Chemotherapy given before surgery to remove cancer is called neoadjuvant treatment. An oncologist might recommend this based of the size of the tumor -- it being very large. The idea is to shrink the tumor and then have surgery to remove the cancer.

Having chemotherapy administered while the tumor is still there can show what drugs are working and what drugs have no effect on the tumor. Chemotherapy when started immediately, not after surgery with healing time needed, gives the patient systematic treatment right away. This could be beneficial and is why physicians might recommend this form of treatment. The truth is they don't know if it is better or not.

Of course, every case of breast cancer is different. We all need to make tough decisions regarding our treatment plan. The facts are that currently there is no evidence that survival is improved with neoadjuvant verses adjuvant (after surgery) chemotherapy in women with locally advanced breast cancer.

The clinical trials that are done help physicians understand what treatments are more effective. Results from a Phase II clinical trial was published in the Journal of Clinical Oncology. It stated that neoadjuvant treatment with Taxotere, Navelbine, and Herceptin resulted in a complete disappearance of detectable cancer in 39 percent of women with locally advanced HER2 positive breast cancer.

The study showed that after two years followup, on the thirty one women with locally advanced breast cancer involved in the study, the overall survival was 97 percent and cancer free survival was 84 percent.

So, the message here is that, even though the study group was small, the results showed a good response to this treatment plan.

In previous studies there has not shown to be an increase in survival when adding chemotherapy after surgery for gastric cancer compared with surgery alone. Most U.S. patients that are diagnosed with cancer of the stomach or lower esophagus have locally advanced disease that is hard to cure.

The MAGIC trial represents a landmark study in gastric cancer, as it is the first trial to demonstrate a survival benefit for pre- and postoperative chemotherapy. Researchers studied 503 patients with cancer of the stomach, esphagogastric junction or lower esophagus. One arm of the trial received three preoperative and three postoperative cycles of chemotherapy, the other arm of the study had only surgery.

The trial concluded that the chemotherapy group had smaller resectable tumors with negative margins, fewer patients had advanced nodal disease and the five year survival rate increased by 13 percent. It was noted that this is a significant advance for the treatment of this disease.

Where does the time go? Even though most of us have been experiencing the height of the summer season in the form of a nationwide scorcher of a heat wave, summer is almost over for school kids and teens leaving for college. Yes, in less than a month, it's back to school. There are advertisements everywhere you look for new school supplies and new school clothes. In preparation for the new school season, Duke Health has published Back to School Tips for Healthy Eating.

The experts say it is not about counting fat grams and calories but portion control and choices. According to pediatrician Dr. Terrill Bravender, "You don't have to be obsessive about it. If you generally eat healthy, there is room for some foods that aren't as healthy."

Dr. Bravender offers these basic common sense tips:

• Involve kids in lunchbox planning. If you let them make some choices about what goes into their lunchbox, they are more likely to eat it.
• Avoid the peanut butter and jelly rut. Nothing wrong with the traditional, but try new foods. Make it a food adventure.
• While everyone is still on summer break, encourage children to prepare their own lunch. Dr. Bravender suggests easy-to-make ideas like graham crackers with peanut butter and a glass of milk; fresh fruit with cheese cubes; a hard boiled egg with whole grain crackers; yogurt with a sliced banana; granola bars with milk; or tortilla chips and bean dip made without hydrogenated oils.
  

Ultimately, as the mother, what foods come in to the home are my choosing, so I try to make nutritious choices in food purchases. But I have found great success over the years by taking my kids to the grocery store with me, and allowing them to choose between several choices I offer. We also take a look at new foods, and talk about the food item. We read ingredients. Some we decide, by group vote, to bring home and try. During the growing seasons, they are with me when I stop at a roadside stand to buy local produce straight from the field, and each year we have an annual tradition of blueberry picking enough blueberries to last most of the year ahead. Food can be fun, and learning about good food a lifetime benefit in cancer prevention.

Young women sometimes are dismissed when they pursue medical attention for suspicious lumps, bumps, pains, or changes in their breasts -- because breast cancer is not so common in young women and medical professionals may assume that breast cancer is not the culprit for the complaints brought before them by young women. But young women do get breast cancer -- I did at age 34 -- and many times, the tumors found in young breasts are more aggressive than those that appear for older women. So it is critical that young women seek medical attention for anything out-of-the-ordinary. And it is critical that doctors respond with urgency so that breast cancer in young women can be detected early -- and treated appropriately.