2012 in review

This was a slow year…sorry readers.  I promise to make 2013 a more productive year by writing more posts about cancer trends and medical issues including controversial issues!  Thanks for your support!

Dr C

Here’s an excerpt:

The new Boeing 787 Dreamliner can carry about 250 passengers. This blog was viewed about 1,200 times in 2012. If it were a Dreamliner, it would take about 5 trips to carry that many people.

Click here to see the complete report.

Vitamins that kill?

Ok…the title is a bit over the top I know, but new and some not so new evidence suggests that this supplement craze (most vitamins) that is ever so popular now may actually be damaging and not helpful. 

How so?  Well a number of studies have now linked the over consumption of vitamin A, C and E to the development of a number of cancers including lung cancer, bladder cancer, and prostrate cancer.  Statistical analysis also showed an increase risk in premature death is a cohort (a subset) of people such as post menopausal women.  

It seems as if the antioxidant observations in aging, first made in the 1950’s, with natural antioxidants found in fruits and vegetables has now grown into a multibillion dollar industry with man made vitamins in the form of pills.  It is now clear with more and more studies using correct scientific and clinical methodology, that ingesting large (or even moderate) amounts of these supplements not only do NOT prevent illness as prescribed, but result in increased mortality, increased risk of certain cancers, and in some cases increase risk for heart complication.  This is scary folks. This is dangerous folks.

So, what to do?  First and foremost, something that we all know but for some reason refuse to practice (many of us); eat healthy fruits and vegetables that provide you with all the vitamins, minerals, fibers, etc. that your body needs and in the correct natural form.  Avoid taking supplements unless instructed to do so by your doctor (e.g. a pregnant women taking folic acid is absolutely advisable).  Especially steer away from those vitamins which are in far excess of the recommended daily doses (e.g the USDA has recommended dosages).  Extra vitamins do not mean extra protection.  Furthermore, if you are a vegetarian or on a strict dietary regime (or do not eat fruits, vegetables, and nuts) than you might need to take some supplement (but look for those at lower doses).

  Remember, antioxidants can be found in many forms…coffee, teas, vitamins, fruits, vegetables.  However, we now know that oxidants are natural and helpful as well.  Our own body produced them to fight infection and kill microorganisms.  So, oxidants and antioxidants are both important.  Let’s not get carried away bu sales adds and such and buy buy buy, based on what marketing executives tell us.

 

Cheers

Dr. C

What happened to me?

OMG….I have not enetered a post on cancer or anything in over 6 months.  What in the heck happened?  Well honestly, a baby happened.  Charlie Massimo was born on Oct. 6th 2011 and he is the happiest, healthiest and cutest baby on the planet (slightly biased father here).  So, that is what has been distracting me.  Please do let me know if there is anything that you want discussed here and I will try and do so.  Sorry for those of you who read this often.

Cheers

Dr. C

Cancer terms defined

metaphase showing one part of the mitosis divi...

Image via Wikipedia

As I write more and more blog entries…it occurs to me that many of you reading these and other cancer related information may be thrown off from time to time with the technical terms that many of us use without thinking.  One of the primary reasons I started writing this blog is that I hope to reach out to the scientific and non-scientific community.  Scientists spend a huge amount of time hidden in their labs, reading highly technical journal articles, and then trying to publish highly specialized articles that are not reaching out to the majority of people out there.  I hope to do that less and reach out to more…more often.

So here are some common terms that you will see when you read,view, or hear cancer information.

Cancer:  A set of over 200 different disorders that arise from uncontrolled cell growth and usually form tumors

Blood cancer A large number of highly different cancers that arise from uncontrolled cell growth of blood cells (such as T and B cells) that are circulating on the body and may or may not form solid tumors.

Metastasis:  The term referrers to the state of cancer in which cells from a primary cancer have moved from its original location to that of another location.  For example, a breast cancer tumor cell that has moved from the area of the breast to the bone.  The newly targeted bone cancer is actually part of the breast cancer that has metastasized (either from the blood or from the lymph nodes).  The metastatic cancer is usually much more difficult to treat than the original primary tumor.

Clinical Trials:  A set of human trials used to measure safety or efficacy of a new drug against cancer or a new combination of drugs or an old drug being studied on a new disease.  There are four types and they get more and more expensive as you go up.  All  drugs must go through all four of these and if they succeed at each step are likely to be approved by the Food and Drug Administration.

Efficacy:  The effectiveness of a drug or treatment for cancer.  How well does it treat the disease.  There are many ways to measure this and some of the terms that are used are:  progression free survival (PS), overall survival (OS), Partial Response (PR) and others. 

Cure:  Oncologists’ definition:  The clinical absence of the cancer in question for five (sometimes ten) years is often referred to as the cure rate.  Pateints’ definition:  The complete absence of the disease for life.  This is difficult to achieve for many cancers and only a few can be said to permanently cured.  success stories are mostly found in some childhood blood cancer and a few adult cancers. 

Chemotherapy:  Chemical agents that are used to target pathways in the cancer cells that are essential for its survival but often affect normal cells as well.  For example, many chemotherapuetic agents target the proliferative capacity of the cancer cell and thus stop its division.  However, other cells that divide quickly can also be affected such as hair follicles and gut epithelial cells (thus hair loss and diarrhea are common side effects).

 Bone marrow transplant:  A very complicated medical procedure where the bone marrow from a donor is removed and placed inside a sick patient (recipient) that has been treated with radiation to “kill” off his own bone marrow in hopes that the donors cells will replace the recipient.  The objective is to either remove the cancer (if it is located in the bone marrow of the recipient) and replace it with healthy new bone marrow or to use the new bone marrow to fight off the cancer in the patient.  This procedure is complex, has many side effects, and works only for some types of cancers. 

That is a good start for now.  Please do let me know if there other terms you have heard but don’t really understand of if you wish to have some clarification of any of the above definitions.  Please do visit cancer made simple for more information and resources.

Thanks Dr. C

Cancer made simple!

Multiple Myeloma: bone or B cell cancer?

Human bone marrow.

Image via Wikipedia

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

Image via Wikipedia

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

the new WHO directive about cancer

US 1988–2007 No Leisure-Time Physical Activity...

Image via Wikipedia

Well the WHO (world health organization) has just come out with very strong recommendation to help one prevent cancer.  They recommend that one should exercise for at least 150 minutes a week in order to help reduce one’s chances of getting several of the main cancers.  In fact, their estimates (and yes, this is only an estimate) is that one can improve their chances by 25% in avoiding both breast and colon cancer by doing this much physical activity per week.  Another way of saying this is that if you do 150 minutes of exercise a week you may reduce your risk of getting some cancers by 25%. The exercise in question need not be intensive but can be moderate…e.g. a 30 minute brisk walk or jog five times a week.

This may alarm some people or may delight others.  150 minutes is a lot of time for many people. Indeed this is 2.5 hours per week.  Actually, let’s not kid ourselves here, some people (not all) really don’t have so much time in their day…with kids, school, and a host of other activities that take up their time.    Some people really don’t like to work out or exercise for that long if at all.  Some people live in cramped areas and in cities where finding a decent place to walk may be tough.  Anyhow, despite this….this is the recommendation and it is a very good idea for many reasons.

Let me tell you about some of these reasons.  It has always been know that inactivity leads to weakened immune system function and cold fighting ability in general (although this is hard to quantify exactly).  People who do not get much if any physical activity suffer from many ailments and in fact it is now known that physical inactivity is the fourth leading contributor to deaths worldwide.  This means that for of all the risk factors out there such as smoking, eating processed foods, etc., not getting enough exercise is the fourth worst one to have.  I am not sure what classifies as not enough activity, but those who sit around and watch TV all day and never go out (including children) are at high risk.  It turns out that this is so common that in in three people in developed world are at risk and may be classified as low physical activity folks.

Where did that number come from and how accurate is the information that went behind their recommendation? The short answer is I don’t know.  The longer answer is that a panel of experts were called together and they looked at all the published data out there and came up with this magic number of 150 minutes and the risks.  This does remind me of something else I have read and seen and that is that one should walk at least 10,000 steps per day to be healthy and to lead a healthy life.   This is one reason I personally went out and bought a pedometer, to see if I was achieving this.  Those of you who work in offices all day, you might be sadly disappointed to see how you might be well under that threshold of steps.  It is not easy to reach that number.

None of this is easy.  It is all about making sometimes difficult lifestyle  choices.  We have no problems tweeting, facebooking, and eating by the computer or TV.  We have no problems going for a beer in our cars, and eating unhealthy fried foods and watching movies in the theater.  But, do we also go jogging, running, hiking, walking, rock climbing, biking, doing yoga consistently?  Do we really make sure that we get enough exercise?  If the answer is no, then that should perhaps become a priority.  The movies can wait….facebook will still be there when you finish your jog.  However, physical inactivity can slowly (or quickly) rob you of your health and your life…and then facebook will not be there anymore for you.

Anyhow, for those of you who don’t get much physical activity…time to SERIOUSLY consider doing so.  Do you 150 hours minimum.  Go out and have fun.

Thanks for reading….Dr. C

For more information about cancer and to get more resources….please see Cancer Made Simple!