The Big C: Cancer–The Disease in a Nutshell

Cancer is arguably the most feared disease in the Western world.  In America, cancer is the leading cause of death of people between 35-65 years of age.  Nearly 1 in 7 deaths worldwide in 2007 was due to cancer.  Cancer rates are exploding throughout the world as developing nations industrialize and eat diets that are less nutritious (think of pollution and McDonald’s).  Because of physiological and social reasons, gynecological cancers are some of the most lethal types of cancer in women.  To better understand gynecological cancers, let’s take a step back and get to grips with the basics of cancer.

Cancer is a disease affecting humans, and other animals, that is a result of abnormal cells growing out of control.  Cancer can happen in virtually any part of the body and there are more than 100 distinct types.  The cells in our bodies are continually regenerating.  There is a saying that our bodies completely regenerate every seven years.  (In fact, each type of cell–each part of the body– regenerates at a different pace.)  When our bodies dictate the script (DNA being the script) that causes cell reproduction, occasionally there is a typo.  Many different things (such as smoking) can cause a “typo.”  When this happens, the body has difficulty righting the mistake and it can grow out of control resulting in cancer as seen in this illustration:

The top half of the illustration is a process called apoptosis, by which a damaged cell is removed through programmed cell death.  (I jokingly think of apoptosis as telling a “bad cell” to “pop off.”)  A lack of apoptosis is when the damaged cells are not programmed out.  This is where cancer begins.

If this growth of abnormal cells is caught in an early stage, it usually can be treated easily by removing the growth.*  Stages are a means by which the cancerous growths can be classified by how far along it has progressed.  There are four main stages, and with specific types of cancers there are further subdivisions such as “Stage II-C.”  Usually by the time a cancerous growth has reached the fourth, most advanced stage it has undergone a process called metastasis.

Metastasis is when the cancer spreads from its primary site to other sites.  So, if you hear an official cancer diagnosis, it may sound something like, “metastatic breast cancer” or “metastatic cancer primary to the liver.”  This indicates where the cancer began and that it is present in other locations.  Metastasis usually occurs through the body’s lymphatic system.  That’s why one often hears about lymph nodes in relation to cancer.

There are innumerable ways in which cancer is diagnosed.  Once it is found and diagnosed, there is a great divergence between how cancer behaves and how it is best treated depending on the type of cancer, medical history, and other factors.  If you ever find yourself receiving a cancer diagnosis, you will need to create a very specific plan with your physicians–no two diagnoses are ever exactly identical.  Hopefully this brief overview of the Big C helps build your understanding of the disease if you ever find yourself in close contact with cancer.

*(In my case, I had a very slow-growing cancer.  So, even though it was not caught at all “early,” it was still in an early stage.)

Hormonal Differences

If you are anything like me and read the medical headlines every day you have probably noticed in the past few weeks a spate of articles about how hormones can affect a person’s social behavior.  The first such article was a timely piece, considering the state of the economy, that argues that the length of a person’s ring finger in relation to his or her index finger is indicative of his or her responsiveness to testosterone in the womb, and thus this measure correlates with how well the person is suited to financial trading. (Oddly, the Washington Post categorizes this article under “Women’s Health.”)

Specifically, these researchers say, the longer one’s ring finger in relation to the index finger the more likely it is that this person will be successful at financial trading.  Scientists are hailing this as “completely new and novel in terms of showing how sex hormones impact the brain.”  (Though there have been other studies that argue that sex hormones in the womb influence sexual orientation and anorexia.)  The trials performed in this study only examined men.  While it is possible that this effect also influences such behavior in women, it is unlikely to affect women as often as men since women naturally have less testosterone than men.

However, another article came out on the heels of this study arguing that higher amounts of estrogen (as an effect from the womb) cause women to not only feel more attractive and be perceived as more attractive but also to cheat on their partners more often.  The study showed that women with high levels of estradiol, a type of estrogen, were more likely to “dress more provocatively and show more thrill-seeking behavior.”  Interestingly, the likelihood of cheating on a partner was shown to take the form of monogamous affairs rather than one-night stands.  These women with higher estradiol are generally more fertile and therefore are hypothesized to biologically be programmed to continually look for other, better mates.  One of the researchers said, “Our results are consistent with the possibility that highly fertile women are not easily satisfied by their long-term partners and are especially motivated to become acquainted with other, presumably more desirable, men.”

Prenatal hormones and their effects have been known for years to play a great role in sexual differentiation.  Levels of testosterone and other factors in the womb can contribute to an XY-karyotype (or genetic boy) being born as a phenotypical female (with the appearance of female genitalia).  Research is constantly discovering more along these lines, such as the perceived psychological differences between males and females (i. e., men are from Mars, women are from Venus), including cognitive performance.  In light of these discoveries, many people cling to the notion that many of these naturally occurring situations are, rather, a result of nurture (e. g., a woman who cheats on her partner does so because of the way she was reared).

So, what do you think about all of this?  I would love to hear any or all questions or comments.  Thanks!

Crabs: What Are They?

In school growing up there were numerous crab jokes made by my classmates.  If we wanted to give the ultimate insult we would say, “S/he’s got crabs.”  Of course, we didn’t really know what crabs were.  We knew vaguely they were something one acquired in the genital region generally from a sexual encounter and are considered embarrassing.  So, let’s delve into the question:  what are crabs?

The scientific name for what is generally referred to as a “crab” is phthirus pubis (pronounced how it looks, I’m sure).  It is also referred to as pubic louse or crab louse, named so for its slight resemblance to crabs.  (Remember, too, that the word “cancer” comes from the Latin word for crab, via the Greek carcinoma also meaning crab.  What’s up with that?)  These lice are actually insect parasites that feed entirely on blood and live on human hairs.  Pubic lice are a different species than body lice and head lice.  They are whitish-gray in color, though are temporarily reddish after feeding.  They are usually 1-2 millimeters in size, with females being larger than males for the purpose of producing eggs.

Pubic lice, in spite of their name, can infest more than just the pubic region.  Though they are most often found in the pubic region they can also be found in hair on the abdomen, under the arms, in beards and mustaches, as well as eyelashes and eyebrows.  Crabs, if you will, are most often transmitted between hosts through close physical contact, i. e. sex.  However, they can be transferred between family members or roommates who share towels, beddings, or clothes.  Rarely, pubic lice can be acquired from public toilet seats, though this is very unlikely.  Crabs are more commonly found among adults, though they can be found among children.

Symptoms of a pubic lice infection include itching in the pubic region, visible nits or lice, lesions due to bites, and sometimes secondary infection of the bite-induced lesions.  Pubic lice can be diagnosed by a healthcare professional by visual examination and may further review a found louse under a microscope to confirm its species (pubic, body, or head louse).  Treatment consists of a treatment shampoo or wash that contains chemicals such as pyrethrins and piperonyl butoxide followed by combing to remove remaining nits.  These treatments are available over-the-counter.  For extreme infestations that persist following treatment, a prescription of lidane shampoo may be necessary.

Pubic lice are usually easily cured, though they will not go away on their own.  If pubic lice are found it is prudent to be tested for other sexually transmitted diseases, as most transmissions of crabs are through unprotected, non-monogamous sex.  Shaved or waxed pubic areas may help prevent infestations of crabs but will not stop all crabs.  Shaving already infested pubic hair will not stop the infestation.

So, did you learn anything new?  Maybe, maybe not.  Either way, I hope you can avoid acquiring pubic lice.  Questions or comments?  Spill the beans.

Lactation: Mother’s Milk

So, since we talked about conventional cow milk a couple of days ago as well as soy and organic milks, I thought we should spare a thought for human-produced milk.  I have no firsthand experience with human lactation, so please feel free to jump in with your two cents!  Many new mothers will tell you, though, that they did not realize how difficult breastfeeding would be.  Babies, unfortunately, don’t just attach themselves naturally to a woman’s breast and easily begin to suckle.  It is a skill that must be cultivated.  (No wonder wet nurses came to be.)

During a woman’s pregnancy a woman’s breasts become enlarged, to varying degrees, due to a chemical released by the placenta called human placental lactogen (HPL).  The first stages of lactation begin during the latter part of a woman’s pregnancy.  During this period a woman’s breast begin to produce “first milk” called colostrum that can be yellow in color.  Progesterone during this time is too high to allow true milk production.

When the placenta is delivered following birth, the woman’s body experiences a sudden drop in progesterone, HPL, and estrogen.  This shift causes the breast tissue to begin to produce real milk.  Milk will usually be produced within a day or two of birth, though it is not uncommon for it to take longer.  Colostrum production will slowly cease over a two week period as mature breast milk as steadily produced.  Colostrum is an important part of breastfeeding, though, because it contains larger amounts of antibodies and white blood cells helping to protect the child from germs and food allergies.

After the breasts become more accustomed to producing milk they begin to function on what I call a “made-to-order” system.  A woman’s breasts produce milk as the milk is removed from the breasts (through direct latching, breast pumps, or otherwise.)  Breasts will continue making milk so long as it is being removed.  The only other reasons that would inhibit continued milk production are maternal endocrine disorders, maternal malnutrition, breast hypoplasia, and in some cases lack of sexual activity, as sexual activity increases milk production.

When actually breastfeeding, the mother may experience milk ejection reflex though it is not unusual to not have this experience.  Essentially, the muscles in the breast push out the milk which may result in pain or a tingling sensation.  Another cause of pain due to lactation is contraction of the uterus.  The same hormone that causes the muscles in the breast to contract and express milk also cause the uterus to contract helping it return to its original size.  These contractions may range from mild and menstrual-like to severe and labor-like.  I shudder to think what they would feel like following a c-section.

That, in a nutshell, is the basic biology of lactation, though it does not begin to touch on the enormous issue of breastfeeding (perhaps in later entries).  But here are a few interesting facts about lactation you might not have known:

*Men can lactate, it’s true!  They have mammary glands just like women, and it can result due to a hormone imbalance.

*A woman can lactate without ever having given birth.  It is a phenomenon known as galactorrhea and happens either due to a specific hormone imbalance, continued stimulation to the nipples, and in rare cases is caused by prescription drugs.

*New born babies often lactate, colloquially called “witch’s milk,” as a result of the mother’s hormones just before birth.  It generally only lasts a few hours.

Questions?  Comments?  Don’t be shy.

Oncofertility: A Budding Field

So, another topic brought up by my time at the bioethics conference in Cleveland:  oncofertility.  I had often thought about this very idea, but didn’t realize there was a field, the name coined of 2006, addressing just this.  Basically, it is what its name indicates–fertility options for persons with cancer.  De facto, it addresses women’s fertility specifically though in the future it may include men’s fertility as well.  Scientifically there is no reason it couldn’t address men’s fertility.  Anyway, women with cancer who undergo chemotherapy or radiation treatments for cancer often become infertile as these treatments usually impede ovarian function.  Not to mention, of course, that cancers of the reproductive organs can directly cause infertility.

Scientists at Northwestern University created an consortium in around 2005 to help study the efficacy of harvesting ovarian tissue before cancer treatment for cryopreservation and later retrieval and use by their owners.  This brings up many ethical issues.  The first one that comes to my mind is how ethical is it for surgeons to perform what I term “uninformed unilateral or bilateral oophorectomies” now that the technology exists to attempt cryopreservation through oncofertility.  Many women, anecdotal evidence suggests, go in for a particular pelvic or abdominal surgery such as an appendectomy and awake to find that the surgeons removed one or both ovaries (oophorectomy).  This may be morally justified if there is immediate peril for the patient by a condition or disease and the only possible solution is to immediately remove the ovary or ovaries.  All to often, though, this is not the only option and many women lose ovaries for very poor reasons.  One in particular seen more often in the past was the removal of a woman’s ovaries after she had finished bearing children (whether she had entered menopause or not) to prophylactically prevent ovarian cancer.  Studies now show that a woman can actually develop ovarian cancer when she has no ovaries, due to the residual tissue that surrounded it when intact.  In any event, is it ethical for women in these positions to not at least have been offered the option of later fertility especially if they have not had any children, are intent on having some in the future, and could produce enough healthy ovarian tissue for cryopreservation?

Another ethical issue that springs forth is that of pediatric oncofertility.  At the conference I attended one researcher directly addressed this issue, though I greatly disagree with most of her conclusions.  She argued that allowing parents, or even the child in question, to choose cryopreservation is unethical.  Clearly it is unethical for the doctors to directly decide as that would be rather blatant paternalism.  Various people in the session questioned her stating that they did not believe parents choosing cryopreservation for their child was dictating a child-bearing future to them, as the researcher had argued.  The particular researcher strung together a rather loose argument, in my opinion, indicating that women in the United States are increasingly defined by their ability to birth children.  Thus, cryopreservation (at the current time, she stated) unduly reinforces on the child that they are obligated to use the preserved tissue.  I agreed with the audience members who contradicted her in saying that cryopreservation merely allowed the child to have the choice, that nothing in cryopreservation inherently pressed the child into unwillingly having babies.  I would like to further add that I feel there is nothing wrong with women being defined by the ability to bear children, even though some women have no ability to and some women consciously choose not to have children.  I believe that the ability to bear children can be expressed both in the positive and negative:  having babies and not having babies.  Neither is better or worse than the other.  It is simply a fact:  a fact that indicates we are female.  If we had nothing that indicated we were female (as virtually everything “female” about the female body is designed in order to bear children) then what would be the point of delineating sexes in humans?  Men and women would be identical.  We delineate, to some degree, because we must in order to reproduce and survive as a race.  Delineation based on sexual reproduction is essential to our existence.  (This is not to say, of course, that it is not perfectly acceptable for some to appear and live as the opposite gender than they were born or to be gay or lesbian.  I am merely saying that if everyone did that then humans would quickly dwindle away.)  I digress.

A further ethical issue in the field of oncofertility is what rights the owner of the harvested ovarian tissue has over the tissue.  In order to successfully enter into the oncofertility research (as there are no commercial means currently available for this method), a “donor” must be able to produce six strips of ovarian tissue measuring 2 by 10 millimeters.  This amount of tissue must be recovered in order to continue.  80% of the tissue is retained for the “donor” to use at will, though she must pay for storage until such time she decides to use it or dispose of it.  The other 20% is used by researchers to develop new techniques of retaining and restoring fertility.  So, what if the “donor” decides after the harvesting that she does not want the 20% used for research?  What is the ethical response?  Legally, the researchers outright own the tissue so they have no obligation (other than perhaps a moral one) to follow these wishes.  Also, what if research with the 20% reveals a viability problem that would apply to the 80%, such as a genetic defect?  What obligation do the researchers have to inform the “donor” of such a defect?  Currently, there is no legal standard indicating they must inform the “donor.”

There are many more ethical issues to be addressed within the field of oncofertility, but these are meant to present a starting point to understanding the complexity of the research being done.  Ethical obstacles notwithstanding, I am enthusiastic about this new field and am encouraged that the field is now developing.  It reminds me of another session I attended at the conference in which a scholar postulated that the narratives of cancer survivors are considered finished once the cancer has been eradicated.  The development of oncofertility shows that a cancer survivor’s narrative is nowhere near complete when the cancer goes away.  There is more life to live than just surviving cancer.  Questions?  Comments?  Let’s talk about it!