DEAR MAYO CLINIC: My mother was recently diagnosed with breast cancer. Given my family history, when should I consider preventive surgical options, and what do those look like? Are there other risk factors I should be aware of? 

ANSWER: Given your family history, it's understandable to think proactively about your breast cancer risk. The good news is that today we have more tools than ever to help people understand their personal risk and choose prevention strategies that fit their goals, health needs and stage of life. 

An important first step is meeting with a healthcare clinician experienced in breast cancer risk assessment, such as a breast health specialist at a high-risk breast clinic. Clinicians use a combination of personal history, family history, genetic testing and validated risk-prediction models to estimate your lifetime risk of developing breast cancer. 

What factors increase breast cancer risk?

Risk factors may include: 

• Age. 

• Genetic mutations, such as BRCA 1 or BRCA 2. 

• Family history of breast or ovarian cancer. 

• Hormonal factors, including age at first menstrual period, pregnancy history and breastfeeding. 

• Prior breast biopsies or certain benign breast conditions. 

• Breast density on imaging. 

Reviewing risk, family history and any genetic results of family members with a genetic counselor may be helpful to determine whether genetic testing may be appropriate for you. 

Once your risk is better defined, your care team can recommend a personalized screening plan. For people at higher risk, this may include earlier and more frequent screening, often using breast MRI or other imaging options in addition to mammography. 

What are the options for reducing breast cancer risk?

Prevention strategies generally fall into three categories: 

Lifestyle approaches. Maintaining a healthy weight, staying physically active, limiting alcohol intake and avoiding smoking can help reduce breast cancer risk. Research shows that combining regular aerobic exercise with strength training offers the most significant benefit. 

Risk-reducing medications. Certain medications can lower breast cancer risk by about 50%-70% in select people. These are typically taken daily for several years and may be an option depending on your age, menopausal status and individual risk profile. 

Risk-reducing surgery. For some people at very high risk, including those with BRCA mutations, preventive surgery may be considered. A bilateral (double) mastectomy can reduce the risk of developing breast cancer by approximately 90%-95%, although no surgery can eliminate risk entirely. This is a permanent decision that affects appearance, sensation and quality of life, so it’s essential to carefully discuss this with your care team. 

When should preventive mastectomy be considered?

Risk-reducing mastectomy can be performed with or without breast reconstruction. There are different approaches to both mastectomy and reconstruction, and eligibility for a particular approach will be discussed by your care team. Options include: 

• Total mastectomy, which removes the breast tissue and results in a flat chest wall. 

• Skin-sparing mastectomy, which preserves most of the breast skin. 

• Nipple-sparing mastectomy, which preserves the skin and nipple-areola complex for select patients. 

Robotic-assisted nipple-sparing mastectomy can also be an option for select patients with increased risk of breast cancer who are considering a prophylactic (preventive) mastectomy. This approach also may be used for patients who have early-stage breast cancer with tumors located away from the nipple and skin. 

The minimally invasive approach allows the surgeon to remove breast tissue through a small incision near the side of the breast under the arm while preserving the skin and nipple-areola complex. Early experience suggests this technique may reduce visible scarring, improve cosmetic outcomes and improve patient-reported outcomes, such as postoperative physical well-being, while maintaining the same cancer-control principles as other surgical options.  

Ongoing evaluation and research continue to refine patient selection and outcomes for this innovative technique. 

How do you decide which prevention option is right for you?

Choosing whether, and when, to pursue medication or surgery to reduce breast cancer risk is a deeply personal decision. It also can change over time as circumstances evolve. Factors such as age, menopausal status, plans for pregnancy, family responsibilities and personal values all matter. 

Meeting with a breast surgical oncologist, genetic counselor and reconstructive plastic surgeon can help you fully understand your options and feel confident in your decision. 

Being proactive about your health is an important step. With individualized care and a thoughtful approach, you and your healthcare team can develop a plan that best supports your long-term well-being. 

Jeffrey E. Johnson, M.D., Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota, and Mara Piltin, D.O., Surgical Oncology, Mayo Clinic, Jacksonville, Florida

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DEAR MAYO CLINIC: My spouse was recently diagnosed with a blood cancer, and we're overwhelmed by everything we're being told. What should patients and families expect after a diagnosis, and how do doctors determine the right treatment? 

ANSWER: A blood cancer diagnosis can bring a lot of information and uncertainty all at once. In the first days and weeks, you may meet with specialists and undergo several tests as your healthcare team learns more about your cancer and plans your care. 

It can feel like treatment should begin immediately, but one of the most important first steps is getting the diagnosis right. Blood cancers such as leukemia, lymphoma and multiple myeloma have different types and subtypes that can behave and respond to treatment differently. 

A pathology review is a key part of this process. A pathologist examines blood, bone marrow or tissue samples to look for features that help identify the cancer. For complex or uncommon cases, having someone with extensive experience diagnosing blood cancers review the samples can provide valuable insight. 

Additional testing may look more closely at the cancer's characteristics, including changes in its chromosomes or DNA. These changes are found in the cancer itself and are not necessarily inherited. They can help your healthcare team understand how the cancer may behave and guide decisions about your care. 

How are blood cancers treated?

Not every blood cancer needs to be treated immediately. An acute leukemia, for example, generally requires urgent care, while some chronic leukemias or slow-growing lymphomas may be monitored until treatment is needed. 

Treatment options for blood cancers may include: 

• Chemotherapy.  

• Immunotherapy.  

• Targeted therapy.  

• Radiation therapy.  

• Stem cell transplant.  

Which treatment is recommended depends on the type and behavior of the cancer. Your healthcare team also considers your age, overall health, other medical conditions, possible side effects and practical considerations, such as how often you'll need to travel for treatment.  

Clinical trials are research studies that help researchers learn more about new or existing approaches to care. They can be considered at different points in the care process. A common misconception is that clinical trials are only an option when standard therapies have stopped working. Some trials are available at the time of diagnosis, and they may study new approaches or ways to reduce the intensity or side effects of existing therapies. 

If you're considering a clinical trial, ask what is already known about its safety, how often you'll need appointments, how long participation lasts and whether assistance is available for expenses such as travel or lodging. 

Blood cancer care often takes a multidisciplinary team. Specialists in areas such as hematology, pathology, radiology and radiation oncology may work together when making treatment decisions. This collaboration helps them consider your cancer, other health conditions and potential complications. 

During and after treatment, you may hear several terms used to describe the status of your cancer: 

• Response: Testing shows the cancer is decreasing in some way.  

• Remission: There is no evidence of cancer based on the tests used to detect it, but this does not necessarily mean the cancer is cured.  

• Disease control: The cancer isn't growing, even if it hasn't disappeared.  

• Recurrence: The cancer has returned after a period of remission.  

Follow-up depends on the type of blood cancer and care you've received. It may include physical exams, blood tests, imaging or bone marrow biopsies. Your healthcare team also will monitor for potential long-term effects related to your cancer and its treatment, including cardiovascular problems and the risk of developing other cancers. 

After a blood cancer diagnosis, you don't have to understand everything at once. Ask questions, bring a family member or friend to appointments if it helps, and take time to learn about your diagnosis and options. Having the right information can help you feel more prepared for the decisions ahead. 

Urshila Durani, M.D., Hematology, Mayo Clinic, Rochester, Minnesota.

Join the conversation on Mayo Clinic Connect Blood Cancers & Disorders Support Group.

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DEAR MAYO CLINIC: My doctor told me my cancer has spread to my brain. What treatments are available, and what should I expect next? 

ANSWER: Brain metastases, sometimes called "brain mets," occur when cancer that began elsewhere in the body spreads to the brain. 

Treatment may include surgery, focused radiation, whole-brain radiation, medicines or a combination of these approaches. There's no single treatment plan that's right for everyone. Your healthcare team may recommend an individualized plan based on many different factors. 

How do doctors decide which treatment is right for you?

Brain MRI scans will help your care team assess the size, location and extent of brain metastases. Treatment planning also depends on several other considerations, including: 

• The number of tumors. Your team will determine whether there is one brain metastasis, a few or many. 

• Their size and location. A tumor's position may affect whether it can be removed safely and whether it's pressing on an area that controls an essential function. 

• Your symptoms. Brain metastases may cause headaches, seizures, weakness, confusion or other symptoms. 

• Cancer elsewhere in the body. Your team will consider whether cancer outside the brain is controlled or progressing. 

• The tumor's molecular features. These are the specific genetic characteristics of cancer. Understanding them may help your team predict how the cancer could behave and identify treatments that may work. 

• Your priorities. Your goals and quality of life are important parts of treatment planning. 

When is surgery recommended for brain metastases?

Surgery may be considered when a brain metastasis can be safely reached and removing it fits into your overall cancer treatment plan. It may be recommended when a tumor is large, is causing pressure in the brain, is producing symptoms that require relief, or when tissue is needed to confirm the diagnosis or perform molecular testing. 

The surgical approach depends on the tumor's size and location. Some tumors may be treated using minimally invasive techniques. If a tumor is near an area that controls speech, movement or another essential function, awake brain surgery may allow the surgical team to monitor those functions during the procedure. 

How is radiation therapy used to treat brain metastases?

Radiation therapy uses powerful beams of energy to destroy cancer cells. The type of radiation recommended depends on factors such as the number and location of the tumors, whether surgery is part of the plan, whether medicines may help control the cancer, and how treatment could affect your quality of life. 

• Stereotactic radiosurgery is commonly used to treat brain metastases. Despite its name, it doesn't involve an incision. It delivers highly focused radiation to specific areas of the brain while limiting exposure to nearby healthy tissue. Treatment often is completed in one or a few sessions. 

• Whole-brain radiation treats the entire brain and may be considered when cancer is more widespread within the brain.  

Can medicines treat cancer that has spread to the brain?

Systemic therapies are medicines that travel through the bloodstream to treat cancer throughout the body. They include chemotherapy, immunotherapy, targeted therapies and other cancer medicines. 

In the past, brain metastases often were treated first with surgery or radiation because many cancer medicines had difficulty reaching tumors in the brain. Advances in treatment are changing that approach. Some targeted therapies and immunotherapies can treat certain brain metastases, depending on the type of cancer and its molecular characteristics. 

For example, a tumor with a particular genetic mutation may respond to a medicine designed to target that mutation. Not everyone has a mutation for which a targeted treatment is available. When one is identified, however, systemic therapy may help treat cancer in the brain and elsewhere in the body. 

Often, the question isn't which single treatment to use but which combination to use and in what order. For example, surgery may be recommended first to relieve symptoms or obtain tissue for testing, followed by focused radiation. Chemotherapy, immunotherapy or other medicines also may play a role in treating cancer throughout the body. 

Because these decisions are complex, treatment planning often involves specialists from neurosurgery, medical oncology, radiation oncology and other areas. Ask your healthcare team what each treatment is intended to accomplish, why the treatments are being recommended in a particular order and how the plan reflects your priorities. 

Although there is no one-size-fits-all approach, a coordinated evaluation can turn a complicated set of choices into a clearer path forward. 

Ian Parney, M.D., Ph.D., Neurosurgery, Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: I have a friend who was diagnosed with ovarian cancer, but she didn't have any obvious symptoms. What are some signs or symptoms women should pay attention to and get checked out? 

ANSWER: Unfortunately, ovarian cancer can be a difficult-to-detect disease early on because its symptoms often are vague and easily mistaken for common digestive, urinary or gynecologic problems. Many of the symptoms are things women experience from time to time. 

The key is to recognize when something has changed. Occasional indigestion or bloating usually isn't a reason for alarm. But when a symptom is new, different from what's normal for you or doesn't go away, it's important to pay attention to it and have a talk with your healthcare team. 

Five signs that can be easily overlooked and brought up when you see your healthcare team: 

1. Persistent heartburn or indigestion

Heartburn is common, so it's easy to reach for an over-the-counter antacid and move on. But persistent indigestion sometimes can be associated with ovarian cancer. In the past, ovarian cancer symptoms were described as being "hidden" by prolonged antacid use because women might treat what seems like routine heartburn for months without investigating why it continues. That doesn't mean heartburn is usually cancer. It means persistent digestive symptoms that don't settle down deserve attention rather than repeated self-treatment. 

2. Bloating or abdominal fullness

Most people experience bloating occasionally. With ovarian cancer, however, a woman may notice ongoing bloating or a sense of fullness in her abdomen that wasn't there before. The sensation may be difficult to describe. Because this symptom can develop gradually, it may be easy to dismiss.  

3. Feeling full after eating only a small amount

A woman may sit down for a meal and find that after only a few bites, she feels as though she's eaten enough. It could be a concern if this happens repeatedly and represents a change in appetite or eating pattern. 

4. Changes in urination

Ovarian cancer also can cause symptoms that seem more likely to be related to the bladder. A woman may need to urinate more frequently or feel as though her bladder hasn't completely emptied after going to the bathroom. Urinary changes can have many causes, but new or ongoing changes deserve attention. 

5. Changes in bowel habits

A woman who has been fairly regular throughout her life may suddenly notice more constipation, occasional diarrhea or another significant change in bowel habits. As with the other symptoms, an isolated episode generally isn't a concern. 

Changes in menstrual cycles also shouldn't automatically be dismissed. Irregular cycles can be common during perimenopause and menopause. While menstrual changes are more commonly associated with uterine, endometrial or cervical cancers, ovarian cancer also can be associated with changes such as more frequent or heavier cycles or increased menstrual pain. 

With ovarian cancer, awareness is particularly important. By the time symptoms become noticeable, the cancer may no longer be at an early stage. There also isn't a routine ovarian cancer screening recommendation for the general population comparable to mammograms for breast cancer or screening for colorectal cancer.  

Tests such as the CA-125 blood test and pelvic ultrasound can be useful in certain situations, including for some people at higher risk, but these tests have limitations and can produce false-positive or false-negative results. 

Women are at higher risk if they: 

• Are older. 

• Have inherited gene changes, including BRCA1 and BRCA2. 

• Have several other gene changes known to increase the risk of ovarian cancer, such as those associated with Lynch syndrome and the genes BRIP1, RAD51C and RAD51D. 

• Have a family history of ovarian cancer.  

• Are overweight or obese.  

• Are undergoing postmenopausal hormone replacement therapy.  

• Have endometriosis. 

• Began menstruation early or late.  

• Have never been pregnant. 

The most important takeaway is to know what's normal for your body. Digestive discomfort, bloating and urinary changes are common and usually aren't caused by ovarian cancer. But if you have symptoms that are new, persistent, distinctly different from your usual pattern or don't feel right, talk with your healthcare team. An evaluation can help determine the cause and whether additional testing is needed. 

Sandeep Basu, M.D., Breast Cancer Care, Hematology and Oncology, Mayo Clinic Health System, Eau Claire and Menomonie, Wisconsin 

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DEAR MAYO CLINIC: I've been diagnosed with a rotator cuff tear. What factors determine the best treatment approach, and what can I expect during recovery?

ANSWER: To better understand whether a rotator cuff tear may require surgery, it helps to first understand what the rotator cuff is and how it works.

The rotator cuff is a group of muscles and tendons that connects the shoulder blade to the upper arm bone. Together, these muscles help provide shoulder motion, strength and stability. A rotator cuff tear occurs when one or more of these tendons partially or completely detach from the upper arm bone.

Such tears can vary considerably. Some are small and may cause few or no symptoms, while others can lead to substantial pain, weakness and limitations in shoulder function. The best treatment depends on several factors, including the type of tear, your symptoms and your specific circumstances.

What determines treatment for a rotator cuff tear?

How the tear occurred is one of the most important considerations. Tears that happen suddenly because of an injury, known as acute traumatic tears, generally are more likely to require surgical repair.

Chronic tears, which develop over time from wear and tear, often can improve without surgery. The torn tendon itself doesn't heal with nonsurgical treatment, but physical therapy can strengthen and retrain other muscles so they compensate for the damaged rotator cuff.

For a chronic tear, your healthcare professional will consider factors such as:

• How long you have had pain and limitations.
• The size and location of the tear.
• Your age and overall health.
• Whether the shoulder muscles have developed wasting, or atrophy, or have been partly replaced by fat.

Surgery may be recommended when pain and functional limitations continue despite several months of well-executed physical therapy. Surgery also may be considered for a large tear when the muscles remain in good condition, particularly in a younger person, because the goal may be to repair the tendon before progressive muscle loss occurs.

Can a rotator cuff tear heal without surgery?

Physical therapy is the most important element of nonsurgical treatment. Exercises focus on restoring shoulder motion and improving strength to help rebalance the shoulder and compensate for the torn rotator cuff.

Pain can make therapy difficult at first. Over-the-counter anti-inflammatory medicines may help with discomfort for some people. A cortisone injection also may help some shoulders, although multiple repeated cortisone injections should be avoided.

You and your healthcare professional can judge whether treatment is working by assessing improvement in:

• Pain.
• Shoulder motion.
• Strength.

Within about three to four months after beginning a therapy program, you generally should have a better sense of whether this approach is helping.

The most common surgical procedure is a tendon repair, typically performed arthroscopically, meaning through small incisions using a camera and specialized instruments. Some large tears can't be repaired. In those cases, other operations, such as transferring another tendon or performing a reverse shoulder replacement, may be considered.

Recovery after rotator cuff repair takes patience. Typical milestones include:

• First six weeks: Most people protect the shoulder in a sling-like immobilizer.
• After six weeks: Physical therapy focuses first on restoring motion and later, the focus is on rebuilding strength.
• Four to six months: Many patients feel substantially recovered.
• Up to one year: Complete recovery often takes this long.

Protecting the shoulder during the first six weeks and completing the prescribed physical therapy program are particularly important. An injury to the shoulder during early healing can damage the repair.

Before deciding on surgery, ask whether your tear can be repaired and, if so, whether delaying repair could make it irreparable over time. Understanding the type of tear, the condition of the shoulder muscles and the expected recovery can help you and your healthcare professional choose the treatment approach that best fits your situation.

Joaquin Sanchez-Sotelo, M.D., Ph.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: Our daughter plays field hockey, and it can get physical on the field with collisions and falls. We're worried that we won't know if she gets a concussion. What signs should we watch for? 

ANSWER: With school team sports amping up, student-athletes are at greater risk of concussion. In addition to coaches, parents play a role in spotting signs of symptoms. A possible concussion isn't something to brush off. It's a form of mild traumatic brain injury.  

During a concussion, the brain moves within the inner walls, sliding back and forth. This can be due to a violent blow to the head and neck or upper body, a collision, or a hard fall during practice or a game. Typical symptoms include: 

• Headache. 

• Ringing in the ears. 

• Upset stomach. 

• Vomiting, nausea.  

• Fatigue or drowsiness. 

• Blurry vision or hazy spots in their vision field. 

• Confusion or feeling as if in a fog. 

• Amnesia about what happened. 

• Dizziness. 

• Slowness getting up after a play. 

• Changes in behavior, such as irritability and crankiness. 

• Loss of balance or unsteadiness in walking. 

• Ringing in the ears that doesn't go away. 

It's important to know that no two concussions are the same. While student-athletes often compare themselves with teammates or friends who have had concussions, one athlete may experience only one symptom, and another may have several. The absence of a particular symptom doesn't rule out a concussion; all potential symptoms should be taken seriously. 

Concussion symptoms may not appear immediately. An athlete may seem fine at first but develop symptoms later. Athletes may also minimize or hide symptoms because they're worried about being removed from a game or missing future competitions. That makes it especially important for parents, coaches and athletic trainers to pay attention not only to what an athlete says but also to changes in how they look or behave.  

A concussion doesn't require a direct blow to the head. If someone is pushed, falls backward or experiences a whiplash-type motion, that action can cause the brain to move within the skull. If parents see that type of injury or their child reports concussion-like symptoms afterward, they should be alert for changes. For younger athletes, it may be difficult to explain exactly what they're feeling. Parents know what's typical for their child, so recognizing that something seems "off" can be important. 

Today's school sports concussion protocols require that if a student-athlete has possible concussion symptoms, they shouldn't return to play that day and not return until cleared by a healthcare professional. 

At home, parents should continue monitoring symptoms. If their child's symptoms get worse, they should receive medical attention right away. Parents also should watch how symptoms change in the following days. Symptoms often begin to improve within the first several days, with recovery typically progressing over about 7 to 14 days. If symptoms aren't resolving after about two weeks, more evaluation may be needed. This could include referral for physical therapy and therapies that address lingering problems, such as problems with balance and dizziness. 

Recovery also involves more than getting an athlete back onto the field. Returning to school should come before returning to sport. If a student can't tolerate a full school day, they shouldn't be participating fully in athletics. Some students may need temporary academic adjustments, such as additional time for tests, help with note-taking, or reduced exposure to screens if computers or projected displays make symptoms worse. 

Concussions can be challenging because there's often no outward sign of injury, such as a cast or crutches, that shows others something is wrong. That can make it tempting for an athlete — or the people around them — to underestimate the injury. Protecting the brain and giving it adequate time to recover needs to be the priority. For young people, that means remembering they are students first and athletes second. 

Kimberly Penkert, Sports Medicine, Mayo Clinic Health System, Mankato and New Prague, Minnesota 

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DEAR MAYO CLINIC: My older sister was recently diagnosed with thickened heart muscle, and her doctor recommended a procedure called a "septal myectomy." I’ve never heard of it before. What does this surgery do, and how do doctors know when it's the right treatment? 

ANSWER: Hearing that someone you love may need heart surgery can be scary, especially when you're also trying to understand an unfamiliar heart condition. Treatment usually starts with medication. However, for some people, surgery becomes the best option when symptoms continue despite medical therapy.  

Your sister's condition is called hypertrophic cardiomyopathy, or HCM. It's a relatively common genetic condition that affects about 1 in 500 people. It causes the heart muscle to become abnormally thick, most often in the wall between the heart's two main pumping chambers. As a result, the normal pathway where blood leaves the heart can become blocked. 

HCM can affect the heart in two ways. The muscle may become obstructive from the thickening, or it may become stiff. Both forms can cause symptoms such as shortness of breath, chest pain, fatigue, low energy and reduced endurance. The obstructive form caused by the thickened heart muscle is the one that surgery can often correct. Most people with HCM have this type, which is why septal myectomy can be an effective treatment for appropriately selected patients. 

Doctors usually diagnose HCM with an echocardiogram, an ultrasound that lets them see the heart and measure the thickness of the heart muscle. Because HCM is a genetic disease, blood tests can identify some genetic mutations. However, not every mutation can be detected with a blood test, so imaging remains the primary way doctors diagnose the condition. 

Treatment

Treatment usually begins with medications such as beta blockers, calcium channel blockers and newer medicines called myosin inhibitors to help manage symptoms. Surgery is rarely the first treatment that is recommended. Instead, it is considered when symptoms continue despite medication or when patients are not able to tolerate their medical therapy. That's why deciding whether surgery is the right treatment depends not only on the diagnosis but also on how well symptoms respond to medication. A cardiologist experienced in treating HCM can help determine when it's time to consider surgery or another form of septal reduction therapy called alcohol septal ablation. During this procedure, a small amount of alcohol is delivered through a catheter to shrink a portion of the thickened heart muscle and improve blood flow. In general, this procedure is reserved for patients who cannot undergo surgery. 

A septal myectomy is an open-heart operation that removes the portion of thickened heart muscle blocking blood flow. During the procedure, echocardiographic imaging helps surgeons identify where the muscle is thickened. Afterward, imaging confirms that blood flow out of the heart and the function of the heart valves have returned to normal. 

Like any heart operation, septal myectomy has risks. When it's performed at a center with expertise in this procedure by an experienced surgeon, the risk of death or a major complication like stroke is less than 1%. Another possible complication is the need for a pacemaker because the area where the muscle is removed is close to the heart's electrical system; in specialized centers, this is usually less than 2%. 

After surgery, most patients stay in the hospital for about five days. Recovery takes about six to eight weeks. During that time, patients are encouraged to stay active by getting up, walking and moving around. The main restriction is avoiding heavy lifting until the breastbone heals. By two or three months, many people can return to activities such as exercising, running and weightlifting.  

One of the biggest benefits of the procedure is a significant improvement in quality of life. People who were limited by their symptoms before surgery often are able to return to the activities they enjoy afterward. Many patients need less medication after surgery, and others no longer require it. Growing evidence also suggests surgery may help people live longer than medication alone. 

Because HCM is a complex disease, experience matters. Patients considering septal myectomy should feel comfortable asking where the procedure will be performed and how much experience the multidisciplinary care team has treating HCM. Centers with expertise in HCM use a multidisciplinary approach, bringing together cardiologists, surgeons, imaging specialists, genetic experts and other specialists to determine the best overall treatment plan for each patient. 

Joseph Dearani, M.D., Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 

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DEAR MAYO CLINIC: I know prostate cancer is common, but I’m not sure who is most at risk or whether there are symptoms to watch for. When should men consider screening? And if cancer is found, what treatments are available, and what side effects should patients expect? 

ANSWER: About 1 in 8 men will be diagnosed with prostate cancer during their lifetime, making it one of the most diagnosed cancers in men. The good news is that most cases are found early, and patients often do well with treatment. 

Prostate cancer develops when cells in the prostate gland grow out of control. Several factors can increase the risk of developing the disease, including age and family history. Your risk increases as you get older and also may be higher if a father, brother or grandparent has been diagnosed. Black men have a higher risk of developing prostate cancer and are more likely to develop aggressive disease. Genetics also can play a role. For example, an inherited change in the BRCA2 gene, which is often associated with breast cancer, also can be linked to aggressive prostate cancer. 

Knowing these factors is important because many early prostate cancers cause no symptoms. Urinary problems, such as trouble urinating, may raise concerns, but they are often caused by an enlarged prostate, which is common as men age. Blood in the urine or semen, unexplained weight loss or bone pain can occur with aggressive or advanced disease; however, the goal is to find the cancer before symptoms develop.  

Prostate cancer screening

Screening generally begins around age 50, while men at higher risk may consider starting earlier, closer to 40 or 45. Your overall health, life expectancy and personal preferences also can help you and your healthcare team decide whether screening makes sense. Asking about screening does not necessarily mean you will need a biopsy or other procedure. 

One of the main screening tools is a prostate-specific antigen, or PSA, blood test. PSA is a substance made by the prostate that can be measured in the blood. A high level can signal a problem, but it does not always mean cancer is present. Because PSA levels can rise and fall, the test may be repeated to confirm the result. Additional testing may include other PSA measurements, biomarker tests or a prostate MRI. A digital rectal exam also may be recommended in certain situations, but it is becoming less common for routine screening. 

If a biopsy is needed, small tissue samples are taken from the prostate and examined. The results show whether cancer is present and whether it is low grade, high grade or somewhere in between. That information helps determine what comes next. A diagnosis does not always mean you need treatment right away. Many low-risk cancers and even some intermediate-risk cancers can be safely watched through active surveillance. 

With active surveillance, the care team closely watches the cancer rather than starting treatment. This can include PSA testing every six months to a year, periodic prostate MRIs and repeat biopsies. The approach can help some men avoid or delay treatment side effects without compromising outcomes. 

Treating prostate cancer

When treatment is needed, options include surgery to remove the prostate or radiation. Radiation can be delivered by a machine that directs it at the prostate or through small radioactive seeds, called brachytherapy. Focal therapy is a newer option for some patients. It targets cancer in one area while leaving the rest of the prostate alone.  

Each option has different potential downsides to consider. Surgery and radiation, for example, can have similar results for controlling cancer but different side effects. Urinary leakage and erectile dysfunction are two common concerns, while radiation also can cause rectal or bowel irritation. Talking through these differences with your care team can help you decide what is best for you.  

For advanced disease, treatment may include therapies that work throughout the body, including hormone deprivation therapy and some chemotherapies. Surgical techniques and radiation also have become more precise and less invasive, which can lead to faster recovery. Advances in managing side effects also help patients maintain a good quality of life after treatment. 

When found early, prostate cancer is highly treatable and often curable. Because many men have no symptoms in the early stages, ask your healthcare team whether screening makes sense for you. A simple conversation could make a big difference. 

 Adam R. Miller, M.D., Urology, Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: I've heard that many symptoms of gynecologic cancers can mimic menstrual or menopausal changes, such as bleeding and pelvic pain. What symptoms should never be ignored, and when do I know it's time to see a healthcare professional? 

ANSWER: Pay attention to changes that are new, persistent, worsening or simply different from what is typical for your body. Many gynecologic cancer symptoms also can have noncancerous causes, but certain changes deserve medical evaluation rather than automatically considering them a natural part of menstruation, menopause or another common condition. 

There are five types of gynecologic cancers: ovarian, endometrial, cervical, vulvar and vaginal. Their warning signs can overlap with expected changes across a woman's life, which is why the pattern of a symptom — whether it's new, persistent or progressing — matters. 

Symptoms that should prompt a conversation with a healthcare professional include: 

• Postmenopausal bleeding. Menopause means going 12 months without a menstrual period. Any bleeding after that point should be evaluated.  

• Bleeding after intercourse. Cancer isn't the only possible cause, but bleeding after intercourse should be checked. 

• Pelvic pain that's new or getting worse. If you usually have discomfort with menstrual periods but notice that the pain is becoming progressively worse, that change deserves attention. 

• Persistent bloating or feeling full quickly. Feeling full soon after starting to eat is called early satiety. Bloating and early satiety can occur with ovarian cancer, particularly when symptoms are new or worsening. 

• Changes in bowel or bladder habits. When changes develop or get worse, they should be looked into rather than considered only as a gastrointestinal or urinary condition. 

• New or persistent vulvar changes. A new lump or lesion, bleeding, itching, burning or irritation on your vulva should be examined. A biopsy may be recommended, particularly if symptoms persist or don't improve with treatment. 

The key is to know your own baseline. A symptom doesn't have to be severe, but if it's unusual for you or continues, it should be evaluated. 

One common misconception is that a Pap test means a woman has been screened for all gynecologic cancers. A Pap test only screens for cervical cancer and cervical precancer. It doesn't screen for ovarian, endometrial, vulvar or vaginal cancers. 

For cancers without routine screening tests, recognizing symptoms and seeking diagnostic evaluation if you become concerned is especially important. 

Screening and diagnostic evaluation are different. Screening is performed in people who don't have symptoms. Diagnostic evaluation, such as imaging or a biopsy, is prompted by a symptom or other concern, and it may involve additional testing depending on each person's situation. 

Risk of gynecological cancers differs by cancer type, but several factors may be important: 

• Aging puts people at greater risk of these cancers.  

• Obesity is a risk factor for a common type of endometrial cancer. 

• Inherited conditions, including BRCA1 and 2 and Lynch syndrome, can increase the risk of certain ovarian or endometrial cancers. 

• Family history of cancers, such as breast, ovarian or colon cancer, can be important when assessing inherited risk. 

• Human papillomavirus, or HPV, is associated with cervical and vulvar cancer risk. Smoking can make it more difficult to clear up an HPV infection, increasing the chance that it will persist. 

Knowing your family history and discussing relevant risk factors with a healthcare professional can help guide appropriate care. 

Earlier detection can reduce the challenges of treatment and may improve outcomes. In some cases, cancer found earlier may be treated with surgery without the need for additional treatments like chemotherapy or radiation therapy. For some younger patients, earlier diagnosis also may allow them to consider fertility-preserving treatment options. 

The goal isn't to assume that every episode of bleeding, pelvic pain or bloating means cancer. It's to recognize when a change deserves an explanation. 

If something is new, persistent, worsening or simply doesn't feel right for your body, have it evaluated. You know your body best, and speaking up when something feels different is an important part of protecting your health. 

Shariska Harrington, M.D., Obstetrics & Gynecology, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q&A: Warning signs of gynecologic cancer every woman should know appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: My mother gets headaches from time to time, but recently she's been reading that some headaches can be signs of serious medical problems. What's the difference between a headache that's just a nuisance and one that needs immediate medical attention? 

ANSWER: Most headaches aren't a symptom of a life-threatening condition. Common headaches, including tension headaches and migraines, can be painful and disruptive, but they usually aren't medical emergencies. However, certain headache symptoms shouldn't be ignored because they can signal a serious underlying condition, such as a stroke, bleeding in the brain, meningitis or, less commonly, a brain tumor. Knowing the warning signs can help you decide when to seek emergency care. 

You should contact your healthcare team if you experience: 

• Headaches that wake you from sleep or are present when you wake up. 

• Headaches that become more frequent or progressively more severe. 

• Headaches that don't improve with over-the-counter medications such as acetaminophen or ibuprofen. 

A severe headache can be described as the "worst headache of your life" — one that develops suddenly and reaches maximum intensity within seconds or minutes. This can be a sign of a medical emergency. 

Go to the emergency department or call 911, especially if your headache is accompanied by: 

• Weakness or numbness. 

• Slurred speech. 

• Confusion. 

• Loss of consciousness. 

• Double or blurred vision. 

• Severe dizziness or difficulty walking. 

• Fever and a stiff neck. 

While serious causes of headaches are uncommon, they do occur. For example, headaches can be associated with brain aneurysms, although these headaches are typically sudden and severe, and they may be accompanied by loss of consciousness. 

Brain tumors are rare, but about half of the people who are diagnosed with one experience headaches. These headaches often become progressively worse over time, and may occur in the morning or wake someone from sleep. They're frequently accompanied by nausea or neurological symptoms, such as weakness, numbness or vision changes. 

Headaches with vision changes can have several causes. Some people with migraines experience visual disturbances. In other cases, vision changes and headaches may be related to inflammatory conditions such as giant cell arteritis, which is an immune disease that causes swelling and narrowing of medium- and large-sized arteries, and it can cause blindness.  

If you're over the age of 50, you should always discuss new headaches with your healthcare professional. Most primary headache disorders, including migraines and tension headaches, begin much earlier in adulthood. 

You also should seek medical evaluation if headaches consistently occur with coughing, sneezing or straining, or if they're triggered by exercise and continue to recur. Although these headaches are often benign, they sometimes can signal an underlying structural condition. 

After a head injury, it's common to develop headaches. Many go away with rest and over-the-counter pain relievers. However, seek medical care after a head injury if you lose consciousness, have memory loss or repeated vomiting, take blood thinners, are age 65 or older, have obvious head trauma, or were injured in a significant fall or by a direct blow to the head. 

If you're being evaluated for headaches, be prepared to describe: 

• How severe the headache is. 

• When it started and how long it lasted. 

• Whether it wakes you from sleep. 

• Whether it's different from your usual headaches. 

• Any associated symptoms, such as fever, weakness, numbness or vision changes. 

• What treatments you've tried and whether they helped. 

Depending on your symptoms, your healthcare team may recommend imaging, such as a CT scan or MRI, to help identify the cause. 

The bottom line is that most headaches aren't dangerous, but some require immediate attention. Remember the key warning signs. And when in doubt, it's always safest to seek medical evaluation. 

Grant Mallory, M.D., Spine Care, Neurosurgery, Mayo Clinic Health System, La Crosse, Wisconsin

The post Mayo Clinic Q&A: Headaches that should never be ignored appeared first on Mayo Clinic News Network.