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Cervical Health

The neck is part of a long flexible column, known as the spinal column or backbone, which extends through most of the body. The cervical spine (neck region) consists of seven bones (C1-C7 vertebrae), which are separated from one another by intervertebral discs. These discs allow the spine to move freely and act as shock absorbers during activity. ​

What does the cervical spine do?

Your cervical spine has several functions, including:

  • Protecting your spinal cord. The nerves of your spinal cord pass through a large hole (called the vertebral foramen) that passes through the center of all of your vertebrae — from the base of your skull through the cervical vertebrae, the thoracic (middle back) vertebrae and ending between the first and second lumbar (lower back) vertebrae. Taken together, all the stacked vertebrae of your spine form a protective central canal that protects your spinal cord.
  • Supporting your head and allowing movement. Your cervical spine supports the weight of your head (average weight of 10 to 13 pounds). It also allows your head and neck to tilt forward (flexion), backward (extension), turn from side to side (rotation), or bend to one side (ear-to-shoulder; lateral flexion).
  • Providing a safe passageway for vertebral arteries. Small holes in cervical spine vertebrae C1 to C6 provide a protective pathway for vertebral arteries to carry blood to your brain. This is the only section of vertebrae in the entire spine that contains holes in the bone to allow arteries to pass through.

Cervical spondylosis

Cervical spondylosis (Arthritis of the Neck) is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs).

Cervical spondylosis is very common and worsens with age. More than 85% of people older than age 60 are affected by cervical spondylosis.

Symptoms

Most people experience no symptoms. When symptoms do occur, they typically include pain and stiffness in the neck.

Sometimes, cervical spondylosis results in a narrowing of the spinal canal within the bones of the spine (the vertebrae). The spinal canal is the space inside the vertebrae that the spinal cord and the nerve roots pass through to reach the rest of the body. If the spinal cord or nerve roots become pinched, you might experience: :​

  • Pain in the neck that may travel to your arms or shoulders
  • Headaches
  • A grinding feeling when you move your neck
  • Weakness in your arms and legs
  • Numbness in your shoulders, arms, or hands
  • Stiff neck
  • Trouble keeping your balance, especially when walking
  • Trouble controlling your bladder or bowels

Causes of cervical spondylosis

As you get older, your spine changes due to decades of normal wear and tear. Starting in middle age, the disks between your vertebrae start to change. These changes can include: (4)

  • Degeneration: The spinal disks in your neck may slowly wear down (degenerate). With time, the disks become thinner, and the soft tissue has less elasticity. If you or your parents measure in a little shorter in height than you did years ago, this is normal collapsing or settling of your disks.
  • Herniation: Normal aging can cause part of your spinal disk to tear or crack. This is called a herniated disk. The herniation can allow the disk to bulge out, pressing on nearby tissue or a spinal nerve. This pressure can cause pain, tingling, or numbness.
  • OsteoarthritisOsteoarthritis is a progressive (ongoing) condition that causes the cartilage in your joints to degenerate (wear down with time). With osteoarthritis, cartilage degenerates faster than normal aging.
  • Bone spurs: When cartilage in the joints of the vertebrae in your spine starts to degenerate and bone tissue rubs directly against other bone tissue, abnormal bone growths develop along the edges of vertebrae. These growths (called osteophytes or bone spurs) are common as you age. Often, they cause no symptoms.

Diagnosis

Your healthcare provider will likely start with a physical exam that includes:

  • Checking the range of motion in your neck
  • Testing your reflexes and muscle strength to find out if there's pressure on your spinal nerves or spinal cord
  • Watching you walk to see if spinal compression is affecting your gait

Imaging tests

Imaging tests can provide detailed information to guide diagnosis and treatment. Examples include:

  • Neck X-ray. An X-ray can show changes in the spine, such as bone spurs, that indicate cervical spondylosis. Neck X-rays can also rule out rare and more serious causes of neck pain and stiffness, such as tumors, cancer, infections, or fractures.
  • MRI. Using radio waves and a strong magnetic field, MRI can produce detailed images that can help pinpoint areas where nerves might be pinched.
  • CT myelography. In this type of CT scan, a dye is injected into the spinal canal to provide more-detailed imaging. This test makes it easier to see the details of the spinal cord, spinal canal, and nerve roots.

Nerve function tests

You may need tests to determine if nerve signals are traveling properly to your muscles. Nerve function tests include:

  • Electromyography. This test measures the electrical activity in your nerves as they transmit messages to your muscles when the muscles are contracting and at rest.
  • Nerve conduction study. Electrodes are attached to the skin above the nerve to be studied. A small shock is passed through the nerve to measure the strength and speed of nerve signals

Treating cervical spondylosis

Treatments for cervical spondylosis focus on providing pain relief, lowering the risk of permanent damage, and helping you lead a normal life.

Nonsurgical methods are usually very effective.

Physical therapy

Your doctor might send you to a physical therapist for treatment. Physical therapy helps you stretch your neck and shoulder muscles. This makes them stronger and ultimately helps to relieve pain. (7)

You might also have neck traction. This involves using weights to increase the space between the cervical joints and relieve the pressure on the cervical discs and nerve roots.

Medications

Your doctor might prescribe certain medications if over-the-counter (OTC) drugs don’t work. These include: 

 

Surgery

If your condition is severe and doesn’t respond to other forms of treatment, you might need surgery. This can involve removing bone spurs, parts of your neck bones or herniated discs to give your spinal cord and nerves more room.

Surgery is rarely necessary for cervical spondylosis. However, a doctor may recommend it if the pain is severe and it’s affecting your ability to move your arms.

Home treatment options

If your condition is mild, you can try a few things at home to treat it:

5 easy-to-follow at-home exercises to reduce cervical spondylosis pain: (8)​ 

Push forward

This exercise is very easy to follow and also helps better flexibility in the neck. Here's how to perform the neck push-forward exercise:

  • Stand straight
  • Try to push your neck forward as far as possible
  • At this point, your neck would be protruding forward ahead of the rest of your body
  • Hold this stretch for a few snoods and release
  • Repeat it a few times daily

Neck tilts

Neck tilts as the name suggests helps in stretching the neck in different directions and help relieve pain and stiffness. Here is how you can practice neck tilts.

  • Try to place your head on your right shoulder
  • At this point, your right ear should be touching your right shoulder
  • Hold this position for a few seconds
  • Now witch, with your head resting on your left shoulder
  • Repeat this at least 4-5 times, a few times a week, or whenever you feel discomfort

Neck bowing

Similar to the pushing the neck forward exercise, neck bowing focuses on stretching the neck out as far as possible. A combination of these two regularly can ensure better flexibility and a reduction in pain in the neck. Here's how you perform the neck-bowing exercise:

  • Try to rest your neck on your chest
  • In this position, your chin should be touching your chest
  • Hold this position for a few seconds and release
  • Repeat this along with push forward exercise, alternatively
  • Repeat at least 3-4 times

Look behind

As the name suggests, the looking behind neck exercise focuses on stretching the neck behind. For this exercise, the motive is to turn your neck around in an attempt to see behind you. Here's how to practice the look behind the exercise:

  • Stand straight and turn your neck to the left as far behind as you comfortably can
  • Hold for a few seconds
  • Repeat on the other side
  • Repeat this set 4-5 times or more, however comfortable
  • Please note that your body must stay in the same position and angle throughout

Raised shoulders

This is another easy-to-follow exercise for cervical spondylosis. It also helps release tension from the neck and promotes a calming feeling. This is how to practice raised shoulders:

  • As the name suggests, try to raise your shoulders as you normally would
  • At this point, your shoulders might be touching your ears
  • Hold this position for a few songs and release
  • You can practice this position 10-15 times daily to reduce pain and stiffness

References:  

​​1. Cervical Spine – Anatomy, Diseases, and Treatments [Internet]. [cited 2023 Feb 21]. Available from: https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Cervical-Spine 

​2. Cervical Spine (Neck): What It Is, Anatomy & Disorders [Internet]. [cited 2023 Feb 21]. Available from: https://my.clevelandclinic.org/health/articles/22278-cervical-spine 

​3. Cervical spondylosis - Symptoms and causes - Mayo Clinic [Internet]. [cited 2023 Feb 21]. Available from: https://www.mayoclinic.org/diseases-conditions/cervical-spondylosis/symptoms-causes/syc-20370787 

​4. Cervical Spondylosis: Symptoms, Causes, Treatments [Internet]. [cited 2023 Feb 21]. Available from: https://my.clevelandclinic.org/health/diseases/17685-cervical-spondylosis 

​5. Theodore N. Degenerative Cervical Spondylosis. New England Journal of Medicine. 2020 Jul 9;383(2):159–68.  

​6. Cervical spondylosis - Diagnosis and treatment - Mayo Clinic [Internet]. [cited 2023 Feb 21]. Available from: https://www.mayoclinic.org/diseases-conditions/cervical-spondylosis/diagnosis-treatment/drc-20370792 

​7. Cervical Spondylosis: Causes, Symptoms, Home Treatments, and More [Internet]. [cited 2023 Feb 21]. Available from: https://www.healthline.com/health/cervical-spondylosis#treatment 

​8. Cervical Spondylosis: 5 Exercises To Reduce Neck Pain [Internet]. [cited 2023 Feb 21]. Available from: https://www.ndtv.com/health/cervical-spondylosis-5-exercises-to-reduce-neck-pain-2988112 

Thyroid

The thyroid gland is a small organ that’s located in the front of the neck, wrapped around the windpipe (trachea). It’s shaped like a butterfly, smaller in the middle with two wide wings that extend around the side of your throat. The thyroid is a gland. You have glands throughout your body, where they create and release substances that help your body do a specific thing. Your thyroid makes hormones that help control many vital functions of your body. (1)

What does the thyroid do?

Your thyroid has an important job to do within your body — releasing and controlling thyroid hormones that control metabolism. Metabolism is a process where the food you take into your body is transformed into energy. This energy is used throughout your entire body to keep many of your body’s systems working correctly. Think of your metabolism as a generator. It takes in raw energy and uses it to power something bigger. (1)

The thyroid controls your metabolism with a few specific hormones — T4 (thyroxine, which contains four iodine atoms) and T3 (triiodothyronine, which contains three iodide atoms). These two hormones are created by the thyroid and they tell the body’s cells how much energy to use. When your thyroid works properly, it will maintain the right amount of hormones to keep your metabolism working at the right rate. As the hormones are used, the thyroid creates replacements. (1)

This is all supervised by something called the pituitary gland. Located in the center of the skull, below your brain, the pituitary gland monitors and controls the amount of thyroid hormones in your bloodstream. When the pituitary gland senses a lack of thyroid hormones or a high level of hormones in your body, it will adjust the amounts with its hormone. This hormone is called thyroid-stimulating hormone (TSH). The TSH will be sent to the thyroid and it will tell the thyroid what needs to be done to get the body back to normal.

Thyroid disease is a general term for a medical condition that keeps your thyroid from making the right amount of hormones. Your thyroid typically makes hormones that keep your body functioning normally. When the thyroid makes too much thyroid hormone, your body uses energy too quickly. This is called hyperthyroidism. Using energy too quickly will do more than make you tired — it can make your heart beat faster, cause you to lose weight without trying, and even make you feel nervous. On the flip side of this, your thyroid can make too little thyroid hormone. This is called hypothyroidism. When you have too little thyroid hormone in your body, it can make you feel tired, you might gain weight and you may even be unable to tolerate cold temperatures.

Hyperthyroidism (overactive thyroid)

Symptoms

Hyperthyroidism sometimes looks like other health problems. That can make it hard to diagnose. It can cause many symptoms, including:(2,3)

  • Losing weight without trying.
  • Fast heartbeat, a condition called tachycardia.
  • Irregular heartbeat, also called arrhythmia.
  • Pounding of the heart, sometimes called heart palpitations.
  • Increased hunger.
  • Nervousness, anxiety, and irritability.
  • Tremor, usually a small trembling in the hands and fingers.
  • Sweating.
  • Changes in menstrual cycles.
  • Increased sensitivity to heat.
  • Changes in bowel patterns, especially more-frequent bowel movements.
  • Enlarged thyroid gland, sometimes called a goiter, which may appear as a swelling at the base of the neck.
  • Tiredness.
  • Muscle weakness.
  • Sleep problems.
  • Warm, moist skin.
  • Thinning skin.
  • Fine, brittle hair.

Causes

Many diseases and conditions can cause hyperthyroidism, including:(4)

  • Graves’ disease (the most common cause of hyperthyroidism)
  • Inflammation (thyroiditis) of the thyroid due to viral infections, some medicines, or after pregnancy (common)
  • Taking too much thyroid hormone (common)
  • Noncancerous growths of the thyroid gland or pituitary gland (rare)
  • Some tumors of the testes or ovaries (rare)
  • Getting medical imaging tests with contrast dye that has iodine (rare, and only if there is a problem with the thyroid)
  • Eating too many foods that contain iodine (very rare, and only if there is a problem with the thyroid)

Exams and Tests

The healthcare provider will do a physical exam. The exam may find the following:(5)

  • High systolic blood pressure (the first number in a blood pressure reading)
  • Increased heart rate
  • Enlarged thyroid gland
  • Shaking of the hands
  • Swelling or inflammation around the eyes
  • Very strong reflexes
  • Skin, hair, and nail changes

Blood tests are also ordered to measure your thyroid hormones TSH, T3, and T4.

You may also have blood tests to check:

  • Cholesterol levels
  • Glucose
  • Specialized thyroid tests like Thyroid receptor antibody (TRAb) or Thyroid Stimulating Immunoglobulin (TSI)

Imaging tests of the thyroid may also be needed, including:

  • Radioactive iodine uptake and scan
  • Thyroid ultrasound (rarely)

Risk factors

The main risk factors for hyperthyroidism are:(6)

  • Sex. Females are much more likely to have hyperthyroidism than males. Experts believe this may have to do with hormones.
  • Pregnancy. Pregnancy can stimulate hyperthyroidism in some people, which can cause complications for both the parent and fetus.
  • Age. You’re considered at higher risk for hyperthyroidism as an older adult, especially after age 60.
  • Genetics. A family history of hyperthyroidism usually indicates an increased likelihood of developing the condition.
  • Iodine exposure. You may get too much iodine from certain medications or foods.
  • Having another health condition. People with type 1 diabetes, primary adrenal insufficiency, or pernicious anemia are considered more at risk.

Lifestyle is an important part of lowering your risk factors for hyperthyroidism. This includes eating a balanced diet, taking nutritional supplements if necessary, and getting adequate physical activity during the week. Work with your doctor to create a plan with individualized goals.

How to treat hyperthyroidism

Medication(6,7)

Anti-thyroid medications prevent the thyroid from making hormones. The most common anti-thyroid medications are a class called thionamides, which includes the drugs methimazole (MMI) and propylthiouracil (PTU).

Thionamides have been used to treat hyperthyroidism for decades, and are considered safe for both children and adults, including pregnant people. Anti-thyroid medications can have uncomfortable side effects such as joint pain, hair loss, and rash. In rare cases, they can cause liver damage.

Make sure to tell your doctor if you’re pregnant or plan on becoming so and if you take other medications. Always take medication as directed by your doctor.

Radioactive iodine

Radioactive iodine (RAI), also just called radioiodine, effectively destroys the cells that produce thyroid hormones without damaging other bodily tissues. It is usually taken as an oral tablet or liquid.

Most people who receive radioiodine treatment for hyperthyroidism develop the opposite condition, hypothyroidism. However, this is easier to treat, and you’ll take a daily thyroid hormone supplement. RAI is also used in higher doses to treat thyroid cancer.

In rare cases, at sustained higher doses, RAI is associated with an increased risk of certain cancers. This is not true in lower doses used to treat hyperthyroidism.

Side effects can occur with RAI treatment, especially at higher doses. These include neck pain, nausea, and dry mouth. RAI treatment at high doses can also impact fertility.

Surgery

During a thyroidectomy, all or part of your thyroid gland is removed. This surgery may be recommended for certain people with hyperthyroidism, but it’s evaluated on an individual basis. Surgery may be used for patients that don’t respond to other treatment options or can’t partake in them.

Thyroid gland removal is also used to treat types of thyroiditis, thyrotoxicosis, and thyroid cancer.

If your thyroid gland is fully removed, you will need to take thyroid hormone supplements for the rest of your life. The drug levothyroxine is a synthetic version of the thyroid’s T4 hormone and is usually prescribed in pill form. Taking this drug prevents hypothyroidism, an under-active thyroid that secretes too little hormone.

As with all surgeries, thyroid removal comes with risks and complications. The surgery is usually done by an endocrine surgeon, otolaryngologist, or general surgeon.

Hyperthyroidism diet 

Foods to eat if you have hyperthyroidism(8)

  • Low-iodine foodsThe mineral iodine plays a key role in making thyroid hormones. A low-iodine diet helps to reduce thyroid hormones. Add these foods to your daily diet:(8)
    • non-iodized salt
    • coffee or tea (without milk or dairy- or soy-based creamers)
    • egg whites
    • fresh or canned fruit
    • unsalted nuts and nut butter
    • homemade bread or bread made without salt, dairy, and eggs
    • popcorn with non-iodized salt
    • oats
    • potatoes
    • honey
    • maple syrup

    Cruciferous vegetables

    Cruciferous vegetables and other types may stop your thyroid from using iodine properly. They may be beneficial for hyperthyroidism:(8)

    • bamboo shoots
    • bok choy
    • broccoli
    • Brussels sprouts
    • cassava
    • cauliflower
    • collard greens
    • kale
    • mustard
    • rutabaga

    Vitamins and minerals

    Several nutrients are essential for thyroid health and to balance thyroid hormone production.

    Iron

    Iron is important for many vital bodily functions, including thyroid health. This mineral is needed for blood cells to carry oxygen to every cell in your body. (9)

    Low levels of iron are linked to hyperthyroidism. Get plenty of iron in your diet with foods such as:

    • dried beans
    • green leafy vegetables
    • lentils
    • nuts
    • poultry, such as chicken and turkey
    • red meat
    • seeds
    • whole grains

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Selenium

Selenium-rich foods may help to balance thyroid hormone levels and protect your thyroid from disease. Selenium helps to prevent cell damage and keep your thyroid and other tissues healthy. (8)

Good food sources of selenium include:

Zinc

Zinc helps you use food for energy. This mineral also helps keep your immune system and thyroid health. Food sources of zinc include:(8)

Makkah Pharmacy recommends: 

Treatment(10)

Your doctor determines your breast cancer treatment options based on your type of breast cancer, its stage and grade, size, and whether the cancer cells are sensitive to hormones. Your doctor also considers your overall health and your own preferences.

Breast cancer surgery

  • Removing the breast cancer (lumpectomy). During a lumpectomy, which may be referred to as breast-conserving surgery or wide local excision, the surgeon removes the tumor and a small margin of surrounding healthy tissue.

A lumpectomy may be recommended for removing smaller tumors. Some people with larger tumors may undergo chemotherapy before surgery to shrink a tumor and make it possible to remove it completely with a lumpectomy procedure.

  • Removing the entire breast (mastectomy). A mastectomy is an operation to remove all of your breast tissue. Most mastectomy procedures remove all of the breast tissue — the lobules, ducts, fatty tissue, and some skin, including the nipple and areola (total or simple mastectomy).

Newer surgical techniques may be an option in selected cases to improve the appearance of the breast. Skin-sparing mastectomy and nipple-sparing mastectomy are increasingly common operations for breast cancer.

  • Removing a limited number of lymph nodes (sentinel node biopsy). To determine whether cancer has spread to your lymph nodes, your surgeon will discuss with you the role of removing the lymph nodes that are the first to receive the lymph drainage from your tumor.

If no cancer is found in those lymph nodes, the chance of finding cancer in any of the remaining lymph nodes is small and no other nodes need to be removed.

    • Removing several lymph nodes (axillary lymph node dissection). If cancer is found in the sentinel lymph nodes, your surgeon will discuss with you the role of removing additional lymph nodes in your armpit.
    • Removing both breasts. Some women with cancer in one breast may choose to have their other (healthy) breast removed (contralateral prophylactic mastectomy) if they have a very increased risk of cancer in the other breast because of a genetic predisposition or strong family history.
  • Radiation therapy
  • Chemotherapy
  • Hormone therapy
  • Immunotherapy

Most women with breast cancer in one breast will never develop cancer in the other breast. Discuss your breast cancer risk with your doctor, along with the benefits and risks of this procedure.

References 

  1. Thyroid Disease: Causes, Symptoms, Risk Factors, Testing & Treatment [Internet]. [cited 2023 Jan 21]. Available from: https://my.clevelandclinic.org/health/diseases/8541-thyroid-disease
  2. Davies TF, Schwartz AE. Hyperthyroidism. Endocrine Surgery [Internet]. 2003 Jan 1 [cited 2023 Jan 21];101–14. Available from: https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-20373659
  3. Hyperthyroidism - Symptoms and causes - Mayo Clinic [Internet]. [cited 2023 Jan 21]. Available from: https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-20373659
  4. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016 Oct 1;26(10):1343–421. 
  5. Hyperthyroidism (Overactive Thyroid) - Symptoms and Causes [Internet]. [cited 2023 Jan 21]. Available from: https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/hyperthyroidism-overactive-thyroid
  6. Hyperthyroidism: Causes, Symptoms, Treatment, Diagnosis & More [Internet]. [cited 2023 Jan 21]. Available from: https://www.healthline.com/health/hyperthyroidism#risk-factors
  7. Overactive thyroid (hyperthyroidism) - Treatment - NHS [Internet]. [cited 2023 Jan 21]. Available from: https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/treatment/
  8. Hyperthyroidism Diet Plan: Foods to Eat and Foods to Avoid [Internet]. [cited 2023 Jan 21]. Available from: https://www.healthline.com/health/hyperthyroidism-diet#foods-to-eat
  9. Wang YP, Lin HP, Chen HM, Kuo YS, Lang MJ, Sun A. Hemoglobin, iron, and vitamin B12 deficiencies and high blood homocysteine levels in patients with anti-thyroid autoantibodies. Journal of the Formosan Medical Association. 2014;113(3):155–60. 
  10. Hypothyroidism (underactive thyroid) - Symptoms and causes - Mayo Clinic [Internet]. [cited 2023 Jan 21]. Available from: https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284
  11. Hypothyroidism (Underactive Thyroid): Symptoms, Causes, Tests, Treatments [Internet]. [cited 2023 Jan 21]. Available from: https://www.webmd.com/women/hypothyroidism-underactive-thyroid-symptoms-causes-treatments
  12. Underactive thyroid (hypothyroidism) - Diagnosis - NHS [Internet]. [cited 2023 Jan 21]. Available from: https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/diagnosis/
  13. Hypothyroidism: Causes and Risk Factors [Internet]. [cited 2023 Jan 21]. Available from: https://www.verywellhealth.com/hypothyroidism-causes-risk-factors-3231721
  14. Hypothyroidism (Underactive Thyroid): Symptoms, Causes, Treatment [Internet]. [cited 2023 Jan 21]. Available from: https://www.healthline.com/health/hypothyroidism/symptoms-treatments-more#medication

Breast Cancer

What is breast cancer?

Breast cancer originates in your breast tissue. It occurs when breast cells mutate (change) and grow out of control, creating a mass of tissue (tumor). Like other cancers, breast cancer can invade and grow into the tissue surrounding your breast. It can also travel to other parts of your body and form new tumors. When this happens, it’s called metastasis. (1)

Symptoms (2)

Signs and symptoms of breast cancer may include:

  • A breast lump or thickening that feels different from the surrounding tissue
  • Change in the size, shape, or appearance of a breast
  • Changes to the skin over the breast, such as dimpling
  • A newly inverted nipple
  • Peeling, scaling, crusting, or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin
  • Redness or pitting of the skin over your breast, like the skin of an orange

When to see a doctor

If you find a lump or other change in your breast — even if a recent mammogram was normal — make an appointment with your doctor for prompt evaluation.

Causes(3)

After puberty, a female’s breasts are made up of fat, connective tissue, and thousands of lobules. These are tiny glands that can produce milk. Tiny tubes, or ducts, carry the milk toward the nipple.

Breast cancer develops as a result of genetic mutations or damage to DNA. These can be associated with exposure to estrogen, inherited genetic defects, or genes that can cause cancer, such as the BRCA1 and BRCA2 genes.

When a person is healthy, their immune system attacks any abnormal DNA or growths. When a person has cancer, this does not happen.

As a result, cells within breast tissue begin to multiply uncontrollably, and they do not die as usual. This excessive cell growth forms a tumor that deprives surrounding cells of nutrients and energy.

Breast cancer usually starts in the inner lining of the milk ducts or the lobules that supply them with milk. From there, it can spread to other parts of the body.

Factors that are associated with an increased risk of breast cancer include:(4)

  • Being female. Women are much more likely than men to develop breast cancer.
  • Increasing age. Your risk of breast cancer increases as you age.
  • A personal history of breast conditions. If you've had a breast biopsy that found lobular carcinoma in situ (LCIS) or atypical hyperplasia of the breast, you have an increased risk of breast cancer.
  • A personal history of breast cancer. If you've had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.
  • A family history of breast cancer. If your mother, sister, or daughter was diagnosed with breast cancer, particularly at a young age, your risk of breast cancer is increased. Still, the majority of people diagnosed with breast cancer have no family history of the disease.
  • Inherited genes that increase cancer risk. Certain gene mutations that increase the risk of breast cancer can be passed from parents to children. The most well-known gene mutations are referred to as BRCA1 and BRCA2. These genes can greatly increase your risk of breast cancer and other cancers, but they don't make cancer inevitable.
  • Radiation exposure. If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.
  • Obesity. Being obese increases your risk of breast cancer.
  • Beginning your period at a younger age. Beginning your period before age 12 increases your risk of breast cancer.
  • Beginning menopause at an older age. If you began menopause at an older age, you're more likely to develop breast cancer.
  • Having your first child at an older age. Women who give birth to their first child after age 30 may have an increased risk of breast cancer.
  • Having never been pregnant. Women who have never been pregnant have a greater risk of breast cancer than women who have had one or more pregnancies.
  • Postmenopausal hormone therapy. Women who take hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these medications.

Drinking alcohol. Drinking alcohol increases the risk of breast cancer.

Breast Cancer Stages(5)

The stages are the number zero and the Roman numerals I, II, III, or IV (often followed by A, B, or C). In general, the higher the number, the more advanced cancer. But there’s more to it than that.

Stage 0.  Cancer has been diagnosed early. It started in the breast ducts or milk glands and has stayed there. You’re likely to hear or see the words in situ, meaning “in the original place.” Get more details about stage 0 breast cancer types and treatment options.

Stage I. starting at this level, breast cancer is called invasive, meaning it has broken free to attack healthy tissue.

Stage 1A means cancer has spread into the fatty breast tissue. The tumor itself is no larger than a shelled peanut, or there may be no tumor.

Stage IB means some cancer cells, but just tiny amounts, have been found in a few lymph nodes.

Stage II. Cancer has grown, spread, or both.

IIA means the tumor in the breast is still small if there's one at all. There may be no cancer in the lymph nodes, or it may have spread to as many as three.

A stage IIB breast tumor is bigger -- it may be the size of a walnut or as big as a lime. It may or may not be in any lymph nodes.

Stage III. Cancer has not spread to bones or organs, but it’s considered advanced, and it’s harder to fight.

IIIA means cancer has been found in up to nine of the lymph nodes that form a chain from your underarm to your collarbone. Or it has spread to or enlarged the lymph nodes deep in your breast. In some cases, there is a large tumor in the breast, but other times there’s no tumor.

IIIB means the tumor has grown into the chest wall or skin around your breast, even if it hasn’t spread to the lymph nodes.

IIIC means cancer has been found in 10 or more lymph nodes or has spread above or below your collarbone. It’s also IIIC if fewer lymph nodes outside the breast are affected but those inside it are enlarged or cancerous.

Stage IV. Breast cancer cells have spread far away from the breast and lymph nodes right around it. The most common sites are the bones, lungsliver, and brain. This stage is described as “metastatic,” meaning it has spread beyond the region of the body where it was first found.

What can I do to reduce my risk of breast cancer?

Research shows that lifestyle changes can decrease the risk of breast cancer, even in women at high risk. To lower your risk:(6)

  • Limit alcohol.
  • Maintain a healthy weight.
  • Be physically active.
  • Breast-feed. Breastfeeding might play a role in breast cancer prevention. The longer you breastfeed, the greater the protective effect.
  • Limit postmenopausal hormone therapy. Combination hormone therapy may increase the risk of breast cancer. Talk with your doctor about the risks and benefits of hormone therapy. You might be able to manage your symptoms with nonhormonal therapies and medications. If you decide that the benefits of short-term hormone therapy outweigh the risks, use the lowest dose that works for you and continue to have your doctor monitor the length of time you're taking hormones.
  • Take your daily supplements like Vitamin D, Calcium, and probiotics

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How Is Breast Cancer Diagnosed?(7)

Doctors often use additional tests to find or diagnose breast cancer. They may refer women to a breast specialist or a surgeon. This does not mean that she has cancer or that she needs surgery. These doctors are experts in diagnosing breast problems.

  • Breast ultrasound. A machine that uses sound waves to make pictures, called sonograms, of areas inside the breast.
  • Diagnostic mammogram. If you have a problem in your breast, such as lumps, or if an area of the breast looks abnormal on a screening mammogram, doctors may have you get a diagnostic mammogram. This is a more detailed X-ray of the breast.
  • Breast magnetic resonance imaging (MRI). A kind of body scan that uses a magnet linked to a computer. The MRI scan will make detailed pictures of areas inside the breast.
  • Biopsy. This is a test that removes tissue or fluid from the breast to be looked at under a microscope and do more testing. There are different kinds of biopsies (for example, fine-needle aspiration, core biopsy, or open biopsy).

Breast self-exam (8)

1) In the Shower 

With the pads/flats of your 3 middle fingers, check the entire breast and armpit area pressing down with light, medium, and firm pressure. Check both breasts each month feeling for any lump, thickening, hardened knot, or any other breast changes.

2) In Front of a Mirror 

Visually inspect your breasts with your arms at your sides. Next, raise your arms high overhead.

Look for any changes in the contour, any swelling, or dimpling of the skin, or changes in the nipples. Next, rest your palms on your hips and press firmly to flex your chest muscles. Left and right breasts will not exactly match—few women’s breasts do, so look for any dimpling, puckering, or changes, particularly on one side.

3) Lying Down

When lying down, the breast tissue spreads out evenly along the chest wall. Place a pillow under your right shoulder and your right arm behind your head. Using your left hand, move the pads of your fingers around your right breast gently covering the entire breast area and armpit.

Use light, medium, and firm pressure. Squeeze the nipple; check for discharge and lumps. Repeat these steps for your left breast.

Finding Breast Cancer during Pregnancy(9)

Breast cancer during pregnancy isn't common. But if you find a lump or notice any changes in your breasts that concern you, tell your doctor or nurse right away. There are a variety of tests a pregnant woman can have if breast cancer is suspected. And there are options for treating breast cancer if you are pregnant.

If you are pregnant and breast cancer is found, it may be called gestational breast cancer or pregnancy-associated breast cancer (PABC).

Breast cancers can be harder to find when you’re pregnant

Changes in hormone levels during pregnancy cause the breasts to change. The breasts may become larger, lumpy, and/or tender. This can make it harder for you or your doctor to notice a lump caused by cancer until it gets quite large.

Another reason it may be hard to find breast cancers early during pregnancy is that many women put off breast cancer screening with mammograms until after the pregnancy. Even when women do get mammograms, pregnancy and breastfeeding can make breast tissue denser, which can make it harder to see early cancer on a mammogram.

Because of these challenges, when a pregnant woman develops breast cancer, it’s often diagnosed at a later stage than it usually is in women who are not pregnant. For example, it’s more likely to have already spread to lymph nodes.

Treatment(10)

Your doctor determines your breast cancer treatment options based on your type of breast cancer, its stage and grade, size, and whether the cancer cells are sensitive to hormones. Your doctor also considers your overall health and your own preferences.

Breast cancer surgery

  • Removing the breast cancer (lumpectomy). During a lumpectomy, which may be referred to as breast-conserving surgery or wide local excision, the surgeon removes the tumor and a small margin of surrounding healthy tissue.

A lumpectomy may be recommended for removing smaller tumors. Some people with larger tumors may undergo chemotherapy before surgery to shrink a tumor and make it possible to remove it completely with a lumpectomy procedure.

  • Removing the entire breast (mastectomy). A mastectomy is an operation to remove all of your breast tissue. Most mastectomy procedures remove all of the breast tissue — the lobules, ducts, fatty tissue, and some skin, including the nipple and areola (total or simple mastectomy).

Newer surgical techniques may be an option in selected cases to improve the appearance of the breast. Skin-sparing mastectomy and nipple-sparing mastectomy are increasingly common operations for breast cancer.

  • Removing a limited number of lymph nodes (sentinel node biopsy). To determine whether cancer has spread to your lymph nodes, your surgeon will discuss with you the role of removing the lymph nodes that are the first to receive the lymph drainage from your tumor.

If no cancer is found in those lymph nodes, the chance of finding cancer in any of the remaining lymph nodes is small and no other nodes need to be removed.

    • Removing several lymph nodes (axillary lymph node dissection). If cancer is found in the sentinel lymph nodes, your surgeon will discuss with you the role of removing additional lymph nodes in your armpit.
    • Removing both breasts. Some women with cancer in one breast may choose to have their other (healthy) breast removed (contralateral prophylactic mastectomy) if they have a very increased risk of cancer in the other breast because of a genetic predisposition or strong family history.
  • Radiation therapy
  • Chemotherapy
  • Hormone therapy
  • Immunotherapy

Most women with breast cancer in one breast will never develop cancer in the other breast. Discuss your breast cancer risk with your doctor, along with the benefits and risks of this procedure.

References

  1. DeSantis CE, Ma J, Goding Sauer A, Newman LA, Jemal A. Breast cancer statistics, 2017, racial disparity in mortality by state. CA Cancer J Clin [Internet]. 2017 Nov [cited 2022 Sep 21];67(6):439–48. Available from: https://my.clevelandclinic.org/health/diseases/3986-breast-cancer
  2. Breast cancer - Symptoms and causes - Mayo Clinic [Internet]. [cited 2022 Sep 21]. Available from: https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470
  3. Breast cancer: Symptoms, causes, stages, types, and more [Internet]. [cited 2022 Sep 21]. Available from: https://www.medicalnewstoday.com/articles/37136#causes
  4. Breast cancer - Symptoms and causes - Mayo Clinic [Internet]. [cited 2022 Sep 21]. Available from: https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470
  5. What Are the Stages of Breast Cancer? [Internet]. [cited 2022 Sep 21]. Available from: https://www.webmd.com/breast-cancer/stages-grades-breast-cancer
  6. Breast cancer prevention: How to reduce your risk - Mayo Clinic [Internet]. [cited 2022 Sep 21]. Available from: https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/breast-cancer-prevention/art-20044676
  7. How Is Breast Cancer Diagnosed? | CDC [Internet]. [cited 2022 Sep 21]. Available from: https://www.cdc.gov/cancer/breast/basic_info/diagnosis.htm
  8. Breast Self-Exam - National Breast Cancer Foundation [Internet]. [cited 2022 Sep 21]. Available from: https://www.nationalbreastcancer.org/breast-self-exam
  9. Finding Breast Cancer During Pregnancy [Internet]. [cited 2022 Sep 21]. Available from: https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/finding-breast-cancer-during-pregnancy.html
  10. Breast cancer - Diagnosis and treatment - Mayo Clinic [Internet]. [cited 2022 Sep 21]. Available from: https://www.mayoclinic.org/diseases-conditions/breast-cancer/diagnosis-treatment/drc-20352475

Prostrate Cancer

Prostate cancer is a common type of cancer in males, but it is highly treatable in the early stages. It begins in the prostate gland, which sits between the penis and the bladder.

The prostate is a small walnut-shaped gland in males that produces the seminal fluid that nourishes and transports sperm.

Many prostate cancers grow slowly and are confined to the prostate gland, where they may not cause serious harm. However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly. (1)

Prostate cancer that's detected early — when it's still confined to the prostate gland — has the best chance of successful treatment.

Signs and symptoms

There are often no symptoms during the early stages of prostate cancer, but screening can detect changes that may indicate cancer. Screening involves a test that measures levels of PSA in the blood. High levels suggest that cancer may be present.

Males who do experience symptoms may notice:(2)

  • Difficulty starting urination.
  • Weak or interrupted flow of urine.
  • Urinating often, especially at night.
  • Trouble emptying the bladder.
  • Pain or burning during urination.
  • Blood in the urine or semen.
  • Pain in the back, hips, or pelvis that doesn’t go away.
  • Painful ejaculation.

What Is Screening for Prostate Cancer? (3)

Cancer screening means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.

If you are thinking about being screened, learn about the possible benefits and harms of screening, diagnosis, and treatment, and talk to your doctor about your risk factors.

There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are described below.

Prostate Specific Antigen (PSA) Test(3)

A blood test called a prostate-specific antigen (PSA) test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other prostate conditions.

As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.

PSA levels also can be affected by:

  • Certain medical procedures.
  • Certain medications.
  • An enlarged prostate.
  • A prostate infection.

Because many factors can affect PSA levels, your doctor is the best person to interpret your PSA test results. If the PSA test is abnormal, your doctor may recommend a biopsy to find out if you have prostate cancer.

Prostate Specific Antigen (PSA) Test(3)

Digital rectal examination (DRE) is when a health care provider inserts a gloved, lubricated finger into a man’s rectum to feel the prostate for anything abnormal, such as cancer. The U.S. Preventive Services Task Force does not recommend DRE as a screening test because of a lack of evidence on the benefits.

Causes

Researchers are unsure of the exact cause of prostate cancer. It develops when specific changes occur, usually in glandular cells. When prostate gland cells appear abnormal, a doctor may refer to these changes as prostatic intraepithelial neoplasia (PIN). Nearly 50% of all males over the age of 50 years have a PIN.(4)

At first, the changes will be slow, and the cells will not be cancerous. However, they can become cancerous with time. Cancer cells can be high or low grade. High-grade cells are more likely to grow and spread, while low-grade cells are not likely to grow and are not a cause for concern. (4)

Risk factors (1)

  • Age: The risk of prostate cancer increases after the age of 50, but it is rare before 45.
  • Race or ethnicity: The condition is more common in Black people than white people. Asian and Hispanic people have a lower risk than Black or white people.
  • Family history: A person with a close relative who has a history of prostate cancer has a higher chance of developing it themselves.
  • Genetic factors: Inherited features, including changes to the BRCA1 and BRCA2 genes, may increase the risk. Mutations in these genes also increase the chance of breast cancer. Men born with Lynch syndrome also have a higher risk of prostate and other cancers.
  • Diet: Some evidence suggests that high-fat diets may increase the risk of prostate cancer.

Other factors that may influence prostate cancer risk include:(5)

Stages

Staging typically describes how much cancer is present in the body and how serious the cancer is. Knowing the stage of prostate cancer can help a person understand what to expect and will inform decisions about treatment.

Cancer staging is complex and accounts for many different factors. Usually, the lower the number, the less cancer has spread. Stages may include:(5)

  • Stage I: Cancer is only present in the prostate gland.
  • Stage II: Cancer has not yet spread from the prostate, but a person will have a higher PSA level.
  • Stage III: Cancer may have spread to nearby tissues.
  • Stage IV: Cancer may have spread to distant parts of the body.

How Is Prostate Cancer Treated? (6)

Different types of treatment are available for prostate cancer. You and your doctor will decide which treatment is right for you. Some common treatments are:

  • Expectant management. If your doctor thinks your prostate cancer is unlikely to grow quickly, he or she may recommend that you don’t treat cancer right away. Instead, you can choose to wait and see if you get symptoms in one of two ways:
    • Active surveillance. Closely monitoring prostate cancer by performing prostate specific antigen (PSA) tests and prostate biopsies regularly, and treating cancer only if it grows or causes symptoms.
    • Watchful waiting. No tests are done. Your doctor treats any symptoms when they develop. This is usually recommended for men who are expected to live for 10 more years or less.
  • Surgery. A prostatectomy is an operation where doctors remove the prostate. Radical prostatectomy removes the prostate as well as the surrounding tissue.
  • Radiation therapy. Using high-energy rays (similar to X-rays) to kill cancer. There are two types of radiation therapy—
    • External radiation therapy. A machine outside the body directs radiation at the cancer cells.
    • Internal radiation therapy (brachytherapy). Radioactive seeds or pellets are surgically placed into or near cancer to destroy the cancer cells.

Other therapies used in the treatment of prostate cancer that is still under investigation include—

  • Cryotherapy. Placing a special probe inside or near the prostate cancer to freeze and kill the cancer cells.
  • Chemotherapy. Using special drugs to shrink or kill cancer. The drugs can be pills you take or medicines given through your veins, or, sometimes, both.
  • Biological therapy. Works with your body’s immune system to help it fight cancer or to control side effects from other cancer treatments. Side effects are how your body reacts to drugs or other treatments.
  • High-intensity focused ultrasound. This therapy directs high-energy sound waves (ultrasound) at cancer to kill cancer cells.
  • Hormone therapy. Blocks cancer cells from getting the hormones they need to grow.

Can Prostate Cancer Be Prevented? (7)

There is no sure way to prevent prostate cancer. Many risk factors such as age, race, and family history can’t be controlled. But there are some things you can do that might lower your risk of prostate cancer.

  • Get to and stay at a healthy weight.
  • Keep physically active.
  • Follow a healthy eating pattern, which includes a variety of colorful fruits and vegetables and whole grains, and avoid or limit red and processed meats, sugar-sweetened beverages, and highly processed foods.

Vitamin E and selenium: Some early studies suggested that taking vitamin E or selenium supplements might lower prostate cancer risk.

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Soy and isoflavones: Some early research has suggested possible benefits from soy proteins (called isoflavones) in lowering prostate cancer risk.

Taking any supplements can have both risks and benefits. Before starting vitamins or other supplements, talk with your doctor.

References:

  1. Rock CL, Thomson C, Gansler T, Gapstur SM, McCullough ML, Patel A v., et al. American Cancer Society guideline for diet and physical activity for cancer prevention. CA Cancer J Clin. 2020 Jul;70(4):245–71. 
  2. What Are the Symptoms of Prostate Cancer? | CDC [Internet]. [cited 2022 Sep 4]. Available from: https://www.cdc.gov/cancer/prostate/basic_info/symptoms.htm
  3. What Is Screening for Prostate Cancer? | CDC [Internet]. [cited 2022 Sep 4]. Available from: https://www.cdc.gov/cancer/prostate/basic_info/screening.htm
  4. Prostate cancer: Symptoms, treatment, and causes [Internet]. [cited 2022 Sep 4]. Available from: https://www.medicalnewstoday.com/articles/150086#causes
  5. Prostate cancer: Symptoms, treatment, and causes [Internet]. [cited 2022 Sep 4]. Available from: https://www.medicalnewstoday.com/articles/150086#risk-factors
  6. How Is Prostate Cancer Treated? | CDC [Internet]. [cited 2022 Sep 4]. Available from: https://www.cdc.gov/cancer/prostate/basic_info/treatment.htm
  7. Rock CL, Thomson C, Gansler T, Gapstur SM, McCullough ML, Patel A v., et al. American Cancer Society guideline for diet and physical activity for cancer prevention. CA Cancer J Clin [Internet]. 2020 Jul [cited 2022 Sep 4];70(4):245–71. Available from: https://www.cancer.org/cancer/prostate-cancer/causes-risks-prevention/prevention.html

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