BREAST CANCER & ITS PREVENTION

The term “breast cancer” refers to a malignant tumor that has developed from cells in the breast.

WHAT IS A MALIGNANT TUMOR?

A tumor that invades surrounding tissues, is usually capable of producing metastases, may recur after attempted removal & is likely to cause death unless adequately treated.

INTRODUCTION TO BREAST CANCER

Breast cancer is an uncontrolled growth of breast cells. To better understand breast cancer, it helps to understand how any cancer can develop.
Cancer occurs as a result of mutations or abnormal changes in the genes responsible for regulating the growth of cells & keeping them healthy. The genes are in each cell’s nucleus, which acts as the “control room” of each cell. Normally the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out. But over time, mutations can “turn on” certain genes & “turn off” others in a cell. That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.

Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty & fibrous connective tissues of the breast.

INCIDENCE RATE

Approximately 1 in every 9 Pakistani women is likely to suffer from breast cancer. This is one of the highest incidence rates in Asia. Pakistani women show an incidence rate of 50/100,000. The pattern of rapid premenopause increases in breast cancer is also seen in Pakistan, but breast cancer risk plateaus after the age of 45 years.



SIGN & SYMPTOMS


The changes appears in the breasts:

  1. Any unexplained change in the size or shape of the breast
  2. Dimpling anywhere on the breast
  3. Unexplained swelling of the breast (especially if on one side only)
  4. Unexplained shrinkage of the breast (especially if on one side only)
  5. Recent asymmetry of the breasts (Although it is common for women to have one breast that is slightly larger than the other, if the onset of asymmetry is recent, it should be checked)
  6. Nipple that is turned slightly inward or inverted
  7. Skin of the breast, areola or nipple that becomes scaly, red, or swollen or may have ridges or pitting resembling the skin of an orange
  8. An existing lump that gets bigger
  9. Vaginal pain
  10. Unintentional weight loss
  11. Enlarged lymph nodes in the armpit
  12. Too many visible veins on the breast

Any Nipple Discharge—Particularly Clear Discharge Or Bloody Discharge

It is also important to note that a milky discharge that is present when a woman is not breastfeeding should be checked by her doctor, although it is not linked with breast cancer.




RISK FACTORS FOR BREAST CANCER

These risk factors are divided into 2 forms:

  1. Modifiable Factors (which can be changed)
  2. Non-Modifiable Factors (which cannot be changed)

NON-MODIFIABLE RISK FACTORS:

  1. GENDER: Simply being a woman is the main risk factor for developing breast cancer. Men can develop breast cancer, but it’s about 100 times more common among women than men.
  2. AGING: Your risk of developing breast cancer goes up as you get older. About 1 out of 8 invasive breast cancers are found in women younger than 45, while about 2 of 3 invasive breast cancers are found in women age 55 or older.
  3. INHERITING CERTAIN GENES: About 5% to 10% of breast cancer cases are thought to be hereditary, meaning that they are caused by gene defects (called mutations) passed on from a parent.
  4. BRCA1 & BRCA2 GENE CHANGES: The most common cause of hereditary breast cancer.
  5. FAMILY HISTORY OF BREAST CANCER: It is higher among women whose close blood relatives have this disease. Having a first-degree relative (mother, sister, or daughter) with breast cancer about doubles a woman’s risk. Having 2 first-degree relatives increases her risk about 3-fold. Although the exact risk is not known, women with a family history of breast cancer in a father or brother also have an increased risk of breast cancer. Overall, less than 15% of women with breast cancer have a family member with this disease. This means that most (85%) women who get breast cancer do not have a family history of this disease.
  6. PERSONAL HISTORY OF BREAST CANCER: A woman with cancer in one breast has an increased risk of developing a new cancer. This risk is even higher if breast cancer was diagnosed at a younger age.
  7. RACE & ETHNICITY: Overall, white women are slightly more likely to develop breast cancer than are African. In women under 45 years of age, however, breast cancer is more common in African-American women. Asian & Native American women have a lower risk of developing & dying from breast cancer.
  8. DENSE BREAST TISSUES: Breasts are made up of fatty tissue, fibrous tissue & glandular tissue. A woman is said to have dense breasts on a mammogram (radiological test to scan density of breast tissue) when she has more glandular & fibrous tissue & less fatty tissue. Women with dense breasts on a mammogram have a risk of breast cancer that is 1.2 to 2 times that of women with average breast density. A number of factors can affect breast density, such as age, menopausal status, the use of certain drugs (including menopausal hormone therapy), pregnancy & genetics.
  9. STARTING MENSTRUATING BEFORE AGE 12: Women who have had more menstrual cycles (periods) because they started menstruating early (before age 12) have a slightly higher risk of breast cancer. The increase in risk may be due to a longer lifetime exposure to the hormones estrogen & progesterone.
  10. GOING THROUGH MENOPAUSE AFTER THE AGE OF 55: Women who have had more menstrual cycles because they went through menopause later (after age 55) have a slightly higher risk of breast cancer. The increase in risk may be due to a longer lifetime exposure to the hormones estrogen & progesterone.

MODIFIABLE RISK FACTORS

  1. DRINKING ALCOHOL: Drinking alcohol is clearly linked to an increased risk of breast cancer.
  2. BEING OVERWEIGHT OR OBESE: Being overweight or obese after menopause increases breast cancer risk.
  3. PHYSICAL ACTIVITY: Evidence is growing that physical activity in the form of exercise reduces breast cancer risk.
  4. HAVING CHILDREN: Women who have not had children or who had their first child after age 30 have a slightly higher breast cancer risk overall.
  5. BIRTH CONTROL: The use of oral contraceptives. Studies have found that women using oral contraceptives (birth control pills) have a slightly greater risk of breast cancer than women who have never used them.
  6. DEPOT-MEDROXPROGESTERON ACETATE (DMPA; DEPO-PROVERA): This is an injectable form of progesterone that is given once every 3 months as birth control. A few studies have looked at the effect of DMPA on breast cancer risk.
  7. HORMONE THERAPY AFTER MENOPAUSE: Hormone therapy with estrogen (often combined with progesterone) has been used for many years to help relieve symptoms of menopause & to help prevent osteoporosis (thinning of the bones). This treatment goes by many names, such as post-menopausal hormone therapy (PHT), hormone replacement therapy (HRT) & menopausal hormone therapy (MHT).
  8. COMBINED HORMONE THERAPY (HT): Use of combined hormone therapy increases the risk of getting breast cancer. It may also increase the chances of dying from breast cancer.
  9. TOBACCO SMOKE: In recent years, some studies have found that long-term heavy smoking might be linked to a higher risk of breast cancer.
  10. NIGHT WORK: Some researchers think the effect may be due to changes in levels of melatonin, a hormone whose production is affected by the body’s exposure to light.

SCREENING TEST

Screening is looking for cancer before a person has any symptoms.

The average guidelines for a women to screen herself are as under:

  1. Women ages 40 to 44: should have the choice to start annual breast cancer screening with mammograms if they wish to do so.
  2. Women age 45 to 54: should get mammograms every year.
  3. Women age 55 & older: should switch to mammograms every 2 years, or have the choice to continue yearly screening.

Physical examination

This is one of the most easy & rapid test a women can perform by herself. The method is to gently rub one hand against the breast in search of any abnormal hardness, lump, tenderness(pain on touch), abnormal nipple dislocation, abnormal shape & size of nipple & breast, any discharge if seen.

Imaging procedures

Procedures that make pictures of areas inside the body.

  • Mammograms
  • MRI
  • CT-Scan
  • Ultrasound
  • X-ray
  • PET-Scan.
  • Biopsy
  • Blood Cell Counts
  • Blood Chemistries
  • Blood Marker Tests
  • Bone Scans
  • Breast Cancer Index Test
  • Digital Tomosynthesis
  • Ductal Lavage
  • EndoPredict Test
  • FISH Test (Fluorescence In Situ Hybridization)
  • IHC Tests (ImmunoHistoChemistry)
  • Inform HER2 Dual ISH Test
  • MammoPrint Test
  • Mammostrat Test
  • MarginProbe
  • Molecular Breast Imaging
  • Oncotype DX Test
  • Prosignia Breast Cancer Prognostic Gene Signature Assay
  • SPoT-Light HER2 CISH Test
  • Thermography
  • Tumor Genomic Tests
  • Urokinase Plasminogen Activator Protein Inhibitor Test

PREVENTION

  1. The most important point to prevent the breast cancer is to decrease the risk factors are already mentioned above.
  2. Self physical examination by the females herself.
  3. Early detection & prompt diagnosis of disease.
  4. Use of Antioxidant containing food such as juicy fruits & green vegetables.
  5. Maintaining personal hygiene.
  6. Breastfeed if possible.

COMMON MYTHS ABOUT BREAST CANCER OCCURRENCE

  1. Only women with a family history of breast cancer are at risk.
  2. Exposing a tumor to air during surgery causes cancer to spread.
  3. Breast implants can raise your cancer risk.
  4. All women have a 1-in-8 chance of getting breast cancer.
  5. Wearing antiperspirant increases your risk of getting breast cancer.
  6. Small-breasted women have less chance of getting breast cancer.
  7. You can’t get breast cancer after a mastectomy.
  8. Caffeine can causes breast cancer.
  9. Wearing an under-wire bra increases your risk of getting breast cancer.

TREATMENT PLANS

Your breast cancer treatment plan is based on both medical and personal choices. It is tailored to:

  • The specific kind of breast cancer (the biology of the tumor)
  • The stage of the breast cancer
  • Other medical issues
  • Personal preferences

Because of the differences between tumors the your treatment plan may differ from person to person. Each treatment option has risks & benefits to consider along with your own values & lifestyle.

Whereas, breast cancer treatment can be divided into two parts; Local & Systemic.

1. LOCAL THERAPY: Local therapy removes the cancer from a limited (local) area, such as the breast, chest wall and lymph nodes in the underarm area (axillary nodes). It also helps to ensure the cancer does not come back (recur) to that area. Local therapy includes surgery & radiation therapy to the breast area.

2. SYSTEMIC THERAPY (ADJUVANT THERAPY): Systemic therapy aims to get rid of cancer cells that may have spread from the breast to other parts of the body. This usually means drug therapy, which travels throughout the body to get rid of cancer cells that may have spread. Systemic therapy includes chemotherapy, hormone therapy & targeted therapy. Because systemic therapy is in addition to (an adjunct to) breast surgery, these treatments are often called adjuvant therapy.

Young women WITH BREAST CANCER

Young women with breast cancer have special concerns about early menopause & loss of fertility due to treatment.

SURGICAL THERAPY

Mastectomy (removal of breast) is the effective procedure done to get rid of breast cancer. This depends on the stage of cancer present, it might include the excision of lymph nodes of armpit or a complete armpit removal.



 

P.S. There is no shame in self-examination. It is good to know your body. Prevention is always better than cure! 
#ByeByeOctober #BreastCancerAwarenessMonth #TheWordsCraft

FACTORY FARMED CHICKEN – A CAUSE OF POLYCYSTIC OVARIAN SYNDROME (PCOS) IN WOMEN

Definition

It is defined as hormonal problem that causes women various symptoms including:

  • Acne
  • Excess hair growth
  • Irregular or no periods

Introduction

As a girl grows old & she achieves her puberty certain hormonal changes takes place in females which leads her to puberty & finally she achieves her puberty soon after her first menstrual cycle (periods). These periods must be regular on every month, but if it gets irregular the problem starts from here, girl starts worrying about her cycles & further stress begins.

WHAT IS POLY-CYSTIC OVARIAN SYNDROME (PCOS)?

As per abbreviation PCOS means Poly Cyctic Ovarian Syndrome which means that there are multiple cysts (balloon like structure) present in the ovaries abnormally. Ovaries are the 2 endocrine structures present in the female reproductive tract mainly responsible for certain hormones secretion & egg production which lets a female to achieve her reproductive cycles & to conceive.

The basic problem begins from the pituitary gland which is responsible for the hormone release as the sedentary life style, genetic makeup & obesity combines this causes the hypothalamus to release excessive gonadotrophs which leads to the mismatch between the LH (Luteinizing Homone) & FSH (Follicle Stimulating Hormone). These are the hormones which luteinize & stimulate the follicles from the ovaries to develop & finally shed off leading to the menstrual cycle. Due to this mismatch, the androgens are the hormones which when increase in the blood, causes the ovaries to develop multiple pearl like cysts in the ovaries. Other action of this excessive androgen is on the hair follicles which starts growing on the different parts of body. Due to the increased androgen & cysts formation the regular monthly cycles (period) gets irregular.

HOW IS FACTORY FARMED CHICKEN A CAUSE OF RAPIDLY INCREASING CASES OF PCOS?

In 1957 the average growth period for an eating chicken to reach slaughter weight was 63 days. By the 1990s the number of growth days had been reduced to 38 & the amount of feed required halved. Today these values have dropped to surprising values.



The consumers of chicken are currently way higher than the chicken are produced. In order to fulfill the increased chicken requirement they are being injected by hormonal injections which reduce their growth time resulting the chicken to reach the slaughter weight in a very few days.

The chicken is injected with Bovine Growth Hormone, which can increase insulin-like growth factor one in humans.  Perhaps worse, other hormones such as estrogen & testosterone are approved by the FDA for injection into the animals via an earpiece each animal is implanted with at birth. The FDA claims that even with supplementation the animal’s hormonal profile falls within normal ranges.

Moreover, chickens have been bred through genetic selection for several decades to produce birds that grow larger & faster, on less feed, than chickens of earlier eras. Giving growth hormones to modern farmed poultry would be pointless, as those birds could not possibly grow any faster. Hormones must be injected, not consumed through the intake of feed, in order to work. Chickens would have to be injected with growth hormones on a regular basis, a far too expensive & labor-intensive process for poultry farmers to undertake.

Clinically what happens to a female who has pcos?

The female gets under some changes which includes:

  • Menstrual disorders
  • Adrenal enzyme deficiencies
  • Hirsutism (excessive growth of hair on lips, chin, buttocks, thighs – known as male like hair pattern) are 80% common
  • Infertility (unable to conceive)
  • Obesity & metabolic syndrome
  • Diabetes
  • Decrease breast size
  • Deepening of voice
  • Hair loss (alopecia)
  • Acne
  • Pelvic pain
  • Stress & Depression



 

As PCOS is recently found to be one of the major endocrine disorder in young females. Every female needs answer to the question that why & what causes this PCOS.

  • A female with central obesity (fat on the tummy) is said to be on the major risk of POCS understanding evidently the relation between obesity & PCOS. Obesity means increased fat (adipose tissue) in your body, which increase fats causing androgen production & this androgen as mentioned above causes the multiple pearls formation on the ovaries.
  • Studies suggest that the poultry chicken that are grown in the poultry farms on the basis of injections injected to the chick to grow rapidly are also the cause of PCOS in the young females as the population in our country is more use to of eating junk food in terms of chicken.
  • Genes are always responsible for certain syndromes which includes PCOS as well. We all carry genes from our parents if a parent is affected or even the parent have a mutated gene their offsprings have more chance to have PCOS.
  • Antiepileptic drugs such as valproic acid are also the culprit.
  • Females having type II diabetes are insulin resistant which usually leads to PCOS.
  • Female born with type I diabetes are also on the risk of PCOS.
  • Living sedentary life with lots of junk food in your diet leads to increase adipose tissue as this condition is related to the hormone imbalance the increase in adipose tissue causes insulin resistance which causes the androgens to increase and leads to PCOS.

HOW TO DIAGNOSE PCOS?

The diagnosis is easy as compared to the pathophysiology of the PCOS. PCOS is diagnosed on the criteria knows as ROTTERDAM criteria, the presence of 12 or more cysts in the ovary measuring 2-9 mm in size is the diagnostic criteria for the PCOS.

Other diagnosis is based on the:

  • Increased LH-FSH ratio
  • Abnormal TSH levels
  • Raised androgen levels
  • Fasting glucose level

Getting PCOS diagnosed is not a worrisome condition being worried is not a solution to the problem. PCOS is treated with the medical intervention in worsened cases & conditions.

  • The first thing need to treat is your sedentary lifestyle (a type of lifestyle with little or no physical activity. A person living a sedentary lifestyle is often sitting or lying, while reading, socializing, watching television, playing video games, or using a mobile phone/computer for much of the day) & obesity.
  • Decreasing the weight leads to decreased number of adipose tissue, which as a result decrease the insulin resistance further resulting in decreased androgen formation. When androgens are regulated properly the pearls in ovaries will not be formed.
  • Metformin is the drug of choice in these patients because it has a dramatic role in decreasing the insulin resistance.
  • GNrH analogues can be given
  • Oral contraceptive pills
  • Combined oral contraceptive pills
  • Androgen antagonists

As soon as the hormonal imbalance gets reverse & the balance starts the female achieves her normal cycles back & then the infertility treatment can let her to conceive.

If you are afraid of sharing your condition with your health care provider then this condition may lead to its complication which can be really troublesome for a doctor to treat. Every person in the world is not perfect, no matter what condition you have a doctor is always a good care taker.

PCOS Complications include

  • Infertility
  • Hypertension (high blood pressure)
  • High cholesterol
  • Anxiety and depression
  • Sleep apnea
  • Endometrial cancer
  • Heart attack
  • Diabetes
  • Breast cancer

Homes Remedies include



 

CANCER & ITS PREVENTION

Definition

A malignant growth or tumor resulting an uncontrolled division of cells.

Introduction

  1. PHYSIOLOGICAL (NORMAL MECHANISM): The human body is made up of trillions of multiple types of cell which is known as basic structural unit. As every structure have its own life period up to which it lives. The cell has also the same. Therefore the nature has provided cell, the ability to divide & make its offsprings, expect of few type of cells. The cells continuously keeps on dividing & the other cells keeps on dying apoptosis (programmed cell death). This process of division & killing is regulated by certain genes & regulators. There is strict monitoring of these regulators so that the excessive cells are not formed & the excessive cells and not killed. Once there is an abnormality in the regulator the cells starts excessive division here the word cancer begins.
  2. GENETIC CHANGES: In normal cells, genes regulate growth, maturity and death of the cells. Genetic changes can occur at many levels. There could be a gain or loss of entire chromosomes or a single point mutation affecting a single DNA nucleotide.


 

There are 2 broad categories of genes which are affected by these change:

  • ONCOGENES: These are cancer causing genes. They may be normal genes which are expressed at inappropriately high levels in patients with cancers or they may be altered or changed normal genes due to mutation. In both cases these genes lead to cancerous changes in the tissues.
  • TUMOR SUPPRESSORGENES: These genes normally inhibit cell division & prevent survival of cells that have damaged DNA. In patients with cancer these tumor suppressor genes are often disabled. This is caused by cancer-promoting genetic changes. Typically, changes in many genes are required to transform a normal cell into a cancer cell.


 

There are usually two broad terms used in case of cancer:

  1. Benign
  2. Malignant

The term Benign is used in case of tumor which does not have the potential to spread or replicate so fast and does not have the ability to metastasize to the other organs. They are usually not worrisome.

The tern Malignant is used in those tumors which are relatively aggressive then benign & have the potential to replicate faster then benign & have the ability to metastasize to the other organs.

Types of cancers according to the Morbidity & Mortality




 

There is a big question in everyone’s mind is what causes the cancer but the answer is still unknown to the science yet certain mediators certain may be responsible which are as follows:

CHEMICAL CARCINOGENS

  • Cigarette smoking
  • Aflatoxins
  • Asbestos
  • Poly-cyclic hydrocarbons
  • Cancer chemotherapeutic drugs
  • Benzene
  • Chromium

RADIATIONS

  • Ultra-Violet rays
  • X-rays

VIRUSES

  • RNA Virus (HIV, Human T-cell virus)
  • DNA Virus (HPV, Hepatitis B, C, HSV type II).

DIETARY FIBERS

  • Low fiber diet
  • High fat Diet
  • Alcohol consumption

It is said that certain chronic diseases may lead to Cancer which includes:

  • Chronic varicose ulcer
  • Chronic osteomyelitis
  • Old burn scars
  • Tropical burns scars
  • Gastric ulcers
  • Gall stones
  • Crohn’s & Ulcerative colitis

What if I have a tumor? How can I know that is it benign or malignant? Do I have to wait for a Doctor to tell me?

The answer to your question is NO. You can yourself evaluate between the benign & malignant but always remember always meet a doctor for the confirm diagnosis.

Here come the difference between the clinical benign & malignant tumors:

The benign tumors are always:

  • Slow growing
  • They are mobile (can move not fixed)
  • Do not have Ulceration
  • They are soft to touch
  • Does not bleed

Where as the malignant tumors are always:

  • Rapidly growing in nature
  • They are fixed adhered to the wall
  • Shows ulceration
  • Firm to hard while touching
  • Usually bleeds on touch or otherwise

These signs can give you an idea about the severity of you disease.

What can be the symptoms?

Yes!! The symptoms can also give the hint.

The benign tumors usually are symptom less they are found on the examination usually which may include:

  • Pain at any site
  • Pressure effects
  • Compression to any nerve or vessel
  • Vague pain or complains
  • Can produce the signs of obstruction or any hormone production

A malignant tumor produces the symptoms which includes:

  • Pain at any site
  • Bleeding from any site
  • Edema formation (Swelling sign)
  • Fever
  • Infections
  • Anemia
  • Malignant Cachexia (Weakness, Loss of weight, Insomnia, Loss of Apatite & Fatigue)

How to investigate a Cancer?

There are two types of investigations done for the purpose of cancer:

  1. For the purpose of diagnosis
  2. For the purpose of spread & Mets.

Cancer investigations includes a complete history with a complete physical examination, lab reports & radiology reports.

CYTOLOGICAL EXAMINATION: The cellular study is performed where the cells are seen live under microscope their nature activity & biology gives the evidence of being cancerous or non-cancerous. The methods to take the cells are:

  • FNAC (fine needle aspiration cytology)
  • Trucut biopsy
  • Core cut biopsy
  • Frozen section

SEROLOGICAL EXAMINATION: The serological study is designed to perform via blood examination where certain specific & non-specific tumor marker are detected to know about the presence of type of cancer such as:

  • CEA
  • AFP
  • HCG
  • PSA
  • Monoclonal immunoglobulins.

RADIOGRAPHIC STUDY: This is performed in a dual beneficial aspect to know the morphology of the tumor & also to know about the spread of disease beneficial in treatment & staging which includes:

  • X-ray
  • Ultrasound
  • CT-Scan
  • MRI
  • DEXA-Scan
  • Sestamibi-Scan
  • Isotope-Scan
  • PET-Scan
  • Mammography
  • HIDA-Scan

How can I prevent from being attacked from Cancer?

Cancer prevention is an important topic to be discussed the preventive measures. Certain cancers can be prevented by early detection soon when the changes are about to begin.

  • Such as PEP smear for cervical cancer
  • Mammography & breast examination
  • Testicular cancer by testis examination

Early sign or symptom of any condition discussed above if seen in any patient can prevent the person from malignancy.

Dietary factors can also prevent this condition which are:

  • Use of antioxidant fruits & vegetables
  • Sour fruits
  • Juicy fruits
  • One of the best fruit yet found is know as SOUR SOP and its leave the other name of this fruit is GAYA BANO.


How can I get treated form cancer?

There are many types of cancer treatment. The types of treatment that you have will depends upon the type of cancer you have & how advanced it is. Some people with cancer will have only 1 treatment, but most people have a combination of treatments, such as surgery with chemotherapy or radiation therapy. You may also have immunotherapy, targeted therapy, or hormone therapy.

THE Side effects of Cancer therapy

The effects varies from person to person but few of them are:

  • Anemia
  • Appetite Loss
  • Bleeding & Bruising (Thrombocytopenia)
  • Constipation
  • Delirium
  • Diarrhea
  • Edema
  • Fatigue
  • Hair Loss (Alopecia)
  • Infection & Neutropenia
  • Lymphedema
  • Memory or Concentration Problems
  • Mouth & Throat Problems
  • Nausea & Vomiting
  • Nerve Problems (Peripheral Neuropathy)
  • Pain
  • Sexual & Fertility Problems (In Both Men & Women)
  • Skin and Nail Changes
  • Sleep Problems
  • Urinary and Bladder Problems

 

BENEFITS OF BLACK CUMIN (KALONJI)

Also known as Nigella Sativa (Kalonji). It is native to Mediterranean region but also has been grown on the Arab peninsula, Africa & Western Asia. It belongs to Ranunculacease .
 
Black Cumin is not only used for adding flavour to foods but also therapeutic. It is rich in unsaturated fatty acids & essential oils. Other nutrients including proteins, carbohydrates & many vitamins. The plant grows up to 30 cm & have white flowers with black seeds. Our beloved Prophet Muhammad (peace be upon him) told us about black cumin & its benefits 14 centuries ago.
“There is healing for all disease expect death.” (Bukhari 7:71)
There is another Hadith regarding Black Cumin our beloved Prophet Muhammad (peace be upon him) puts emphasis on consistent use of Black Cumin with the phrase “hold on to use of the seed.”
 
Recent research tells us the benefits of Black Cumin in the induction of apoptosis (cell death) in cancer cell lines & in decreasing blood sugar levels. Black seed extracts and its oil have been shown to strengthen the immune system, radio protectively, reduces high blood pressure, pain reliever, anti-inflammatory, hypoglycemic, anti-fungal, anti-tumor. Black Cumin maladies such as respiratory disorders, skin disorders & allergies. One research even shows that Black Cumin oil is more effective than the Omega 3-s oil in fish oil. Black Cumin is a natural cure that people have been using since 1400 years.

SOMETHING ACCIDENTALLY FOUND IN YOUR BRAIN – “PITUTARY ADENOMA”

What is an Adenoma?

A benign epithelial tumor in which the cells form recognizable glandular structures or in which the cells are derived from glandular epithelium.
These tumors are usually found accidentally in the brain during certain investigations hence they are known as Incidentaloma, when found with other investigations such as MRI, CT-Scan & SPECT.
These patients are usually A-symptomatic & have no symptoms, even people do not know that they may be carrying this tumor for years in their cranial cavity.



Some times the patients may have some vague complains of Headache, vertigo, blurring of vision. Whereas, females may encounter this condition soon after their first visit to a Gynecologist may be with the complain of irregular menstrual cycle or with a complain of infertility.

These tumors are mainly divided into 2 categories:
1. Functional (Secreting)
2. Non-Functional (Non-Secreting)

Further the Functional tumors are divided according to their Secretions:
1. Prolactin cell Adenoma
2. Growth hormone cell Adenoma
3. ACTH cell Adenoma
4. Gonadotroph cell Adenoma
5. Mixed Adenoma.

The Non-Functional Adenomas are silent do not secretes any hormone, hence no hormone specific symptoms are produced.

What is Pituitary Gland?

The pituitary gland is a small, bean-shaped organ that sits at the base of the brain, behind the bridge of the nose. It sits in a small pocket of bone in the base of the skull called the sella turcica.
The internal carotid arteries & the nerves that control eye movement lie on the sides of the pituitary. Directly above the pituitary gland is the optic chiasm, which is responsible for vision. The gland is basically responsible for the hormonal secretions & its regulation.

What if I have this tumor?

The tumor is more or less benign(non-cancerous) in nature only few of them are malignant & rapidly growing. Hence the tumor does not produce symptoms for years soon from its initial growth.
The Adenoma is said to be slow growing 1mm/year.

How will I know that I have the tumor?

If a patient is suffering from the Non-Functional Tumor it will not produce specific hormonal symptoms. The symptoms are produced due to the pressure effects on the adjacent structures as the cranial cavity is a bonny structure & does not have the ability to expand.
If the tumor is large (Macro-Adenoma sizes more then 10mm), usually produces the symptoms such as:

  • Bi-temporal hemianopsia (Decreased ability to see the peripheral objects when eyes are focused to the central point of focus) or decreased field of vision.
  • Vomiting
  • Nausea
  • Headache
  • Blurring of vision
  • Depression
  • Anxiety
  • Apathy
  • Mood swings

If a patient is suffering from the Functional tumor secretory type usually produce the hormone specific symptoms:

  1. PROLACTIN SECRETING PITUTARY ADENOMA (PROLACTINOMA): The pituitary tumor causes & overproduction of prolactin, causing loss of menstrual periods & breast milk production in women. In men, high Prolactin levels can lower testosterone levels, leading to diminished sexual interest.
  2. GROWTH HORMONE SECRETING PITUTARY ADENOMA: An excessive production of growth hormone (GH) causes acromegaly in adults or gigantism in children. Symptoms include enlarged hands & feet & other changes in the body.
  3. ACTH SECRETING PITUTARY ADENOMA: Excessive ACTH hormone production causes Cushing’s disease. Symptoms include unexpected weight gain, easy bruising of the skin & muscle weakness.
  4. TSH SECRETING PITUTARY ADENOMA (THYROTROPINOMA): Excessive TSH hormone production leads to hyperthyroidism.

Associated features which Pituitary Adenoma shows are as follows:
When the tumor compresses the normal pituitary gland, it can cause it to fail leading to pituitary insufficiency (hypopituitarism). The symptoms will depend upon which hormone is involved.

  • Reduction of sex hormones, luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
  • In men, this can lead to a low testosterone level, causing decreased sexual drive and impotence.
  • In some cases, there can be loss of body and facial hair.
  • In women, this can lead to infertility.
  • Reduction in TSH production can lead to hypothyroidism, which can cause appetite loss, weight gain, fatigue and decreased mental function.
  • Reduction in ACTH production causes adrenal insufficiency, because Cortisol production is reduced. Symptoms include fatigue, low blood pressure, electrolyte abnormalities. If severe, death can occur.
  • Reduction in growth hormone (GH) production is called growth hormone insufficiency.
  • In children, this results is stunted growth and delayed puberty.
  • In adults, the effects can be subtle but can include generalized tiredness, loss of muscle mass and tone.
  • Reduction in Prolactin production is uncommon and occurs with severe pituitary insufficiency.
  • Large pituitary tumors can slightly elevate blood Prolactin levels. Doctors think this occurs because of compression of the pituitary stalk, the connection between the pituitary gland and the brain. It is called the “stalk effect.”
  • In menopausal women, this can lead to reduction or loss of menstrual periods and/or breast milk production (galactorrhea).
  • Prolactin levels are only slightly elevated, as opposed to prolactinomas in which the Prolactin level is usually very high.


Keeping these features in mind if a person experiences above mentioned features should go for some lab investigation & imaging techniques like:

Lab Investigations

  • Prolactinomas
  • Serum Prolactin levels.
  • Serum Prolactin level >200 mcg/L in a patient with a macroadenoma greater than 10 mm in size is diagnostic of a prolactinomas. Levels below that range in a macroadenoma suggest hyperprolactinemia secondary to hypothalamic compression.
  • Growth hormone abnormalities
  • Growth hormone (GH) levels are elevated in acromegaly but can fluctuate significantly.
  • Intravenous (IV) GH levels every 5 minutes for 24 hours may show consistent elevation of GH.
  • Oral glucose tolerance test is the definitive test for the diagnosis of acromegaly; a positive result is the failure of GH to decrease to < 1 mcg/L after ingesting 50-100 g of glucose.
  • Thyrotrophin releasing Hormone (TRH), 200 mcg, can be given to increase the test’s accuracy. A GH level > 5 mcg/L suggests acromegaly.
  • Failure to decrease the GH concentration to < 2 mcg/L after a glucose load and after TRH stimulation is highly suggestive of acromegaly
  • Cushing disease and Cushing syndrome
  • 24 hour urine is collected for free cortisol. Usually 2 baseline values are obtained.
  • If Cortisol levels are increased abnormally, corticotrophin releasing factor (CRF) in a dose of 100 mcg can be given to differentiate between Cushing disease & other causes of hypercortisolism (ie, Cushing syndrome). With pituitary adenomas, Cortisol secretion is increased over the baseline.
  • Glycoprotein hormones – Thyroid stimulating hormone, follicle stimulating hormone, luteinizing hormone.
  • Pituitary adenomas that are associated with thyroid-stimulating hormone (TSH) hypersecretion are uncommon. These patients have increased T3 and T4 levels, hyperthyroidism & goiter with inappropriately high levels of TSH.
  • Increased follicle stimulating hormone (FSH) levels may be apparent in the histologic examination of a pituitary adenoma in patients without apparent preoperative endocrine abnormalities & in some patients with hypogonadism.
  • Increased luteinizing hormone (LH) levels also may be seen in patients with hypogonadism. The secreted hormone is not intact LH & serum testosterone levels are not increased.

Imaging techniques

  • MRI
  • CT-Scan
  • SPECT
  • PET-Scan

How can I get Rid from this medical condition?

1. MEDICAL THERAPY: Usually the Hormone secreting tumors are best treated on medical therapy such as prolactinomas.

2. SURGICAL INTERVENTION: Keeping in mind that the brain is one of the most delicate & major organ of human body so many approaches are being performed to prevent the open cranium (skull) surgery which may include:

  • Craniotomy


  • Trans-sphenoidal (Endoscopic nasal approach)


  • Key hole surgery via eyebrow
  • Trans-labial Approach.
    One of the major advancement in the field on Radio-surgery is:
  • Gamma knife
  • Stereo-tactic radio surgery

One of the major question the patient asks is about the recovery after surgery and its outcomes

The recovery after surgery depends upon the size of Adenoma, its nature, skills & number of surgeries the neurosurgeon have performed.
Usually the recovery is fast & the patient can go home within few days again depends on the approach the surgeon chooses. Sometimes the normal pituitary tissues are also excised during surgery which leads to the decreased hormonal production leading to hypo-pituitarism which shall sometimes requires life long hormone replacement therapy in the form or oral medications.

Another question, which people wants to know is that how to choose my surgeon?

The answer to this question is based on few questions to be asked from the doctor:

  • Do you specialize in pituitary surgery?
  • How many pituitary surgeries do you perform every week/month/year?
    It is said that 2 – 5 operations per month are the minimum for a neurosurgeon to perform to maintain a high degree of surgical competency.

patients with Prolactin secreting macro adenomas should always be treated through surgery?

No patient with a pituitary Adenoma should go to surgery without a pituitary hormone level baseline test being done & a decision made as to whether medical or surgical treatment would be most appropriate. Decisions would be based upon the individual circumstances. In general, however, there is an increasing trend to treat these tumors with drugs to shrink the tumor mass. In many instances this is used as primary treatment, with surgery used only if drug therapy fails to bring about the desired tumor shrinkage.