Dear Dr. Roach: I have heard of almost every organ or part of the body being attacked by cancer, but I鈥檝e never heard of cancer of the heart. Can that be the case?
C.L.
Tumours of the heart are extremely rare, seen in less than one person in a thousand, and an even smaller subset of those tumours are cancer. The most common tumour of the heart is called a myxoma, and these occur in the left or right atrium. They are common enough that
I have seen a few in my career. They can grow to a large size, and they cause problems by interfering with blood flow, and by predisposing a person to embolization 鈥� when small bits of tumour or clot break off, they can go to the lung, or in the case of left-sided tumours (or a septal defect, 鈥渉ole in the heart鈥�), to the brain.
About 15 per cent of cardiac tumours are cancers. The most common is a sarcoma, a cancer of connective tissue, such as muscle or the lining of the blood vessels. I fortunately have never had a patient with one of these.
Dear Dr. Roach: My cancer doctor told me that progesterone should always be prescribed with estrogen. I was prescribed only progesterone by my family doctor. My doctor said this probably caused my uterine cancer. My symptom of bleeding led to the early detection of my uterine cancer. Luckily, a hysterectomy removed all of my cancer.
L.H.K.
Estrogen taken without any kind of progesterone (we say 鈥渦nopposed estrogen鈥� for this situation) is a very strong risk factor for development of uterine cancer (it increases the risk more than sixfold), and almost never is done. However, progesterone-type compounds alone (without estrogen) are commonly used, both for birth control and other indications, and actually protect against the development of endometrial cancer (they have been shown to reduce the risk by 80 per cent, but clearly not by 100 per cent). It sounds like the message got confused.
Dear Dr. Roach: Four years ago, and again three years ago, I had colonoscopies, with Dulcolax tablets and Miralax powder drink as the prescribed cleansers. Since that time, my regular early-morning bowel movement has become much less predictable, once or twice a week requiring prune juice or occasionally a docusate capsule. Is it possible that the laxative cleansers changed something in my natural rhythms? If so, do you have any suggestions for alternatives?
H.S.
I see people with changes in their bowel habits after colonoscopy fairly routinely, and people are happy with the changes more often than they are unhappy. Usually the changes are short-lived, and although I don鈥檛 have definitive proof of my guess, I do think that people with longer-lasting changes have undergone a change in their gut bacteria due to the colonoscopy preparation. Our gut bacteria are responsible for many effects in the body, and I wonder if you lost a healthy strain.
I have recently written about probiotics, and I think it may be worthwhile for you to try a course of probiotics (there are many commercial products) to try to return to your natural rhythm.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
