The S.C.C Is a tumour arising from the prickle cells of the epidermis which lie above the basal layer. This form of cancer easily Invades the dermis, and may on occasions spread to local lymph glands or more widely through the blood stream.

Causes. S.C.C.s are much more prevalent on sun-damaged skin. They may however arise following prolonged exposure to chemical carcinogens such as tar, lubricating oils, creosote and soot. Occasionally they arise at the site of an old Injury, such as a burn or leg ulcer. The taking of arsenic for medical purposes, many years previously, will predispose one to developing a S.C.C. The majority of these cancers are due to the cumulative effect of solar damage in genetically predisposed people, and occur on sun-exposed areas. The incidence is high amongst outdoor workers—especially those with fair or freckled complexions—living in countries like Australia, South Africa, or in the American State of California. (The incidence is 15 times less in blacks than in whites of the same area.

Features. A S.C.C. rarely arises in healthy-looking skin. They usually appear against a background of blotchy pigmentation, alternate thickening and thinning of the skin, and wrinkling. Frequently, they occur within a longstanding solar keratosis. The most common sites are the backs of the hands, the arms and the facial area.

The earliest sign of a S.C.C. is often a firm thickening of the skin, usually at the base of a solar keratosis. More frequently, however, the earliest sign is a warty growth, or a small ulcer, with a rolled solid border. Initially the ulcer is not obvious because of a firmly adhering crust, which bleeds when it is knocked off. The lower lip is a favourite site for these S.C.C.s. Here a S.C.C. may be preceded by a white flat patch, known as leukoplakia, or dry, scaly, cracked lips. It may begin as a persistent fissure or crack, which becomes hard and ulcerated, or as a warty or fleshy, red growth.

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Disease of the arteries is the Number One cause of death in women over 50. Whether the cause is heart attack or stroke, arterial disease kills one woman in every four.

The arteries carry blood from the heart all round the body, and so it is important for our health that they remain in good condition. If they become narrowed, or clogged up, then the blood can’t flow so freely, and there is a much increased chance that the flow will suddenly become completely restricted, causing a heart attack or a stroke.

Some of the factors that contribute to heart disease are outside our control, such as the natural ageing process, and the hereditary aspect of heart disease; other risk factors we can do something about, by giving up smoking, not drinking too much alcohol, taking enough exercise, eating the right diet and learning how to handle stress.

One of the factors that increases the risk of developing diseases of the arteries is being male; until the age of 40-50, far more men than women die of heart disease. In fact, it is unusual for otherwise healthy pre-menopausal women to have heart attacks, whereas, sadly, it is not unusual for men in this age group to do so. The reason is thought to be the protective effect of a woman’s oestrogen. Once a woman is past the menopause (whether natural or surgical) her risk of having a heart attack increases, until by the age of 75-80 she has the same risk as men.

The reason for this is possibly to do with cholesterol. There are two forms of cholesterol flowing through the blood vessels: low density lipoproteins (LDLs) which build up on the walls of the blood vessels and are ‘bad for you’, and high density lipoproteins (HDLs) which are ‘good for you’ because they latch on to the LDLs and absorb them through the artery walls to be disposed of by other organs in the body. Many years of research have shown that oestrogen lowers the level of LDLs and raises the level of HDLs. As high levels of LDLs increase the risk of arterial disease (by blocking the arteries), and high levels of HDLs are good for you (because they remove the LDLs), oestrogen has a very positive protective effect.

Also, at times of increasing age, when the major arteries of the body are narrowing, HRT is thought to widen them and so allow blood to flow more freely. In fact, women on HRT tend to have healthier arteries than those not on it; even women of 70 or more can benefit from this protective effect of HRT.

As you will read in Chapter 8, there is a small but increased risk of developing breast cancer after several years on HRT, a fact that has received a lot of publicity. However, heart disease and stroke are the largest single cause of death among women in this country, completely dwarfing the number of deaths from breast cancer. The average reader of this book over the age of 50 is many times more likely to die from heart disease or stroke than from breast cancer (although under the age of 50 the risk of breast cancer is greater). A great deal of research has been carried out in recent years into HRT’s effect on menopausal symptoms and osteoporosis, but much less into its effect on arterial disease. This balance is beginning to change, and over the next few years more will become known about the effect different hormones have on heart disease and stroke. Although HRT was originally prescribed primarily to treat hot flushes, etc, and more recently also to prevent osteoporosis, it is likely that in future years it will be prescribed mainly for its role in reducing the risk of heart disease and stroke. Even now, it is thought that women who take oestrogen have one-third to one-half the risk of developing these two conditions than women who don’t.

(It is worth noting here that almost all the studies that show the beneficial effect of oestrogen on arterial disease have been carried out on women taking oestrogen alone, and not oestrogen with progestogen, although recent work suggests that progestogen may not detract from oestrogen’s cardiovascular protection; there have not yet, however, been any results based on long-term data.

To gain significant protective effect against arterial disease, you may need to stay on HRT for two years or so, preferably longer, and the effect will diminish once you stop. Even then, the oestrogen only reduces your risk of developing these diseases, it cannot guarantee that you won’t get them. We are not immortal!

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Despite a considerable amount of energy, ingenuity and research in recent years, the cause of endometriosis remains shrouded in mystery. This has undoubtedly slowed progress in developing effective treatments.

Drugs such as danazol, progestogens and GnRH agonists are capable of shrinking endometriosis tissue. They work by blocking the action of oestrogen which seems to be an essential ingredient in endometriosis growth. While these drug therapies are not capable of eliminating severe endometriosis, they are often used in the lead-up to surgical, electrical or laser treatment in the hope of making the removal of endometriosis tissue safer and more effective. Many doctors prefer not to prescribe danazol, progestogens at low dose, or GnRH agonists for longer than six months because of side-effects such as weight gain, breast tenderness, depression, nausea and hot flushes. There is also little information about the effects of long-term usage but what we do know gives cause for concern. For example, danazol has adverse effects on blood fats and GnRH agonists cause loss of calcium from bones. For some women, high daily doses of progestogens cause few problems and this therapy maybe recommended when endometriosis recurs after other attempts to remove it.

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To understand how the penis can double in size, one has to know something about how the penis is constructed. The penis is like two spongy sausages side by side, or a double-barrel shotgun. It can be filled with blood by the opening and closing of a special form of valve system. When the valve of the incoming blood vessel is opened and the valve on the outgoing blood vessel is closed, a lot of blood is trapped in the spongy component of the penis. The penis becomes turgid and erect. It is estimated that the blood flow in the flaccid penis is 5 ml per minute. At the start of the erection, the blood flow may go up to 100 ml per minute. When the penis reaches a stable turgid state, the blood flow is maintained at about 50 ml per minute. The control of this valve system is not a completely voluntary one. If a man decides to have an erection, even if he desperately wants to, he may not be able to have one. This is because the valves around the spongy part of the penis are controlled by the autonomic nervous system. This system controls various bodily functions, such as stomach movements, and is not directly under our control. Remember the time when you burped in public and were embarrassed? You had no way of preventing the burp, because burping is under the control of the autonomic nervous system.

In fact there are two major groups of activities in the body, which are controlled by two separate systems. These are like the gear changes of our cars—automatic and manual:

* The automatic system is controlled by the autonomic nervous system. This regulates our stomach movements, heart rate, blood pressure, etc. and, of course, male erection

* The manual system is controlled voluntarily by our brain; for example, you can move around or sit still whenever you want.

The only time that these two systems are not under our control is during dreaming. In REM sleep, the manual system is no longer working and the muscles are completely relaxed, even in the most tense people. So when a man dreams, on the one hand the genitalia are doing their compulsory exercises, on the other hand the muscles of the body are having a compulsory rest.

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