Introduction-topic hormone sensitive cancers illustrating God’s Love for us

By Dr. Mustafa Rahim • Assalamo alakheiri khalqihi wa nuri arshihi, sahibe Ttaha wa Yasin, AhmedeMujtaba MohamedeMustafa SAW.Thuma baad qala Laaha subhanahu wataala wii muhkmi kitabihi in sura As Saff Verse 4 ‘Inna llahi yuhibulllazina yuqatiluna fi sabilillahi saffan, kaanahum bunyanun marsusun’ Verily God loves those who fight in His way in ranks as if they were an unbreakable metallic wall’. Fighting can be physical or as in educating, like spreading good for mankind. ‘Jihad bilisan’(with the tongue);like in trying to prevent low blood sugar etc.as taught by specialist hormone specialists. The aimas mostly did Jihad bilisan in guiding people. Sahifa Sajjadiya is a typical example.

Aimas multi-professionals did jihad bilisan

• To say Imam Jaffer Saddiq or other aimas were just farmers does an injustice to them. Imam Jaffer Saddik’s students described pulmonary circulation(Blood circulation in the lungs and there is a manuscript in British museum saying he learnt it from his master and Lord imam Jaffer Saddik. Al Jabir ibne Hyan a student of same Imam advanced mathematics in the form of algebra and circulation of blood in lungs-medicine. They were professors of professors of mathematics, Medicine, chemistry, biology, geography, geology; including Ibne Haitham father of modern optics (Mentioned in my previous lectures), their ashaabs taught ibne Sinan(Avicenna) and Alrazi(Rhazes).their books have been taught in western universities until last century. A Muslim deciple of Imam Jaffer Sadik described the circumference of the earth and distance to the sun (physics, astronomy and geography. The Imams had ilmeladunni.

Quran urges us to unite in His cause

• We shiane Ali, The Imame madhlum wa sabir and Qarrar ghaire farrar ,should be united like an unbreakable wall. We should stop unnecessary hurtful criticisms of each other, under umbrella of Quran’s directions and sunnate rasul, whose followers we Shias are. Muhammad al Tijani says ’Shias are the ahle- Sunnah We should fight by gentle persuasion to better our own community in Stanmore, giving good suggestions and discussing them fairly ,under guidance of sharia, and work for the World at large, in preparation for Imame Zamana. For God loves us all equally seeing the loving way he has built us, as I will continue to show in this talk. We should reciprocate His Love by obeying Him without question in Furueddin; . Once we confirm our faith in usuleddin and after studying His Love for us.

• Like we try to please our beloved in this world, we should be bonded to Allah. God says ’Waummuhu hamalatahu wahnan ala wahnin ,wa fisaalahu aamaini, washkurhu wa shukurli ,ilainalmasir’ ‘Thank your mothers for looking after ,despite fainting spells and breast feeding you for 2 years, and thank Me, to Me you all will return’. God has built our whole wonderful body and given us loving parents to guide and help us develop.

God is loving-sura e Hud verse 90

• In Surae Hud verse 90 ‘Wastaghfirurabakum, thuma yatubu ilaihi; Inarabi rahimunwadud’.-’Ask you forgiveness of Your Lord, and turn you unto Him ;surely My Lord is Merciful ,Loving-Kind.’ When we have such a Loving God; should we be ever scared to meet Him? He will be with us, if we bond ourselves to Him, at the time of death and at time of munkarun nakir, in the grave and when we arise from it .For He is Lord and Boss of all the angels including Izrael and Munkar and Nakir,.as well. It is Satan who whispers into our ears and keeps us away from Him. We should accept what He, in his Loving wisdom has decreed for us, according to our capacities, at all times as the Ahlebait did that . He knows our weakness.’Latakalifullahanafsan ila usgaha’.We should follow the orders in Quran and Sunna of the Prophet in all our actions ,meetings, deliberations.

Hormone sensitive breast and prostate

cancerBreast and Prostate are similar microscopically and

functionally and the treatment are a mirror image when things go wrong. God has recommended breast feeding

for infants’ Wa ummu hu hamalata wahnan ala wahninWafusaalahu aameini …,2 years b'feeding .Breast feeding helps family planning and has been proved to

prevent breast cancer, which is a common scourge today.

Hereditary breast cancer, endometrial cancer(cancer of inner lining of womb)

• . Mutations (changes)of the breast cancer susceptibility (predisposing)gene BRCA1,commoner in European Ashkenazi Jews, are linked to hereditary early onset breast and breast–ovarian cancer syndromes, and also to prostate cancer in men . These mutations(changes) give an increased risk for other hormone-dependent cancers, including those of the uterus, cervix and prostate. BRCA1&BRCA2 gene expression is decreased or absent in a significant proportion of sporadic (occurring at random)breast and ovarian cancers, suggesting a bigger role in these tumour types. Multiple functions(actions) for BRCA1 have been identified, including roles in DNA(genes) repair, cell-cycle progression and apoptosis(cell death). These functions are consistent with a tumour suppressor activity,(which we have discussed in my Immunology lectures before) but they do not explain why BRCA1 mutation carriers develop hormone-responsive cancer types. Recent studies indicate that BRCA1 interacts with and regulates the activity of oestrogen receptor α (ERα) and the androgen receptor. Its expression is regulated by carcinogens (Cancer predisposing substances)and carcinogens that modulate ERα signalling(we have spoken about signalling by mitochondria in my last talk|), suggesting a molecular linkage between BRCA1 and hormone-responsive cancers. Saturated fat ,no breast feeding raises breast cancer risk .We should avoid paya (The fat of the feet)and other saturated fats which we often eat. Ladies should breast feed their infants as ordered by the Quran, to prevent breast cancer. It helps in child spacing as well

• Fats on their own are not bad for they have vitamin A ,D, and E. It is saturated fats that are bad.

• The BMJ 3.5.2014 pg. 28 states ‘The risk of breast cancer has many factors, some women have high risk due to BRCA1 and BRCA2 mutations(changes).women with Family history should be referred to local genetics services for checking. Ashkenazi Jewish women have higher carrier(2.5%) frequency for BRCA1&2 and should be considered for genetic testing .Ashkenazi(European Jews) also have Cystic fibrosis genes unlike in Jews of Jesus Christ (Sephardic -Middle Eastern Jews)

• You can also reduce the risk of developing these cancers by bilateral removal tubes and ovaries –castration(which produce Oestrogens) reduces risk by 50%In BRCA1 and 95%BRCA2 gene carriers .Drug prevention by Tamoxifene for 5years reduces risk of breast Cancer by 30% and can be useful alternative to reduce risk of surgery

• Cancer of body of uterus is oestrogen driven (female hormone dependant and can be helped by androgens(male hormone)progesterone in Depo Provera, a 3 monthly injection; also used in contraception. It is used to treat metastatic (Cancer Spread to other tissues) and also endometrial (Uterus lining ca.)cancer.

Cancer of lining(Endometrium) of body of uterus-which is shed when lady has her menses

Diagnosing Cancer of uterus lining(endometrial) and normal menstruation

• Women with PCOS(Polycystic ovaries-multiple ovarian cysts-describe s formation of oestrogen producing multiple ovarian Graffian follicle cyst)) have a higher chance for developing endometrial cancer. The more irregular and few periods a woman has, the greater her risk becomes. During a normal menstrual cycle, the endometrium(Uterus inner lining,) is shed ) lining of womb which is exposed to hormones, like oestrogen, which cause the lining of womb to proliferate(multiply) and thicken. On an average 14th day of the cycle Ovulation occurs (Egg shedding by woman),it releases progesterone from the follicle which becomes yellow-corpus luteum, which prepares the lining of the womb for a fertilised ovum and also inhibits oestrogens and thereby stops thickening of the lining . How marvellous is the creation of Allah

• When ovulation does not occur, which happens in PCOS, the lining is not shed and is exposed to much higher amounts of oestrogen causing the endometrium(Inner womb lining) to grow much thicker then normal. This is what increases the chance of cancer cells to grow. Any continuous stimulation to make the cell multiply can result in cancer be it on the skin or inside of the body!

• If a woman does not get regular periods(Haiz), they should keep a calendar documenting when and how often she does gets her periods and the amount of blood shed, so she can speak with her doctor with her menstrual chart. There are many options that can help to reduce her risk, which we will discuss. It can present with excess/irregular bleeding- diagnostic dilatation and curettage (D&C) or biopsy of endometrium (lining of uterus usually shed in monthly bleeding) should be done and that can also diagnose possible cancer of endometrium(inner lining of womb). PCOS is a topic in itself which I will describe briefly .

• As you all know, it is when the egg meets the sperm that forms the ovum and child.

Polycystic ovary syndrome(PCOS)

Polycystic ovary syndrome which is associated with endometrial Uterine cancer

• Menstrual disorders: PCOS (multiple ovarian cysts)mostly produces oligomenorrhea (less menstrual periods) or amenorrhea (no menstrual periods), but other types of menstrual disorders may also occur.[7][9].(ladies periods )occur .

• Infertility:[9] This generally results directly from chronic anovulation (lack of ovulation).[7]

• There is a High levels of masculinizing (predisposing the lady to male features)hormones( Progesterone is female hormones with masculinising properties)): The most common signs are acne and hirsutism (male pattern of hair growth, beards), but it may produce hyper menorrhea (heavy and prolonged menstrual periods), androgenic (male)alopecia (increase hair thinning or diffuse hair loss), or other symptoms.[7][10] Approximately three-quarters of people with PCOS (by the diagnostic criteria of NIH/NICHD 1990) have evidence of hyperandrogenemia.[11](Increase amount male hormones)

• It also accompanied by increased incidence of Metabolic syndrome(which we discussed it my lecture ‘Diabetes the silent killer’:[9] This appears as a tendency towards central obesity and other symptoms associated with insulin resistance. And therefore DM.7] Serum insulin, insulin resistance, and homocysteine (a hormone)levels are higher in women with PCOS.[12]

• It is reported that when Asian women are affected with PCOS, they are less likely to develop hirsutism (Male pattern hair distribution)than women of other ethnic backgrounds.[1

• Infertility with polycystic (Multiple ovarian cysts) is treated with metformin and clomiphene to induce egg shedding. I have used this treatment in the past in Mombasa

Oestrogen dependant breast cancer.Too much of a good thing- oestrogen or testosterone is bad, like too much

sugar, which can cause sugar plating(end products of glycation) of blood vessels all over the body and blood clots

Androgen(Male hormone) induced Prostate cancer

Adrenal (organs resembling an Admiral’s hat )androgens and oestrogen precursors

• A subset of androgens, adrenal (above each kidney)androgens, includes any of the 19-carbon steroids( a type of cholesterol derivative) synthesized by the adrenal cortex, in the innermost layer of the adrenal cortex ( called zonula reticularis).These function as weak steroids or steroid precursors, including dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), and androstenedione(names of different hormones). Cholesterol, made by the liver is the building block of all hormones! Yet too much of it is bad like in cholesterol/sugar plating discussed earlier. Too much Iman can also lead to a man not striving himself but relying only on God. Yet God tells us in Quran to strive.

• Besides testosterone, other androgens(male hormones)include:• Dehydroepiandrosterone (DHEA) is a steroid hormone, produced in the adrenal (above kidney) cortex, which sits like a hat above both kidneys, is made from cholesterol.[2] It is the primary precursor (which becomes)of natural oestrogens. DHEA is also called dehydroisoandrosterone or dehydroandrosterone.

• Androstenedione (Andro) is an androgenic steroid produced by the testes, adrenal cortex, and ovaries. While androstenediones are converted metabolically to testosterone and other androgens, they are also the parent structure of estrone(another hormone). Use of androstenedione as an athletic or bodybuilding supplement has been banned by the International Olympic Committee, as well as other sporting organizations.-These are Muscle building hormones.

Androgen(male hormone) dependant Prostate cancer are treated with oestrogens/anti-androgens (can cause breast enlargement)like Zoladex( Zoladex

can cause breast enlargement) to slow cancer down plus minus surgery radiotherapy

Microscopic slide of normal breast tissue

Microscopic slide of normal prostate tissue

Position of prostate and how swelling including cancer can obstruct urine flow; use of PR to examine the prostate .

Similarities between prostatic tissue and breast tissues

• The prostate produces prostatic fluid rich in fructose(a sugar) to feed sperm in an alkaline fluid(to propel the sperm through mildly acidic female body canal in its invasion into uterus to impregnate the ovum.

• The breast produces lactose( a sugar) to nourish the infant produced. It| also produces antibodies (weapons)to fight diseases mentioned in my previous talks to you.

• This shows how much Our Lord God cares and loves us. He cares for us us from time we are sperm ,babe and beyond. Do we reciprocate His Love. If you love anyone you would go to any extent to please the person loved. We should obey our Beloved Loving Allah without question. You have seen, in my last talk how the immobile infant is provided with brown fat to keep it warm. If a mother creates bonding with the baby by breast feeding her babe ,how much should be our bonding with Allah, Who gives us much more.

Secondaries (Spread of cancer to bone)

• Although any type of cancer can spread to the bone, the most common types that do, in decreasing frequency, are cancers of the:

• breast• prostate• lung• thyroid • kidney.

Spread of cancer to the bone

• It is always better to treat the cancer before it spreads to bones or lymph nodes. Once we diagnose prostate cancer by rising PSA level, a level over 2ng/l at age 60 and it increases as we age over 80 when it is commonest. We do MRI scan to exclude Secondaries (cancer spread)and we remove primary cancer. Similarly in the breast once we detect a lump we remove it, do mammogram scanning by introducing a dye into breast into mammary gland(Mammogram),remove and check target lymph node(‘The body’s central police station) as we do for bowel cancer .We can see from previous slide that these two hormone dependant cancers are the most likely to spread to the bones.

It always preferable to remove the cause of Fitna before it spreads and wrecks the

country(our body)

• In summary, just as Quran says ‘al fitna ashadu minal qatl.’Fitna (mischief )is worse than killing. It is the fifth column amongst us (The Takfiris,slanderers, amongst the Muslims who cause the problems for all Muslims and they should be identified and neutralised; similarly the cancer in our body should be removed before it spreads and kills us. Women should be taught to examine their breasts, refer any unusual lumps/appearances to their GPs. Men when they have problems with their urine flow should be checked by their GP, by digital rectal examination and serial Prostate surface antigen .They should be referred to Urologists for Prostate enlargement/cancer. Prostate cancer is commoner as we age reaching a high level at age of 80 years.

Benign prostatic hypertrophy

• Everyone above the age of 50 years has some problem with urine flow. How far urine flows when you stand, the quality of the stream-thick, split can lead to a sign of blockade of urethra by an enlarged prostate. PSA is a protein produced by prostatic gland and can rise after strenuous activity, sex and also with benign enlargement of the prostate. It the increased rate of rise of PSA levels that would be significant .The measurements done after abstaining from sex for 2 weeks. A family history of prostate cancer like breast cancer is important .A PSA level of <2ngrms/l is unlikely to suggest Prostate cancer.

• Finasteride used with Flomax to treat Benign prostatic enlargement can lower PSA level. If a suspicious hard lump suggestive of cancer is found on PR,- trans rectal U/S, PSA tests, cystoscopy and Xray /MRI scan would be indicated. Rectal examination is necessary to provide access to Prostate gland. If the median line of prostate is obliterated, or prostate cannot be tipped it indicates benign enlargement

PSA and Pro PSA• Pro-PSA refers to several different inactive precursors (Parent of PSA). There is some evidence that pro-PSA is more strongly associated with prostate cancer than with BPH. One recently approved test combines measurement of a form of pro-PSA called [-2]pro PSA(A PSA precursor protein),considered possibly more indicative of cancer than noncancerous enlargement of prostate ,coupled with measurements of fixed PSA and free PSA. The more the bound PSA is thought that there is more chances of Prostate cancer. The resulting “prostate health index” can be used to help a man with a PSA level of between 4 and 10 ng/mL decide whether he should have a biopsy. Free PSA can also increase with Benign (Non cancer)prostatic enlargement. A biopsy will confirm the cause of the blockade of urine, but can cause unnecessary anxiety in benign(non Cancer) disease. Biopsy will also show the level of cancer danger in prostate. There are also different tumour markers available .It is beyond the scope of this talk.

Sticking to God• If we obey and Love God with all our soul and body and all our heart He will be with us when his slaves Malikul maut comes to us and in the grave and also when Munkar & Nakir question us, I am confident He will be there to prevent fishale Qabr. After All Allah is the Master and Owner of all angels and all the elements. This is why when Imam Ali was struck by the sword he said fudhtubirabilqaaba.