#stop colon cancer EARLY with screening

[grits-galraisedinthesouth]

This is absurd. The patient is high risk for a myriad of cancers (including colon) due to a history of bladder cancer.

Bureaucratic red tape in a developed country delayed his life saving screening for 5+months!

If he could get to North America, we could see him this week.

Couldn't Aussie stars like Rusell Crowe or Mel Gibson help this high risk cancer survivor get to the USA for a simple colonoscopy?

[sapphic-sex-ed]

i'm at a certain age (early 20s) where i keep getting messages from my doctor saying i should come in and get a pap smear. the thing is, i'm still a virgin. do i actually need this test if i haven't had sexual contact with another person before? if not, is there some way i can get my doctor to stop trying to bring it up other than just lying and saying i'm waiting for marriage?

I don’t know how it works internationally, but in Sweden you start getting pap smears at age 24 and then with a few years’ interval until it becomes yearly in your 50’s.

Now, cervical cancer is commonly caused by HPV and part of the reason for smears, but you can also develop cancer without an infection so if the screening is free (like it is here) or very cheap I would recommend going just to be sure, just like how when you get older (40’s-50’s) you should start looking into getting regular screenings for colon cancer (most common cancer after breast and prostate and maaaaybe lung, don’t remember if lung or colon was more common) and how you should go to mammography screenings too.

It can be scary to get a pap smear when you haven’t had it done before, but in my experience it isn’t painful, just slightly uncomfortable. If you’re under 24 I’d say hold off until then.

As for automated texts/letters, I’d say contact your doctors’ office admin department and ask about it. They know the systems and can help you with those questions.

-mod liz

[vedamgastrohospital]

Comprehensive Guide to Colonoscopy: Procedure, Benefits, and Expert Care by the best Gastro hospital in Surat

Introduction

When it comes to colonoscopy procedures in Surat, it’s essential to have access to the right resources and medical professionals. We will go deeper into the definition of colonoscopy, how it is performed, its safety profile, the strong justifications for its necessity, and detailed directions on how to be ready for the procedure in this extensive guide.

Finding Expert Care in Surat

When seeking a specialist for colonoscopy, being one of the Best Gastro Hospitals in Surat with a skilled team of gastroenterologists, Vedam Gastro Hospital emerges as the trusted choice. Their team of experienced gastroenterologists specializes in colonoscopy procedures, colon cancer screening, and the diagnosis of various digestive issues. If you’re searching for a dedicated colonoscopy doctor in Surat or comprehensive colon cancer screening in Surat, contact Vedam Gastro Hospital today. Your digestive health is in expert hands, and timely action can be lifesaving. Don’t delay; schedule your colonoscopy at Vedam Gastro Hospital for peace of mind and optimal health. Your journey to digestive wellness starts here.

What is Colonoscopy?

A colonoscopy is a crucial diagnostic technique used to look into the rectum and colon’s inner lining. It makes use of a colonoscope, a lengthy, flexible tube with a tiny camera at the tip. Real-time views of the colon’s interior are provided by this camera, enabling medical practitioners to spot and evaluate anomalies like polyps, tumors, inflammation, or other gastrointestinal problems.

How is Colonoscopy Done?

The method of a colonoscopy is well-trained and exact, and it is typically carried out by a gastroenterologist, a doctor who specializes in the digestive system. The team of highly qualified and experienced gastroenterologists available at Vedam Gastro Hospital considered as one of the Best Stomach Hospitals in Surat excels at carrying out this surgery. To ensure comfort throughout the examination, patients are typically given sedatives. The rectum is used to gently insert the colonoscope, which is then slowly progressed through the colon. The colonoscope’s camera tip delivers high-definition images to a monitor, enabling the physician to carefully examine the whole colon. If any polyps or abnormal tissues are found, they can be swiftly removed or biopsied while the surgery is being performed.

Is Colonoscopy Safe?

Colonoscopies are known to be safe, especially when done by a qualified medical expert. Although they are uncommon, complications could include mild bleeding, infection, or damage to the colon’s wall. Before the procedure, it is essential to discuss any worries or inquiries with your doctor. You can be confident that the staff at Vedam Gastro Hospital in Surat is committed to explaining the procedure’s advantages and disadvantages in great detail while placing a priority on your health.

Why Should Colonoscopy Be Done?

Colonoscopy is essential for the following reasons:

1.Colon cancer screening: Colonoscopy is one of the best ways to identify and stop colon cancer. Precancerous polyps can be removed before they turn malignant with early detection, potentially saving lives. Colon cancer screening is a specialized service that Vedam Gastro Hospital in Surat excels at providing.

2.Diagnosis of Digestive Problems: Colonoscopy is also helpful in identifying and assessing a variety of digestive disorders, such as Crohn’s disease, ulcerative colitis, and persistent diarrhea. The skilled medical staff at Vedam Gastro Hospital can offer precise diagnosis and specialized treatment regimens for various problems.

3.Keeping an eye on pre-existing conditions: Patients with a history of colorectal problems or colon cancer might need routine colonoscopies to keep an eye on their health and ensure early detection.Vedam Gastro Hospital offers comprehensive care for patients with ongoing digestive health concerns, ensuring continuity and consistency in their treatment.

How to Prepare for Colonoscopy?

A successful colonoscopy depends on careful planning:

1.Dietary Restrictions: At Vedam Gastro Hospital, one of the best stomach specialists in Surat, will provide you detailed dietary guidelines. This usually entails following a clear liquid diet for a day or two prior to the treatment.

2.Medication Modifications: Prior to the colonoscopy, some medications may need to be modified or temporarily stopped. To ensure a successful surgery, discuss this with your doctor at Vedam Gastro Hospital.

3.Colon cleansing: To fully cleanse your colon, a specific laxative solution will be administered to you. To ensure a clear vision during the procedure, it’s imperative to strictly follow the offered directions.

4.Make Travel Arrangements: You won’t be able to drive yourself home after the procedure due to anesthesia.

[sidshospital]

The Role of Endoscopy in Diagnosing Digestive Issues

Digestive problems can be a real pain — literally and figuratively. If you’ve been experiencing persistent stomach issues, your doctor might recommend an endoscopy. But what exactly is this procedure, and how does it help diagnose digestive problems? Experts from SIDS Hospital, which is one of the best gastro hospitals in Surat, help us in diving into the world of endoscopy and explore its crucial role in gastrointestinal health.

What is Endoscopy?

Endoscopy is a medical procedure that allows doctors to look inside your body using a long, thin tube with a tiny camera attached to its end. This tube, called an endoscope, is inserted either through your mouth or rectum, depending on which part of your digestive system needs examination.

There are several types of endoscopic procedures, including:

1. Upper Endoscopy (EGD): Examines the oesophagus, stomach, and upper part of the small intestine.

2. Colonoscopy: Looks at the large intestine (colon) and rectum.

3. Sigmoidoscopy: Examines the lower part of the colon.

4. Capsule Endoscopy: Involves swallowing a small capsule with a camera that takes pictures as it moves through your digestive tract.

When is Endoscopy Recommended?

Your doctor might suggest an endoscopy from the best hospital in Surat if you’re experiencing symptoms such as:

- Persistent abdominal pain

- Chronic heartburn or acid reflux

- Unexplained weight loss

- Difficulty swallowing

- Gastrointestinal bleeding

- Chronic diarrhoea or constipation

- Unexplained anaemia

Endoscopy is also used for regular screening of certain conditions, like colon cancer in individuals over 50 or those with a family history of the disease.

The Diagnostic Power of Endoscopy

Endoscopy is a powerful tool in a gastroenterologist’s arsenal. Here’s how some of the best gastroenterologists in Surat use endoscopy for diagnosing various digestive issues:

1. Direct Visualization: Unlike other imaging techniques, endoscopy allows doctors to see the inside of your digestive tract in real-time. This direct view can reveal issues like inflammation, ulcers, or abnormal growths that might not show up on other tests.

2. Tissue Sampling: During an endoscopy, doctors can take small tissue samples (biopsies) for further testing. This is crucial for diagnosing conditions like celiac disease, inflammatory bowel disease, or cancer.

3. Detecting Subtle Changes: Endoscopy can pick up on subtle changes in the digestive tract lining that might indicate early-stage diseases or precancerous conditions.

4. Assessing Severity: For known conditions, endoscopy helps doctors assess the severity and extent of the problem, which is vital for planning treatment.

5. Immediate Intervention: In some cases, doctors can treat issues during the endoscopy itself, like removing polyps or stopping bleeding.

Common Digestive Issues Diagnosed Through Endoscopy

Endoscopy plays a crucial role in diagnosing a wide range of digestive problems:

1. Gastroesophageal Reflux Disease (GERD): Endoscopy can reveal damage to the oesophagus caused by chronic acid reflux.

2. Celiac Disease: A biopsy taken during endoscopy can confirm this autoimmune disorder triggered by gluten.

3. Inflammatory Bowel Disease (IBD): Conditions like Crohn’s disease and ulcerative colitis can be diagnosed and monitored through endoscopy.

4. Ulcers: Endoscopy can identify ulcers in the stomach or small intestine and help determine their cause.

5. Gastrointestinal Cancers: Early detection of cancers in the oesophagus, stomach, or colon is possible through endoscopic examination.

6. Barrett’s Oesophagus: This precancerous condition, often related to long-term GERD, can be identified and monitored with regular endoscopies.

Preparing for an Endoscopy

If your doctor recommends an endoscopy, don’t worry — the procedure is generally safe and well-tolerated. Ensure that you choose a hospital that performs the best laparoscopic surgeries in Surat. Here’s what you can expect:

1. Fasting: You’ll need to avoid eating and drinking for several hours before the procedure.

2. Medication Adjustments: Your doctor might ask you to temporarily stop certain medications, especially blood thinners.

3. Bowel Prep: For lower GI endoscopies like colonoscopy, you’ll need to clean out your colon using laxatives or enemas.

4. Sedation: Most endoscopic procedures are performed under sedation to ensure your comfort.

The procedure itself usually takes 15–30 minutes, although you’ll need some time to recover from the sedation afterward.

Limitations and Alternatives

While endoscopy is an excellent diagnostic tool, it’s not always the first or only option. Your doctor might start with less invasive tests like:

- Blood tests

- Stool samples

- Imaging studies (X-rays, CT scans, or MRIs)

Additionally, endoscopy has some limitations. It can’t see through the wall of the digestive tract, so some conditions might require additional testing. In some cases, more advanced techniques like endoscopic ultrasound might be necessary.

Conclusion

Endoscopy has revolutionized the way we diagnose and treat digestive problems. It allows doctors to see inside your body, take samples, and even perform treatments — all through a tiny tube. If you’re experiencing persistent digestive issues, don’t hesitate to talk to your doctor about whether an endoscopy might be right for you and which hospital can perform the best endoscopy in Surat. Remember, early detection and diagnosis are key to effectively managing many gastrointestinal conditions. With endoscopy, we have a powerful ally in the fight for digestive health.

[colonoscopycostsingapore]

The Importance of Colonoscopy in Singapore: A Guide to Early Detection and Prevention

A colonoscopy is a critical procedure for the early detection and prevention of colorectal cancer, one of the leading causes of cancer-related deaths worldwide. In Singapore, with its advanced healthcare infrastructure, undergoing a colonoscopy is a straightforward and highly effective way to maintain colon health. This blog aims to provide comprehensive information about colonoscopy, its benefits, and why Singapore is an ideal place to undergo this essential procedure.

What is a Colonoscopy?

A colonoscopy is a medical procedure that allows a gastroenterologist to examine the interior lining of the large intestine (colon and rectum) using a flexible tube called a colonoscope. This tube is equipped with a camera and light, enabling the doctor to identify any abnormalities, such as polyps, tumors, or inflammation.

Why is a Colonoscopy Important?

A colonoscopy is the gold standard for detecting and preventing colorectal cancer. Here’s why it is crucial:

Early Detection: Early detection of colorectal cancer significantly improves the chances of successful treatment and survival.

Polyp Removal: During the procedure, precancerous polyps can be removed, preventing them from developing into cancer.

Diagnosis of Other Conditions: Besides cancer, a colonoscopy can diagnose other gastrointestinal conditions such as Crohn’s disease, ulcerative colitis, and diverticulosis.

Peace of Mind: For individuals with symptoms or a family history of colorectal cancer, a colonoscopy can provide reassurance and clarity.

Who Should Get a Colonoscopy?

Colonoscopy is recommended for:

Individuals Aged 50 and Above: Routine screening is typically advised starting at age 50.

Family History of Colorectal Cancer: Those with a family history of colorectal cancer or polyps should consider earlier and more frequent screenings.

Symptoms of Colorectal Issues: Symptoms such as rectal bleeding, persistent abdominal pain, unexplained weight loss, or changes in bowel habits warrant a colonoscopy.

Previous Polyps or Cancer: Individuals who have had polyps or colorectal cancer in the past need regular follow-up colonoscopies.

Preparing for a Colonoscopy

Proper preparation is crucial for the success of a colonoscopy. Here’s what you can expect:

Dietary Restrictions: Typically, patients are advised to follow a clear liquid diet for 24 hours before the procedure.

Bowel Preparation: Laxatives or enemas are used to cleanse the colon, ensuring a clear view for the doctor.

Medication Adjustments: Certain medications may need to be adjusted or stopped prior to the procedure. Always consult your doctor for specific instructions.

What to Expect During the Procedure

A colonoscopy is generally a safe and well-tolerated procedure. Here’s what happens:

Sedation: Patients are usually sedated to ensure comfort during the procedure.

Insertion of the Colonoscope: The colonoscope is gently inserted through the rectum and guided through the colon.

Examination and Polyp Removal: The doctor examines the colon and may remove any polyps or take biopsies if necessary.

Recovery: The procedure typically takes 30-60 minutes, and patients are monitored until the effects of sedation wear off. Most people can resume normal activities the next day.

Why Choose Singapore for a Colonoscopy?

Singapore is a top destination for medical procedures, including colonoscopy, due to several factors:

World-Class Healthcare System: Singapore’s healthcare facilities are equipped with state-of-the-art technology and adhere to the highest standards of care.

Expert Gastroenterologists: The country boasts highly qualified and experienced gastroenterologists who specialize in colonoscopy and colorectal health.

Efficient and Comprehensive Care: From initial consultation to follow-up care, patients receive efficient, comprehensive, and compassionate care.

Cultural Sensitivity and Multilingual Staff: Medical professionals in Singapore are adept at handling patients from diverse backgrounds, ensuring clear communication and comfort.

Success Stories

Numerous patients have benefited from timely colonoscopies in Singapore, leading to early detection and successful treatment of colorectal cancer and other gastrointestinal conditions. These success stories underscore the importance of regular screenings and the quality of care available in Singapore.

Conclusion

A colonoscopy is a vital tool in the early detection and prevention of colorectal cancer. With Singapore’s advanced medical facilities and expert healthcare professionals, undergoing a colonoscopy is a reliable and effective way to safeguard your health. If you’re due for a screening or have any symptoms of colorectal issues, don’t hesitate to schedule a colonoscopy.

For more information or to book an appointment, contact : https://www.ardenjrsurgery.com.sg/colonoscopy-singapore

[smokinvideomaker]

To all who follow my blog and those of you who stumble upon it, I would like to thank you and hopefully I can save some of you by confirming what you already know that smoking comes with risks. I had a recent colonoscopy and colon cancer was found, so I am thinking of giving up the habit that I love. I regret this more than you know but if I do quit smoking, I may have to stop making smoking videos too, another thing I love. If you smoke (and even if you don’t) make sure to get screened for cancer every few years ! Cancer can be a death sentence if it is not caught early and take it from me, it is no fun !

[veritascancercare]

GastroIntestinal Cancer (GI) and A Study On The Exemplary Cancer Therapy In Chennai

Gastrointestinal Cancer or gastric cancer is the cancer that develops along the lining of the GI tract, i.e. starting from the esophagus to the anus. It also includes cancers in the organs such as the stomach, large and small intestine, pancreas, colon, liver, rectum, anus, and biliary system.

It is the fourth most commonly diagnosed form of cancer and second in the leading cause of death. One of the primary reasons for the latter is due to the fact that it is generally asymptomatic and hence it is nearly impossible to detect the tumors as they develop in the early stages.

Only when the tumors are at a relatively advanced stage, the symptoms begin to appear. The most commonly noticeable symptoms are:

Bloody or dark stools

Difficulty swallowing

Jaundice (yellowing of the eyes and skin)

Nausea 

Digestive problems

Swelling in the abdomen

Tiredness

Weakness

Weight loss or loss of appetite

Abdominal cramping or pain

Diarrhea or constipation

Stomach cancer could spread to other parts of the body, and this is called metastatic stomach cancer. The symptoms then varies based on where it has spread to. Lumps are formed when the cancer spreads to the lymph nodes or there is yellowing of the skin and whites of the eyes if the cancer spreads to the liver. 

The major reasons for the development of GI cancers are typically due to unhealthy diet, smoking, obesity, alcoholism, inactive lifestyle. Certain other factors also contribute such as hepatitis A or B, family history of cancer and GI cancer. 

Treatment procedures:

There are multiple therapies for treating GI cancer. Surgery, chemotherapy or chemo+radition are the main treatment therapies, sometimes including all three. As mentioned earlier, early detection is incredibly essential to prevent serious GI cancer complications. The screening tests such as colonoscopy can diagnose colon and rectal cancer in earlier treatable stages much before the symptoms develop. 

While the primary goal is to cure cancer, it is also vital to safeguard the surrounding organs and tissues. Upper GI can be treated with surgery, chemotherapy, radiation therapy or immunotherapy.

Surgery

It is one of the most common treatment methods for upper GI cancer. Removing the cancerous mass ensures prevention of metastasis of cancer. The surgeries can be carried out by robotic or laparoscopic or open surgery. Robotic however is the most advanced option.

Immunotherapy

A method of stimulating the body’s natural immunity to fight the cancer cells. The immunity substances made in the lab are used to boost or restore the body’s natural defence system against the cancer cells.

Chemotherapy Introducing medicine into the blood stream to stop the growth of cancer cells is called chemotherapy. They are either introduced by injecting them into the vein or taken via the mouth. The cells are either killed or are stopped from dividing. This prevents the cells from growing and spreading. The chemotherapy regime is based on the aggressiveness of your cancer.

Targeted Drug Therapy

A cancer treatment in which drugs or other substances are used to target and precisely attack the cancerous cells. The difference between this and chemo is that the chemotherapy can end up affecting the healthy cells as well. Targeted drug therapy only attacks the cancerous cells.

Radiation Therapy

A cancer treatment that uses high radiation to destroy the cancer cells by damaging their DNA. Internal and External are the two types of treatment.

External radiation therapy uses a machine to send radiation towards the area of the body to keep radiation from damaging nearby normal tissue. While internal therapy uses a radioactive substance sealed in seeds, wires, needles and catheters that are placed near or directly into the cancerous cells.

Palliative care The quality of life post recovery from GI cancer can be quite challenging especially after the patients undergo aggressive cancer treatments like chemotherapy, surgery and radiation therapy. However, cancer care teams such as Veritas aim is to provide comfort and care for the treatment of the patients and improve the quality of life as much as possible. While cancer is a daunting disease, they provide you with all the help and hope to recover.

Veritas cancer team at Apollo Cancer Centre located in Chennai is one of the most versatile Cancer Care Centres. Equipped with renowned oncologists and the latest technology, they are the trusted group to join you in your fight against cancer and empower you in winning.

The team at Veritas Cancer Care is headed by Dr. Venkat, a highly-trained surgical oncologist and robotic surgeon with over 22 years of experience has a niche in treating GI cancers.  He has also performed over 20,000 surgeries and managed 25,000 oncological cases. He is one of the very few surgeons armed with the latest treatment procedures such as robotic surgery, ERAS and flourescence-guided surgery. Prompt care and treatment can be guaranteed at Veritas at his safe and experienced hands. This makes Veritas cancer care one of the best places for Gastrointestinal Cancer Treatment In Chennai.

Stay strong and keep your hopes high, the Veritas Cancer Care Team at Apollo Cancer Centre can be reached by calling them on + 91 7373735352. Alternatively, you could browse through our website www.veritascancercare.com, to know more about us and what we do!

[drdodulmondal]

Colon Cancer: Detecting and Preventing the Silent Killer

Colon cancer, which is also called colorectal cancer, is a bad growth that happens in the big tube in our belly or the bottom part. It's one of the most common cancers in the world and a main reason for cancer-related deaths. Even though a lot of people have it, colon cancer usually starts without showing any clear signs at first. That's why it's important to get checked regularly and know about it. In this blog, we'll talk about the things that can increase the chances of getting colon cancer, the signs to look out for, how doctors find it, ways to treat it, and how to stop it from happening.

Risk Factors:

Many things can increase a person's chances of getting colon cancer. One important factor is age, as it mostly affects people who are over 50. Other factors include having a family history of colon cancer, having had inflammatory bowel disease in the past, certain genetic conditions, eating a lot of red and processed meats, being overweight, not being physically active, smoking, and drinking too much alcohol.

Symptoms and Diagnosis:

In the early stages, colon cancer may not present any noticeable symptoms. However, as the disease progresses, common symptoms may include changes in bowel habits, persistent abdominal discomfort, rectal bleeding, unexplained weight loss, fatigue, and anemia. To diagnose colon cancer, healthcare professionals may employ various screening methods, such as colonoscopies, fecal occult blood tests, and imaging studies like CT scans or MRIs.

Dr. Dodul Mondal is one of the best Oncologist in Delhi, India. He specializes in cancer treatment and radiation oncologists. He is working as the Director at Max Super Speciality Hospital, Saket Delhi. Dr. Dodul Mondal is skilled in treating various types of cancer, including lung, kidney, liver, ovarian, breast, stomach, head & neck cancers, and more, Dr. Mondal’s extensive expertise has led to successful outcomes for many facing cancer challenges.

Read More -

[aasthaoncologyassociates]

Best Cancer Prevention Tips That Can Be Helpful

Cancer is a complex disease that can be a result of a variety of factors. Some of them can be due to genetics, environmental exposures, and lifestyle choices. Of course, there is no way you can prevent the caner and its appearance altogether, there are a few tips that can be helpful in arriving at the prevention of cancer to certain extent. Experts at the Cancer Hospital in Ahmedabad Gujaratvouch for the fact that following a few lifestyle habits can help you prevent the disease.

Maintain a Very Healthy Weight

Being obese is one of the most possible cause that can make you susceptible to cancer attack. The service providers and hospitals such as cancer specialist hospital Ahmedabad can be helpful in avoiding the cancers such as breast, colon, and pancreatic cancer. For maintaining a healthy weight, you should take the best food such as fruits, vegetables, whole grains, and lean protein.

Take Part in a Regular Exercise

The best cancer hospitals of Ahmedabad, Gujarat opine that a regular exercise is the best option to help you in fighting and preventing cancer. It is advisable to go for at least 150 minutes of less intensive exercise or 75 minutes of more vigorous exercise per week. Hospital offering the best cancer treatment in Ahmedabadsuggest taking part in a host of exercise activities such as walking, cycling, swimming, or strength training for staying fit and fighting cancer in every way possible. Staying fit will increase your chances of fighting the cancer by several counts.

Avoid Smoking

Smoking is an open invitation to cancer and that is something that you need to avoid at any cost. In fact, smoking has been considered to be the leading cause of the preventable cancer deaths. You can talk to your healthcare professional to help you in how to deal with the smoking habit. Talking to your healthcare professional will help you in quitting smoking. Some options would include nicotine replacement therapy, medication, and support groups.

Limit Your Alcohol Consumption

Drinking alcohol can cause developing certain types of cancer. The alcohol is known to induce several cancer types that would include breast, liver, and esophageal cancer. Limit your alcohol consumption to not more than one drink per day if you are a woman and two drinks per day if you are a man. If possible, it is advisable to quit drinking altogether.

Go For Regular Cancer Screenings

Regular cancer screening can be helpful in letting you detect the cancer early. That would assist you in undertaking the treatment plans well ahead of time. That would be the best means to help fight and defeat the cancer cells. You can talk to your health provider to find the frequency of your cancer screenings which would be based on the age, sex and medical history.

It may be noticed that there are several things that would be helpful in preventing cancer. If you can follow the instructions and guidance offered by the best cancer surgeon in Ahmedabad dealing in the cancer treatment, you can be assured of staying away from the dangerous disease. The Aastha Oncology Associates is your one stop solution for getting access to one of the best care against cancer. If you are looking to find the best cancer treatment by Cancer specialist Doctor in Ahmedabad, you would find the Aastha Oncology Associates to be a great pick to go with.

[kabbur28]

Preventive Cancer

After more than 3 decades of Medical Oncology practice, now I am firmly convinced about the importance of cancer prevention.   We cure a very small percentage of cancer patients and in others it is  at its best a prolongation of useful life.  Even when we achieve cure it is many times at a great financial and organ loss.  In general the popular notion that cancer is the greatest misfortune that can descend on man is true.

The only cost effective way of dealing with cancer is to prevent it.  Wherever the etiology is firmly known, prevention is possible.  Where cause is not known, screening the high risk groups for cancer can detect precancerous conditions or early chances and cure rates can be high.  The best person to advise prevention in my opinion is an oncologist who will be in a priviliged  position to be in touch with family, friends of a cancer patient, who will be amenable to preventive advice.

At least 40% of cancers are tobacco related and are perfectly preventable. About 30 – 40% are related to wrong diet,obesity,lack of exercise and wrong sexual practices.  These require change of life style and this change also is possible to achieve.  Some common cancers are  virus induced and vaccination will be the perfect answer for their prevention.

Cancer arises from a loss of normal growth control.  In normal tissues, the rates of new cell growth and old cell death are kept in balance.  In cancer, this balance is disrupted. This disruption can result from uncontrolled cell growth or loss of a cell’s ability to undergo “apoptosis”. Apoptosis, or “cell suicide,” is the mechanism by which old or damaged cells normally self-destruct.

Cancer can originate almost anywhere in the body. Carcinomas are the most common types of cancer arise from cells that cover the external and internal body surfaces. Sarcomas are the cancers arising from the supporting tissues of the body like bone, cartilage, fat, muscle etc. Lymphomas are cancers that arise from the lymph nodes and tissues in the bodys immune system. Leukemias are cancers of the immature blood cells that grow in the bone marrow and tend to accumulate in the blood stream.

Cancers are capable of spreading through the body by two mechanisms- invasion and metastasis. Invasion refers to the direct migration and penetration by cancer cells into the neighbouring tissues. Metastases refers to the ability of the cancer cells to penetrate into lymphatic and blood vessels, circulate through the blood stream and invade normal tissues elsewhere in the body.

70-75% of the patients are preventable. In the rest 25% many of them can be detected early if screened regularly. Cancers related to tobacco like lung cancers, head and neck cancers, pancreatic cancers, bladder cancer are preventable if the patient does not use tobacco or stops using tobacco. About 30% of the cancers are related to obesity, wrong diet and lack of exercise. These cancers like colon cancer, breast cancer and prostate cancer can be reduced by the right lifestyle intervention.

About 15-20% of cancers are related to infection either a viral infection like HPV, EBV and Hepatitis B and C viruses. Cancer of uterine cervix, liver cancer, some head and neck cancers can be prevented by vaccination against these viruses. Some bacterial infections also can cause cancer as exemplified by stomach cancer and stomach lymphoma caused by H Pylori.  Lack of physical exercise can be responsible for 15% of the cancers directly and several other cancers indirectly.

Published Article By Dr Radheshyam Naik:

A Narrative Review of the Risk factors for Cancer and Preventive Opportunities: Current Status, Future Perspectives and Implications for India

https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0041-1731092.pdf

Characteristics of tobacco consumption among cancer patients at a tertiary cancer hospital in South India-A cross-sectional study

https://pubmed.ncbi.nlm.nih.gov/34720601/

[safeenaposts]

Preventive Cancer

After more than 3 decades of Medical Oncology practice, now I am firmly convinced about the importance of cancer prevention. 

We cure a very small percentage of cancer patients and in others it is at its best a prolongation of useful life. Even when we achieve cure it is many times at a great financial and organ loss. In general the popular notion that cancer is the greatest misfortune that can descend on man is true.

The only cost effective way of dealing with cancer is to prevent it. Wherever the etiology is firmly known, prevention is possible. Where cause is not known, screening the high risk groups for cancer can detect precancerous conditions or early chances and cure rates can be high. The best person to advise prevention in my opinion is an oncologist who will be in a priviliged position to be in touch with family, friends of a cancer patient, who will be amenable to preventive advice.

At least 40% of cancers are tobacco related and are perfectly preventable. About 30–40% are related to wrong diet,obesity,lack of exercise and wrong sexual practices. These require change of life style and this change also is possible to achieve. Some common cancers are virus induced and vaccination will be the perfect answer for their prevention.

Cancer arises from a loss of normal growth control. In normal tissues, the rates of new cell growth and old cell death are kept in balance. In cancer, this balance is disrupted. This disruption can result from uncontrolled cell growth or loss of a cell’s ability to undergo “apoptosis”. Apoptosis, or “cell suicide,” is the mechanism by which old or damaged cells normally self-destruct.

Cancer can originate almost anywhere in the body. Carcinomas are the most common types of cancer arise from cells that cover the external and internal body surfaces. Sarcomas are the cancers arising from the supporting tissues of the body like bone, cartilage, fat, muscle etc. Lymphomas are cancers that arise from the lymph nodes and tissues in the bodys immune system. Leukemias are cancers of the immature blood cells that grow in the bone marrow and tend to accumulate in the blood stream.

Cancers are capable of spreading through the body by two mechanisms- invasion and metastasis. Invasion refers to the direct migration and penetration by cancer cells into the neighbouring tissues. Metastases refers to the ability of the cancer cells to penetrate into lymphatic and blood vessels, circulate through the blood stream and invade normal tissues elsewhere in the body.

70–75% of the patients are preventable. In the rest 25% many of them can be detected early if screened regularly. Cancers related to tobacco like lung cancers, head and neck cancers, pancreatic cancers, bladder cancer are preventable if the patient does not use tobacco or stops using tobacco. About 30% of the cancers are related to obesity, wrong diet and lack of exercise. These cancers like colon cancer, breast cancer and prostate cancer can be reduced by the right lifestyle intervention.

About 15–20% of cancers are related to infection either a viral infection like HPV, EBV and Hepatitis B and C viruses. Cancer of uterine cervix, liver cancer, some head and neck cancers can be prevented by vaccination against these viruses. Some bacterial infections also can cause cancer as exemplified by stomach cancer and stomach lymphoma caused by H Pylori. Lack of physical exercise can be responsible for 15% of the cancers directly and several other cancers indirectly.

[sidshospital]

The Role of Endoscopy in Diagnosing Digestive Issues

Digestive problems can be a real pain — literally and figuratively. If you’ve been experiencing persistent stomach issues, your doctor might recommend an endoscopy. But what exactly is this procedure, and how does it help diagnose digestive problems? Experts from SIDS Hospital, which is one of the best gastro hospitals in Surat, help us in diving into the world of endoscopy and explore its crucial role in gastrointestinal health.

What is Endoscopy?

Endoscopy is a medical procedure that allows doctors to look inside your body using a long, thin tube with a tiny camera attached to its end. This tube, called an endoscope, is inserted either through your mouth or rectum, depending on which part of your digestive system needs examination.

There are several types of endoscopic procedures, including:

1. Upper Endoscopy (EGD): Examines the oesophagus, stomach, and upper part of the small intestine.

2. Colonoscopy: Looks at the large intestine (colon) and rectum.

3. Sigmoidoscopy: Examines the lower part of the colon.

4. Capsule Endoscopy: Involves swallowing a small capsule with a camera that takes pictures as it moves through your digestive tract.

When is Endoscopy Recommended?

Your doctor might suggest an endoscopy from the best hospital in Surat if you’re experiencing symptoms such as:

- Persistent abdominal pain

- Chronic heartburn or acid reflux

- Unexplained weight loss

- Difficulty swallowing

- Gastrointestinal bleeding

- Chronic diarrhoea or constipation

- Unexplained anaemia

Endoscopy is also used for regular screening of certain conditions, like colon cancer in individuals over 50 or those with a family history of the disease.

The Diagnostic Power of Endoscopy

Endoscopy is a powerful tool in a gastroenterologist’s arsenal. Here’s how some of the best gastroenterologists in Surat use endoscopy for diagnosing various digestive issues:

1. Direct Visualization: Unlike other imaging techniques, endoscopy allows doctors to see the inside of your digestive tract in real-time. This direct view can reveal issues like inflammation, ulcers, or abnormal growths that might not show up on other tests.

2. Tissue Sampling: During an endoscopy, doctors can take small tissue samples (biopsies) for further testing. This is crucial for diagnosing conditions like celiac disease, inflammatory bowel disease, or cancer.

3. Detecting Subtle Changes: Endoscopy can pick up on subtle changes in the digestive tract lining that might indicate early-stage diseases or precancerous conditions.

4. Assessing Severity: For known conditions, endoscopy helps doctors assess the severity and extent of the problem, which is vital for planning treatment.

5. Immediate Intervention: In some cases, doctors can treat issues during the endoscopy itself, like removing polyps or stopping bleeding.

Common Digestive Issues Diagnosed Through Endoscopy

Endoscopy plays a crucial role in diagnosing a wide range of digestive problems:

1. Gastroesophageal Reflux Disease (GERD): Endoscopy can reveal damage to the oesophagus caused by chronic acid reflux.

2. Celiac Disease: A biopsy taken during endoscopy can confirm this autoimmune disorder triggered by gluten.

3. Inflammatory Bowel Disease (IBD): Conditions like Crohn’s disease and ulcerative colitis can be diagnosed and monitored through endoscopy.

4. Ulcers: Endoscopy can identify ulcers in the stomach or small intestine and help determine their cause.

5. Gastrointestinal Cancers: Early detection of cancers in the oesophagus, stomach, or colon is possible through endoscopic examination.

6. Barrett’s Oesophagus: This precancerous condition, often related to long-term GERD, can be identified and monitored with regular endoscopies.

Preparing for an Endoscopy

If your doctor recommends an endoscopy, don’t worry — the procedure is generally safe and well-tolerated. Ensure that you choose a hospital that performs the best laparoscopic surgeries in Surat. Here’s what you can expect:

1. Fasting: You’ll need to avoid eating and drinking for several hours before the procedure.

2. Medication Adjustments: Your doctor might ask you to temporarily stop certain medications, especially blood thinners.

3. Bowel Prep: For lower GI endoscopies like colonoscopy, you’ll need to clean out your colon using laxatives or enemas.

4. Sedation: Most endoscopic procedures are performed under sedation to ensure your comfort.

The procedure itself usually takes 15–30 minutes, although you’ll need some time to recover from the sedation afterward.

Limitations and Alternatives

While endoscopy is an excellent diagnostic tool, it’s not always the first or only option. Your doctor might start with less invasive tests like:

- Blood tests

- Stool samples

- Imaging studies (X-rays, CT scans, or MRIs)

Additionally, endoscopy has some limitations. It can’t see through the wall of the digestive tract, so some conditions might require additional testing. In some cases, more advanced techniques like endoscopic ultrasound might be necessary.

Conclusion

Endoscopy has revolutionized the way we diagnose and treat digestive problems. It allows doctors to see inside your body, take samples, and even perform treatments — all through a tiny tube. If you’re experiencing persistent digestive issues, don’t hesitate to talk to your doctor about whether an endoscopy might be right for you and which hospital can perform the best endoscopy in Surat. Remember, early detection and diagnosis are key to effectively managing many gastrointestinal conditions. With endoscopy, we have a powerful ally in the fight for digestive health.

[colonoscopycostsingapore]

Colonoscopy Surgery: A Crucial Screening and Treatment Procedure for Gastrointestinal Health

Colonoscopy surgery is a critical medical procedure that serves both as a powerful screening tool and an effective treatment option for gastrointestinal conditions. From detecting early signs of colorectal cancer to providing therapeutic interventions for various intestinal issues, colonoscopy surgery plays a pivotal role in ensuring optimal digestive health. In this blog, we will delve into the significance of colonoscopy surgery, its benefits, and how it can positively impact your overall well-being. To learn more about colonoscopy surgery and other gastrointestinal services, visit our website https://www.ardenjrsurgery.com.sg/

What is Colonoscopy Surgery?

Colonoscopy surgery is a medical procedure that allows a gastroenterologist to examine the lining of the colon and rectum using a flexible tube equipped with a tiny camera called a colonoscope. The colonoscope is gently inserted into the rectum, and it is navigated through the entire length of the colon, providing real-time images to the doctor.

Importance of Colonoscopy as a Screening Tool

Early Detection of Colorectal Cancer: Colorectal cancer is the third most common cancer worldwide, but when detected early through colonoscopy screening, it has a high chance of being treated successfully. Polyps, which can develop into cancer over time, can also be removed during the procedure, reducing the risk of cancer development.

Identifying Gastrointestinal Conditions: Colonoscopy helps identify a range of gastrointestinal conditions, such as inflammatory bowel disease (IBD), ulcerative colitis, and Crohn's disease. Early detection and treatment of these conditions can help manage symptoms and improve the quality of life.

Screening for High-Risk Individuals: Individuals with a family history of colorectal cancer or certain genetic conditions that predispose them to gastrointestinal issues may require more frequent colonoscopy screenings. Regular screenings in high-risk individuals can aid in early diagnosis and prevention.

Colonoscopy as a Therapeutic Intervention

Polyp Removal: During colonoscopy, if any polyps are found, they can be removed immediately. This minimizes the risk of these polyps developing into cancer and eliminates the need for additional invasive surgeries.

Biopsies: Colonoscopy allows for tissue samples to be collected (biopsies) from suspicious areas for further examination. This aids in diagnosing various gastrointestinal disorders and guiding appropriate treatment plans.

Treating Gastrointestinal Bleeding: Colonoscopy can be used to locate and stop sources of gastrointestinal bleeding, helping patients avoid further complications.

Benefits of Colonoscopy Surgery

Minimally Invasive: Colonoscopy is a minimally invasive procedure, requiring only a small incision for insertion. This results in less pain, reduced recovery time, and a lower risk of complications compared to traditional surgical methods.

Same-Day Procedure: In most cases, colonoscopy is performed on an outpatient basis, allowing patients to return home the same day and resume their normal activities shortly after the procedure.

Highly Accurate: The advanced technology used in colonoscopy ensures high-definition images of the colon and rectum, enabling precise diagnosis and treatment planning.

Preventative Approach: Regular colonoscopy screenings can help detect potential health issues early, allowing for timely intervention and a proactive approach to healthcare.

Visiting Our Website for Comprehensive Gastrointestinal Services

At [Your Clinic/Hospital Name], we understand the importance of gastrointestinal health and strive to provide comprehensive services to address your specific needs. Our team of experienced gastroenterologists is committed to delivering top-notch medical care in a compassionate and patient-centric environment.

On our website, you can find detailed information about our gastrointestinal services, including colonoscopy surgery, endoscopy, treatment for gastrointestinal disorders, and more. We prioritize patient education, and you will find resources to help you understand various procedures, prepare for appointments, and make informed decisions about your health.

Conclusion

Colonoscopy surgery is a powerful tool in the fight against colorectal cancer and other gastrointestinal conditions. Its dual role as a screening procedure and a therapeutic intervention makes it an indispensable part of maintaining optimal digestive health. Prioritize your health and well-being by scheduling a consultation with our expert team and taking proactive steps toward a healthier future. Remember, early detection and timely treatment are the keys to a healthier and happier life.

Here you can find our post: https://stomachcancertreatmentinsingapore.blogspot.com/2023/07/colonoscopy-surgery-crucial-screening.html

[largedenominationsplease]

you’d come over, right?

Summary: A year after Kiara and JJ broke up, they come home to the Outer Banks to deal with one of the hardest years of their lives.

Word Count: 5.2k

Warnings: swearing, canon-compliant smoking, au, minor character death, cancer, current events

A/N: Alternate Universe: JJ and Kiara dated seriously for a long while, but over a year before this story, they parted ways. Set in present-day with current events, but most current events are only mentioned briefly for context. All characters aged 21+. Partially inspired by If the World Was Ending by JP Saxe and Someone You Loved by Lewis Capaldi and current events and Sad Feels™ and a sad playlist my sister made. Come cry with me... also on ao3

Shoutout to @alexandracheers​ for proofreading <3

Sometimes even the most beautiful things die. It’s the sad cycle of life. 

It starts with a spark, a first touch, a first look, a first kiss; 

a few embers of warmth, holding hands, secret glances, flirty texts; 

the roaring flames of passion, clinging to one another, leaving the party early, tangled limbs and tangled sheets; 

then the steady heat of a well-tended fire, cozy mornings making coffee, binging your favorite shows, texting to see how your day is. 

But, sometimes, even the most loved and cared for fires die. They go out with little warning or reason. What was a welcome flame in the hearth one night may be a bed of ash by morning. 

Their fire died a long time ago. It wasn’t anyone’s fault - no one was trying to douse the flames - it just went out. When they sat down and discussed breaking up - parting ways was a more apropos term - she hadn’t even cried. When he packed up and moved out, it was unceremonious. He even kissed her forehead as he left, like he’d done a hundred times before, only this time he wasn’t coming back. 

She still dreamed about him. Sometimes unbidden images of picket fences and a dog and home-cooked meals and potted plants intruded upon her thoughts. Once, when her period was late, she’d even dreamt of a curly-haired little boy with blue eyes - which was ridiculous because she was very single at the time. Did she even want to have kids?

He thought about her, too. Each new destination she traveled to brought new Instagram posts and awakened an ache in his chest he couldn’t quite place. That ache deepened when she revisited places they had gone together - unwanted memories flooding his senses. The smell of coconut still sent him spinning, missing the feeling of running his fingers through her hair, over the smooth skin of her arms and legs. 

What hurt so badly about their fire dying wasn’t that it died. What hurt was that it should never have died; that it died so quietly and suddenly; that one day it was there, burning bright, and the next it was a cold gray heap of coals. 

Even their friends were surprised when he moved back home. “Where is she?” and “What happened?” and “We had no idea you had any problems.”

Followed by the futile response of, “It was just time to move on.”

And they did move on, eventually. She traveled to forget and perhaps after a few months she could call herself truly happy - though there was always an ache of not having someone to share each experience with. He stayed at home, but he opened his own business and the familiarity of home soothed any wounds he sustained. Their fire might have gone out, but they kept the bed of ash in the fireplace, a shrine to what they once had, and it was more comforting than sad after a time. 

When the virus first hit, she’d been back in the states, on the West Coast. She messaged him:

Are you safe? Still have a job? Anyone sick?

Fine for now. You?

Fine.

When the protesting started, he knew she’d be in the thick of it. Not that he didn’t get involved, he just knew her passion for people and justice. He messaged her back this time:

You’re protesting, aren’t you? Are you safe?

Of course! But I’m being careful. You?

Staying safe. Protesting here, too. 

Hurricane Isaias wasn’t meant to be a bad storm, but she had still tracked it up the East Coast. Her suspicions were confirmed when it intensified.

Isaias didn’t wipe y’all out, did it?

No, blew through pretty quick. The Cut took a hit. Gonna take some time to fix it up. 

At first, after reading the headlines about the fires out west, he thought it was a joke. As they spread, he realized how serious it was and it worried him. 

You evacuated, right? The air quality is shit where you are. 

Yep. Gonna take a pandemic-friendly tour of some national parks further east.

Every new development meant more messages sent. Simple little check-ins that meant nothing and everything. It was a scary year the world faced, and even after all those months apart, the only thing they wanted was to find comfort in one another’s safety. On opposite ends of the country, the two of them tied together by current events and the memory of their relationship. 

Mid-September, while she was traveling away from the fires on the West Coast, he got a call from her mother. He hadn’t spoken to her mother much since they had broken up, over a year ago, but she still liked his Instagram posts and struck up conversations when she saw him around town. 

“Hey, Mrs. Anna.”

“Hi, JJ. I’ve told you, it’s just Anna.” Her voice was soft and as kind as ever, but held an edge of tiredness and strain he hadn’t heard from her before. “We have some… tough news, and we wanted you to hear it from us first.”

Colon cancer…

Kiara’s hearing faded into white noise as her mother spoke those words to her through the phone. Her mother went on to explain that even though they caught it late, the doctors were optimistic that her father would make a recovery. Treatments were set to start right away. 

“Mom, I’m coming home.”

“Honey, we know you’ve got traveling plans. We’ll be fine. We don’t want to interrupt your-”

“Mom, I can’t do much traveling with this virus. Dad is more important than any of that, anyway. I’m coming home.”

JJ cried when Anna hung up the phone. Mike was rough around the edges, and he was resistant to Kiara dating a Maybank, but once JJ won him over, he treated him like a son. Hearing this news was a punch to the gut - it was like losing a father. Even in the midst of his sadness he knew Kiara would be sent into a tailspin.

Hey. You okay?

She was typing in response, then nothing. He waited, seeing the little bubble pop up again and again and fade away each time. And then she videocalled. She hadn’t called him in months - not since they parted ways. The little screen showed her in her car, only illuminated by her dim phone screen and the passing street lights. Tears stained her cheeks, but she kept her eyes trained on the road. “I’m not okay.”

“You’re driving right now?”

“I’m coming home.”

“Kiara, pull over. It’s late. Get some sleep.”

“I can’t. They caught it late - he might… who knows how much time I have-”

“Kie.” His voice was soft. He was always soft toward her.

Her face crumpled as the tears fell fresh. He let her cry. He talked to her about nothing and everything as her tears subsided. She cried as she drove through the night, talking to him when she was calm, crying harder when the conversation lulled. She didn’t stop until she noticed he’d fallen asleep, the video call still rolling. It was after four in the morning. The pang of nostalgia that tore through her was enough to make her catch her breath. They hadn’t talked like that since they first started dating. A few tears sneaked out of the corners of her eyes, but she couldn’t tell if the memories or the fear of the future caused them. She found a safe place to park and fell into a fitful sleep in the back of her car. 

She made it home just in time for her dad’s first surgery. JJ met her and her mother at the hospital parking lot, all masks and six-feet of distance until she said, “I could really use a hug.” The three of them colliding into a group hug within seconds. 

JJ made sure the Carreras didn’t need anything as Mike went through chemo and more and more hospital stays. He ran errands for them since none of them could risk going out and bringing anything home. He did yard work since Mike hated an unkept lawn. Kiara always made sure to leave him snacks and drinks on the back deck as the North Carolina heat stretched into October. Aside from that, he willingly put himself at Anna’s beck and call. Anything and everything she needed done, he jumped at the opportunity to help. He would even come over in the evenings to play cards with Mike - masks included. Kiara’s heart ached as she watched her parents get along with him so well. She hadn’t realized how far he had wormed his way into their little family, but here they were, acting as though nothing had changed between him and their daughter, loving him like a son. He praised her mom’s cooking until she blushed and there were times he could make her dad laugh so hard they all forgot for a moment that cancer existed. Those moments were fleeting and oh-so cherished. 

Mike deteriorated quickly. It made Kiara sick to see her father become a cancer-wasted shell of himself. As optimistic as the doctors had been originally, the treatments weren��t taking well. As chemo wrapped up, his numbers were still dangerously high. November brought another emergency surgery that confirmed their worst fears. Mike moved home. They were told all that was left was to manage the pain and make him as comfortable as they could. They had perhaps a month left. JJ moved into the guest room to be as close as possible in case anything was needed from him. The four of them were left waiting as Thanksgiving approached. 

Kiara wasn’t sleeping. Maybe it was knowing her ex-boyfriend was staying down the hall from her, though that was an odd thing to focus on. More likely, it was the fact that her father was passing away right before her eyes, slipping through her fingers as she stood by, helpless. The sun had set hours ago, and she sat with a now-cold cup of tea in front of her at the kitchen table, mulling over each crazy event that had led her to this point. 

JJ wandered into the kitchen, opening the fridge to inspect the contents. “What are you doing up so late?” he asked.

“I could ask you the same thing.” The words came out harsher than she had intended, but then again, she was exhausted in every single sense of the term.

JJ brushed off her roughness. “Hungry. Did you eat dinner?” He knew she hadn’t, so he set about making an extra sandwich.

After a few moments of silence, Kiara whispered, “It’s all my fault.”

“What?”

“It’s my fault,” she repeated, her lip trembling. “I always kept track of his appointments for him. He was always shit at remembering to go to the doctor. He should have had one last year, but I didn’t come home and I didn’t remind him. If I hadn’t broken up with you, I would have been here to remind him to go.” Tears shone in her eyes and on her cheeks.

JJ gave her a quizzical look, deciphering what she was saying. “I seem to recall being the one who left. But really none of this is anyone’s fault,” he kept his voice even, wanting nothing more than to hug her, to wipe away all the tears, and make sure she never had to shed another one again.

“I know, I know, it’s ridiculous, but it’s what keeps running through my head.” She reached up and readjusted the messy bun that her hair was falling out of. “But, for the record, I asked you to leave.” JJ raised an eyebrow as she said this, as though he didn’t believe her. The truth was, neither of them really remembered who had dumped who or why he had left in the first place. Nothing happened that they couldn’t work out with a little bit of effort. “Didn’t I?” she faltered.

He shrugged. “I don’t remember.”

“We just fought a lot, didn’t we?”

“Constantly. You were a bitch.”

She turned to him, mouth open. She slapped at his shoulder, “I know you did not just call me a bitch, bitch!”

He smirked at her. “Maybe you weren’t that bad. Apparently, I was a slob.”

“You are a slob,” she chuckled. Then she sighed and moved to heat up her tea. “But that’s no reason to dump someone. We just… fell out of love, I guess.”

“I didn’t.” His voice was so soft he was barely even sure he had spoken. Based on the way Kiara froze, her back tense, he’d definitely said those private thoughts aloud.

She turned slowly, her face pale with lack of sleep and - something else. Was that anger? Or sadness? “You’ve had more than a year to confess something like that to me, and you choose now?”

JJ shrugged helplessly, unsure of what to say.

“That was the issue all along, wasn’t it?” Kiara’s voice shook, but she kept her tone cool, even. “You wouldn’t communicate with me.”

“Oh, come on, Kie, that’s not fair.” It was too late for a fight. They were both tired and emotional. This wouldn’t end well.

“What’s not fair?” Her voice had started to rise in volume and pitch as her anger increased. She wasn’t even sure why she was angry in the first place, but something about JJ’s confession caused her blood to boil. “The fact that you didn’t admit you still loved me when you left over a year ago? Or the fact that you choose to admit that to me while I’m exhausted and emotionally compromised?”

“Don’t be like that! That’s not what I’m doing.” JJ tried to keep his voice lower than hers, so they wouldn’t wake Mike or Anna, but the way her eyes flashed told him that wouldn’t happen. He grabbed her bicep and led her out to the backyard.

“Let go of me!” She pulled away from him, trying to hide the shiver that ran up her spine in the cool November evening air. “You don’t get to manhandle me and manipulate me into falling back into your arms like nothing happened.”

“That’s not-“ JJ ran his hands through his hair, frustrated. “You know I’m shit at communicating this stuff.”

“At saying ‘I love you?’ At being emotionally present? Listen, I know your dad was fucked up and he fucked you up, but you’re a grown-ass man now. You could have learned how to be there for me!”

“Don’t bring him into this!” They’d had this fight a million times before. The recurring theme of their demise being communication. Their fire had been sputtering under the faulty system they had in place long before they realized what their problems were - it was something neither of them wanted to admit. “Fuck it, Kie, even if I had wanted to get any better at communicating, you were no help. You held every single one of my mistakes over my head. There was no road to redemption for you.”

“No, no that’s not true. I tried to help you-“

“Only telling me what I did wrong wasn’t helpful.”

She opened her mouth and closed it again, stuttering in anger. “Well… if you still loved me so much, why did you leave?”

“Why stay when I knew you didn’t love me anymore?” JJ’s voice dropped and he avoided eye contact with her. 

Her eyes grew wide in realization. “You know what? Fuck you! I loved you until the day you left. If I had known you weren’t coming back I would have fought harder to keep you with me, and if you’re too dense to see-” He cut her words off, cupping her face in his hands and kissing her roughly. She melted into him, a single tear squeezing itself from her eye. He tasted of a coconut flavored vape pod and nicotine and the sea. He was just as stupid and lovely as ever. It only lasted a moment before she shoved at his chest, clearing her throat and turning from him to hide the blush rising to her cheeks. 

“I’m… I’m seeing someone,” she muttered by way of explanation.

“Oh.” JJ licked his lips, missing her more than he had before he kissed her. “Oh, sorry. I didn’t know. Who is it? Why aren’t they here?” He hadn’t meant to add that last part, but he was curious. Who could she be seeing that wouldn’t support her during all of this? Who could she want to be with that wasn’t there, like he was?

“Um, her name’s Fern. I asked her not to come. I didn’t want her to meet my dad this way.” She started to walk toward the door, wrapping her arms around herself in the cold November evening air. 

“Kie,” JJ called after her. She turned slightly, to catch his eye out of the corner of her own. “I’m sorry. I’m sorry about everything… I fucked a lot of things up. And I’m sorry about your dad.”

She nodded. “Me too.” With everything, she added mentally, and he knew she had.

Kiara and JJ wordlessly promised each other that they wouldn't let their differences ruin the upcoming holidays. So Thanksgiving passed uneventfully. It was almost a normal Carrera family holiday, besides the fact that Anna and JJ did most of the cooking. Mike tried once or twice to wander into the kitchen, but he didn’t make it long before having to sit back down. Kiara made him comfortable on the couch and they watched what little football was playing. She was sure to commentate on each play alongside him. The four of them ate extreme amounts of food, and laughed and played games. “Tomorrow we go get our Christmas tree,” Mike announced at the end of the night. Kiara bit her lip and glanced at JJ. He shrugged half-heartedly.

“That’s right, baby,” Anna replied, looking meaningfully at the others. 

And they did. They didn’t travel to the mountains, like other years, but they did go down to the local tree lot. Kiara made a big fuss about finding the fattest tree and over-scrutinized each one until she found the perfect Christmas tree, just like always. JJ had spent holidays with the Carrera’s before, but he had never been so intimately involved in all of their traditions. He thought Christmas might just become his favorite holiday at this rate. 

The weeks leading to Christmas weren’t all smooth sailing. Just a few days after Thanksgiving Mike was confined almost exclusively to a hospital bed in the living room. A nurse moved in a few days after that. He slept fitfully if he slept at all, and most days, the pain (or the pain medication) kept him from interacting with the rest of them. Kie would read to him in the evenings, starting with A Christmas Carol. He fell asleep after only a few paragraphs each time, so it took a long while to get through the story. All four of them watched classic Christmas movie after classic Christmas movie - many of which JJ hadn’t ever seen (to which Anna always replied, “That’s going on our list, then!”). Mike managed to stay awake for the entirety of Elf, his favorite. 

Christmas day was quiet. JJ cooked breakfast for everyone, and Anna gushed about how good his cooking had gotten. They had opted not to exchange gifts this holiday, instead filling their stockings with all their favorite candies and snacks. It had been JJ’s idea, and Kiara thought he might have been a secret genius for suggesting it. In the afternoon, Fern called Kie and they talked for over an hour. JJ thought she looked satisfied when she returned, but nowhere near as happy as one should be when they got off a long conversation with their girlfriend. It was probably just the current circumstances. She didn’t say anything other than, “What’s the next movie, Dad?”

Mike died two days after Christmas. He went in his sleep, which was exactly what he had wanted. No fuss, no doctors trying desperately to save him. Just a good night’s sleep where he peacefully breathed his last. He didn’t look the same as he once had. Cancer had changed him so drastically, his once strong imposing frame a mere shadow of its former glory. But his face was smoothed out, lines of pain, grief, and illness wiped away, leaving simply peace. He could have been asleep, but now he would never wake up. Looking at him, Kiara felt like she was drowning. Like every breath she fought to take just filled her lungs with more and more water. Her dad was her rock, and now she was sinking in a wide, dark ocean. She thought she might never breathe again. 

The funeral was tiny - it was only close family that attended - three days after he passed. The sky was clear and blue and the air was cold, typical North Carolina winter. It had snowed the day before, just a bit, so the ground was frozen and white. It could have been beautiful if it wasn’t so heartbreaking. Anna didn’t cry that day. She said she had cried enough. The snow started falling again that evening, once they got home, and she said that was Mike’s way of telling her he loved her. She loved the snow.  

JJ went back home the day after the New Year. Anna told him to stay as long as he wanted, but he said it was time for him to move on. She understood, hugged him tightly before he went, admonishing him to come around often. He said he would, and promised to help with anything she needed around the house, too. Kiara sat huddled on the front porch in a rocking chair, wrapped in a thick blanket with a cup of hot cocoa as he walked out. “You’re not going to say goodbye?” he teased kindly. 

She looked up at him, her eyes still bloodshot and sorrowful. He wanted to hold her. He wished she had never had to go through any of this. She didn’t deserve it. “I don’t know what to say,” she said. “You’ve done so much for us.”

JJ shook his head. “It was selfish. I thought if I was nearby maybe it wouldn’t happen.”

“It was anything but selfish,” She insisted, standing up and wrapping the blanket tighter around her shoulders. She placed a cold hand on his cheek. “Really, J. We couldn’t have made it through any of this without you.”

JJ might have leaned too deeply into her touch, no matter how cold her hands were. It somehow felt colder when she moved away. He cleared his throat. “So what’re your plans now? Getting back on the road?”

“Not until spring. Mom won’t admit it, but she’s not ready to be alone. She’ll need some help coping. And honestly, I’m not itching to leave.”

“I thought you’d wanna skip out as soon as possible. Doesn’t Fern miss you?”

She squinted her eyes but didn’t say anything in response. “I’ll miss having you around, Maybank.”

“Yeah, don’t worry, I’ll still be around. I think your mom will institute Sunday dinners or some shit if I don’t come over regularly.”

Kie chuckled. “She really loves you. Dad does - did, too.” Her voice broke slightly.

“I love them, too,” JJ said, honestly. He pressed a kiss to her forehead before picking up his bags and leaving. Kiara caught her breath as his lips brushed her skin, warmth spreading from where he made contact. Her wide eyes stayed glued to his figure as he loaded up his truck and drove away. 

If normal could be achieved after a year like the Carrera women had experienced, they worked their hardest to achieve it. Anna threw herself into caring for the Wreck and it had the best off-season it had had in years. Kiara wrote songs and worked alongside her mother and even took some online classes. Anna did indeed institute Sunday dinners with JJ and he came to as many of them as he could. Life was slow to move forward, but Kie and Anna kept each other afloat, reminding themselves that Mike wouldn’t have wanted them to sit still crying over him. Step by step they picked up the pieces of their lives. 

Things went along this way for a couple months or so. The world was calming down, but not fully quiet yet - when was the world ever quiet? Kiara never thought she could enjoy the quiet slow life that was the Outer Banks during the off-season, but after the year she’d had, she wanted nothing more than simple domesticity. She said as much during one of their Sunday dinners, enticing a knowing smile from her mother and a surprising lack of eye contact from JJ. She cornered him on the back deck when he’d stepped out to smoke. She was grateful they had regained some of the ease their friendship had carried when they were younger. “Okay, what was that all about?”

He chewed on his lip, twisting his cigarette between his fingers. He’d given up weed a while back when they were traveling, out of necessity, but she was secretly glad he’d never taken it up again. “I’m leaving,” he said abruptly. 

“Leaving? Going where?” 

“Not sure yet. My cousin’s gonna watch the shop for me. Travel the states for a bit until it’s safer to leave the country. Then Mexico? Maybe.”

“When will you be back?” 

He shrugged, “Don’t know. Not for a long time.”

“Why?” Her mouth had gone dry and her words had run out. JJ was a die-hard salt-lifer. He might pack up and leave occasionally, but the Outer Banks was home, where he belonged. She thought that no matter where he went, he’d always end up back here. Home. How could he leave now?

He turned to look at her, urgency and honesty shining in his eyes. “I know he was your dad, and I probably don’t have the right to feel this way, but I…” 

“You lost him, too,” she said, understanding.

“Need a change of scenery.” He shrugged again, putting out his cigarette before walking back inside. 

Kiara understood better than most the need to keep moving, the change of scenery a welcome distraction. Traveling alone left a lot of time to think and soul-search. She didn’t peg JJ as the soul-searching type, but grief changed people; he needed time. She could support him in that.

“You’re going with him, right?” Anna asked sternly as she and her daughter washed dishes that evening. JJ had just left. 

“What?” Kiara nearly dropped the plate she was drying. 

“JJ told me all about his plans. Getting out of here for a while will be good for him!” She waved a hand over her shoulder, dismissing Kiara’s shocked expression. “He talks to me, too, you know? Always has.”

Kiara chuckled lightly, “So even though he and I broke up, he never broke up with y’all?”

“You shouldn’t have broken up with him.”

Kiara’s heart stopped for a moment, as she processed what her mother had said. “What do you mean?” She started slowly. “I thought you didn’t approve of me dating someone from the Cut.”

Anna sighed, setting down a half-washed pan. She turned to her daughter. “Your dad and I always wanted what was best for you. We thought that meant college, a solid career, marrying up. But we realized recently that that is never what life’s about.” She reached out and took Kiara’s hands, tears starting to shine in her eyes. “Your dad was from the Cut. When we first got married, we had nothing except each other but being with him was the best decision I ever made. He made me happy. I think I made him happy, too.”

“You definitely made him happy, Mom. But JJ and I fought all the time, we couldn’t sort things out.”

Anna scoffed, “Your dad and I fought, too. Fights happen, but you have to realize you’re not fighting each other, you’re a team fighting the problem. Once you figure that out, you can work through anything.”

Kiara shook her head, but she had a soft smile on her lips. “Mom, I just don’t know.”

Anna smiled, tearfully. “That is what life’s about. Nobody knows! What really matters is who is there to walk with you in the unknown. Who is there for you when you need them? Through the good and the bad. Your dad was that person for me.” She paused and looked at Kiara meaningfully, “So I’ll ask again: are you going with him?”

She shouldn’t, but while considering all of this somehow she felt freer. Her father had just died, she should still be mourning him, and yet she knew that he wouldn’t want her to wallow - she had to pick herself up. You knew this was coming, she heard his voice in her head. She hoped she would never forget what that voice sounded like. You knew I was going. Now that I’m gone, you’re free to live your life again. Live it, Kiara.

JJ finished buying his ticket for the ferry. It was cold out, more snow on its way. He had some time to kill before loading up his truck, but not much. He double-checked the straps on his luggage in the bed of the truck and was just beginning to contemplate how to pass the time when he heard his name being called. He turned to see Kiara running toward him, backpack bouncing wildly on her back. She was all flushed cheeks and shining eyes and curls tumbling around her shoulders. 

“I broke up with Fern,” her words came out in a rush as she drew near him before he could even greet her. “I broke up with her months ago.”

“O-okay,” JJ replied, heart pounding. A million thoughts ran through his mind. He had just seen Kiara, why hadn’t she mentioned it then? Or before then? Why had she come all the way here to tell him that?

“And I’m coming with you,” she continued. 

“What?” JJ wasn’t one to be lost for words, but he couldn’t say anything else. 

“You make me happy. When the world went to shit you were the one person I wanted to know was safe. You were there for me and my whole family in the darkest few months of our lives and you really cared about us. I don’t care that we fought or that we will fight because being with you makes me happier than I ever thought possible.”

If she was going to say anything else, her words were swallowed up when he kissed her, hands cupping her cold cheeks. “I love you,” he said when she pulled back to breathe. “I never stopped. I didn’t know how to fight for you, how to stay, but I’ll do better. I can be better.”

She pressed another kiss to his lips. “Shut up, we’ll figure it out. We can do it right this time.” 

Sometimes things die. It’s a sad cycle. The brightest fires turn cold and gray. But with time, new sparks can settle in that bed of ash. With care a new fire can start, burning brighter than before. So, even though things sometimes die, sometimes those dead things lead to an even more beautiful beginning.

[myhealthmag]

8 Ways to Stay Excellent Healthy

Eight healthy behaviors can go a long way toward improving your health and lowering your risk of many cancers as well as heart disease, stroke, diabetes, and osteoporosis. And they’re not as complicated as you might think.

So take control of your health, and encourage your family to do the same. Choose one or two of the behaviors below to start with. Once you’ve got those down, move on to the others.

1. Maintain a Healthy Weight

Keeping your weight in check is often easier said than done, but a few simple tips can help. First off, if you’re overweight, focus initially on not gaining any more weight. This by itself can improve your health. Then, when you’re ready, try to take off some extra pounds for an even greater health boost.

Tips

Integrate physical activity and movement into your life.

Eat a diet rich in fruits, vegetables and whole grains.

Choose smaller portions and eat more slowly.

For Parents and Grandparents

Limit children’s TV and computer time.

Encourage healthy snacking on fruits and vegetables.

Encourage activity during free time.

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2. Exercise Regularly

Few things are as good for you as regular physical activity. While it can be hard to find the time, it’s important to fit in at least 30 minutes of activity every day. More is even better, but any amount is better than none.

Tips

Choose activities you enjoy. Many things count as exercise, including walking, gardening and dancing.

Make exercise a habit by setting aside the same time for it each day. Try going to the gym at lunchtime or taking a walk regularly after dinner.

Stay motivated by exercising with someone.

For Parents and Grandparents

Play active games with your kids regularly and go on family walks and bike rides when the weather allows.

Encourage children to play outside (when it’s safe) and to take part in organized activities, including soccer, gymnastics and dancing.

Walk with your kids to school in the morning. It’s great exercise for everyone.

3. Don’t Smoke

You’ve heard it before: If you smoke, quitting is absolutely the best thing you can do for your health. Yes, it’s hard, but it’s also far from impossible. More than 1,000 Americans stop for good every day.

Tips

Keep trying! It often takes six or seven tries before you quit for good.

Talk to a health-care provider for help.

Join a quit-smoking program. Your workplace or health plan may offer one.

For Parents and Grandparents

Try to quit as soon as possible. If you smoke, your children will be more likely to smoke.

Don’t smoke in the house or car. If kids breathe in your smoke, they may have a higher risk of breathing problems and lung cancer.

When appropriate, talk to your kids about the dangers of smoking and chewing tobacco. A health-care professional or school counselor can help.

4. Eat a Healthy Diet

Despite confusing news reports, the basics of healthy eating are actually quite straightforward. You should focus on fruits, vegetables and whole grains and keep red meat to a minimum. It’s also important to cut back on bad fats (saturated and trans fats) and choose healthy fats (polyunsaturated and monounsaturated fats) more often. Taking a multivitamin with folate every day is a great nutrition insurance policy.

Tips

Make fruits and vegetables a part of every meal. Put fruit on your cereal. Eat vegetables as a snack.

Choose chicken, fish or beans instead of red meat.

Choose whole-grain cereal, brown rice and whole-wheat bread over their more refined counterparts.

Choose dishes made with olive or canola oil, which are high in healthy fats.

Cut back on fast food and store-bought snacks (like cookies), which are high in bad fats.

Buy a 100 percent RDA multivitamin that contains folate.

5. Drink Alcohol Only in Moderation, If at All

Moderate drinking is good for the heart, as many people already know, but it can also increase the risk of cancer. If you don’t drink, don’t feel that you need to start. If you already drink moderately (less than one drink a day for women, less than two drinks a day for men), there’s probably no reason to stop. People who drink more, though, should cut back.

Tips

Choose nonalcoholic beverages at meals and parties.

Avoid occasions centered around alcohol.

Talk to a health-care professional if you feel you have a problem with alcohol.

For Parents and Grandparents

Avoid making alcohol an essential part of family gatherings.

When appropriate, discuss the dangers of drug and alcohol abuse with children. A health-care professional or school counselor can help.

6. Protect Yourself from the Sun

While the warm sun is certainly inviting, too much exposure to it can lead to skin cancer, including serious melanoma. Skin damage starts early in childhood, so it’s especially important to protect children.

Tips

Steer clear of direct sunlight between 10 a.m. and 4 p.m. (peak burning hours). It’s the best way to protect yourself.

Wear hats, long-sleeve shirts and sunscreens with SPF15 or higher.

Don’t use sun lamps or tanning booths. Try self-tanning creams instead.

For Parents and Grandparents

Buy tinted sunscreen so you can see if you’ve missed any spots on a fidgety child.

Set a good example for children by also protecting yourself with clothing, shade and sunscreen.

7. Protect Yourself From Sexually Transmitted Infections

Among other problems, sexually transmitted infections – like human papillomavirus (HPV) – are linked to a number of different cancers. Protecting yourself from these infections can lower your risk.

Tips

Aside from not having sex, the best protection is to be in a committed, monogamous relationship with someone who does not have a sexually transmitted infection.

For all other situations, be sure to always use a condom and follow other safe-sex practices.

Never rely on your partner to have a condom. Always be prepared.

For Parents and Grandparents

When appropriate, discuss with children the importance of abstinence and safe sex. A health-care professional or school counselor can help.

Vaccinate girls and young women as well as boys and young men against HPV. Talk to a health professional for more information.

8. Get Screening Tests

There are a number of important screening tests that can help protect against cancer. Some of these tests find cancer early when they are most treatable, while others can actually help keep cancer from developing in the first place.

For colorectal cancer alone, regular screening could save over 30,000 lives each year. That’s three times the number of people killed by drunk drivers in the United States in all of 2011. Talk to a health care professional about which tests you should have and when.

Cancers that should be tested for regularly:

Colon and rectal cancer

Breast cancer

Cervical cancer

Lung cancer (in current or past heavy smokers)

[irispublisherscancerresearch]

A Simple Screening Test for Cancer-Iris Publishers

Authored by AbulKalam M Shamsuddin*

Abstract

Comparative and correlative studies of the pathology and pathogenesis of colon cancer in animal models and human disease have resulted in conceptualization of ‘field effect” theory, and identification of a simple carbohydrate marker that is expressed early during carcinogenesis. This assimilated body of knowledge has resulted in development of a simple screening test for cancers of the lung, breast, colorectum, uterus, pancreas, and prostate. The marker galactose-N acetyl-galactosamine (Gal-GalNAc) is expressed in the cell surface and secreted glycoproteins of otherwise normal appearing tissues remote from cancer or precancerous lesions and is detected by enzymatic oxidation (10 minutes) followed by color reaction (1 minute). The high sensitivity, specificity, and cost-effectiveness of this point-of-care test makes it a great tool in our strategies for early detection, hence control of cancer. It would also reduce the number of unnecessary and expensive procedures, thereby decreasing the total national health-care cost to the societies and governments, globally.

Keywords: Screening test; Lung cancer; Breast cancer; Prostate cancer; Colon cancer; FOBT

Abbreviations: AOM: azoxymethane; FOBT: fecal occult blood test; Gal-GalNAc: galactose-N acetyl- galactosamine; GOS: galactose oxidase Schiff; MNNG: N-methyl-N’-nitro-N-nitroso-guanidine; NCI: National Cancer Institute; T-Ag or TF-Ag: Thomsen-Friedenreich antigen

Introduction

Regrettably, in 2020 approximately 10 million people were killed by cancer; now-a-days there is hardly a family that is not affected by cancer. Additionally, the healthcare cost, and loss of productivity owing to morbidity and poor quality of life, has been immensely draining to families, societies, and governments alike, everywhere. This scourge has been around for a very long time with no end in sight. As in SARS-Cov-2 now, in 1971 President Richard Nixon had declared ‘War on Cancer’ to combat this menace. Alas, 50 years later, conquering cancer remains an elusive goal despite progress in treatment, albeit modest. Again, akin to SARS-Cov-2, prevention is our best alternative. Cancer prevention includes (a) detection at the very early stage of the disease (secondary prevention) to reduce cancer mortality and increase the survival rate of patients; and (b) etiology prevention or primary prevention to reverse precancerous lesions or in situ carcinomas (a cancer that is still confined) to normal or stop them from progressing to invasive malignancies in populations at high risk – ‘nipping in the bud’. Thus, early detection is fundamental to prevention, and the key is to find the marker which is differentially expressed in highrisk tissues (cancer and precancer) but not in normal. Biomarker(s) meeting this criterion is/are logical choice for establishing accurate methods to detect cancers at infancy; it may also help in monitoring the efficacy of chemoprevention program by serving as intermediate endpoint marker [1].

Fundamental to the success of prevention programs of any disease is the detection of the problems. It includes identification of people with existing disease and those who are at risk of developing the disease. Identification of people with cancer is relatively simple for most cancers because of signs and symptoms from the disease; the individual, now a patient seeks medical attention. Extensive work-up including a battery of diagnostic tests are performed and appropriate therapy is administered; regrettably, it is usually too late for many, if not for most as it does not prevent the disease. Hence the adage: an ounce of prevention is better than a pound of cure. For an effective prevention program, we must actively seek individuals with cancer or high risk thereof from an apparently healthy noncompliant population. This is done by separating i.e., screening individuals into groups with high and low probability of cancer with the help of rapid, simple, accurate, and inexpensive tests (screening tests). Implicit in the definition of screening is a promise that there is a benefit for those who participate; they will be followed with further diagnostic tests and future management of the problem. But a screening test is never intended to give the full diagnosis, hence the distinction from diagnostic tests [2]. An individual who is screening test positive will need to undergo diagnostic procedures to confirm the presence of the disease. Ideal screening tests should have a high sensitivity (proportion of diseased subjects who are test- positive) and specificity (proportion of non-diseased subjects who are testnegative), be simple and non- invasive or minimally invasive, easy to administer – therefore enjoying a high acceptability amongst populations and of course cost-effective. It would not be successful if it is shunned for discomfort, cultural, religious, or other reasons or just too expensive [2]. Currently, except for colon cancer, there are no true good screening tests for other cancers at early stages. Imaging technologies such as mammogram, chest X-ray, low dose CT etc. cannot detect early cancers, for a tumor must attain a minimum size before it can be ‘visible’ by these. And that is too late!

The Galactose Oxidase-Schiff Test

The Galactose Oxidase-Schiff Test is one such screening test that fits all the criteria of an ideal screening test as it is rapid, simple, non-invasive, easy to administer, and inexpensive. Its high accuracy has been consistently and reproducibly demonstrated independently by numerous investigators in three continents. That is not surprising because of extensive scientific research on carcinogenesis and operation of i) field-effect of carcinogens and ii) a marker differentially and specifically expressed during carcinogenesis, shared by both cancer and precancer, but not by normal or regenerating tissue.

Field-effect

I studied early detection of cancer using colon cancer as a model since 1975 at the University of Maryland School of Medicine as my PhD dissertation. The advantages of colon as a model include a) relatively easy access to samples, b) well known precancerous changes (polyps) and conditions e.g., ulcerative colitis, Crohn’s disease etc.; c) well developed animal models with d) well characterized steps of carcinogenesis viz. initiation → promotion → progression; etc. Both in vivo and in vitro carcinogenesis experiments with rats and mice were performed to see how colon cancer forms in them, and to identify the earliest recognizable changes by microscopy and histochemistry [3,4]. Colon tissue from rats and human were cultured in the Petri dishes and exposed to the carcinogens N-methyl-N’-nitro-N-nitroso- guanidine (MNNG) for rat colon [3], and fecapentaene-12 a suspected human carcinogen, for human colon explants [5]. The findings were correlated with in vivo animal models, and ultimately to the human disease [6]: what does the human colon near and far from the cancer look like (Figure 1)?

It has been observed that the earliest recognizable change in the carcinogen-exposed tissue is an alteration in the composition of secreted mucus that persists through precancerous and cancerous tissues. The microscopic and histochemical changes in the human colon away from cancer are identical to those seen in the colons of rats (mouse colon is distinctly different from human or rat colon [7]) treated with the carcinogen azoxymethane in vivo, or MNNG for rat explants and fecapentaene-12 for human explants in vitro in Petri dishes. These changes are therefore the earliest evidence (or markers) of cancer formation – even before a cancer has formed. Using high iron diamine alcian blue technique, the mucus in the colon away from the cancer that looked normal by naked eye appears as blue (Figure 2, lower frame) as opposed to black in truly normal human colon without cancer, in the upper frame (Figure 2). Also note that the colonic glands or crypts in a cancer bearing colon appear distorted – changes identical to the rat carcinogenesis models. It was reasoned that because of the generalized effect of the carcinogen throughout the entire field of the large intestine, it is most likely that the tissue away from an obvious cancer would be abnormal – Field-Effect. The carcinogens in our environment such as the air we breathe, the food we eat etc. expose the entire lung or large bowel. Therefore, it is logical that their effect would be observed throughout the exposed field. While the vast majority of the cells will undergo DNA repair, and other host defense mechanisms such as NK cell will prevent them to progress to cancer, a few cells will be promoted and even fewer progressed to precancer and cancer who may share the same early changes as the rest of the exposed tissue in the field. (Figures 2,3).

Field-Effect phenomenon indicates that the entire field bears the brunt of the carcinogenic assault and expresses variable changes throughout. In the schematic drawing of the large intestine (Figure 3), it is depicted that irrespective of where a cancer or a precancerous polyp may be, areas of the otherwise normal appearing mucosa will show expression of the marker perhaps in a patchy manner (it is not practical to sample the entire large intestine to see if every millimeter has the change; hence this assumption of “patchy”). Rectum being a part of the large intestinal “field” and a convenient sampling site is therefore likely to show the same changes. Since digital rectal examination is a part of routine physical examination (though not practiced diligently by many primary care physicians now-a-days), it is simple and noninvasive. It also allows the physician to examine the prostate in males, and uterus, cervix, and adnexa in females. Samples from lungs such as coughed up sputum, nipple aspirate from breast, endocervical mucus, or prostatic secretion are likewise simple and noninvasive.

The marker: gal-galnac

The observed mucin histochemical change has further been identified as due to a biochemical alteration in the cell surface and secreted glycoprotein – presence of the carbohydrate moiety D- galactose-ß-(1-3)-N-acetyl-D-galactosamine (Gal-GalNAc, also called Thomsen-Friedenreich antigen or T- Ag, or TF antigen, though it may be different). In normal cells, a terminal sialic acid blocks the T-Ag from being recognized by the lectin peanut agglutinin (PNA), or the enzyme galactose oxidase; in cancer and precancer owing to loss of the sialic acid it is now recognizable. D-galactose oxidase specifically oxidizes C-6 hydroxyl groups of D-galactopyranose and N-acetyl galactosamine residues of Gal-GalNAc, generating two vicinal aldehyde groups that react with basic fuchsin to give magenta/purple coloration. Thus, Gal- GalNAc can be visualized by a simple enzymatic reaction with galactose oxidase followed by Schiff’s reagent, resulting in the development of a simple test for early detection, initially of colorectal cancer [8] by using rectal mucus sample.

What is an Ideal Cancer Marker According to the National Cancer Institute (NCI)?

Kelloff et al of the Division of Cancer Control and Prevention (DCCP) at the National Cancer Institute [1] outlined six criteria for intermediate endpoint biomarkers of use in chemoprevention, and here is how Gal-GalNAc and STEDi live up to those expectations:

Is the intermediate biomarker differentially expressed in normal and high-risk tissue? YES!

Figure 4 shows the expression of Gal-GalNAc (magenta) in a colon cancer but, not by the normal human colon (Figure 5). The normal tissues were obtained from healthy normal people without any cancer. Note the absence of magenta color in the mucus of normal colonic goblet cells. Also note that the colonic glands or crypts in truly normal humans appear uniform test tube shaped as compared to the those in cancer-bearing colon or in rats treated with the carcinogen azoxymethane (see Figure 4-6).

At what stage of carcinogenesis does the marker appear?

The earlier a reliable marker appears in the carcinogenic process, the greater is the chance for successful intervention. Answer: Gal-GalNAc is expressed very early during carcinogenesis. Not only the marker is expressed early during the carcinogenesis in rats in vivo (Figure 6 left panel) but also by human precancerous polyp (right panel appearing as purplish). The colors are slightly different owing to different batch of staining and tissue preparation. The mucus alteration is also observed in rat and human explants exposed to carcinogens in vitro [4,5]. Note the distorted appearance of the colonic glands as opposed to uniform test tube shaped ones in normal (Figures 5,6).

Does the marker and its assay provide acceptable sensitivity, specificity, and accuracy?

Answer: Both the marker [9,10] and the assay [11-14, Table I] enjoy 70-100% sensitivity and specificity. That it is not expressed by regenerating cells following wounding is an added evidence that Gal-GalNAc is carcinogenesis specific [10]. Please see the results on colon cancer in the following Table: results on other organ sites are provided after this: (Table 1)

Table 1: Performance Summary of GOS Test for Colorectal Cancer.

The proof of field-Effect: Schematic diagram of the human large intestine depicting the location of the cancers detected by the rectal mucus test. That the “field-effect” phenomenon is operational is proved by the detection of cancers in the various segments of the colon remote from the rectum where the mucus was sampled from. Note that 4 of 5 cancers (80%) of the ascending (or the right) colon, 5 of 7 (71.4%) of the descending (or the left) colon and 29 of 33 (87.9%) of the sigmoid colon were detected in the two studies by Sakamoto et al [11,12] (Figure 7). The widely used current fecal occult blood test (FOBT) for colon cancer screening has been notoriously inaccurate; “Occult blood testing is, at best an imperfect approach to the screening of colorectal cancer” concluded Dr. Ahlquist [15]. And that is not surprising since blood is not a marker of cancer or precancer. A newer test combining FOBT and DNA in stool appears to have better sensitivity and specificity albeit at a very high price.

Gal-GalNAc is a common tumor marker: The usefulness of the tumor marker Gal-GalNAc in differentiating the benign from the malignant and pre-malignant lesions of the prostate was tested [16] yielding similarly high sensitivity and specificity (vide infra). Having determined that the principle is practicable in colon and prostate, studies were conducted on other cancers. The expression of Gal-GalNAc determined in a total of 133 tissue samples from 81 cases of the carcinomas of the breast, ovary, pancreas, stomach, and endometrium and 52 cases of respective normal controls [17]. None of the 52 cases of normal tissues (except 15 cases of stomach) showed expression of Gal-GalNAc. In contrast, 100% of adenocarcinomas from the breast (19 of 19), ovary (15 of 15), and pancreas (6 of 6), and 94.1% of stomach (16 of 17) cancers, and 91.7% (11 of 12) of uterine adenocarcinomas expressed Gal- GalNAc. The normal epithelia and their secretions in the vicinity of the carcinoma (within the “field”) in the breast, bronchus, endometrium, and pancreatic duct also expressed Gal-GalNAc in contrast to normal tissues obtained from non-cancerous individuals, which were totally non-reactive. Thus, the tumor marker Gal- GalNAc recognized by galactose oxidase-Schiff sequence was highly expressed not only by a variety of adenocarcinomas but also by the apparently normal-appearing epithelia and their secretions in the vicinity of carcinomas confirming the operation of a field effect phenomenon by carcinogenic agent(s) in these organs as well, setting the stage for identification of the marker in these secretions for mass screening for these cancers too [17].

Studies on lung cancer: Twelve of 12 pulmonary adenocarcinomas expressed Gal-GalNAc. The bronchial tissue away from the cancer were available in 4 cases, all of whom also expressed the marker both in the epithelial lining cells as well as in the secreted mucus [17]. Coughed-up sputum therefore can be used to screen people for cancers of the lungs. Indeed, three clinical studies on lung cancer were performed on coughed up sputum [18-20]. Lai et al [18] reported the results of their study on sputum specimens from 116 healthy persons; and 216 cases of benign and malignant lung diseases were tested for the marker Gal-GalNAc. The result showed that 165 of the 182 patients (90.7% sensitivity) with lung cancer, confirmed by cytology and histology, had positive results, whereas 22 of 116 (19.0%) healthy controls were positive (81.0% specificity, Table 2). In 28 cases of patients whose sputum cytology showed various degrees of dysplasia-a precancerous condition that progresses to cancer, 21 were found Gal-GalNAc positive, of which 15 patients were identified to have lung cancer on further work-up! Thus, the concept of “false positive” as generally used does not apply to Gal-GalNAc and the GOS Test since they take the precancerous lesions and early cancers into consideration. In addition, three cases of early lung cancer in this study were also positive, supporting the fact that Gal-GalNAc is expressed at an earlier stage in the malignant process of the lung as well. The studies by Cox & Miller [19] and Miller et al [20] had smaller sample size and showed sensitivities of 64.7 – 88% and specificities of 77.8 – 93.6%. The test revealed 20 of 23 lung cancers among 76 patients. The other 53 patients were either healthy or had benign lung disease such as bronchitis. Even more germane to the issue of prevention is the fact that 13 of 15 cancers detected were early stage (Stage I and II). Of note is that a tumor must attain a minimum size before it can be detected by imaging techniques. And that is late! (Figures 8,9) (Table 2).

Table 2: Lung Cancer study.

Breast cancer study: Gal-GalNAc is also expressed by the normal-looking breast tissue away from an obvious cancer by way of the field-effect phenomenon [17]. The marker was positive in 19 of 19 histological specimens of breast cancer giving it a 100% sensitivity. More importantly, and germane to our screening, the ducts away from the cancers and close to the nipple also express the marker both in the cells as well as in the secretions in the ducts. Thus, the nipple aspirate from a breast harboring a cancer should express the marker. Kumar et al [21] demonstrated that Gal-GalNAc (or TF antigen) is differentially expressed in nipple aspirate, albeit using a different technique – monoclonal anti- TF antibody. Nineteen of 25 cancer patients and none of the 25 healthy controls were positive yielding a 100% specificity and 76% sensitivity. The relatively low sensitivity of the test in nipple aspirate as opposed to tissue expression may be due to the use of different techniques for identifying the marker – galactose oxidase Schiff’s v monoclonal anti-TF antibody. Chagpar et al [22] also reported the utility of using nipple aspirate and Gal-GalNAc in screening for breast cancer. They investigated 23 women with biopsy confirmed, unilateral stage I or II breast cancer. They took samples (nipple aspirate by way of a suction cup attached to a syringe) from both breasts prior to surgery. Most, but not all the women were able to provide large enough fluid samples that could then be evaluated. Based on the resulting color of the test strips one could differentiate between a healthy and cancerous breast (Figures 10,11).

Prostate cancer study: The current screening test-PSA is inaccurate primarily because it is non-specific; its level goes up in benign conditions as well. The marker Gal-GalNAc is differentially and specifically expressed in prostate has also been observed in histological sections taken from 65 cases of adenocarcinoma [16]. While none of the 35 benign prostates and 11 foci of adenosis expressed Gal-GalNAc (100% specificity), 62 (95.4% sensitivity) of 65 adenocarcinomas expressed the marker. That the expression of the marker is not non-specific (meeting the NCI’s criteria #3) has been demonstrated by the absence in 25 samples of benign prostatic hyperplasia (BPH) and 11 of adenosis, neither of which are precancerous, nor were the normal prostates (10 samples) giving the marker a specificity of 100%. Notably, foci of prostatic intraepithelial neoplasia when present in some of the cancer specimens were also positive (Figure 12), demonstrating the useful of this marker in identifying early cancers [16]. As for colon, lungs, and breast, testing prostatic massage secretion or seminal fluid with GOS test should yield similar results (Figure 12).

Uterine cancer: Currently there are no screening tests for uterine cancers except for maybe the Pap smear wherein a uterine cancer could be detected by chance; but it is usually advanced when the cancer cells shed from endometrium are detected in Pap smear. Expression of Gal-GalNAc with high sensitivity (91.7%) was observed in 12 cases of uterine endometrial adenocarcinoma [17]. In all three cases where endocervical tissues was available, the endocervical mucus was positive for Gal- GalNAc. The photomicrograph (Figure 13) shows histological section of endocervix of a patient with endometrial adenocarcinoma; magenta coloration of the mucus in the endocervical glands and in endocervix is evident. Again, this supports the Field-Effect of carcinogenesis. More importantly, this makes it a simple, convenient, and non-invasive method of screening for endometrial adenocarcinoma while a gynecologist routinely collects samples for Pap smear (Figure13).

Pancreatic cancer: Pancreatic cancer is one of the deadliest of all cancers, primarily because of its silent inception; and owing to its location, signs and symptoms do not show till very late. All 6 of 6 cases of adenocarcinoma of pancreas were positive for Gal- GalNAc, and the normal ducts away from the cancers also showed positive reaction [17]. Thus, GOS test could be performed on fluid samples including pancreatic juice obtained during ERCP (endoscopic retrograde cholangiopancreatography) thereby providing additional value to the screening of the cancer. Figure 14 shows an adenocarcinoma of the pancreas with magenta color in the cancerous ducts and glands. (Figure14).

How easily can the marker be measured?

Answer: GOS test for detection of the marker is non-invasive done on mucus sample obtained during routine digital rectal examination, coughed-up sputum, nipple aspirate, prostatic massage secretion, endocervical mucus etc., and the entire assay period is ~15 min. This is the only point-of-care test for breast, lung, colon, prostate, and uterus; the results are available before the individual is ready to leave the doctor’s office. The test sample is placed on a special paper and reacted with galactose oxidase for 10 minutes, rinsed with distilled water, reacted with Schiff’s basic fuchsin for 1 minute, washed with tap water and dried. A pinkmagenta- purple color is positive, no color is negative (Figure 15). Positive indicates the presence of the marker Gal-GalNAc which is correlated with the presence of precancer, precancer or a high-risk thereof (Figure15).

Note: Though desirable, quantitative evaluation of the color reaction is neither practical nor meaningful as studies have shown no correlation between the intensity of color and the underlying disease.

Can the marker be modulated by chemo preventive agents?

Answer: YES! Sakamoto et al. [23] and Yang & Shamsuddin [24] have demonstrated that; indeed Gal-GalNAc expression can be suppressed by the chemo preventive agent IP6 [25,26]. Figure 16 shows that HT-29 human colon cancer cells express the marker Gal- GalNAc (magenta color in mucus of cells in left panel). Following IP6 treatment, HT-29 cells terminally differentiate and produce mucin, yet not Gal-GalNAc, akin to normal goblet cells (right panel showing a differentiated HT-29 cell that has a mucus vacuole yet not expressing the marker [23,24]. Clinical studies are needed to validate this, but that would take a very long time. In this regard of particular importance is the study on colon cancer by Vucenik et al [13] where 32 of 53 (60%) samples collected from patients after tumor resection showed persistence of the biochemical change; 5 out of these 32 (16%) post-operative cases with positive GOS Test had tumor recurrence within a year. Thus, persistently positive test may serve as a predictor of tumor recurrence (Figure16).

Does modulation of the intermediate biomarker correlate with a decrease in cancer rate?

This would require a long time-years if not decades, and additional resources.

In conclusion, GOS test is a point-of-care screening test that is very simple, rapid, non-invasive, and inexpensive yet accurate for identifying asymptomatic people who may be at high risk of cancer or precancer of the lung, breast, colon, pancreas, prostate, and uterus. It is based on robust scientific background; researched and validated over three decades in >20 independent clinical studies in North America, Europe, and Asia. It exploits a disaccharide marker expressed early during carcinogenesis that persists in precancer and cancer and, satisfies all the practical rigid criteria set forth by NCI for an ideal marker. Given the fact that cancers of the lungs, breast, colon, prostate, and uterus comprise the most cancers, it is in the interest of public health that they are identified at a very early stage, or even before they are formed. The sooner it is used, the more lives could be saved from these cancers.

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