Cancer info…watch what you read!

"seeds" used for brachytherapy of pr...

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Hello again.  Today I want to mention a few things about information that you will encounter on weekly basis in news, blogs, TV and such.

The first piece of advice (coming from a long time cancer researcher) is to simply be careful with the information you read.  Unless you are trained in the area of cancer, or statistics, or sometimes even psychology; it if often very hard to tell if the authors are being truthful or not.  Even if they are for real, it is very difficult to tell if the conclusions they make from their statements are true.  For example, people who love to drink coffee will look at the recent studies which show a positive impact on coffee drinking and prostate cancer and they will state that the studies now prove that all men should drink lots of coffee to avoid prostate cancer. If you don’t read the original information (and how many of us go back tot he original source these days)  and rely simply on the one blog you read, you may miss out on the fact that this study is an association study.  That means that there is no proof at all, only a link between those who drank lots of coffee or ten to twenty years and the risk of one kind of cancer.  You wont know that for women and breast cancer the studies are not the same as for men and prostate cancer.  So, read lots of stuff and stay informed, but read things carefully and with a grain of salt.

As you start to read more and more you will find that you can spot more and more errors or exaggerations more easily.  It comes only after you have started to see themes repeated over and over.  Then and only then can you start to pick up on how some folks will mold the truth around something they feel strongly in and hide certain details that will detract from their biases.  We all have biases one way or the other and that is OK, but the reader must understand this and should over time read things (about cancer in this case) from people on both sides of the same issue if possible.

What kind of blogs and information web sites are there and which ones should you be more careful about.

1.  The information only website.  The NIH and other cancer information promoting websites are usually going to be pretty good and trustworthy.  These wont bias you so much in one way or the other, but they will usually steer you away from alternative forms of therapy or avoid other issues that have less scientific validity.  There is nothing wrong with that and you just need to go see other websites if you want to learn more about those other area.  Many of these (like mine at Cancer Made Simple) will have trained scientists on their staff.

2.  Blog from people who had or have cancer.  These are a great source of information from people who have been there and done that.  These can be very fun to read and full of interesting information.  They are very useful for people who have the same or similar type of cancer that the blogger had or taking care of someone with that condition.  They, however can be subject to a lot of bias and it all depends on the prior experiences and disposition of the blogger him or herself.  Either way, they make great reading and tend to be less scientific but more day-to-day experiential.

3.  Blog or websites from retailers- be most careful with these (even with large companies).  Larger companies that have drugs or agents that are FDA approved and based on years of very good clinical data are of course more trustworthy that those who don’t have that.  However, companies are very VERY good and making their data look good and have huge budgets for marketing their products (of course legally) but often can mislead us.  However , the biggest problem out there lies in these very small companies or have no or little direct clinical data on cancer treatment, but who still try to sell you an anti-cancer therapy, drug, or agent anyway.  There are so many of those out there.  If the agent is perfectly safe, pure and clean, non toxic, and not too expensive, then it might not be a problem even if it is not effective.  If the product, is harmful (e.g. they ask you to take too much and it damages your liver), has undeclared chemical gents inside (e.g. melamine in milk from China), is very expensive for sugar-water, or is 100% useless (has no value at all), then it should not be consumed.  However, you won’t be able to tell so much.  You will know if they have done the proper studies and they will tell you and most of all show you by directing you to the published data.  Most don’t have it and never will.  Much out there is pure crap.  So, read these sites as they will talk about cancer and push you towards buying their products.  But, their information will be very biased….so use caution.

TV can also be highly misleading so ignore as many of the adds as possible as marketing is always greater than truth.  The news is a great source of information but when the anchorman or woman makes judgement about cancer related information- ignore these.  They have no clue and are just adding their own two cents and can often be way off the mark.

There are many other kinds of websites and blogs relating to cancer.  So read and learn as much as you can!  Just use caution.

Thank you….Dr C  Cancer Made Simple

The coffee cancer connection

Cup of Coffee with Spices

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How many of you are daily coffee drinker like me?  Probably many of you (although if you live in Asia like I do, it seems like much less than what we American’s drink) drink at least one cup a day.  You may have noticed a report recently that indicates that coffee may be good for you- at least in reducing your risk of getting certain types of cancer.

The most recent study indicated that men who were middle-aged and thus more likely to get prostate cancer and who regularly drank coffee thank those who did not drink coffee.  However, there are a few issues here.  A 20% reduction in prostate cancer risk was seen with those who had six cups or more a day (and as a coffee drinker, that is a lot of coffee) for the last twenty years.  That is a lot of coffee and for those who drink it with milk and sugar, that is a lot of milk and sugar.  However, what was really more informative was that heavy coffee drinkers had a 60% reduction in risk of getting the more serious and lethal form of prostate cancer (the one that metastasizes and moves to another location such as bone and is thus much harder to treat).  However, it is important to note that this study represents an ‘association’ study and not a ’cause and effect study’.  In other words, looking at close to 50,000 middle-aged men in general there was an association in the statistics between drinking coffee and developing prostate cancer over time.  This means that there is no absolute proof that coffee prevents prostate cancer, but that the link is statistically likely.  More controlled studies would have to be done and more laboratory-based studies would have to be done to get more formal proof. 

As prostate cancer is one of the largest killers of men, it would be great if medical doctors would now start recommending that all men start drinking 6 cups or more coffee a day (the caffeine content did not matter in this study) earlier in life so as to reduce the prostate cancer risk.  However, due to the fact that this study only associates the two (coffee consumption and decreased prostate cancer) they can not do so.  There could be other things that were similar in general between coffee drinkers (lots of coffee per day) and non coffee drinkers has in common that were not tested for.  So, one must be careful when making very strong arguments about this kind of studies.

What about a big cancer in women, breast cancer does coffee reduce this cancer risk?  Well, it turns out that there are studies that suggest that it does and some that suggest that is does not.  Overall, two large studies (one in Sweden and the other in Germany) suggest that there is no strong association between a large amount of coffee consumption per day and the overall risk of all breast cancer types in general.  However, when they researchers divided the breast cancer into several different types (due to hormone receptor expression) the Swedish group did find a strong association (reducing the risk substantially).  This was not found when the researches did the same this in German women.  Thus, for now….there is no strong evidence that drinking lots of coffee everyday will reduce a women’s risk of developing breast cancer

So, in conclusion one probably has no reason to quit coffee as there are very few studies if any that suggest that coffee increased risk of developing cancer.  However, it is unlikely that the data is so compelling that we all should drink 6 or more cups a coffee a day to prevent cancer either.  It seems like everything else….a healthy balance is best…and we should probably not overdo any beverage (water is probably an exception here) or food.

Thank you and do let me know if you have any comments

Dr. C   Cancer Made Simple

Cancer progress

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Despite some of my numerous ramblings, the negative press, and anti-conventional therapy crusaders out there, there has been a tremendous amount of success made in the war against cancer over the last ten to twenty years.  We know a tremendous amount more than we used to.  We can prevent many cancers from occurring in the first place or delay their onset.  We can remove surgically many cancers and we are identifying at earlier stages more and more cancers now than ever before.  Newer technologies are also being introduced such as affordable bedside instrumentation that allows for instant or near instant cancer screening and better imaging instruments to help stage the cancer.

So, what seems to be the trouble?  Why so much negativity surrounding modern cancer therapies and pessimism about where we are in the war against cancer.

There are several reasons as I have mentioned in various places in this blog before.  The first one that is the least obvious for many people is the overly high optimistic attitude we had in the first place.  A number of politicians and NIH directors in the past have commented that we would win the war on cancer in X number of years and thought that just like other diseases, it was only a matter of time (short time) that we understand cancer and cure it.  Others have set such impossible timelines for the eradication of cancer, that we were doomed to fail.  Still others felt that throwing enough money and brains behind the problems would inevitably lead to complete solutions.   This was perhaps premature and we should have asked that there was restraint amongst those in power or in the press, to limit our expectations.

The second factor (relating to the first) is that cancer is not one thing.  It is hundreds of different diseases some with extensive overlap and others with little.  Thus, small defeats will take place for one cancer or another as we learn about it, but the war is not a singular event.  Treatment for one cancer will NEVER work as treatments for them all…that is a fact that I think even doctors sometimes lose sight of.  Companies producing anti cancer compounds will never find a magic bullet that will treat all cancers.  All treatments, no matter how small, will have some limitations such as side effects or short acting efficacies or cost, etc.  Finally, cancer is so much more complex that I think we ever imagined it would be.  It seems like the only ones who realize this and say it are the scientists….not the folks selling anti cancer products.  it should be made clear to everyone, how complex cancer is and how much we still don’t know.  The same goes for AIDS which has undoubtedly taken so many of our resources (both financial and manpower) and yet we still have not found a cure for that single viral disease.

The last point is the most difficult of them all…us.  We have not as a society and as individuals (in many cases) done the things we need to do to help keep cancer at bay.  How many people do you know make sure they walk 10,000 steps a day?  How many folks do you know that lead a healthy lifestyle low is processed foods, unbleached flours and sugars, and so on?  How many people do you know that take the time to learn about cancer and cancer prevention?  How about the millions who continue to smoke and drink in large amounts.  By asking these questions, I am not advocating taking away personal choices (and I never would), but  am offering a reason why cancer as a disease still ravishes us so much.  Much of it has to do with us.  Drugs and other people can not solve everything…we can and should take some charge over our own health.

So, just some words for thought today.  I hope you enjoyed reading this.  Please do let me know if you have your own ideas or you think I may be way off somehow and leave me a comment.  As usual do visit the cancer made simple site for more information.  Thanks

Dr. C

Cancer made simple

Multiple Myeloma: bone or B cell cancer?

Human bone marrow.

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MM or multiple myeloma is actually a cancer of the mature B cell in the body but as it is targeted to the bone marrow and produces fractures and small pockets of hollowed out bone, many people tend to think of it as a bone cancer.  MM is incurable currently and many treatments are available now to help prolong the life for those with this cancer.

MM has a frequency of about 1 to 4 in 100, 000 in whites but it is as high as almost 10 per 100,000 in African Americans and is the tenth largest cancer killer among that group of individuals.  Usually, the cancer strikes those who are older at 65-70 years of age, but it can occur in younger patients as well.  Unfortunately, there are no easy to detect early signs or symptoms of the disease and by the time bone pain shows up the disease is already at an advanced stage.

The cancer affects cells known as plasma cells or B cells that produce antibodies in large numbers.  They reside in the bone marrow and when they become cancerous they divide quickly, produce lots of a single kind of antibody (that causes lots of problems for the kidney and can also suppress the immune system over time).  However, it can also result in bone pain by the following process.  The cancerous cells stay in the bone marrow where they divide rapidly and stick to the walls of the bone in the marrow area.  They produce all sorts of proteins that make them grow even faster and avoid immune detection and avoid death.  They start to produce products that break down the bone in the localized area and prevent the normal cells in the area from building the bone back up.  So, the results of this is that the cells burrow and make small holes along various bones in the body.  X-ray can pick up these small pockets of hollowed out bone.  A result is that the bones can become fractured easily and patients can get a type of osteoporosis. This of course results in pain over time, but again when the patient visits the doctor the cancer has already reached an advanced stage.  One other symptom in many patients is that they may become anemic (low blood counts) and that is due to the large number of cancerous B cells in the bone marrow that acts to suppress the stem cells from sending the precursors of blood cells into the body.

Anyhow, when the patient goes to the doctor he or she must treat the many symptoms of the disease in addition to the cancer itself.  The cancer itself is a blood cancer and can not be simply removed by surgery.  Thus a number of drugs are used to treat the disease and will not be mentioned here specifically.  In general, MM is treated with chemotherapy (drugs that try to kill the cancer cell itself or all rapidly dividing cells).  There are also drugs given to help boost the production of normal bone marrow cells and those that help to heal the bone.

As this is an incurable cancer overall and some people live with the disease after treatment longer than others, lots of research is being done to try to see if scientists can identify those who will respond well to treatment and those who will not.  For example, using genetic screening on a large-scale we now know that some patients with certain genetic mutations (or sometimes the lack of certain mutations) will have a worse prognosis that others who do not carry that mutation.  Research is also being undertaken for the search for new drugs and the search for potential immunotherapy that might one day help.

So, to make a long story short….MM is a devastating disease that affects both the bones and the cells of the immune system.  However, it is a disease of the B cell primarily and is usually detected late in older patients.  There is no cure but people can live up to seven years after detection of the disease if treatment goes well.

Thank you for reading this…and do let me know if you have any questions or comments about MM or other cancers.  Also, feel free to go to Cancer made Simple for other information.

Dr. C

NPC a type of nose cancer

Illu nose nasal cavities

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NPC; you might not heard of it but if you live in Asia it is very common.

NPC stands for nasopharyngeal carcinoma and is the most common cancer that originates at the nasopharynx (an area around the back of your nose and upper throat).  It is not a very common cancer in the West with a frequency of about 1 per 100,000 people who develop this type of disease.  However, in Southern China, Taiwan, Singapore and other parts of SE Asia, the disease is more common and occurs in 25 out of 100,000 people.

There are two main types of this cancer and they are undifferentiated carcinoma and squamous cell type carcinoma.  These terms refer primarily to the way these cancers look under the microscope which is related to the different cells that are affected in both types.  Caucasians tend to only get the squamous form of the cancer while Asians typically get the undifferentiated forms.  There are two subtypes to the undifferentiated forms and they vary due to the production of keratin and the keratinizing form tends to be a bit more aggressive form of the disease.

Like many other cancers, the disease has a very good prognosis if caught early (ie. caught at the 1st or 2nd stage) but has a more serious mortality rate when caught later.  This is due to the fact that the cancerous cells tend to migrate or metastasize to the nearby lymphnodes where it can spread to other locations and is much more difficult to treat.  Treatment includes surgery, radiation therapy and chemotherapy, but again is limited when the disease is advanced.

No one knows for sure what causes NPC but there are some strong associations or indicators of increased risk.  The salted/preserved foods of the Cantonese diet have been strongly associated with the NPC in SE Asia.  However, it is difficult to prove this association at the moment.  Another culprit for certain forms of the disease is viral.  EBV or Epstein Barr Virus is strongly associated with the development of certain forms of NPC.  Although, most adults are exposed to EBV in their lifetimes and in a certain number of people the virus aids in the transformation process of the cancer cell itself.  Exposure to certain environmental toxins may also lead to the development of this disease as well.

It is one of many cancers ion which active research is badly needed and there are some labs focusing on it in China and elsewhere in SE Asia.  One day, we will understand more about this disease and be able to treat it better and understand how to avoid it.

Thank you for reading….please do visit Cancer Made Simple for more information.

Dr. C