The ABCDE’s of Melanoma Diagnosis

Posted Posted in Continuing Education, Homestudy, Nutrition

melanomaBy Dr. Mary O’Brien MD

Skin cancer is the most common form of cancer in the United States, and exposure to the sun’s ultraviolet (UV) rays appears to be the most important environmental factor involved in the development of skin cancer. People with fair complexions, who burn easily in the sun and freckle easily are at greatest risk for skin cancer and skin damage from the sun’s rays. While the risk is lower, skin cancer can also occur in individuals with darker complexions, including those of African descent.

Clinicians and dermatologists often use the “ABCDE” approach as an effective means of detecting suspect moles and skin lesions.

The ABCDE signs of melanoma are:

  • Asymmetry: One half of the mole is different from the other half.
  • Border irregularity: The spot has borders which are not smooth and regular but uneven or notched.
  • Color: The spot has several colors in an irregular pattern or is a very different color from the rest of one’s moles.
  • Diameter: The spot is larger than the size of a pencil eraser (6 mm).
  • Evolving: The mole is changing in size, shape, color, or overall texture. This may also include new bleeding.

Bleeding, burning, or itching may indicate melanoma but a lesion that is evolving quickly is one sign that a mole is not behaving in a benign manner.

These guidelines can be helpful, but real problem is that many normal moles are completely symmetrical based on their color or shape. This can mean that many spots which have one or more of the ABCDE’s end up being in fact just an ordinary moles and are not melanomas.

Some melanomas fail to have color or be raised above the skin. As a rule, melanoma is not painful unless traumatized. They sometimes itch, but this has no diagnostic or prognostic importance.

Research strongly suggests that an individual may have a great deal of control in minimizing his or her chances of developing cancer. This would include consuming an abundance of foods from plant-based sources and avoiding habits like smoking. Maintaining a healthy weight and exercising regularly also may play a role in preventing cancer, as can reducing or eliminating the amount of red meat in the diet. Protecting the skin from the sun, especially during peak hours, and drinking alcohol in moderation, if at all, may also help lower the risk. Individuals can also take steps to protect their home environment from risk factors such as chemicals, radiation, and industrial pollutants. Regular screening may catch precancerous changes in cells, and chemoprevention may be the appropriate strategy for some people.

While there is not yet one magic bullet to prevent all cancer, individuals can take positive steps to help minimize the risk of cancer. Living a healthy lifestyle—as well as getting proper screenings, protecting oneself from overexposure to the sun and toxins, and choosing chemoprevention if one is at high risk—may well be our best strategy in the war against cancer.

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Primary Care Treatment for Prostate Cancer Survivors

Posted Posted in Continuing Education, Elder Care, Nutrition, Seminars

By Barbara Boughton

cancer-390322_640A new guideline on health care for prostate cancer survivors from the American Society of Clinical Oncology (ASCO) shines a spotlight on the important role of primary care providers.

The new ASCO guideline, published in early February, endorses and adds to a guideline published in June, 2014 by the American Cancer Society. As well as providing guidance on follow up testing for prostate cancer survivors, the ASCO guideline emphasizes counseling about healthy lifestyle behaviors and interventions for the aftereffects of cancer treatment.

Clinicians are an important source for counseling about nutrition, exercise and healthy lifestyle as well as assessments for the late effects of prostate cancer treatment, the guidelines say. Clinicians should play an important part in talking to prostate cancer survivors about their lifestyle habits, and giving them advice about how to make changes. Increasingly, studies show that healthy eating and an active lifestyle can reduce the risk of prostate cancer recurrence. Clinicians should advise prostate cancer survivors to take these healthy lifestyle steps:

  • Achieve and maintain a healthy weight by limiting high calorie foods and drinks. Obesity is associated with worse health outcomes in prostate cancer, including a greater risk for recurrence and decreased survival.
  • Engage in exercise for at least 150 minutes per week, no matter what the survivor’s weight. Research shows that 3 or more hours per week of vigorous exercise is associated with a 61% reduction in prostate cancer-specific death among survivors. As well as discussing these benefits of physical activity with survivors, primary care providers should stress the advantages for quality of life.
  • Eat a diet that emphasizes micronutrient-rich and phytochemical-rich vegetables and fruits, whole grains, and low amounts of saturated fats. Such nutrition improves survival and decreases the risk for second cancers and chronic disease among all kinds of cancer survivors, according to the American Cancer Society.
  • Intake 600 IU of vitamin D per day and consume adequate, but not excessive, amounts of calcium (not to exceed 1200 mg per day). These recommendations are especially important for prostate cancer survivors receiving androgen deprivation therapy (ADT), since these treatments increase the risk of osteoporosis and fractures.

Most adults between ages 19 and 51 and older need 1000 to 1200 mg per day of calcium. Some, but not all studies on nutrition and prostate cancer risk, have indicated an increased risk for prostate cancer among those who had a high intake of calcium, particularly from dairy products. Calcium from supplements has not been associated with increased prostate cancer risk.

All cancer survivors should be given appropriate vaccines, based on age, season (flu), or travel plans. Primary care providers should also counsel prostate cancer survivors to avoid or limit alcohol, since excessive alcohol can affect cancer risk. Clinicians should also assess prostate cancer survivors for tobacco use and provide or refer survivors to cessation counseling.

Bowel dysfunction can occur in prostate cancer survivors as a result of radiation, although bowel symptoms are more common during treatment than after it. Prostate cancer survivors with bowel problems affecting nutrient absorption should be referred to a registered dietitian.

Prostate cancer survivors are also at risk for anemia, cardiovascular disease and diabetes from ADT, and should be regularly assessed for these conditions, and if present, treated. Thirty percent of prostate cancer survivors also experience distress associated with their cancer diagnosis, including increased anxiety and depressive disorders. Ongoing assessment and treatment by primary care providers or referrals to psychologists, psychiatrists and/or social workers are important to minimize cancer-related distress. Treatment for cancer-related anxiety or depression can also minimize the effects of these conditions on survivors’ quality of life.

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