At this point I have seen and treated many patients, with the most diverse illnesses. It is so gratifying to treat patients who really embrace their treatment and really follow the doctor’s instructions. We will always reach out for those who do not cooperate much, but I personally feel that when patients cooperate things just work better. There is no doubt that compliant patients do better, but the experience from the doctor’s perspective is that patients are truly engaged and the patient-physician relationship is stronger.

We are happy to see that The Cancer Blog is being syndicated by Medlogs.com, in the category “Medical News”. Welcome Medlog readers !

I see that the posts are steady (with the exception being myself), and that comments are coming. It is excellent to have a group of people that read us frequently.

Prostate specific antigen

(PSA) tests are commonly used to screen men for the presence of prostate cancer. It is a method that is criticized due to the fact that some prostate tumors can be present with a normal level of PSA.

The March issue of Cancer brings attention to another very important fact: that PSA levels are decreased in obese men. It is known that obese men have a worse prognosis when diagnosed with prostate cancer, although the exact reasons are unclear. This finding means that maybe their worse prognosis is due to detection of the disease in more advanced stages, since they have a lower level of PSA.

There may be the need for reduced PSA cut-off values for obese men to increase cancer detection rates.

Read the article abstract and press release.

A new report from the University of Minnesota concludes that women that consumed more than 800 mg of calcium per day had less chances of developing colorectal cancer. The study included more than 45,000 women with a median age of 61 years. It is important to note that this was a questionaire-type of study, where participants answered a long questionaire about their lifestyle and diet habits, and all the responses were then analyzed.

While I honestly think cause and consequence can not be definitely linked based on this type of study, it gives an indication of what might be true. Regardless of cancer risk or not, most menopausal women should be taking at least 1000 mg of calcium per day to prevent osteoporosis. Maybe the women that took more calcium were more conscientious about their health, and therefore went more frequently to the doctor and had better screening for colon cancer. This is just an example of how the data has to be interpreted with caution.

Seems like Michelle and Catherine are really rocking our blog. I have been absent for a few days, since I am currently travelling during the month of February. Now that I have settled down, I can start posting regularly again.

I am in Brazil, doing a rotation in the Bone Marrow Transplant Unit of a major teching hospital. It is very interesting to see the differences between the more european school of thought that is taught here in Brazil versus the traditional american school of thought. Not that any is superior, it is just a different way of doing things. Patients here expect the physician to make most of the decisions for them; still, things are still discussed at length, but the physicians are basically “driving” the course of treatment, and it is up to them to make judgements and decisions.

I will certainly have a great time here, and will learn some interesting stuff.

New molecular (targeted) approaches to the treatment of cancer are being described. Possible target proteins give researchers (and patients) new hope that a new drug might improve the prognosis. Unfortunately the response observed in some trials is quite disappointing. One such example is the drug Iressa, given for non-small cell lung cancer. The basic mechanism behind Iressa is to inhibit (block) the receptor of a protein called EGF (epidermal growth factor), one of the known pathways responsible for cellular division and growth. Theoretically this could impair tumor growth by reducing the stimuli that trigger cellular growth. Recent phase III clinical studies, however, failed to show a survival benefit in patients treated with Iressa, for example. Some researchers say that the problem is in how drugs are currently researched and developed, as this example consumed several million dollars and several years and yet failed to achieve the expected results.

There are many terms that are confusing to the general public. I wanted to write a bit about what adjuvant and neo-adjuvant chemotherapy mean.

Adjuvant means that the chemotherapy will be administered in after or in addition to some other procedure. This is usually surgery. Neo-adjuvant means that chemotherapy will be given prior to a procedure. Sometimes neo-adjuvant chemotherapy is given in an attempt to reduce the size or bulk of the tumor in order to facilitate the surgical procedure.

Chemotherapy is a very complex group of treatment strategies. That is why only oncologists may prescribe these medications, with few exceptions.

As much as I counsel my patients about quitting smoking, it seems that companies are really pushing it. This company (story) is encouraging employees to quit their habit or leave. They are providing therapists and all pharmacologic therapy to support them. The same company is also offering bonuses and providing free health-clubs and dietary instructions to those that need to lose weight.

I am sure that the primary objective of this company is to spend less on healthcare, and I am not sure if this will pass a legal challenge that is certain to come. On the other hand, I think more companies will likely adopt rules to prevent hiring of smokers and strongly encourage smokers to quit. The same will occasionally happen to overweight employees.

It will be interesting to see how this trend develops.

In a series of posts where I will summarize common questions that the general public has. For this post I chose to define how cancer is diagnosed.

The only way cancer can be diagnosed is by having a pathologist look at a tissue specimen. This can be obtained in different ways: biopsy using needles (fine needle or core needle) and excisional biopsy or surgical resection. The method used depends on several different factors. For example, colon cancer can be diagnosed by biopsying an ulcerated spot in the colon or by excising (removing) the polyp completely.

Contrary to what many think, the various methods that we have to characterize a disease such as CTs, MRIs, PET scans and others only estimate the likelihood of the lesion(s) being malignant. So even if the CT reveals an area that really looks malignant, there is a chance of that area not being malignant at all. It might be an infection, a benign growth, a scar, and many other things that can be seen in Medicine. The diagnosis of cancer means that the patient will probably undergo radical treatment involving toxic drugs, surgery and/or radiation. Imagine if we treat a patient with a lung nodule that really looks malignant, but it turns out that it was an infection; the treatments for cancer can severely impair the immune system, and that infection can become generalized.

Another reason that the diagnosis of cancer needs pathological confirmation is that the different types of tumors need different treatments. For example, breast cancer is not just one disease, but a group of different tumors that have very very different treatment options depending on what the pathologist says.

I hope this helps a bit. I will post soon with another topic. Please let me know if you have any ideas for future topics !

One concept that I think the general public is not really informed about is the difference between the various available stem cell types.

The stem cells that are mentioned all the time in the news as a promise for the treatment of many disease are the embryonic stem cells. These cells are taken from developing embryos, and are very early cells that have not progressed to be a specific type of cell, for example muscle or nervous system.

On the other hand, when we mention stem cell transplants for leukemia and other hematologic cancers we are talking about hematopoietic stem cells. These cells can be obtained by direct aspiration of the bone marrow. Another source is from peripheral blood, after giving someone a medication that increases their production. The correct name is hematopoietic stem cells, as these cells are already “committed” to be blood-forming cells, and for that reason can be used to replace the diseased bone marrow in patients with hematologic cancers.

I have talked about blood cord transplants before, but a new study done at the University of Minnesota gives new hope to those that need a hematopoietic stem cell transplant (bone marrow transplant). The researchers have tried transplanting patients with acute leukemia by giving them hematopoietic stem cells harvested from 2 umbilical cords.

This study is really innovative in a sense that it tries what has not been tried before. One would think that having a group of cells from a different person already causes problems with rejection and most importantly graft-versus-host disease. Having 2 sets of cells may even increase this risk, and there is also a risk of one of the grafts rejecting the other graft as well. The good part is that umbilical cord cells are known to be more “tolerant” for mismatches.

This is clearly something that should be looked in, as this opens a door for people that would never be considered for hematopoietic stem cell transplant.

I had been taught to instruct my patients to avoid aspirin and NSAIDs before obtaining an occult blood stool test. Apparently a study published in the American Medical Journal revealed that aspirin and NSAIDs do not increase the chances of false-positives.

Still, every positive occult blood stool test has to be investigated. The best approach is still a colonoscopy.

Source: Yahoo News.

There is a major discussion on cancer forums about chemotherapy, side-effects and alternatives to conventional chemotherapy. Chemotherapy can have so many different side-effects and complications that it is impossible to discuss each and every complication with the patient. Obviously we go through all major and most common side-effects and complications, but current chemotherapy regimens are still too toxic.

The medications are given through an IV most of the times, and it simply affects every cell in the body. Unfortunately it is like dropping an atomic bomb in a city to cut crime. Crime will certainly be affected, but so will be innocent bystanders. There are attempts at directed therapy, but only in few types of cancer has it been successful. We still have a long way to go.

The “do no harm” part of it is also important. Knowing that the patient may get sicker before getting better is a difficult concept. The point is that the physician still perceives the chemotherapy regimen as more beneficial than harmful. The alternative would be to do nothing or less aggressive regimens, which will be less effective or not effective at all.

While there is still a lot of debate about the COX-2 inhibitors causing heart damage, there is also a lot to say about COX-2 and cancer. A very nice post at Isemmelweiss summarizes the generalized concern about inflammation and heart disease.

COX-2 has been linked to the development and progression of cancer. Now a study reveals that COX-2 is much higher in smokers, up to 4 times compared to non-smoker levels. The same study authors went one and made an experiment that showed that the cause of elevated COX-2 levels is smoke-induced activation of EGFR (a protein that can be blocked by anti-cancer drugs).

With the hundreds of known carcinogenic substances found in cigarettes, this is just one of the mechanisms of why smoking increases your chance of getting cancer. Still, we do not know for sure what is worse: attempting to block COX-2 or just leave it alone. My guess for now is to let it be until we know a bit more about it (and the drugs used to treat it).

In the last few years we have seen a multitude of new drugs against cancer. As we all know, these medications generate a huge amount of money for the drug companies, and there is a lot of market pressure for these drug to generate revenue.

I am seeing a trend that is making me a little bit nervous: the names of the drugs themselves are inexplicably complicated. We used to have names like tamoxifen, doxorubicin, cyclophosphamide. These names were easily memorized and pronounced. Now we are seeing names such as gefitinib (Iressa), trastuzumab (Herceptin), bicalutamide (Casodex). It seems that the drug companies are creating generic names that are difficult to memorize and pronounce, while creating very catchy trade names. This discourages patients and health care providers to use the generic name, which means that the trade name will be strongly associated with this specific medication not only now, but also after the patent protection expires.

Do you think this is a coincidence ?