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CancerTreatment

In previous articles (February 28 and March 14) I described cancer in general terms and then discussed specific common cancers. Now I would like to describe various cancer treatments available and methods of cancer prevention.

There are a variety of treatments available today for treating cancer, including:

- Surgery. This can remove the cancer or as much of it as possible.

- Radiation. This uses X-rays to kill cancer cells.

- Chemotherapy. This uses potent drugs to kill the cancer cells.

- Stem cell transplant. This is also commonly called bone marrow transplant. This uses stem cells which are found in the bone marrow and are the precursors to all other blood cells. The cells are collected from the patient, or less commonly from a donor, and then placed back into the patient after receiving a large dose of chemotherapy or radiation. This allows for the creation of a new healthy bone marrow and immune system.

- Hormone therapy. Some cancers such as breast cancer and prostate cancer are worsened due to the effects of certain hormones in our bodies. Blocking these effects is the goal of hormone therapy.

- Targeted drug therapy. This method allows an anti-cancer drug to specifically attack a specified cancer cell.

- Biological therapy. Helps your own immune system to better recognize and fight off cancer cells.

- Alternative medicine. Not scientifically proven, yet found to be quite helpful for many patients. Such therapies include meditation, acupuncture, yoga, massage, and hypnosis.

- Vitamins and food supplements. Also unproven, but widely used with some success.

Although there is no way as of yet to prevent cancer, there are ways to reduce the risk of having cancer including:

- Stop smoking. Smoking has been associated with many types of cancer, not just lung cancer.

- Eat a healthy diet. Concentrate on fruits and vegetables and select whole grains and non-fatty proteins.

- Avoiding excessive sun exposure. Avoid mid-day sun, use sun screen liberally and avoid tanning booths.

- Get plenty of exercise. At least 30 minutes of exercise daily is a good goal.

- Avoid obesity. Maintain a healthy weight.

- Drink alcohol in moderation if you choose to drink. One dink per day for women, two drinks per day for men.

- Schedule routine screening exams. Talk to your doctor about what exams you may need depending on your risk factors.

The bad news about cancer is that it is still so very prevalent in our society. As I have personally found out, anyone can experience it. The good news is that through early detection and rapidly improving treatments, cancer patients in general have a much improved survival rate. I think that if researchers can somehow find methods to mobilize our immune systems to better recognize cancer and to successfully overwhelm it in its early stages, we may then be close to a cure for many cancers.

From my own personal experience with cancer and from many patients I have treated, my advice is that if something about your health just doesn’t seem right, don’t assume it’s nothing to worry about. Listen to your body as only you can do. Don’t take a chance. Being checked out by your doctor sooner rather than later could save your life.

cancer2

In this article I would like to summarize information for a variety of common cancers as the second of my three-part series on the disease.

-Breast: More than 225,000 new cases of breast cancer are expected this year among women and over 2,000 cases in men. Breast cancer is the most frequently diagnosed cancer in women. Increasing age is the most common risk factor. The survival rate has improved dramatically due to early detection and improving treatments.

-Prostate: Close to 250,000 new cases of prostate cancer are expected this year. It is the most common cancer for men. Increasing age is the most common risk factor. Fortunately more than 90 percent of all prostate cancers are discovered before metastasis occurs, for which there is a five year survival rate close to 100 percent.

-Lung: Some 250,000 cases of lung cancer are expected this year which accounts for more deaths than any other cancer in both men and women. Cigarette smoking is by far the most common risk factor for lung cancer, and increases depending on the number of cigarettes smoked daily and the number of years of smoking. Death rates are dropping as a greater number of people are quitting smoking.

-Colon and Rectum: Over 150,000 cases of colorectal cancer are expected this year. Fortunately, the rate is falling significantly as more people are having colonoscopies which allows for the removal of precancerous polyps. Only 65 percent of eligible adults have been screened as recommended.

-Urinary bladder: Some 75,000 cases of bladder cancer are expected this year. It is found four times more frequently in men than in women. The most common symptom is blood in the urine.

-Uterine: Almost 50,000 cases are expected this year. Early symptoms include vaginal bleeding or spotting, as well as pelvic pain. Obesity and exposure to the hormone estrogen are risk factors.

-Melanoma: Close to 80,000 people will be diagnosed with melanoma, a potentially deadly skin cancer which often metastasizes to other parts of the body. Major risk factors include family history of melanoma, the presence of numerous moles (more than 50), and exposure to ultraviolet rays mostly from sun exposure, but also from tanning booths.

-Kidney: Over 65,000 cases of kidney cancer are expected this year. There are usually no symptoms early in the disease. Tobacco use is a strong risk factor.

-Lymphoma: Close to 70,000 cases of lymphoma will occur this year. This is a cancer of lymphocytes, a type of blood cell. Symptoms include swollen lymph glands, night sweats, weight loss, fatigue, and fever.

-Leukemia: Around 50,000 cases of leukemia are expected this year. Leukemia is a cancer of the bone marrow and blood cells. Leukemia is difficult to diagnose early because symptoms often mimic other less-serious conditions.

-Pancreas: Some 45,000 cases of pancreatic cancer are expected this year. Unfortunately, there are very few symptoms early in the disease, and is therefore not detected until it has spread to other organs. By the time it is detected treatment is often unsuccessful.

-Ovary: Over 22,000 women will be diagnosed with ovarian cancer this year. Symptoms are often nonspecific and include sensations of bloating, pelvic or abdominal pain, and urinary urgency and frequency. Diagnosis is usually confirmed by a pelvic exam and ultrasound test.

-Cervical: Around 12,000 cases will occur this year in women. The most common symptom is abnormal vaginal bleeding. The Pap test is the most common screening method. The primary cause of cervical cancer is infection with the human papillomavirus transmitted by sexual intercourse. It can now be prevented by a vaccine, which is highly recommended for females and males from ages nine to 26.

In this article, I have attempted to cover the most common types of cancer. Unfortunately there is a long list of other less common cancers.

My next and final article on cancer will discuss treatment and prevention of cancer. It will publish March 28.

C

My stem cell transplant has been put off for a while until I see some improvement of severe peripheral neuropathy in my feet and legs caused by the chemotherapy I received. So I am at home biding my time and able to continue writing for the foreseeable future. I’d like to begin today a three-part series on cancer.

Cancer definition and a description

When my oncologist told me that I had multiple myeloma, a type of blood cancer, all I could hear was the dreaded word “cancer.” I felt as if I had just received a death sentence. Even as a seasoned physician I found this difficult to accept. Throughout my career it was always other people who got cancer, not me. When I shared this news with my wife we both had a good cry. It wasn’t until I was told that of all the known cancers—multiple myeloma has one of the most successful treatments for remission—was I then able to get a grip on reality and wanted to get started with treatment.

Since my diagnosis, it seems that everyone I talk to has either had cancer, or has a family member or friend with cancer. It struck me that cancer is a lot more prevalent in our society than I had realized.

What exactly is cancer? Cancer is a group of diseases characterized by uncontrolled growth of abnormal cells that have the ability to spread to and destroy normal body tissue. Cancer cells may stay in one location only or they can spread to all parts of the body by traveling through the blood stream or the lymph system. Once cancer cells arrive at their final destination, they begin to grow and destroy normal tissue. When cancer spreads in this manner it is referred to as metastasis.

Cancer can be caused by internal factors such as genetic mutations, immune system conditions and metabolic disorders, and also by external factors, such as radiation or chemical exposures, tobacco or alcohol use, and even by infectious organisms.

As I have found out, anyone can develop cancer. The risk of cancer increases with age, with the majority of cancers occurring in those above 55 years of age. Sadly, it can also affect the very young. The risk for getting cancer over the course of a lifetime is one in two for men and for women it is one in three. In other words, one-half of all men and one-third of all women can expect to develop some form of cancer during their lifetimes. Only about five percent of all cancers are due to heredity (an internal factor) and the remainder are due to damage to genes occurring during one’s lifetime (the external factors as mentioned above).

About 15 million Americans are living with cancer. It is expected that over a million and a half new cases of cancer will occur this year. Almost 600,000 people will die this year from cancer which works out to more than 1,500 people a day. Cancer is the second leading cause of death in the U.S. exceeded only by heart disease. The cost of cancer is high, with some $100 billion being spent on direct medical care and treatment and about $125 billion of lost productivity due to premature death.

Common symptoms of cancer are:

- A change in weight, especially unintended weight loss.

- Significant fatigue or unexplained increasing pain.

- Changes of skin color, or texture or changes to an existing skin mole, or a sore that doesn’t heal.

- Persistent cough, difficulty swallowing, or hoarseness.

- Changes in bowel or bladder habits.

Risk factors for cancer include:

- Age. Since cancer can take long to develop it most commonly occurs later in life.

- Habits. Smoking, excessive alcohol consumption, exposure to the sun or tanning facilities, and unsafe sex.

- Environmental. Exposure to certain chemicals and second-hand smoke.

- Family history. Cancer development passed on through genes.

- Excess weight and lack of exercise.

There is some good news amongst all this information about cancer and that is that the survival rate for most cancers is improving. This encouraging improvement is due to earlier diagnosis of many cancers, as well as improvement of treatments.

In my next article I will discuss some of the most common types of cancers.

Myeloma journey

hollenbeckAs many of you know, I was diagnosed this past October with a cancer called multiple myeloma. This is a cancer of the plasma cells which are found in the blood and produce antibodies for our immune system. These malignant cells multiply rapidly and can cause damage throughout the body, especially affecting bones and kidneys and ultimately lead to death within two years if left untreated.

 

Myeloma’s effect on bone causes extreme osteoporosis (thinning of bones), which brought about my first symptom of back pain. This was due to several of the vertebral bones of my spine collapsing, which is referred to as compression fractures. Blood tests were done to find out why an otherwise healthy guy like myself would have these fractures. The specific test for myeloma was positive. This was shocking news to me as I immediately saw my life passing in front of my eyes. I was reassured, however, by being told by my oncologist that there is great new treatment for myeloma that can bring about long remissions.

The next step was a bone marrow biopsy to determine the severity of the disease. This procedure involved numbing the skin over the back of my pelvic bone and inserting a needle into the bone marrow to obtain a specimen for more detailed evaluation.

I then began a two month course of chemotherapy at our oncology infusion center here in Santa Cruz. I received three drugs. One was given as a shot (not by IV) and the other two were in pill form. One of the pills costs $700 per pill! Not an uncommon price for the new generation cancer drugs. My particular course of chemotherapy did not cause me to lose my hair, make me sick to my stomach, or any other of the common chemotherapy side effects. I was feeling pretty smug about how I was sailing through the therapy when finally a side effect caught up with me. I developed numbness of my feet and my hands, a condition called peripheral neuropathy. It is causing me some difficulty walking and maintaining my balance. I am told this condition should improve with time, but there is no guarantee that it will go away completely.

Regarding the ongoing back pain from my compression fractures, the day after Christmas, I had a procedure called kyphoplasty, done by a spine surgeon at University of California, San Francisco. This procedure involved my receiving a general anesthesia followed by the surgeon inserting a large needle into each of 4 compressed vertebral bones. Through the needle a small balloon is blown up to help open up the collapsed bone. The balloon is then removed and a rapid drying cement like substance is injected into the boney space. This helps to restore some integrity to the compressed bone and keeps it from collapsing further. It also usually improves the associated back pain, which fortunately proved to be true for me.

So I am now with much less back pain, but with numb feet, weak legs and some unsteadiness. I am tentatively scheduled for a stem cell transplant which will take place at UCSF in mid-February. At that time I will be hospitalized for an estimated three weeks, then allowed to return home, and will be on house confinement for another four weeks. After that it should take a few months to return to normal activities.

So, it is at this time that I will take a short leave of absence from writing my column, to allow me to focus in on the upcoming stem cell transplant and recovery. I will resume my writing after all is said and done and describe this experience.

Thanks for the prayers, cards, emails and general well wishes I have received from so many of you. It makes this all somewhat easier for me, as well as for my wonderfully supportive wife Beth and my dear daughter Emma.

I’ll be back!

Highlights from 2013

medicalarticles

As we prepare to begin a new year, I’d like to share with you some highlights from my columns this past year.

Upper respiratory infections:These infections which cause coughs, sore throats and congestion, are almost always caused by a virus infection and shouldn’t be treated with antibiotics. If symptoms continue to worsen, especially accompanied by a fever, see your doctor for evaluation and treatment.

Hepatitis C:Baby boomers (those born between 1945 and 1965), should be tested for hepatitis C as more than two million Americans currently are infected with this disease and many who are, are unaware of it.

Advanced directives:Sometimes referred to as “living wills,” advanced directives direct physicians as to your wishes for medical treatment if you were to be incapacitated and unable to make decisions on your own. Talk with your doctor about this important document.

Swallowing pills:If you have trouble swallowing them whole, most pills, capsules, or liquid medications, can be crushed and mixed in most any type of food. Check with your pharmacist to ensure that your particular pill or capsule can be mixed with food.

Hearing loss:If you are having problems with your hearing, make an appointment with a qualified audiologist and have a routine hearing test. Technological advances have made hearing aids an excellent option to restore hearing.

Hydration:To keep your body healthy, drink a glass of water or other low- or non-calorie beverage with each meal and between each meal, and drink water before, during, and after exercise.

Constipation:First try life style changes such as adequate liquid intake, and regular exercise. Maintain a high fiber diet to include beans, whole grains, fresh fruits and vegetables, and less dairy, red meat and processed foods.

Childhood immunizations:Immunizations are safe. Many well-controlled scientific studies have all concluded that there is no scientific or statistical relationship between immunizations and autism.

Vision disease:See your doctor immediately if you have any obvious visual change. People between the ages of 18 and 50 should have routine eye exams every two years and every year after the age of 50. Children need routine eye exams as well. Ask your child’s doctor about the frequency.

Hair loss:Losing some 50 to 100 hairs a day is considered normal. If you are experiencing what you consider to be hair loss of more than or sooner than you expect, talk to your doctor or dermatologist. Do this before spending a lot hard earned money on worthless treatments which are so frequently advertised to the public.

Nonprescription pain medication:You may choose from Tylenol, Advil, Aleve, or common aspirin to relieve most simple pain. Taken in the recommended dosage, Tylenol, which is effective and has less potential side effects, would be my first choice.

Generic drugs:With only a very few exceptions, generic drugs are equal in almost all aspects to the equivalent brand name drug and are much less expensive.

Diverticulitis:If you have worsening pain in the left lower abdomen, or no improvement of such pain for a few days, seek medical help immediately.

Have a very happy and healthy New Year!

diverticulosis

Many people these days who are having routine colon screening exams, are being told that they have a condition called diverticulosis which is the presence of small pockets or pouches in the wall of the large bowel found just above the rectum. Risk factors for diverticulosis include inadequate intake of dietary fiber, lack of exercise, and aging. Diverticula are found in up to 60 percent of people by age 60, and the percentage keeps climbing with age.

Most people who are told they have this condition are surprised to find out because they have not had, and probably will never have, any symptoms of the disease. However, at some point in time some 10 percent to 20 percent of those who have diverticula will develop an infection in one of these pouches which is then called diverticulitis. (The suffix “itis” means inflammation.) It has long been thought that eating popcorn, nuts, or seeds would contribute to diverticulitis by becoming trapped in a diverticula, but this has since been disproven.

Common symptoms of diverticulitis are increasing pain and tenderness in the left lower abdomen, fever, nausea, and either diarrhea or constipation. Your doctor will likely order a blood count which may show an increase in the white blood cells indicating an active infection. A CT scan of the abdomen will often confirm the diagnosis.

Most of those in the early stages of diverticulitis can be treated as an outpatient with antibiotics for up to two weeks, pain medicine as needed, and a liquid diet for a few days. In most cases this is all the treatment that is necessary. If there is no significant improvement in two to three days, or if symptoms worsen at any time, a prompt medical re-evaluation is necessary.

Potential complications of diverticulitis necessitating immediate hospitalization are:

n An infected diverticula filled with pus (called an abscess).

n Rupture of an infected diverticula spilling contents of the bowel into the abdominal cavity which can lead to a life threatening infection.

n A bowel obstruction where the bowel stops working.

At this stage, treatment will include powerful intravenous antibiotics, IV fluids with no liquids or food by mouth, and adequate pain control. Surgery may be needed on an emergency basis to remove the infected bowel, or it may be delayed and done at a later date when the infection/inflammation has calmed down.

Up to 40 percent of those who have recovered from non-complicated diverticulitis will have one or many more attacks in the future.

Some now think that recurrent diverticulitis is due to underlying inflammatory changes in the affected portion of the bowel. There is hope that an anti-inflammatory drug currently used to treat colitis may go a long way in treating recurrent diverticulitis.

If you have worsening pain in the left lower abdomen or no improvement of pain for a few days, whether or not you know you have diverticular disease, seek medical help immediately.

generic

“Billions wasted on pricey drugs” was the headline in the newspaper this week. Medicare claims that the program is wasting hundreds of millions of dollars because doctors continue to prescribe and patients continue to ask for pricey name brand drugs when cheaper generic drugs are available.

I agree that this is a major problem which needs to be addressed. My own medical group is working hard and with good success to change the prescribing habits of doctors to use the more reasonably priced generic drugs whenever possible.

What exactly are generic drugs? They are copies of brand name drugs which have the same dosage, side effects, intended use, risks, strength and safety of the brand name drug. In other words, the brand name drug and the generic version of it should be identical.

The generic version of a drug can be manufactured and sold once the patent on the brand name drug has expired. The generic costs much less than the brand name drug mainly because the generic manufacturers don’t have to duplicate the hundreds of millions of dollars spent on research, development and marketing conducted by the original manufacturer.

There is concern by many that generic drugs are cheaper because of a compromise in quality or effectiveness. However, the Food and Drug Administration requires that generics be as safe and effective as the brand name drug. The generic must be bioequivalent to the name brand product, which means that the amount of active ingredient is delivered to the body at the same time, and used in the body in the same way as the brand name. The generic will often be a different color, shape or flavor than the brand name and it also may have different inactive ingredients, but the active ingredients must always be the same.

There are a few classes of drugs, such as anti-seizure medications, thyroid hormone replacement, and blood thinning drugs, where it is best not to switch back and forth between generic and brand name versions. Your doctor can explain this in more detail.

Since nothing in life seems perfect, I recognize that there may be instances where a generic version of a drug just doesn’t seem to work as effectively as its brand name equivalent. This needs to be discussed with your doctor and dealt with appropriately since the number one issue in the doctor patient relationship should be: What’s best for the patient?

Patients do, for the most part, have a choice of generic versus name brand drugs, but must realize that both private and public insurance plans may not pay for the non-generic or will require a higher co-pay, thus increasing the out of pocket cost of the drug. Feel free to discuss this with your doctor and pharmacist.

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