Tumour profiles : targeting cancer treatment

One of the reason why cancer treatment like chemotherapy is not equally effective in all patients is because cancer actually consists of many different subgroup. We need targeted treatment for each specific group in order to acheive the best result.

One of the interesting article on tumor profile is below, from Associated Press :

New cancer treatment: tumor profiles

Genetic testing may soon be used to determine which patients would benefit from chemotherapy.

By ASSOCIATED PRESSPublished August 10, 2006

Scientists have created a gene profiling test that may someday help reveal which people with early lung cancer are likely to suffer a relapse and would benefit most from chemotherapy.
Separately, other researchers found that several new tumor profiling tests for breast cancer, including two already in general use, are similar in accuracy and should allow many women to avoid unnecessary chemo.
The lung cancer one needs far more testing, but is "breakthrough research" building on years of work to develop personalized cancer treatments, said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society.
Its accuracy so far - about 80 percent - is "better than what we have, but it's not as good as we would like," said Lichtenfeld, who had no role in the research.
Both studies were reported in the New England Journal of Medicine.
Treatment guidelines for cancer have been relatively crude - based on a tumor's size, whether it has spread, and other characteristics.
As a result, many women with early breast cancer get chemo even though the vast majority would do fine without it. It is the opposite with early-stage lung cancer: Even though about a third of patients will get worse and die, few get chemo because doctors can't tell which ones will benefit, and the treatment itself carries risks. Chemo can damage the liver, heart and other organs, and in some cases can kill.
Doctors hope that growing knowledge about the genes fueling these cancers will lead to better ways to tell who really needs chemo. The newly emerging tumor profile tests are tools to let them do that.
To develop the lung cancer one, Duke University researchers examined 198 tumor samples and analyzed 133 genes whose activity correlated with how aggressive the cancer was.
"It's a fingerprint unique to the individual patient (that) predicts survival chances," said Dr. Anil Potti, lead researcher.
Patients were scored as having a low or a high risk of recurrence based on the test, and results were compared to what actually happened to them.
The test was 93 percent accurate on the half of patients whose tumor samples came from Duke and 75 percent accurate on the rest. Current best tests to estimate risk based on tissue characteristics are about 60 percent accurate, Potti said.
Several of the researchers are part owners of, or have other financial ties to, a genetic testing lab established by Duke.
A larger study of 1,200 lung cancer patients will start in January to further evaluate the Duke test. After surgery to remove the initial tumor, patients will get chemo or not depending on their test score, and then will be followed for a few years to see how they do.
That study will reveal whether the test really works, said Dr. David Johnson, a Vanderbilt University lung cancer specialist and a former president of the American Society of Clinical Oncology.
"It hardly is a slam dunk," Johnson said. "It is not ready for prime time" yet but could turn out to be "a huge breakthrough for patients."

Different stages of Cancer

Some patients are very anxious to ask their doctors "what stage of cancer am I having" when they were told they have cancer.

We understand the anxiousness, but the patients would need to know that sometimes, staging is not really accurate and survival, may not be totally related to the stage.

Briefly, cancer can be divided into 4 stages, depending on how much the disease has spread.

Stage 1 : tumor normally confines to the organ itself, and can be resected with good long term survival
Stage 2 : tumor may have extended to lymph nodes near the organ, can still be resected, but may need chemotherapy or radiotherapy to improve survival
Stage 3: tumor may have spread to further lymph nodes and sometimes surgery may not be useful and would need chemotherapy as first line treatment. Usually survival is poorer now.
Stage 4: tumor has spread to distant organ and survival is poor

However, these staging are just very general, the actual survival would depends on the type of cancer, how good the response is from the chemotherapy, how successful the surgery is etc.

Even at stage 4, sometimes there is still very good survival if the tumor responds well to the chemotherapy. So, its not the end of the world if you have stage 4 tumor. there is still hope for you.

There are also other staging of cancer, using different classifications, like TNM staging, but these are more complicated.

New way of treating cancer, Proton therapy

This is another new way to treat cancer in US, using Proton therapy. It is like radiation therapy, but more precise and thus more targeted :

-----------------------------------------------

New Cancer Treatment Therapy Gives Hope to Millions, say Physicians
New York03 November 2006
A new state of the art medical facility in the United States is harnessing a new weapon in the cancer fighting arsenal: proton therapy. Medical experts say the procedure, a precise form of radiation to target tumors, offers new hope in the treatment of various types of cancer.
The M.D. Anderson Proton Therapy Center at the University of Texas is one of 25 institutions in the world that use proton therapy.
Traditional radiation therapy uses x-ray beams to shrink cancerous tumors. Large portions of the body are subject to radiation because X-rays cannot be delivered more accurately, so physicians limit the amount of radiation a patient undergoes to spare healthy tissue.
Proton therapy is a form of radiation therapy that is more precise. Protons are positively charged particles, which are accelerated to specific speeds in beams that penetrate the body, pinpointing tumorous growths to shrink them.
Dr. James Cox is head of radiation treatment at the M.D. Anderson Center. He says the center is the first medical facility to combine proton therapy with chemotherapy.
"Very frequently, we combine chemotherapy and radiation therapy together," he explains. "That has not been done in other centers around the world to any great degree thus far and it's one of the areas that we want to concentrate on and to set new examples of how we are having better tumor control and decreased effects on normal tissues, which leads to an overall better outcome."
Dr. Cox says because protons are more precise than x-rays and emit low doses of radiation, sparing healthy tissue surrounding the tumor, its ideal for treating cancer in children.
Proton therapy can be used on patients with cancers of the throat, eye, prostate, lung and brain among others.
According the World Health Organization (WHO), lung cancer is the most common form of cancer worldwide, killing one person every 30 seconds. Currently, there is no screening method that can detect the onset of lung cancer.
Dr. Ritsuko Komaki is professor of Radiation Oncology at the M.D. Anderson Center. She says proton therapy holds the most promise for treating lung cancer.
"One of the reasons why lung cancer outcome was so poor, because the imaging was not perfect," notes Dr. Komaki. "These days we can do a very thin sliced CT scan and we can draw exactly where the tumor is and then contour the normal structures, the heart and the lungs, the esophagus and spinal cord so we can treat just the place where the cancer is without radiating surround normal tissues."
Dr. Komaki says proton therapy is a good option for elderly patients.
"When patients become much older and they cannot go through surgery because of pulmonary function, they can have the treatment by radiation treatment," she adds. "We do have very successful treatment of small legions, less than three centimeters, is almost the same outcome as surgical outcome."
Dr. Cox says most other countries are using proton therapy from a physics standpoint and have yet to integrate it into medical facilities.
"Physics research facilities in all of these countries, including Japan, for example, are funded under a mechanism similar to the US Department of Energy," he explains. "It's not in the medical sphere; it's in the physics research sphere. And until the medical community, the medical administration in those countries arrives at a conclusion that this is really beneficial for patients, I think they will continue to be only in physics research facilities in many countries."
Dr. Cox says the M.D. Anderson Center is committed to sharing research and patient care practices with international colleagues.
"The scientific community is a community that is by definition open," ads Dr. Cox. "We are collaborating with many institutions. We are open to any kind of benefit that might be brought to patients anywhere in the world and we realize that proton therapy is not going to be available for everybody for a while, but we think it's going to grow and we want to help craft the justification for it's growing by the research that we do."
Over 40,000 patients from around the world have received proton therapy since its development in the late 1960s.
The Proton Therapy Center at the M.D. Anderson Center opened to patients in June 2006.

PET scan - new method in staging cancer

One of the biggest challenging in planning for cancer treatment is to stage the disease. Staging means to find out how extensive the cancer has spread. It is important because the kind of treatment given depends on the stage of the cancer.

For example, if we found a cancer in the stomach, we would need to stage the disease to find out if it has spread to other organs like liver. If there is no spread, the treatment would be surgical removal of the stomach. If it has spread, then, it would be futile to go for operation of the stomach as the disease has spread to other organs and the treatment would be chemotherapy instead.

Until recently, the way to stage the disease can only depends on CT scan, MRI and bone scans, which are quite accurate, but yet, it may not picked up small cancer spreads which has occur to other organs. This may result in some futile operations as the cancer already has spread but the doctor does not know.

Now, there is a new scan which is available in the recent years. Its called PET scan (Positron Emission Tomography). Its unique because it uses radioisotopes which lights up in the organ which has tumour. It is more accurate than CT scan and MRI for staging of the disease. It would also lights up the lymph node which has been affected by the cancer and this would enable the surgeon to plan the surgery better.

Only downside at the moment is the cost of the scan is very expensive, more expensive than MRI and CT scan. But it certainly improve the management of the cancer treatment.

Fighting cancer - the psychological battle

Someone asked me recently, what is the key success in fighting cancer? I told him that other than having access to the best doctor and best medical treatment available, the patient's own psychological mindset is also key to fight cancer.

It has been proven that if one is a determined person, he would be able to fight cancer better than one who gives up hope and let fate takes over.

A strong and determined mind not only can help to keep the disease at bay, but it would also help the patient to cope with the various treatment better. This would improve survival rate in the long run.

Remember, cancer is not a death sentence. If you are willing to fight, you would stand a better chance, especially with all the latest treatment available now. Don't give up the fight and let the disease beat you!

Clinical trials

There are many new cancer drugs and vaccines coming into market every year. And there are even more in late stage clinical development which would be available in the next few years.

One way to get access to these latest drugs or vaccines is to participate in clinical trials. Drugs and vaccines from clinical trials are generally free and you could have them a few years before they are available commercially.

However, as they are still undergoing clinical trials, not all of them are effective. However, those which are in the later phase (eg Phase 3) are generally better than those in the earlier phase (Phase 1 and 2) as they would have some good preliminary results from Phase 1 and 2 before progressing to phase 3. Talk to your doctor if you are interested to participate in clinical trials.

The Cancer Blog

There are many cancer blogs in the world. They are wrritten by :

1) Patients who have cancer and want to share their experience
2) Professionals like me who want to share our expertise
3) Public who are interested in cancer.

One of the best website is :

http://www.thecancerblog.com

It has a lot of useful information there.

Cord blood bank

Many potential parents are faced with this question :"Do I need to store my child's cord blood for future use, so that in the event of say he has leukaemia, the cord blood transplant would be useful for him?"

Advances in treatment of cancer, especially childhood blood cancer has improved tremendously over the years. Some of these cancer can have almost 100% cure rate now. This is helped by cord blood transplant.

It is certainly useful to store the cord blood. The issue is whether to store it in the public bank (which is free) or private bank (which you would need to pay quite a large sum of money).

Advantage of public banks are:

1. Free for parents

2. The cord blood can be used for other children who needs it, if it matches your child

3. You may have access to another child's cord blood (if matches), which maybe better than using his own cord blood, for transplantation. Some doctors believe that if your child has leukaemia, even after treatment and transplant with his own cord blood, there is a risk of leukaemia relapse.

Advantage of private banks are:

1. You are assured of the cord blood when you need them, as it would not be given to other parents.

In Singapore, there is a public cord blood bank called "Singapore Cord Blood Bank" and the private ones are like "Stemcord" and "Cordlife".

If you are a parent who is going to have a newborn child, if you have not decided which to opt, at least opt for the private cord blood bank as it is free and your child's cord blood maybe able to save another child one day. The collection of the cord blood is from the cord and there is no pain or complication during the collection process.

Why you need health insurance?

This is to follow-up on the previous postings on health insurance. I know of many of my cancer patients who do not have their own health insurance and was relying on their company's insurance plan to cover them. This is not ideal because :

1. Corporate insurance plans are generally not as comprehensive and specific than you own health insurance plan. As the company buys a group insurance for all the staff, there are a some areas which the coverage may not be sufficient (eg some insurance plans do not pay sufficiently for cancer treatment)

2. Corporate insurance plan are not transferrable when you move to another company. For example, if you were working for company A, you were covered under their insurance plan. Say you were diagnosed to have heart disease during that period while you were working with company A, their insurance plan would cover your health disease treatment. However, one day if you choose to leave company A to go to company B, the health insurance from company B would exclude coverage for your heart disease as they claim that this is an "pre-exisiting disease" which they do not cover. You would be in trouble then because you would no longer have insurance coverage for heart disease. If you buy you own insurance, it would still cover even if you change job as this is your own insurance.

Hence, it is important to note that although your company has health insurance plan for you, it is important that you purchase your own plan too, if you could afford it.

Insurance plan which cover for cancer

Many of my patients asked me whether they could buy health insurance to cover themselves for cancer treatment AFTER they were diagnosed to have cancer. I told them "Sorry, its too late now, as once you are diagnosed to have cancer, the insurance company would normally not provide coverage for you on cancer treatment anymore".

Hence it is very important to purchase your insurance plan while you are healthy. There are many types of health insurance in the market, and sometimes its quite difficult to make a choice. Some of the criterias which you should consider while choosing a plan includes :

1) Cost of the premium : it should be affordable to you, and you need to know that the premium would go up when you are older. Please look at the premium in the later years too, as its not point to buy a high coverage plan with low premium now when you cannot afford it later on.

2) Details of the coverage : does it cover only inpatient treatment or outpatient treatment also (including outpatient chemotherapy, radiotherapy and immunotherapy)

3) What is the annual limit of coverage : this is important especially if you are looking at cancer treatment which is very expensive. Also you need to see if there is a monthy sublimit which you may hit if your monthly cancer treatment is high.

For example :

1) Plan A : no monthy sublimit for chemotherapy, annual limit US $120,000

2) Plan B : monthly sublimit of US$10,000 for chemotherapy, annual limit US$120,000

In theory, both plan looks fairly similar as the annual limits are same, but in practice, plan A is more superior as there is no monthly limit. For example, if your course of chemotherapy is US$20,000 per month for 3 month, with plan A, the insurance company would pay for the full cost of treatment, but for plan B, they would only pay US$10,000 per month even though your treatment cost is US$20,000 per month.

You need to look into the find prints when considering your insurance coverage. If you are in doubt, consult your doctor for his opinion.

(Photo courtesy of www.humanillnesses.com)

Cancer prevention - 2

From the earlier posting on cancer prevention, I have provided more info on cancer prevention, from World Health Organisation (WHO) website:

Cancer prevention
At least one-third of all cancer cases are preventable. Prevention offers the most cost-effective long-term strategy for the control of cancer.
Tobacco is the single largest preventable cause of cancer in the world today. It causes 80-90% of all lung cancer deaths, and about 30% of all cancer deaths in developing countries, including deaths from cancer of the oral cavity, larynx, oesophagus and stomach. A comprehensive strategy including bans on tobacco advertising and sponsorship, tax increases on tobacco products, and cessation programmes can reduce tobacco consumption in many countries. The WHO Framework Convention on Tobacco Control, adopted in May 2003, aims to curb tobacco-related deaths and disease.- Tobacco Free Initiative
Dietary modification is another important approach to cancer control. There is a link between overweight and obesity to many types of cancer such as oesophagus, colorectum, breast, endometrium and kidney. Diets high in fruits and vegetables may have a protective effect against many cancers. Conversely, excess consumption of red and preserved meat may be associated with an increased risk of colorectal cancer. In addition, healthy eating habits that prevent the development of diet-associated cancers will also lower the risk of cardiovascular disease.
Regular physical activity and the maintenance of a healthy body weight, along with a healthy diet, will considerably reduce cancer risk. National policies and programmes should be implemented to raise awareness and reduce exposure to cancer risk factors, and to ensure that people are provided with the information and support they need to adopt healthy lifestyles.- WHO global strategy on diet, physical activity and health
Infectious agents are responsible for almost 22% of cancer deaths in the developing world and 6% in industrialized countries. Viral hepatitis B and C cause cancer of the liver; human papilloma virus infection causes cervical cancer; the bacterium Helicobacter pylori increases the risk of stomach cancer. In some countries the parasitic infection schistosomiasis increases the risk of bladder cancer and in other countries the liver fluke increases the risk of cholangiocarcinoma of the bile ducts. Preventive measures include vaccination and prevention of infection and infestation.- Infectious diseases health topics
Exposure to ionizing radiation is also known to cause to certain cancers. Excessive solar ultraviolet radiation increases the risk of all types of cancer of the skin. Avoiding excessive exposure, use of sunscreen and protective clothing are effective preventive measures.- Ultraviolet radiation
Asbestos can cause lung cancer; aniline dyes have been linked to bladder cancer; and benzene can lead to leukaemia. The prevention of certain occupational and environmental exposure to these and other chemicals is another important element in preventing cancer.- Occupational health

Cancer prevention tips

Someone whose brother was recently diagnosed with colon cancer came and ask me "I am worried, my brother has colon cancer. How do I avoid this?"

Well, before we look into prevention of cancer, we need to know what cause the cancer. In general, cancer could be cause by the gene (i.e. if you have a sibling or parents who has cancer, you risk is higher) and also carcinogen exposure (in this case of colon cancer, it could be high consumption of meat products).

Cancer prevention acts in 2 folds. First, you would need to maintain a healthy lifestyle to reduce your risk. Second, if you have the risk, you would need early screening to pick up the disease early, and you may have a chance of a total cure.

Healthy lifestyle practices would include consume more vegetables and fruits which have been proven to reduce the risk of cancer. They contain anti-oxidants which could reduce your risk. Exercise to reduce fat would also decrease the risk.

For screening, you would need to look for a doctor who is familiar with risk assessment of cancer. By reviewing your age, family history of cancer etc.. he would be able to recommend certain relevant tests to screen for cancer. Not everyone needs all the screening test as some test comes with risk, eg colonoscopy to detect colon cancer has a small risk of causing gut perforation and it should only be done for those whose risk are high. Some GPs and all Oncologists and Cancer Epidemiologists like me would be able to do a proper risk assessment and recommend the relevent tests.

New advances in Radiotherapy machine

There are many types of cancer which are treated by radiotherapy. This includes cancer to the prostrate, cervix etc.

Traditionally, radiotherapy has quite a lot of side effect and also not so effective in treating cancer. However, the latest machines are much better, more precise in delivering the radiation to the actual tumour and less side effect to the surrounding tissues.

The old machines uses a 2 dimension system to hit the tumour, which is less accurate and thus they radiotherapist would not be able to deliver higher doses of radiation for fear of damaging the surrounding good tissues.

Then came the newer 3 dimension conformal radiotherapy (3D-CRT) machine which is better as it could help defined the tumour clearly in 3 dimesion form and thus delivering a more accurate treatment to the tumour.

The newer machine is called IMRT (intensity modulated radiation therapy) which is even better, more accurate and precise in the treatment. I have attached a short write-up on what IMRT is below (from Mayo Clinic):

In intensity modulated radiation therapy (IMRT), very small beams, or beamlets, are aimed at a tumor from many angles. During treatment, the radiation intensity of each beamlet is controlled, and the beam shape changes hundreds of times during each treatment. As a result, the radiation dose bends around important healthy tissues in a way that is impossible with other techniques. Because of the complexity of these motions, physicians use special high-speed computers, treatment-planning software, diagnostic imaging and patient-positioning devices to plan treatments and control the radiation dose during therapy.

So, if you need radiotherapy, please ask your doctor whether the machine is the older 2 dimension, or the 3-dimension CRT or IMRT. Where possible, go for IMRT !

Which doctor is right?

Recently I had a patient who came to me, confused with the advice given by her doctors.

She has breast cancer and her surgeon advised her to have a radical mastectomy (removing the whole breast) and also all the surrounding lymph nodes at her armpit area. It is a massive operation. She then consulted an oncologist who told her that a simple mastectomy would be sufficient and post-operation, she could go for chemotherapy to kills off the rest of the cancer cells.

She was confused as she did not know whom she could listen to.

I told her that in medicine, there are many ways to treat a same illness. Which options to choose would depends on age of the patient, skills of the surgeon (if the surgeon is not skillful enough for a large operation, then a simpler operation with follow-up chemotherapy would be a better option), latest advances in chemotherapy drugs etc.

As a cancer epidemiologist, I sat down and went through these possible options and also other options which was not discussed with her previously, reviewed all the evidence available to see which option can give the best survival rate and also the cost and long term complication of each option. After she was informed with these options, she went back and thought through them and then came back a few days later with her decision made of which option she would choose.

So, don't be confused with all the different advice given by the various doctors, you need to evaluate the pros and cons of each option and make a better decision.

Cancer vaccine - part 2

The cancer vaccines which are use to treat patients who already have cancer uses the principles of immunotherapy. What this means in simple language is the vaccine induces antibodies produced in the body to fight against the cancer cells. In normal vaccines like flu vaccine or chickenpox vaccine, the vaccine acts to induce antibodies to fight against the infectious viruses. In cancer vaccine, the principles are fairly similar, the vaccine induces antibodies to fight against the cancer cells instead.

You can find more information in this website : http://www.cancersupportivecare.com/immunotherapy.html

A summary of this from the website is below :

The concept of immunotherapy is based on the body's natural defense system, which protects us against a variety of diseases. Although we are less aware of it, the immune system also works to aid our recovery from many illnesses.
For many years, physicians believed that the immune system was effective only in combating infectious diseases caused by such invading agents as bacteria and viruses. More recently, we have learned that the immune system may play a central role in protecting the body against cancer and in combating cancer that has already developed. This latter role is not well understood, but there is evidence that in many cancer patients the immune system slows down the growth and spread of tumors. The body's ability to develop an immune reaction to tumors may help determine which patients are cured of cancer using conventional therapies, including surgery, radiation and drugs.
One immediate goal of research in cancer immunology is the development of methods to harness and enhance the body's natural tendency to defend itself against malignant tumors. Immunotherapy represents a new and powerful weapon in the arsenal of anticancer treatments.
Immunotherapy seems to offer great promise as a new dimension in cancer treatment, but it is still very much in its infancy. Immunotherapies involving certain cytokines and antibodies have now become part of standard cancer treatment. Other examples of immunotherapy remain experimental. Although many clinical trials of new forms of immunotherapy are in progress, an enormous amount of research remains to be done before the findings can be widely applied.
Immunotherapy of cancer began about one hundred years ago when Dr. William Coley, at the Sloan-Kettering Institute, showed that he could control the growth of come cancers and cure a few advanced cancers with injections of a mixed vaccine of streptococcal and staphylococcal bacteria known as Coley's toxin. The tuberculosis vaccine, Bacillus Calmette-Guerin (BCG), developed in 1922, is known to stimulate the immune system and is now used to treat bladder cancers.
Many years of research have finally produced the first successful examples of immunotherapies for cancer. Sometimes referred to as biological response modifiers or as biological therapies, these new treatments-such as interferons and other cytokines, monoclonal antibodies, and vaccine therapies-have generated renewed interest and research activity in immunology.

Cancer Vaccines

The new thing in cancer prevention and treatment is cancer vaccines.

There are 2 main groups of cancer vaccines, one group is to prevent cancer and the second group is to cure those who already have cancer.

The first group of cancer prevention vaccines in the market are for liver cancer and cervical cancer. The routine hepatitis B vaccine which the government gives to all newborn is actually a liver cancer vaccine. This vaccine prevents hepatitis B which in turn would prevent liver cancer as hepatitis B infection would cause liver cancer.

Recently, there is this new cervical cancer vaccine which prevents cervical cancer. However, the cost of this vaccine is quite expensive. Its about US $100 per dose and each women would need 3 doses to prevent cervical cancer.

There are new vaccines which treat existing cancer, like lung cancer, prostrate cancer, skin cancer etc. Unfortunately, for this group of vaccines, none of them are available in the market yet as they are still undergoing clinical trials. I will provide more info on cancer vaccines in future postings.

Why me?

When someone is first diagonsed to have cancer, his or her first reaction is "Why me?"

Well, my answer to them is "Cancer is very common, and there are many different types of cancer. There are many reasons why one may have cancer, and among the reasons would include risk of exposure to cancer causing agents like cigarette smokes, industrial smokes, radiation and also genetics transmission of cancer genes from their parents"

Anyway, it is more important now to ask "What do I need to do to treat this cancer?" instead of just "Why me?"

Cancer is certainly curable in the early stage, and in late stage, there are many available treatments to prolong their lives and also to let them have a good quality of life. Do not be despair. Ask your doctor for more information on the treatment option

Are all doctors and hospitals same?

If you have cancer or any illness, do you go to any doctor or hospital which provide cancer treatment service, or do you go and find who is the best? Yes, you should do your research and find where is the best place for cancer treatment.

Not all doctors and hospitals are the same. Doctors are human, some are better trained and more experienced than others. Similarly, for hospitals, there are some hospitals which provide wide range of cancer treatment (eg radiotherapy, chemotherapy) while some smaller centres may not have up to date facilities to treat your illness.

Your outcome of the illness would varies greatly on where you are treated.

In US, in an article publised by USA news which ranked the top cancer centres in 2004 , they are :


1) University of Texas, M. D. Anderson Cancer Center, Houston
Three years in a row, M.D. Anderson Cancer Center has topped the list at No. 1.

2) Memorial Sloan-Ketterling, New York
Memorial Sloan-Ketterling is a not-for-profit hospital. It also is a National Cancer Institute Cancer Center.

3) Johns Hopkins Hospital, Baltimore
Recognized worldwide for it's advances in cancer research and treatment, Johns Hopkins is one of the most respected cancer centers.

4) Dana-Farber Cancer Institute, Boston
Not only was Dana-Farber rated number 4 in the country, it was rated Number 1 in New England.

5) Mayo Clinic, Rochester, Minn.
The Mayo Clinic is considered one of the best when it comes to patient satisfaction. Located in Minnesota, clinics are also available in Florida and Arizona.

6) Duke University Medical Center, Durham, N.C.
Located on campus at Duke University, this medical center is the youngest of the top cancer centers on the list. Don't let its infancy fool you; Duke University Medical Center's clinical and research programs rival the best.

7) University of Michigan Medical Center, Ann Arbor
Patient care is a top priority at U-M. They offer a "Cancer Answer Line", a telephone service which is staffed ny oncology RN's. Anyone may use this service from patients to caregivers who are in need of assistance.

8) UCLA Medical Center, Los Angeles
UCLA's claim to fame was making the first diagnosis of the AIDS virus. The cancer research is award winning. UCLA has made the list 15 consecutive years.

9) University of California, San Francisco Medical Center
UCSF is the one of a handful of cancer centers to receive the title "Comprehensive Cancer Center" in the state of California. They also offer a Cancer Research Center, which is available to patients, caregivers and anyone interested in cancer treatment.

10) University of Washington Medical Center, Seattle
UW is an outstanding cancer hospital. They treat most cancers, common and rare. They offer services from consultation, diagnosis, treatment and follow up care.


If you are living in Singapore, the top cancer centres in the government hospitals (not in any order of priority) are :

1. National Cancer Centre

2. National University Hospital

3. Tan Tock Seng Hospital

To know more about how to choose the right hospital and doctor, you can visit my other website :

http://www.righthospitaldoctor.com

Wonder drugs

Cancer treatment options has improved over the past 10 years. The survival rates for cancer has also improved.

I will try to provide some info on some on some of the new drugs which are in the market in later postings.

One of the new and exciting drug which came out not long ago was Iressa. This is an oral drug which has been found to be useful in treating a certain group of lung cancer. Being an oral drug, it has lesser side effect than the conventional chemotherapy, where the patient needs to go to the hospital for infusion of the chemotherapy drug. Iressa can be taken orally at home.

More information on Iressa is available at wikipedia site below :

http://en.wikipedia.org/wiki/Gefitinib

However, not all lung cancer patients benefits from Iressa. It is only useful for a non-small cell lung cancer with EGFR receptor.

Talk to your oncologist doctor if you have lung cancer to see if you are suitable for Iressa.

Cancer affects many people

One of my most memorable lecture during my medical school many years ago was this old Professor who said to us during one of our lectures "Look to your left, now to your right. Between the three of you, one of you will eventually die from heart attack, and another will die from cancer".

Yes, cancer is very common now. In Singapore, it has recently overtaken heart disease as the number one cause of death in the country. Almost one in 3 of us will eventually die from cancer.

But, if you are newly diagnosed with cancer, its not the end of the world. Most people can survive cancer for many years, with the right treatment. Cancer can be considered like a chronic disease (like diabetes, heart disease etc.) where you can live with the illness for many years.

I will share with you in future postings how to survive cancer.

Doctors who treat cancer

There are several groups of doctors who are specialist in cancer treatment. Each of them are expert in their own area, and it is important to choose the right specialist to treat your cancer.

1. Oncology surgeons: these are the surgeons who specialised in operating and removing cancerous organs and tissues.
2. Oncologists : these are the doctors who specialised in giving chemotherapy to the patients
3. Hematologists : these are the doctors who specialised in blood related cancers like leukaemia and lymphoma

4. Radiation oncologists : these are the doctors who use radiotherapy to treat cancer

5. Cancer epidemiologists: these are the doctors who are expert in the latest in cancer information, treatment protocols and cancer research

I am a cancer epidemiologist and I am starting this blog to help people to know more about cancer, its prevention and latest in the treatment options