Join Gynecologic Oncology and wellness experts for a special "brunch and learn," event for ovarian, cervical and other gynecologic cancer survivors and champions. Speaker-led sessions will cover innovation in treatment and complementary medicine to help manage menopause and other symptoms. Moderated by Darlene Gibbon, MD. FACOG, Medical Director of Gynecologic Oncology.
Other event materials can be found under the Patient Tools tab on this page: https://www.summitmedicalgroup.com/service/gynecological-oncology/
Simple Ways to Reduce Your Cancer Risk - Montclair Public Library - 5.18.19Summit Health
Did you know that up to 50 percent of cancer cases in the United States could have been prevented? Learn strategies you can implement in your life to significantly reduce your risk of getting cancer. Light refreshments will be served.
Presenter(s): Melissa Berlin, MD, Family Medicine Practitioner; Constance Gore, RN-APN, Oncologist; Christina Lavner, RD, Oncologist
What Women Need to Know About Heart DiseaseSummit Health
Do you know your risk for cardiac disease? Take a closer look at guidelines, tools, and techniques that can assess your own risk and learn the latest on preventing cardiovascular disease. This community lecture at Summit Medical Group offers information regarding cardiac screenings such as cholesterol testing, calcium scoring, stress testing and echocardiograms .
Susan L. Simandl, MD, FACC http://www.summitmedicalgroup.com/doctor/ssimandl/
Suzanne Shugg, BSN, MSN, RN, ACNP, DNP http://www.summitmedicalgroup.com/doctor/sshugg/
Awareness session on breast cancer awareness on 21st oct 2021 at Mehran university, Jamshoro organized by American institute of Chemical engineering society AIChE MUET chapter
Simple Ways to Reduce Your Cancer Risk - Montclair Public Library - 5.18.19Summit Health
Did you know that up to 50 percent of cancer cases in the United States could have been prevented? Learn strategies you can implement in your life to significantly reduce your risk of getting cancer. Light refreshments will be served.
Presenter(s): Melissa Berlin, MD, Family Medicine Practitioner; Constance Gore, RN-APN, Oncologist; Christina Lavner, RD, Oncologist
What Women Need to Know About Heart DiseaseSummit Health
Do you know your risk for cardiac disease? Take a closer look at guidelines, tools, and techniques that can assess your own risk and learn the latest on preventing cardiovascular disease. This community lecture at Summit Medical Group offers information regarding cardiac screenings such as cholesterol testing, calcium scoring, stress testing and echocardiograms .
Susan L. Simandl, MD, FACC http://www.summitmedicalgroup.com/doctor/ssimandl/
Suzanne Shugg, BSN, MSN, RN, ACNP, DNP http://www.summitmedicalgroup.com/doctor/sshugg/
Awareness session on breast cancer awareness on 21st oct 2021 at Mehran university, Jamshoro organized by American institute of Chemical engineering society AIChE MUET chapter
Here are slides from my 10-minute talk on breast cancer screening for an AACR webinar (Feb 16, 2017). I'll share the webinar link when that becomes available.
According to Dr. Vo Dang Hung, Director of TMMC Healthcare's Oncology Center. Breast Cancer is the most popular cancer among women. Know your risks and get frequent Breast Cancer Screenings to protect yourself.
Navigating Nutrition During Cancer and COVID-19bkling
Nutrition can be puzzling enough, but when you add a cancer diagnosis and a global pandemic, it’s even harder to make sense of it all. Julie Lanford, MPH, RD, CSO, LDN, "The Cancer Dietitian" for Cancer Services, will help put the pieces together so you’re equipped to navigate nutrition during cancer and COVID-19.
A presentation looking at breast health and BreastScreen Victoria. The presentation covers breast cancer, risks of breast cancer, breast awareness and the BreastScreen Victoria pathway.
Cancer sites associated with tobacco form 35 to 50% of all
cancers in men and about 17% of cancers in women. These cancers
are amenable to primary prevention and can be controlled to a large
extent.
Here are slides from my 10-minute talk on breast cancer screening for an AACR webinar (Feb 16, 2017). I'll share the webinar link when that becomes available.
According to Dr. Vo Dang Hung, Director of TMMC Healthcare's Oncology Center. Breast Cancer is the most popular cancer among women. Know your risks and get frequent Breast Cancer Screenings to protect yourself.
Navigating Nutrition During Cancer and COVID-19bkling
Nutrition can be puzzling enough, but when you add a cancer diagnosis and a global pandemic, it’s even harder to make sense of it all. Julie Lanford, MPH, RD, CSO, LDN, "The Cancer Dietitian" for Cancer Services, will help put the pieces together so you’re equipped to navigate nutrition during cancer and COVID-19.
A presentation looking at breast health and BreastScreen Victoria. The presentation covers breast cancer, risks of breast cancer, breast awareness and the BreastScreen Victoria pathway.
Cancer sites associated with tobacco form 35 to 50% of all
cancers in men and about 17% of cancers in women. These cancers
are amenable to primary prevention and can be controlled to a large
extent.
There are a variety of tests that you may face during the process of your diagnosis which will likely affect your treatment decision making. Join this informative webinar where Scott Weissman, MS, CGC, will explain the difference between tumor and germline testing so that you can better understand the tests you receive and what they mean for you.
SHARE, in partnership with Reproductive Medicine Associates of NY, FORCE, and Sharsheret, hold a presentation on fertility and family planning for patients recently diagnosed with cancer and those who are predisposed to hereditary cancer syndromes due to a genetic mutation. The presenter, Dr. Matthew Lederman, is a board-certified reproductive endocrinologist and infertility specialist.
Report Back from SGO: What’s the Latest in Uterine Cancer?bkling
Dr. Jeannine Villella, Chief of Gynecologic Oncology at Lenox Hill Hospital, provides a comprehensive update from the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer. Dr. Villella breaks down what the research presented at the conference means for you and discusses new developments.
Topic-Driven Round Table on Ovarian Cancer: Understanding Genetics and Ovaria...bkling
Women with ovarian cancer joined Julie Larson, LCSW, guest speaker Dr. Kathryn Pennington of UW Medicine, and peers via video or phone to discuss genetics and ovarian cancer.
In this webinar, Fight CRC Medical Advisory Board member, Heather Hampel, MS, LGC, will discuss the major sub-types of hereditary colon cancer, the types of genetic tests that by be useful for you and your family, and what to do with your test results.
Understanding Cancer Risks Using Genetic Lab tests.pptxHasna Zameer
A test for genes can be used in many ways. One application for gene testing is the detection of cancer. As an example, Cardiology genetics testing Dubai may be very useful to identify cancerous cells inside a patient's heart.
BRCA – Importance in Hereditary Breast & Ovarian CancerLifecare Centre
BRCA – Importance in Hereditary
Breast & Ovarian Cancer
DGF & WOW India
presentation was made by
Dr Sharda Jain
based on presentation made by
Dr Sunil Tadepalli
Genetic counselor, Heather Herrmann, will dive in to the topic of Lynch Syndrome & CRC. Heather has enjoyed working in both pediatric genetics and cancer genetics throughout her career. She has focused the last eight years in the area of hereditary cancer syndromes and hereditary cancer risk assessment.
Similar to Surviving and Thriving with Gynecologic Cancer - 9.7.19 (20)
Pediatric Talk: Managing Arthritis During the Holidays - Dr. Marla Guzman - ...Summit Health
While holiday celebrations and activities are great fun, it’s also a disruptor to the daily routine. Our expert will share tips to help you navigate holiday season stressors to minimize your child’s risk of a potential flare-up. This virtual event is hosted by the Arthritis Foundation.
Safety and Success in a Post-Pandemic Society - Daniela Accurso, MD, MPH - 7...Summit Health
The Covid-19 Pandemic has been a health crises that we have been fighting for the last year and a half. Dr. Accurso’s presentation is focused on reviewing how far we have come as a society and to address the questions, health concerns, and important precautions we need to take as we integrate ourselves back into a healthy community.
Melanoma: Prevention, Detection and Treatment - Stephanie Badalamenti, MD - L...Summit Health
Sun safety needs to start at an early age, and continue throughout life, in order to reduce the risk for skin cancer. Learn about prevention and ways to reduce your risk, screening for skin cancer and innovations in treatments.
Melanoma: Prevention, Detection and Treatment - Stephanie Badalamenti, MD - L...Summit Health
Sun safety needs to start at an early age, and continue throughout life, in order to reduce the risk for skin cancer. Learn about prevention and ways to reduce your risk, screening for skin cancer and innovations in treatments.
Shoulder Pain Relief: Common Rotator Cuff Injuries & Treatment Options - And...Summit Health
If you are experiencing shoulder pain, a rotator cuff tear could be the issue. Learn about how, and why, rotator cuff tears happen, how the condition and severity is diagnosed, and the non-surgical and surgical treatment options available.
My Knee Hurts! A Look at Joint Pain in Children - Marla Guzman, MD - 1.12.2021Summit Health
Is your child complaining of joint pain? Learn about concerning symptoms and when to seek medical advice. Our expert discusses the various causes of joint pains in children, how a pediatric rheumatologist evaluates musculoskeletal complaints, and available treatment options.
Mildred “Mitch” Bentler, MA, RD, CSP, CDE, presented a virtual lecture at on diabetes prevention. According to Ms. Bentler,
“A combination of small changes can really make an impact on lowering your blood sugar. Increasing physical activity and adopting healthier eating habits can go a long way to reducing your diabetes risk.”
Why Does My Stomach Ache? - Dennis Han, MD, Gastroenterologist - Morristown &...Summit Health
Do you have stomach issues which are bothering you and you can't figure out why? Learn about conditions that could be causing abdominal pain or discomfort at this virtual program. Our expert will discuss different conditions such as: Irritable Bowel Syndrome; Inflammatory Bowel Disease; Celiac Disease and other conditions that require a gluten-free diet; and GERD (Reflux). He will explain the differences between these various conditions, how they are diagnosed, and treatment options available. Hosted by Morristown & Morris Township Public Library.
Know Your Numbers and What They Mean for Your Overall Health - Madison Public...Summit Health
What does your blood pressure, BMI, cholesterol, blood sugar and vitamin levels tell you about your health? Our expert will discuss how these numbers tell a story, and why it’s important to understand what that story means to your overall health. Dr. Im-Imamura will also share tips for helping you get these numbers where they should be, and how increasing physical activity and improving nutrition are key factors that can impact those numbers in a good way.
Presented as part of the Madison Public Library Virtual Seminar Series.
Understanding Knee Arthritis and Cartilage Disorders - Maurice M. Pine Free P...Summit Health
Many people suffer from pain, swelling, stiffness, and loss of knee function as a result of knee arthritis. Our expert will discuss the causes, symptoms, and nonsurgical and surgical treatment options available. Hosted by Maurice M. Pine Free Public Library.
Pulmonologist, Jenny Kim, MD, FCCP of our Sleep Disorders Center partnered with the Livingston Health Department to present, Can’t Sleep? The ABCs of Your ZZZs to the community. During the session, Dr. Kim discussed tips for improving sleep and treatment options for common sleep disorders.
Christina Lavner, RDN, Nutrition Services, presented Healthy Eating for Cancer Survivorship, as the second session of our Now What? A Cancer Survivorship Speaker Series for patients wanting to learn more about nutrition that will benefit them during and after treatment. Be sure to check out upcoming presenters in this series and pass the word on to any patients you think would be interested in the information. The next presentation in this series is November 16, Coping with Treatment Side Effects, presented by Constance Gore, RN-APN
Guide to Eating an Anti-Inflammatory Diet Virtual Lecture - Christina Lavner,...Summit Health
An anti-inflammatory diet, along with exercise, can yield many health benefits, such as improved symptoms of many chronic conditions, reduced cancer risk, and a lower risk of obesity, heart disease, and diabetes. Learn more about this healthy way of eating and how to get started.
While most common in teens, the onset of acne can be troubling at any age. Depending on its severity, acne can cause emotional distress and scar the skin. The earlier you start treatment, the lower your risk of such problems. Learn about the causes of acne and effective treatment options for adolescents and adults.
Living a Heart Healthy Life - Liliana Cohen - West Orange Public Library - 2....Summit Health
Learn how to make healthy choices that impact heart health, the typical mistakes to avoid, and how to recognize the signs and symptoms of a heart attack.
Heart of the Matter - Ali Ahmad, MD, FACC - Livingston Library - 1.6.2020Summit Health
Heart disease is the leading killer of adults nationwide and it carries a significant morbidity for the population at risk. Learn about traditional and non-traditional risk factors associated with coronary artery disease, and how to modify your risk and prevent heart disease. Also, learn about how heart disease affects different ethnic backgrounds, particularly the high-risk groups, such as South Asians.
My Feet Ache, Now What? - Dr. Ucciiferri - 12.9.19 - Bernardsville Library Summit Health
Foot, heel and arch pain can occur for a variety of reasons. The pain can be more severe with certain types of footwear, especially dress shoes. Don’t let foot pain stop you from dancing into the holiday season. Learn about some common foot pain conditions, such as plantar fasciitis (heel pain), Morton’s neuroma (feeling of a pebble or folding sock in foot) and other foot pain conditions, and the many treatment methods used to alleviate pain.
Strategies for Managing Menopause - Dr. Soma Mandal - 11.18.19Summit Health
Learn about menopause and associated symptoms, including hot flashes, sleeplessness, weight gain, and other changes - such as bone loss and cardiovascular risks. Our expert discussed treatment and management options to help you navigate this important life transition.
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Moderator
Darlene Gibbon, MD, FACOG
Director of Gynecologic Oncology
Darlene Gibbon, MD, FACOG
Director of Gynecologic Oncology
3. Genetics & Its Impact on
Gynecologic Cancers: Diagnosis to
Treatment
Terri Febbraro, MD, MPH, FACOG
September 7th 2019
Surviving and Thriving with Gynecologic Cancer Series
4. Genetics & Gynecologic Cancer
• 20-25% of women with ovarian cancer
• 5% of women with uterine cancer
Have a hereditary predisposition for cancer
development
SGO Genetic toolkit
6. Germline vs Somatic Mutations
• Present in sperm or egg
• Occurs in all cells
• Are heritable
• Occurs in non-germline
tissue (tumor cells)
• Are not heritable
7. Hereditary Cancers
• Result from mutations in genes which
you are born with and can be passed
down to off spring
• Typically see a pattern across familial
generations
• Early age of diagnosis
• Development of multiple cancer
subtypes
8. Hereditary Breast &
Ovarian Cancer Syndrome (HBOC)
• Inherited germline cancer susceptibility syndrome
characterized by multiple family members with breast,
ovarian, pancreatic, prostate cancer and melanoma.
• Genes associated with increased risk for ovarian cancer
BRCA 1 & 2, MSH2, MLH1, MSH6, PMS2, EPCAM,
BRIP1, RAD51 C & D, PALB2, BARD1, TP53, STK11,
ATM
9. BRCA 1 & 2
• BRCA 1 and 2 genes are located on
chromosome 13 and 17 respectively
• Function to create proteins that help
repair damaged DNA and prevent
tumor growth
10.
11. Hereditary Breast &
Ovarian Cancer Syndrome
Cancer BRCA 1 BRCA 2
Breast 55-78% 45-47%
Ovarian 40-54% 11-27%
Randall L, Pothuri B et al. 2017
V
BRCA 1& 2 increase risk of ovarian cancer 40x that of
the general population
12. Lynch Syndrome &
Cowden Syndrome
• Lynch: Increased risk of colon, endometrial,
stomach, ovary, and kidney cancer
Genes involved: MLH1, MSH 2, MSH6, PMS2,
EPCAM
• Cowden: Increased risk of endometrial, breast,
thyroid
Gene involved: PTEN
13. Lynch Syndrome
Genes that encode for proteins to ensure correct
duplication of DNA are mutated leading to the
production of cells with many mutations in the
DNA and uncontrolled cell growth.
14. Cancer Risk
Gene Endometrial cancer risk Ovarian cancer risk
MLH1 40-57% 5-20%
MSH2 40-60% 10-38%
MSH6 17-46% 1-10%
PMS2 15% 0%
EPCAM Evolving, similar to MSH2 Evolving, similar to MSH2
Domchek S, ME Robson. 2019
17. Background
• Genetic testing became available in 1990s
• 2013 supreme court prohibits patents on
specific human DNA sequences
Opened availability of testing
Development of new technology
18. Testing Recommendations
NCCN guidelines:
All women with ovarian/fallopian tube/primary
peritoneal cancer
• Exception: borderline & mucinous
Uterine cancer < 50 years old
Uterine cancer > 50 years old + 1st degree
w/uterine or colon cancer
Synchronous colon & uterine cancer
Cancer w/evidence of mismatch repair deficiency
19. Genetic Testing Process
• Identify women at risk
• Consultation with genetic expert to collect a
detailed family history
• Identify appropriate testing
• Insurance preauthorization
• Collection of saliva and/or blood
• Post test counseling
20. Benefits of Testing
• Personalized prognosis
• Enhanced risk assessment for synchronous
cancers
• Inspire other family members to get tested
• Ensure family members are proactive about
managing cancer risk
• Triage to targeted therapies
21. Risks
• Anxiety or depression from positive or
uncertain test results
• Fear of discrimination
• Guiltily sentiment
• Change in family dynamics
• Financial costs of testing
22. Genetic Information
Nondiscrimation Act
(GiNA)
• Federal law to protect against discrimination
by employers or health insurers based on
genetic information.
• Disability and life insurance are not includeds
excluded
23. Financial Cost
• Typically covered for women meeting hereditary
cancer criteria
Insurance agency may have slight variations
• Affordable Care Act:
Covers BRCA gene counseling & testing
Lynch testing or testing in men not covered
• Medicare and Medicaid
One time testing for those with cancer
• Financial assistance programs
24. Testing Options
• Individual gene
Used with a known familial or somatic mutation
• Multiplex panel
Significant family history with negative individual
gene testing
Wider risk assessment
• Cascade
Blood relative testing of individuals identified with
specific mutations
25. Test Results
Genetic Testing in Gynecologic Cancers
• GOAL: Identify germline DNA mutations in cancer
susceptibility genes
Sequence Variant
Polymorphism
(Benign)
Variant of Uncertain
Significance (VUS)
Mutation
(Deleterious)
26. Results
• Positive
Mutation identified associated with hereditary
cancer syndrome
• Negative
No mutation found
• Variant of uncertain significance (VUS)
Changes in the sequence of DNA detected but
not enough info is known to classify it as disease
causing
27. I carry a mutation…
so now what?
Women without cancer
28. Surveillance
• Screening for ovarian cancer is not
recommended; does not reduce ovarian
cancer mortality or increase survival
Annual CA 125 and TVUS
• Screening for endometrial cancer:
Endometrial biopsy starting at 35 years of age
every 1-2 years can be considered
NCCN guideline, 2019
29. Risk Reducing Options
• Oral contraceptive pills
• Risk reducing bilateral salpingo-oophorectomy
BRCA 1: 35-40 years of age
BRCA 2: 45 years of age
BRIP1, RAD51C&D: 45-50 years of age
• Consider hysterectomy/BSO in those at risk for
Lynch
PMS2 BSO not indicated
30. Risk Reducing Bilateral Salpingo-
oophorectomy Benefit
• Risk of ovarian cancer is reduced by 80%
• Risk of breast cancer reduced 37-80%
• Decreased overall mortality
Rebbeck TR, Kauff ND et all, J Natl Cancer Inst 2009
31. Reproductive Concerns
• Freeze eggs prior to treatment
• Preimplantation genetic diagnosis in
woman who are carriers
Requires IVF for embryo screening
32. I carry a variant of uncertain
significance (VUS)…
so now what?
33. Variant of Uncertain Significance
• Treatment should not be based on VUS
• Keep contact info updated
Notified of reclassifications
34. I carry a mutation…
so now what?
Women with a cancer
diagnosis
37. Parp Inhibitors
FDA approved oral treatments
• Lynparza (Olapraib):
After 3 or more lines of tx
Maintenance therapy after initial treatment
• Rubraca (Rucarparib):
After 2 or more lines of tx
Maintenance therapy after initial treatment
• Zejula (Niraparib)
Maintenance therapy after two or more lines of tx
38. Parp Inhibitors
• Improvement in progression free survival and
overall response rate
SOLO-1 trial 60% vs 27%
• Combination therapy with immunotherapy or
anti-angiogenesis treatment
Numerous trials are underway
• Expansion to women without BRCA mutation
39. Pembrolizumab (Keytruda)
• Immunotherapy targeting PDL-1
• FDA approval for treatment of advanced
tumors that are mismatch repair deficient or
microsatellite instable after one line of
treatment.
May be given in combination with Lenvatinib
• IV infusion every three weeks
40. Trastuzumab (Herceptin)
• Monoclonal antibody that binds to the HER-2
receptor to block cell proliferation
• Mutation is identified during somatic testing of
serous uterine cancer
• Given in combination with carbo/taxol
41. Conclusions
• Increased genetic testing options due to technologic
advancement enhancing accessibility
• Broader knowledge of genetic contribution to cancer
development
• Implementation of genetic testing results represents
advancement in precision medicine and progress to
targeted treatment that are leading to improved
outcomes and survival
44. Guide to Eating an
Anti-Inflammatory Diet
Christina Lavner, RD
45. QUIZ:
1)Does eating a Mediterranean diet or plant
based diet mean I can only eat Italian or
Greek dishes?
NO!! A Mediterranean diet is a pattern of
eating that can offer health protective
potential by avoiding adult weight gain and
preventing metabolic changes that can lead
to cancer & other disease development.
46. 2) Does eating a Mediterranean
diet or plant based diet mean I
have to become a vegetarian?
NO!! The goal is to increase the
fiber in your diet & change the
way we think about protein
foods.
47. 3) Does eating a Mediterranean diet or
plant based diet mean I will have no
flavor in my food?
NO!! Spices are not only delicious the are
good for us! Many spices such as
Turmeric, Ginger, Garlic, etc. are
considered anti-inflammatory foods,
when we EAT them!
48. 4) Is eating green veggies, like Kale,
Broccoli, Spinach better for me than other
vegetables?
NO!! No one veggie is more important than
another. It is the combination of eating a
variety of fruits and veggies that create a
synergistic effect to make our bodies as
healthy as possible & have the ability to
fight off disease.
49. 5) Is diet more important than exercise
in preventing cancer or other
diseases?
NO!! Exercise plays a key role in
maintaining good health. A recent
study found that adding exercise,
independent of diet, decreases 17
different types of cancer by 50-55%.
We are meant to move!
50. A few things to note when we talk about
cancer prevention:
1)Any “diet” you choose has to be
sustainable for the rest of your life
2)Exercise should be considered
“medicine” not “torture”
3)No food can cure cancer
4)It’s not just food that keeps us healthy –
our mental/emotional state plays a
big role in our health.
Sometimes we need to feed our soul.
52. Step #1:
It isn’t just about food,
it is why we eat it.
This isn’t just another “diet”,
it is a lifestyle.
A commitment to yourself for long
term good health.
A commitment to allow your body to
be as healthy as possible.
53. Step #2
Get rid of processed foods in your
diet. Move to a more all natural diet.
Increase: fruits, vegetables & whole
grains in your diet.
Decrease: white flour, cakes, candies,
cookies and other processed or fast
foods.
55. Step #4:
Reduce the amount of red meat in
your diet and increase fish & non-
meat protein sources.
For example, nuts, beans, seeds,
tofu, non-fat dairy products
56. Step #5:
Eat the colors of the rainbow!
The different colors of fruits &
vegetables represent the variety of
different protective compounds they
offer. The more colorful your plate is
the more abundant the nutrients are.
57. Step #6:
Skip the salt!
Use different herbs and spices to
season your food, such as
Turmeric, Ginger, Garlic,
Rosemary, Basil, Oregano,
Parsley, etc.
58. Step #7
Drink Water!!
New recommendations are half
your body weight in oz. of
water.
Start with 64 oz. per day
59. Step #8
Drink red wine in moderate (optional)
No more than 2 glasses per day for
men
& 1 glass per day for women.
AICR recommends no alcohol for
cancer prevention.
60. Step #9
Take small steps!!
You don’t have to be perfect
tomorrow.
Make small changes that are
realistic and achievable.
NO perfection or extremes!!
61. INFORMATION OVERLOAD!!
Doing the right thing
is confusing!!
*90% of health information &/or claims on
the internet are based on someone’s option or
information that was made up to sell a
product.
NOT everything you read on the internet is
true!!
62. Small Realistic Changes
Instead of saying “I’m never eating any
CARBS ever again”
Try cutting out processed foods or
sweets,
i.e.: chips, cookies, baked goods, etc.
Change from French Fries to a baked
potato or a side of vegetables instead.
63. Exercise is Medicine!!
Add exercise in as much as possible - the goal is to prevent
metabolic changes.
As we age, we lose lean mass or muscle, you need to work to
maintain it or you can lose up to a pound of muscle every year.
It is replaced with fat!
Muscle burns 9 calories an hour & fat burns 3 calories an hour to
maintain it’s state.
Muscle burns 3x’s more calories!!
64. Less muscle + More fat +
decreased physical activity +
unchanged eating patterns =
Difficulty losing weight &
keeping it off.
Weight Gain = Metabolic Changes =
Increased Cancer Risk
65. Healthy Fats … Not High Fat!
Healthy fats are linked to:
Lower Cholesterol levels,
Healthy Hearts
Weight Loss
Overall Fewer Health Problems
Avocado, Olives, Olive Oil, Walnuts, Seeds,
etc.
68. Summary:
1) Vegetable – At least 6 servings per day
2) Fruit – 2-3 servings per day
3) Dairy – 2-3 servings per day, avoid processed
cheeses
4) Meat – 1x week or less
5) Chicken – 2x week
6) Fish & Seafood – At least 3x week
7) Grains & Breads – Bread 3 slices/day, Pasta 1x
week, other grains 1x week
8) Fats & nuts – At least 3 Tbsp. Olive Oil per week
& 3 servings of nuts & seeds per week
9) Beans – 2-3 servings per week
77. Topics for Discussion
• Diagnosis
• Treatment
• Survivorship (up to 2 years)
• Survivorship (2+ years)
• Resiliency and Post Traumatic Growth
• Helpful Tools, Strategies and Techniques
• Resources
78. Why Me?
• My Background/Story
• Therapy Patients with a Cancer History
• Therapy Patients with Family Members
that have had Cancer
• 14 years of Leading Support Groups
79. Statistics
• By 2026, there will be over 20 million cancer
survivors in the US alone
• Over 100,000 women a year are diagnosed
with a gynecologic cancer
• 18-25% of long-term cancer survivors report
anxiety
• Fear of recurrence specifically is much
higher (up to 80%)
• PTS/PTSD in survivors: 5 – 60%
• Cancer related distress: 35 – 43%
82. The First Month
• Biopsy/Surgery/Staging
• Decisions about Treatment
o How was information presented?
o How quickly did you have to make
decisions?
o Any personal experience with cancer?
o Know others that have been through this?
o Have faith in the Treatment Team?
o If there were options, was there stress of
making the "wrong" decision?
83. Distress Thermometer
• Given at various points through the journey
o Practical Problems
o Family Problems
o Emotional Problems
o Spiritual/Religious Concerns
o Physical Problems
84. PTS/PTSD In Cancer Patients
• Anxiety disorder that can be brought on by a traumatic
event
• Event is life threatening
• Difficulty with daily functioning
• PTS vs. PTSD
• Symptoms to highlight:
o Reliving the event, avoiding situations that
are reminders, trouble sleeping, intense feelings of
fear, bouts of crying, difficulty in relationships, being
irritable or numb, trouble concentrating,
remembering & focusing, negative changes in beliefs
& feelings
85. During Treatment
• Patient rarely seek out help in this stage
• Following orders (like a soldier)
• Physical symptoms dominate:
o Fatigue
o GI Problems
o Appetite/Weight
o Hair Loss
o Blood levels
o Infection
86. Survivorship post treatment -
2 years out
• Emotions are confusing!
• The toughest time – most likely to seek help or
experience symptoms
• Realize what you survived
• The "island" phenomenon
• Returning to a life that the new you doesn't quite
know how to navigate
o Wants and needs have changed
o Abilities may be different
• Long term side effects and obstacles
• Fear of recurrence
87. Survivors 2+ years out
• Continued adjustment in the role that
"survivor" takes on
• Regular scans and check-up remain stressful
times with fear of recurrence
o Important to note how normal this is
• Potential increased health anxiety in general
• Life's landscape may begin to change
88. Additional Struggles
• Sexual Dysfunction
• Relationships
o Partner, children, friends
• Body Image
• Mood disorders
• Loss of $$$, job, career
• Grief
• Survivor Guilt
• Identity Crisis
89. Resiliency
• Ability to maintain or restore relatively stable
psychological and physical functioning when
confronted with stressful life events and adversity
• In the context of cancer: an individual’s protective
attributes and/or personal characteristics, which are
thought to be modifiable and to promote
successful adaptation to cancer
• Those who are resilient may also experience post-
traumatic growth
90. Post-Traumatic Growth
• Fairly new terminology in cancer literature
• 53-83% reported lives changed positively after
cancer, and they used coping skills
• Positive life changes that develop over time as a
result of the struggle with a traumatic experience
• A change in self-perception (empowerment)
• A change in relationships with others
o Improve or lose
• A changed philosophy of life
o Priorities, goals, appreciation for life,
spiritual gains, lifestyle adjustments
91. Promoting Emotional
Resilience & Recovery
At any point in the journey:
• Ask for help
• Self-Care
• Find Ways to Express Emotions
• Allow private time and space (journal, meditate)
• Exercise (as gentle as necessary)
• Find others that have been where you are, that
"get it" and can relate
• Take back control where you can (cultivating
healthy habits, etc.)
92. Additional Techniques
• Post trauma Vision Board
• Schedule Time to Think
• Evidence For and Against
• Change the Narrative
o Adjust the words
o "I am having the thought that..."
• Mindfulness (5,4,3,2,1)
• LAUGH
93. Treatment
• Therapy with someone who understands trauma
or life-threatening medical conditions
• Medication to ease symptoms
• Support Groups
• Specialists (sexual dysfunction, physical
therapy, nutritionist, other MDs)
• Self Help
o Books/Organizations/Podcasts/Conferences
94. From Cancer Transitions
"Cancer brings changes that are not
always for the worst and may bring
about healthy personal growth.
The cancer experience and your
emotional responses can become
important resources as you face your
future."
Starts October 17th
To register, call Jill Kaplan at 908-658-5400
97. • Traditional Chinese Medicine has been used for over 4000 years to
diagnose, treat and prevent disease.
• Acupuncture and Qigong are two modalities in this medicine
• Based on the theory of Yin and Yang
History
98. Theory of Yin and Yang
• This theory states that there are opposing yet complementary forces
in nature.
• These forces have to stay in balance to maintain a healthy body
99. Examples of Yin and Yang
Yin Yang
Night Day
Darkness Brightness
Cold Heat
Moisture Dryness
Rest Movement
Passivity Activity
Feminine Masculine
100. Meridians
• In Oriental medicine we work on pathways called meridians
• There are 12 main meridians.
• Each is named after an organ in the body
101. Qi
• An energetic force called Qi flows through the meridians
• Disharmony results when Qi is disrupted by illness, emotional trauma,
• Medication, lack of rest, overwork, dehydration, poor nutrition
• Disharmony is an imbalance in the body
102. Western Theories on Acupuncture
Neurotransmitter theory
Acupuncture may release or regulate neurotransmitters and cause an analgesic effect to modify pain
Stimulate the body’s capacity to heal
Release opioids and endorphins – Impact the limbic system and effect mood an emotions
Gate theory-
Change the perception of pain in the brain
Blood Chemistry theory-
Acupuncture has an impact on blood chemistry. Point combinations used to increased blood cell counts
Boost the immune system
Meridians are thought to lie along fascial planes between muscles bones and connective tissue.
Thought to improve nerve conduction and when acupuncture points are combined with electric stim.
can accelerate nerve repair.
Needles cause a controlled microtrauma that can lead to an inflammatory response- regulate antibodies
and stimulate pain receptors.
103. Body Acupuncture
• Fine needles are inserted along meridians
to manipulate Qi and bring the body into a
balanced state
• Acupuncture points are where the pathway
comes close to the surface of the body
104. Auricular Acupuncture
• The entire body is reflexed
on the ear
• Can be used to treat the
physical body and emotions
• Can be used for self care
105. What does acupuncture treat?
The WHO lists a wide range of medical problems that acupuncture
treats including Neurological disorders, Orthopedic disorders,
gastrointestinal disorders, respiratory disorders, gynecological
disorders, chronic disorders including insomnia, stress and
addictions.
Acupuncture is used to treat side effects from Chemotherapy, RT,
and is used pre and post operatively to aid in healing.
106. Acupuncture’s Role in Cancer Treatment
Acupuncture is used to support your treatment
Point combinations are used to:
• Relieve nausea and vomiting
• Regulate bowels- constipation and diarrhea
• Regulate urination
• Reduce hot flashes
• Boost energy
• Improve sleep
• Improve salivation in cases of xerostomia
• Control allergic reactions
• Increase antibodies
• Improve T-cell count
• Improve Red and white blood cell count
• Enhance ovulation
Allopathic medicine treats cancer
107. Benefits Pre and Post Surgery
Pre surgery
• Promotes relaxation
• Helps to alleviate side effects
Post surgery
• Decreases swelling
• Improves mental alertness
• Improves intestinal motility and urination
• Promotes incisional healing
108. Other Considerations
• Meridians go from the head to the toes and chest to the arms
• One end of the body can be used to treat the other
• The site of a tumor, surgical incision or limb with lymphedema
need not be needled to treat the problem
Examples- the ankle can be used to treat the neck or the wrist; the
elbow can treat the knee; one side of the body can be used to treat
the other.
109. Self Care
I think I can say that all of your healers work in a partnership with
our patients. We are with you a relatively short time throughout the
week so self care is of great importance. This means focusing on
the physical through exercise, nutrition, hydration and the psycho-
emotional. We know that attitude has a great impact on healing!
110. Qi Gong
Qi is translated as life force or energy
Gong is translated as to cultivate
Together this exercise cultivates energy
• Enhances mental, physical,
spiritual and emotional well-
being
• Exercises combine movement,
breathing and visualization
• Some forms use stillness and
meditation
Editor's Notes
Increase in technology
Increase in acceptable options for prevention and targeted chemotherapt makes heredtiatry cancer a topic on the forefront of clinical practice
Although number for lynch is small, there are more woman diagnosed with endo ca and hence this 5% represents a significant number of women.
So when we talk about mutations, there are two types that we are speaking of
1 the germline that is passed down though sperm and egg
Somatic that is found in other tissue
HBOC is the result in a mutatation in a number of genes. Th emost common ones are listed here.
However the most common are BRCA 1 and 2. Everyone has BRCA genes, Problems arise when there are mutations in DNA and create a protein that doesn’t function properly so cells overgrow. Not all women with mutation sin these genes get cancer but they are at an increased risk.
This chart shows the risk of developing either breast or ovarian cancer carryin a BRCA mutation. As you can see the risk is higher with BRCA 1
Lifetime risk of developing endo ca with Lynch is 70% Pothuri
3% of all endometrial cancer cancer are attributed to Lynch, women less than 50, up to 9%
50% of cases endo Ca is the sentinel cancer
MLH1 and MSH2 mutation result in cancer more frequently than PMS2 and MSH6
MSH2 25-60% risk of uterine ca 5-24% ov ca
PMS2 15% endo and 6% ov ca
EPCAm similar risk to MSH 2
IHC or MMR
Rates are still low, 30%
Racial disparities exist
After this ruling, the number of companies offering genetic testing expanded and the technology they used exploded from sanger sequencing to next generation sequencing.
NCCN SGO and ASCO logs as they have all recommended testing
All women <60 should have MSI testing
Typically visit is in person.
Can also be done in providers office
Moving towards phone and telemedicine
Children should not be offered testing until age 18
Good to discussed with counselor
Not panel testing
Next gen started in 2013
Non BRCA genes make up 6-10% of inherited serous ov ca
As cost goes down and we are idetfiying new genes implicated in cancer susceptibility that panel testing is becoming increasing utilixed.
Clinical decisions should not be made on VUS
UTTOKC
Postmen consider US not for premen
Recommendation for BSO after child bearing is complete.
Performing a salpingectomy with delayed oophorectomy has not yet been proven and remains a clinical trial
Hyst doesn’t reduce mortality