Is It Preventable?
Discussant: Jennifer Obiles-Madera, M.D.
Cervical Cancer is a common illness of the cervix, which is the entrance between the vagina and the uterus. It is the second most common cancer among women worldwide, and is the leading cause of cancer-related deaths among women in the developing countries. Like any other cancer, it is caused by the abnormal growth of cells; and when normal cells change into cancer cells, it usually takes up to 10 to 30 years. Nevertheless, this illness is preventable and curable at an early stage.
The cause of Cervical Cancer is HPV (Human Papilloma Virus). It is a DNA virus that infects the skin (epithelial or mucosa) cells. HPV is a common virus that easily spreads through skin to skin contact even without sexual penetration. Most women will get infected by the HPV at one point in their lives. Half of the time, this will be an oncogenic type of HPV.
The factors which increase the chance of getting Cervical Cancer are: (1) increased number of pregnancies, (2) history of smoking, (3) long term use of oral contraceptives, (4) sexually transmitted infections, and (5) sexual behavior: early onset of sexual intercourse, multiple sexual partners, and having partners with multiple partners. All factors is due to the persistent and chronic exposure to infection, with high risk oncogenic or cancer-causing type of HPV.
The symptoms are usually diagnosed late because the early stage of cervical cancer produces no symptoms. Some of the late symptoms are: vaginal bleeding after intercourse or between menstrual periods or after menopause, watery bloody vaginal discharge that may be heavy and foul smelling, pelvic pain or pain experienced during intercourse.
The steps below can be followed to prevent Cervical Cancer:
n reduce high-risk sexual behavior by having lifetime mutual monogamy
n reduce or avoid exposure to HPV and other sexually transmitted infection
n identifying and treating precancerous lesions before they progress to cervical cancer, through screening tests
Cervical Cancer Vaccine
The HPV Vaccine can prevent most cases of cervical cancer and protect against some of the most common types of HPV. For most benefit, person should complete all 3 doses before sexual activity begins. The following are the most popular HPV vaccines: (1) Cervarix: given to females only, and (2) Garadsil: can prevent some vaginal and vulvar cancers of females, and genital warts of males.
Cervical cancer tests should be started about 3 years after start of sexual activity, but not earlier than 21 years old. Below are the tests conducted to detect HPV infection/Cervical Cancer:
n Pap Smear: gold standard in the country, but higher cost
n Visual Inspection with Acetic Acid Wash (VIA): lower cost
n HPV DNA Test: detects cell change caused by HPV infection
n Biopsy: confirms presence of cervical cancer
Like any other cancer the most common treatment is surgery or chemotherapy with concomitant radiotherapy.
Medical Forum No. 260
Stem Cells: Separating Truth from Myth
Discussant: Arvin C. Faundo, M.D.
tem Cell are cells which are capable of self-renewal and differentiation into specialized cells. Simply put, stem cells are “nature’s building blocks and repairmen”. A popular treatment nowadays is Stem Cell Therapy, which is defined as the procedure of using living cells for replacement, regeneration or repair of diseased, injured or aged cells, tissues or organs. The stem cells may come from embryos (which poses ethical issues), birth tissues (placenta, umbilical cord) which are normally discarded, and all organs of an adult especially bone marrow (blood, eyes, fats, joints, heart, teeth).
There are different types of stem cells:
n Hematopoietic (HSC) - forms blood cells
n Epithelial (EpSC) - forms lining of organs
n Mesenchymal (MSC) - forms bones, joints and muscles
And there are two classification of Stem Cell Therapy namely, Allogeneic (from related or unrelated donor) and Autologous (from self). Stem cells can be administered through systemic procedure via intravenous (through bone marrow), intra-arterial (through limbs), or local/direct application of eye, heart, joint, spinal cord, etc.
It can be the main mode of treatment or the replacement for unsuccessful treatments using other options. The endpoint is the cure of the disease, and not just control. Some of the diseases which turn to Stem Cell Therapy are blood cancer (leukemias and lymphomas), metabolic disorders, blood disorders (thalassemia, aplastic anemia), immune-deficiencies, and solid malignancy (neuroblastoma).
There has been a number of clinical trials for Stem Cell Therapy for cerebral palsy, spinal cord injury, diabetes mellitus, heart attack or failure, etc. Although Stem Cell Therapy has shown to be beneficial, it has not been adopted as the standard treatment. Based from the trials, Stem Cell Therapy may have slowed the progression of the disease but not necessarily have cured it. Nevertheless, the therapy may fully cure the disease but the optimum dosage and usage of the stem cells is still under investigation. On the other hand, experimental therapy has been done on Alzheimer disease, Parkinson disease, and regenerative medicine but there is no proof yet on the efficacy in humans.
Some complications that may arise from Stem Cell Therapy are:
n Tumor formation: associated with embryonic stem cells
n Immune reactions: severe allergy due to foreign substances
n Iatrogenic: bleeding, herniation, etc.
Medical Forum No. 261
What is the Visual Outlook for Children in the Future?
Discussant: Ma. Rebecca P. Abes-Servera, M.D.
yopia or nearsightedness is when close objects look clear but distant objects appear blurred. There is an increasing incidence of myopia especially among East Asians. Nevertheless, myopia’s progression can be slowed down.
There is a number of factors which causes myopia and it can be one or a combination of the following: parental myopia, long reading hours or use of computer, and lack of outdoor exposure.
The following are some steps which can be taken to slow down progression of this illness:
n Use of antimuscarinic eye drops
n Use of bifocal lenses
n Use of rigid gas permeable contact lenses
n Under correct prescription lenses
n Increase time spent outdoors
Medical Forum No. 262
Towards a Healthy Heart
Discussant: Eduardo Tin Hay, M.D.
lood pressure levels, the rate of age-related increases in blood pressure, and the prevalence of hypertension vary among countries and among subpopulations within a country. Hypertension or high blood pressure is present in all populations except for a small number of individuals living in primitive, culturally isolated societies.
In industrialized societies, blood pressure increases steadily during the first two decades of life. In 2001, approximately 7.6 million deaths (13–15% of the total) and 92 million disability-adjusted life years worldwide.
Below are the factors which double the risk of cardiovascular diseases:
n coronary heart disease (CHD)
n congestive heart failure (CHF)
n ischemic and hemorrhagic stroke
n peripheral arterial disease
n renal failure
Antihypertensive therapy reduces the risks of cardiovascular and renal disease, but is still inadequate to treat hypertension.
Medical Forum No. 263
Leukemia: Diagnosis and Treatment
Discussant: Juanita Lu Lim, M.D.
eukemia or cancer of the blood cells, is classified as: lymphocytic or myelogenous, based on the type of blood cells involved. Leukemia can be acute or chronic.
The symptoms of Acute Leukemia include:
n pallor, fatigue, shortness of breath
n presence of bruises, nose bleeding
n fever, frequent infections
n enlarged lymph nodes, spleen, liver
Diagnosis of acute leukemia is via examination of the bone marrow, while treatment can be done by chemotherapy or stem cell transplant.
On the other hand, Chronic Leukemia symptoms include:
n fatigue, weight loss, loss of appetite
n early satiety, abdominal discomfort
n enlarged lymph nodes, spleen
n low-grade fever
n or may be asymptomatic (no symptoms)
Diagnosis of chronic leukemia is done thru examination of the peripheral blood and bone marrow, or chromosomal analysis for chronic myelogenous leukemia. In chronic leukemia, treatment is administered via less toxic oral medications.
Medical Forum No. 264
Rainy Season Blues: Leptospirosis and Influenza in the Philippines
Discussant: Patrick Leonard G. Co, M.D.
eptospirosis is a common tropical zoonotic infection caused by a spiral-shaped bacteria called leptospires. This bacteria is normally found in the urine of both wild and domestic animals. Humans are most commonly infected after coming in direct contact with the urine of an infected animal, or with contaminated soil/water, or after ingestion of contaminated food.
Leptospires can penetrate both abraded or waterlogged skin as well as mucous membranes (like eyes, nose and mouth). It can also invade the bloodstream, where they leak and burst while the blood carries the bacteria to other organs (liver, kidneys, lungs and brain), in turn causing more serious damage.
The clinical manifestation of leptospirosis are (1) mild: conjunctival suffusion, abdominal pain and influenza-like illness with fever, muscle and joint pains and (2) severe: liver and kidney failure, uncontrollable bleeding (Weil’s disease) and death. Diagnosis is done thru clinical criteria.
Treatment for mild infection is done thru both antibiotics and supportive care (outpatient), while hospitalization must be done to administer dialysis and mechanical ventilator support for moderate to severe infection.
Like any other infection, Leptospirosis can be prevented by wearing gloves and boots to avoid contact with infected animals, their urine, or contaminated soil or water.
On the other hand, Influenza is a common, serious and acute viral infection caused primarily by influenza A and B viruses. Influenza spreads easily from person to person and is transmitted by contact with virus-laden respiratory secretions of infected persons. It can also be transmitted directly or indirectly via contaminated objects and surfaces. Persons with influenza are contagious starting day 1 prior to the appearance of symptoms, until 5 to 7 days after symptoms appear.
Below are the clinical manifestations of influenza infection (after 2 day’s incubation period):
n nasal discharge
n sore throat
n red, watery eyes
n weakness, severe fatigue
n cough and other respiratory symptoms
Diagnosis is thru clinical criteria, chest x-ray to rule out pneumonia, or laboratory confirmation via viral culture of nasopharyngeal secretions.
Treatment can be done by isolating patients, maintaining adequate hydration and nutrition, bed rest, judicious use of antipyretics. An antiviral therapy with Oseltamivir is considered most effective when given during the first 48 hours, and reduces the risk of severe complications and death. It may also be used as post-exposure prophylaxis to prevent spread of infection.
Spread of influenza can be prevented most effectively by immunization. Immunization is via the Trivalent Inactivated Vaccine (TIV) which consists of 2 influenza A with H1N1 and 1 influenza B strain.