2010. She died a year later. Too late.

We can just go on our everyday lives and hope cancer will befall on any family but ours. It’s like an inverse lottery; everyone has a ticket but no one wants to be picked out. But Cancer has its own rules. It just doesn’t latch itself onto the usual suspects like the chain smokers or the obese – although these people have a very high risk on getting the diseases, so if you’re one of those, you might want to rethink your lifestyle choices – Cancer affects anyone. It could be the people who haven’t exercised a day in their lives, or the people who meticulously count their calorie intake. It could be you next.

I don't want to sound too morbid about this topic. But the truth of the matter is – Cancer kills. You know the drill when you’re buying a house, for example. Security also comes first, because you don’t want cold-bloodied murderers to get into your house and hack on your family members with a knife, now would you? I didn’t think so either. So, what do we do then? Lock the doors and ensure that everyone is safe. Protect yourself and all that you love dear because Cancer is the last thing you’d want to invite into your home.

How many women do you have in your life? Could you afford to lose any of them to Endometrial Cancer? What are YOU gonna do about it?

Wednesday, October 17, 2012

Uterine Cancer Screening & Prevention

Information about the prevention of cancer and the science of screening appropriate individuals at high-risk of developing cancer is gaining interest. Physicians and individuals alike recognize that the best “treatment” of cancer is preventing its occurrence in the first place or detecting it early when it may be most treatable. 

Uterine (endometrial) cancer is the most common invasive gynecologic cancer in women, with 36,100 new cases each year. This incidence would be higher if it weren’t for the relatively large number of hysterectomies performed for non-cancerous reasons. It is estimated that approximately 6,500 women will die of uterine cancer in the United States each year. The lifetime risk of developing uterine cancer for an American woman is 2%.

There has been an increase in the incidence of, but not mortality from, uterine cancer since the mid 1970s, which has been attributed to the use of hormone replacement therapy for treatment of menopausal symptoms. Studies show that the most common type of uterine cancer, endometroid adenocarcinoma, develops from the overgrowth of cells lining the uterus in the setting of excessive or prolonged exposure to the female hormone estrogen. Other less common uterine cancers, such as serous carcinoma, do not seem to be related to estrogen levels in the body.

The chance of an individual developing cancer depends on both genetic and non-genetic factors. A genetic factor is an inherited, unchangeable trait, while a non-genetic factor is a variable in a person’s environment, which can often be changed. Non-genetic factors may include diet, exercise, or exposure to other substances present in our surroundings. These non-genetic factors are often referred to as environmental factors. Some non-genetic factors play a role in facilitating the process of healthy cells turning cancerous (i.e. the correlation between smoking and lung cancer) while other cancers have no known environmental correlation but are known to have a genetic predisposition, meaning a person may be at higher risk for a certain cancer if a family member has that type of cancer.

Heredity or Genetic Factors

Women with a family history of uterine cancer are twice as likely to develop uterine cancer than women without a family history. Women who have a family history of hereditary nonpolyposis colon cancer (HNPCC) have an increased risk for carrying the HNPCC genetic abnormality. Studies suggest that women who carry this genetic abnormality have a 10-fold increased risk of uterine cancer and a 20% incidence of uterine cancer by the age of 70. Women with a family history of uterine cancer may wish to discuss genetic testing with their physician. For more information about genetic testing, please refer to the section Genetic Testing.

Environmental or Non-Genetic Factors

Factors associated with an increased risk of developing uterine cancer include obesity, a high-fat diet and a prolonged exposure to the female hormone, estrogen. Women who begin to menstruate early in life, experience a late menopause and/or have no children have the longest exposure to estrogen, and are thus, at the highest risk. Completion of at least one pregnancy appears to lower the risk of uterine cancer by 50%, as after the birth of the first child, the risk of developing uterine cancer appears to decrease with increasing age. The risk also decreases in proportion to the number of induced abortions. Women who take oral contraceptives also appear to have a reduction in the incidence of uterine cancer.

Hormone Replacement and Uterine Cancer: Women who take estrogen replacement therapy to control menopausal symptoms have a 4 to 8-fold increase in the risk of developing uterine cancer. This risk increases with the duration of use. For example, after 5 or more years of estrogen use, the risk of developing uterine cancer increases to 10 to 30-fold. The risk appears to last for 10 years or more after discontinuation of estrogen replacement therapy. When this information was made public, there was a decline in the use of estrogen replacement and a decline in the incidence of uterine cancer. However, women need to consider all risks and benefits before discontinuing hormone replacement for treatment of menopause because the benefits of hormone replacement therapy may outweigh the risk of cancer.

There is some evidence that adding progesterone to estrogen for the treatment of menopausal symptoms can decrease the risk of uterine cancer that is presented by estrogen; however, there is also evidence that this strategy increases the risk of breast cancer. The main issue for women taking hormone replacement is to have periodic gynecologic evaluations to detect early uterine cancer. With this strategy, women can both achieve the benefits of hormone therapy and detect uterine cancer early when it is small and curable.

Tamoxifen and Uterine Cancer: Tamoxifen is a chemopreventive drug that blocks estrogen from entering the cells. Tamoxifen and other anti-estrogens are commonly used in the treatment of breast cancer, but have also proven successful in the prevention of breast cancer in women at high-risk.

One uncommon complication of tamoxifen therapy is uterine cancer. Several clinical studies around the world have evaluated the risks and benefits of tamoxifen. The results of the National Cancer Institute clinical study evaluating tamoxifen were presented in 1998. During this study, 13,388 women at high risk of developing breast cancer were treated with either tamoxifen or placebo for 5 years. While the results indicated a 45% reduction in the development of breast cancer, they also showed an increase in the risk of uterine cancer, as 33 women treated with tamoxifen developed uterine cancer, compared with only 14 women in the placebo group. All of the uterine cancers occurring in the tamoxifen group were early stage I cancers.

Since the majority of uterine cancers will be detected at an early stage when they are highly curable, the overall benefit of anti-estrogen treatment in breast cancer patients probably outweighs the risk of uterine cancer. All women who have a uterus and are receiving anti-estrogen therapy should undergo regular gynecologic examinations.

Furthermore, in response to the risks posed by tamoxifen, newer anti-estrogens have emerged. Selective estrogen receptor modulators (SERM) are believed to have positive effects on bones as well as anti-estrogen effects on breast cancer without increasing the risk of uterine cancer. For more information, please refer to the section Hormonal Therapy.

Prevention of Uterine Cancer

Cancer is largely a preventable illness. Two-thirds of cancer deaths in the U.S. can be linked to tobacco use, poor diet, obesity, and lack of exercise. All of these factors can be modified. Nevertheless, an awareness of the opportunity to prevent cancer through changes in lifestyle is still under-appreciated.

Decreasing body weight and reducing exposure to estrogen may decrease the risk of developing uterine cancer. The addition of progesterone to estrogen may also decrease the risk of developing uterine cancer in women taking hormone replacement for menopausal symptoms. There is evidence to suggest that the use of combined hormone therapy in the form of oral contraceptives can also reduce the risk of uterine cancer by up to 40% if used for at least a year.

Diet: Diet is a fertile area for immediate individual and societal intervention to decrease the risk of developing certain cancers. Numerous studies have provided a wealth of often-contradictory information about the detrimental and protective factors of different foods.

There is convincing evidence that excess body fat substantially increases the risk for many types of cancer. While much of the cancer-related nutrition information cautions against a high-fat diet, the real culprit may be an excess of calories. Studies indicate that there is little, if any, relationship between body fat and fat composition of the diet. These studies show that excessive caloric intake from both fats and carbohydrates lead to the same result of excess body fat. The ideal way to avoid excess body fat is to limit caloric intake and/or balance caloric intake with ample exercise.

It is still important, however, to limit fat intake, as evidence still supports a relationship between cancer and polyunsaturated, saturated and animal fats. Specifically, studies show that high consumption of red meat and dairy products can increase the risk of certain cancers. One strategy for positive dietary change is to replace red meat with chicken, fish, nuts and legumes.

High fruit and vegetable consumption has been associated with a reduced risk for developing at least 10 different cancers. This may be a result of potentially protective factors such as carotenoids, folic acid, vitamin C, flavonoids, phytoestrogens and isothiocyanates. These are often referred to as antioxidants.

There is strong evidence that moderate to high alcohol consumption also increases the risk of certain cancers. One reason for this relationship may be that alcohol interferes with the availability of folic acid. Alcohol in combination with tobacco creates an even greater risk of certain types of cancer.

Exercise: Higher levels of physical activity may reduce the incidence of some cancers. According to researchers at Harvard, if the entire population increased their level of physical activity by 30 minutes of brisk walking per day (or the equivalent energy expenditure in other activities), we would observe a 15% reduction in the incidence of colon cancer. The association between exercise and uterine cancer is not as well defined.

Screening and Early Detection of Uterine Cancer

For many types of cancer, progress in the areas of cancer screening and treatment has offered promise for earlier detection and higher cure rates. The term screening refers to the regular use of certain examinations or tests in persons who do not have any symptoms of a cancer but are at high-risk for that cancer. When individuals are at high-risk for a type of cancer, this means that they have certain characteristics or exposures, called risk factors that make them more likely to develop that type of cancer than those who do not have these risk factors. The risk factors are different for different types of cancer. An awareness of these risk factors is important because 1) some risk factors can be changed (such as smoking or dietary intake), thus decreasing the risk for developing the associated cancer; and 2) persons who are at high-risk for developing a cancer can often undergo regular screening measures that are recommended for that cancer type. Researchers continue to study which characteristics or exposures are associated with an increased risk for various cancers, allowing for the use of more effective prevention, early detection, and treatment strategies.

Periodic gynecologic evaluation is crucial for the early detection of uterine cancer. All women should undergo regular physical examinations and patients on hormone replacement therapy or tamoxifen might consider monitoring with transvaginal sonography (ultrasound examination) and hysteroscopy (endoscopic evaluation of the uterus). The ability to detect abnormalities in the uterus may be improved with a test called sonohysterograpy, where a salt-water solution is infused into the uterus before the transvaginal sonography is performed. This is a safe and inexpensive improvement over conventional ultrasound examinations.

For women taking tamoxifen, annual examinations beginning 2-3 years after the start of treatment are currently advised. Abnormal bleeding or undiagnosed postmenopausal bleeding warrants immediate evaluation with endometrial biopsy. Ultrasound performed through the vagina for the evaluation of bleeding can also be used in some patients instead of immediate biopsy.

Strategies to Improve Screening and Prevention

The potential for earlier detection and higher cure rates increases with the advent of more refined screening techniques. In an effort to provide more screening options and perhaps more effective prevention strategies, researchers continue to explore new techniques for the screening and early detection of cancer.

Predictive Genetic Testing: The identification of the cancer susceptibility genes has led to predictive genetic testing for these genes. Since most uterine cancers are not the result of known inherited mutations, not all women would benefit from genetic testing. However, women who have a family history of hereditary nonpolyposis colon cancer (HNPCC) have an increased risk for carrying the HNPCC genetic abnormality. These women may benefit from undergoing a test to determine if they do carry the HNPCC genetic abnormality. An accurate genetic test can reveal a genetic mutation, but cannot guarantee that cancer will or will not develop. At this point, genetic tests are used to identify individuals who are at an increased risk of developing cancer, so that these individuals may have the option of taking preventive measures. For more information about genetic testing, please refer to the section Genetic Testing.

Copyright © 2012 Omni Health Media Uterine Cancer Information Center. All Rights Reserved.

Source: National Foundation for Cancer Research
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Monday, October 15, 2012

A Woman Named Jocelyn

My name is Dan. And I support Endometrial Cancer Awareness.

Why – you might ask – would a guy like me advocate something which he is totally and physiologically exempt from? Yes, Endometrial Cancer is a silent killer of women, and I could support other causes; however, this issue is particularly close to my heart and let me tell you why.

It’s about a woman named Jocelyn.

She was a firecracker, a thunderbolt of sorts. It’s impossible not to notice Jocelyn even if you throw her amid a cacophony of jungle animals. She never failed to light up any dull and dreary room with her burst of energy. Jolly, funny, witty, and happy are among the many things people would often use to describe Jocelyn. She was a painter of smiles on everyone’s faces and a refreshing ray of warm sunlight on a cold, gloomy day. She once said that perhaps her only mission in this world was to cheer up those who were down. But to those who loved her, she was much more.

She was only 4’9” (or 5’1” depending on who’s asking), but she could effortlessly tower anyone twice her size with the enormity of her personality. Jocelyn was a brave little warrior against life’s innumerable and oftentimes extravagant tribulations. With nothing but a chill pill and a purple sword in tow, she was always ready to vanquish many of life’s fire-breathing dragons, especially the one that’s called negativity. She’s arguably one of the most positive people anyone could ever meet. Good vibes always and smile, she would always say. Funny, little girl.

A few days after she turned 53, she was diagnosed with cancer. Endometrial Carcinoma. Stage 4. A little over a year after – on June 13, 2011 – she died peacefully in her home in Dipolog City.

She was my mother.

The first time I learned about the diagnosis, my reaction wasn’t anywhere near the histrionics we see in the movies – no explosive theatrics, no hair-tearing, no crazy wailing of cinematic proportion. It was my Aunt Viola, my mom’s sister, who broke the news. And although I had the immediate reaction of most people, it was coupled with a scratch on the head, oddly. “Endo-what? H-how? Wh-? Huh?” I thought it was just a silly joke, a heartless prank and that I would then be that it’s April Fools! But no.

Like most people I spoke with, I didn’t have the faintest idea what Endometrial Carcinoma was. I knew what carcinogens are. Mom would always warn me about the dangers of eating burnt barbeque. They’re carcinogenic and carcinogens could kill you y’know, she would always say. But what about Endometrium? What is that? Too technical if you take it at face value; it sounded like something on the Periodic Table of Elements.

But seriously, what is that?

Endometrial Cancer was as exotic to me as the Martian volcanoes. It was as though a green blinking steamy rock feel from godknowswhere and hit me right smack on my massive forehead. “What is that … thing!?”

Before we progress, though, for the benefit of everyone reading this blog (yeah, the three of you), allow me to provide you with some quick facts regarding this green blinking alien thing called Endometrial Cancer.
Cancer of the lining of the uterus, the endometrium, is the most common gynecologic cancer and ranks seventh among causes of female cancer deaths.
The average woman who develops uterine cancer is in her early 60s.

A small number of uterine cancers (three percent) are sarcomas, a type of cancer that grows in the muscular and connective tissue elements of the uterus.

I am male. I do not have a uterus and never will I have any uterine linings with which cancerous cells could latch onto while it nurtures itself into becoming a life-draining monstrosity. I have an appendage, thank you very much. And it is physically impossible, scientifically implausible, and logically improbable that I will ever get Endometrial Cancer. So what gives?

The epiphany came to me one day while my sister and I were having a rather animated conversation about our plans for Mom’s first death anniversary. While my sister was having a mental vomit on the exciting plans that she hoped to carry on June 13th, it suddenly occurred to me. Looking at my sister, I realized that she’s the only girl standing out of the five immediate family members that I originally have. And I was sure as hell that I don’t want to lose her or anyone to Endometrial Cancer – ever again.

Yes, I am a guy. And I have other roles that I actively take part in this life. I am a brother to an amazing sister. I am a nephew to my supportive aunts. I am a Kuya to my loving female cousins. I am a grandson to a doting grandma. I am a boyfriend to a fantastic girlfriend. And on top of that, I have a throng of wonderful female friends and colleagues. I know in my heart that I don’t want to lose any of them to Endometrial Cancer.

Whenever I go to my mom to rant, whine, grumble, and complain about any issue imaginable – whether it be about work or school or my siblings or even a little mud on the side of my shoe – she would always rattle off a litany of things to say about the topic at hand. But almost always, she would end it with a provocative question – “So … what can YOU do about it?”

How about you? What can YOU do about Endometrial Cancer?

My name is Dan. And I support Endometrial Cancer Awareness.


For Jocelyn “Joji” Adriatico Aleta,
the woman who taught me how to
live and love and is now
my shining star.
I love you, Ma.

Disclaimer: Except for the picture of my Mom, the other photos on this post are not the author’s own.

Saturday, October 13, 2012

What is Endometrial Cancer?

Uterine cancer, also called endometrial cancer, is a cancer that originates in the endometrium, the inner lining of the uterus. (It is different from cancer of the uterine muscle, which is called uterine sarcoma.) The uterus is the hollow, pear-shaped organ where a fetus develops. It is located between a woman’s bladder and rectum.

What are the risk factors for endometrial cancer?

Most of the known risk factors for endometrial cancer appear to be related to changes in the balance between estrogen and progesterone, the two main female hormones. During a woman’s childbearing years, levels of each of these hormones shift on a monthly cycle, producing changes in the thickness of the endometrium.

When the menstrual cycle begins, the endometrium is very thin, consisting only of a few layers of cells. But for the first 14 days of a woman’s menstrual cycle, the ovaries produce more and more estrogen, which causes endometrial cells to proliferate (grow). This results in a thickening of the endometrium. Around day 14, ovulation occurs, and the ovaries begin to produce increasing levels of progesterone. At this stage, the cells of the endometrium become filled with glycogen, a complex sugar that will provide energy for a fertilized egg. If a fertilized egg is not implanted into the endometrium, the ovaries will stop producing progesterone after about two weeks. This sudden drop in progesterone levels causes the blood vessels that provide blood for the endometrium to contract. The endometrium then sloughs off, exiting the body as menstrual blood.

Understanding this cycle helps to show how a shift toward relatively more estrogen compared to progesterone can set the stage for uncontrolled endometrial cell growth, a precursor to cancer. In fact, any factor that increases the lifetime exposure of a woman’s endometrium to estrogen — for example, beginning menstruation early (before age 12) or going through menopause late (after age 52) – raises the risk of endometrial cancer. Because pregnancy shifts the hormonal balance toward more progesterone, women who have never been pregnant have a greater risk of developing cancer than women who have had children. Obesity also contributes to risk; women who are 50 pounds overweight have ten times the risk of endometrial cancer. The reason is that fat tissue can change certain hormones into estrogen, raising a woman’s total estrogen levels. Because both a diet high in animal fat and diabetes are associated with obesity, they are also considered risk factors for endometrial cancer.

Certain hormonal medications that affect estrogen levels influence the risk of endometrial cancer as well. Tamoxifen– a drug used to treat breast cancer or to lower the risk of developing breast cancer – is one example (though the benefit of the drug in treating breast cancer and in reducing the risk of cancer developing in the other breast far outweighs the risk of endometrial cancer).

The risk of endometrial cancer may also be affected by hormone replacement therapy, the use of female hormones after menopause to offset the sudden decline in estrogen production. Hormone replacement therapy is often prescribed for relieving menopausal symptoms such as hot flashes. Taking estrogen alone, however, has been shown to increase significantly a woman’s risk for developing endometrial cancer. Fortunately, this increase in risk can be erased by adding progesterone to estrogen replacement therapy. Estrogen is therefore almost never prescribed alone in menopausal women who still have a uterus.

As it is with all cancers, aging is also a risk factor for endometrial cancer; 95 percent of all cases occur in women over age 40, and the average age at diagnosis is 60. In addition, for unknown reasons, white women have a 70 percent greater risk for endometrial cancer compared with African Americans.

Other risk factors for endometrial cancer include a personal history of breast or ovarian cancer, or previous pelvic radiation therapy. A family history of endometrial cancer also raises the likelihood of developing the disease. A small number of cases may be due to the hereditary nonpolyposis colorectal cancer genetic abnormality, which, as the name implies, raises the risk of colorectal cancer as well. Women who carry this mutation are at higher risk for endometrial cancer.

Can anything be done to prevent endometrial cancer?

Because we do not know what exactly causes endometrial cancer, most cases cannot be prevented. However, there are several steps a woman can take that may help to reduce her risk of developing the disease.

First, the use of combination oral contraceptives by premenopausal women has been shown to decrease the risk of endometrial cancer. Controlling obesity and diabetes can also help. For a woman experiencing menopause and considering hormone replacement therapy, taking a combination of estrogen and progesterone, rather than estrogen alone, is essential if she still has her uterus. Finally, obtaining proper treatment for any precancerous disorders of the endometrium, such as endometrial hyperplasia (increased growth of endometrial cells), can stop the disease from developing. For example, a dilation and curettage (D & C, described below in “What tests are used to diagnose endometrial cancer?”) or a hysterectomy can prevent hyperplasia from turning cancerous. In some cases, taking progesterone medications can also control hyperplasia.

What are the symptoms of endometrial cancer?

The most common symptom of endometrial cancer is abnormal vaginal bleeding. In fact, about 90 percent of patients diagnosed with the disease have complained of irregular bleeding.

Other symptoms include abnormal vaginal discharge, difficult or painful urination, pain during intercourse, and pain in the pelvic area. These symptoms can be – and usually are – caused by conditions other than cancer. But it is important to visit a doctor to get a diagnosis.

What tests are used to diagnose endometrial cancer?

A routine screening test for endometrial cancer has not yet been developed. But if a doctor suspects that endometrial cancer may be causing a woman’s symptoms, he or she will conduct a thorough medical history and a physical exam, as well as one or several of the following diagnostic tests:

Pelvic exam: The doctor will check the vagina, uterus, cervix, ovaries, bladder, and rectum, feeling for any abnormalities such as lumps or changes in size.

Pap smear test: During the pelvic exam, the doctor will perform a Pap-smear test, in which he or she collects a sample of cells from the cervix and upper vagina. The sample is sent to a laboratory, where it is examined for abnormalities. However, because endometrial cancer originates inside the uterus, it may not show up on a Pap test.

Transvaginal ultrasound: The doctor inserts a probe into the vagina. The probe emits sound waves that echo off pelvic structures, projecting images of the uterus and its lining. The images can help the doctor detect the presence and size of a tumor.
Biopsy: The doctor uses one of several methods to remove a sample of tissue from the uterine lining for closer examination under a microscope. A biopsy is the only way to know for sure whether cancer is present.

In some cases, the biopsy will require a dilation and curettage (D&C). During a D&C, the cervix is widened, allowing entry to the uterus. The doctor scrapes a sample of tissue from the uterine lining. The tissue is then examined by a pathologist for cancer cells or other conditions.

If the biopsy reveals cancer, more tests will be done to find out how far the cancer has spread. This is called staging the cancer, and usually involves some blood and imaging tests. An example is a blood test for CA-125, a substance released into the bloodstream by many (not all) endometrial and ovarian cancers. Elevated levels of CA-125 suggest that the cancer has spread beyond the uterus.

Tests may also include a cystoscopy to check if the cancer has spread to the bladder; a proctoscopy to check if the cancer has spread to the rectum; and a chest x-ray to check the lungs for cancer.

What are the stages of endometrial cancer?

The stage of a cancer is the most significant factor when devising a treatment plan. The system used to stage endometrial cancer is called the FIGO (International Federation of Gynecology and Obstetrics) system. It classifies the cancer in stages I through IV and further divides some of the stages into A through C; for example, IA, IB, and IC. Below we provide the general definition of each stage, without detailing what differentiates letters A, B, and C. What you need to know is that the higher the stage number and letter, the more serious the condition.

Stage I: The cancer is limited to the body of the uterus.
Stage II: The cancer has spread from the body of the uterus to the cervix, which is the lowest part of the uterus. (The cervix marks the end of the vagina.)
Stage III: The cancer has spread beyond the uterus (to the vagina or the lymph nodes near the uterus, for example) but remains confined to the pelvic area.
Stage IV: The cancer has spread to the bladder or the rectum, and/or has spread to lymph nodes in the groin, and/or has spread to organs outside the pelvic area, such as the lungs.

How is endometrial cancer treated?

Treatment of endometrial cancer depends on the stage as well as a woman’s age, overall health, and desire to have children. Overall, treatment is very effective, with the five-year survival rate – the percent of patients who live at least five years after diagnosis – reaching 84 percent.

Surgery to remove the uterus (called a hysterectomy) and the fallopian tubes and ovaries (called a bilateral salpingo-oophorectomy) is the most common treatment for women with endometrial cancer. If the cancer has not spread beyond the endometrium, the disease can usually be cured with surgery alone.

The specific type of hysterectomy that a patient needs depends on the extent to which her cancer has spread:

Simple hysterectomy (also called a subtotal or supracervical hysterectomy) removes the upper portion of the uterus, leaving the cervix, fallopian tubes and ovaries intact.

Total hysterectomy removes the uterus and the cervix.

Total hysterectomy with salpingo-oophorectomy removes the uterus, cervix and either one (unilateral) or both (bilateral) ovaries and fallopian tubes. Radical hysterectomy removes the uterus, cervix, ovaries, fallopian tubes, nearby lymph nodes and tissue, and the upper part of the vagina. If the lymph nodes contain cancer cells, this means that the cancer may have spread to other parts of the body.

Radiation therapy, in which high-energy rays are used to kill cancer cells, may also be used to treat endometrial cancer, either before surgery to shrink the tumor or after surgery to destroy any remaining cancer cells.

There are two types of radiation therapy: external and internal. In external-beam radiation therapy, the radiation is administered from a machine, and the procedure is a lot like having an x-ray. Treatment requires four or five weeks of five-days-per-week therapy.

In internal radiation therapy, also called brachytherapy, tiny pellets containing a radioactive substance are inserted through the vagina. The procedure is usually performed about four to six weeks after a hysterectomy. Brachytherapy may require several treatments.

Hormone therapy involves the use of drugs such as progestins (synthetic progesterone) to thwart the growth of endometrial cancer cells by preventing them from using hormones they need to grow. The drugs are usually taken by mouth, then enter the bloodstream and travel throughout the body (called systemic therapy). Hormone therapy is used for treating women whose cancer has spread (metastasized) to distant sites (e.g., the lungs) and women with recurrent endometrial cancer.

Like hormone therapy, chemotherapy, the use of cancer-killing drugs, is a systemic treatment: It can kill cancer cells throughout the body. Typically, a combination of anticancer drugs are administered by vein (through an IV) or by mouth. Chemotherapy can be useful for women whose cancer has metastasized.