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With ovarian cancer and its treatments potentially bringing on more than a dozen symptoms at once, caregivers may begin to feel burnt out as well. A web- or app-based strategy may be an innovative solution to symptom management and patient-provider communication, according to research conducted at the University of Pittsburgh School of Nursing.

“(Ovarian cancer symptoms) makes it extremely overwhelming for patients and their family members, but also for health care providers. With the current pressures in our health care system, there’s very little time for providers or patients to talk about symptoms … and so for patients, they end up tolerating or suffering through symptoms,” Heidi Donovan, a professor of Health and Community Systems at the University of Pittsburgh School of Nursing said in an interview with CURE®.

In an effort to combat this, Donovan and her team created web-based interventions (one that was self-led and one that was led by a nurse) to help patients track their symptoms, set goals and receive strategic help on the difficult situations that they are going through.

“In a study we published, we found that both the nurse-delivered and self-directed (web-based symptom management tool) were equally good at giving women a better sense of control over managing their symptoms,” Donovan said.

After the success of the app, Donovan wanted to make the tool even more user-friendly and turn it into a mobile app. So, she called on Haomin (Leon) Hu, a rehabilitation science PhD student in the Department of Health Information Management at the School of Health Rehabilitation Science at the University of Pittsburgh. Together, they are working on a mobile app that will help not only the patients, but their family caregivers who are at home helping them, too.

“There’s a trend that more caregivers also need to take care of themselves while providing care to their loved one,” Hu said. “That’s why we’d like to base (our project) on this foundation and establish a more complicated system that will also provide features for family caregivers to either improve their caregiving skills or teach some problem-solving skills, as well as providing some quick tips and tools for when they’re providing care.”

Donovan, who said that family caregivers are at the “core of our health care system,” is hoping that by making caregivers more equipped to handle their loved one’s needs, that patient outcomes will be improved as well.

“We are really trying to prevent negative outcomes for the family caregiver, while also helping them to be the best caregiver they can for their loved ones,” Donovan said.

The app — which is expected to be released sometime next year — will raise awareness for family caregivers about the stressors that they are going through (such as financial problems and education about the disease), while validating their feelings and undergoing a risk assessment of emotional and physical symptoms.

“Distressing physical or emotional symptoms can add to the stress of cancer for both patients and their family caregivers, especially if (they) don’t have good strategies for managing symptoms,” Donovan said, noting that the app will offer resources on how patients and their loved ones can improve their physical and 

Tips for improving caregiver stress range from evidence-based practices like breathing exercises to setting reminders for asking other friends and family members for help with tasks that need to get done. While some 

 by delegating tasks, a much-needed break is essential for those who are constantly looking out for a loved one.

“Caregivers are an essential part of our team, and they deserve our support, right alongside patients,” Donovan said. “We can’t do it without them.”

For more news on cancer updates, research and education, don’t forget to 

When caregivers — considered by many to be an essential part of a patient’s care team — have the tools they need to care for themselves and their loved ones, cancer outcomes can be better, too.

New App Aims to Improve the Lives of ‘Core of Our Health Care System’ — Cancer Caregivers

I think one of the scariest things about cancer is its propensity towards silence. Pancreatic cancer not showing symptoms until it is in advanced stages, breast cancer disguising itself as a swollen milk duct in a nursing mother, men thinking that prostate cancer symptoms are just “getting older.” Cancer is smart and its tricky. In many cases, our best defense is a good offense, as the cliché goes.

I was a freshman in college when Madelyn Khan succumbed to ovarian cancer in December 1999. Although my young life had already been touched by cancer at that point, I was still relatively naïve when it came to the different forms of cancer. I remember calling my mom to talk about it, as Ms. Khan was one of my favorite actresses. It was then that Mom was able to really hammer home the importance of yearly well woman exams.

Let’s take some time today to talk about ovarian cancer, its symptoms and stages, and outlook and treatment options.

Remember how I talked about silent killers? Well, ovarian cancer isn’t necessarily silent, but it disguises itself as other things. Its symptoms are those that just about every woman has at least once a month – regardless of if we have gone through menopause or not: bloating, symptoms in our urinary tract (feeling like you need to go often), feeling full after not much of a meal, and pelvic/abdominal pain. What differentiates these symptoms in ovarian cancer from something more benign such as a urinary tract infection or bloating from gas, is their persistence – they don’t go away despite treatments that should make them disappear. The American Cancer Society tells us that if you experience these symptoms more than 12 times a month, you should discuss this with your doctor. Other more severe symptoms may include: may during intercourse, changes to your period, fatigue, pain in your back, and swelling in the tummy though you may be losing weight.

The staging of ovarian cancer is very complex and detailed, utilizing the T,M,N system that we are used to, but also using stages one through four and substages within those. For a very detailed look at these stages, I encourage you to navigate over to the American Cancer Society’s page for 

. What I am presenting you below is the readers digest version of this.

Stages IA through IC represent disease that is T1, M0, N0. Within this, the cancer can be in only one ovary or fallopian tube, or in both ovaries or fallopian tubes. Here, the tumor(s) have not broken the surface of the ovary or fallopian tube, although in IC, the tumor capsule may have ruptured either before or during surgical intervention, allowing cancer cells to spread to the surrounding fluids, or cancer cells were found in those fluids (known as ascites).

Stages IIA through IIC indicate that the disease has spread to nearby structures such as the bladder, the uterus, or the sigmoid colon. Here, we have T2, M0, N0 – with no spread to lymph nodes or distant metastases.

In stage IIIA1 through IIIC we see the disease progress in its spread. Lymph nodes may or may not be affected (N0 or N1), although distant metastases are still not present (M0). The tumor spread can be anywhere from T1 to T3 at this stage. Here surgeons may or may not be able to see cancer spread on other organs, but under the microscope cancerous cells can be seen. Spread of the disease here is termed regional – staying in the abdominal and pelvic cavities.

Stage IVA and IVB describe disease that has spread to distant sites such as the fluid around the lungs and to the bones. Any T, any N, and M1a and M1b describe these stages.

Across all stages and types of ovarian cancers, the 5-year survival rate is about 47%. When it is found early (stages IA and IB) the survival rate is as high as 92%; sadly, however, only about 15% of ovarian cancers are found this early.

When treating ovarian cancer, there are local treatments such as surgery and radiation, and systemic treatments such as chemotherapy, targeted therapies, and hormone therapies. Many of the hormone therapies are aimed at pre-menopausal women in an effort to bring their estrogen and leutenizing hormone levels down, as the ovaries are greatly affected by these hormones.

The treatment options and decisions made will depend greatly upon the extent or stage of the disease, as well as the exact type of ovarian cancer that the patient has.

For women at average risk of developing ovarian cancer, there are currently no increased screenings recommended above yearly well woman exams. At these exams, your doctor will assess your uterus and ovaries for size, shape, and texture. Some ovarian tumors are able to be felt, but sadly, many are not. Women at higher risk, such as those with BRCA mutations, may opt for enhanced screenings such as transvaginal ultrasounds to get a better look at the ovaries. If you are at a high risk for this disease, please discuss your screening options with your doctor.

As always, much love, many prayers, and abundant blessings to all of the warriors out there!

https://www.cancer.org/cancer/ovarian-cancer.html

When treating ovarian cancer, there are local treatments such as surgery and radiation, and systemic treatments such as chemotherapy, targeted therapies, and hormone therapies. Many of the hormone therapies are aimed at pre-menopausal women.

Ovarian Cancer-

Ovarian Cancer: Diagnosis

No screening test for ovarian cancer is considered accurate enough to use on the general population.

A manual pelvic exam can reveal several health problems but is likely to miss many ovarian cancers.

Those at high risk of ovarian cancer may be screened with transvaginal ultrasound, which can find a mass in the pelvis but not determine whether it is cancerous. A blood test for elevated levels of the cancer antigen (CA)-125, a protein, is useful in women known to have ovarian cancer but is not an accurate way to diagnose the disease. High CA-125 levels can occur in people who have conditions unrelated to ovarian cancer, and tests for this antigen can miss people with ovarian cancer who don’t express a lot of this protein.

If screening or symptoms suggest ovarian cancer, a doctor will use imaging to look for a tumor. This can include CT, MRI or positron emission tomography scans or laparoscopy, in which a thin, lighted tube is threaded through a small abdominal incision to send images of the ovaries and other pelvic organs to a video monitor.

If a mass is found, a piece will need to be removed (biopsied), usually surgically, and then analyzed in a lab. If ovarian cancer is present, it will be given a stage ranging from 1 (indicating that the cancer hasn’t spread beyond the site of origin) to 4 (indicating that it has spread to distant parts of the body). These cancers are also assigned a grade of 1 through 3 or classified as low grade or high grade to indicate how different from normal the cancer cells are. High-grade cancers are more likely to grow quickly and spread.

A patient who receives a diagnosis of ovarian cancer should undergo genetic testing using blood or saliva to find out if an inherited gene mutation is the cause of the disease. This information can help guide treatment, alert a woman that she should be screened for additional cancers and make family members aware that they might also have an inherited predisposition to cancer.

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Diagnosis

Bladder Cancer: Overview

Bladder cancer is also known as urothelial carcinoma. Urothelial cells line the urinary tract, including the urethra, bladder, and ureters and renal pelvis in the kidneys. These urothelial or transitional cells are in contact with urine. Bladder cancer happens when those cells in the bladder start to grow out of control.

Smoking and being exposed to secondhand smoke increases the risk of developing bladder cancer. In addition, people exposed to occupational or environmental chemicals may have a higher risk of developing bladder cancer. White people are twice as likely to develop bladder cancer as are Black people or Hispanic people, and older age is another risk factor. Health history also matters, with chronic bladder inflammation, such as urinary tract infections or kidney stones, as well as a personal or family history of bladder cancer, associated with risk of the disease.

Many people are unaware of the common signs of bladder cancer, such as blood in the urine, known as hematuria. If blood in the urine can be seen, this is called gross hematuria. When a physician runs a urinalysis test as part of a routine checkup, tiny amounts of blood may be detected. This is microscopic hematuria. Any blood seen in the urine should be checked by a physician. Irritation when urinating, urgency and frequency are other warning signs. These signs may also be from other causes, such as a urinary tract infection, kidney stones or aging.

Bladder Cancer: Living with Cancer

Bladder cancer has a high rate of recurrence, which implies the need for regular surveillance with cystoscopy over the course of a patient’s lifetime. For some patients, the new normal after bladder removal surgery is adjusting to life with a urinary diversion. A patient should always feel comfortable talking with their health care team about any issues or questions. If the team can’t help, they can usually find someone who can.

Bladder Cancer: Types of Disease

Doctors usually describe and treat bladder cancer by how far it has grown into the bladder wall.

NMIBC (non-muscle invasive bladder cancer) is cancer that remains in the urothelial cells that line the bladder.

MIBC (muscle-invasive bladder cancer) is cancer that has grown into the deeper layers of bladder muscle.

If bladder cancer has spread to other parts of the body outside the urinary tract, it is advanced disease, or metastatic.

Types of bladder cancer include urothelial carcinoma, squamous cell carcinoma, adenocarcinoma, small cell carcinoma and sarcoma.

Urothelial carcinoma, the most common type of bladder cancer, is also known as transitional cell carcinoma. Transitional cell carcinoma begins in the part of the kidney, called the renal pelvis, where urine collects before moving to the bladder.

Squamous cell carcinoma comprises 1% to 2% of bladder cancers, according to the American Cancer Society. Most squamous cell carcinomas of the bladder are invasive.

Adenocarcinoma, which are also mostly invasive, occur in only 1% of bladder cancers.

Small cell carcinoma, which occurs in less than 1% of bladder cancers, start in the neuroendocrine cells. This subtype of the disease can grow quickly.

Sarcoma of the bladder is rare, and start in the muscle cells of the organ.

Bladder Cancer: Diagnosis

A urologist will make a bladder cancer diagnosis. Urologists use a cystoscope to examine the lining of the bladder and the tube that carries urine out of the body (urethra).

If bladder cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has invaded the bladder wall or spread beyond that, and, if so, to what parts of the body. Grade refers to how abnormal the cancer cells look and how many cells are multiplying. A higher grade means the cells are more uneven and are multiplying more. Knowing the grade can help your doctor predict how quickly the cancer will grow and spread.

Bladder Cancer: Treatment

When bladder cancer is classified as NMIBC, surgery to remove the tumor is often the first step. A transurethral resection of the bladder tumor uses a special instrument inserted through the urethra to remove the tumor. If the tumor is low risk/grade and has not invaded the muscle wall of the bladder, it may not require more treatment. Unfortunately, bladder cancer has a high rate of recurrence so most of those who receive diagnoses must return to their urologist at regular intervals for surveillance using cystoscopy to see if the tumors return.

If the tumor cells appear aggressive under the microscope and the pathologist determines that the cancer is high risk/grade, it is more likely to return or worsen. In these cases, further treatment to keep the cancer from returning or worsening is required. Most often, patients with high-grade NMIBC receive intravesical (inside the bladder) treatments. Bacillus Calmette-Guérin (BCG) is an early form of immunotherapy that uses a weakened form of bacteria. When these bacteria are put into the bladder, the immune system goes on alert. It responds by killing cancer cells on the bladder lining. Though BCG is very effective, it doesn’t work for all tumors. If BCG doesn’t work, there are other options such as mitomycin C, an antibiotic that helps fight tumors.

When bladder cancer grows into the deeper layers of the bladder (MIBC), it is more difficult to treat. In many cases, a urologist may suggest radial cystectomy, which is surgery to remove your bladder. Removing the bladder also involves removing lymph nodes around the organ. As part of the surgery, it will be necessary to create a urinary diversion, a new way for urine to leave your body.

Systemic chemotherapy is medicine that treats cancer throughout the whole body. Neoadjuvant chemotherapy is chemotherapy patients get before bladder removal surgery. Clinical trials have shown that cisplatin chemotherapy before bladder removal improves survival for patients with MIBC because it helps kill bladder cancer cells that may be outside the bladder. Adjuvant chemotherapy is the chemotherapy patients get after surgery.

Recently approved targeted therapies can block the growth and spread of cancer. They focus on stopping the cancer-driving activity caused by specific genetic mutations that are found in some bladder cancers.

Some patients may benefit from combined modality therapy, which uses surgery to remove the tumor, plus chemotherapy and radiation to help kill the cancer while keeping the bladder intact. This option can be used for some patients who are ineligible for bladder removal surgery. Those with advanced or metastatic disease may benefit from chemotherapy and a variety of immunotherapies that can help the body fight off the cancer.

There are many talented researchers and clinicians working to improve the diagnosis and treatment of the disease. Clinical trials are an essential part of bladder cancer research. They may provide treatment alternatives to patients who have not had success with standard and approved therapies.

Breast Cancer: Living with Cancer

Similar to other cancers, there is often a fear breast cancer will return, and in some individuals, the cancer will never go away completely. Therefore, it is key to maintain follow-up appointments for physicians to watch closely. These include consistent doctor appointments, mammograms, pelvic exams, bone density tests, as well as we blood and imaging tests.

Survivorship care plans, comprised of a suggested schedule for follow-ups, a list of long-term effects, lifestyle modification suggestions and a summary of ones diagnosis, may be very helpful for long-term care and to aid individuals in transitioning back to a primary care provider.

Breast Cancer: Types of Disease

The type of breast cancer that is diagnosed is determined by specific cells.

Ductal carcinoma in situ, or DCIS, also known as intraductal carcinoma, is when the abnormal cells have not spread through the ducts into surrounding breast tissue. It is a non-invasive breast cancer that has not spread outside of the breast; however, it can become invasive.

Lobular carcinoma in situ, also called lobular neoplasia, is when the abnormal cell growth starts in the lobules of the breast and has likely not spread to surrounding tissues. This subtype can be an indicator for the likeliness of developing invasive cancer in either breast.

Invasive ductal carcinoma, also known as infiltrating ductal carcinoma, is the most common type of breast cancer that occurs when the cancer starts in the ducts of the breast, then grows into fatty breast tissue. This type of breast cancer may spread to other parts of the body.

Invasive lobular carcinoma, also known as infiltrating lobular carcinoma, starts in the lobules of the breast. As one of the less common types, invasive lobular carcinoma may be difficult to detect via mammogram.

Inflammatory breast cancer, an uncommon type of invasive breast cancer, occurs when the cancer cells block the lymph vessels in the skin, causing inflammation, redness, pitted appearance, itchiness or tenderness. In this instance, a lump may not be detected

Paget disease, also rare, starts in the ducts and spreads to the skin of the nipple. Symptoms include crusted, scaly, red, bleeding, oozing, burning or itchy nipples.

Lastly, there are subtypes of breast cancer driven by hormones that will drive treatment decisions: hormone receptor-positive, HER2-positive and triple-negative breast cancer.

Breast Cancer: Diagnosis

After a biopsy or surgery to remove the breast cancer, a pathologist examines the tissue and may run additional tests to create a pathology report to help create an appropriate treatment plan for the patient. In addition, the use of an Oncotype Dx® Recurrence Score results may also be considered and used to determine certain treatment.

Stage 0, carcinoma in situ, is the earliest stage of breast cancer, followed by:

Stage 1: The tumor is 2 centimeters or smaller; the cancer has not spread outside of the organ; or small clusters of cancer cells are found in the lymph nodes.

Stage 2: There is no tumor, or the tumor is smaller than 2 centimeters, but the cancer is also found in the lymph nodes or the breast; or the tumor is larger than 2 to 5 centimeters, but the cancer has not spread to lymph nodes.

Stage 3: There is no tumor, or the tumor can be any size, but the cancer has spread to the lymph nodes; the tumor is larger than 5 centimeters and small clusters of cancer cells are found in the lymph nodes or the breast; or the tumor is larger than 5 centimeters and the cancer has spread to the lymph nodes.

Stage 4: The cancer has spread to other parts of the body, often in the bones, lungs, brain or liver.

Ovarian Cancer

DIAGNOSIS

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