Health World News and Features

WASHINGTON (AP) – Researchers in Japan have discovered some eye-opening news about coffee: It may help prevent the most common type of live cancer.

A study of more than 90,000 Japanese found that people who drank coffee daily or nearly every day had half the liver cancer risk of those who never drank coffee.

The protective effect occurred in people who drank one to two cups a day and increased at three to four cups.
Animal studies have suggested a protective association of coffee with liver cancer, so the research team led by Monami Inoue of the National Cancer Center in Tokyo analyzed a 10-year public health study to determine coffee use by people diagnosed with liver cancer and people who did not have cancer.

They found the likely occurrence of liver cancer in people who never or almost never drank coffee was 547.2 cases per 100,000, the researchers report in this week’s issue of the Journal of the National Cancer Institute.

They were unable to compare the effect of regular and decaffeinated coffee, however, because decaf is rarely consumed in Japan.

The caffeine in coffee has been shown in other studies to prompt mental alertness in many drinkers, although it makes some people nervous.

Some studies have suggested caffeine aggravates symptoms of menopause or intensifies the side effects of some antibiotics.

Heavy caffeine use has been linked to miscarriage. But studies have also shown that a skin cream spiked with caffeine lowers the risk of skin cancer in mice.

“It’s an excellent, interesting and provocative study and their conclusions seem justified,” commented Dr. R. Palmer Beasly of the University of Texas M.D. Anderson Cancer Center in Houston.

“It will provoke a lot of new work here,” said Beasley, who was not part of the research group.

The American Cancer Society estimates that 18,920 new cases of liver cancer were diagnosed in the United States last year and some 14,270 people died of the illness.

Causes include hepatitis, cirrhosis, excess alcohol consumption and diseases causing chronic inflammation of the liver.
While the study found a statistically significant relationship between drinking coffee and having less liver cancer, the authors note that it needs to be repeated in other groups.

The reason for the reduction remains unclear.

Inoue’s team noted that coffee contains large amounts of antioxidants, and several animal studies have indicated those compounds have the potential to inhibit cancer in the liver.

In their study, the team also looked at green tea, which contains different antioxidants, and they found no association between drinking the tea and liver cancer rates.

“Other unidentified substances may also be responsible” for the reduction in cancers, they said.

A separate study reported in the same issue of the journal reported no relationship between drinking caffeinated coffee or tea and the rates of colon or rectal cancer.

However, that analysis did find a 52 percent decline in rectal cancer among people who regularly drank two or more cups of decaffeinated coffee.

In that study a team led by Karin B. Michels of Brighan and Women’s Hospital in Boston analyzed data from two large studies – the Nurses’ Health Study of women and the Health Professionals’ Follow-up Study involving men.

The analysis of nearly 2 million person-years found 1,438 cases of colorectal cancer.

While they did not find any association between cancer rates and consumption of caffeinated coffee or tea, people who regularly drank two or more cups per day of decaffeinated coffee had about half the incidence of rectal cancer as those who never drank decaf.

The rate of rectal cancer was 12 cases per 100,000 person years among those who consumed two or more cups of decaffeinated coffee per day.

For those who never drank decaffeinated coffee, the rate was 19 cases per 100,000 person years.

That difference may, however, be due to differences in lifestyle, the researchers commented, suggesting that drinkers of decaffeinated coffee might be more health-conscious overall.

The Japanese study was funded by the Ministry of Health, Labor and Welfare of Japan.

The U.S. study was funded by the National Institutes of Health.

*On the net: Journal of the National Cancer Institute:
jncicancerspectrum.oupjournals.org/

Manila Bulletin

Many are still unaware of the high incidence of chronic hepatitis B and liver cancer in Asia. The World Health organization estimates that there are 400 million people with chronic hepatitis B virus (HBV) infection, many of whom are not even aware of their health condition. Most hepatitis B carriers have no symptoms, but they can still transmit the infection and develop liver cancer.

These were among the concerns discussed during the 64th Educational Trans-Pacific Telemedicine Multi-site videoconference lecture, “Updates on the Research, prevention, and Treatment of Liver Cancer,” held recently at the MMC-Pfizer virtual library of Makati Medical Center (MMC).

Dr. Samuel So, director of the Asian Liver Center at Stanford University, was the resource speaker of the event held every last Friday of the month and participated in by doctors from Stanford University Hospital, Singapore General Hospital, the Chinese University in HongKong, and MMC.

Liver cancer is one of the leading cause of death in Asia-Pacific, and sub-Saharan Africa, and at least 80 percent of the liver cancer is caused by HBV. Most people from Asia, the Pacific Rim, and Africa were infected with the virus during childhood: from infected mother to child at birth, from child to child contact in household settings, and from reuse of non-sterilized needles and syringes in poor healthcare facilities.

“While hepatitis B can be transmitted by blood transfusions, sharing needles, and unprotected sex, most individuals become infected as infants or young children,” So explained. Frequently, transmission of the hepatitis B virus occurs during the birthing process when the virus is passed on from the mother-who is unaware that she is a carrier – or during early childhood through close physical contact with blood or bodily fluid of infected individuals, such as contact between open wounds or sharing contaminated toothbrushes. However, hepatitis B is not spread by contaminated food or water, as with other types of hepatitis.

The danger of hepatitis B lies in its silent transmission and progression. “Many chronic hepatitis B carriers have no symptoms and feel healthy. If the proper tests are not administered, carriers may even appear to exhibit normal blood tests for liver functions, granting them a deceptively clean bill of health,” So added.

Diagnosis of hepatitis B cannot be made unless the doctor orders a specific blood test that tests for the presence of the hepatitis B surface antigen (HbsAg), marker for chronic infection.

One out of four hepatitis B carriers die from liver cancer or cirrhosis. Some develop cancer as early as 30 years of age. “The greatest single health disparity. The campaign is an initiative to build awareness about hepatitis B and its deadly impact in an effort to reduce the incidence of chronic hepatitis B and liver cancer in this high-risk group.

“Since it is one of the largest health threats for Asians, it is important for all to be checked for hepatitis B and get vaccinated if not previously exposed. Also, chronic carriers need to take control of their own health, avoid drinking too much alcohol, learn about hepatitis B treatments available, and be regularly screened for liver cancer after a certain age.”

Manila Bulletin

Just like other tropical countries all over the world, the Philippines often experiences a rise in the incidence of dengue during the rainy season. Dengue fever is a disease caused by a virus that is transmitted by mosquitoes known as Aedes aegypti. Because of the damp weather, dengue is often mistaken for a simple case of influenza and is often treated as such. However, dengue can be fatal if not properly treated.

Dengue is an acute fever caused by a virus, and can occur in two forms, namely: Dengue Fever and Dengue Haemorrhagic Fever. Dengue fever is marked by sudden onset of high fever, severe headache (mostly in the forehead), pain behind the eyes (which worsens with eye movement), muscle aches and joint pains, nausea or vomiting.

Dengue Haemorrhagic fever (DHF) is a more severe form, in which bleeding and sometimes shock occurs – leading to death. It is most serious in children, Symptoms of bleeding usually occur after 3-5 days of fever.

Symptoms of DHF are similar to dengue fever with the inclusion of any one of the following: severe ad continuous pain in abdomen; bleeding from the nose, mouth and gums or skin bruising; frequent vomiting with or without blood; black stools, like coal tar; excessive thirst (dry mouth); pale, cold skin; and restlessness, or sleepiness.

Typically dengue starts with chills, headache, pain upon moving the eyes, and low backache. Painful aching I the legs and joints occurs during the first hours of illness. The body temperature rises quickly as high as 104°F (40°C). The high fever can continue for five to six days (103-105°F or 39-40°C).

Fever and other signs of dengue usually last for 2 to 4 days, followed by rapid drop in temperature (defervescene) with profuse sweating, which heralds a period with normal temperature and a sense of well-being that lasts about a day. A second rapid rise in temperature follows.

There is a relative low heart rate (bradcardia) and low blood pressure (hypotension). The eyes become reddened. A characteristic rash appears simultaneously with the fever, spreading from the extremities to cover the entire body except the face. The palms and soles may become bright red and swollen.

The glands (lymph nodes) in the neck and groin are also often swollen. The patient often experiences much discomfort and feels very weak even several weeks after the illness (asthenia).

There is currently no specific medicine to treat dengue. For typical taking care of the symptoms (symptomatic). Proper and early treatment can relieve the symptoms and prevent complications, even death. Complete bed rest is important.

Acetaminophen/paracetamol, NSAIDs except aspirin, coxibs such etoricoxib, and codeine may be given to relieve the severe headache and the joint and muscle pain (myalgia). However, traditional NSAIDs (like iburprofen, mefenamic acid, naproxen, diclofenac, and the like) have been associated with gastrointestinal irritation and problems such as perforations, ulcers, and bleeding, particularly with prolonged use.

Aspirin should be NOT be given to patients with dengue fever, since it is known to increase the bleeding tendency and can also cause stomach pain and irritation. If dengue is suspected, it is best to take the patient to a doctor or to the hospital immediately. Fluids (water or juice) should be given to the patient often, even while bringing him/her to the hospital.

Dengue ca spread rapidly and can result in the loss of many lives, particularly during an epidemic. Most susceptible to the disease are children and persons with low immunity levels. However, with early diagnosis and proper treatment, complications and death can be avoided.

Prevention is the key in stopping the occurrence and spread of this deadly disease. Homes, schools, and office buildings should be kept clean. It is important to take control measures to eliminate the mosquitoes and their breeding places. Efforts should be intensified before the transmission season (during and after rainy season) and at the time of the epidemic.

Since the dengue mosquito is known to bite during the daytime, it is important to protect oneself fro mosquito bites by wearing clothing that covers the arms and legs (including the feet); using mosquito repellants, insecticide and electric vapor mats even during the day; and using mosquito nets for babies and the elderly during daytime naps.

To prevent the multiplication of dengue mosquitoes, it is advisable to drain all stagnant water from tanks, barrels, drums and buckets, etc.; remove water in coolers when not in use; remove from the house all objects, e.g. plant sauces, etc. which have water collected in them; drain water for refrigerator drip pans every other day; water storage containers should be kept covered at all times; and discard solid waste and objects where water collects, e.g. bottles, tin cans, old car tyres, etc. for schools and office buildings, it would be advisable to have the premises treated and sprayed with insecticide before, during, and after the rainy season.

For comments and insights, please write to Pain Management Information Agency (PMIA) at fax 894-1980 or e-mail at paincare@pmiagroup.com. PMIA was established primarily to increase public awareness and understanding of pain and to recommend appropriate medical and practical ways to manage and control pain.

August 12, 2005 Philippine Star

The hallmarks of hepatocellular carcinoma (HCC) are that it is identified clinically at an advanced stage and usually together with cirrhosis. Surgical resection has been considered the optimal treatment approach, but only a small proportion of patients’ quality for surgery, and there is a high rate of recurrence.

Approaches to prevent recurrence have included chemoembolization before and neoadjuvant therapy after surgery, neither of which has proven to be beneficial.

Liver transplantation has been successful in treating limited-stage HCC, affecting cure of both the tumor and underlying cirrhosis. However, only a minority of patients with HCC qualify for transplantation. Recently chemoembolization has been shown to prolong survival in selected patients who do not qualify for resection.

Both doxorubicin and cisplatin are frequently used, but overall response rates are low, and neither seems to prolong survival. Prospective, ran-domized controlled trials using current therapies are needed to better define optimal management of this important tumor. Most needed, however, are new therapeutic agents that are effective against HCC, are noncytotoxic, and are tolerated by the atypical patient with underlying cirrhosis.

Newly emerging agents with promise include 90Y microspheres, natiangiogenesis agents, inhibitors of growth factors and their receptors, and K vitamins.

Hepatocellular carcinoma (HCC) is the most common tumor that originates in the liver, and it has great hetero-geneity with respect to tumor behavior and disease of the underlying liver. Although most types of cancer are sub classified on the basis of the TNM staging system or the extent of disease, HCC is not a uniform disease within any given current staging system.

In addition, it is heterogeneous with regard to the severity of disease, and measurement of treatment outcomes in HCC related to the fact that 80 percent of patients with HCC have two diseases, each of which, independently, may cause death; namely the cancer and the underlying cirrhosis. Concomitant cirrhosis distinguishes HCC from all other types of cancer, and has bee acknowledged in at least one staging system, but confounds and confuses the evaluation of different treatments.

HCC in the United States

The experience with HCC at the Liver Cancer Center of the University of Pittsburgh recently has been summarized. During the 15-year period, 1700 patients with HCC were evaluated. Seventy-five percent of patients had bilobar cancer, 72 percent had portal vein thrombosis, and 65 percent had three or more tumor masses in their livers.

Thirty percent had HCV infection, 20 percent were infected with HBV, and 28 percent had alcohol-associated cirrhosis. Among those with HCV infection, more than 66 percent of the patients had no identifiable underlying liver disease. The male-to-female ratio was 2.5:1. The ages of the patients averaged 56 years and anges from 6 months to 92 years. Twenty percent presented with endstage liver disease and were not eligible for any form of treatment. The median survival I these untreatable patients was three months, in keeping with the known rate of survival of HCC.

Treatments for HCC

A high proportion of patients with HCC in he United States do not receive any therapy. The exact proportions is not known, but may be as high as 50 percent. There are several reasons for this low rate of therapy. Chronic liver disease is often silent, and many patients are unaware of having liver disease or being at risk for liver cancer.

Furthermore, among those patients who are known to have liver disease, there are no guidelines or accepted approaches to regular surveillance. As a consequence, most patients with HCC rarely present with symptoms unless there is advanced-stage cancer.

Because the cancers are large, they are often bilobar or have already invaded a major trunk of the portal vein, and hence are not respectable. Because of the late stage of presentation, many patients with HCC are not referred to a medical oncologist for either systemic chemotherapy reflects an atmosphere of nihilism over therapy for this tumor, and until recently, lack of new and innovative therapies.

Finally, contraindications to therapy may already be present (ascites, end-stage liver disease) and referral is considered unjustified.

Surgical resection

Surgical resection of varying degrees and extent has been time-honored standard treatment for HCC. Recent series, particularly from Asia, suggest that in experienced hands, perioperative mortality can be less than 5 percent. Although recurrence rates after surgery have decreased and survival has increased over the last 20 years, most patients with TNM stage II still have only a 50 percent 5-year survival, death usually being caused by recurrent cancer.

Other ablative localized treatments

An increasing array of other localized semi surgical treatments has become widely accepted for extremely localized tumors. These include percutaneous ethanol injection, radiofrequency ablation, cryotherapy, and newer forms of radio-wave therapy. These local ablative therapies seem to be similar in applicability, and results are highly dependent on clinician skills and choice of patients. Local ablative therapies are generally useful for patients with 1 or 2 tumor lesions with a maximum diameter of 3 cm.

Liver transplantations

There were two hopes for liver transplantation in the management of patients with advanced HCC. The first was to remove the limitations that cirrhosis imposes on the surgeon to reset HCC. The second was to improve the ability of the surgeon to resect larger tumors.

In the first category, liver transplantation has been gratifying successful, and HCCs that are confined to the liver can be surgically removed, whatever the degree or severity of the underlying cirrhosis. For the second, there continues to be a learning phase on how to use and extend the possibilities of liver transplantation for the management of advanced-stage HCC.

In addition, the standards for acceptable of liver transplantation for HCC need to be continually reviewed and reconsidered. In other types of advanced cancer, a 50 percent 5-year survival rate is considered worthwhile, but in liver transplantation, a 50 percent 5 year survival is not. For most patients with advanced HCC, extension of life for three years would be considered meaningful if the quality of life were reasonable.

Hormonal therapy

Almost 9 percent of newly diagnosed HCCs referred to the University of Pittsburgh were considered to be non-resectable and non-transplantable as judged by the extent of the tumor. The management of such tumors is currently nonsurgical.

The gender differences noted in HCC incidence rates have encouraged many investigators to examine tumor profiles for hormonal or growth factor receptors and, with or without this information, to embark on clinical trials of various hormonal modalities, including agents such as tamoxifen to inhibit estrogen actions (which is unlikely to be successful because this tumor predominantly occurs in male subjects) and anti-androgens such as leuprolide acetate and flutamide.

Despite many trials, the overall results have been disappointing and survival has remained poor. Nevertheless, such approaches are attractive because the agents are in general non-toxic, inexpensive, and easy to administer.

Chemotherapy

A huge number of randomized and non-randomized clinical trials to evaluate the usefulness of single agents or combinations of agents of cytotoxic cancer chemotherapy have been published and recently reviewed. Overall, few published series have been able to show response rates in >20% of the patients (considered to be a lower limit of usefulness for most cancers), and very few claims have been made for prolonging survival. Some more recent combinations such as cisplatin, interferon, Adriamycin, and 5-fluorouracil are extremely toxic and yield response rates of only 20 percent, and supportive care alone.

New medical agents

Several new classes of nonsurgical therapy for HCC have begun to be evaluated systematically in the pas 2 years. These include the following.

1. Antiongiogenesis agents, such as vascular endothelial growth factor (VEGF) antibody, Angiostatin, and endostatin; thalidomide, thrombosponding analogs; and interferon-The vascularity of HCC makes it an excellent candidate for the action of these agents.

2. Inhibitors of growth-factor signaling and cell-cycle enzymes, such as inhibitors of Kinase (Bay 43-9006), Cdks, tyrosine kinases, epidermal growth factor receptor antagonists (Iressa), P13 kinase and phosphatase and tensin (PTEN) pathways, mitogen activated protein (MAP) kinase pathway, and suramin.

3. Nonspecific growth inhibitory agents, including Sandostatin and arsenic trioxide and Activators of apoptosis.

4. Novel means of delivering localized radiation, such as Yttrium microscopheres, Theraspheres, and Sirsphres.

5. Specific antagonists of HCC tumor markers, such as vitamin K2 and the Cde 25-Antagonizing vitamin K analogs.

6. Anti-inflammatory agents that might interfere with the carcinogenic process, such as Cox-2 inhibitors (celecoxib, rofecoxib).

Conclusions

The largest impact on mortality from HCC will clearly come initially from primary prevention such as decreasing alcohol consumption, decreasing HCV infection through lifestyle changes, improving screening of blood donors, and vaccination against HBV. Next will be the benefit derived from earlier diagnosis leading to more effective therapy for more limited-stage disease.

However, new therapies for HCC will continue to be needed. Multiple new therapies are now being evaluated, and combination of modalities clearly should be examined to improve the efficacy of treatment of most patients who continue to present with an advanced stage of their tumor.

CHARLES C. CHANTE, MD – August 7, 2005Philippine Star

Sleep is as essential as balanced diet and regular exercise to stay fit and healthy. But today’s lifestyle seems to have overlooked the necessity of sleep-hence, it is sometimes ignored.

The fact remains that sleep is one form of pleasure that our body longs for at the end of every day – and if we deprive ourselves of a sound, rejuvenating sleep, the end effect is a cascade of numerous health problems. Below is a list of how to get a relaxing and rejuvenating sleep.

* Try to go sleep at the same time each night and get up at the same time each morning – this will help establish your sleeping pattern or rhythm which is essential in a regular sleep-wake cycle.
Try not to take naps during the day because it may disrupt your rhythm and make you less sleepy at night.

* Avoid caffeine, nicotine and alcohol late in the day. Caffeine and nicotine are stimulants that may keep you from falling asleep. Alcohol is often used as a depressant but it’s actually a stimulant that will make your body’s entire system in hyper mode. People falling sleep drunk are more unconscious than asleep because of the alcohol overload in the system.

* Get regular exercise, but try not to exercise close to bedtime because it may stimulate you and make it hard to fall asleep. When we perform physical activities, a hormone called adrenaline is released. When the physical activity is finished, it take a little while for this hormone to subside.

* Make your sleeping place comfortable. Be sure that it is dark, quiet and not too cold or two warm. If light is a problem, try a sleeping mask. If noise is a problem, try putting on earplugs.

* Follow a routine to help relax and wind down before sleeping such as reading a book, listening to soft music, or taking a bath. This approach is individualized because one routine which is effective to one may not be effective to another.

* If you have problems sleeping, consult your doctor. You may have physical or psychological disorders that keep you from sleeping.

* Remember that there are natural means to help solve sleeping problems. It may not work as dramatic as a pill, but you can be certain that you will be reaping its benefits once it takes effect.
One example is Leizenzi herbal food supplement from Better Herbs Inc. It will not make you sleep immediately, but once its effects are manifested by the body, it will improve your sleep quality and length.

It will not make you sleepy during day, only at night because its action is on the brain and body’s sleep-wake cycle. It helps establish your sleeping pattern by regulating the body clock. Leizenzi, or formerly Better Sleep is now available at Mercury Drug and Watsons.

Manila Bulletin