Saturday, January 18, 2014

How to Prevent Mouth Problems During Cancer Treatment

January 17, 2014  No comments

Chemotherapy and radiation are often prescribed because they are both very effective at destroying cells that grow rapidly, such as cancer cells. Unfortunately, they can also harm healthy cells that grow quickly, such as the cells lining the inside of your mouth. Patients undergoing chemo or radiation treatment often report mouth problems, such as sores, dry mouth, or infections, because the treatments make it difficult for the mouth to heal itself and fend off germs.
To help prevent or minimize mouth problems, consider these tips:
Nathaniel Treister, DMD, an oral expert with Dana-Farber/Brigham and Women's Cancer Center, checks a patient during an oral exam.
Nathaniel Treister, DMD, DMSc, a stem cell transplant oral health provider, examines a patient.
  • See your dentist. Try to see your dentist before treatment begins, so he or she can conduct a thorough teeth cleaning and check for potential sources of dental irritation that may cause problems during cancer treatment. Once treatment begins, be sure to see your dentist again so he or she can watch for any potential issues.
  • Maintain good oral health to help prevent infection and tooth decay.Brush three times a day with a soft toothbrush, floss daily, and eat a healthy diet, low in sugar. (However, don’t floss if it causes bleeding when your platelet count is low.)
  • To help lessen the symptoms of mouth sores (also called mucositis),ask for ice chips or sugar-free popsicles to suck on while you receive chemotherapy. Research shows that this may help decrease mouth sores.
  • Talk with your doctor. He or she may be able to prescribe a medication to help prevent sores and ease discomfort. Your doctor may also recommend over-the-counter pain relievers, such as Tylenol, to help reduce mouth pain.
  • Avoid commercial mouthwashes, because they contain alcohol that may burn your mouth. Instead, rinse your mouth with warm salt water or baking soda and water (a teaspoon of either dissolved in eight ounces of warm water).
  • Drink at least eight glasses of water or juices daily. Drinking fluids throughout the day can help with dry mouth (also called xerostomia). It is also important to avoid caffeinated beverages, because caffeine can increase mouth dryness. Dana-Farber nutritionists offer a number of recipes to help relieve dry mouth.
When your cancer therapy ends, be sure to continue good dental habits to keep teeth and gums healthy. If you’ve had radiation, your salivary glands may be making less saliva, which can put you at greater risk for developing cavities and gum disease. This means you’ll need to schedule regular dental visits and eat a healthy diet. Visit Dana-Farber’s website for more tips for mouth care during and after cancer treatment.
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Friday, January 17, 2014

It’s In Our Genes: A Survivor’s Quest To Unearth Ancient Patterns Of Cancer

Did cancer plague our ancestors who lived in centuries past? And if it did, what can doctors learn from that?
Kathryn Hunt was studying archaeology in college and doing digs of ancient burial sites in Egypt when, at 22, her studies were interrupted by the diagnosis of a Nerf ball-sized malignant tumor in her ovaries and immediate, aggressive treatment.
Today, four years later, she’s a bona fide survivor--and her passion for the field has taken a personal turn. A master's degree now in hand, she’s embarking on a major project to uncover the ancient history of cancer, a disease that's often assumed to be triggered by modern ills (even being called “purely man-made” by a few researchers).
“The impressive advancement of modern cancer research has been based on limited knowledge of cancer over several decades,” she says. “However, cancer was active in humans for hundreds of thousands of years before that.”
The field of “paleo-oncology” is not entirely new, but it is very small and scattered. For example, the researchers who concluded that cancer was a man-made disease did this on the basis of studying Egyptian mummies. While it may be true that cancer rates, in today’s time of smoking, toxic chemicals, and longer life expectancy, may be higher than the past, cancer is actually a very old disease, says Hunt. Hippocrates, ancient Greece's father of medicine, first named the disease. The possible earliest documented case in a human ancestor was 1.5 million year in Africa, and scientists have even found it in dinosaur fossils.
Hunt is now launching an organization, the Paleo-oncological Research Organization, that is working to compile and code for evidence of cancer in an online, open-source database that spans societies and eras. The long-term work will aim to answer unwieldy questions about how cancer has evolved, both culturally and biologically, over key historical periods. She wonders how cancer changed when humans became farmers, rather than hunters and gatherers, or once the Industrial Revolution truly got going.
“I realized that the reason why no one has done this work extensively is because there’s never been a foundation. There’s never been a jumping off point,” she says. She’ll be raising the profile of the discussion at a conference of archeologists this spring. Recent advances in DNA analysis will likely help her work along with researchers’ knowledge about all kinds of diseases in the ancient past, such as tuberculosis.
A recently named TED Fellow for 2014, Hunt is in full remission and plans to make this work her life’s contribution to combating a disease she wishes no one else would have to battle, especially at such a young age. “If we can get a better understanding of why cancer manifests the way it does, because of genetic, environmental, and cultural factors...that behavior might lead us to better treatment, better prevention, and better quality of life for those going through cancer,” she says.
[Image: Abstract via Shutterstock]
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Monday, January 13, 2014

Happy 20th Anniversary and New Book Coming in March



    We are excited to announce our 20th anniversary helping thousands of women locally and across the country. Our Unique perspective on the “Journey with Cancer” stems from Susan’s experience as an Oncology Nurse Clinician and also a Breast Cancer Survivor. She has had a mastectomy and lost her hair due to chemotherapy and thus shares her experience of those difficult days. Her store addresses those needs. Susan and her nationally acclaimed staff discuss process and options with knowledge and compassion helping to find solutions in a beautiful private setting. Women walk in with hesitance and walk out with joy looking like themselves having products that are comfortable and fit well. We are Fully Accredited and Certified to confidently meet the needs of our clients.

   


We are also thrilled to announce that Susan has been invited by physicians and therapists at Harvard and Georgetown University to co-author a new book titled “Managing Breast Cancer – A Guide to Living Well Through Physical Medicine and Rehabilitation”. Providing knowledge and strategies how to maximize the patient’s function and quality of life throughout the spectrum of care.  This practical – and inspirational – book is an easy to use reference for anyone affected by cancer.

    Susan will have books available at her store in March 2014 and looks forward to helping patients experiencing breast cancer.
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Friday, January 10, 2014

Two-in-one nanoparticles exploit tumor cells to precisely deliver multiple drugs

January 9, 2014
3 Pictures
A nanoparticle delivery mechanism (left) treats tumors in mice more effectively
A nanoparticle delivery mechanism (left) treats tumors in mice more effectively
Image Gallery (3 images)
A common strategy for treating tumors is combining two or more drugs, which has the effect of decreasing toxicity and increasing the synergistic effects between the drugs. However, the efficacy of this kind of cocktail treatment suffers when the drugs require access to different parts of the cell, a bit like fighting a battle by depositing all your archers on the same spot as your infantrymen. By making use of nanoparticle-based carriers, researchers at North Carolina State University are able to transport multiple drugs into cancerous cells optimally and precisely, in maneuvers that any field commander would be proud of.
Their research has focused on multiple scenarios of drugs, including those targeted for gene therapy or chemotherapy, but all rely on the same nanoscale drug delivery mechanism or “nanodepot." In it, an outer gel shell surrounds a liposomal core, each layer bearing a different drug. The shell and core are collectively known as “Gelipo."
In their tests, Gelipo’s outer layer was laced both with a cancer drug, TRAIL, that requires delivery to the outer membrane of the cancerous cell, and with an additional chemical, HA. Hidden inside is yet another drug, Dox, targeted for the cell’s nucleus and attached to peptides. Hold onto those terms, because HA and the peptides are about to manipulate the cell’s natural mechanisms against itself.
A diagram of the process of Gelipo's targeted delivery of two different drugs to the cell ...
A diagram of the process of Gelipo's targeted delivery of two different drugs to the cell membrane and nucleus
As Gelipo approaches the cell, anti-HA enzymes naturally present in the cell’s exterior latch onto the HA and begin to break down the gel layer, releasing the first drug. This drug is then free to bind to receptors in the tumor cell’s membrane, triggering programmed cell death.
But Gelipo’s progress doesn’t stop there. As its outer layer is breaking down, the tumor cell encapsulates Gelipo’s contents into what would be a defensive sphere (see the diagram below), unwittingly transporting the second drug into the cell, Trojan-horse-style. However, the peptides attached to the second drug allow passage through this defensive membrane, where the second drug is free to bind with its target.
Though this exploitation of biochemical and cellular pathways, the Gelipo-TRAIL-Dox combo accumulated more than the controls in the affected tumor tissue and had a greater cytotoxicity. The synergistic effects of using two drugs was controlled by comparing Gelipo with just one drug, Dox. Below are mice with tumors treated with saline, just Dox, Gelipo and Dox, and finally, Gelipo with both drugs.
Tumor size in mice, left to right, with treatment with saline, just Dox, Gelipo-Dox, and G...
Tumor size in mice, left to right, with treatment with saline, just Dox, Gelipo-Dox, and Gelipo-TRAIL-Dox
The team describes this experiment as proof-of-concept and has further refinements to make on the technique, but expects that the process can be scaled up for manufacturing. A paper on the research was recently published in the journal Advanced Functional Materials.
Source: NCSU
- See more at: http://www.gizmag.com/nanoparticle-tumor-cell-site-specific-drug-delivery/30377/?utm_source=Gizmag+Subscribers&utm_campaign=efa216ec93-UA-2235360-4&utm_medium=email&utm_term=0_65b67362bd-efa216ec93-90055698#sthash.HSwnnev1.dpuf
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Monday, January 6, 2014

Why Everyone Seems to Have Cancer

Jillian Tamaki
By 
Published: January 4, 2014 358 Comments

EVERY New Year when the government publishes its Report to the Nation on the Status of Cancer, it is followed by a familiar lament. We are losing the war against cancer.
Graphic
Graphic
Declining Lethality

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Readers shared their thoughts on this article.

Half a century ago, the story goes, a person was far more likely to die from heart disease. Now cancer is on the verge of overtaking it as the No. 1 cause of death.
Troubling as this sounds, the comparison is unfair. Cancer is, by far, the harder problem — a condition deeply ingrained in the nature of evolution and multicellular life. Given that obstacle, cancer researchers are fighting and even winning smaller battles: reducing the death toll from childhood cancers and preventing — and sometimes curing — cancers that strike people in their prime. But when it comes to diseases of the elderly, there can be no decisive victory. This is, in the end, a zero-sum game.
The rhetoric about the war on cancer implies that with enough money and determination, science might reduce cancer mortality as dramatically as it has with other leading killers — one more notch in medicine’s belt. But what, then, would we die from? Heart diseaseand cancer are primarily diseases of aging. Fewer people succumbing to one means more people living long enough to die from the other.
The newest cancer report, which came out in mid-December, put the best possible face on things. If one accounts for the advancing age of the population — with the graying of the baby boomers, death itself is on the rise — cancer mortality has actually been decreasing bit by bit in recent decades. But the decline has been modest compared with other threats.
A graph from the Centers for Disease Control and Prevention tells the story. There are two lines representing the age-adjusted mortality rate from heart disease and from cancer. In 1958 when the diagram begins, the line for heart disease is decisively on top. But it plunges by 68 percent while cancer declines so slowly — by only about 10 percent — that the slope appears far less significant.
Measuring from 1990, when tobacco had finished the worst of its damage and cancer deaths were peaking, the difference is somewhat less pronounced: a decline of 44 percent for heart disease and 20 percent for cancer. But as the collision course continues, cancer seems insistent on becoming the one left standing — death’s final resort. (The wild card in the equation is death from complications of Alzheimer’s disease, which has been advancing year after year.)
Though not exactly consoling, the fact that we have reached this standoff is a kind of success. A century ago average life expectancy at birth was in the low to mid-50s. Now it is almost 79, and if you make it to 65 you’re likely to live into your mid-80s. The median age of cancer death is 72. We live long enough for it to get us.
The diseases that once killed earlier in life — bubonic plague, smallpox, influenza, tuberculosis — were easier obstacles. For each there was a single infectious agent, a precise cause that could be confronted. Even AIDS is being managed more and more as a chronic condition.
Progress against heart disease has been slower. But the toll has been steadily reduced, or pushed further into the future, with diet, exercise and medicines that help control blood pressure and cholesterol. When difficulties do arise they can often be treated as mechanical problems — clogged piping, worn-out valves — for which there may be a temporary fix.
Because of these interventions, people between 55 and 84 are increasingly more likely to die from cancer than from heart disease. For those who live beyond that age, the tables reverse, with heart disease gaining the upper hand. But year by year, as more failing hearts can be repaired or replaced, cancer has been slowly closing the gap.
For the oldest among us, the two killers are fighting to a draw. But there are reasons to believe that cancer will remain the most resistant. It is not so much a disease as a phenomenon, the result of a basic evolutionary compromise. As a body lives and grows, its cells are constantly dividing, copying their DNA — this vast genetic library — and bequeathing it to the daughter cells. They in turn pass it to their own progeny: copies of copies of copies. Along the way, errors inevitably occur. Some are caused by carcinogens but most are random misprints.
Over the eons, cells have developed complex mechanisms that identify and correct many of the glitches. But the process is not perfect, nor can it ever be. Mutations are the engine of evolution. Without them we never would have evolved. The trade-off is that every so often a certain combination will give an individual cell too much power. It begins to evolve independently of the rest of the body. Like a new species thriving in an ecosystem, it grows into a cancerous tumor. For that there can be no easy fix.
These microscopic rebellions have been happening for at least half a billion years, since the advent of complex multicellular life — collectives of cells that must work together, holding back, as best each can, the natural tendency to proliferate. Those that do not — the cancer cells — are doing, in a Darwinian sense, what they are supposed to do: mutating, evolving and increasing in fitness compared with their neighbors, the better behaved cells of the body. And these are left at a competitive disadvantage, shackled by a compulsion to obey the rules.
As people age their cells amass more potentially cancerous mutations. Given a long enough life, cancer will eventually kill you — unless you die first of something else. That would be true even in a world free from carcinogens and equipped with the most powerful medical technology.
Graphic
Graphic
Declining Lethality

Readers’ Comments

Readers shared their thoughts on this article.
Faced with this inevitability, there have been encouraging reductions in the death toll from childhood cancer, with mortality falling by more than half since 1975. For older people, some early-stage cancers — those that have not learned to colonize other parts of the body — can be cured with a combination of chemicals, radiation therapy and surgery. Others can be held in check for years, sometimes indefinitely. But the most virulent cancers have evolved such wily subterfuges (a survival instinct of their own) that they usually prevail. Progress is often measured in a few extra months of life.
OVER all, the most encouraging gains are coming from prevention. Worldwide, some 15 to 20 percent of cancers are believed to be caused by infectious agents. With improvements in refrigeration and public sanitation,stomach cancer, which is linked to Helicobacter pylori bacteria, has been significantly reduced, especially in more developed parts of the world. Vaccines against human papilloma virus have the potential of nearly eliminating cervical cancer.
Where antismoking campaigns are successful, lung cancer, which has accounted for almost 30 percent of cancer deaths in the United States, is steadily diminishing. More progress can be made with improvements in screening and by reducing the incidence ofobesity, a metabolic imbalance that, along with diabetes, gives cancer an edge.
Surprisingly, only a small percentage of cancers have been traced to the thousands of synthetic chemicals that industry has added to the environment. As regulations are further tightened, cancer rates are being reduced a little more.
Most of the progress has been in richer countries. With enough political will the effort can be taken to poorer parts of the world. In the United States, racial disparities in cancer rates must be addressed. But there is a long way to go. For most cancers the only identifiable cause is entropy, the random genetic mutations that are an inevitable part of multicellular life.
Advances in the science will continue. For some cancers, new immune system therapies that bolster the body’s own defenses have shown glints of promise. Genomic scans determining a cancer’s precise genetic signature, nano robots that repair and reverse cellular damage — there are always new possibilities to explore.
Maybe someday some of us will live to be 200. But barring an elixir for immortality, a body will come to a point where it has outwitted every peril life has thrown at it. And for each added year, more mutations will have accumulated. If the heart holds out, then waiting at the end will be cancer.
George Johnson is a former reporter and editor at The New York Times and the author of “The Cancer Chronicles.”
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Friday, January 3, 2014

Do Ovarian Cysts Mean Ovarian Cancer?

An ovarian cyst can be benign or malignant. But if you've gone through menopause, a cyst could indicate ovarian cancer is present.

By Diana Rodriguez
Medically reviewed by Lindsey Marcellin, MD, MPH
Ovarian cysts are collections of fluid within the ovaries. They don't always indicate ovarian cancer; ovaries will frequently develop benign cysts called functional cysts during your menstrual cycle. Cysts may also be part of other conditions, like endometriosis, which aren't ovarian cancer. But sometimes, especially after a woman has gone through menopause, ovarian cysts may turn out to be a very early ovarian cancer symptom.
Ovarian Cysts: Subtle Symptoms
An ovarian cyst might have no symptoms or a few barely noticeable ones. That means these cysts are tough to detect and treat.
"The difficulty with any ovarian neoplasm or growth is that they can be completely [without symptoms] or they can have subtle symptoms, such as feeling gassy, pressure, or urinating more," says Colleen Feltmate, MD, a gynecologist at Brigham and Women's Hospital and the Dana-Farber Cancer Institute, both in Boston. Some people, she says, can have changes in bowel movements, or small changes in their gastrointestinal tract. "That can be really subtle, and it can happen with benign cysts or cancerous cysts."
Most often, a cyst is spotted when a patient is being examined for something else, says Dr. Feltmate.
Ovarian Cysts: Not-So-Subtle Symptoms
On rare occasions, ovarian cysts can hurt and be easier to spot, says Feltmate. "A cyst can present with pain, or nausea and pain."
An ovarian cyst can cause significant symptoms. These are:
  • Sore breasts
  • Weight gain
  • Pain in the abdominal area, pelvis, the low back, and the thighs
  • Difficulty urinating
  • Painful intercourse and menstruation
  • Bleeding abnormalities
Ovarian Cysts: Are They Ovarian Cancer?
Feltmate says that most simple cysts do not turn into ovarian cancer. "Cycling cysts are very normal and aren't necessarily very concerning."
But in older women who have gone through menopause — most often those between the ages of 50 and 70 years old — cysts are more likely to be ovarian cancer. Anyone in that age group, or anyone with symptoms of an ovarian cyst that won't go away, should be tested to determine if the cyst is cancerous.
"In post-menopausal women these symptoms are not expected, and they should see their doctor," Feltmate says. "Anyone should be seen if symptoms persist for over a period of time."
Testing for Ovarian Cancer
A number of tests are performed to determine whether an ovarian cyst is actually ovarian cancer. An ultrasound is often done first. A laparoscopic surgical procedure, in which a tiny camera is inserted into the area through small abdominal incisions, can also be done to see and remove the ovarian cyst.
Other tests can help determine if the cyst is malignant or benign. The CA-125 blood test and even a pregnancy test can give clues as to what type of ovarian cyst you have. An MRI (magnetic resonance imaging) test and a pelvic exam could also be done to detect cysts.
It's very important for anyone with persistent symptoms to mention them to their doctor. Treatment could be as simple as keeping an eye on it, or as serious as surgery to remove the cyst. Being aware of ovarian cysts and working with your doctor to monitor them can help protect you against ovarian cancer.
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Missing a Cancer Diagnosis

By SUSAN GUBAR
Stuart Bradford
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Living With Cancer
LIVING WITH CANCER
Susan Gubar writes about life with ovarian cancer.
Stories of misdiagnoses circulate throughout the testimonies of people contending with all sorts of cancers. Such errors, made by patients as well as doctors, bring in their wake a sense of betrayal, self-recrimination and anger. Should we accept them as inevitable?
Like many women, I misinterpreted the muted symptoms of ovarian cancer. Bloating, satiety, fatigue and constipation are often attributed to menopause, aging, indigestion, irritable bowel syndrome, depression, laziness or whining. My general practitioner prescribed half a cup of wheat bran, applesauce and prune juice every day. By the time a CT was ordered a year later, the cancer had progressed to an advanced stage that is treatable but not curable. I was furious at myself and upset with my doctor.
People leading active lives seem especially prone to dismissing subtle warning signs. The philosopher Gillian Rose declared, “I was so attuned to regular exercise of body and mind that I could easily take minor symptoms of ill-health in my stride.” Similarly, the physician and marathon runner Dr. Geoffrey Kurland deceived himself about symptoms of leukemia: “I now realize that for several months my body had been giving me warnings I had chosen to ignore, warnings that something was not right with me.”
Physicians are particularly likely to miss a cancer diagnosis in the case of young adults. According to S. Lochlann Jain’s book “Malignant,” “doctors often work under the misguided assumption that cancer is a disease of older people, leading to an immorally high number of delayed diagnoses and, in turn, the large proportion of late-stage cancers.” When she received a late-stage breast cancer diagnosis in her mid-30s, Professor Jain turned to the tort system because her doctor had first refused to biopsy a lump in her breast and then ordered a fine needle aspiration (rather than a more reliable core biopsy). A false negative deferred treatment.
One 2013 study, undertaken by the National Coalition on Health Care along with Best Doctors, Inc., found a disconnect between what cancer specialists assume to be the case about physician misdiagnosis and the facts of the matter. A majority of the 400 doctors in the study believed that from zero to 10 percent of patients are misdiagnosed; however, research indicates that the actual figure may be as high as 28 percent. I suspect that patients would put the percentage higher.
There are, of course, numerous causes of misdiagnosis: physician overconfidence or complacency, insufficient time with a patient, unreliable detection tools and poor pathology protocols, knowledge limited by over- or under-specialization, fragmented informational systems, and patient inattention or repression. But regardless of cause, the results can be catastrophic.
Ironically, the fate of a sociologist who studied endemic medical errors illuminates the consequences of a misdiagnosed sarcoma. Marianne A. Paget’s physician in Illinois failed to order a chest X-ray in the course of investigating the source of her back pain. And then a Florida physician misread an X-ray as normal. Ms. Paget first experienced symptoms in late 1987. It took eight months to get the cancer diagnosis. Despite extensive treatments, she died in Dec. 1989, at age 49.
Misdiagnosis can result in devastating surgical blunders, too. A friend’s sister, Lisa, underwent surgery for what her doctor assumed was a benign ovarian cyst, which he removed. He saw a suspicious area on the second ovary and — without waiting for the pathology report of the frozen section — cut into it. It turned out the lesion was cancerous and, by slicing into it, he had released cancer cells into her body.
A senior surgeon stepped in and successfully completed a much larger operation than had been planned, then insisted that the first surgeon tell Lisa what had happened. Lisa was horrified by the first doctor’s “huge mistake,” which “increased the risk of recurrence dramatically.” But the honesty of both doctors allowed her “to keep a sense of trust in them.”
Lisa uses the word “mistake” when she talks about her first surgeon’s error, avoiding words like “incompetence,” “negligence” and “malpractice” that suggest culpability, dereliction of duty, violation of professional standards, and the legal assignment of blame. In contrast, Professor Jain points out that legal recourse, and in particular “lost chance” claims, which establish the difference in prognosis if the cancer had been found sooner, can be used to raise doctors’ consciousness about cancer’s occurrence in younger people and help patients gain compensation for expensive injuries that are irreparable. Missed diagnoses make up a considerable proportion of malpractice claims.
But how many of us have the strength, or the money or expertise, to manipulate complex legal systems and take on the burden of proof in order to protest bungles that continue to exact their toll in suffering? And since patients make mistakes, too, we often concede that they arise less from irrevocable faults in our physicians, and more from the fallibility of medicine. “To err is human; to forgive, divine,” as the poet Alexander Pope put what has since become a platitude: mistakes happen.
In my all too human way, I struggle to forgive the honest mistakes of my doctors who are also mere mortals. Sometimes, though, I have trouble forgiving myself.
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