Breast cancer is ranked the number one cause of cancer amongst Indian women with an age-adjusted rate of 25.8 per 100,000 women. The number of women who succumb to this disease is almost 12.7 per 100,000 women. Radiation therapy forms an integral and important part of the armamentarium for the treatment and cure of breast cancer. The aim of radiation therapy is to kill the DNA of the cancer cells that persist and lead to relapse after surgery and chemotherapy. Radiation is delivered with megavolt X-Ray generating machines to the breast and lymph node areas after surgery to create a cancer-free zone.
Radiation is always recommended after breast-conserving surgery and over eight randomised trials since the 1980s have established the role of radiation in breast cancer. The trials done in the 1980s-1990s showed remarkable control rates of >90% for stage 1-2 breast cancer post Breast Conserving Surgery (BCS). Data has shown that radiation reduced the risk of local recurrence by 50% when given post-surgery versus the patients who did not receive radiation. The biggest benefit was seen in women less than 40 years of age where only 10% women developed recurrence as compared to 19.5% in women not receiving radiation. The study had been conducted by the European Society for Radiotherapy and Oncology enrolling 5300 women with stage 1-2 breast cancer. Women with stage 1-2 breast cancer with negative nodes in the axilla do not need radiation unless they have other aggressive features like lympho-vascular invasion, margin positive disease or triple receptor-negative breast cancer.
For stage 2-3 breast cancer with lymph node involvement in the axilla, radiation therapy is recommended as it reduces the risk of local recurrence by 67% and the risk of death by 6%. A study published in the New England Journal of Medicine reported a decrease in the risk of death from cancer by 33% and the probability of survival at 10 years with radiation treatment increased from 54% to 64%. Hence the current recommendation is to support the use of radiation therapy for women in stage 2-3 breast cancer after surgery and chemotherapy. Women at high risk of recurrence include
Cancer size >5 cms
lymph nodes involved in the armpit (axilla)
Cancer at the surgical specimen cut margin
In stage 4 breast cancer or post radical treatment with surgery and chemotherapy, the incidence of relapse is 36% in patients not treated with radiation versus 19% in patients treated with radiation. Radiation is also an effective tool for pain palliation in bone metastases and stereotactic radiosurgery (SRS) or stereotactic body radiotherapy (SBRT) is the recommended treatment for brain metastases and lung/liver metastases respectively. SRS & SBRT have been shown to aid and prolong the intracranial/intrapulmonary control of cancer in addition to chemotherapy/immunotherapy/hormone therapy.
To summarise, radiation is a key member of cancer care in breast cancer for local, loco-regional, recurrent and metastatic disease control.
The author is Chairperson Radiation Oncology, Cancer Center Medanta – The Medicity.
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Seven warning signs of brain tumour
The signs and symptoms of brain tumour are diverse and may vary from mild to major red flag signs.
Change in the pattern of headaches, constant sensation of vomiting, blurred vision can be the warning sign of a brain tumor which cannot be ignored. Brain tumour is a cluster of abnormal cells that arises from the nervous tissues of the brain. It is the irregular proliferation of cells creating a tumour. Brain tumours can either be benign, with no cancer cells, or malignant, with cancer cells that grow quickly.
Common types of non-cancerous tumours are pituitary adenoma, meningioma, acoustic neuroma. The cancerous tumours are gliomas, ependymomas, medulloblastomas, metastasis from cancers of different body parts, etc.
The signs and symptoms of brain tumour are diverse and may vary from mild to major red flag signs. Not all the signs or symptoms are present in all patients. The symptoms mainly depend on the location of the tumour in the brain. The most common warning signs of brain tumours are as follows. Majority of the tumours presents with a mix of these signs & symptoms.
1. SEIZURES / CONVULSIONS
A brain tumour may cause the neurons to fire uncontrollably leading to abnormal body movements. The seizure may be focal, involving one area of the body or it may be generalized involving the whole body. This usually happens when the tumour involves parietal lobe of brain, which controls motor function of the body.
2. IMBALANCE / GIDDINESS
Loss of balance and clumsiness in fine movements are linked with tumours of the cerebellum. The cerebellum commonly known as small brain which is behind the head and just above the neck area controls the balance of the body. So, a tumour in this location leads to vertigo, giddiness, or imbalance. Sometimes a person tends to sway towards one side while walking and feels like falling.
3. VISUAL DISTURBANCES OR HEARING LOSS
Blurred vision, double vision, partial or complete loss of vision can be signs of a brain tumour if it is in occipital lobe, temporal lobe, brain stem or near pituitary gland. The tumours may lead to pressure on optic pathways leading to visual disturbances. Pituitary adenoma and optic nerve meningiomas are most common tumours leading to visual disturbances. Acoustic neuromas are tumours located in nerve of ear, which leads to hearing loss or some whistle like noise in ear (tinnitus).
4. MEMORY LOSS OR PERSONALITY CHANGES
Tumours in the frontal or temporal lobe may lead to forgetfulness, changes in behaviour, confusion, changes in judgement and changes in speech. People tend to become agitated without any reason or may tend to become inactive in some situations. Usually, the recent memory loss is a common symptom in such tumours.
5. NAUSEA/ VOMITING
Nausea and vomiting may be a symptom of simple gastric disturbance but if it is persistent in nature and associated with projectile vomiting, it may signal an underlying brain problem. This usually happens because of edema in surrounding brain due to tumour.
6. WEAKNESS IN ARMS AND LEGS (PARALYSIS)
Altered perception of touch, pressure, weakness, or decreased movements of limbs on one side are signs of a tumour located in frontal or parietal lobe. Many times, patients just feels that his or her handwriting has changed, or the signature has changed because of weakness in hands. Difficulty in swallowing and facial weakness is a sign of brain stem tumours.
Headache may be experienced around the tumour area. Unlike the usual headache, it is persistent for more than few days and associated commonly with nausea, vomiting or other signs. The swelling near the tumour area leads to pressure on surrounding tissues and it leads to headache. It may be severe and experienced more in early morning. The headache usually happens in many other conditions also, so only headache may not be the symptom in many brain tumours.
The treatment depends on the type, size, location of the tumour and the general health of the patient. Malignant tumours are usually treated with a surgery. Some tumours multiply rapidly while some tumours grow very slowly. Treatment options include surgery, radiation therapy, chemotherapy, and targeted therapy. If you see any of the signs and symptoms mentioned immediately consult a doctor for further evaluation and treatment.
The authors are radiation oncologist, Department of Radiation Oncology, HCG Cancer Centre Ahmedabad.
PRECAUTIONS AND AFTER-CARE POST COVID VACCINATION FOR 15-18 YEARS
WHO and regulatory authorities will continuously monitor the use of Covid -19 vaccines to identify and respond to any safety issues that might arise.
Covid vaccine in children is very safe. Approved by Govt of India for children between 15-18 years of age. There are strict precautions in place to ensure the safety of all Covid vaccines. Before receiving validation from WHO and national regulatory agencies for emergency use, Covid -19 vaccines must undergo rigorous testing in clinical trials to prove that they meet internationally agreed benchmark for safety and efficacy. As with all vaccines, WHO and regulatory authorities will continuously monitor the use of Covid -19 vaccines to identify and respond to any safety issues that might arise. Need few precautions before giving Covid vaccine. Covid -19 vaccine and other vaccines should be separated by an interval of at least 14 days. Second dose should also be of the same Covid -19 vaccines which was administered as the first dose. Interchangeability of Covid -19 vaccines is not allowed. Persons who developed allergic reactions to a previous dose of vaccine should not receive the second dose. Persons who have active Covid infection, vaccination should defer till 4-8 weeks after recovery. Vaccine should be administered with caution in persons with history of bleeding disorder. It is recommended that both doses of vaccine should be taken for full benefit of vaccination.
Like any vaccine, some people will experience mild to moderate pain on the injection site, muscle pain, headache. These are the signs that the body’s immune system is responding to vaccine and gearing up against the virus. Sometimes mild to moderate fever with or without chill. These symptoms disappear own its own in few days without any treatment.
Following are the reported side effect of Covid -19 vaccine
• Muscle pain
• Pain at the injection site
If high temperature lasts longer than 2 days, a new continuous cough developed, should suspect to have Covid -19 infection. And infection not from the Covid -19 vaccine, may have caught it just before or after vaccination.
The Author is a Paediatrician
CAN AIR POLLUTION CAUSE IRREGULAR HEARTBEATS?
Depleting air quality is a significant threat to our body, it may cause severe and potentially fatal symptoms and complications.
Air pollution can cause harm to the cardiovascular and respiratory systems due to its effect on inflammation in the heart and throughout the body. For people with existing heart problems, exposure to high levels of air pollution can trigger irregular heartbeats that may lead to cardiac disease like irregular heartbeats, heart attacks, strokes, and heart failures. Incidences of heart diseases like arrhythmia are increasing among the general population across younger age groups. Also, for people with a medical condition called heart failure, air pollution can further reduce the ability of the heart to pump blood the way it should.
Air pollution can cause various diseasesPollutants released from industries are very harmfulAir pollution could increase risk of heart disease
Let us dive deeper to know more about heart rhythm disorders.
UNDERSTANDING HEART RHYTHM DISORDERS
Heart rhythm disorders can be termed arrhythmia or Atrial Fibrillation (irregular heartbeats), which occurs when there is a problem with the rate or rhythm of the heartbeat. It mainly occurs when the electrical signals that coordinate heartbeats are not working correctly. An irregular heartbeat may feel like a racing heart or fluttering. A person’s heart can beat too fast, too slowly, or with an irregular rhythm during an arrhythmia. When a heart beats too fast, the condition is called tachycardia. When a heart beats too slowly, the situation is called bradycardia. However, many heart arrhythmias are harmless. You may feel faint or dizzy or have difficulty breathing. But, in case if they are highly irregular or result from a weak or damaged heart, then it may cause severe and potentially fatal symptoms and complications.
If an arrhythmia is left untreated, the heart may not pump enough blood to the body. This can damage the heart, the brain, or other organs.
Arrhythmia mainly occurs during old age as the heart gets weak, but cases have been rising among the younger population in recent years.
HOW DOES AIR POLLUTION AFFECT YOUR HEART RATE?
Depleting air quality is a significant threat to our body, PM 2.5, PM 10, and nitrogen-di-oxide released due to traffic pollution, burning of firewood, smoking, industrial pollution, etc. can cause heart palpitations (irregular heartbeats) as plaque can build up in the arteries through which nutrients, blood, and oxygen are supplied to various parts of the body. In addition, these pollutants can travel up the bloodstream, which can, in turn, narrow your arteries and weaken your muscles, making you prone to heart attacks.
Other parts of the body like your lungs, brain, and skin can also be affected in the long run.
SYMPTOMS CAUSED BY AIR POLLUTION ON YOUR HEART
When a person suffers from Arrhythmia caused by air pollution, they can experience a series of symptoms, including abnormal heartbeats (slower or faster than the regular BPM), breathlessness, fatigue, anxiety, sweating, dizziness, and chest pain.
Since air pollution can also affect your lungs, symptoms like shortness of breath, headaches, allergic fevers, and asthma also trigger pre-existing medical conditions. In addition, daily exposure to high levels of pollution can increase the aging of your lungs and heart, leading to death at an early stage.
HOW CAN YOU BEAT AIR POLLUTION AND WHEN TO SEEK A CARDIOLOGIST?
When the above symptoms worsen, for instance, increased breathlessness, sudden palpitations caused by irregular heart rhythm, raging chest pains, or a heart attack, it is advisable to visit a cardiologist for immediate consultation and ensure timely treatment.
Appropriate lifestyle style changes should be made to avoid suffering from heart conditions; it is essential to realize that one should avoid smoking, indulging in excess alcohol, having a heart-healthy diet that contributes to strengthening your heart, maintaining a physically active routine by exercising, and also managing your stress; these steps can help in effectively managing your heart health.
The author is the Director and Head of Cardiology at FHVK
Skincare tips for new mothers and their babies
Motherhood is a blissful period in the life of every woman, however, being a mother we are so focused on the child that our needs tend to take a backseat. While post-pregnancy looks and changes in skin texture is not a bad thing, however, not taking care of your skin may result in a variety of changes such as melasma, acne, stretch marks, and puffy eyes.
At the same time, it is also important to look after baby skincare needs as their skin is sensitive and gets exposed to harsh environments such as pollution, chemicals.
Here, we bring top skincare tips for new moms to get glowing skin post-pregnancy.
It always pays to be organised, to begin with, keep all your skincare needs in one place as it helps to better take care of yourself rather than wasting time looking for essential things. Make optimum use of your ‘Me time’ and manage it properly to pamper your needs.
HAVE A ROUTINE
• Our skin undergoes a renewal cycle by dispensing toxins and debris as we sleep, so it is important to cleanse your skin thoroughly with a face wash suitable for your skin type before you hit the bed.
• Steaming is another important step of your skincare routine, take steam for two to three days a week as it will help to open up your clogged pores.
• Facial scrub removes the dead skin and helps make your skin softer and radiant. Scrub your face for five minutes and wash it with tap water.
• A toner forms a vital part of skincare for new moms. Look for toners that help to maintain the pH value of your skin.
• Moisturising your face is the last step to give hydration
Baby products being mild in nature are ideal for new mothers as well. They are created in such a way as to lock moisture in the baby’s skin, so new moms can use them as well. Every time you use body oil, lotion or cream for your baby, you can apply some on your skin as well, this way you do not need to dedicate extra time every day for your skincare needs.
All said about skincare routine for new moms, we cannot ignore skincare needs of newborns as well. Their skin being sensitive needs to be protected from the harsh environment—pollution, high temperature etc. here we bring some simple and easy tips to help you with the skincare needs of your young one.
Babies need to bathe only two to three times a week with warm and not hot water to stay clean. Their skin being soft and sensitive may be ripped-off of essential oils and nourishment with a regular bath.
REGULAR BODY MASSAGE
Regular massage with coconut, olive or almond oil hydrates the skin and helps in a good blood flow which finally results in glowing skin. Moreover, slightly heating the oil before the massage has therapeutic benefits on the skin.
PROTECT FROM THE HARMFUL RAYS OF THE SUN
While early morning rays of the sun work wonders for your baby, direct exposure to sun rays in the later hours can irritate the skin. Therefore, if you happen to venture out with your young one during the day, make sure to cover the baby adequately to prevent the sun from directly hitting the skin.
DIAPER BASICS UNEARTHED
It is important to get the diaper basics right or else it may end up in diaper rashes and harm your baby’s sensitive skin around the area of use. Make sure to change the diaper at regular intervals and as and when it gets spoiled, cleaning tenderly however completely each time with child wipes. While several myths surround the use of diapers such as rashes and irritation of the skin, nevertheless, it is not due to the diaper itself but due to lack of attention and knowledge about proper usage of diapers.
PROPER AWARENESS OF BABY PRODUCTS
Do not forget to read the product label before you purchase your baby’s products. It is best to avoid chemical and alcohol-based products and instead use products made explicitly for infants. Baby’s skin is very delicate and needs optimum care, a single mistake here-and-there could make things worse.
While you work hard to take optimum care of your newborn, still you may come across rashes, skin-peeling, acne or flea-bite like marks on the baby’s skin. Some of these are quite normal and would fade away quickly as they come. If they take time to go away, consult your doctor as it might take a toll on a newborn’s sensitive skin.
The writer is a Plastic and Cosmetic Surgeon, Jupiter Hospital, Pune.
WHY CERVICAL CANCER SCREENING IS MUST
Cervical cancer is a disease that originates in the cells lining the cervix. It can expand to various parts of the body. Cervical cancer is the most common cancer in women between 20 and 35 years old. It develops from the cells of the cervix, which is at the lower part of the uterus (womb). Many women do not have symptoms early on and may not know they are at risk for cervical cancer until it’s too late. Regular Pap tests can find changes to cells before a woman notices anything wrong. Most cases happen among women who have not been regularly screened for cervical cancer.
SYMPTOMS OF CERVICAL CANCER
Cervical cancer often doesn’t cause symptoms until it’s in the late stages, so knowing your body and being aware of your health is important. To help fight cervical cancer, we aim to keep you informed with the latest news and research on this disease.
Regular cervical cancer indications are:
• Unusual bleeding, such as within periods, after sex, or after menopause
• Vaginal discharge that seems or smells unusual than normal
• Discomfort in the pelvis
• Requiring to pee more often
• Burning during urination
Cervical cancer was once one of the most well-known reasons for cancer death for women. The cervical cancer death rate declined significantly with the increased screening. (This screening method can find changes in the cervix before cancer forms. It can also find cervical cancer at an early stage− when it’s tiny and easy to cure.)
SCREENING INFORMATION FOR CERVICAL CANCER
Cervical cancer is the most common gynecologic cancer. It is preceded by premalignant cervical changes, which are slow-growing and often asymptomatic. Screening tests can detect the presence of these changes before they develop into invasive cancers. Evidence supports that both HPV DNA testing and Pap cytology (with or without HPV DNA testing) decrease mortality rates from cervical cancer by 20% to 55%.
The comprehensive aim of cervical cancer screening is to:
• Lessen the number of people who die from cancer, or entirely exclude deaths from the cancer
• Lessen the number of people, developing the cervical cancer
A Pap test and an HPV test work together to help prevent cervical cancer. The Pap test checks for cell changes in the cervix, while the HPV test checks for a virus that can lead to these changes. HPV is a virus that develops through sexual contact and can spread throughout the entire body. It also leads to cancer. If your screening tests are not under control, your doctor may do more tests, such as biopsy.
IMPORTANCE OF REGULAR SCREENING FOR CERVICAL CANCER
This article is about the importance of regular screening for cervical cancer. Pap test screening has lowered the death rate from cervical cancer by more than 50%. But it misses cases that develop into cervical cancer. So, now we are using a newer HPV test to find infections that may lead to cervical cancer.
• Early detection of cervical cancer may save your life
• A Pap test is an important part of a woman’s regular healthcare
• Early screening can find changes in the cervix before they turn into cancer
• Having a test every year is as important to your health as brushing your teeth, eating healthy and exercising regularly
Women who get the recommended screening tests for cervical cancer are more likely to find out if they have any abnormal cells in their cervix before they turn into cervical cancers. If a woman finds out she has abnormal cells, she can take steps to get them removed so that she doesn’t develop cervical cancer.
The writer is Director, Lifeline Laboratory.
5 LIFESTYLE CHANGES TO MANAGE YOUR WEIGHT
It is never too late to begin your journey towards good health and weight loss. But stop depending on any kinds of shortcut methods or fad diets, instead proceed in your weight loss journey in a scientific and planned way.
Did you know one of the most searched queries on weight loss over the internet is—‘How to lose weight fast?’ There are numerous ways described to help one get the answer. But despite the knowledge and the widely available tips, India remains the third most obese country in the world (according to a 2014 report). So why do we fail to lose weight? Lack of motivation? Lack of knowledge? Or trying something that doesn’t really work?
The real reason is lack of proper knowledge and the wrong approach. You should take the right steps in reducing your weight and expanding waistline. Else the dangers could cost you your health and well-being.
WHY YOUR BODY WILL THANK YOU FOR LOSING WEIGHT
Obesity sets the stage for insulin resistance which happens prior to the onset of prediabetes or type 2 diabetes. Insulin basically works like a key to let the sugar get into cells where it is needed. If it doesn’t function properly, sugar levels increase in the blood leading to prediabetes and diabetes.
Incidentally, insulin resistance also leads to obesity. Controlling one factor can considerably lessen the risk of the other and reduce the chances of developing related consequences.
Weight gain is known to compromise one’s heart health. Over time, fatty deposits on the arteries can increase the chances of heart attack, cholesterol levels and triglycerides.
Obesity increases the risk of developing sleep problems like sleep apnea. The fat deposits around the neck can momentarily stop breathing at night. Snoring is a common symptom of sleep apnea.
Obesity can lead to fatty liver, scarring the organ and leading to other related complications. Obesity is also considered to be a significant risk factor for various kinds of cancers.
There is a strong correlation between obesity and major depressive disorders. Also, discrimination based on body size has a significant effect on one’s mental well-being.
WHAT YOU CAN DO
It is never too late to begin your journey towards good health and weight loss. But stop depending on any kinds of shortcuts methods or fad diets, instead proceed in your weight loss journey in a more scientific and planned way. Here are a few things that you can do:
1. Understand what’s causing you to put on weight or not letting you lose weight easily: Remember every body type is different. Each of our metabolism is different and responds differently to food and exercise. While people are now aware of body composition analysis where they know their percentage of fat, muscle, etc., they still do not understand what’s increasing their fat percentage, especially the visceral fat.
One needs in-depth assessments in terms of their diet, fitness levels, stressors and sleep. All of these are factors that affect metabolism, insulin resistance, blood sugar levels can cause increased obesity.
2. Opt for a personalised approach to diet: Did you know that all healthy foods might not be good for you? Sometimes you might be eating healthy, in moderation, but your blood sugar levels say a different story. This is because everyone has a unique glycemic response to foods, which means how your blood sugars respond after having a certain food. For instance, two people will have different blood sugar readings after having the same food. This is why a personalised approach to diet is necessary to know. Our programs come with a CGMS device that painlessly monitors blood sugars for 14 days in response to food, activity, sleep patterns, and mood swings. It takes around 1300 such readings which are mapped with the food and activity of a person through specialised software. This helps to track and tweak diet and behaviour for better blood sugar control and weight loss.
Also, one needs to be attentive towards including micronutrients in the diet. Essential nutrients like calcium, phosphorus, zinc, magnesium, iron, potassium, sodium iodine and vitamins like Vitamin A, B, C, D, E, and K help in proper muscle development, build immunity, improve metabolism and energy expenditure and help you to lose weight. So balancing these micronutrients in the diet is crucial.
3. Upgrade to personalised fitness plans: Probably walking 10,000 steps a day is not what is going to work for you or just doing 30 minutes of Zumba. Sometimes you need a combination of exercises or a personalised plan to fight the fat war. Look for an expert who can help you.
4. Don’t neglect other aspects that affect it: Lack of sleep and weight gain have a strong link. Fewer hours of sleep in the night can increase the secretion of the hunger hormones (ghrelin) that make one eat more or trigger mindless emotional eating. It also slows down metabolism and increases glucose levels in the bloodstream.
When the body and mind are deprived of rest and rejuvenation, it takes a toll on one’s mental health, which can significantly derail one’s efforts in the weight loss journey. So it is advisable to have your eight hours of shut-eye and pay attention to your mental well-being to fight the flab.
5. Focus on long-term behaviour change: Don’t aim for completing 10,000 steps on the first day of your fitness journey, try walking for 30 minutes every day and be consistent with your routine. Gradually upgrade yourself from walking to jogging to weight training. Make small changes that are sustainable.
We know weight loss isn’t easy. It is a lonely journey that needs some exceptional commitment and self-discipline. Probably having a buddy in the form of a digital therapeutics or a DTx program can help. We have come up with a unique DTx weight management program, Reset23, which focuses on helping reduce weight and attain a healthy BMI below 23 while shrinking your waist circumference to a healthy measure.
The program offers detailed macro and micronutrient analysis through our wellness app to help coaches draft a diet chart and work on your nutritional deficits for personalised weight loss meal plans. A team of physiotherapists’ guides on exercise regimens to help lose weight as well as ensure stamina building and muscle strength with minimal risk of injury.
Proper psychological counselling is offered to help one make small behaviour changes that help stay on track with weight loss goals and make sustainable changes to adapt to a healthy lifestyle and keep the flab at bay. Proper stress and sleep management tips also help to bring in these positive lifestyle changes. Weight loss needs a 360-degree approach and that is what Reset23 promises.
The writer is Co-founder and CEO, Fitterfly.
Why do we fail to lose weight? The real reason is lack of proper knowledge and the wrong approach. You should take the right steps in reducing your weight and expanding waistline. Else the dangers could cost you your health and well-being.
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