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    Understanding the Difference Between Hodgkin's and Non-Hodgkin's Lymphoma

    Patients, family members, and friends may have a difficult time understanding the differences between Hodgkin’s Lymphoma and Non-Hodgkin’s Lymphoma. To understand the differences between the two diseases, perhaps we should first begin by learning a little about lymphoma.


    What is Lymphoma?
    Lymphoma is a type of cancer that affects the lymphatic system of our bodies — our lymph nodes, bone marrow, tonsils, adenoids, spleen and thymus gland. Lymphoma can affect any of these parts of our lymphatic system.
    The lymphatic system carries lymph fluid containing white blood cells throughout our body to fight infections. Our spleen acts as a filter for our blood and helps fight infection. When our spleen detects a potentially dangerous bacteria or virus in our blood, the spleen and lymph nodes produce white blood cells called lymphocytes to fight the infection. Lymphocytes produce antibodies to kill dangerous micro-organisms and stop the spread of infection.
    Lymphomas make up about half of all of the blood cancers diagnosed each year. When abnormal lymphocytes develop into cancerous cells, they damage our immune system.
    What causes lymphoma to develop is unknown, but a person is more likely to develop lymphoma because of these factors. • Being older • Male • Caucasian • Having an autoimmune disease • Having HIV/AIDS • Having the Epstein-Bar virus, known for causing mononucleosis • Diet high in fats and meat • Exposure to certain pesticides

    Symptoms include: • Chest pain or difficulty breathing • Fatigue, lack of energy • Fever • Itchy skin • Rash • Sweating • Swollen lymph nodes • Weight loss

    There are two types of lymphoma — Hodgkin’s and non-Hodgkin’s.
    What is Hodgkin’s Lymphoma?


    About 12 percent of lymphomas are the Hodgkin’s type. Hodgkin’s Lymphoma was once almost universally incurable, but advanced research has turned this kind of lymphoma into a curable disease.
    As might be expected, Hodgkin’s Lymphoma is named after Sir Thomas Hodgkin’s, a British physician. In 1832, Sir Thomas Hodgkin’s recounted to his colleagues about some of his patients who had swollen lymph nodes and enlarged spleens that was unlike any other known disease of that period.
    In the early 1880’s, U.S. and German pathologists, independent of each other, wrote the microscopic diagnostic characteristics of the same disease that Sir Thomas Hodgkin’s had described. During that same time frame, two physicians used newly discovered X-ray beams on the enlarged lymph nodes of Hodgkin’s lymphoma patients and reported a substantial reduction in the size of their lymph nodes.
    Types of Hodgkin’s Lymphoma
    Classical Hodgkin’s Lymphoma (cHL). Approximately 95 percent of patients fall into the cHL category. The diagnostic criteria for cHL is the presence of a particular abnormal lymphocyte called a Reed-Sternberg cell. Then there are subsets:
    Nodular sclerosis Hodgkin’s lymphoma. This is the most common sub-type of cHL, accounting for about 80 percent of those diagnosed with cHL and is most common in young adults and women. Besides the Reed-Sternberg cells, there are also band of fibroid tissue in the lymph nodes. The presence of these bands is diagnostic. • Lymphocyte-rich classical Hodgkin’s lymphoma. Only 6 percent of cHL patients fall into this subset, with more male patients. Patients have the Reed-Sternberg cells along with normal with numerous normal lymphocytes in the lymph nodes. • Uncommon subsets. Less than 15 percent of cHL patients are diagnosed with mixed cellularity Hodgkin’s lymphoma (older patients) and lymphocyte-depleted Hodgkin’s lymphoma (seen in older patients and those with HIV and AIDS).
    Nodular lymphocyte-predominant Hodgkin’s lymphoma. Only 5 percent of Hodgkin’s Lymphoma patients have this type. It is more common in younger adults and is similar to one type of non-Hodgkin’s lymphoma.
    Hodgkin’s Lymphoma will be diagnosed in about 8,110 people in the U.S. this year. Death rates have been steadily declining with about 1,000 deaths estimated for 2019.
    Treatments may include chemotherapy, radiation and immunotherapy. Patients who don’t respond to treatment or whose cHL recurs may have a stem cell or bone marrow transplant.
    What is Non-Hodgkin’s Lymphoma?


    Non-Hodgkin’s Lymphoma covers the broad range of cancers that occur in our lymphatic system. The lymphatic system contains different types of lymphocytes:
    B-lymphocytes. B cells make antibodies that kill bacteria and fight other infections. • T-lymphocytes. T cells fight viruses and foreign cells along with triggering B cell to make antibodies. • Natural killer cells (NK cells). These specialized cells kill certain viruses, cells infected by viruses and some cancer cells.
    Non-Hodgkin’s lymphoma is diagnosed when these healthy B, T and NK cells change and grow out of control forming tumors. These tumors may cause additional symptoms depending on where the tumor is located. • An abdominal tumor may cause stretched skin over the belly or belly or back pain. • An enlarged spleen can cause a feeling of fullness or back pain. • A tumor in the groin can cause leg swelling. • A tumor in your underarm area may cause swelling in your arm. • A tumor in the center of your chest may press against your trachea, causing a cough. • A tumor in your brain may mimic a stroke.

    Almost 75,000 people in the U.S. will be diagnosed with NHL in 2019. NHL is the 9th most common cause of cancer death in the U.S.
    Types of Non-Hodgkin’s Lymphoma
    Treatment depends on what type of non-Hodgkin’s lymphoma a patient has. There are over 60 subtypes of non-Hodgkin’s lymphoma (NHL). • Ninety percent of patients in western countries have the B-cell type. • Ten percent have the T-cell type — most of these are in Asian countries. • Less than 1 percent have NK-cell type.

    NHL is also divided into two categories, by rate of growth. • Indolent NHL grows slowly and may not be treated when it is first diagnosed. • Aggressive NHL develops quickly, and treatment begins within weeks.
    The two most common subtypes of B cell NHL are diffuse large B-cell lymphoma (DLBCL) and Follicular lymphoma. These two subtypes account for about half of all NHL. The remaining subtypes each account for less than 5 percent each, with most of the other subtypes considered rare.
    Treatments for NHL include chemotherapy, radiation, targeted therapy and immunotherapy. Treatment choices depend on stage and type.
    What are the Differences?
    These two kinds of cancer surely sound similar. Although they share the lymphatic system as the site of cancer activity, they have many differences. What are the major differences?
    • Hodgkin’s lymphoma’s hallmark difference is the presence of Reed-Sternberg cells (B cells that turn malignant, grow very large and may have more than one nucleus). • The first symptom of Hodgkin’s lymphoma is enlarged lymph nodes. The swollen lymph nodes are usually in the neck, under the arms and the chest (the upper body). • Non-Hodgkin’s lymphoma can develop from B or T cells and begin in other parts of the body, like the spleen, thymus gland tonsils or adenoids or in normal organs. • Hodgkin’s lymphoma is seen most often in young adults, 15 to 24, and in people of 60 while non-Hodgkin’s lymphoma occurs in all age groups. The median age for NHL is 60. • Both kinds of lymphoma can occur in children and teenagers. • Non-Hodgkin’s lymphoma is much more common. • Hodgkin’s lymphoma is often diagnosed at an earlier stage when it is easier to treat.

    These two types of cancer are similar in that they both occur in the lymphatic system. However, they have distinct disease progressions with different treatments. An accurate diagnosis is the first step in successful treatment.
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    Measles Outbreak An Unseen Risk for Some Cancer Patients

    You may be wondering why we are talking about measles and cancer. But the recent measles outbreak reminds us that measles is a potentially dangerous disease was thought to have been eliminated in the United States.


    History of the Measles Vaccine

    Measles was first identified in recorded history in the 9th century by a Persian doctor. In 1757, a Scottish doctor (Francis Home) discovered measles was an infectious disease carried in the blood of patients.
    In 1912, measles officially became a notifiable disease in the U.S. During the first 10 years after measles was declared a notifiable disease, some 6,000 deaths in the U.S. were attributed to measles.
    So most of us who are “Baby Boomers” had the measles as children. In the decade before 1963, virtually every child contracted measles before they were 15. Some 3-to-4 million children contracted measles every year — resulting in 400-to-500 deaths annually, almost 50,000 hospitalizations annually and 1,000 cases of encephalitis (swelling of the brain), a serious complication of the measles.
    The first measles vaccine was developed in 1963. By 1968, an improved measles vaccine combined with mumps and rubella (known as MMR) became the standard vaccine and is still in use today.
    By 2000, measles was declared “eliminated” (absence of continuous disease transmission for greater than 12 months) in the United States. 2019 Outbreak Facts
    By early April, over 450 cases of measles have been reported to the Centers of Disease Control and Prevention (CDC). Measles is HIGHLY contagious. That means that more than 90 percent of people who are not immune (because they had measles as a child or were vaccinated) will contract measles.
    Measles is a serious disease, resulting in the hospitalization of one out of every four people who contract measles. There is no treatment — doctors can only treat the symptoms like ear infection (which can result in hearing loss), pneumonia and encephalitis.
    The bad news is that measles can be spread up to four days before a person has symptoms.


    Why are We Experiencing a Measles Outbreak?
    Parents are refusing to have their children vaccinated. Reasons for not vaccinating include: Will overwhelm child’s immune system Vaccines contain toxins Vaccines don’t work – comparing childhood vaccines to flu vaccines Vaccines are a way for doctors and pharmaceutical companies to make more money Vaccine side effects are worse than the disease Vaccines cause autism Violates parent’s rights Against religious beliefs Violates personal or philosophical beliefs

    Because measles are communicable four days before symptoms, any unvaccinated child exposed in day care, kindergarten or school has a 90 percent chance of contracting measles.
    Are Measles a Risk for Cancer Patients?
    Some cancer patients are immune-compromised because of the treatments they had for their particular type of cancer. These patients are at extremely high risk.

    Stem cell transplants. Stem cell recipients lose the protection they had from their past vaccinations. They have to be revaccinated, usually beginning about 6-to-12 months after the transplant. They have to delay some vaccinations that use a live virus for even longer. During this period before revaccination, they are vulnerable.
    Bone marrow transplants. Bone marrow transplant patients can’t get the measles, mumps and rubella (MMR) vaccine for at least two years afterward. They are at high risk for serious complications if they contract measles.


    Pediatric cancer patients. Children in active cancer treatment can’t receive their vaccinations until they are out of cancer treatment. A young pediatric cancer patient may have received that first dose of the MMR vaccine but is too young (less than four years old) to receive their second dose. A pediatric cancer patient may be a bone marrow or stem cell transplant recipient and lose the immunity from their first MMR vaccine.
    Neutropenia. Patients with extremely low white counts should avoid any contact with someone who has measles and avoid crowds if their community has experienced a measles outbreak. Avoid contact with children (including your grandchildren) if they have recently received a live virus vaccine – MMR is a live weakened virus vaccine.
    The Bottom Line …
    Use good judgment.

    Bone marrow and stem cell transplant patients need to be extra cautious; it’s probably best to decline invitations to events where there are lots of children. Be sure to talk to your transplant team about the risk of measles and the precautions you should take.
    Be extra cautious if you are the parent or grandparent of a pediatric cancer patient.
    What if you are exposed to a person with measles? If you are in active treatment for cancer, tell your oncologist immediately. They may give you measles immune globulin, a blood product containing measles antibodies that will help prevent measles from developing.


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    Important Facts About Esophageal Cancer

    April is the month that we highlight esophageal cancer, one of the faster increasing cancer diagnoses in the Western world, increasing 600 percent in the last 35 years. Most of us hear about breast, colorectal and lung cancers, but every adult needs to be aware of the risk factors and early symptoms of esophageal cancer.


    What is the Esophagus?
    The esophagus is the narrow, muscular tube that connects our mouth to our stomach. The muscular walls of our esophagus push food from our mouth and the liquids we drink into our stomach. The esophagus is between 11 and 13 inches long (28-33 cm) and about three-quarters of an inch in diameter (2 cm).

    Our esophagus consists of four layers.

    Inner lining. This lining is moist to help the food pass into the stomach. Submucosa. The glands that produce the moist mucous are located here. Muscle layer. These muscles push the food we eat down in our stomach. Outer layer. The layer that covers our esophagus.
    These layers are important because different types of esophageal cancer
    attack different layers and sections of the esophagus. Statistics
    About 17,650 people (13,750 men and 3,900 women) will be diagnosed in the U.S. during 2019. Given the disproportionate number of men diagnosed with esophageal cancer, it is not surprising that it the seventh most common cause of cancer death in men in the U.S. Every 36 minutes, someone dies of esophageal cancer in the U.S.
    Risk Factors for Esophageal Cancer
    There are two types of esophageal cancer. Risk factors vary by which type of esophageal cancer a patient has.
    Squamous cell carcinoma. Begins in the squamous cells of the lining of the esophagus and is usually located in the upper and middle regions of the esophagus.


    Alcohol consumption (particularly heavier consumption) – alcohol contains two substances that cause changes in our DNA – ethanol and acetaldehyde.
    Achalasia – a condition when the lower ring of the esophagus does not during the swallowing of food. Diet – low consumption of fruits and vegetables. Hot liquids – drinking liquids at extremely high temperatures. Lye – children who accidentally swallowed lye are at increased risk. Race – African-Americans are twice as likely to develop squamous cell esophageal cancer. Tobacco – using any type of tobacco increases the risk, whether it’s cigarettes, cigars, pipes or smokeless tobacco products like chewing tobacco or snuff.
    Adenocarcinoma. Begins in the glandular tissue in the lower portion of the esophagus.

    Acid reflux – especially if frequent and severe. Presence of a hiatal hernia can increase acid reflux. Some people with acid reflux develop Barrett's esophagus, which is a risk factor for esophageal cancer. Obesity – being overweight increases the risk of adenocarcinoma of the esophagus. Men are 3 to 4 times more likely to develop either type of esophageal cancer. Growing older is an unavoidable risk factor. Esophageal cancer occurs most often in people, aged 45 to 70.
    What Are the Symptoms of Esophageal Cancer?
    The sad reality of esophageal cancer is that there are few, if any symptoms, in its earliest stages. Most people don’t have symptoms until the tumor is large enough to block the esophagus making swallowing difficult.
    Pressure or burning in the chest Difficulty swallowing Indigestion or heartburn Vomiting Frequent choking on food Unexplained weight loss Coughing or hoarseness Pain behind the breastbone or in the throat

    Diagnostic Tests
    Some specialized tests help doctors determine if you have esophageal cancer. They will take a complete medical history and evaluate any risk factors you have. Your risk factors and symptoms help your physician determine what tests to perform.
    Barium swallow. Patients swallow a liquid containing barium. The barium coats the esophagus. Then X-rays are taken – a tumor or other abnormality will stand out on the X-ray.
    Upper endoscopy. Sometimes, called an “upper GI” — this test allows a gastroenterologist to look at the esophagus through a thin, flexible tube. A suspicious area can be biopsied.
    Endoscopic ultrasound. This ultrasound is perform at the same time as the upper endoscopy. The ultrasound produces a picture/map of the walls of the esophagus and near-by lymph nodes. The ultrasound shows how deep a tumor has grown into the wall of the esophagus. The ultrasound also helps in getting a biopsy of lymph nodes.
    Imaging tests. Imaging tests allow your medical team to see if a tumor has spread to local areas or other parts of your body. These tests include CT scans, PET scans and MRIs.
    These diagnostic tests also provide sufficient information for staging of esophageal cancer.


    What Treatments Are Available?
    Surgery may be all that is needed for early-stage esophageal cancer. Surgery may also provide relief of symptoms — this is known as palliative care. A feeding tube may be placed before beginning chemotherapy or radiation so that a patient receives the nutrition they need.
    Palliative endoscopy includes an endoscopic procedure to dilate their esophagus, or physicians may place an expandable, metal mesh stent to keep the esophagus open. Specialized procedures to freeze or heat cancer cells may provide symptom relief before and during treatment.
    Radiation therapy aims X-ray beams at the tumor to shrink the tumor. Occasionally, internal radiation to the tumor by temporarily inserting a radioactive wire into the esophagus. Clinical trials are underway using proton therapy.
    Chemotherapy, targeted therapy and immunotherapy are other tools to treat esophageal cancer. Every patient’s particular circumstances differ so treatment is personalized for the patient. If a patient has metastatic esophageal cancer, genetic testing helps oncologists choose a targeted therapy or immunotherapy which will be effective.
    Clinical trials. Many patients opt for a clinical trial to have access to new cutting-edge medication and radiation therapies.
    WhatNext?
    Patients at high risk may want to consider chemoprevention. Patients who have Barrett’s esophagus may want to talk to their gastroenterologist about this pro-active method of preventing the development of esophageal cancer.
    New chemotherapy combinations offer new hope. More patients with genetic mutations will benefit from targeted therapy and immunotherapy. Never underestimate the value of a second opinion.
    Esophageal Resources Pages
    Esophageal Cancer Awareness Association
    Esophageal Cancer Education Association
    Esophageal Cancer Action Network



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    April is Testicular Cancer Awareness Month

    April is Testicular Cancer Awareness Month. Testicular cancer is an uncommon cancer. About 1 in every 250 men will be diagnosed with testicular cancer. In the U.S., about 9, 560 men will be diagnosed with this cancer in 2019. About 400 men die annually of advanced testicular cancer.


    Every hour of every day of the year, a man hears the words – “You have testicular cancer.”
    Testicular cancer is a younger man's disease, occurring mostly in men ages 15-34. It is most common in Caucasian men. Testicular cancer rates had been rising over the last four decades, but the rates have been declining recently.
    Symptoms
    Survival rates are extremely high when testicular cancer is caught early. So recognition of symptoms is key to a positive outcome. Regular self-exams are critical to a man’s health — as are breast self-exams for women. Most men (or their partners) detect their cancer themselves. Early testicular cancer is usually painless and you don’t feel sick.

    Many men find that performing their monthly self-exam is easiest in a warm shower. The scrotum is relaxed allowing each testicle to be easily examined. Don’t be alarmed if one testicle is larger than the other or if one is lower than the other. This is normal.
    Lump or swelling in the testicle – may feel like a garden pea or marble Any enlargement of a testicle A significant loss of size in one of the testicles A feeling of heaviness in the scrotum A dull ache in the lower abdomen, back or in the groin A sudden collection of fluid in the scrotum Pain or discomfort in a testicle or the scrotum Enlargement or tenderness of the breasts


    See your doctor immediately if you detect any lump, nodule or swelling in one or both of your testicles or one of these other symptoms
    . Don’t wait — remember that testicle cancer diagnosed in its earliest stages is almost always curable.
    Risk Factors
    Researchers don’t know why cancer forms in the testicles, but there are several risk factors. If you have any risk factors, talk to your doctor about screenings to help detect testicular cancer early.
    An undescended testicle Family history of testicular cancer HIV infection Carcinoma in situ of the testicle Having had testicular cancer before Being Caucasian – testicular cancer is 4 to 5 times more likely than in Asian or African-American men Body size – some studies show that taller men are at slightly increased risk Age – half of the men diagnosed are between 20 and 34
    How is Testicular Cancer Diagnosed?
    Not all lumps or irregularities are cancerous. Urologists usually care for men if they experience a lump, swelling or other abnormality. Ultrasound. An ultrasound is a non-invasive test where sound waves produce an image of your scrotum and testicles. The ultrasound can detect whether a lump is filled with fluid or is a solid tumor. The ultrasound detects whether the lump is on the inside or outside of the testicle. Blood tests. Cancerous tumors in the testicles may make proteins called alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG), called tumor markers. Elevated levels of these proteins are suggestive of cancer in the testicle.
    Surgery. When the ultrasound reveals a solid tumor and your tumor marker tests are elevated, a surgeon removes the testicle and a biopsy is done. The pathologist reports the type of cancer and to what extent it has spread.
    Imaging tests. CT scans, MRIs, PET or bone scans show if your cancer has spread locally or to other parts of your body.
    The stage is the extent of the growth of a cancerous tumor. The tumor may be localized or it might have grown outside the testicle or spread to the lymph nodes.


    Treatments
    Surgery may be the only treatment you need. You will have regular check-ups afterward including checking your tumor makers to detect if your cancer might have returned.
    Most men are still able to have normal sexual relations and be able to father children. Patients may decide to have reconstructive surgery and implant an artificial testicle. Every patient is different, and the decision is up to each patient.
    Treatment options
    often depend on whether your cancer is a seminoma or non-seminoma type.
    Patients with lymph node involvement may receive radiation or chemotherapy after surgery to help prevent recurrence. Men may decide to have sperm banking if they need additional surgery and want to have children.
    Regular physical exams and blood work help doctors detect a possible recurrence and treat it immediately. Most of the time, cancer recurs within the first two years after treatment.
    What Next?
    Testicular cancer is an earth-shattering diagnosis for many young men. These young men wonder about their future. If a young man is single, he wonders about dating, marriage and having children. If he’s a young father, he worries about dying and leaving his wife and children. He wonders if his wife will still love him and if they’ll be able to have more children.
    More than 220,000 testicular cancer survivors are living in the U.S. Just as with other cancer survivors, reading others’ stories helps us re-aright ourselves and continue living.
    Here are some resources to help survivors after testicular cancer.

    Sex After Testicular Cancer Fertility and Sexuality Testicular Cancer Patient StoriesApril is Testicular Cancer Awareness Month. Testicular cancer is an uncommon cancer. About 1 in every 250

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    Chemo and Radiation's Effect on Your Eyes

    When we think of chemotherapy side effects, we think about nausea, fatigue and low blood counts. But did you know that some chemotherapy drugs and other cancer treatments may affect your eyes? From tearing to dry eyes to sensitivity to light, be sure to tell your oncologist about any changes to your eyes.


    How Can Chemotherapy Affect Our Eyes?
    Chemotherapy and the steroids that help prevent side effects can cause eye problems.
    • Cataracts. When the lens of your eye become cloudy, the cloudy lens is called a cataract. As the cloudy area grows larger, your vision gets dimmer. Your color vision is adversely affected too. The usual cause of cataracts is aging, but steroids (used to help prevent side effects from chemo), exposure to radiation and long term exposure to sunlight may promote the development of cataracts. Rarely, tamoxifen can cause cataracts. Many oncologists recommend wearing sunglasses to help prevent development of cataracts — if you already wear glasses, get a pair of the wear over sunglasses.
    • Conjunctivitis. This is also called “pink eye.” It’s inflammation of the conjunctiva, the membrane that covers the white of your eye. Symptoms include redness, swelling of the eyelids, scratchiness, watering or pus. They may also be sensitive to bright light. Conjunctivitis can be highly contagious so practice good hygiene. Your doctor will probably prescribe eye drops or antibiotics. Medicines most likely to cause conjunctivitis are capecitabine, carmustine, epirubicin, methotrexate and oprevelkin.
    • Dry Eye Syndrome. Dry eye syndrome is caused from lack of a key chemical that lubricates your eyes. Your eyes may be producing enough tears, but if this particular chemical is missing from your tears, you’ll have dry eye syndrome. Artificial tears or eye ointments provide relief. Isotretinoin and tretinoin may contribute to the development of dry eye.
    • Glaucoma. Glaucoma occurs when increased pressure within the eye damages the optic nerve. Untreated, glaucoma will cause irreversible blindness. Pressure buildup may rarely appear if a tear duct becomes blocked due to chemotherapy. Or glaucoma can occur as a natural occurrence during treatment. Be sure to have your annual eye exam even when you are in cancer treatment.
    • Photophobia. Photophobia is extreme sensitivity to light. Wearing sunglasses helps, but be sure to call your oncologist and let them know that this is a new symptom. A few chemotherapy drugs (cytarabine, fluorouracil, isotretinoin and tretinoin) can cause photophobia.
    • Watery Eyes. Also called excessive tearing, you may notice that tearing and watering eyes similar to “allergy eyes.” Some chemotherapy drugs can occasionally cause your tear ducts to become blocked creating watery eyes. Be sure to mention this symptom to your oncologist — a stent can be inserted during treatment to keep your tear ducts open. The watery eyes can become problematic if your job is in television, movies or modeling. Capecitabine, cytarabine, doxorubicin, and fluorouracil may contribute to the development of watery eyes.


    Can Radiation Therapy Affect your Eyes?
    Patients with head and neck cancers can suffer side effects to their eyes. Radiation may affect the eyelids, block the tear ducts or even a radiation-induced optic neuropathy, which could affect the optic nerve. Proton therapy sometimes results in the loss of a patient’s eyelashes because of the placement of markers. Diabetic patients are at particular risk if they receive radiation to the back of their eyes.
    Does Immunotherapy Affect the Eyes?
    Because immunotherapy generates an immune response in patients, it can cause inflammation of the eyes. Ocular side effects are uncommon — they include conjunctivitis, scleritis, intraocular inflammation, Graves’ ophthalmopathy as well as fluid buildup or edema in and around the eye.
    Occasionally, a bone marrow transplant patient will experience graft-versus-host disease that affects the eyes. Loss of eye pigment, eyelashes or eyebrows or problems involving the cornea can occur.


    The Bottom Line …
    Be proactive about your eye health. Always tell your treatment team about any eye symptom or change in vision. It’s a good idea to have an eye exam before treatment to serve as a baseline. Have regular eye exams at least every 12 months during and after treatment to detect changes. Never assume anything about your eye health during cancer treatment. Let your doctor know immediately if you experience any change in your vision or excessive tearing.


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    April is Oral, Head, and Neck Cancer Awareness Month

    April 7-14, 2019 is Head and Neck Cancer Awareness Week. Head and Neck cancer includes a family of cancers that occur in the larynx, mouth, nose, sinuses and throat. Many of the particular locations are uncommon locations for cancer to occur, but when this group of cancers that occur in the oral, head and neck are combined, over 65,000 people in the U.S. are diagnosed annually.


    Statistics and Types of Head and Neck Cancer
    Head and neck cancer is more prevalent among men. Of the 65,000 people diagnosed annually, about 48,000 are men. Most patients are over 50. Almost 15,000 people die annually in the U.S. due to head and neck cancer.
    Most head and neck cancers are squamous cell cancers. It begins in the flat squamous cells that are on the surfaces of the head and neck. There are five major types, grouped according to their location.
    Laryngeal and hypopharyngeal cancer. The larynx is often called your voice box.

    Nasal cavity and paranasal sinus cancer. These areas are the air-filled areas in our nasal cavity.

    Nasopharyngeal cancer. This is the area of our upper throat located behind our nose.

    Oral and oropharyngeal cancer. These cancers may occur in our mouth, on our tongue or in the middle of our throat (between the tonsils and upper part of our voice box).

    Salivary gland cancer. The salivary glands produce saliva that keeps our mouth moist.



    What are the Risk Factors?
    Two substances are the biggest risk factors for head and neck cancer.

    Tobacco use. Smoking cigarettes, pipes or cigars increases your risk for head and neck cancer. Chewing tobacco or snuff use also contribute to one’s risk for head and neck cancer. About 85 percent of head and neck cancer is attributed to tobacco use.
    Alcohol. Frequent and/or heavy alcohol consumption increases the risk for esophagus, larynx, mouth and pharynx cancer.
    Other risk factors include sun exposure (for lip cancer), the Epstein-Barr virus (the “mono” virus, the HPV virus, gender (2-3 times more men), age (over 40), poor oral/dental hygiene, occupational hazards, marijuana use, low vitamin A and B intake, acid reflux and a weakened immune system are all contributing factors for head and neck cancer.
    What are the Symptoms of Head and Neck Cancer?
    Some symptoms seem obvious for head or neck cancer, but some symptoms are a little unexpected. Consult with your doctor or dentist about symptoms like these.
    Sore throat that does not go away Lump or sore that does not heal Trouble swallowing Hoarse-sounding voice Difficulty speaking Persistent earache Sinus congestion Bad breath Mouth ulcers or sores that do not heal Sore tongue White or dark red patches on the sides of the mouth or the tongue Bleeding from the mouth Numbness in the mouth Enlarged lymph nodes in the neck Neck pain



    How is Head and Neck Cancer Diagnosed?
    Your doctor will take a complete medical history and do a thorough physical exam. Your doctor will feel for lumps in your neck, lips, gums and cheeks. Your doctor performs a complete visual exam of your mouth, throat and nasal passages.
    If cancer is suspected in the nasal passages or your throat, they will utilize an endoscope. Patients receive sedation — the endoscope is a thin, lighted, flexible tube that allows a physician to look at our throats, larynx, tonsils, sinus cavities and other inaccessible areas.
    A biopsy determines if a lump, tumor or lesion contains cancer cells. The biopsy may also test to see if the person has HPV — people with HPV are at higher risk for head and neck cancer. The presence of HPV may help determine the most effective treatment.
    Imaging tests such as CT scans, MRIs, and sonograms help determine the size and exact location of any cancerous tumors. These imaging tests help determine the stage of head and neck cancer.
    Treatments for Head and Neck Cancer
    A multidisciplinary team of medical professions treat head and neck cancer patients. Specialties include surgeons, oncologists, radiologists, dental specialists and a reconstructive/plastic surgeon. You may also get help from a speech pathologist and physical therapist. Just remember that you are never alone — there is help available for you and your family members throughout and after treatment.
    Most treatment plans include surgery and/or radiation. Sometimes, chemotherapy is given before surgery to shrink the patient’s tumor. Chemotherapy, targeted therapy or immunotherapy is utilized for advanced or recurrent head and neck cancers.
    Side Effects and Treatments
    As we have learned from other kinds of cancer, cancer occurs in essential parts of body and may cause uncomfortable side effects. Eating and drinking. The tumor itself may cause swallowing problems, the treatments may damage muscles and nerves. Swallowing exercises help strengthen the muscles during treatment and help keep them flexible.
    Dry mouth. Radiation may damage the salivary glands and cause dry mouth, leading to dental problems. Use alcohol-free mouthwash, drink lots of fluids and suck on ice chips. Acupuncture helps if some of your salivary glands still work.
    Tooth loss. Radiation sometimes damages the bones of your mouth resulting in tooth loss. Patients should get needed dental work done a month before radiation begins to minimize tooth damage.
    Lymphedema. Removal of lymph nodes during surgery or damage to lymph nodes from radiation may cause lymphedema. Facial and neck tissues swell, causing discomfort. Be sure to let your healthcare team know ASAP — exercises and massage techniques ease the discomfort and help prevent further damage.
    Body image/self-confidence. Weight loss, tooth loss or a prosthetic voice box may cause a patient emotional distress. Be sure to talk to your healthcare team about the feelings and emotions you are experiencing. Counseling helps many patients and their family adjust.
    What Next?
    Several organizations help people with head and neck cancer. These groups provide support and hope during and after treatment.
    Support for People with Oral and Head and Neck Cancer (SPOHNC) Head and Neck Cancer Alliance American Head and Neck Society Oral Cancer Foundation