Gynecological Cancer Awareness Month

According to the CDC, uterine cancer (cancer which develops in the uterus) is the most commonly diagnosed gynecological cancer in the U.S. and the fourth most common cancer in U.S. women overall.

Types of Gynecological Cancer

  • Cervical cancer.
  • Ovarian cancer.
  • Uterine cancer.
  • Vaginal cancer.
  • Vulvar cancer.

September is Gynecologic Cancer Awareness Month, a national recognition established by the in 1999.


It is estimated that this year 98,000 women will be diagnosed with a gynecologic cancer and some 30,000 will die from the disease. Gynecological Cancer Awareness Month provides an important opportunity to draw attention to this important women’s health issue and offer vital information on risk cancers, warning signs, and prevention strategies.

Uterine Cancer

According to the CDC, uterine cancer (cancer which develops in the uterus) is the most commonly diagnosed gynecological cancer in the U.S. and the fourth most common cancer in U.S. women overall. While any woman can develop uterine cancer, it is most commonly diagnosed in women who have gone through menopause. Risk factors for uterine cancer include age (being age 50 or older), obesity, taking estrogen alone as hormone replacement, and having a family history of uterine, ovarian or colon cancer.

Routine testing is not recommended for uterine cancer, so it is important for women to be aware of symptoms—such as abnormal vaginal discharge or bleeding and/or pain and pressure in the pelvic area—and talk to a healthcare provider if they experience these.

Ovarian Cancer

While ovarian cancer accounts for about 3% of cancers among women, it causes more deaths than any other gynecological cancer, according to the American cancer Society. While the survival rates for ovarian cancer are excellent when the disease is diagnosed early, only about 20% of ovarian cancers are found at this early stage. One reason for this is that there is no recommended routine screening for ovarian cancer on women without symptoms. And the symptoms of ovarian cancer—including abnormal abdominal bloating, abdominal pain or pressure, and feeling full quickly when eating—can also be easily be ignored or mistaken for other problems.

For women who experience these symptoms, or who at at higher risk (including women who have had breast cancer or have a family history of ovarian, breast or colorectal cancer), a healthcare provider may recommending further screening. Testing may include rectovaginal pelvic exam, a transvaginal ultrasound,or a CA-125 blood test.

Cervical Cancer

According to the American Sexual Health Organization, the vast majority of cases of cervical cancer—cancer that develops on the cervix, the opening to the uterus—are linked to human papillomavirus (HPV) infection. The majority of women with an HPV infection will not develop cervical cancer, but regular screening is essential. In most cases cervical cancer can be prevented through early detection and treatment of abnormal cell changes that occur in the cervix years before cervical cancer develops. These changes are typically detected through a Pap test or an HPV test. HPV vaccines can also prevent cervical cancer.

In its early stages, cervical cancer typically doesn’t have any symptoms, which is why regular screening is so important. At later stages, symptoms may include abnormal vaginal discharge or bleeding or pain during sex. While these can also be signs of other health issues, if a woman experiences these symptoms, she should report them to her healthcare provider.

Vaginal and Vulvar Cancer

According to the American Sexual Health Organization, vaginal and vulvar cancers are rare—an estimated 1,000 women are diagnosed with vaginal cancer and 3,500 women with vulvar cancer each year. Like cervical cancer, vaginal and vulvar cancers are also associated with HPV infection, with up to 90% of vaginal cancers and pre-cancers and more than 50% of vulvar cancers linked to infection with the high-risk HPV types.

HPV vaccines, which prevent some of the high-risk types of HPV, can also help prevent vaginal and vulvar cancers.

 

 

 

QUOTE FOR MONDAY:

Most cancers are solid—a collection of mutated cells that grow out of control and form a tumor. The six most common cancers—breast, lung, prostate, colorectal, melanoma and bladder—are solid cancers that account for almost 1 million new cases a year. Cancers that are not considered solid cancers are often lumped together in the category of blood cancers: leukemia, lymphoma and myeloma. ”

Cancer Treatments of America

Blood Cancer Month

The six most common cancers—breast, lung, prostate, colorectal, melanoma and bladder—are solid cancers that account for almost 1 million new cases a year. Cancers that are not considered solid cancers are often lumped together in the category of blood cancers being:

Leukemia, Lymphoma and Myeloma.

The three main types of blood cancers are:

Multiple myeloma: This cancer develops in the bone marrow and affects plasma cells, which produce antibodies that attack infections and diseases. When plasma cells become cancerous, they may accumulate in the marrow and damage or weaken bone and cause pain. Cancerous plasma cells also produce faulty antibodies, which make it hard for the body to fight infections. multiple myeloma may be treated with targeted therapy, radiation therapy, chemotherapy and/or a stem cell transplant.

Leukemia: This cancer of the blood cells usually starts in bone marrow and travels through the bloodstream. In leukemia, the bone marrow produces mutated cells and spreads them into the blood, where they grow and crowd out healthy blood cells. Leukemia comes in many forms, but the key diagnosis is determined by whether the disease is acute or chronic. Acute leukemias are fast-growing and may require aggressive treatments.

Lymphomas: These diseases affect the cells in the lymphatic system. In lymphomas, immune cells called lymphocytes grow out of control and collect in lymph nodes, the spleen, in other lymph tissues or in neighboring organs. There are dozens of types of lymphoma, but the disease is largely categorized as Hodgkin lymphoma or non-Hodgkin lymphoma. Immunotherapy may be used to treat some cases of Hodgkin lymphoma. Other lymphoma treatments include chemotherapy and surgery to remove affected lymph nodes.

What purpose do these fluids have?

  • Blood: Blood regulate the flow of oxygen and carbon dioxide in and out of the body, contains immune cells that fight infection, and delivers nutrients and hormones.
  • Bone marrow: Red bone marrow produces new blood cells and platelets, which help regulate clotting. Yellow bone marrow produces and stores fats that help build bone and cartilage.
  • Lymph: Lymph fluids carry immune cells throughout the body, deliver bacteria to lymph nodes to be filtered out of the circulatory system, and return excess proteins to the blood supply.

Patients with blood cancers often have symptoms common to all three forms of the disease: weakness and fatigue, bone pain, infections, fevers and weight loss. And some leukemias and lymphomas are so similar, they may be considered the same disease, but are named depending on whether they are found in the blood or in the lymph system. For instance, chronic lymphocytic leukemia and small lymphocytic lymphoma affect the same kind of cells—small lymphocytes—and are often considered different versions of the same disease. A definitive diagnosis may require a bone marrow biopsy or a procedure called flow cytometry, in which cancerous cells are analyzed with a laser.

QUOTE FOR THE WEEKEND:

“Ventricular tachycardia (VT or V-tach) is a type of abnormal heart rhythm, or arrhythmia. It occurs when the lower chamber of the heart beats too fast to pump well and the body doesn’t receive enough oxygenated blood.”

John Hopkins

Part III What is and what does a cardiac rhythm tell us?

Ventricular Rhythms Part III

  PVC1PVC  ventrhy2PVC after every one normal beat

PVC1BIGEMINI-PVC AFTER 2 NORMAL BEATS (TRIGEMINI-AFTER 3 BEATS)

PVC3 PVC3QUADROGEMINI -AFTER 4 NORMAL BEATS

ventrhy1a 40 to 60 beats is just Idioventricular Rhythm, ventrhy4Monomorphic V-Tacventrhy3

ventrhy6Below is 2 views of Torsades de Pointes (article describes)

torsades de pointes & Torsades de pointes2

When the atriums aren’t working as the natural pacemaker, called the SA Node located in the top L corner of the right atrium.  The atriums that took over for the sinus node now fail don’t work so now the ventricles take over and the rhythms of all ventricle rhythms will show on the EKG which present NO p waves since the atriums are not working so no p wave is involved but we have QRS waves but their wide in measurement because the rhythm starts in the ventricles. The rhythms are PVC (Premature Ventricular Contractions), Idioventricular Rhythm, Ventricular tachycardia (Monomorphic and Polymorphic-rhythm getting more irregular. When regular and monomorphic=looking identical with every ventricular beat or contraction as opposed to polymorphic=not looking identical each contraction but each one is a ventricular contraction), Torsades De Pointes Ventricular Tachycardia (the rhythm starts upright but turns upside down but each contraction without a p wave and a wide contraction meaning a ventricular contraction), and Ventricular Fibrillation, to asystole.

Here’s what they look like:

 Accelerated Idioventricular Rhythm

Accelerated idioventricular rhythm occurs when three or more ventricular escape beats appear in a sequence. Heart rate will be 50-100 bpm. The QRS complex will be wide (0.12 sec. or more).

A regular QRS measures less than 0.12 which is with all atriums rhythms. 

Asystole

Asystole is the state of no cardiac electrical activity and no cardiac output. Immediate action is required.

Idioventricular Rhythm

Idioventricular rhythm is a slow rhythm of under 50 bpm. It indicates that then ventricules are producing escape beats.

Premature Ventricular Complex

Premature ventricular complexes (PVCs) occur when a ventricular site generates an impulse. This happens before the next regular sinus beat. Look for a wide QRS complex, equal or greater than 0.12 sec. The QRS complex shape can be bizarre. The P wave will be absent.

Premature Ventricular Complex – Bigeminy a QRS after every 2 regular beats

Premature Ventricular Complex – Trigeminy a QRS after every 3 regular beats

Premature Ventricular Complex – Quadrigeminy a QRS after every 4 regular beats 

Ventricular Fibrillation

Ventricular fibrillation originates in the ventricules and it chaotic. No normal EKG waves are present. No heart rate can be observed. Ventricular fibrillation is an emergency condition requiring immediate action.

Ventricular Tachycardia

A sequence of three PVCs in a row is ventricular tachycardia. The rate will be 120-200 bpm. Ventricular Tachycardia has two variations, monomorphic and polymorphic. These variations are discussed separately.

Ventricular Tachycardia Monomorphic

Monomorphic ventricular tachycardia occurs when the electrical impulse originates in one of the ventricules. The QRS complex is wide. Rate is above 100 bpm.

Ventricular Tachycardia Polymorphic

Polymorphic ventricular tachycardia has QRS complexes that very in shape and size. If a polymorphic ventricular tachycardia has a long QT Interval, it could be Torsade de Pointes.

Torsade de Pointes

Torsade de Pointes is a special form of ventricular tachycardia. The QRS complexes vary in shape and amplitude and appear to wind around the baseline.

Ventricular ending line needs to be treated stat to be switched back to atrial since the heart is missing ½ of the conduction it’s to normally receive from the atriums and if not reversed the heart will go into failure to heart attack or to asystole flat line and go into a cardiac arrest.

With PVCs=Premature Ventricle Contractions asymptomatic we just closely monitor the pt and telemetry the pt is on. Now a pt with PVCs and symtomatic usually meds with 0xygen (sometimes 02 alone resolves it but other times with meds) but if it gets worse into V Tachycardia the treatment is below.

Idioventricular Rhythm is usually with a slow brady pulse and needs meds.                           AIVR is usually hemodynamically tolerated and self-limited; thus, it rarely requires treatment.

Occasionally, patients may not tolerate AIVR due to (1) loss of atrial-ventricular synchrony, (2) relative rapid ventricular rate, or (3) ventricular tachycardia or ventricular fibrillation degenerated from AIVR (extremely rare). Under these situations, atropine can be used to increase the underlying sinus rate to inhibit AIVR.

Other treatments for AIVR, which include isoproterenol, verapamil, antiarrhythmic drugs such as lidocaine and amiodarone, and atrial overdriving pacing are only occasionally used today.

Patients with AIVR should be treated mainly for its underlying causes, such as digoxin toxicity, myocardial ischemia, and structure heart diseases. Beta-blockers are often used in patients with myocardial ischemia-reperfusion and cardiomyopathy

With Ventricular rhythms with fast pulse over 100 with symptomatic signs for the patient we may use as simple as valsalva pressure on the neck that medical staff only do but when pt is in asymptomatic (no symptoms) Ventricular Tachycardia (V-Tac) to even medications but when symptomatic if in V-Tac start cardioversion with a pulse if no pulse called pulseless V-Tac we use a defibrillator since there is no pulse there is no QRS to pace with in having the shock hit at the R wave, why? NO PULSE.

Treatment for Torsade de Pointes is Magnesium deficiency and Mag. Supplement given IV 2gms. Usually effective but if necessary the same as above as directed for it with a pulse or the other V Tac. (without a pulse)-See above.

Ventricular Fibrillation is when the ventricles are just quivering and the atriums in any ventricular rhythm doing nothing. The pt needs CPR and ASAP a defibrillator in hopes the shock will knock the rhythm back to a normal sinus or some form of a real rhythm.

Asystole which is a straight line, no pulse and this is CPR with epinephrine or Vasopressin 40 for only the replacement of the 1st or 2nd dose of Epinephrine 1mg. This is given 3-5 minutes (epinephrine). No defibrillation since no pulse. A rhythm may come back and if not the MD will call when CPR stops. Asystole is hard to resolve in most cases highier probability of resolution if in a hospital where close monitoring is done and its detected quicker.

The PURPOSE to all treating rhythms for all patients to the best optimal rhythm they can live with and hopefully reaching the best NSR-Normal Sinus Rhythm is give effective oxygen perfusion to the heart to allow it to do its function and get good amounts of oxygen to all our tissues to keep us alive. A human without oxygen or low oxygen to their tissues or any tissue is starvation to the tissues (in general) or to a tissue (Ex. Diabetic the foot to lack of 02 to cyanotic purple tissue to necrotic black tissue=dead to amputated since the tissue is dead.).

 

 

QUOTE FOR FRIDAY:

“Heart rhythm problems (heart arrhythmias) occur when the electrical impulses that coordinate your heartbeats don’t work properly, causing your heart to beat too fast, too slow or irregularly.

Heart arrhythmias (uh-RITH-me-uhs) may feel like a fluttering or racing heart and may be harmless. However, some heart arrhythmias may cause bothersome — sometimes even life-threatening — signs and symptoms.”

MAYO CLINIC

Part II What is and what does a cardiac rhythm tell us?

HeartBlocks2 HeartBlocks1

Than when AV nodes which can be blocked=atrio-ventricular block (AV heart block)=HB is a type of heart block in which the conduction between the atria and ventricles of the heart is impaired. Under normal conditions, the sinoatrial node (SA node) in the atria sets the intial pace for the heart, and these impulses travel down to the atriums than passing the AV valves into the ventricles and up the purkinje fibers . In an AV block, this message does not reach the ventricles or is impaired along the way. The ventricles of the heart have their own pacing mechanisms, which can maintain a lowered heart rate in the absence of SA stimulation.

The causes of pathological AV block are varied and include ischemia, infarction, fibrosis or drugs, and the blocks may be complete or may only impair the signaling between the SA and AV nodes.

Types of AV blocks: 1st degree HB which is NSR with a prolonged PR interval and can live a totally normal life with it. PR interval is the time from beginning of the p wave to the beginning of the qrs wave.  In all degrees of HB the PRI interval is prolonged. 

2nd degree HB-Mobitz I called Wenkebach is a NSR with a progressing increasing PR interval longer and longer till it actually drops a QRS and you see just the p wave without a QRS once and the rhythm restarts the pattern all over again.

Than 2nd degree HB-Mobitz II and this is a NSR with a prolonged PRI that measures the same amount each time but even though its not progressively getting longer its worse than Mobitz I always.  This is because with the same measurement prolonged PRI interval you only see 2 or 3 or more  p waves without the QRS and these need immediate external subcutaneous pacing or just as effective if its not available (external subcutaneous pacing) than a dopamine IV drip 2-10 mcg/kg/min or epinephrine IV drip 2 to 10 mcg/min.

Than there is complete HB 3rd degree heart block where no conduction from atriums to ventricles is going throught so the atriums are contracting the way they want and the ventricles contracting the way they want and total disassociation between the upper and lower chambers. Treatment is a most patients with acquired complete heart block will require a permanent pacemaker or an implantable cardioverter defibrillator (ICD).  Temporarily till OR try a subcutaneous pacing but may not work at all.

QUOTE FOR THURSDAY:

“An arrhythmia is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slowly, or with an irregular rhythm. When a heart beats too fast, the condition is called tachycardia. When a heart beats too slowly, the condition is called bradycardia.  Arrhythmia is caused by changes in heart tissue and activity or in the electrical signals that control your heartbeat.  Often there are no symptoms, but some people feel an irregular heartbeat. The most common test used to diagnose an arrhythmia is an electrocardiogram (EKG).”

National Heart, Lung and Blood Institute

Part I What does a cardiac rhythm tell us?

heart attack 2   cardiacmonitoring

First the engine to the human body is the heart; our car can’t work without a good working engine just like the body can’t work without a good working heart. In the heart we have a natural pacemaker of the heart which is called a Sinus Node. The sinus node conducts impulses from the top right chamber of the heart to the left chamber in the heart (called Atriums) and follows its way down to the bottom chambers (called ventricles) but for the conduction traveling originally from the right atrium to the left atrium the left side is slightly behind in conduction compared to the right when going down horizontally on each side due to the conduction having to cross over to the left top from the right top of the heart. Than the conduction continues on the atrio-ventricle valves (called AV valves) causing these valves to open and close completely allowing blood to drop in the ventricles from the atriums when open but without back up in the AV valves if the valve completely seals like any valve operating correctly by closing whether it be pipes, actual engine valves, or our veins/arteries or the actual heart in this case in the human body. Whatever valves used in our body or inanimate objects all pretty much play the same role.

The Rt. AV valve is the tricuspid valve the Lt. AV valve is the mitral valve. The conduction continues than to the bottom chambers-ventricles the conduction goes up and around the entire ventricles sensing up actually the purkinje fibers/papillary muscles to aid in contracting (depolarization) and relaxation (repolarization) of the ventricles. This allows the heart to go “Lub Dub” after from the SA node to the end process of conduction (described above) which gives a single beat or pulse. This allows our red blood cells that are more oxygenated than with carbon dioxide in them on the left side to go out the aorta to the bloodstream giving our tissues oxygen all over where needed when leaving the L side of the heart which after the 02 used up it will be returning to the right side when needing to refill with more oxygen and release the C02 from the red blood cells.   How do we get our red blood cells reoxygenated? The right side; when the Lt side is doing its function through this conduction process so is the right side. The Rt side allows the blood on the right side more carbon dioxide red blood cells that are carrying with some oxygen (but very little) so these red blood cells after going through the whole conduction process from the Rt. ventricle enter into the pulmonary artery to the lungs (a much shorter pathway than the Lt. side of the heart sends its RBCs-it goes from the aorta down the body up to the brain and back to the Rt. side of the heart needing more 02). This side is where the RBCs get reoxygenated than reentry to the left side of the heart going through that side out the aorta when those cells get into the Lt. through through our last process of the conduction system. This conduction system is so vital in our heart operating properly.   Since the Rt. and Lt. side have 2 completely different functions with our RBCs in dispensing 02 and C02 but both sides need to work correctly and are vital to keep us alive.

On a tele strip a sinus rhythm is made up of a P wave=Atriums contracting (atrial depolarization) than a straight line= atriums relaxing (atrial repolarization) than followed by a QRS wave=Ventricles contracting (ventricular depolarization) followed by a straight line than a T wave (ventricular depolarization) than in some a U wave. A U wave is on an electrocardiogram that is not always seen. It is typically small, and, by definition, follows the T wave. High probability you will see a U wave in normal sinus rhythm (NSR) or sinus bradycardia (SB). This is because the HR is slow enough to show a U wave on the rhythm you won’t see them in tachycardias. U waves are thought to represent repolarization of the papillary muscles or Purkinje fibers.

A regular QRS measures less than 0.12 which is with all atrial normal rhythms. If your rhythm has started in the atiums (upper chambers than the QRS is normal in measurement but if the rhythm starts in your ventricles-NOT GOOD-than the QRS is wide).

In most cases if the sinus node is working properly (located in the upper Rt chamber or atrium) with the person taking care of their body staying in good shape, eating healthy and getting rest to balance stress and no cardiac disease or in some cases compliance with all above in taking cardiac meds it shows on the telemetry monitor sinus rhythm heart rate (HR) 80 – 100 but if HR over 100-150 the person has sinus tachycardia (fast pulse) or if HR less than 60 it is sinus bradycardia (slow pulse) which maybe normal for the person, like an athlete.  All these rhythms derive from the sinus node originally and have regular rhythms giving you a regular HR not irregular unless you have a premature contraction from the atriums causing a PAC (Premature atrial contraction) or a PVC premature ventricle contraction that pop up in your sinus regular rhythm (but remember simple stress or caffeine can cause this as well as heart disease of many types). These premature contractions pop on the telemetry reading with the ingredients that make up a atrial rhythm = p wave + a normal QRS + t wave unlikely for a u wave or other rhythms as well which we will get into. All these occasional or frequent premature contractions mean is the heart rhythm of the heart is getting irritable. The more irritable any rhythm gets the higher the probability the rhythm can go into a worse rhythm.

PVCs in the rhythm has the features that are the same as a atrial except no p wave with the QRS measuring wide because the contraction is in the Ventricle where the p wave is in the chamber above it (atriums). In the Ventricles where a premature contraction occurs will only have a wide QRS rather than a regular because of the chambers its in=Ventricles.

PVCs will be discussed with Ventricular Rhythms.

If the sinus node breaks down the heart works by having the next area of conduction take over by compensating having the natural pacing take over in the atriums where we have atrial rhythms which start at a HR over 150 unless controlled atrial fibrillation but we’ll get into that rhythm shortly.

The rhythms you see when the atrium is the natural pacemaker of the heart taking over for the SA node that doesn’t work with the heart now compensating with the atrium, they are atrial tachycardia or SVT supraventricular tachycardia, simple meaning above the ventricles. This is where the rhythm is over 150 to 250 showing a p wave and QRS and usually not a T wave but if the HR is slow enough it might show on the telemetry monitor but usually doesn’t. If it shows no PACs or PVCs it’s a regular rhythm.

Another atrial rhythm is atrial flutter or A- Flutter)=AFL which shows only QRSs with flutter waves. A regular rhythm but this rhythm needs to be changed or in time the heart will stress out and lead on to more dangerous rhythms. This has no p waves but flutter waves with QRS waves. You can have 2 flutter waves to every QRS wave or 3 to every QRS or 4 flutter waves to every QRS or even 5 but the it can even be a variable ratio of flutter waves to every QRS wave meaning the rhythm is getting more irregular and dangerous. If left untreated, the side effects of AFL can be potentially life threatening. AFL makes it harder for the heart to pump blood effectively. With the blood moving more slowly, it is more likely to form clots. If the clot is pumped out of the heart, it could travel to the brain and lead to a stroke or heart attack.

The treatment for aflutter is cardioversion using a defibrillator in sync mode so when the shock is given it lands with the R wave and avoiding the vulnerable T wave section which if the shock landed their could put this rhythm into V Tac or V fib. The other atrial rhythm is atrial fibrillation (afib) and if under 100 great for if its chronic afib it will be hard to change to NSR but if a new Dx. of afib higher odds with cardioversion it will shock it the rhythm back into NSR. Those who are chronic afib or new afib that can’t convert to NSR usually are given Coumadin and ASA aspirin to keep the blood from clotting in the heart and breaking free with the irregular rhythm. Also possibly used is Beta blockers that slow the conduction of impulses down being a beta blocker it blocks the beta stimulus especially lopressor or Metoprolol that is a selective beta 1 stimulus blocker which is in the heart to slow the HR down. Than there is calcium channel blockers possibly used to slow down the HR if needed by blocking cardiac cells sending impulse signals from the top to the bottom of the heart. Keeping afib under 100 of a pulse rate and more like 80 or less can live a completely normal life if compliant with meds, diet and exercise.

QUOTE FOR WEDNESDAY:

“Despite the limitations of the study designs, there is consistent evidence that higher amounts of body fat are associated with increased risks of a number of cancers.”

National Cancer Institute