You can beat cancer !

Obesity and Cancer

2007-11-07T17:54:00.000-08:00

We know some of the traditional risk factors like smoking and genetics.

One of the recent discovery on the risk of cancer is actually obesity. Obesity has been linked to diseases like heart attack, but its link to cancer has been quite recent.

Many big studies has found that risk of breast, colon, kidney cancer etc. are linked to obesity.

Living a healthy lifestyle is very important, regular exercise and good diet not only lowers your risk of heart attack, but also cancer!

Cancer pain

2007-08-31T19:29:00.000-07:00

One of the most distressing issue about cancer is the pain cause by the disease. However, now with the better understanding of how cancer causes pain and new ways to treat the pain, cancer patients do not need to suffer from extreme pain anymore.

There is a good article on cancer pain at :

http://www.cancerhelp.org.uk/help/default.asp?page=5883

Causes of cancer pain
Most cancer pain is caused by the tumour pressing on bones, nerves or other organs in your body. Sometimes pain is related to your cancer treatment. For example, some chemotherapy drugs can cause numbness and tingling in your hands and feet or a burning sensation at the site where they are injected. Radiotherapy can cause skin redness and irritation. Remember – pain may have nothing to do with your cancer - you may just be feeling the general aches and pains that some people get from time to time.
Acute and chronic painCancer pain can be acute or chronic. Acute pain tends to only last a short time. Chronic pain is more long term. For example, having an operation can cause acute pain. The pain goes when the wound heals. In the meantime, painkillers will usually keep it under control.Chronic pain can range from mild to severe. It can be there all the time. You may hear chronic pain called ‘persistent pain’. Painkillers or other pain control methods can successfully control chronic cancer pain in about 95 out of every 100 people (95%).If you have chronic cancer pain, you may also have episodes of acute pain that are not controlled by the medication you are taking. This is often called ‘breakthrough pain’. If you are on regular painkillers but still have episodes of pain, let your doctor know. He or she can prescribe extra 'top up' doses of painkillers for you to take when you need to. There is more information about how your cancer pain can be managed in Treating Cancer Pain.Whatever type of pain you have, it can affect your quality of life. Chronic pain can make it hard for you to do everyday things such as bathing, shopping, cooking, sleeping and eating. This is sometimes very hard for your close friends and relatives to understand, as they are not feeling your pain. There is more about how your pain can affect you and your loved ones and how to deal with this in support when you have pain.
Types of cancer painIt is extremely important for your doctor to find out the type and cause of your pain in order to treat it in the right way. Different pains are treated differently. You may have one or more of the 3 main types of pain. These are
Nerve pain
Bone pain and
Soft tissue painAnother type of pain can come on after amputation of a limb or other part of your body. This is really another type of nerve pain and is called phantom pain. Nerve painThis is caused by pressure on nerves or the spinal cord, or by damage to nerves. Your doctor may call it neuropathic pain. It is usually more difficult to treat than other types of pain. People often describe nerve pain as burning or as a feeling of something crawling under their skin. Nerve pain is not usually widespread. You often feel it in a particular place, or perhaps along the path of a nerve. Nerve pain is the one type of pain that can sometimes go on for a long time after an operation. Nerves are cut during surgery and they take a long time to heal because they grow so slowly. Nerve pain is particularly common after an operation to the chest called a thoracotomy. Some people may have pain around their scar for 2 years or more after their surgery. It does eventually go, but can be difficult to treat while it lasts.
Bone painBone pain can affect one specific area or several areas, depending on how much the cancer has spread. People often describe it as aching, dull or throbbing. Bone pain is very common in people who have breast, prostate or lung cancer. The cancer spreads to the bone, and it is the growth of the cancer within the bone that damages the bone tissue and causes the pain. You may also hear bone pain called somatic pain.
Soft tissue painSoft tissue pain means pain from a body organ or muscle. For example, you may feel pain in your back caused by tissue damage to the kidney. You cannot always pinpoint this pain, but it is usually described as sharp, aching or throbbing. You may also hear soft tissue pain called visceral pain. Some soft tissue pain comes from the covering of an organ, rather than the organ itself. The liver does not contain nerves. If it contains cancer, it is usually bigger than it should be. The enlarged liver stretches the fibrous covering, called the capsule. The capsule does contain nerve endings and that is what causes the pain. This type of pain is called liver capsule pain.
Phantom painPeople with sarcoma or osteosarcoma sometimes have to have a limb amputated. You may feel pain in an arm or leg after it has been removed. This is 'phantom pain'. But it is very real and people sometimes describe it as unbearable. You may also have phantom pain after having a breast removed. Doctors are still trying to understand why phantom pain happens. One theory is that the 'thinking part' of your brain knows that you have had a part of your body removed but the 'feeling part' of your brain cannot understand this. Other possible causes of phantom pain are
Changes in the air pressure or temperature
Stress
Not moving around enough and poor posture
Other illnesses such as flu and infections
Having your surgery done by an inexperienced surgeonBetween 6 and 7 out of 10 people (60 - 70%) who have had an arm or leg removed feel phantom pain. About one third of women who have had a breast removed to treat breast cancer feel phantom breast pain. The pain usually lessens after the first year, but some people can still feel phantom pain after one year or more.Phantom pain is quite common. It is real and you are not imagining it. In most people it will go away after a few months. It is as if your brain has to realise that part of your body has gone. Be sure to let your doctor know about phantom pain as it does respond to painkillers.How much pain you might haveThe amount of pain you have with cancer depends on
The type of cancer you have
Where it is
The stage of your cancer
How much pain you're able to tolerateHow much pain you can stand is your pain threshold. Everyone has a different pain threshold. It isn't related to how weak or strong you are. It is just one of those things.

A new lung cancer vaccine

2007-08-16T00:57:00.000-07:00

Among all the new therapeutic cancer vaccine in clinical trial now, this one is one of the most exciting. It tackles mucin producing tumour, which is present in many tumours like in the lung, colon etc. Hopefully, it would be available in the next few years. The article also mentions about other battle with lung cancer.

http://www.biopeer.com/biopeer/cancer_vaccines/index.html

Battle against lung cancer continues
In separate studies, researchers have come up with possible treatment options for lung cancer.Scientists are on their way to treating non-small cell lung cancer (NSCLC) with gene therapy and nanotechnology. Scientists from the University of Texas MD Anderson Cancer Center and the University of Texas Southwestern Medical Center conducted a study on mice to test whether gene therapy administered through lipid-based nanoparticles can successfully fight tumors. They sent positively charged nanoparticles to the negatively charged cancer cell membrane. When these nanoparticles are taken into the cell, the genes express the tumor suppressing p53 or FUS1 gene depending on the design. The scientists then found that while p53 and FUS1 individually fought well against cancer, they were most effective when combined. The two together bring about apoptosis, a process wherein the cancer cells self-destruct. Since FUS1 hinders the functioning of a gene that destroys p53, the combination therapy caused more cells to die. In the final analysis, the combination caused a 75 per cent reduction in the number of tumors per mouse and a decrease of 80 per cent in the weight of the tumors. Meanwhile, the lung cancer vaccine Stimuvax that scientists from Cancer Research UK had prepared is now set to enter phase III of its clinical trial. Stimuvax is a therapeutic vaccine that will compel the immune system to kill MUC1, a molecule found in large quantities in tumor cells. This way, no harm will be done to the healthy cells. Merck KgaA will conduct this trial named START (Stimulating Targeted Antigenic Responses To NSCLC). The trial will evaluate the efficacy of Stimuvax in comparison to a placebo. It aims to involve over 1,300 patients across 30 countries. With lung cancer being the most common cancer worldwide, any progress towards its treatment is welcome news.

Green Tea and cancer prevention

2007-08-01T19:07:00.000-07:00

There are many studies which showed various products can prevent cancer. One of the most studied product is green tea. This is the theory behind why Japanese lives longer, because they drink green tea.

I have an article here on green tea from National Cancer Insititute which is a reputable independant agency :

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Tea and Cancer Prevention: Fact Sheet
Key Points
The antioxidants found in tea--called catechins--may selectively inhibit the growth of cancer (see Question 1).
In laboratory studies using animals, catechins scavenged oxidants before cell damage occurred, reduced the number and size of tumors, and inhibited the growth of cancer cells (see Question 3).
However, human studies have proven more contradictory, perhaps due to such factors as variances in diet, environments, and populations (see Question 4).
NCI researchers are investigating the therapeutic and preventive use of tea catechins against a variety of cancers (see Question 5).
Tea drinking is an ancient tradition dating back 5,000 years in China and India. Long regarded in those cultures as an aid to good health, researchers now are studying tea for possible use in the prevention and treatment of a variety of cancers. Investigators are especially interested in the antioxidants-called catechins-found in tea. Despite promising early research in the laboratory, however, studies involving humans so far have been inconclusive.
1. What are antioxidants?
The human body constantly produces unstable molecules called oxidants, also commonly referred to as free radicals. To become stable, oxidants steal electrons from other molecules and, in the process, damage cell proteins and genetic material. This damage may leave the cell vulnerable to cancer. Antioxidants are substances that allow the human body to scavenge and seize oxidants. Like other antioxidants, the catechins found in tea selectively inhibit specific enzyme activities that lead to cancer. They may also target and repair DNA aberrations caused by oxidants (1).
2. What is the level of antioxidants found in tea?
All varieties of tea come from the leaves of a single evergreen plant, Camellia sinensis. All tea leaves are picked, rolled, dried, and heated. With the additional process of allowing the leaves to ferment and oxidize, black tea is produced. Possibly because it is less processed, green tea contains higher levels of antioxidants than black tea.
Although tea is consumed in a variety of ways and varies in its chemical makeup, one study showed steeping either green or black tea for about five minutes released over 80 percent of its catechins. Instant iced tea, on the other hand, contains negligible amounts of catechins (1).
3. What are the laboratory findings?
In the laboratory, studies have shown tea catechins act as powerful inhibitors of cancer growth in several ways: They scavenge oxidants before cell injuries occur, reduce the incidence and size of chemically induced tumors, and inhibit the growth of tumor cells. In studies of liver, skin and stomach cancer, chemically induced tumors were shown to decrease in size in mice that were fed green and black tea (1, 2).
4. What are the results of human studies?
Although tea has long been identified as an antioxidant in the laboratory, study results involving humans have been contradictory. Some epidemiological studies comparing tea drinkers to non-tea drinkers support the claim that drinking tea prevents cancer; others do not. Dietary, environmental, and population differences may account for these inconsistencies.
Two studies in China, where green tea is a mainstay of the diet, resulted in promising findings. One study involving over 18,000 men found tea drinkers were about half as likely to develop stomach or esophageal cancer as men who drank little tea, even after adjusting for smoking and other health and diet factors (3). A second study at the Beijing Dental Hospital found consuming 3 grams of tea a day, or about 2 cups, along with the application of a tea extract reduced the size and proliferation of leukoplakia, a precancerous oral plaque (1).
However, a study in the Netherlands did not support these findings. It investigated the link between black tea consumption and the subsequent risk of stomach, colorectal, lung, and breast cancers among 58,279 men and 62,573 women ages 55 to 69. The study took into account such factors as smoking and overall diet. It found no link between tea consumption and protection against cancer (4).
5. Is NCI evaluating tea?
National Cancer Institute (NCI) researchers are also investigating the therapeutic use of green tea. One recently completed but unpublished NCI trial studied the antitumor effect of green tea among prostate cancer patients. The 42 patients drank 6 grams of green tea, or about 4 cups, daily for four months. However, only one patient experienced a short-lived improvement, and nearly 70 percent of the group experienced unpleasant side effects such as nausea and diarrhea. The study concluded drinking green tea has limited antitumor benefit for prostate cancer patients (5).
Other ongoing NCI studies are testing green tea as a preventive agent against skin cancer. For example, one is investigating the protective effects of a pill form of green tea against sun-induced skin damage while another explores the topical application of green tea in shrinking precancerous skin changes. For more information about NCI-sponsored studies on green tea, go to http://cancer.gov/clinical_trials/.
References: (1) Dufresne CJ, Farnworth ER. A review of latest research findings on the health promotion properties of tea. J. Nutri Biochem 2001; 12 (7): 404-421. (2) Hakim IA, Harris RB. Joint effects of citrus peel use and black tea intake on risk of squamous cell carcinoma of the skin. BMC Derm 2001; 1 (3). (3) Sun CL, Yuan JM, Lee MJ, Yang CS, Gao YT, Ross RK, Yu MC. Urinary tea polyphenols in relation to gastric and esophageal cancers: a prospective study of men in shanghai, china. Carcin 2002; 23 (9): 1497-1503. (4) Goldbohm RA, Hertog MG, Brants HA, van Poppel G, van den Brandt PA. Consumption of black tea and cancer risk: a prospective cohort study. JNCI 1996; 88 2): 93-100. (5) Phase II Study of Green Tea Extract in Patients with Androgen-Independent Metastic Prostate Cancer. Protocol Ids: NCCTG-N9951. NCI Clinical Trials http://cancer.gov/clinical_trials/.

Breast cancer recurrence and fruits/vegetables

2007-07-23T04:55:00.000-07:00

A very interesting report.

Previously, we think fruits and vegetables can help reduce risk of cancer and recurrence cancer, but his study did not show.

However, as fruits and vegetables in general are healthier choice of food, for the heart and and also less calories compared to meat and other sweet food, we would still advised strongly for all to stick to sufficient amount of fruits and vegetables everyday.

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July 18, 2007, 6:07AMBreast cancer study: Fruits, veggies not the answerBut researchers at M.D. Anderson say a healthy diet, exercise help ward off its recurrence
By TODD ACKERMANCopyright 2007 Houston Chronicle
TOOLS

A healthy diet and exercise help prevent the return of breast cancer, but meals loaded with fruits and vegetables provide no extra benefit, according to a new study.
The study, conducted at the University of Texas M.D. Anderson Cancer Center and six other facilities, found recurrence and survival rates were no better for those who ate nine or more daily servings of fruits and vegetables than for those who ate five.
"The good news is that a healthy diet is sufficient," said Lovell Jones, a professor in M.D. Anderson's department of health disparities and the study's principal investigator here.
"We always assumed we're not eating enough fruits and vegetables and that the more we ate, the better," Jones said. "Now we know you don't have to eat nine, 10 or 11 servings a day."
The findings, published in today's Journal of the American Medical Association, are a setback to the hope that better diets can prevent breast cancer recurrence.
Cancer recurred in 17 percent of women in the study, regardless of whether they were in the five-serving or nine-serving group. About 10 percent in both groups died, the vast majority from breast cancer.
The study focused on more than 3,000 women — average age 53 — who had been treated successfully for early-stage breast cancer. They were followed for six to 11 years.
An earlier analysis of the study concluded that women who ate five servings of fruit and vegetables and exercised 30 minutes a day had significantly improved cancer-free survival.
Previous research into diet and breast cancer has shown mixed results, but the authors of this study said the earlier ones were not rigorous.
Researchers emphasized such nutrient-dense vegetables as dark, leafy greens, sweet potatoes and carrots and didn't count iceberg lettuce and french fries. A serving was a half-cup.
John Pierce, head of cancer prevention at the University of California at San Diego and the study's lead investigator, said he and Jones will further analyze the study to see whether certain groups — blacks, those with certain genetic profiles and post-menopausal women — benefit from extra servings of fruits and vegetables.
Pierce said that as many as 20 percent of women could fit into a group that benefited. But he also acknowledged the results so far were a surprise.
"I went into the study expecting to see a difference between the two groups," he said. "I don't think anyone expected a washout like this."

Second opinion - Part 2

2007-07-19T07:09:00.000-07:00

Today I will discuss more about second opinion, as this is a hot topic.

As a doctor and specialist, I strongly believe all patients should have seek a second opinion, or even more, if you are dealing with a serious illness. The reasons are :

1. You need to know if you are having the best option. Some treatments are irreversible. For example, if you opt for a surgery, if its not done properly, it cannot be re-do again by another surgeon. So, it is very important to get it right the first time.

2. All doctors are good is some areas but not so good in other areas. The doctor who recommends you one mode of treatment may not be familiar with another mode, which could be better. In this case, your second opinion doctor should be good in the other area. For example, if you are not sure if you need radiotherapy or surgery, you should consult both surgeon and radiation oncologist to seek their respective opinions and then decide yourself.

3. A second opinion allows you to understand the illness better.

Having said that, you need to seek a respectable doctor for second opinion, and not ask some other doctors who are not expert in that area, or even non-doctors for second opinion.

You may ask, "Would my doctor be unhappy if I seek a second opinion". The answer is : "Generally they are fine with you seeking a second opinion". This is because the second opinion may concurs with their recommendations which reniforce to you the need to have that recommended treatment. We doctors always believe that ultimately, its the patient who have to make the decision and in order to do that, a second opinion is important.

What is the advantages and disadvantages of seeking a second opinion?

2007-07-12T09:07:00.000-07:00

Many of my patients have asked me whether its wise for them to seek a second opinion when their doctor told them they have cancer and provided the various treatment options. As a cancer epidemiologist, my role is to explain to them the various treatment options available and which option is the most suitable for them, based on the latest medical reseach.

I have took a good article from this website :http://cancerguide.org/second_opinion.html
which discussed about second opinions:

Second Opinions: Why, When, and Who

Why

First, you can get a different perspective on your options. Some doctors are more conservative and others more aggressive. There may be good arguments for several different options; getting a second option can be a good way to hear some of them.
Another doctor might come up with a completely different and promising option - one that your first doctor didn't think of, or didn't know about. It happens - no doctor can know everything or make the right decision all the time.
A second opinion can also serve a general quality check - to make sure you're really getting the most up to date, most effective treatment.

When

Here is a list of some reasons why you might want a second opinion. This should help focus your thinking, but there is no cookbook answer for when you need a second opinion. So you'll need to consider your situation and think about whether you might benefit.
If You Have Been Given No Hope
Many patients are told there's no hope and that no further treatment can be of benefit. In this case, there's certainly nothing to lose by getting a second opinion, but there is a chance, however small, for a huge gain, since if your doctor is in error, a second opinion could save your life. Sometimes tumors deemed inoperable by one surgeon are found to be operable by another. Sometimes close examination of the case could change the diagnosis from one kind of cancer to another, more treatable type. Sometimes another doctor will know of a promising treatment that the first one didn't know about. All of these things have happened. You don't know until you check.
If There is Something "Borderline" About Your Case
If your tumor is almost operable, but not quite, or conversely almost inoperable but not quite, you might want a second opinion. You might either save yourself unnecessary surgery or you might save your life. Similarly if your tumor is on the borderline of requiring adjuvant chemotherapy you might want a second opinion.
If You Live in a Rural Area
If you live in a rural area and get treatment as a small hospital, it may pay to get a consult from a major hospital. I'm not saying you can't get good treatment from a small rural hospital, but I have heard some real horror stories.
If You Are an HMO Member
Although HMOs can and do offer fine care in many cases, there is a fundamental conflict of interest between an HMO and its members. The more money the HMO spends on you, the less it makes, so there is an incentive to give less expensive care, and an incentive not to refer outside the network. As a consequence, HMO members may not be told of clinical trials, or other promising new treatments. They may also be discouraged from trying expensive treatments that have only a small chance of success - even if that chance is real.
Actually it's worse then that. Some HMOs actually prohibit their doctors from telling their patients about options that aren't available through the HMO. According to an article in Oncology Times (5/96 P22), "virtually all" HMOs have a "gag rule" in the contract between them and their doctors that discourages them from, "fully informing patients about options not included in their coverage." The AMA calls this practice "unethical" which it surely is. The contract between an HMO and its doctors is not a public document, so there's not even an easy way to tell if your HMO doctor is operating under a Gag Rule. While I think public outcry has probably reduced the number of HMOs which have Gag Rules, the very fact that Gag Rules were once common, and may still exist, is very strong evidence that HMOs are not always motivated to inform patients of the best possible treatment.
Given this, I think don't think any HMO patient can assume that they are getting the best treatment, or that they have been informed of all of their options. Therefore, I think that any HMO member should have their treatment plan reviewed by an outside oncologist. You'll probably have to pay for the opinion yourself, but it's worth the expense. I recommend getting the opinion at a major cancer center or university hospital.
If Your Doctor Wants You to be in His Clinical Trial
If your doctor wants you to take part in a clinical trial that he is participating in as an investigator, then I think you ought to get a second opinion before signing up. One of the toughest things about running clinical trials is finding patients to participate. So the doctor has an interest in having you sign-up that goes beyond his interest in getting you the best treatment. Sometimes there is a financial incentive or other pressure to accrue patients. Don't get me wrong. I'm not saying that all doctors who want to sign you up for their trial are just doing it to have another body. Many if not most, physicians enter patients who they feel would benefit from the trial.
Many trials are "multi-center", that is they are done in many hospitals across the country participate in the trial. If the trial you are being proposed for is like that, the experiment probably wasn't your doctor's idea to begin with. But it is natural for a doctor to be excited about a new treatment especially if it was his idea. An objective second opinion is in order!
Clinical trials vary tremendously in their promise. A trial that was in essence randomly selected (Because your doctor just happens to be participating) may well not be the most promising one out there. For this reason, I also think you ought to research all of your options in clinical trials rather than automatically accepting the one your doctor happens to be offering. For much more, see CancerGuide's Clinical Trials Section.
If You Have a Rare Cancer
If you have a rare cancer, it definitely pays to get a second opinion. What you really want is to find an expert in that form of cancer. If such an expert is local then you should probably switch to that doctor, if the expert is far away, which is likely, your doctor may be able to work with him via telephone consultations. If you have the good fortune to already be under treatment by an expert, then, of course, you don't need a second opinion to get expert advice.
Even if your cancer isn't all that rare, you may very well benefit from finding someone with a special interest in your cancer. My cancer, kidney cancer, is not really rare, but it's not exactly common either. But in my experience, many patients with this cancer do not get the latest and greatest treatment. Finding a real expert is never a bad idea! For more, see my article on Rare Cancers.
If you have "Cancer of Unknown Primary Site"
In some cases, the doctors are unable to tell what kind of cancer the patient has. Typically metastatic tumors are found, the type of which can't be determined from examining the cells, and no primary tumor is found. Or perhaps it's just not clear which is the primary tumor. Cancer treatment varies greatly depending on the type of cancer, so if a diagnosis can be established, you may be able to get much more effective treatment. In this case, I think it makes sense to get a second opinion to make sure that all appropriate tests have been done. You should also consider a pathology second opinion in this situation.
Pathology Second Opinions
Most people never consider the possibility of getting a second opinion on the pathology report from which the diagnosis was made, but the entire plan of treatment depends on what kind of cancer you have and how far it has spread, both of which usually depend in part or whole on the pathologists interpretation of the biopsy or surgical specimen. Changes in the interpretation of the pathology can dramatically change both the treatment and the prognosis.
At the same time, most patients probably do not need a second pathology opinion. There are some common sense cues that can let you know if it might make sense. I think that if you have a really rare cancer, it is always advisable to get a second pathology opinion. It is likely that the pathologist had little or no experience with that particular kind of cancer, so the chance for an error may be higher.
If your pathology report doesn't give a definite diagnosis, a second opinion is probably in order. But also if the pathology report describes something as unusual, or you find that it is unusual based on your knowledge of the disease, it may be more likely than usual that there was an error. I met one patient who had just had surgery for a large kidney cancer. The diagnosis was renal cell carcinoma. He told me that the tumor was "well differentiated" which, while not impossible, is not at all usual for large renal cell carcinomas. He also said that the pathology report described the tumor as an "atypical renal cell carcinoma". He got a second opinion on the pathology, and it turned out that he had a completely different and extremely rare cancer called a "renal carcinoid". This totally changed his follow-up schedule, his prognosis as well as the treatment of any future problems.
As a basic step, you should obtain a copy of the appropriate pathology report from your doctor. See Dr. Ed. Uthman's Biopsy Report for the basics of understanding a pathology report.
One place with an superlative reputation in pathology is the Armed Forces Institute of Pathology (AFIP). You can get contact and other information at AFIP's Web Page
FindCancerExperts is a free, not-for-profit service which will refer you to expert pathologists with special experience in the pathology of your tumor. They also have excellent patient oriented information about when to get a second pathology opinion and about pathology in general.

Who

Independent Doctors
You want your second opinion to be independent - so you should choose a doctor who doesn't have a close relationship with your doctor. Doctors who practice together are likely to think similarly, and might tend defer to the opinions of their colleagues. What you want is a fresh perspective. I'd go so far as to recommend finding a doctor who practices at a different hospital. A research hospital or major cancer center is usually a good place to get a second opinion since they should be up on the latest in treatment and diagnosis.
Tumor Boards
There is a special kind of second opinion that, while not independent, is worth considering because it's a great way to get a wide range of opinions all at once. This is the "tumor board" or tumor conference. Most hospitals have a tumor board which is a regular meeting of a group of doctors to consider the best treatment for specific cases presented by members of the group. Typically, doctors from several specialties such as surgery, radiation oncology, and medical oncology will attend. If your doctor doesn't seem to have a clear recommendation for you, consider asking if he could present your case to the tumor board.
The R.A. Bloch Cancer Foundation has been instrumental in setting up a program of "multidisciplinary second opinions" which works much like a tumor board, but the patient is actually present when their case is discussed. This is intended for patients who have been diagnosed with a new cancer or a recurrence within the last three weeks. Their information on Multidisciplinary Second Opinions includes a listing of participating centers.
A Different Specialist
Many types of cancers are treated by several different types of specialists. For instance, prostate cancer is treated by urologists, who are surgeons, by radiation oncologists, and by oncologists who use drug treatment. After doing some basic research on your type of cancer, you will probably know what specialists treat it. It often makes a lot of sense to see one of the other types of specialist to get a different perspective. For instance, a surgeon may be convinced that "he got it all" and that you need no more treatment. At the same time, an oncologist may have more detailed knowledge of studies that show benefit from adjuvant treatments such as chemotherapy or radiation. Similarly, a surgeon may have a better idea than an oncologist of whether a tumor is operable or not. Very often, one specialist will call in another for a consultation, so you may not have to do anything to get this second opinion. But I have heard from patients who didn't get a needed consultation, and who missed out on potentially life saving treatment.
A World Class Expert
In some cases, what you need is world class expert - a surgeon who does operations most others don't - an oncologist who is in the forefront of research in a new and promising area that applies to you. Or an expert in a rare cancer.
In many cases, expertise is quite narrow - Dr. X is skilled at removing a particular type of brain tumor. Dr. Y is an expert in biological therapy for melanoma. It's not as simple as just finding someone who's got a reputation as a good doctor. I know of no foolproof way to find the expert you need (If you do, please let me know!). Doctors often do know who the experts are, and your doctor may be able to give you a referral. You can also research the medical literature to see who's published papers relating to your particular problem. Often, this will be quite effective.

Chemotherapy and immunocompromised

2007-07-05T21:15:00.000-07:00

One common question which my patients who went for chemotherapy would ask "Do I need to avoid crowded places during this period of chemotherapy"?

Chemotherapy functions by killing off cancer cells, but in the process, it would also kills off normal cells, which include the white blood cells and its precursors and these white blood cells function as "police" to kill the infections.

There is a risk of lower resistance against infection in patients in chemotherapy, especially around 1 week after the chemotherapy when the risk of infection is highest. what you normally need to do, is you need to balance between trying to lead a normal life as much as possible and yet to avoid crowded places or sick people in case you are infected during this period. Of course, you are not expected to be "bubble boy" as in this picture.

Tumour profiles : targeting cancer treatment

2007-06-30T19:30:00.000-07:00

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

2007-06-28T09:30:00.000-07:00

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

2007-06-24T06:37:00.000-07:00

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

2007-06-20T00:25:00.000-07:00

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

2007-06-18T18:13:00.000-07:00

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

2007-06-16T23:06:00.000-07:00

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

2007-06-16T21:53:00.000-07:00

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

2007-06-11T23:32:00.000-07:00

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?

2007-06-10T23:53:00.000-07:00

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

2007-06-09T19:24:00.000-07:00

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

2007-06-07T23:43:00.000-07:00

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

2007-06-07T20:20:00.000-07:00

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

2007-06-07T00:37:00.000-07:00

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?

2007-06-05T20:46:00.000-07:00

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

2007-06-05T19:03:00.000-07:00

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

2007-06-05T08:24:00.000-07:00

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?

2007-06-05T01:19:00.000-07:00

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?

2007-06-04T15:55:00.000-07:00

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

2007-06-03T20:01:00.000-07:00

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

2007-06-03T09:04:00.000-07:00

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

2007-06-03T08:49:00.000-07:00

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