Vulvar Cancer

Vulvar cancer

Vulvar cancer is a relatively rare diagnosis, representing about 5% of all gynecologic cancers, and only about 1% of all female cancers in general. There are about 3,500 new cases reported annually in the US and approximately 900 death a year attributed to this disease. The incidence of vulvar cancers has remained stable over the past two decades but the rates of precancerous lesions has more than doubled over the same period of time. The cause for the growing number of cases is not well-understood.
Vulvar cancer is most common in women over 50 years of age. Additional risk factors for vulvar cancer include having multiple sexual partners, cervical cancer, and the presence of chronic vaginal and vulvar inflammations. This typeof cancer is often associated with sexually transmitted diseases.
The vulva is the skin and fatty tissue between the upper thighs of women, from the area of the anus to about an inch below the pubic hairline. Cancer of the vulva most often affects the two skin folds (or lips) around the vagina, known as the labia.
Vulvar cancer is a rare type of cancer. It forms in a woman's external genitals, called the vulva. The cancer usually develops slowly over several years. First, precancerous cells grow on vulvar skin. This is called vulvar intraepithelial neoplasia (VIN), or dysplasia. Not all VIN cases turn into cancer, but it is best to treat it early.
Vulvar cancer forms in a woman's external genitalia. The vulva includes the inner and outer lips of the vagina, the clitoris (sensitive tissue between the lips), and the opening of the vagina and its glands. Vulvar cancer is a rare disease in which malignant (cancer) cells form in the tissues of the vulva.
At the front of the vagina, the labia minora meet to form a fold or small hood of skin called the prepuce. Beneath it lies the clitoris, an approximately ¾-inch structure of highly sensitive tissue that becomes swollen with blood during sexual stimulation. At the lower end, just beneath the vaginal opening, is the fourchette, where the labia minora meet. Beyond the fourchette is the anus, the opening to the rectum. The space between the vagina and the anus is called the perineum.
Most women with cancer of the vulva are over age 50. However, it is becoming more common in women under age 40. Women who have constant itching and changes in the color and the way the vulva looks are at a high risk to get cancer of the vulva. A doctor should be seen if there is bleeding or discharge not related to menstruation (periods), severe burning/itching or pain in the vulva, or if the skin of the vulva looks white and feels rough.
Vulvar cancer is usually treated with surgery. The type of surgery depends on the size, depth and spread of the cancer. Your doctor will review all the options for surgery and the pros and cons of each option. Some people may also need radiation therapy.
It is best treated by excision or sometimes by laser evaporation. If a large area is involved and must be removed, then a skin graft can be applied. These premalignant conditions are likely to recur after treatment so continued follow up is a necessity. Another condition that can occur on the vulva and also cause itching and soreness is called lichen sclerosis. It is not a premalignant change, but an atrophy of the skin. It will not be improved by anti-yeast medications either. It can be diagnosed by biopsy.

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Ovarian Cancer

 

 

Ovarian cancer is claiming the lives of millions of women all over the world, even in countries that are stereotyped to be the leaders in medical technology. In fact, it is actually the lack of medical technology that is resulting in so many ovarian cancer deaths, since there are no screening methods that can officially detect the disease. And yet, they can still help a woman save her life, if she knows when she should get the screening. If you need help in making such a determination, read on as this article will provide 5 chunks of information about ovarian cancer you must know.
1. Fact 1: It Can Take Years Before Ovarian Cancer Develops Symptoms
The first fact of the 5 chunks of information about ovarian cancer you must know is concerning how the symptoms of the disease develop. Basically, you can have the tumors growing inside you for a very long time and not have any idea that you have ovarian cancer. And when the symptoms start, it can mean the cancer has gotten to a point where it's not easily treated.
2. Fact 2: If Ovarian Cancer is Caught in its Early Stages, it has a 90 Percent Survival Rate
The second fact of the 5 chunks of information about ovarian cancer you must know is concerning the survival rate if the cancer is caught early. It can be as high as 90 percent. Yet, only 25 percent of women are able to catch the disease in these stages. Why is this so? Well, women who are at higher risk of ovarian cancer tend to get screening at the very moment something seems wrong with their bodies, (sometimes even earlier). You can be in this category mainly if you have a history of the disease in your family. When you get your gynecological exams, press your doctor for ovarian cancer screening. Be careful if you do this and you are not in the high risk category, since unfortunately ovarian cancer screening does carry a high rate of misdiagnoses, (which is why it isn't encouraged for the general population).
3. Fact 3: Breastfeeding and Having Babies Lowers Your Chances of Getting Ovarian Cancer
The third fact of the 5 chunks of information about ovarian cancer you must know concerns childbirth and breastfeeding. Having your first baby in your 20s along with breastfeeding significantly decreases your chances of having ovarian cancer. However, you do not have this advantage if you had your first baby in your teens or if you have a baby after 35.
4. Fact 4: Taking Birth Control Lowers Your Ovarian Cancer Risk
The fourth fact of the 5 chunks of information about ovarian cancer you must know concerns birth control. It is believed that birth control is effective at helping to prevent ovarian cancer because it lowers a woman's estrogen level, which is believed to be a factor for the disease. Be careful, though since some women may not be able to take birth control due to certain risk factors.
5. Fact 5: Get a Hysterectomy or Ovary Removal if You're High Risk
The final fact of the 5 chunks of information about ovarian cancer you must know concerns the hysterectomy or removal of one's ovaries. Hysterectomies provide protection for virtually any time of uterine cancer, but it can drastically decrease sexual pleasure. This is why if a woman is not at risk for any other type of reproductive cancer, a doctor may instead opt to remove just her ovaries.

You can learn more about ovarian cancer as well as the symptoms of ovarian cancer on my website http://www.OvarianCancerPrognosis.net My website includes a whole range of articles focusing on the problems caused by ovarian cancer, treatments and of course what you should do if you think you have ovarian cancer.

Cervical Cancer

Cervical Cancer - The HPV Myth

This investigation began when through my researches for my book I could demonstrate that all cancers can readily be linked to chemical and radiation causes, but there is one that was an exception. It was the cuckoo in the nest and this was cervical cancer. This cancer variation is now firmly established and universally attributed to having been caused by a virus as many of the articles in this Ezine more than testify. However, the evidence proves otherwise and I shall prove beyond any doubt that what I have said is true but before proceeding with the evidence to support this heretical statement, let us take a look at some background information about the disease. Clues to the cause of the disease can be found within the information that now follows.
Worldwide, cervical cancer is the third most common type of cancer in women. According to the NCCC (National Cervical Cancer Coalition) about 14,000 women in the United States are diagnosed with the disease each year and more than 3,900 women die in each year from this disease. However, the number of women getting the disease in the western world is very few when compared to the rest of the world. Women in developing countries account for about 85% of both the yearly cases of cervical cancer (estimated at 493,000 cases worldwide) and the yearly deaths from cervical cancer (estimated at 273,500 deaths worldwide). In fact, whereas breast cancer is the leading cancer for women in the west, in the majority of developing countries, cervical cancer remains the number-one cause of cancer-related deaths among women. Keep these statistics in mind because what they tell us is very important as far as determining the cause of cervical cancer is concerned.
Initially I was taken aback by the revelation that a virus caused cervical cancer but then I began to wonder what it was that led the medical profession to almost unanimously adopt this idea when all other cancers clearly showed that chemicals (or radiation) was responsible. As I looked into this more deeply, I came across a most perplexing riddle. You see, what set doctors along a path in search of a viral cause of the disease was triggered by an obscure report in a regional medical journal in Venice. It was made by an Italian surgeon and an amateur epidemiolist named Rigoni-Stern in 1842. He had analysed 150,000 death certificates from the Veronese district for the years 1760-1839 and found that out of 74,184 women who died, 1288 of them were nuns. The cause of death of the nuns varied but many had died of breast cancer, five times more common than other women. Incidently, he correctly attributed one of the reasons for the increase in breast cancer in nuns compared to other women was due to the corsets they wore). He recorded four deaths from uterine cancer (cervical cancer was not distinguished from other cancers of the uterus), while he had expected at least six based on 361 cases in the remaining 72,896 women.
From this somewhat vague analysis, others saw this data as evidence that there was little or no cervical cancer among Catholic nuns compared with the rest of the Italian female population. Subsequent doctors endeavoured to expand on this obscure report, adding various invented details, including the idea that cervical cancer in prostitutes was prevalent. So arose the myth that as nuns were supposed to be celibate and yet cervical cancer was rare among them, and that the disease was said to be quite common among prostitutes this could only mean one thing. Cervical cancer was caused by something that was sexually transmitted and it was not long before this speculation became accepted as fact. Professor Skranbanek put things in perspective when he said that, "A reference to an obscure Italian communication has become a de riguer in the opening paragraphs of articles on the aetiology of cervical cancer, but how many authors have read the orignal? Skranbanek, proved as did Dr Griffiths of Luton Hospital, that the basis upon which the theory that a sexually transmitted virus was a red herring, that has led to doctors following a false trail ever since.
For a hundred years or more the search for the elusive virus was searched for, with Smegma and Herpes at one time thought to have been the cause, but eventually proven to be unfounded. Then came along Professor Harald zur Hausen and his team who found that a number of HPV virus strains could be found in women who had cervical cancer. The elusive virus had been found and ever since then, this has become the established scientific hypothesis. But is wrong!
If HPV does not cause cervical cancer as I have said, even though most if not all of the medical profession would disagree with me, then what do I say is the cause of the disease? To answer this question we need first to take a look at the intriguing statistic that I mentioned earlier in this treatise, because it gives us a vital clue. "Women in developing countries account for about 85% of both the yearly cases of cervical cancer".
Did you know that the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH) in the United States lists cervical cancer as a "rare disease"? This means that Cervical Cancer, or a subtype of the disease, affects less than 200,000 people in the United States, a country that has a population of over 300 million people. According to the estimated new cases and deaths from cervical (uterine cervix) cancer in the United States in 2007 by the National Cancer Institute are 11,150 new cases with deaths about 3,650. This compares to 470,000 new cases and 230,000 deaths every year to cervical cancer world wide, most of which occur in developing countries. The good news is that cervical cancer incidents are on the decline in the West and it is believed that the introduction of the Pap test is responsible. This may be partially true, but how does one explain that cervical cancer was already in decline before the Pap test was introduced?
The World Health Organisation says that "More than 80% of the burden of this easily detectable and preventable disease is borne by developing countries" To illustrate this the WHO have published a map of the world that shows the projected global incidence of cervical cancer for 2005 in various countries, and it is most informative. The reason I say this is because I have seen an almost exact duplicate of this map elsewhere, accept that it has nothing to do with cervical cancer. It is a map that shows the national energy consumption of wood fuels in the world. The correlation is remarkable and self evident. OVERLAY THE STATISTICAL WORLD MAP OF CERVICAL CANCER DISTRIBUTION AND A MAP OF THE COUNTRIES THAT USE WOOD AS THEIR PRIMARY FUEL AND YOU WILL FIND AN ALMOST PERFECT MATCH.... This is no coincidence.
Thank you

Brain Cancer

Brain Cancer

We all know the function of brain. It is the main control center of our body that monitors/instructs everything thing in our body. Any disease that affects this central control system is really a big problem. And the worst thing to happen is brain cancer. Brain cancer is the development of brain tumors i.e. tumors in the brain. These could either be benign or malignant; the latter being the really harmful one.
Types of brain cancer
As most other types of cancer, brain cancer is also classified as primary brain cancer and secondary brain cancer. Primary brain cancer is the one that originates from the brain itself i.e. that originates in the brain cells. Secondary brain cancers is the one that doesn't originate from the brain cells but is instead passed on from another organ/ part of the body
Causes of brain cancer
As is the case with many other types of cancer, the causes of brain cancer is a big topic for researchers. However, certain genetic conditions and exposure of head to radiation (as received during radiotherapy as part of treatment of other conditions) are known to be causes of cancer. There are a number of other theories that keep coming up time and again, each suggesting different possible causes of brain tumor (one famous one is about mobile phones causing brain cancer). However, there really isn't a very convincing theory about what causes brain cancer.
Symptoms of brain cancer
Some very common symptoms of brain cancer are headaches and nausea; but these can really be caused by something else. So, headache and nausea shouldn't really be taken as brain cancer. Some other symptoms of brain cancer are related to incorrect working of some of the basic senses (that are mainly governed by brain) e.g. speech, vision and smell etc. Again, there is no point in getting worried all by yourself; you should, in any case, consult a qualified doctor and let them know clearly about the various symptoms that you have observed. The doctor can then diagnose whether it is brain cancer. You might be referred to a neurologist for further examination (if brain cancer is suspected).
Diagnosis and treatment of brain cancer
The diagnosis of brain cancer will include tests that are based on the working of the nervous system. So, testing of basic human senses like vision, speech, hearing, mental capability, reflexes is taken up for diagnosis of brain cancer. The treatment of brain cancer is done through surgery, radiotherapy or chemotherapy (and the combination of these).

Warren and Karen have been involved in the internet for a number of years and run several websites. They are most interested in providing opportunities for people to connect with information relating to business, health and creativity. Check out their Brain Cancer blog for more information.

Mouth Cancer

Mouth Cancer

Cancer is one of the most deadly diseases known to the world. There are various causes which are responsible for different types of cancer in different parts of the body. Mouth cancer is one of them. Unwanted growth of cells in the mouth region is termed as mouth cancer. It can be developed in any part of the mouth. This includes jaws, lips, gums, cheeks, tonsils, etc. All the mouth parts are covered by a sheet of soft cells called as squamous cells. These cells are very much prone to cancer cells thus causing mouth cancer. Mouth cancer can be also called as squamous cell carcinoma.
There is a wide range of causes which are responsible and many bad habits like smoking, tobacco chewing, in take of alcohol are the main causes of mouth cancer. Apart from these the other reasons for mouth cancer is exposure to UV rays, Candida infection in mouth etc. Lack of vitamin A, E, C, iron, zinc etc. is also responsible for mouth cancer. This can be diagnosed by a large number of symptoms. One can do a biopsy of the mouth to diagnose mouth cancer. Different technology like endoscopy, MRI scan, X-ray, CT scan can also be used for diagnosing mouth cancer.
Mouth cancer can be easily treated if diagnosed in an early stage or it can be said that treatment of cancer depends on the stage it is diagnosed in. There are three useful methods which have proved themselves helpful in treating mouth cancer. These include surgery, radiation therapy and chemotherapy. During chemotherapy treatment is done using the intravenous injections containing the anticancer drugs. It is possible that the victim may experience some side effects of chemotherapy. These side effects can include hair loss, quick weight loss, mouth sores, nausea, vomiting etc. In radiation therapy beta rays are used for killing the deadly mouth cancer cells. This surgery is usually done when the tumor is small and gentle. Some physicians suggest all these three ways for the treatment of mouth cancer.
There are many steps which can be taken to minimize the risk and as stated above, mouth cancer is generally caused by the consumption of alcohol or due to cigarette smoking. So, by avoiding these things you can keep yourself less prone to mouth cancer. We can also reduce the risk by avoiding tobacco chewing as it is also one of the major causes of this deadly disease. One can remain away from mouth cancer by in taking a healthy diet. Taking a diet rich in vitamins and minerals can help in staying fit thus avoiding mouth cancer. Keeping mouth clean can also help in avoiding skin cancer.

Candis Reade is an accomplished niche website developer and author. To learn more about mouth cancer [http://smokingandcancer.info/mouth-cancer], please visit Smoking and Cancer [http://smokingandcancer.info] for current articles and discussions.

Lung Cancer

General Information on Lung Cancer

Lung cancer, or carcinoma of the lung, is one of the most common forms of cancer today. It is one of the most frequent causes of cancer-related mortality in the United States today. In the United States, another form of cancer that is becoming increasingly common is breast cancer, which is the development of malignant tissue in the breast. Breast cancer is seen mostly in women, though this does not mean that men are immune to it. A small percentage of men too contract breast cancer. The numbers are small, 1 man with breast cancer against a 100 women with it, but its there. However, there is one major difference between breast cancer and lung cancer. One can see the symptoms of breast cancer at an early stage, while in the case of lung cancer, the symptoms are not detected early, primarily because they match the symptoms of other lesser ailments. In this article, we will discuss lung cancer.
A person is said to suffer from lung cancer when a growth of malignant cancer cells is detected in the lungs. Depending on the stage at which lung cancer is detected, it can be classified as being in the:
o Early stages
o Mid-stages
o Advanced stages
Today, there is a vast amount of information on lung cancer available. Patients or relatives of patients can access information over the Internet, which has an almost limitless number of websites dedicated to different aspects of lung cancer - types, causes, symptoms, diagnosis, treatment, etc. For example, if you are from the United Kingdom and want to research information on lung cancer treatment, facilities, etc in your country, you can simply log onto the website of Cancer Research UK, UK's leading cancer charity, and collect whatever information you want from their site.
Earlier on, treatment of lung cancer was not an easy thing to do, owing to the huge amount of expenses in the form of medical bills, hospital stays fees, etc. However, nowadays with the availability of insurance, things have become easier. Lung cancer insurance is available easily, as is insurance covering other forms of cancer.
Types of Lung Cancer
Two main types of lung cancer exist today. Both of these are seen in the epithelial cells of the lungs. They are:
o Small cell lung cancer (SLCC)
o Non-small cell lung cancer
There is another type, called mixed small cell/large cell lung cancer. In this type you can find both kinds of cells in the cancerous tissue.
Besides these two types, there is another form of cancer of the lung area, called mesothelioma or mesothelioma cancer or cancer of the mesothelium. However, this is not considered a primary form of lung cancer, as its target area is not the lobes of the lung, but the pleural membrane covering the lung.
Small Cell Lung Cancer
This is the rarer of the two basic forms of lung cancer. One out of every five lung cancer patients suffer from small cell lung cancer.
Non-Small Cell Lung Cancer
Non-small cell lung cancer, or non-small lung cancer, is the more common of the two basic forms of lung cancer. Four out of five lung cancer patients suffer from this type of cancer.
Based on the cell type/area in which the carcinogenic cells proliferate in the lungs, non-small cell lung cancer is further categorized into three types. They are:
o Squamous cell carcinoma
o Adenocarcinoma
o Large Cell Carcinoma
o Bronchioalveolar Carcinoma (BAC)
Squamous Cell Carcinoma
This is the most common type of lung cancer. It occurs in the cells lining the airways inside the lungs. This form of cancer occurs mostly due to nicotine ingestion through smoking.
Adenocarcinoma
This form of cancer is seen in the mucus cells within the airways in the lung.
Large Cell Carcinoma
This is also called undifferentiated lung cancer. In large cell carcinoma, the proliferating cells are round and much larger than the cells seen in adenocarcinoma or squamous cell carcinoma.
Bronchioalveolar Carcinoma (BAC)
This form of cancer is seen in the bronchioalveolar region of the lung.
What Causes Lung Cancer?
The main cause of lung cancer is exposure to tobacco. This is primarily through smoking. About 80% of lung cancer patients are smokers. Smokers may be cigarette smokers, cigar smokers, or pipe smokers; it doesn't matter. The risk of contracting lung cancer is equal in all the three cases.
A person may inhale smoke directly. A person can also inhale smoke passively or involuntarily. This smoke is also called secondhand smoke. Secondhand smoke is of two types:
o Mainstream - This is the smoke exhaled by the smoker, and amounts to more than 50% of all secondhand smoke.
o Sidestream - This is the smoke emanating from the burning end of a cigarette/cigar/pipe/hookah.
Passive smokers too stand a high chance of contracting lung cancer. The chances of passive/secondary smokers contracting lung cancer is 30% higher than people who do not inhale smoke either actively or passively.
However, there have been instances of even total non-smokers suffering from lung cancer. This indicates that smoking is not the only cause for lung cancer. It is the primary cause, yes, but not definitely the only cause. The following are some of the other causes of lung cancer:
o Air pollution
o Inhalation of asbestos fibers
o Exposure to radon, a radioactive substance formed by breaking down uranium
o Inhalation of marijuana fumes by smoking
o Exposure of the chest area to radiation therapy during cancer treatment
o Hereditary reasons
o Presence of arsenic in drinking water
o Diet with low fruit and vegetable content (this increases the risk of lung cancer in smokers)
A combination of exposure to tobacco along with any of these causes greatly increases the chances of a person contracting lung cancer.
Lung Cancer Symptoms
The following are some of the common symptoms of lung cancer. They do not usually manifest in the early stages. Even if they do, they are usually mistaken for some other ailment. These symptoms are:
o Persistent coughing
o Reddish or muddy brown spit
o Loss of breath
o Loss of appetite
o Persistent or repetitive infections of the bronchial tract
o Hoarseness of voice
o Renewed wheezing
In its later advanced stages, when the lung cancer is said to be in metastasis, the symptoms are:
o Numbness in the arms or legs
o A jaundiced appearance
o Tumorous growths near the skin surface
o Seizures
o Bone pain
o Dizziness
Lung Cancer Detection and Diagnosis
It is very rare to be able to detect lung cancer in its early stages. There are no specific symptoms of early stages of lung cancer. This is one of the reasons why lung cancer is usually detected in its later stages.
The use of a proper screening technique would greatly increase the chances of early lung cancer detection. However, there is no such proper and totally effective screening technique yet. Research is on to see if one can be formulated soon. As of now, a new technique called spiral CT seems to be the best option for early detection.
Once lung cancer is detected, the next step is to determine the stage it is in. This is done using the AJCC system. Roman numerals are used to mark the different stages of lung cancer, numerals from 0 to IV. Sometimes the stages are further divided into substages, using denotations A and B. The general rule of thumb is that the lower the denomination, the less serious the condition.
Lung Cancer Treatment
Lung cancer treatment options are usually the same as prostate cancer treatment options or colon cancer treatment options. What I mean is that all forms of cancer have the same treatment options. However, lung cancer tests may be different from colon cancer tests. The standard treatment options for lung cancer are:
o Surgery
o Radiation Therapy
o Chemotherapy
What matters is the combination of methods being used. The more serious the cancer, the more chances that different treatment options will be used in tandem, or one after the other.
References
o http://www.aacr.org
o http://www.cancer.gov/cancertopics/types/colon-and-rectal
o http://www.cancerbackup.org.uk/Cancertype/Lung/General/Typesoflungcancer
o http://www.cancer.org
o http://www.lungcanceronline.org

Breast Cancer

Breast cancer stages form the basis for a proper and systematic pattern of breast cancer diagnosis and give a rough idea about the intensity of tumors formed in breast areas. Stages of cancer also help to know the approximate chances of elimination of tumors so that an apt breast cancer cure can be recommended accordingly.

Breast Cancer Stages in Detail   

Stages of cancer explain the pattern of growth or tumors in a systematic manner depending upon analysis of various breast cancer causes and the kind of cancer symptoms displayed by the victim. They also help to understand the location of tumors and the damage they may cause to the victim's body in future.
Cancer stages are closely related to chances of survival of the victim. Life expectancy of a person depends mainly upon the stage of the disorder she is suffering from, and each stage has different rates of survival. Also, the form of treatment to be undergone by the victim depends upon the stage of malignant infection. Usually the treatment is light in initial stages while its intensity increases as the victim progresses from lower to higher phase of cancer. A person may undergo high mental and physical sufferings in the final stages as the treatment pattern gets considerably aggressive. Also, the chances of survival are lowest in final stages and a person may also suffer from cancer recurrence.
Cancer stages can be identified on the basis of output obtained in the diagnosis process undergone by victim. The disease can be safely eliminated if a person initiate cure as soon as the tumors get detected. Any delay in the process may allow tumors to metastasize rapidly and make their elimination difficult. Stages also determine the pattern of post-treatment care to be undergone by a victim and the kind of support one needs in future to tackle the disease.
In most of the cases, stages of cancer progress due to faulty treatment pattern or ignorance of victim in following necessary lifestyle and dietary pattern. Strong immune system is the biggest defense to cancerous development and plays a vital role in limiting tumors to a certain stage.

Main Stages of Breast Cancer

Stage 0 is the most basic stage and is a general indication of cell abnormality. It is difficult to judge presence of cancerous growth at this stage.

Stage 1 is a condition in which the infected cells start to invade tissues. Tumor-size is less than 2cm and no damage is caused to lymph nodes.

Stage 2 is a phase wherein the tumors spread to axillary lymph nodes and their size is between 2cm and 5 cm. They also try to invade tissues further.

Stage 3 is a phase of breast cancer in which the cancer moves further from axillary lymph nodes. It spreads to chest walls or breast skin and may also invade lymph nodes near breast bone or collarbone.

Stage 4 displays the spread of tumors in wide areas of the body and metastasis takes place at the maximum possible pace. Tumors may spread to lungs, lymph nodes present at distant locations, liver, abdomen, skin or even the brain.
Breast cancer stages are the main indicators of seriousness of cancerous growth and should be examined carefully. Proper cure pattern should be followed in accordance with the mental and physical condition of the victim.