Thursday, February 19, 2015

Cancer treatments could evolve from research showing that acetate supplements speed up cancer growth

UT Southwestern Medical Center researchers seeking novel ways to combat cancer found that giving acetate, a major compound produced in the gut by host bacteria, to mice sped up the growth and metastasis of tumors.

Bacteria living inside the gut can have beneficial, but potentially also harmful effects on human health. Further studies are needed to determine whether restricting acetate production by gut bacteria will affect growth of tumors.

"With insights generated from our current studies, we may be able to design therapies that treat cancer patients by modulating acetate production in the body," said Dr. Joseph Garcia, Associate Professor of Internal Medicine at UT Southwestern and staff physician-scientist at the VA North Texas Health Care System.

The work is published in the February issue of the journal PLOS ONE.

Cancer, the second leading cause of death in the US, is estimated to account for nearly 1 out of every 4 deaths in 2014. It can have a significant impact on length and quality of life, which carries a tremendous economic burden. Cancer can develop in any part of the body and some are notoriously difficult to treat, although recent discoveries from basic science laboratories hold great promise for more effective treatments and potential cures.

In cancer cells, low oxygen and low glucose conditions turn on signaling pathways that allow otherwise healthy cells to survive these stresses. UT Southwestern researchers previously discovered a critical pathway that controls the response of cells and organs to low oxygen conditions, a state known as hypoxia. In this study, the researchers show that the production of acetate is also stimulated by low glucose conditions, another condition frequently found in solid tumors.

Acetate, in turn, activates a molecular pathway that ultimately results in the production of several proteins that stimulate the growth and spread of tumors.

"Our study shows that acetate functions in this context as a growth signal for cancer cells, one that links changes in metabolism within cancer cells that occur during tumor growth with activation of a selective stress-signaling pathway. This same signaling pathway is normally protective in healthy individuals. In fact, stimulating this pathway in anemic mice without cancer has a profound effect on restoring red blood cell levels to near-normal or normal levels, and is otherwise very safe" said Dr. Garcia, a member of the Harold C. Simmons Comprehensive Cancer Center.

"The challenge facing us now is to define which patients may benefit from having this pathway stimulated and which patients will benefit from having this pathway inhibited. Preclinical studies of this nature are essential for informing the pharmaceutical and federal health oversight agencies about potential benefits as well as potential harms that may result from use of compounds that affect this key signaling pathway," said Dr. Garcia.

http://medicalxpress.com/news/2015-02-cancer-treatments-evolve-acetate-supplements.html

Chemobrain—It’s Real, It’s Complex, and the Science Is Still Evolving

Author: Susan Krigel, PhD

Talk with almost any cancer survivor, and he or she is likely to bring up the topic of “chemobrain,” that that fuzzy, murky state that patients blame for impaired memory. When physicians first began hearing patients complain about chemobrain, they may have wondered whether it truly existed. As time has passed, they may now be wondering why science hasn’t found a solution.

A review of the research documenting cognitive decline after chemotherapy indicates that the most common complaints have concerned learning and memory, processing speed, verbal and spatial abilities and executive function (planning and decision-making).

Interestingly, about half of the studies reviewed documented cognitive decline even before the initiation of chemotherapy. Cognitive impairment due to chemotherapy can significantly impair a patient’s quality of life. A recent review of 17 qualitative studies focusing on patients’ experience of chemobrain documented that patients reported fearing that they “were going crazy,” or developing Alzheimer’s. Patients noted they had difficulty learning and had to work harder to accomplish tasks. As a result, they were less confident in work and social situations.

[Read "Finding Solutions for Chemobrain" from CURE's winter 2013 issue]

Estimates vary on the prevalence and duration of chemobrain, due in part to timing of assessment and degree of impairment. A recent meta-analysis demonstrated that about 16 percent to 75 percent of breast cancer patients had moderate to severe impairment. As may be expected, deficits are most evident during treatment, with most patients returning to baseline within a few months of completing chemotherapy. However, a subset of patients has been found to have ongoing deficits, even after 20 years. Older patients with lower cognitive reserve at baseline are most likely to have higher levels of impairment. Co-occuring factors may also contribute to chemobrain. Approximately 30 percent of cancer patients experience depression, anxiety or distress during treatment, and depressed individuals score lower than non-depressed individuals on neuropsychological tests in attention, sustained attention, processing speed, recall, fluency, and speed of retrieval.

Fatigue, an almost universal symptom during and shortly after cancer treatment, may impair memory by decreasing attention, processing speed, and motivation. In addition, about 30 percent to 60 percent of cancer patients report having insomnia, which may cause poor concentration and memory.

What Is the Evidence Behind Chemobrain?

Although cancer patients have been reporting symptoms of cognitive impairment for many years, the first scientific studies began appearing in the mid-1990s. Some of the first studies began exploring the impact of particular chemotherapy protocols on cognition.

But as studies progressed, it seemed that more questions arose than were being resolved. There were so many confounding factors, such as age, hormonal status, baseline cognitive performance, educational level, genetic predisposition, comorbidities that impact oxygenation, depression, anxiety, fatigue, pain, anemia, time since treatment and dietary factors. How would it be possible to control for all those factors?

Thankfully, advances in neuroimaging have provided us with information that has moved the field forward. Functional MRI (fMRI) studies have documented that: Chemotherapy results in both cerebral functional and structural changes; the alterations correlate with complaints regarding impaired cognition and performance, and the alterations persist over time.

In an early study exploring functional changes in the brain due to chemotherapy, researchers asked twin, 60-year-old females, one of whom had been treated with chemotherapy, to perform a series of tasks while undergoing fMRI. The resulting images documented areas of hyperactivity in the chemotherapy-treated twin relative to the untreated twin, which the authors interpreted as areas of deficits due to chemotherapy.

[Read "Lifting the Fog on Chemobrain" from CURE's summer 2011 issue]

Findings of several functional brain imaging studies have been reviewed by Reuter-Lorenz and Cimprich, and relative to “controls,” individuals treated with chemotherapy have been found to exhibit functional differences, including both areas of hyper- and hypoactivity during tasks, as well as differences in brain activity while the brain is at rest.

In addition, structural differences have been noted as well. Researchers compared brain images of women with breast cancer, some of whom received chemotherapy and some did not, and found decreases in volume and density of both white and grey matter in the group treated with chemotherapy. Chemotherapy-related reductions in grey matter have also been correlated with impairment in cognitive abilities.

Researchers have constructed a model detailing a proposed mechanism by which cancer treatment may lead to cognitive changes: Cancer treatment (chemotherapy but also including surgery, radiation treatment and hormonal therapy) combined with other clinical factors (inflammation, stress, fatigue, comorbidities and co-occurring symptoms) lead to cytokine dysregulation, hormonal changes and neurotransmitter dysfunction. This process, which may be moderated by baseline cognitive function, genetic variations, and age, combine to create cognitive changes. Researchers have put forth another model in which chemotherapy increases oxidative stress and inflammation, and decreases brain vascularization, neurogenesis and growth factors, and catecholamines.

These processes combine to decrease hippocampal function, leading to impaired learning and memory, and decrease frontal cortex function, which hinders planning and decision-making.

What Treatments Are Available?

The National Comprehensive Cancer Network’s Guidelines on Cognitive Function assert that despite increasing evidence of the validity of cancer-related cognitive dysfunction, there is limited evidence regarding treatment. Healthcare professionals are urged to validate patient concerns, provide education and to assess for contributing factors, including medications, depression, anxiety, pain, fatigue, substance abuse and sleep disturbance. Imaging studies are only recommended in specific situations.

Although most patients eventually return to pretreatment baseline, a subset report significant impairment in quality of life, independence and self-confidence. One of the most important things physicians can do is to provide emotional support by listening to the patient’s concerns and validating the existence of chemobrain.
It is common for families, coworkers and friends (and sometimes even healthcare professionals) to not understand that the emotional, physical or cognitive effects of cancer treatment may linger after treatment has ended. In a review of treatments for chemobrain, researchers categorized treatment into pharmacologic and non-pharmacologic interventions. The review documented that so far there is no strong evidence supporting the effectiveness of medications for chemobrain. Trials have explored the use of psychostimulants and drugs used to treat dementia; however, results have been mixed, and further research is needed.
Erythropoietinstimulating agents have also been tested, but due to concerns with adverse effects, they are not recommended for this purpose. Despite advertisements touting the effectiveness of their own programs, currently no strong evidence exists that computerized cognitive training produces significant, lasting, cognitive benefits.

Thankfully, non-pharmacologic strategies are available, including exercise, mindfulness, social support, and organizational strategies (See Box). Perhaps the largest body of evidence supports exercise to boost cognitive function, although much of the research in this area has been conducted with noncancer populations. Several studies with cancer patients have documented the effectiveness of exercise, including Qigong, Tai Chi, physical fitness, and resistance training to alleviate the symptoms of chemobrain.

One review documented that structured cognitive training programs, addressing memory, attention and processing speed have been promising, but the programs are not generally available outside of clinical trials. One final note: A recent study found that loneliness increases the risk of cognitive problems among breast cancer survivors. Encouraging increased socialization for those at risk of being lonely may be helpful.

http://www.curetoday.com/articles/ChemobrainIts-Real-Its-Complex-and-the-Science-Is-Still-Evolving

My Own Life

Oliver Sacks on Learning He Has Terminal Cancer

By OLIVER SACKSFEB. 19, 2015

Continue reading the main story

A MONTH ago, I felt that I was in good health, even robust health. At 81, I still swim a mile a day. But my luck has run out — a few weeks ago I learned that I have multiple metastases in the liver. Nine years ago it was discovered that I had a rare tumor of the eye, an ocular melanoma. Although the radiation and lasering to remove the tumor ultimately left me blind in that eye, only in very rare cases do such tumors metastasize. I am among the unlucky 2 percent.

I feel grateful that I have been granted nine years of good health and productivity since the original diagnosis, but now I am face to face with dying. The cancer occupies a third of my liver, and though its advance may be slowed, this particular sort of cancer cannot be halted.

It is up to me now to choose how to live out the months that remain to me. I have to live in the richest, deepest, most productive way I can. In this I am encouraged by the words of one of my favorite philosophers, David Hume, who, upon learning that he was mortally ill at age 65, wrote a short autobiography in a single day in April of 1776. He titled it “My Own Life.”

“I now reckon upon a speedy dissolution,” he wrote. “I have suffered very little pain from my disorder; and what is more strange, have, notwithstanding the great decline of my person, never suffered a moment’s abatement of my spirits. I possess the same ardour as ever in study, and the same gaiety in company.”

I have been lucky enough to live past 80, and the 15 years allotted to me beyond Hume’s three score and five have been equally rich in work and love. In that time, I have published five books and completed an autobiography (rather longer than Hume’s few pages) to be published this spring; I have several other books nearly finished.

Hume continued, “I am ... a man of mild dispositions, of command of temper, of an open, social, and cheerful humour, capable of attachment, but little susceptible of enmity, and of great moderation in all my passions.”

Here I depart from Hume. While I have enjoyed loving relationships and friendships and have no real enmities, I cannot say (nor would anyone who knows me say) that I am a man of mild dispositions. On the contrary, I am a man of vehement disposition, with violent enthusiasms, and extreme immoderation in all my passions.

And yet, one line from Hume’s essay strikes me as especially true: “It is difficult,” he wrote, “to be more detached from life than I am at present.”

Over the last few days, I have been able to see my life as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts. This does not mean I am finished with life.

On the contrary, I feel intensely alive, and I want and hope in the time that remains to deepen my friendships, to say farewell to those I love, to write more, to travel if I have the strength, to achieve new levels of understanding and insight.

This will involve audacity, clarity and plain speaking; trying to straighten my accounts with the world. But there will be time, too, for some fun (and even some silliness, as well).

I feel a sudden clear focus and perspective. There is no time for anything inessential. I must focus on myself, my work and my friends. I shall no longer look at “NewsHour” every night. I shall no longer pay any attention to politics or arguments about global warming.

This is not indifference but detachment — I still care deeply about the Middle East, about global warming, about growing inequality, but these are no longer my business; they belong to the future. I rejoice when I meet gifted young people — even the one who biopsied and diagnosed my metastases. I feel the future is in good hands.

I have been increasingly conscious, for the last 10 years or so, of deaths among my contemporaries. My generation is on the way out, and each death I have felt as an abruption, a tearing away of part of myself. There will be no one like us when we are gone, but then there is no one like anyone else, ever. When people die, they cannot be replaced. They leave holes that cannot be filled, for it is the fate — the genetic and neural fate — of every human being to be a unique individual, to find his own path, to live his own life, to die his own death.

I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and traveled and thought and written. I have had an intercourse with the world, the special intercourse of writers and readers.

Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.

Friday, February 13, 2015

The Cancer That's Poised To Explode

Not long ago, a new medical epidemic arose: "the cancer." When people started to live longer, their aging bodies began to succumb to this disease we only poorly understood. Looking back, it is clear that much has changed for the better.

As we recognize World Cancer Day 2015, we have a lot to celebrate. By a number of measures, we are on our way to beating cancer. The Susan G. Komen foundation is arguably the most powerful medical advocacy organization the world has ever seen, and the growing awareness of lung cancer has nearly suffocated the multi-billion dollar tobacco industry. In almost all corners of the world, we are beginning to live and act in ways that lower our risk of getting cancer.

But the story is not only of progress. Though we've made leaps in our abilities to prevent, treat, and manage "the cancer," our success remains patchwork.

A quick pop quiz demonstrates the point. One-third of all cancer diagnoses are for cancer of the ________. a) bones; b) skin; c) pancreas; d) colon.

One doubts that many would have answered "skin" with any degree of confidence. And that's too bad, because many cases of skin cancer are preventable. But we're not paying attention.

In the past decade, we have seen a magnificent proliferation of the "heart healthy" icons on our foods. But where's the "skin healthy" icons on our soaps, lotions, and sunscreens? And as the NFL and Major League Baseball have brought the Komen Foundation's signature pink to cleats, gloves, bats, and penalty flags, where are the symbols for skin cancer?

Out of sight, out of mind.

Looking ahead, skin cancer is poised to explode. As people live longer -- as individuals routinely celebrate their 80th, 90th, and even 100th birthdays -- their skin will deteriorate. And with this deterioration comes an increase in susceptibility to cancer. This decline is, at the moment, nearly inevitable. That needs to stop. Healthy skin in older age is possible -- and it's an enabler of healthy aging.

This conclusion was reached at the first summit of its kind in Manchester, England, in June of 2014. A cross-sector group of experts from medicine, innovation, economics, and demography convened and agreed that a "life-course of healthy skin" is a pillar ofhealthy and active aging in the 21st century.

Moreover, it was also agreed that the need for healthy skin was pressing, given the rate at which the population is aging and the increased risk that older adults have in contracting skin cancer.

The data is powerful. Of all cases of non-melanoma skin cancer, more than 80 percent occur in people over 60. And over half of melanoma skin cancers occur in people over 50.

And, with nearly one-third of the U.S. population over 55 within the next five years, it is not only a health imperative to become more proactive in caring for our skin -- but also a social and economic imperative. In other "old" societies like Europe and Japan, the imperative is even greater. In emerging markets, which are still "younger" but are aging at breakneck pace, there is also no time to waste.

To elevate skin cancer to its rightful place at the top of our public health agenda, we will need to see strategies from both public and private leaders.

What Policymakers Can Do
In case you missed it, Congress and Obama signed the Sunscreen Innovation Act at the close of 2014. This was a smart move. It will streamline the FDA review and ingredient approval process so better, more innovative sunscreens can make it to supermarket shelves at a faster pace.

It's a step in the right direction, but let's use World Cancer Day to demand more action from the White House and Capitol Hill. Let's leverage World Cancer Day to get better sunscreens out of the shadows of the FDA's filing system.

Even more, let's ensure that this piece of legislation triggers a basic public policy shift where spending on health - including innovative medicines -- is seen as an investment in healthy aging that will have huge payback. From FDA regulations to government pricing policies, the next wave of innovative cancer medicines will be facilitated by a supportive environment innovation.

What Health Companies Can Do
If history is any guide, we are best at beating diseases when science, innovation, and business strategy come together. Looking at skin health as well as cancer treatment and prevention, we might be witnessing the first sign of such a marriage. Reuters recently reported that Nestle is planning to open 10 "skin care research centers" worldwide.

This is the latest sign that Nestle is investing seriously in dermatology, with a particular interest in age-related skin conditions. Nestle's Galderma, which has been in the skin health business for decades, is showing a commitment to a life course of healthy skin for all of us. This includes skin cancer, of course, but it also stretches to other conditions of our aging skin, which, when addressed, will lead to a healthier aging.

This World Cancer Day, let's reflect on our tremendous progress. Since "the cancer" was first recognized as a lethal disease, we've made remarkable strides in prevention and treatment. But it's time to broaden our lens. Our skin is our first line of defense, and also the site of one-third of all diagnosed cancers.

Michael Hodin Become a fan

Executive Director, Global Coalition on Aging

http://www.huffingtonpost.com/michael-hodin/cancer-poised-to-explode_b_6603854.html?ncid=txtlnkusaolp00000592

Friday, February 6, 2015

Glowing compound could lead to more effective cancer surgery

By Nick Lavars

January 8, 2015

2 Pictures

Scientists have developed a a new method that sees cancer cells glow, potentially allowing for more accurate surgeries (Image: Shutterstock)

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Scientists from Oregon State University (OSU) have developed a new method that could make for better precision in the killing of cancer cells. The technique puts to use a unique compound with the ability to illuminate cancerous cells when exposed to near-infrared light, potentially acting as markers for surgeons taking on the intricate task of tumor removal.

The compound in question, known as naphthalocyanine, has three useful attributes once it has been exposed to near-infrared light. It can warm cancer cells and kill them off, it generates reactive oxygen species that can also cause the cancer cells to die, and it glows to serve as a potential marker for surgeons.

However, one weakness of naphthalocyanine is that it isn't water soluble, meaning that once it enters the body it tends to form clumps, foregoing its ability to make cells glow and produce the reactive oxygen species. On the plus side, the compound's properties can be manipulated by exposing it to different light intensities. So, by applying just the right amount of near-infrared light, it can be used to kill off only cancerous cells and leave healthy tissue unharmed.

To overcome its aversion to water, the researchers used a special water-soluble polymer called dendrimer. This enables the naphthalocyanine to travel inside a molecule that is attracted only to cancer cells and not healthy tissue. Once attached to the tumor, the scientists applied the required intensity of light, illuminating the cancer cells for the surgeons to more easily determine which tissues need removing. Completing the two-pronged attack, the lighting was optimized to activate the heating ability of the naphthalocyanine, killing off the cancer cells that might still linger following surgery.

The scientists performed their studies with laboratory mice, which showed no side effects. They say the technique shows great promise in improving the success rate of cancer treatments.

"With this approach, cancerous cells and tumors will literally glow and fluoresce when exposed to near-infrared light, giving the surgeon a precise guide about what to remove," says Oleh Taratula, an assistant professor in the OSU College of Pharmacy. “That same light will activate compounds in the cancer cells that will kill any malignant cells that remain. It’s an exciting new approach to help surgery succeed.”

Like-minded researchers have developed similar techniques in the past, involving different instruments and varying approaches. Early last year, scientists at Washington University produced a set of goggles through which surgeons could see cancer cells as a blue glow. Meanwhile, back in 2010 a device called the SpectroPen emerged, which was designed to make the edges of a tumor more visible during surgery.

But the OSU team says its approach could lead to a cheaper, more effective method than other solutions, and with less side effects. Next, it plans to perfect the process and test it on dogs with malignant tumors.

The research was published in the journal Nanoscale.

Source: Oregon State University

http://www.gizmag.com/glowing-compound-cancer-surgery/35531/?utm_source=Gizmag+Subscribers&utm_campaign=ba2dfbdaf4-UA-2235360-4&utm_medium=email&utm_term=0_65b67362bd-ba2dfbdaf4-90055698

New study may provide fresh avenues of treatment for patients suffering from skin diseases

By Anthony Wood

January 15, 2015

1 Comment

A new study from KCL could lead to treatment options designed to lower the of occurrence of cancerous tumors forming around broken skin (Photo: Shutterstock)

A fresh study carried out by researchers from King's College London (KCL) has established a link between a certain form of bacteria present on the skin following a surface wound and a type of white blood cell receptor, that together tip the scale away from the normal healing process and instead encourage the formation of cancerous tumors. The results of the study have the potential to create innovative treatment options for patients suffering from skin diseases, such as those that result in chronic ulcers and severe blistering.

There is a long standing association between tissue damage in patients suffering from chronic skin inflammation and the occurrence of cancerous tumors, however the reasoning behind the phenomenon has never been truly understood. The research carried out by KCL has brought us one step closer by establishing a link between the receptor found on the surface of white blood cells, Toll-like receptor 5 (TLR5), and the bacteria flagellin.

Over the course of the study, mice exhibiting chronic skin inflammation were wounded on their side, resulting in tumors forming around the break in the skin, with heightened levels of the protein HMGB1 being observed.

Ordinarily, the protective characteristics of unbroken skin prevent the flagellin and the white blood cells from interacting. However, when there is a break in the skin, the bacteria come into direct contact with the body's protective white blood cells, and more specifically, the TLR5 receptors that coat the outer layer of the tiny protectors.

When the receptors detect the bacteria, they increase the amount of HMGB1 present around the wound, and it is the heightened concentration of this protein that the team believes is responsible for disrupting the body's ordinary healing process, instead prompting the growth of cancerous tumors.

While the team is as of yet unsure how their findings will translate to human tumor growth, members have drawn a comparison with patients suffering from the disease epidermolysis bullosa, an extremely painful and debilitating condition that manifests itself through fragile skin and painful blisters.

Patients suffering from the disease run an increased risk of tumors forming around the open wounds that are so prevalent with this condition, and researchers have noted that, like the mice afflicted with chronic skin inflammation, sufferers of epidermolysis bullosa exhibit the same increased levels of HMGB1.

"These findings have broad implications for various types of cancers and in particular for the treatment of tumors that arise in patients suffering from chronic ulcers or skin blistering diseases," states lead author and Director of the Center for Stem Cells and Regenerative Medicine at KCL, Professor Fiona Watt. "Our findings raise the possibility that the use of specific antibiotics targeting bacteria in wound-induced malignancies might present an interesting clinical avenue."

The study is available in the online journal Nature Communications.

Source: King's College London

http://www.gizmag.com/kcl-skin-disease-cancer-tumor-flagellin-hmgb1-tlr5/35608/?utm_source=Gizmag+Subscribers&utm_campaign=858dec0a2a-UA-2235360-4&utm_medium=email&utm_term=0_65b67362bd-858dec0a2a-90055698

Tuesday, February 3, 2015

Ultrasound Narrows Which Breast Cancer Patients Need Lymph Nodes Removed

Rochester, Minn. — Which breast cancer patients need to have underarm lymph nodes removed? Mayo Clinic-led research is narrowing it down. A new study finds that not all women with lymph node-positive breast cancer treated with chemotherapy before surgery need to have all of their underarm nodes taken out. Ultrasound is a useful tool for judging before breast cancer surgery whether chemotherapy eliminated cancer from the underarm lymph nodes, the researchers found. The findings are published in the Journal of Clinical Oncology.

This ultrasound shows an abnormal lymph node before chemotherapy for breast cancer (Mayo Clinic).

In the past, when breast cancer was discovered to have spread to the lymph nodes under the arm, surgeons routinely removed all of them. Taking out all of those lymph nodes may cause arm swelling called lymphedema and limit the arm’s range of motion.

Now, many breast cancer patients receive chemotherapy before surgery. Thanks to improvements in chemotherapy drugs and use of targeted therapy, surgeons are seeing more women whose cancer is eradicated from the lymph nodes by the time they reach the operating room, says lead author Judy C. Boughey, M.D. a breast surgeon at Mayo Clinic in Rochester.

MEDIA CONTACT: Sharon Theimer, Mayo Clinic Public Affairs, 507-284-5005, Email: newsbureau@mayo.edu
Journalists: Sound bites with Dr. Boughey are available in the downloads.

The current study finds that repeating ultrasound after chemotherapy is a sound way to help determine whether surgeons should remove only a few lymph nodes and test them for cancer, sparing patients whose sentinel nodesare cancer-free the removal of all nodes in the armpit, or take out all of the nodes, Dr. Boughey says.

“Our goal here is really to try to get away from, ‘Every patient with breast cancer needs these drugs, and this amount of chemotherapy and this surgery,’ and instead to personalize surgical treatment based on how the patient responds to chemotherapy,” Dr. Boughey says.

Avoiding complete underarm lymph node removal when possible means fewer women will experience the complications that can accompany that surgery, and avoiding those side effects should also save health care costs, she says.

This ultrasound shows a lymph node appearing normal after chemotherapy for breast cancer (Mayo Clinic).

“That’s one of the really nice things about giving chemotherapy up front: It allows us to be less invasive with surgery, both in terms of breast surgery and lymph node surgery, and to tailor treatment based on response to chemotherapy,” Dr. Boughey says.

Most patients with lymph node-positive breast cancer receiveradiation treatment after surgery. A new study is under way formen and women with breast cancer whose underarm lymph nodes are still positive for cancer after chemotherapy. It will evaluate which is more effective: removing all of those nodes, or leaving the nodes and treating them with radiation, Dr. Boughey says.

The current research was supported by National Cancer Institute grants U10 CA76001 to the American College of Surgeons Oncology Group, CA31946 to the Alliance for Clinical Trials in Oncology and CA33601 to the Alliance Statistics and Data Center.

The study’s senior author is Huong T. Le-Petross, M.D., of MD Anderson Cancer Center in Houston. Co-authors include Karla V. Ballman, Ph.D., of the Alliance Statistics and Data Center at Mayo Clinic in Rochester; Kelly K. Hunt, M.D., and Elizabeth A. Mittendorf, M.D., Ph.D., of MD Anderson Cancer Center; Linda M. McCall of the Alliance Statistics and Data Center at Duke University in Durham, N.C.; Gretchen M. Ahrendt, M.D., of the University of Pittsburgh Cancer Institute in Pittsburgh, Pa., and Lee G. Wilke, M.D., of the University of Wisconsin Hospital and Clinics in Madison, Wis.

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About Mayo ClinicMayo Clinic is a nonprofit organization committed to medical research and education, and providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinicor http://newsnetwork.mayoclinic.org/.

About the Alliance for Clinical Trials in OncologyThe Alliance for Clinical Trials in Oncology is a national clinical trials network sponsored by the National Cancer Institute that consists of a network of nearly 10,000 cancer specialists at hospitals, medical centers, and community sites across the country and Canada. The Alliance is dedicated to developing and conducting clinical trials with promising new cancer therapies, and utilizes the best science to develop optimal treatment and prevention strategies for cancer, as well as researching methods to alleviate side effects of cancer and cancer treatments. To learn more about the Alliance, visit http://www.allianceforclinicaltrialsinoncology.org/.

http://newsnetwork.mayoclinic.org/discussion/which-breast-cancer-patients-need-lymph-nodes-removed-ultrasound-narrows-it-down-study-finds/