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Archive for the ‘Cancer’ Category

Colon Cancer

Colon.jpg

Cancer of the colon and rectum is the third leading cause of cancer in men and the fourth leading cause in women and is more commonly seen in the western industrialized world.

Risk factors can include: age (50 years and older), family history of colon cancer, a high fat diet, smoking, and excessive alcohol intake. Most colon cancers begin from polyps in the colon which usually start out as benign, but after time can become malignant. Therefore, timely diagnosis and removal of the polyp can help to prevent the development of colon cancer, and thereby significantly decrease the mortality of this mostly preventative cancer.

A colonoscopy exam is the current best method for detecting colon polyps. During this same procedure, the doctor can easily remove the polyp. Colonoscopy is essentially painless, is an outpatient procedure, and is a small price to pay for the possible early detection of colon cancer.

The more common symptoms of colon cancer include rectal bleeding and/or blood in the stool, a change in bowel habits, a feeling that your bowel doesn’t empty completely, weakness or fatigue, and unexplained weight loss. Any of these symptoms should get you to see your doctor as soon as possible.

Your doctor will most likely do a rectal exam (don’t be shy, as this is very important), perform a rapid chemical test of a sample of your stool to check for blood, take a blood sample to check for anemia, and most likely schedule a colonoscopy exam.

Surgery is the most common treatment for colon cancer. Chemotherapy and radiation are also often used depending on the extent and location of the cancer.

The bottom line is that colon cancer, if diagnosed early enough, has a very favorable prognosis.  If found too late after it has metastasized (spread) to other organs, it has a much poorer survival rate.

Talk to your doctor about colon cancer screening with colonoscopy and check with your health insurer about what is covered. You should begin screening if you are 50 years old or older, or if you are younger and have a family history of colon cancer.

See your doctor if you have any of the above mentioned symptoms, and if you do, don’t settle for anything less than a colonoscopy exam. Denial or delay can be a matter of life or death.

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terrybeth

For those of you who have followed my journey since being diagnosed with a bone marrow cancer called multiple myeloma in September of 2013, I wanted to bring you up to date. Myeloma, as of now, is still considered incurable but treatable. So, I have been on continuous chemotherapy since my diagnosis.

The most recent chemotherapy had been working well, but a recent PET scan has shown some new myeloma activity in a few of my bones. This is not unexpected for many of us dealing with multiple myeloma since relapse is common after initial treatment. I have recently begun a new chemotherapy drug with the hope that this will keep the myeloma under control for as long as possible.

This new  drug that I am now receiving, is called Daratumumab or more commonly referred to as Darzalex. It is in a new class of drugs called monoclonal antibodies, and was just approved for use this past year. It binds itself to a marker on the surface of the cancerous myeloma cell directly affecting the cell as well as enabling the body’s own  immune cells to kill the myeloma cells. As with most of the chemo drugs for myeloma, they usually only work for a period of time before losing effectiveness and then on to a new and different treatment.

In general, I feel well and am learning to live with the neuropathy of my feet as disabling as it has become. I try to push myself, by exercising as much as I am able to do, which I think is helping to make me feel better. I would recommend exercise, to the best of one’s ability, to anyone suffering a chronic disease as part of an overall treatment program.

There are, in development,  new treatments for cancer in general and for multiple myeloma in particular. One of the new and exciting directions in cancer treatment involves the use of our own immune systems to fight the disease such as the drug I am currently using. Also, the rapidly expanding field of genetics also will play a big role in diagnosing and treating cancer.

Of course those of us with cancer hope to survive long enough to benefit from the new treatments on the horizon. Hopefully, in the near future as we develop a better understanding of cancer, it will, in many cases, become a mostly preventable and curable disease.

Thank you again for your prayers and well wishes.

PS:  I would like to start a local support group for myeloma patients. If you, or someone you know would be interested in this, please contact me at valleydoctor@sbcglobal.net

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SkinCancer

Just as I was enjoying my remission from my multiple myeloma (blood cell cancer), I was recently diagnosed with melanoma (skin cancer), which was thankfully the superficial curable kind.

For several months, my hair stylist commented about a lesion on my scalp and said I should have it checked out. I eventually did see my dermatologist and the biopsy showed the melanoma. It was surgically removed and I’ve been told there should be no further concern. Enough with the cancers already.

My recent experience has lead to this article on common skin cancers.

Skin cancer occurs when DNA changes cause the skin cells to form a cancerous growth. Most of the common skin cancers are caused by exposure to the sun and its ultraviolet light rays that damage the skin. Even one bad sunburn as a child can increase the chance of skin cancer in adulthood.

I would like to discuss the three most common types of skin cancer:

Basal cell carcinoma: The most common of skin cancers. Usually appears as a flesh colored or brown flat lesion or as a waxy pearly bump. Usually not serious and treated by removal of the lesion.

Squamous cell carcinoma: Appears as a red small bump or a scaly, flat, crusty lesion. It is usually not serious, but can rarely be more aggressive. It also needs removal.

Melanoma: The least common of the three, but most potentially deadly. It is usually found on sun-exposed areas of the skin, but can rarely be found in other parts of the body such the eyes, some internal organs, and under finger/toe nails. Melanoma often presents as a new, usually dark colored lesion or it can present as a change in an existing mole

If you have moles remember the letters ABCDE to help identify the changes to melanoma:

– A is for asymmetry. If you draw a line through the lesion the halves will not match.

– B is for irregular-shaped border.

– C is for change in color, usually becoming darker.

– D is for diameter (a mole becoming greater than 1/4 inch).

– E is for evolving (changing).

Factors that may influence skin cancer are:

– A history of sunburns and excessive exposure to the sun.

– Fair skin and/or having blond or red hair.

– Moles and other common skin lesions such as actinic keratoses (non-cancerous skin lesions).

A family or personal history of skin cancer.

The most important thing to help prevent these common skin cancers is to avoid exposure to ultraviolet light, whether naturally from the sun or artificially from tanning booths.

The bottom line is that if you or someone close to you sees something suspicious on your skin, even your scalp with a full head of hair, see your doctor as soon as possible

Remember that the sooner a skin cancer is identified, the more successful will be the treatment. I’m living proof of that.

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neuropathy

As part of my cancer treatment journey, I have developed a pretty severe case of peripheral neuropathy of my feet. I was warned that the chemotherapy could cause neuropathy, but I didn’t know it would be quite this uncomfortable.

Peripheral neuropathy is caused by damage to certain nerves — mostly the sensory nerves — which deal with touch, pain, and heat. Most of the time, the problem starts in the fingers and toes and can worsen to include the feet, legs, and hands.

Causes of peripheral neuropathy include:

– Diabetes (the most common cause).

– Chemotherapy.

– Alcoholism.

– Vitamin deficiencies.

The most common symptoms are:

– Pain, burning or tingling of fingers, toes, hands and feet.

– Muscle weakness and balance problems.

– Loss of sensation to touch.

– Difficulty using fingers for tasks such as buttoning one’s clothing.

Measures that may help relieve the symptoms of neuropathy:

– Acupuncture, massage, physical therapy and reflexology.

– Relaxation therapy.

– Prescribed medications such as pain medicine, lidocaine patches, capsaicin cream, and anti-depressant and anti-seizure medications.

– Vitamins and supplements such as vitamins B1, B6, B12 and alpha lipoic acid. Check with your doctor for proper doses and any other treatment options.

How to take care of yourself:

– Because neuropathy can cause poor balance, remove throw rugs and clear up any clutter.

– Put grab bars near shower, bathtub or toilet.

– Protect your hands and feet where sensation is decreased and be aware of very hot or cold temperatures.

– Don’t drink alcohol.

– Check hands and feet for cuts, scrapes, burns or any other signs of injury.

If you think you are having any of the symptoms of neuropathy see your doctor for evaluation and suggested treatment.

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Terry

I am in remission of my multiple myeloma cancer. The three months of chemotherapy last fall and winter did a great job in knocking out most of those cancerous plasma cells which were taking over my body. The stem-cell transplant I was originally to have following chemotherapy has been canceled. I will have my blood tested regularly to monitor my remission. My thanks to Dr. Michael Wu and his wonderful caring staff at the Palo Alto Medical Foundation oncology department who did a superb job treating my disease.

I discovered that one doesn’t necessarily have to leave Santa Cruz for state-of-the-art cancer care that I found right here through my group at PAMF. I sure wasn’t used to being — nor particularly enjoyed — being on the patient side of the doctor/patient relationship. It was a humbling experience and has taught me more about patients and patience along my journey.

Unfortunately, I am suffering from a fairly severe neuropathy of my feet from the chemo drugs, and this is currently adversely affecting my ability to walk normally. I do, however, feel it’s a small price to pay for my successful cancer treatment. I’m told the neuropathy should improve with time. I’ll try to be patient, (not one of my virtues however).

Another little complication I had in the past month, most likely unrelated to my cancer or treatment, is a condition of my heart called constrictive pericarditis. This occurs when the sac of tissue surrounding the heart (the percardium) becomes inflamed and tightens in on the heart, causing the heart to pump less efficiently.

This threw me into mild heart failure with significant shortness of breath, swelling of lower extremities and general fatigue. Dr. Neil Sawheny, one of my cardiologist partners at PAMF, is treating me for this unexpected complication and I seem to be responding well and improving day by day.

In general , my overall well-being is improving significantly. I feel as though my life as I once knew it is being slowly restored. Once my neuropathy shows signs of improvement, I hope to return to work at least half-time.

I’ll give myself a break to work a bit less since I’ve now been practicing medicine for the past 40 years, 27 years in urgent care Scotts Valley. I love my staff, my patients, many of whom I’ve come to know quite well. Most of all, I love the satisfaction I receive in helping make people feel better and in maintaining their good health.

My thanks to all of you who have mailed get-well cards or sent email messages for my recovery. I am a strong believer in the power of prayer and I know your prayers for me have been heard.

My personal lesson from my cancer experience is this: If you have any health symptoms that seem unusual to you or are lasting longer than you think they should, see your doctor for a work up. If everything checks out OK and your symptoms soon improve, then be thankful.

If something serious like cancer is found, the sooner it’s treated the better the outcome. This a proven fact. Also, for those many of you who are healthy, give thanks every morning that you can begin a new day.

My best wishes to you for long healthy lives.

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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.

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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.

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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.

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multiple, myeloma, cancer

I would like to begin this week’s article with a deeply sincere appreciation for the outpouring of emails, cards, well wishes and words of encouragement from my readers, patients, friends, family and even strangers. This support will go a long way in getting me through my recent diagnosis of multiple myeloma. I’ve survived my first two weeks of chemotherapy and feel fine, except for the persistent back pain.

Although described as being somewhat uncommon, I’m aware of a number of people who have had multiple myeloma and many more who are acquainted with or related to someone with the disease. The good news is that most of them are doing well. I like to hear that.

So what is multiple myeloma?  It is a cancer that causes an over production of plasma cells — a type of white blood cell found in the bone marrow. Plasma cells function to produce antibodies which are necessary for our immune system to fight infections. In multiple myeloma, the growth of the cancerous cells causes them to produce an over-accumulation of a certain protein called immunoglobulin that travels throughout the body and can cause damage to various organs.

The other problem, as in my case, is that the plasma cells can enter normal healthy bone causing osteoporosis as well as causing local areas of bone weakness leading to bone fractures, such as I have in my spine. I also have the typical anemia because the plasma cells crowd out the red blood cells in the marrow.

The cause of multiple myeloma remains a mystery, however there are some associated risk factors such as:

– Being over age 65.

– Being a male.

– Being African-American.

– Having a family member with multiple myeloma.

Early stages of multiple myeloma may cause no symptoms. However, as the disease progresses, plasma cells accumulate in the bones and other tissues causing these symptoms:

– Unexplainable persistent pain in any location of the body especially the back.

– Extreme weakness and fatigue.

– Unintended weight loss.

– Recurring infections.

After seeing your doctor for any of these symptoms, you will have some blood tests done and if there is some indication that you may have multiple myeloma you will be referred to a doctor specializing in blood and cancer diseases. Further testing can prove or disprove whether or not one has multiple myeloma.

Therapeutic options include the one I just began, which is undergoing up to four months of chemotherapy followed by a stem cell transplant which I will explain in more detail as I get further along with my treatment.

What I have learned from my experience is that it is important to recognize early symptoms and see your doctor about your concerns. As with any cancer, the sooner it is detected and treated the better the chance of survival. If you or a loved one have any of the above-mentioned risk factors and unexplainable symptoms, see your doctor.

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Good news has just come from the California Department of Public Health, which recently reported that the state’s adult smoking rate has hit a record low. Last year, 11.9 percent of the state’s adults smoked, down from 13.1 percent in 2009. By comparison, in 1984, 26 percent of our state’s adults smoked.

This is a very encouraging trend.

Tobacco use causes a greatly increased risk of death. More deaths are caused by tobacco use (mostly in the form of cigarette smoking), than by HIV infection, illegal drug use, alcohol use, motor vehicle injuries, suicide and murder combined.

Cigarette smoking causes one in five deaths in the U.S. each year, with about 400,000 deaths from direct smoking and 50,000 deaths from indirect smoke. On average, adults who smoke die 14 years sooner than nonsmokers. Between the years 1960 and 1990, deaths from lung cancer in women increased more than 500 percent.

Smoking damages nearly every organ in the human body. Here are some of the more common health problems caused by tobacco products:

– Cancer of the lung (23 times higher rate among smokers than nonsmokers)

– Cancers of the bladder, mouth, throat, vocal cords, esophagus, cervix, kidney, pancreas and stomach, and certain forms of leukemia

– Coronary heart disease, which usually leads to heart attacks

– Doubled risk of a stroke

– Blockage of blood flow to legs and feet, sometime leading to amputation

– Tenfold increase in likelihood of death from emphysema, a condition in which lung tissue is slowly destroyed by smoke

– Reproductive problems, such as infertility, early birth, stillbirth and impotency

– Decreased bone density in the elderly, leading to increased chance of fractures

It is estimated that more than 370 billion cigarettes are consumed by American smokers per year. In 2005, cigarette manufacturers spent more than $13 billion on advertising to lure people into smoking. What is the cost to our financially precarious health care system? It is estimated that cigarette smoking costs $96 billion yearly in health care expenditures and another nearly $100 billion in lost productivity.

I personally find all of this data shocking. We, in this society, must take a firmer stand against the use of all tobacco products. Every day, more than 1,000 American teenagers begin smoking. We need do a better job in preventing our youth from beginning to smoke and to get those, young and old, who are already addicted to tobacco to quit.

For those of you who wish to quit but have been unable to do it on your own, your doctor has various treatment options that could help you.

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