Cancer and Bone Marrow transplants…a scary past

A bone marrow harvest.

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Cancers can be potentially treated with surgery (removal of the tumor if possible), radiation (high intensity laser source that kills the cells in the path of the laser beam), chemotherapy (drugs used to kill the tumor) or in combination of those.  Some of these work well.  Some of these don’t.  It really depends on the cancer type and the stage of the cancer and on other factors.

Surgery does not work well when a cancer is caught at later stages and when it has spread to other areas (we call that metastasis).  Radiation therapy only works on certain cancers that have cells that are sensitive to radiation (not all cells types are sensitive).  Chemotherapy works quite well for many types of cells and thus many kinds of cancers but each kind of cancer requires its own special cocktail (usually more than one) of chemotherapy and thus is often quite toxic.  None of these are curative for all cancers.  In fact, with the exception of some childhood cancers and some blood cancers, most are still not 100% cured by any means.

So, in more recent time more drastic procedures have been attempted at reaching a cure to breast cancer (and other cancers).  One of these is bone marrow transplants.  A bone marrow transplant is one in which the bone marrow (the soft liquid inside the bones) is removed and stored (usually frozen) and then added back into the same patient.  That is called autologous bone marrow transplant.  Why is this done.  Well it turns out that the chemotherapy these days being used is very toxic.  The cells that tend to be most sensitive to the drugs besides the cancer are the stem cells in the bone marrow.  As cancer doctors have tried harder and harder to kill tumors permanently they have used higher and higher doses of chemotherapy…so high that people with cancer started to lose their bone marrow.

So, they devised a way to remove the marrow and treat people with almost lethal doses of chemotherapy that would kill the tumor cells and then put the bone marrow back in.  This was a risky procedure and was still dangerous and lead to many complications.  In the 80’s it was thought that this really should work.  More and more doctors were convinced even though there was no good evidence.  Then someone from South Africa said that he had done a large trial and showed how superior this method (called STAMP) was to other treatment methods for curing breast cancer.  He claimed that he got long-term remission and that women were living longer and longer.  In reality, he cheated and made up the data (although he did try to treat many women) and when he was exposed as a fraud, it was quite late.  Oncologists, believed him and started treating more and more women this way.  Just like radical surgery that was not needed, it was discovered ten years later that STAMP was no better than standard chemotherapy and radiation for advanced stages of breast cancer.

So, in conclusion….again (seems like I have repeated this theme so often) doctors who were so sure of themselves and their procedures were so convinced that they were doing the right thing that they did not bother to collect evidence that it actually works.   Finally, it took other doctors who were passionate about learning the truth to realize that perhaps things were not as they seem.  So, doctors do want to help and they are trying.  But, often just like the rest of us, they fall into temptation.  What I am doing must be right…why challenge the status quo…why look for evidence, etc.?

Anyhow, thanks for reading…will follow up with more stories later.

For more general information on cancer please do see Cancer Made Simple!

Dr. C

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Cancer- overall prevention

Pedometer omron HJ-112 user review

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Today I just wanted to write a few quick reminders on easy (relatively simple) ways to help you stay healthy and keep cancer at bay.

Walk at least 10,000 steps a day (this is not as easy as it sounds especially if you work in an office all day).  Purchase a very inexpensive pedometer that tracks the number of steps a day so you can get an idea on how much walking you are doing in a day.  If you are under 10,000 steps a day on average then you are not leading as healthy a life as you can be.  Getting at least this number of steps a day has been associated with a healthy lifestyle that in turn lowers your cancer risk.  Try it….get out there and walk.

150 hours a week (no not a day) of exercise will help you keep healthy and significantly decrease your risk of a number of cancers.  This means two and a half hours of physical activity a week.  This is certainly not impossible, but with busy schedules, people with kids, folks who love to go out, people who drive everywhere, this is surprisingly difficult. I urge you though, to change your lifestyle and try to achieve this if not more than this.  Effectively, this can be achieved by doing 5 thirty minute sessions every week?  If it’s possible make this your goal.

Eat healthy.  This does not mean going crazy and becoming a vegan or eating expensive organic foods, although I am not discouraging the later.  It simply means reducing the amount of refined sugars and flour that you take every day.  It means reducing the amount of red meats you take.  It means eating more raw fruits and vegetables.  It also means trying to avoid processed foods or those foods with added hormones and other chemical derivatives.  You will simply be decreasing your risk of getting cancer this way but will not eliminate your chances of course.

No smoking, no smoking and no smoking.  This is as simple as it gets…if you are a smoker…stop.  If you drink heavily, you should also consider giving up alcohol or at least drastically reducing the amount you drink.

Ok…so you see it’s not that hard.  You can’t prevent getting cancer by 100%, its just not possible.  But, why not reduce your overall chances by leading a more healthy lifestyle?

Thanks, Dr. C

For more info. see Cancer Made Simple

The troubles with screening – Prostate/Breast cancer

breast cancer surgery in 18. century

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Cancer history has progressed from indifference or even downright marginalization (of cancer patients in the past), to surgical removal of the tumors (sometimes without even knowing what to remove), to drug therapy (sometimes the therapy is worse than the cancer), to prevention, to screening and early detection.  All have been well received as they became popular and evidence based and all have been suggested at the time to be the answer to curing cancer for good, but NONE have delivered that promise.  Let me first say that perhaps the call to eliminate cancer once and for all has been too hasty (how can we cure things we don’t understand).  The second point is that even with screening and trying to detect cancer earlier is fought with lots of problems.  That is what I will spend some time addressing next.

Screening or attempting to use medical tests of one kind or another to assist in detecting cancer earlier than it is usually detected (e.g. pateint develops symptoms and goes to see his/her doctor) has been one of the most recent advances in the push to cure cancer.  Unfortunately, it has turned out that the way we do screening or the way it has been done in the past is frequently not as informative/useful as it could be.  Screening is designed to be used int he general population to help detect cancer earlier so that treatments can be done sooner so that patients can live longer and reduce mortality (death rates).

One important thing to consider first is that NO screening test is going to be 100% accurate.  Some will pick up cancers that don’t exist and this is known as false positives.  These need to be kept at a minimum as it would funnel patients who are healthy into anti-cancer treatments.  On the other side of the coin, some test are not as sensitive and fail to pick up some people with true cancers and call them as non cancer.  This is known as false negatives.  These types of tests tend to put fewer patients into the positive pile and thus can results in cancer patients failing to get proper treatment and only get treatment when they have symptoms (too late in some cases).  As you can imagine, both false negatives and false positives are bad, but in terms of mortality the latter might be more severe.  So, the conclusion with this part is that no matter what kind of screening test you have, no test is perfect and the only way to determine how good it is…is to test this screening tool on a very large population of patients.

This then leads me to the next part.  How are these trials done.  When X-ray was discovered as a potentially effective tool for breast cancer screening, some US doctors started performing clinical trials with a large number of  women patients in the 1940’s and 1950’s.  Women were placed into a trial and the women who got X-ray screening were told about the trial and the women who were put into the control group (no X-ray but wait to detect the cancer naturally if they get it) were not told anything.  So, you have one X-ray screening arm and a control arm.  Sounds reasonable, no?  Unfortunately, as caring physicians they placed women who were at higher risk of getting breast cancer (prior cancer that was removed or those with a family history) into the X-ray screening trial.  As nurses and or doctors in the cancer clinics they of course felt obligated to do this as they did not feel that it would be fair to put them into the control (no X-ray) arm.  Although, this is a very understandable reaction, this type of ‘caring’ is actually very bad for the statistical outcome of the trial.  As you can imagine, the X-ray arm is going to be very different (the composition of women) that they control arm.  The women getting screened will be those who are likely to have more serious outcomes as they have more numbers of high risk individuals.  You can not perform a randomized trial if you weigh one group differently with the other group.  One must conduct trials without ANY prejudice.  This is very hard to do.

Huge breast cancer trials where then conducted in Canada with large numbers of women to ask if screening using x-ray helped to reduce mortality.  This time they had a ledger where every other women was randomized into the two different groups.  This time for many reasons women who were more prone to getting cancer were placed into the control arm…perhaps to overcompensate .  This also made the data that came out hard to interpret.  In both examples, it turned out that the scientific/clinical community refused to agree on the outcome of the trials as the way women were picked was not random.

Only later when the Scandinavians held massive trials with 100% complete randomization of women into the two arms of the trial did the results of the breast screening trial turn out valid and agreeable by all.  In one medium-sized city in Sweden all from one clinic, thousands of women were placed into this screening clinical trials.  The results showed that there was a very tiny benefit in mortality for women who had been screened versus those who did not get screening for breast cancer.  This was very disappointing for many who thought that screening would help save millions of lives.  However, when statisticians looked at the data in terms of age….a huge difference was noted.  Women above 50 benefited from screening while those below 50 did not.  This was later statistically validated in many centers around the world.

So, although this story focuses on breast cancer screening, it also holds true for prostate screening.  One, tests are not perfect by any means and they must be very sensitive before they can be adopted.  Two, clinical trials must be carried out before clinicians can definitively trust any new screening method.  Three, the clinical trials must be done correctly, balanced, and without bias.

Thanks and again, I hope this has been useful to you.  For more information please see Cancer Made Simple!

Dr. C

Medical News….fact or fiction

Health care costs as a percent of GDP for OECD...

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Medical information, including health care information on diet, exercise, cancer, heart disease and so forth is available to everyone.  Hundreds of thousands of studies are published every year in journals and articles released to the press yearly.  This fact, seems to suggest that the information we get from the news, blogs, and dozens of other sources is reliable and timely and will help to save many lives etc.  Unfortunately, this may not always be the case.  I will discuss how a prominent health care information scientist is suggesting that the information we get about health care daily may in fact be primarily wrong (for more information please see the original article at http://bit.ly/h5KZQA).

Scientific evidence has been generated all over the world for almost all ailments that affect mankind for years and years now.  Larger and larger, better designed studies are the norm now.  More and more information on health care is accessible by every day people now more than ever before. The data underlying the conclusion that are made very day is not wrong nor is it right.  It is data.  However, unfortunately the conclusions themselves may or may not be accurate.  In fact, Dr. John P.A. Ioannidis, at the Stanford University Prevention Research Center feels that most of the conclusions that are made from the data that is shared to the public may in fact be wrong.  Not just a small amount butr perhaps almost all of it.  That is scary, as many people, including myself buys into the ideas that are promoted by the medial

Why does he believe this and why am I a supporter of his ideas?  In the US right now, health care policy makers (such as insurance companies) are trying hard to save costs as the US tries to implement a semi-universal health care coverage agenda.  In order to do this, economists and policy makers turn to claims made in the literature and by companies that suggest only certain treatment work for certain people in certain conditions.  However, the claims that are made in the literature and by the companies who sell the products in the first place are actually often wrong.  For example, Dr. Ioannidis looked at both Vitamin D for preventing bone disease and Statins such as LipitorTM in preventing heart disease .  In both cases, new huge studies that were done with little influence by the makers of Statin and Vitamins concluded that neither prevented heart disease nor bone disease and were not necessary as a preventative agent.  These results if acknowledged by the medical community can save BILLIONS of dollars on unnecessary prescriptions per year.  As you can imagine, the makers of Statin drugs and vitamin manufacturers are not happy with the news.  I think it should be clear to you why there is some inherit bias in medical studies and why conclusions are often made that are not supported by evidence sometimes….that is that money often drives decisions not facts.

I do not wish to pick on these two industries as it turns out that the entire drug trial industry may be at fault.  In fact, Ioannidis has found that the majority of conclsuions made by drug trials about the efficacy of the drug in questions are often wrong….most of the time.  One reason for this is that is it virtually impossible for anyone to publish negative data.  More time than not in research, one gets no data (or negative data) and does not publish it (because no journal will take it).  Thus, no one knows if a drug is NOT effective as that information is not released.  The company will either bury the study and mark it down as a waste of time, or they will slowly change th outcomes of the way the data is collected or just prolong the study until the negative data turns positive.  Very often the positive data is so weak and so anemic that the significance of the positive data is only slightly better than the negative data that existed before it .  These clinicial trials that drug companies must use in order to show safety and efficacy are extremely expensive…costing hundreds of millions of dollars.  There is HUGE pressure to make sure these trials give positive data.

Another reason that Dr. Ioannidis gives is that in many cases the statistics used are shoddy.  This is either intentional in order to make the numbers (within the data) look good or simply by using the wrong statistical tools on the wrong data sets.  Often, the statistics that are used to not really lead at all the conclusions that are reached or they don’t have the right ‘power’ to make those conclusions.  Now, many previous studies have been called into question and Dr. Ioannidis and his teams have started analyzing large studies using their own statistical tools and have found that many many overstated claims.  For example, the link with Vitamin E and heart prevention in not accurate, PSA as a way to save lives as a screening tool, now seems false and so on (for Prostate Cancer).   The list goes on and on.  It seems fashionable now to have newspaper promote their own scientific researchers (in Singapore this is often done) by informing the public that his/her studies are changing people lives or about to revolutionize treatment etc, in one way or another.  All sorts of untested ideas are floating around at dizzying speeds in articles by newspapers, blogs, etc.  Doctors and other health care professionals have to be careful and ignore most of these as they are usually 100% baseless.  We are lay people need to be very careful to listen but not swallow whole what we read from the newspapers.

Thanks for reading my current rantings.  For more information about cancer in general please do see Cancer Made Simple!

Cancer Stem cells

Stem cell diagram illustrates a human fetus st...

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So, someone asked me the other day to explain cancer stem cells to him and I realized this is something I have never written about.  It happens to be a relatively new concept but an important one so I will quickly talk about what they are,

All cells in the body came from originally a very small set of cells at one time.  All of our blood cells for example came from one set of cells called the blood stem cells at one point (the technical name is hematopoietic stem cell).  We call the different kind of stem cells that give rise to different kinds of general cell types as lineage derived stem cells.   Fat tissue, cells that line the intestine, nerve cells, etc. all come from different stem cells at the beginning.

So, one property of stem cells that is that they can give rise to a whole series of like cells (e.g nervous tissue cells or fat tissue cells).  In order for this to happen the original stem cells must be able to do this without dying and without itself changing.  This is NOT a property of most cells….most cells die after some rounds of division and they change as they mature.  Stem cells do not share this property and can in fact multiply for ever potentially.

So, most cancer cells develop from very specific tissues like the cells of the eye, or cells from the nervous tissue and so on and so forth.  In some cases and in some cancers, scientists have found that cancers develop from the stem cells themselves….either very early stem cells (very rare) or mare differentiated stem cells (more common).

Either way, there is a big difference between a cancer from a non stem cell to that of a cancer from a stem cells.  Or, if a single cancer has both stem cells and non stem cells this also poses a unique problem.  To make a long story short, cancer stem cells are very difficult to treat.  They are usually very resistant to treatment and don’t respond well to things like chemotherapy, etc.  Also, when you kill off cancer cells and the cancer seems to go away, if the cancer remains in the cancer stem cells, then they can divide and create more cancer cells.  So, even if you think you have gotten rid of the cancer, it is still there but in small amounts as a stem cell.  We do not know how frequent this is but it has been seen in breast cancer and in a few other cancers.  It is still a bit controversial so we do not know anything yet about true clinical experience with these.

Thanks and let me know if you want more information on this as I only just scratched the surface.

Dr. C please visit Cancer Made Simple!@

new cancer devices

Chicago screening

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I don’t know about you, but lately I have seen in the news the introductions of new cancer devices and cancer screening tests that are inexpensive and fast.  For example, the other day I read about a prostate cancer screening device that is handheld and is very low-cost.  I am not sure what exactly it screens for (perhaps Prostate Screening Antigen or PSA) and how it will be useful for the average person, but I believe the news mentioned that it is great for physicians in countries with few well equipped hospitals etc.

In another article another device that screens or detects the amount of anti cancer agents that are radioactive (for those types of agents that are linked to radioactive compounds that target and destroy hard to reach cancers).   Again these were hand-held and inexpensive screening tools.

I have also seen that there are small kits that people can buy that will help them collect samples from their body that they can mail to get back complete cancer profiles.  Now companies of course will also give you your entire genetic sequence and inform you of any risks you will have for virtually any conditions.  Wow…things are getting kind of sci-fi like.

The list of new tools, kits, screening devices, and so on go on and on.  It seems to be the fashionable thing now.  However, what is uncertain is how much they will actually help in the long run.  What would you do with a cancer risk profile or even a total disease profile risk chart ?  Would you modify your lifestyle due to risks that were identified?  Would you worry excessively?  Would you live a less satisfying life as you constantly worry about dying from something the test said you were high risk for?  Might you have no children as a result of your new concern…even if it was only a risk?

This is the risk of knowing your risks.  It may sound great for insurance companies and health care professionals, but it might not be good for us.  Many people do not go to see a doctor for years for the potential fear that the doctor may indeed find something and some folks just simply don’t want to know.  I certainly don’t personally support that idea, but it is out there.  The same certain goes for list of risk factors that may indicate something like this: you have a 20% higher risk than average of developing diabetes.  What will you do with that information?  SOme might celebrate and say, wow I am doing well and I don’t need to worry about such a low risk and others might say, I am doomed with such a high risk.  The first person might continue to drink coke and eat junk food while the latter may drink water and eat fibre for the rest of their lives.

So, we are going to start to see changes in the information we get about our health or the health of our loved ones.  We are going to start to think about things we never did before.  It can be scary or it can be an opportunity to make our individual lives better….depends on which road you take and how you educate yourself.

Thank

Dr. C

Cancer made simple

Cancer: a tough look at ourselves

Drugs in Mind

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Cancer is a dirty word.  Cancer kills.  No one is doing enough about cancer.  All of these statements can be heard from time to time if not frequently.  But, perhaps it’s time that we think about cancer another way.  We may need to start looking inwards at ourselves and thinking about our responsibilities and our habits.  We may need to start thinking about whether or not we are partially or sometimes fully to blame.

Wow, sounds tough…and yes it is, but perhaps it’s accurate.  Let me explain.  Many folks over the years (and quite a few now) blame doctors for being unable to cure cancer or treat cancer patients so effectively.  They get quite angry that some of the treatment have numerous side affects and that many are expensive.  They are angry at the pharmaceutical companies as they suggest that these companies only design drugs that are costly and that patients must depend on for the rest of their lives.  They truly believe that both the doctor and the pharma industry are not interested in the patient and are intent only on making money.  Cancer is something that someone gets through no fault of their own and doctors and companies out there take advantage of the situation and make things worse.  I am going to offer an alternative explanation as to responsibility and culpability.

It perhaps may be true that there are some very bad doctors who care solely for cash and that there are a few company executives who would love to make as much money as possible with almost zero consideration for ethics or moral issues.  Actually, there are all kinds of people in this world like that.  However, most doctors and most pharmaceutical industry players are not like that at all.  They are like you and I, they hope to help people in what ever they do.  I have NEVER ever met an oncologist that has said, let’s see how I can screw over this patient today.  Or, let’s see what I can do to order the most expensive tests  and make the cancer patient suffer the most.  It is simply just not the case.  On other other hand, some doctors do not have the time to listen to their patients, some have made mistakes, and some may not be trained that well, or perhaps are suffering themselves from illnesses (e.g. perhaps alcoholism) that prevent them from keeping up properly with their field.  And yes, many of the drugs out there do cause huge amounts of side effects and are not fun at all to take.  However, it was not the intention of the company to make a drug like that.  It’s aim was to treat cancer and since cancer can be very hard to treat, often the drug is quite powerful and hurts.

So, if we can not blame the doctor or company that makes the medicine who can we blame? One option is ourselves.  This does not sound very nice does it.  But perhaps there is so truth to it.  First of all, we can not blame others for our inherited genetics. We only have ourselves and our parents to blame for that….no one else. Genetics play a large part in making our bodies sensitive to cancer in some of us, and resistant to cancer in others.  We often inheret defective genes from our parents and those defects result in increased risk of cancer (of one kind or another).  However, before you start to berate yourself and tell off your parents, it is hard to tell which genes they gave you that contribute to the cancer and it is the combination of genes not just mom or dad’s that makes you….YOU.   So, sometimes the only choice is to not have been born, and since you are reading this….that can not be an option.

So, what else makes us somewhat responsible.  Even if we get a ‘bad’ set of genes, that does not mean we are destined to get aggressive cancer.  We still need further mutations to occur in our genomes.  Those come from out environment.  For those of you who smoke…then it is absolutely your responsibility when you get cancer and you directly caused it to yourself.  Sorry, there is no easier way to say this than you gave yourself cancer willingly (if you get it…lung cancer, that is).  So, do NOT blame anyone but yourself.  You did it.  However, if you smoke and you do not have cancer…than here is the lovely thing.  You can quit…wow, yes stop smoking and decrease your chances of getting lung cancer.  Besides smoking, there are other environmental ‘pathogens’ than can lead to cancer.  There is no way to avoid them all, but be aware that excessive sun exposure, toxins, asbestos, some types of plastics, and so forth have been linked to cancer development.  So, again there are ways you can try to minimize exposure…to a limit.  Again, blame yourself for sunning on the beach, eating foods with lots of additives, and so on.  Don ‘t blame others.  Or do something that changes the world around you.  Write letters to the companies who are making the foods and such that are poising the world.  Stop buying their products if you can, etc.

Another way we have ourselves to blame is diet and exercise. I have mentioned several times in my previous blog entries how diet and proper exercise can lead to or prevent cancer.  So, the question you need to ask yourself is, do I eat healthy and do I actually get the minimum amount of physical activity that is recommended.   Do I eat a lot of refined flowers and sugars, do I consume a lot of red meats.  If not do I eat a lot of vegetables and fruits and get the right amount of fiber in my diet.  All of these things are not exact ‘rocket science’.  If you eat tons of junk food and drink lots of sodas, than you know the answer.  If you make a conscious effort to eat fresh vegetables and eat high fiber breads etc, than you also know the answer.  What about 150 minutes worth of exercise a week… which does not include walking to the TV and refrigerator ever 30 mins?  Are you getting enough?  Can you?  Will you?

So, it is so easy to blame the world around us.  The food I eat is not my problem, the lack of exercise is not my problem , the exposure to harmful elements are not my problem.  It is far easier for me to blame the doctor and the drug companies than actually make some changes in my life.  It may not be easy, and the reward may seem so far away, but doing all of this will reduce your cancer risk.  The best way to not get cancer is to prevent it in the first place.

Thank you for reading my rantings of today.  DO feel free to contact me or get more information on my page…. cancer made simple!