Beam Energies Treatment for Lung and Larynx

Beam Energies Treatment for Lung and Larynx Larynx Error Plan Errors: Beam energies for larynx treatment are not correct both fields have 10MV instead of 6MV Field sizes are not right The Right Lateral (RLat) field is too big resulting in shielding errors The Left Lateral (LLat) field is too small and is just skimming the anterior portion of the patients shell The number of fractions on the plan is one (1) instead of 20 daily fractions. The global maximum dose is 110.98% (given as 6103.7 cGy) and is largely outside the Planning Target Volume (PTV), meaning the plan is too hot The 108% region is a hot spot as it exceeds the International Commission on Radiation Units and Measurements (ICRU 50 62) maximum value of 107% The LLat field wedge is too thin 1o, so not helping with uniform dose distribution of the plan, hence the right skewed isodoses and the 108% hot spot The plans maximum spinal cord dose of 5112 cGy, exceeds the maximum dose constraint value for the organ of 5000 cGy. Multi-Leaf Collimators (MLC) use on the plan There is not much conformality to the PTV anteriorly from the RLat field There is insufficient shielding of the neck anteriorly Some MLC are not pulled up properly as they are on the field edge which is better shielded by the Primary collimators The RLat field is over-wedged (60o), resulting in the 108% hotspot region The RLat field is not placed optimally re-collimator angle in order to better avoid the spinal cord The Dose Volume Histogram (DVH) data/graph/chart is insufficient as it is only for the spinal cord excluding for example the PTV information The isocentre could be placed more centrally for the plan Criteria use to evaluate the suitability of the treatment plan This is a conventional parallel-opposed field arrangement, which is suitable for head and neck treatment of the larynx (Barrett and Dobbs, Practical Radiotherapy Planning, page 171). Since this is an error plan, the fields do not match in size though they are parallel opposing. The radical dose prescription is 55 Gy in 20 daily fractions of 2.75 Gy over 4 weeks (Barrett and Dobbs, 4th Ed., page 175). This would apply as a prescription for a T1-2 N0 glottic larynx tumour with a volume of 26-49 cm3 (RSCH, St Lukes Radiotherapy Clinical Protocol, Head and Neck Larynx). Use is made of isodose charts, PTV coverage as indicated by the D95 (95% isodose line), maximum PTV dose (Dmax), maximum spinal cord dose, dose volume histograms (for PTV and spinal cord), and departmental protocols to evaluate the suitability of the treatment plan. The Quantec/Emami et. al. (2013) document of Tolerance of Normal Tissue to Therapeutic Radiation provided the dose constraints for the organs at risk e.g. the spinal cord. NICE guidelines only stipulate an offer of choice of trans-oral microsurgery or radiotherapy to people with newly diagnosed T1b-2 squamous cell carcinoma of the glottic larynx. The plan is optimised by use of beam modifying devices like wedges and MLC (Barrett and Dobbs, page 171), and checking the effect using the planning software. Solutions to eliminate identified errors: The beam energy needs to change from 10MV to 6MV in the field properties of the planning software. This will ensure adequate coverage of the PTV as a significant part of the larynx is very close to the skin. A less energy beam offers less penetration and lower build up depth (for skin sparing effect) for dose deposition. The RLat field size can decrease slightly anteriorly, while the LLat field size can increase slightly to ensure adequate anterior coverage. The fields could also be more symmetrical. The LLat wedges orientation needs to change so that the Thick end is Anterior as per the setup information (Toe in). The number of fractions is should change to 20 from the current one fraction. This would give the appropriate dose prescription for the plan of 55Gy/20#/4weeks/2.75Gy per fraction The current plan is too hot, so the beam weightings need adjusting downwards until the plan conforms to the ICRU limits of maximum 100% + 7% (= 107%), and the lower limit of 100% 5% (= 95%) of the proscription dose (ICRU). This process can also improve by correcting the wrongly orientated LLat wedge and using a better wedge angle on it, as well as adjusting down the angle of the over-wedged RLat wedge. Correcting the 108% hotspot region is through adjusting the wedge angles, re-orienting the LLat wedge and adjusting the field weightings. The thin 1o LLat wedge angle needs changing up to 30o for the wedge to have an effect on the isodose distribution, on top of reversing its orientation. This would help in creating a uniform dose distribution for the plan and a reduction/elimination in/of hotspots. According to the Quantec/Emami et al. (2013) guidelines, the spinal cord is to receive a maximum core dose of 50Gy, but the current plan is exceeding this limit. Adjusting theÂÂ   collimator angle for the fields to be parallel to the spinal cord will help avoid treating this critical organ This is also aided by reducing the field weightings, adjusting the wedge angles and orientation of one of them, adjusting the field sizes posteriorly. The MLC leaves need to close where they are open outside the treatment field edges. There is a leaf to shield the anterior corner of the neck but is pulled back, so needs to be part of the configuration. There are five (5) pairs of almost central leaves, that are on the field edges inferiorly and superiorly, they need pulling back by 0.5 cm from the field edge so they do not interfere with primary collimation (Royal Surrey County Hospital (RSCH), St Lukes Radiotherapy Clinical Protocols). Adjusting the RLat field size anteriorly will aid in correcting the shielding of the neck and improve conformality to the PTV. The RLat field wedge needs reducing to at most 30o to aid uniform dose distribution and reduction of hotspots. Changing the collimator angle of the RLat field so that it is parallel to the spinal cord, will avoid treating through this critical organ. This will result in reducing the spinal cords maximum dose for the plan to within the organs maximum dose constraint value of less than 50Gy, thus aiding in optimising the plan. The DVH information of the plan should include the PTV data and line plot to enable plan evaluation of its suitability. Making the isocentre more central may improve the uniform dose distribution of the plan. Suitability of Plan and Alternative beam arrangement According to De Virgilio, A., et. al. (2012), there is currently no set therapeutic gold standard for the treatment of laryngeal squamous cell carcinoma. This contributes to a lack of consistency and inhomogeneity in treatment planning. The plan under consideration is a 2D conventional plan, which in itself is suitable with the exception of the errors, but is not optimal. The identified errors are correctable and the plan optimisable. In remaining with the conventional plan, a third anterior low-neck field with a light weighting (3DCRT) is an option to improve dose distribution and eliminate hotspots. However, this would require the addition of electron beams to match the photon fields, according to Herrassi, M. Y., Bentayeb, F, and Malisan M. R. (page 98-105). Another option is to use Intensity Modulated RadioTherapy (IMRT) with 3 or 5 beams, or Volumetric Modulated Arc Therapy (VMAT) with one arc, (Matthiesen C, SinghÂÂ   H, Mascia et. al. (2012)). IMRT offers more conformalit y in regards to carotid arteries as stated by Gomez, D., Cahlon, O., et. al. (2010). Portaluri, M., et. al (2006), suggest that 3D Field-in-Field techniques are a valid alternative as they offer the best global performance when considering PTV coverage and parotid sparing. Conclusion The task was instrumental in reinforcing the importance of understanding the process of treatment planning, and how to check the suitability of the plan before its approval. There is not much information to work with in suggesting alternative beam arrangements. Useful information could have been correct TNM classification, appropriate oncological classification taking into account the anatomic-embryologic and functional complexity of the larynx. There were glaring errors in the plan, and as an exercise, they were useful in sharpening treatment planning knowledge. IMRT is the preferred treatment technique that is efficacious especially for parotid gland and carotid artery sparing. Lung Plan Errors: Beam energies should all be 6MV, some are 10MV on the plan There are too many fields for the plan The LLat beam is going through the contralateral lung The field placement of the right posterior oblique (RPO) is not optimal as its MLCs are shielding part of the PTV contributing to the inadequate 95% dose coverage of the PTV. The global max value of 109% exceeds the ICRU guidelines, meaning the plan is very hot in places. There is an 80% hot spot on the chest, which is very hot for the area close to the skin There are many wedges on this plan resulting in hot and cold spots and a high dose gradient in the PTV. The Right Lateral and Anterior fields are over-wedged, resulting in the 80% and 109% hot spots. The RPO and LLat field wedge angles are not conventional (50o and 33o respectively, when considering the standard wedge angle specifications of 15o, 30o, 45o and 60o. The Lateral fields (Right Lateral and Left Lateral), are too big in relation to the size of the PTV, resulting in unnecessary irradiation of healthy tissue. The current plan exceeds the spinal cord core dose (maximum 50Gy), as interpreted from the DVH data. There is less than 95% PTV coverage laterally , resulting in a max dose to the PTV of 5304 cGy, which is very much less than the expected 6080 cGy (95% of 6400 cGy). Criteria use to evaluate the suitability of the treatment plan Barrett and Dobbs (page 252), acknowledge that there are a number of challenges to covering the PTV fully and remaining within the ICRU constraints, while maintaining acceptable toxicity levels at the same time. A three (3) field conformal plan is normally used for stage I or II non-small cell lung cancer (NSCLC). A compromise on choosing the best plan is mostly dependent upon the location and size of the PTV, and its closeness to critical structures, like the spinal cord and oesophagus. The plan should try to minimise dose to the contralateral lung as much as possible by using anterior oblique, posterior oblique and lateral beams. Beam modifying devices such as wedges compensate for obliquity at the chest, with MLC shielding conforms each beam to the shape of the PTV (Dobbs and Barrett). Use is made of the Quantec/Emami et. al. (2013), document on Tolerance of Normal Tissue to Therapeutic Radiation in checking dose constraints to organs at risk e.g. brachial plexus, oesophagus and spinal cord. Plan evaluation also uses isodose charts, dose volume histograms and departmental protocols to establish the suitability of the plan. NICE guidelines for Radiotherapy with curative intent for Non-small cell Lung Cancer stipulate that the patient should have good performance status (WHO 0 or 1). It says, CHART should be offered first, but if unavailable then conventional radiotherapy of 64-66 Gy in 32-33 fractions over 6 ÂÂ ½ weeks or 55 Gy in 20 fractions over 4 weeks is the next option. This plan is for 64 Gy in 32 fractions over 6 ÂÂ ½ weeks, so meets with this criterion. Dobbs and Barrett (page 253), mention that careful evaluation of the plan using DVHs is especially important when considering keeping the V20 below 32 per cent (the volume of lung receiving more than 20Gy of the dose). Solutions to eliminate identified errors: Barrett and Dobbs (page 255), point out that beam energies above 10 MV should be avoided due to greater range of secondary electrons in lung tissue, which result in a wider penumbra and thus more radiation to normal tissue. Beam energy of 6MV is adequate, while use of 10MV is for separation at the centre is greater than 28 cm. (Dobbs and Barrett, page 252). As no mention of the separation, it is appropriate to use 6MV on all the beams for this plan instead on mixed energies. This is a conventional plan, and the common number of beams 3 instead of the current 5. The many fields have not helped in conforming the plan to the PTV and improving the dose distribution, but have contributed in unnecessary irradiation of normal tissues. So, removal of the anterior and left lateral beams, would bring the plan back to a conformal 3 field plan. The right posterior oblique field would need setting at around 215o-225o in order to cover the PTV better and its MLC not to shield the PTV as at the present. (RSCH and London Cancer centre protocols). The left lateral field is treating through the contralateral lung, which is operationally against ICRP (2007), ICRU and IR(ME)R 2000 guidelines of keeping dose as low as reasonably achievable (ALARA) to patients, employees and the general public. The corrective measure is to remove the left lateral field from the plan. The gantry angle for the right posterior field is not optimal and moving it to around 215o-225o range would improve coverage of the PTV and avoid the spinal cord, even though the MLC is shielding the cord (ideal) in the current setup but also part of the PTV that is not ideal and compromising the 95% coverage of the PTV. The global maximum value of 109% exceeds the ICRU target of maximum 107% within the PTV. Removing the anterior and left lateral fields, and adjusting the over-wedged posterior and right lateral field wedge angles to either 15o or 30o depending on the uniformity of the dose distribution within the PTV, will rectify this issue. The remaining field weights will need adjusting as well to fully optimise the plan. Moving the RPO beam angle to between 215o and 225o, as well as reducing the wedge angle to 30o and removing the anterior beam from the plan will correct the 80% hotspot region. Removing the anterior field will effectively eliminate the 80% hot spot region on the chest. Removing the left lateral field and wedging the right anterior oblique field will help in reducing or eliminating the 109% hot spot region in the PTV. These measures will also result in more uniformity in dose distribution when combined with adjusting the weights of the remaining fields. The current plan has many wedged fields (some over-wedged), which is rectified by removing the anterior and left lateral field from the plan, adjusting the right lateral wedge angle to either 15o or 30o, and that of the posterior field from 50o to either 15o or 30o and inserting a 15o or 30o wedge on the anterior oblique field. This should improve the uniformity of the dose distribution within the PTV. The non-conventional wedge angles of the posterior and left lateral fields (50o and 33o respectively), have not improved the dose distribution in any noticeable way, as there is still a high dose gradient in the PTV. Reverting to the standard angles and using either 15o or 30o at most, would improve the dose distribution of the plan. The two lateral fields are too big; therefore adjusting them posteriorly would improve the PTV coverage of the plan and less irradiation of normal tissue. The left lateral field however needs taking off the plan altogether. The current plan shows excessive dose to the spinal cord and according to the Quantec/Emami et. al. (2013) document, the maximum core dose to the spinal cord should not exceed 50Gy. Moving the right posterior field angle to 215o-225o range and removing the anterior beam will correct this anomaly The less than 95% coverage of the PTV is achieved by: positioning the posterior field optimally (between 215o and 225o), so that the MLC will not shield the PTV but still manage to shield the spinal cord; adjusting the field sizes of the oblique fields; applying 15o or 30o wedge to the right anterior oblique field andÂÂ   adding MLCs to it so that it conforms the PTV better thus improving the dose distribution to the plan; and applying MLCs to the right lateral field to conform the PTV better. Suitability of Plan and Alternative beam arrangement This plan is not suitable for patient treatment in many respects, as highlighted by the errors identified. Improving it is by reverting to the conventional three field/beam plan, with two right oblique fields and the right lateral field as the third one (Barrett and Dobbs, page 252). Other treatment techniques, e.g. IMRT (with emphasis on carotid sparing), helical tomotherapy, VMAT have been found to offer better results on dosimetric comparisons. However, a multi-modality approach could be the best approach when considering new data coming from immunology, molecular biology and genetics on top of the usual surgery, chemotherapy and radiotherapy treatment options (Franco, P., et. al. (2016)). Conclusion This exercise highlighted the importance of quality assurance and having several layers of checking the suitability of treatment plans that are eventually used on the patients.

How Does the Childhood Obesity Rates Compare in Wales and Usa

How Does The Childhood Obesity Rates Compare in Wales and USA Intro I have chosen the issue of childhood obesity in Wales and America. I have chosen this issue as obesity is a main problem in today’s society, and I want to see how Wales compares to what is known as the ‘Fattest’ country, America. Also I hope to find out the main reasons behind the high or low rates in obesity. This topic interests me as it has a big impact on today’s youth, and I as a rugby player would prefer to see more people out exercising than sitting in the house eating. Aims For my investigation I have found both secondary and primary information.My secondary information is from various sources off the internet. This will help me find out the information I need such as rates of obesity in Wales and USA, and also give me a better understanding of the issue. I will use facts and figures from my research to give a clear outlook of childhood obesity. For my primary information I produced a questionnaire to hand out to a range of people. Twenty five of these questionnaires will be given out to children aged eleven to sixteen, and the other twenty five will be handed to adults. This will give me a two different view points which could contrast or be very similar.From this I should be able to see what the main cause of childhood obesity is, and shall show my findings in graph form to show clearly my results. I will show a clear understanding of the issue chosen by looking at both view points (adult and children), this will give me a balanced view and not a bias one. I shall also then produce an overall conclusion about my investigation and evaluate the quality of my findings too. Issue Childhood obesity has nowadays become a serious health matter world wide. â€Å"Obesity is an abnormal accumulation of body fat, usually 20% or more over an individual's ideal body weight.Obesity is associated with increased risk of illness, disability, and death. † [www. answer. com] Even though obesity does not affect every child, it is becoming more increasing. Also with obesity comes health problems, maybe not straight away but in the future, these problems could be such things as diabetes, heart disease, cholesterol and heart attacks which could lead to an early death. In today’s world many people had a part to play in the rising obesity figures. Today's reliance on cheap convenience and fast foods make it easy to consume large amounts of calories and they are well advertised to children.Only a very few children are overweight due to medical problems. Parents may be feeding their child too much at a young age, therefore making them obese before they have a choice of what to eat and what not to eat, from this when the grow up a bit they may feel depressed and look to food for comfort, only making the problem worse. Another reason is that in schools the amount of physical activity has dropped, with more children getting lifts to school too, and ch ildren now prefer to sit on the computer or watch the T. V. than going out and playing. Secondary ResearchFor my secondary research I planed to find rates of obesity for both Wales and America, and see how much/if the rates have risen through the years. I am expecting to find an increase over the years and hopefully find an explanation to why this is happening. Also I plan to find out if the government has any plans to try help this issue and decrease the rates. I hope to find that most information gives the similar answers, so I can then find out who is most responsible for the rates increasing. The figures of childhood obesity all over Europe are rising quickly, and up to 400,000 deaths each year in Europe are linked to excess weight.In America it has 25,814 deaths related to obesity a year, this is close to the European number for just one country. Therefore proving obesity is a huge problem within today’s everyday life. In Wales around 10% of six year olds are obese, with it rising to 17% of 15 year olds being obese. It is said that Welsh children are now among the fattest in the world, aged ten to fifteen years old. With the United Kingdom number three in the world with 23% of the population being classed as obese. RankCountry%Population Obesity 1USA30. 6 2Mexico24. 2 3United Kingdom23 information from http://www. nationmaster. com/graph/hea_obe-health-obesity) America is rated the number one for obesity in the whole world, with a 30. 6% of the population being classed as obese. Also it has had its own T. V. documentary show done on it, â€Å"Super Size Me† which shows what Americans eat and the drastic damage it can do to your body. I have found from my research that child obesity is a major issue in Wales and more so, America. There needs to be drastic changes to try solve this problem, yet there doesn’t seem anyone/any organisation big enough to do so.However, there are small changes over world that I have noticed, such as schools taking out more fatty foods and bringing in new healthy options to take there place. This started with Jamie Oliver going round Britain looking at school dinners and then giving the children a new healthy option. Also from my research I have found that in both America and Wales the main cause seems to be an unhealthy diet combined with a lack of exercise. High-calorie foods such as chocolates, sweets and fast food are cheap and readily available to children.Alongside this, physical activity and exercise are no longer a part of most children's days – some children never walk or cycle to school or play sport. Instead, many of them spend hours in front of a television or computer. With this being the main cause it seems that the parents are also to be blamed for not controlling or joining in with activities in their children’s lives, if this is the case it may be a hard trend to get out of. Primary Research For my primary research I decide to produce 50 questionnaires to hand out, twenty five went to children aged eleven to sixteen and twenty five to adults.I have done this to try give a balanced view on what people of the area believe the main cause of obesity could be. However I know with questionnaire that you do not always get all of them back completed fully and appropriately, but I cannot let this effect me as it happens to everyone. Fourteen of the adults I asked to complete my questionnaire had children while eleven didn’t, but I found this did not affect my findings significantly. Below I will show you a few results of my questionnaire in graph form, and also a copy of the questionnaire I gave out. Who do you think is responsible for the wellbeing of obese children? (Adults)Who do you think is responsible for the wellbeing of obese children? (Children) As you can see from the graphs, there is a slight trend in who people believe to be responsibility, this is the parents. However from the adult graph you can see that parents come seco nd behind cheap foods, but this could be that the parents asked did not feel it was their fault and felt it was someone else’s. What do you believe the main cause for child obesity is? (Adults) What do you believe the main cause for child obesity is? (Children) From the above graphs you can see most adults saw junk food being the main cause for obesity, then parental control.I agree with this as junk food has become more advertised and easier to get hold of in today’s society, and with lack of parental control over their children they give in to them and let them have junk food or let them watch the T. V. instead of controlling them and giving them the healthy option and time slots for video gaming. However, in the children’s graph you can see they feel the school meals are to blame. I disagree with my findings here as I believe the children who have done the questionnaire have been more boas towards the rest of the options and not voted for them as much as it i s what they like in today’s life.Instead of going out, they prefer to sit in watching T. V. instead of eating healthy, they snack on junk foods. I find the adults graph to be more realistic in finding the main cause, but to get a balanced opinion I had to look at what children in my age range thought. Conclusion After looking over all my findings from both my primary and secondary research I have been able to come to a valid conclusion on the topic I chose to look at, Childhood Rates of Obesity in Wales and USA. It is easy to say that America is most obese country out of the two, with it being ranked number one for obesity in the whole world, with 30. % of the population being obese. I found that childhood obesity can be caused by a number of issues. Firstly the way children are brought up; if they are brought up on junk food it is hard to get out of this bad habit and they will carry on this into their adulthood and then carrying it on to their children. Another reasons is t he bombardment of fast food and its advertisement, this entices people to go to a fast food restaurant like McDonalds which is full of unhealthy foods that some people chose to live off instead of making a healthy meal in their house.In Wales the rates may not be as high as America, but they are still a great deal of children classed as obese. This has become a bigger problem in Britain over the past few years, with Britain being number 3 in the world rankings for obesity. However, there has been some Government work towards solving this problem such as change in school meals and healthier advertisements for restaurants like Pizza Hut and McDonalds, but most people feel this isn’t enough and more work could be done to help. EvaluationI encountered a number of problems during my research for both secondary and primary research. With my primary research the main problem I had was getting the questionnaires back in fully completed, also once in I was able to see that some may ha ve been done quickly and not completed seriously. The main problem with the secondary research was finding appropriate websites that can be trusted and give valid information. With so much on obesity it was difficult to find the right sources, however once found it was relatively simple to extract the information needed.Another problem that occurred was the size of both countries, Wales being a tiny country compared to America so it was hard to compare the rates in both. Overall though, I felt my investigation went well and what I believed was true, that USA was higher in childhood obesity than Wales. If I had to do this investigation again I would change two parts to what I have done, firstly I would have chosen a different country to USA due to its size over Wales, now looking back I think it would have been better to have pick a country such as France.The other change to my investigation would be with the questionnaire, I would ask more people to try get a wider picture instead o f a small amount which may not be an accurate opinion of the country in hand.Websites Usedhttp://news. bbc. co. uk/1/hi/wales/2997940. stmhttp://www. cdc. gov/nchs/products/pubs/pubd/hestats/overweight/overwght_child_03. htmhttp://www. nationmaster. com/graph/hea_obe-health-obesity

Cancer, Gender, and Environmental Justice Essay

As of today, cancer is one of the utmost feared diseases in the world. In the early 1990s, approximately 6 million new cancer incidents propagated and more than 4 million mortalities arose from cancers. Cancer is a disease that is killing individuals all around the world. More than one-fifth of all fatalities were triggered by cancer and its been predicted, by the American Cancer Society, that about 33% of Americans will ultimately acquire this disease. The expertise of cancer analysis is titled Oncology. Cancer is the furthermost aggressive disease of a greater class recognized as neoplasms. Neoplasms don’t quite conform to the portions of the cell that regulate the development and tasks of the cell. These cells ultimately become anomalous tumors and are acknowledged as non-typical tissue. These mannerisms are passed down as the cell replicates, thus spreading the cancer. The government has consumed billions of dollars on investigation for a cure of this deadly disease. â€Å"It is estimated that one out of every two men and one of every three women will have cancer in their lifetimes. About one in four persons will die of cancer. The American Cancer Society estimates that about 570,000 cancer deaths occur each year in the United States. Cancer is the second leading cause of death after heart disease† (Pat Quinn). The government spends huge amounts of money on cancer exploration. They’re constantly finding remedies and enhanced techniques to treat and deal with cancer. As of today, research has progressed for the better and has helped countless individuals fight cancers. Although there is so much effort put into cancer research, it is still a feared disease, but is now treatable which grants numerous people faith in recovery. Cancer and Gender Cancer affects male and females in different ways. â€Å"In the United States, lung cancer is the leading cause of cancer-related deaths for both sexes, followed by prostate cancer in males and breast cancer in females. It is estimated that one out of every two men and one of every three women will have cancer in their lifetimes† (Pat Quinn). â€Å"Another gender issue in cancer is adipose tissue (fat)† (Tarter). â€Å"Some of the most dangerous carcinogens those that are most persistent in the environment and the most persistent in our bodies- are stored in fatty tissues which affects women in a different ways than men† (Tarter). Also women are more prevalent in developing breast cancer, as men are more prevalent to developing colon cancer. â€Å"Between 1977 and 2006, the top five biggest disparities in age-adjusted cancer death rates were for the following types of cancer, according to the study; cancer of the lip: 5.51 men died for every one woman, cancer of the larynx: 5.37 men died for every one woman, cancer of the hypo pharynx: 4.47 men died for every one woman, cancer of the esophagus: 4.08 men died for every one woman, and cancer of the bladder: 3.36 men died for every one woman. All of those cancers are relatively rare. But men also die at much higher rates from the most common forms of cancers that affect both sexes† (Laura Blue). The American Cancer Society estimates that approximately 570,000 cancer related deaths occur annually in the United States. Cancer is the second leading cause of death after heart disease. Human Rights and Environmental Justice Environmental Justice is the field of study that explains the connection between environmental exploitation and human exploitation. â€Å"The term environmental justice emerged as a concept in the United States in the early 1980s. The term has two distinct uses. The first and more common usage describes a social movement in the United States whose focus is on the fair distribution of environmental benefits and burdens. Second, it is an interdisciplinary body of social science literature that includes (but is not limited to) theories of the environment, theories of justice, environmental law and governance, environmental policy and planning, development, sustainability, and political ecology† (Wikipedia). â€Å"Federal and state right-to-know laws, established in the past decade, have made available disturbing information about the extent to which our environment has been polluted by known carcinogens (and many others which are probable, suspected, or untested)† (Tarter) . â€Å" Environmental justice writers and activists have consistently made links between environmental exploitation and human exploitation, attempting to reveal, criticize, and transform relationships between human social practices and environmental issues† (Tarter). Also another example to human rights and environmental justice is that the lower income class people tend to live in the urban areas where they are exposed to factories and carcinogens as opposed to the higher classes that live in the suburbs and aren’t exposed to any or very little of these toxins. Some people argue that environmental justice is also racial discrimination. Facing Living Downstream In this essay Tarter talks about how it is to live downstream. Living downstream means that whatever happened previously in your life can affect what happens later down the road. â€Å"There are individuals who claim, as a form of dismissal, that links between cancer and environmental contamination are unproven and improvable. There are others who believe that placing people in harm’s way is wrong whether the exact mechanism by which this harm is inflicted can be deciphered or not. At the very least, they argue, we are obliged to investigate, however imperfect our scientific tools; with the right to know comes the duty to inquire† (Tarter). â€Å"In contemporary American society there are many layers of silence wrapped around cancer, not only because the disease itself is frightening and we have trouble with issues of death and dying in our culture, but also because it is too frightening to contemplate the huge investment of money, power, and emotional capital in toxif ying the environment and ourselves in the way we do now† (Tarter). The environmental contaminations role of causing cancer is on the rise. Conclusion When a family is forced to deal with a relative who has been diagnosed with cancer life gets difficult. Cancer affects many people all around the world. Throughout this essay by Jim Tarter I learned that cancer affects others on many different level. Cancer affects through gender, environment, race, and poverty. At the beginning of the essay I read Tarter gives us an insight on his life and how it was to be a cancer patient. He uses many perspectives on this topic through Rachel Carson and Sandra Steingraber’s work. This essay opened my eyes and I learned through reading from other’s experiences.

The Colonization Of Egypt During The Middle East - 1460 Words

Colonialism is a cultural phenomenon that traces back hundreds of years and has affected nearly every region in the world. The effects of colonialism have significantly affected the countries of the Arab world and the Middle East. The 1800 s were known as the colonial era, and most of the occupation in the Middle East took place during that era. While we are supposedly living in the days of post colonialism†, there are still signs of colonization evident in the Arab world today. Throughout the readings of Fatima Mernissi and Ahdaf Soueif, the reader comes across the theme of colonization. The British colonization of Egypt is very similar to the French colonization of Morocco during the 19th century. Despite the negative connotations imperialism has in history, after reading the novels, in the long run colonization has given more opportunities to the lives of Egyptians and Moroccans, especially women, in the terms of individual freedom. 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