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CANCER OPTIONS NEWSLETTER
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www.pathwayforhealth.co.uk
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LATEST NEWS
Hello and welcome to our newsletter for September 2010. I have been quiet
on the newsletter front as I have been updated on the communications front
and now have a blog which I update regularly and am regularly twittering with
latest news.
For those of you familiar with these, my blog is available at;
http://tinyurl.com/3adk6pf and on Twitter as Patricia Peat please sign up
and link us up with anyone you think will benefit and be interested.
NEW COLLEAGUE
I am delighted to have been joined by the wonderful Margella Salmins BSc
Hons. TCM, BM (Beijing), MRCHM MBAcC MATCM
Margella is a fully qualified practitioner of Chinese Medicine, having completed
her studies and clinical training in London and Beijing. In addition she is also
trained and qualified in Macrobiotic Nutrition; Therapeutic Healing; Reiki and
Esoteric Astrology.
She is an incredibly talented practitioner who is bringing her many skills and
talents to developing the Pathway Programme into the most comprehensive
programme for anyone diagnosed with ill health. I feel very lucky to be working
with her and I am sure we will be bringing you further news of how people are
empowering themselves to good health.
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ANALYZING EFECTIVENESS
A big question with any integrative programme is always “how will I know if it
is working” In the absence of tumour markers P53 gene, protein and Bcl-2gene
expression have always given a comprehensive of how the body is dealing with
cancer. They have now been developed by Neurolab to be available as a lower
cost home finger tip blood test.
For more details contact me at [email protected]
FINANCIAL ADVICE
As many of you will know, being diagnosed with cancer does bring the practical
challenges of normal life particularly financial. A very useful chap for you to
know is George Emsden. With along background in financial services, followed
by a bout of cancer himself, he is now the most the most amazing resource for
dealing with financial matters relating to ill health. He has a web site and blog
full of good advice and is well worth consulting if financial issues crop up.
www.georgeemsden.co.uk
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COMING SOON!!!
The Yes to Life Seminar Series
Cancer: Building an Integrated Treatment Programme
It gives us great pleasure to announce the next Seminar in the Yes to Life Series.
Our top speakers
from the world of integrated cancer care include
Patricia Peat RGN - Founder, Cancer Options
Dr Nicola Hembry – Specialist in environmental and nutritional medicine
Dr Seigfried Trefzer - Medical Director, High Tree Clinic
Kristen Chick – Nutritionist, Vision of Hope Clinic
Date to be confirmed in November
To find out about Yes to Life, visit www.yestolife.org.uk.
This event is supported by
Amy Trotter
Events coordinator/Office administrator
[email protected]
YES TO LIFE EMPOWERS PEOPLE WITH CANCER WITH INFORMATION ON CAM AND SUPPORTS THEM IN
TAKING AN INTEGRATED APPROACH TO THEIR TREATMENT
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HAVING TROUBLE FITTING IT ALL IN?
One of the problems you may encounter when embarking on an integrative
regime is fitting it all in. With juicing, meditation, food preparation etc people
often complain they can’t fit in the normal household activities. Below is an
example of the sort of ingenuity and lateral thinking we have come to expect
from our wonderful clients, utilising the FIR sauna lent to him by Yes to Life,
the wonderful Derek Foot shows that it is not just women who know how to
multi task!!
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NEWSLETTER CONTENTS
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Cancer Survivors Face Tough Road Long After Treatment Ends
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New Alarm Bells About Chemicals and Cancer
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New Technique In Treating Patients With Liver Cancer Proves
Effective, Study Suggests
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NICE calls for specialist cancer teams to boost patient care
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Scientists find gene that causes lung cancer in non-smokers
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Advance Toward Earlier Detection of Melanoma
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Most Patients Survive Common Thyroid Cancer Regardless of
Treatment
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Concentration, Timing and Interactions Are Key When It Comes to
Dietary Compounds
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Virtual Colonoscopy Allows Detection of Unsuspected Cancers
Beyond Colon
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Everolimus Improves Progression-Free Survival in Pancreatic
Neuroendocrine Tumours
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A Long Time Coming: New Guidance on "Normal Tissue Effects"
for Radiation Oncology
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Spicing the Meat Also Cuts the Cancer Risk, Research Suggests
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Vitamin C can curb cancer growth, say New Zealand researchers
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Aspirin cuts cancer deaths: Painkiller can boost breast cancer
survival rates by 71%
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CANCER SURVIVORS FACE TOUGH ROAD LONG AFTER
TREATMENT ENDS
Cancer survivors are more likely than their healthy peers to suffer serious
psychological distress such as anxiety and depression, even a decade after
treatment ends, new research shows.
Those who were relatively young at the time of diagnosis, unmarried, had less
than a high school education, were uninsured, had other illnesses or had
difficulty doing the activities of daily living were at the highest risk of
psychological problems.
The study appears in the July 27 issue of the Archives of Internal Medicine.
To gauge the long-term psychological impact of the disease, they analyzed
mental health and medical data on 4,636 adults who'd survived cancer and
122,220 who had never had cancer. The data was collected between 2002 and
2006 by the National Health Interview Survey, which is conducted yearly by the
U.S. Census Bureau.
During a follow-up period of at least five years and an average of 12 years,
about 5.6 percent of cancer survivors were found to have experienced severe
psychological distress within the previous month, compared with 3 percent of
those without cancer.
Dr. James Zabora, a former associate professor of oncology at Johns Hopkins
School of Medicine who has researched cancer and mental health issues, said
the study was well done but that the measure of mental health has not been
scientifically validated for use in cancer survivors. In fact, he said, he suspected
the incidence of mental health issues among cancer survivors may be higher.
"It's a well-designed study, and the investigators document a significant issue,
that is, survivors of cancer continue to struggle well after their treatment and
recovery," said Zabora, now dean of the National Catholic School of Social
Service. "But you could argue maybe this instrument under-diagnosed
psychological distress."
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"When you are faced with a serious stressor, in order for you to respond to it,
you have to define what it means for you," Zabora said. "That process depends
on how many resources you have to manage that stressor. The younger you
are, the less experience you have dealing with stressors. The lower your
education, the more difficult it is to understand the complex nature of the
disease. If you're unmarried, you may have less support."
Getting a diagnosis of cancer and going through chemotherapy can be among
life's most trying experiences, said Kevin Stein, the American Cancer Society's
director of quality-of-life research.
The physical and emotional fallout of cancer treatment, including fatigue, pain,
nausea and vomiting, mouth sores and hair loss, can contribute to feelings of
anxiety and depression. While many of these symptoms may subside or
disappear after treatment ends, some, including fatigue, can linger for months
or years.
Chemotherapy can also cause delayed problems that aren't apparent until
months or years later, including peripheral neuropathy (nerve pain or
numbness), infertility, organ dysfunction, hearing loss, muscle atrophy and
cardiovascular disease.
"Chemotherapy is an effective treatment because it's toxic to the cancer cells,
but sometimes it does collateral damage," Stein said. Cancer can also bring
about job loss and changes to relationships, including family roles and sexual
intimacy. Survivors also may fear the cancer will recur, worries that may
contribute to psychological distress.
In the study, 9 percent of long-term cancer survivors and 6 percent of
individuals without cancer reported seeing or talking to a mental health
professional within the previous year. One-third of cancer survivors with
serious psychological distress reported using mental health services, while 18
percent said they could not afford mental health care.
Screening for psychological distress in cancer survivors by primary-care
physicians and oncologists may help direct people to services that can help
them cope, Stein said. Some may find benefit from anti-anxiety medications,
cognitive behavioral psychotherapy and stress management techniques, such
as deep breathing and progressive muscle relaxation.
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And don't underestimate the power of eating a proper diet, maintaining a
healthy weight and staying physically active, Stein said.
"All of those things impact mood in a positive way and can help manage
distress," Stein said. "And always stay in touch with your doctor. When you
recognize signs of emotional distress, discuss it."
This study highlights all the elements of diagnosis and treatment that our two
services Cancer Options and the Pathway for Health are designed to help
people with. For the most comprehensive personal service available for anyone
diagnosed with cancer; Cancer Options and the Pathway Programme are
available. www.canceroptions.co.uk www.pathwayforhealth.co.uk
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NEW ALARM BELLS ABOUT CHEMICALS AND CANCER
The President’s Cancer Panel is the Mount Everest of the medical mainstream,
so it is astonishing to learn that it is poised to join ranks with the organic food
movement and declare: chemicals threaten our bodies.
The cancer panel is releasing a landmark 200-page report, warning that our
lackadaisical approach to regulation may have far-reaching consequences for
our health.
It calls on America to rethink the way we confront cancer, including much
more rigorous regulation of chemicals.
Traditionally, we reduce cancer risks through regular doctor visits, selfexaminations and screenings such as mammograms. The President’s Cancer
Panel suggests other eye-opening steps as well, such as giving preference to
organic food, checking radon levels in the home and microwaving food in glass
containers rather than plastic.
In particular, the report warns about exposures to chemicals during pregnancy,
when risk of damage seems to be greatest. Noting that 300 contaminants have
been detected in umbilical cord blood of newborn babies, the study warns
that: “to a disturbing extent, babies are born ‘pre-polluted.’ ”
It’s striking that this report emerges not from the fringe but from the mission
control of mainstream scientific and medical thinking, the President’s Cancer
Panel. Established in 1971, this is a group of three distinguished experts who
review America’s cancer program and report directly to the president.
One of the seats is now vacant, but the panel members who joined in this
report are Dr. LaSalle Leffall Jr., an oncologist and professor of surgery at
Howard University, and Dr. Margaret Kripke, an immunologist at the M.D.
Anderson Cancer Center in Houston. Both were originally appointed to the
panel by former President George W. Bush.
“We wanted to let people know that we’re concerned, and that they should be
concerned,” Professor Leffall told me.
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The report blames weak laws, lax enforcement and fragmented authority, as
well as the existing regulatory presumption that chemicals are safe unless
strong evidence emerges to the contrary.
“Only a few hundred of the more than 80,000 chemicals in use in the United
States have been tested for safety,” the report says. It adds: “Many known or
suspected carcinogens are completely unregulated.”
Industry may howl. The food industry has already been fighting legislation in
the Senate backed by Dianne Feinstein of California that would ban bisphenolA, commonly found in plastics and better known as BPA, from food and
beverage containers.
Studies of BPA have raised alarm bells for decades, and the evidence is still
complex and open to debate. That’s life: In the real world, regulatory decisions
usually must be made with ambiguous and conflicting data. The panel’s point is
that we should be prudent in such situations, rather than recklessly approving
chemicals of uncertain effect.
The President’s Cancer Panel report will give a boost to Senator Feinstein’s
efforts. It may also help the prospects of the Safe Chemicals Act, backed by
Senator Frank Lautenberg and several colleagues, to improve the safety of
chemicals on the market.
Some 41 percent of Americans will be diagnosed with cancer at some point in
their lives, and they include Democrats and Republicans alike. Protecting
ourselves and our children from toxins should be an effort that both parties
can get behind — if enough members of Congress are willing to put the public
interest ahead of corporate interests.
One reason for concern is that some cancers are becoming more common,
particularly in children. We don’t know why that is, but the proliferation of
chemicals in water, foods, air and household products is widely suspected as a
factor. I’m hoping the President’s Cancer Panel report will shine a stronger
spotlight on environmental causes of health problems — not only cancer, but
perhaps also diabetes, obesity and autism.
This is not to say that chemicals are evil, and in many cases the evidence
against a particular substance is balanced by other studies that are
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exonerating. To help people manage the uncertainty prudently, the report has
a section of recommendations for individuals:
· Particularly when pregnant and when children are small, choose foods, toys
and garden products with fewer endocrine disruptors or other toxins.
· For those whose jobs may expose them to chemicals, remove shoes when
entering the house and wash work clothes separately from the rest of the
laundry.
· Filter drinking water.
· Store water in glass or stainless steel containers, or in plastics that don’t
contain BPA or phthalates (chemicals used to soften plastics). Microwave
food in ceramic or glass
· Give preference to food grown without pesticides, chemical fertilizers and
growth hormones. Avoid meats that are cooked well-done.
· Check radon levels in your home. Radon is a natural source of radiation linked
to cancer.
By Nicholas D. Kristof
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NEW TECHNIQUE IN TREATING PATIENTS WITH LIVER
CANCER PROVES EFFECTIVE, STUDY SUGGESTS
Use of multipolar radiofrequency ablation in the treatment of colorectal liver
metastases is effective and has a relatively low recurrence rate, according to a
recent study conducted by researchers at Charité, Campus Benjamin Franklin
in Berlin, Germany.
Radiofrequency ablation (RFA) has become a widely used treatment option for
patients with primary liver cancer and liver metastases from some primary
tumors, if surgery is not an option. However, because of limited sizes of the
ablation zones the technique has been limited to tumors smaller than four
centimeters," said Bernd Frericks, MD, lead author of the study. "This longterm study (four years) was performed using a new multipolar radiofrequency
(RF)-device allowing for up to six ablation probes to be used simultaneously,
thus providing larger ablation zones. We evaluated this new technique
prospectively regarding ablation zone size, technical effectiveness,
complications and clinical outcome in patients with colorectal liver
metastases," he said.
The study evaluated 27 patients with 67 colorectal liver metastases that were
treated using multipolar RF ablation. According to the study, complete tumor
destruction occurred in 66 of 67 cases. Of the 67 metastases, eight required
reablation. After a mean of nine months, 16 patients developed new
metastases in the liver and the lung, eight of which were successfully
reablated. After four years, 52% of the patients are now tumor-free and 78%
are still living.
"Using this new device, the rate of local tumor progressions was not influenced
by the size of the tumor to be treated," said Dr. Frericks.
The full results of this study will be presented on Wednesday, April 16, 2008
during the American Roentgen Ray Society's annual meeting in Washington,
DC.
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NICE CALLS FOR SPECIALIST CANCER TEAMS TO
BOOST PATIENT CARE
THIS IS GOOD NEWS AS PEOPLE WITH UNKNOWN
PRIMARIES CAN BE LEFT WITHOUT PROPER SUPPORT
Specialist cancer teams should be set up to improve the care and treatment of
patients whose cancer has spread to other parts of the body from an unknown
primary location, NICE says.
Around 10,000 people are diagnosed with cancer of unknown primary origin
(CUP) in England and Wales every year, making the disease one of the most
common causes of cancer death. However, current levels of care for patients
with CUP are patchy, with many patients missing out on the high-standards of
care on offer to patients with site-specific cancers such as breast and bowel.
This latest guidance calls for a re-organisation of cancer services to boost care
for this group of patients, and has received the support of the National Cancer
Peer Review Programme in England, which is developing a number of peer
review quality measures,
Hospitals will be expected to follow the measures and are assessed against
them with the aim of improving care for cancer patients and their families.
Under the plans, all hospitals with a cancer centre or unit should set up
specialist CUP teams to support and manage the care of patients with this
diagnosis. This team will be responsible for guiding patients’ care until they are
referred to a consultant with expertise in a particular type of cancer, referred
for palliative care alone or are finally diagnosed with confirmed CUP.
Specialist CUP Multi Disciplinary Teams should be set up at a Network level to
review the treatment and care of patients with confirmed CUP, or with
complex diagnostic issues.
Professor Peter Littlejohns, NICE Clinical and Public Health Director, said: “We
are pleased that the National Cancer Peer Review Programme in England is
taking note of our guideline and looking to use it to improve services.
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“It is important that patients with this form of cancer receive the same level of
care that other cancer patients experience. This guideline seeks to provide a
consistent, national approach to the diagnosis and management of this
condition.”
Dr Andrew Fowell, Guideline Development Group (GDG) Chair and a Macmillan
Consultant in Palliative Medicine at Eryri Hospital, North Wales, said: “Just as
specialised teams help care for patients with a site-specific cancer such as
breast, prostate, bowel or liver, the same needs to exist for those with CUP.
These teams can provide great support for cancer patients and better one-onone care.
"We expect some oncologists to become CUP specialists, alongside their more
conventional site-specific activities. They will be supported by CUP Nurse
Specialists, Palliative Care physicians, and other core diagnostic staff. These
teams should be supported by their hospitals to ensure they are given
sufficient time in their job plans for this specialist role and any training that
may be needed."
Dr David Brooks, a member of the GDG and Macmillan Consultant in Palliative
Medicine at Chesterfield Royal Hospital, helped to establish a specialist CUP
team earlier this year.
He said: “Our Unknown Primary Team consists of existing members of the
Upper GI Cancer and Palliative Care teams. We see one or two patients per
week in a Cancer Unit that covers a population of just over 300,000 so the
workload is not onerous.
“It is early days but we are already seeing benefits in both providing early
supportive and palliative care, more effective targeting of investigations to
confirm treatable disease and, in those who are not fit for treatment, stopping
inappropriate tests and re-focusing care towards arranging appropriate
support and palliation to enable the patient to get home.”
Dr Richard Osborne, GDG lead clinician and Consultant in Medical Oncology,
Dorset Cancer Centre, added:“This guideline will provide a sound basis for
healthcare professionals to ensure patients are informed and their care is
centred around their needs and wishes.”
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SCIENTISTS FIND GENE THAT CAUSES LUNG CANCER IN
NON-SMOKERS
A gene that can cause lung cancer in people who have never smoked has been
pinpointed by scientists.
Mutations in the gene - known as GPC5 - could lead to a 'significantly higher
risk' of lung cancer among those who have never touched tobacco.
The research suggests that targetting the gene could lead to new treatments
for the disease and identify high risk patients earlier.
Mutations: A gene that can cause lung cancer in people who have never
smoked has been pinpointed by scientists. A quarter of people who die from
lung cancer each year globally have never smoked.
An international team of scientists, led by Ping Yang from the Mayo Clinic
College of Medicine in Rochester, New York, studied people who have smoked
less than 100 cigarettes in their lifetime. They examined DNA samples from
754 non-smokers to find the genetic variations most likely to lead to lung
cancer.
Tests showed that GPC5 expression levels were 50 per cent lower in
adenocarcinoma - the most common form of lung cancer - than in matched
normal lung tissue.
This indicates that reduced GPC5 expression could be specific for
adenocarcinoma in people who have never smoked.
The research is published in The Lancet Oncology journal.
But Dr Ramaswamy Govindan, of Washington University, warned: 'Even though
this study reports a two-fold reduction in GPC5 expression in adenocarcinoma
tissues compared to matched normal controls, it is far from clear how reduced
GPC5 expression could predispose individuals to lung cancer.
'More studies are needed to confirm these preliminary observations in the
tumour samples from those with no history of tobacco smoking.'
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ADVANCE TOWARD EARLIER DETECTION OF
MELANOMA
Melanoma is one of the less common types of skin cancer but it accounts for
the majority of the skin cancer deaths (about 75 percent).
The five-year survival rate for early stage melanoma is very high (98 percent),
but the rate drops precipitously if the cancer is detected late or there is
recurrence. So a great deal rides on the accuracy of the initial surgery, where
the goal is to remove as little tissue as possible while obtaining "clean margins"
all around the tumor.
So far no imaging technique has been up to the task of defining the
melanoma's boundaries accurately enough to guide surgery. Instead surgeons
tend to cut well beyond the visible margins of the lesion in order to be certain
they remove all the malignant tissue.
Two scientists at Washington University in St. Louis have developed
technologies that together promise to solve this difficult problem.
Their solution, described in the July issue of ACS Nano, combines an imaging
technique developed by Lihong Wang, PhD, the Gene K. Beare Distinguished
Professor of Biomedical Engineering, and a contrast agent developed by
Younan Xia, PhD, the James M. McKelvey Professor of Biomedical Engineering.
Together the imaging technique and contrast agent produce images of startling
three-dimensional clarity.
Photoacoustic tomography (PAT) can detect deep structures that strongly
absorb light because sound scatters much less than light in tissue.
"PAT improves tissue transparency by two to three orders of magnitude," says
Wang.
Moreover, it's a lot safer than other means of deep imaging. It uses photons
whose energy is only a couple of electron-volts, whereas X-rays have energies
in the thousands of electron-volts. Positron emission tomography (PET) also
requires high-energy photons, Wang says.
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Photoacoustic images of biological tissue can be made without the use of
contrast agents, particularly if tissues are pigmented by molecules like
hemoglobin or melanin.
Still, photoacoustic images of melanomas are fuzzy and vague around the
edges. To improve the contrast between the malignant and normal tissue, Xia
loads the malignant tissue with gold.
"Gold is much better at scattering and absorbing light than biological
materials," Xia says. "One gold nanocage absorbs as much light as a million
melanin molecules," says Xia.
The molecule is alpha-melanocyte-stimulating hormone, slightly altered to
make it more stable in the body. This hormone normally stimulates the
production and release of the brown pigment melanin in the skin and hair.
As is true in many types of cancers, this hormone seems to stimulate the
growth of cancerous cells, which produce more hormone receptors than
normal cells.
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MOST PATIENTS SURVIVE COMMON THYROID CANCER
REGARDLESS OF TREATMENT
Individuals with papillary thyroid cancer that has not spread beyond the
thyroid gland appear to have favorable outcomes regardless of whether they
receive treatment within the first year after diagnosis, according to a report in
the May issue of Archives of Otolaryngology-Head & Neck Surgery, one of the
JAMA/Archives journals.
Papillary thyroid cancer is commonly found on autopsy among individuals who
died of other causes, according to background information in the article.
"Studies published as early as 1947 demonstrated it, and more recently, a
report has shown that nearly every thyroid gland might be found to have a
cancer if examined closely enough," the authors write. "The advent of
ultrasonography and fine-needle aspiration biopsy has allowed many
previously undetected cancers to be identified, changing the epidemiology of
the disease. Over the past 30 years, the detected incidence of thyroid cancer
has increased three-fold, the entire increase attributable to papillary thyroid
cancer and 87% of the increase attributable to tumors measuring less than 2
centimeters."
Louise Davies, M.D., M.S., of Dartmouth Medical School, Hanover, N.H. and
Gilbert Welch, M.D., M.P.H., both also of Department of Veterans Affairs
Medical Center, White River Junction, Vt., and The Dartmouth Institute for
Health Policy and Clinical Practice, Hanover, studied cancer cases and
individual treatment data from National Cancer Institute registries. They then
tracked cause of death through the National Vital Statistics System.
The researchers identified 35,663 patients with papillary thyroid cancer that
had not spread to the lymph nodes or other areas at diagnosis. Of these, 440
(1.2 percent) did not undergo immediate, definitive treatment. Over an
average of six years of follow-up, six of these patients died of their cancer. This
was not significantly different from the rate of cancer death among the 35,223
individuals who did undergo treatment (161 over an average of 7.6 years of
follow-up).
The 20-year survival rate from cancer was estimated to be 97 percent for those
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who did not receive treatment and 99 percent for those who did. "These data
help put management decisions about localized papillary thyroid cancer in
perspective: papillary thyroid cancers of any size that are confined to the
thyroid gland, have no lymph node metastases at presentation and do not
show extraglandular extension [reach beyond the thyroid gland] are unlikely to
result in death due to the cancer," the authors write.
"Thus, clinicians and patients should feel comfortable considering the option to
observe for a year or longer cancers that fall into this category," they conclude.
"When treatment is elected, the cancers in this category can be managed with
either hemithyroidectomy [removal of part of the thyroid] or total
thyroidectomy [removal of the complete gland], and the prognosis will be the
same
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CONCENTRATION, TIMING AND INTERACTIONS ARE
KEY WHEN IT COMES TO DIETARY COMPOUNDS
Agricultural Research Service (ARS) chemist Thomas Wang, who specializes in
cancer prevention research, has reported evidence that for some dietary
compounds, length of exposure over time may be key to whether or not
ingestion leads to a beneficial, or detrimental, effect.
Scientists do not know exactly why one person develops cancer and another
does not. But they do know that certain nutrients might increase or decrease
cancer risk. There are "layers" of factors involved in the development of
cancer, and Wang is studying the layers involving peoples' diet complexity and
gene expression.
Wang works at the ARS Diet, Genomics and Immunology Laboratory, part of
the Beltsville (Md.) Human Nutrition Research Center. He published a
complementary cell-culture and animal-model study showing that
concentrations of resveratrol -- a highly bioactive compound found in grapes
and other plant foods -- actually turned out to be a double-edged sword when
it came to mitigating cancer risk.
First, Wang exposed human prostate cancer cells to resveratrol and found that
it inhibited the cells' growth. He further tested the cells' gene expression. Then
Wang tested the effects of resveratrol on a group of laboratory animals that
had sex-hormone-dependent tumor cells.
Half of those animals were fed a daily diet that included 3 to 6 milligrams of
purified resveratrol (equal to roughly the amount in five glasses of wine or
grape juice). At first, the tumor cells in the resveratrol-fed lab animals grew
slower. But as the animals continued to consume resveratrol, there was an
increase in blood vessels developing around the tumors of the resveratrol-fed
animals, effectively setting up a system of feeding the tumors.
The study, published in the journal Carcinogenesis, showed that the
concentration of the plant compound is important, but so is length of
exposure, according to the authors.
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VIRTUAL COLONOSCOPY ALLOWS DETECTION OF
UNSUSPECTED CANCERS BEYOND COLON
A new, large-scale study of more than 10,000 adults found that more than one
in every 200 asymptomatic people screened with CT colonography, or virtual
colonoscopy, had clinically unsuspected malignant cancer and more than half
of the cancers were located outside the colon. The findings were published in
the April issue of the journal Radiology.
We are finding that virtual colonoscopy screening actually identifies more
unsuspected cancers outside of the colon than within it," said lead author
Perry J. Pickhardt, M.D., professor of radiology and chief of GI Imaging, at the
University of Wisconsin School of Medicine & Public Health. "As with
asymptomatic colorectal cancers identified by virtual colonoscopy screening,
these cancers are often detected at an early, curable stage."
Colorectal cancer remains the second leading cause of cancer death in the U.S.,
and the National Cancer Institute estimated that there would be 146,970 new
cases diagnosed in 2009 and 49,920 deaths. The disease is largely preventable
through screening for colon polyps, which are benign growths that may
develop into cancer if not removed. The American Cancer Society recommends
that people at average risk for colorectal cancer begin regular colorectal cancer
screening at age 50, but current compliance with this recommendation is
below 50 percent. Many people resist screening because of the discomfort and
inconvenience caused by the conventional optical colonoscopy test.
Virtual colonoscopy is less invasive than optical colonoscopy and produces
precise and detailed "fly-through" images of the entire colon's interior without
having to insert a scope. With virtual colonoscopy screening, there is
essentially no risk of bleeding or of perforating the colon. There is no need for
intravenous sedation, and the procedure is less costly than conventional
optical colonoscopy. It also is more convenient, typically taking 10 minutes or
less. Virtual colonoscopy also allows for limited assessment of structures
outside the colon (extracolonic), including the abdomen, pelvis and portions of
the lungs. Additional diagnostic tests for unsuspected extracolonic findings are
performed in about 6 percent of cases, nearly half of which ultimately prove to
be clinically relevant.
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"Optical colonoscopy cannot provide for any assessment beyond the colon
itself, whereas virtual colonoscopy can detect a wide array of unsuspected
extracolonic diseases, most notably cancers and aortic aneurysms," Dr.
Pickhardt said.
For the study, Dr. Pickhardt and colleagues set out to determine the detection
rate and clinical outcome of unsuspected malignancies detected with virtual
colonoscopy in an asymptomatic screening population. The researchers
retrospectively reviewed the medical records of 10,286 adults (5,388 men and
4,898 women) with a mean age of 59.8 years who were evaluated at either the
University of Wisconsin or National Naval Medical Center. All of the adults had
undergone colorectal cancer screening with virtual colonoscopy at the two
centers between April 2004 and March 2008. The mean time for follow-up was
30.2 months.
Unsuspected cancer was confirmed in 58 patients, including 33 women and 25
men. Invasive colorectal cancer was found in 22 patients, and extracolonic
cancer was found in 36 patients. Cancers in 31 patients (53.4 percent) were
stage 1 or localized cancers.
"To our knowledge, none of the patients who presented with stage 1, stage 2
or localized disease at diagnosis has progressed to a higher stage," Dr.
Pickhardt said. "The fact that so many of the cancers in our study were
localized or detected at an early stage appears to have positively affected
survival."
Extracolonic malignancies, which outnumbered cases of invasive colorectal
cancer, included renal cell carcinoma, lung cancer and non-Hodgkin lymphoma,
among others.
"Although extracolonic evaluation at screening CT colonography does carry
some disadvantages, such as patient anxiety, inconvenience, or the potential
for benign biopsy, our results suggest that early detection of asymptomatic
extracolonic cancer represents an additional benefit of screening CT
colonography that is not available with optical colonoscopy," Dr. Pickhardt
said.
"Virtual colonoscopy is an accurate, safe and convenient screening test that
could potentially be a life-saving examination," he added.
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EVEROLIMUS IMPROVES PROGRESSION-FREE SURVIVAL IN
PANCREATIC NEUROENDOCRINE TUMORS
THIS IS GOOD NEWS FOR A CANCER THAT HAS FEW VIABLE OPTIONS
AVAILABLE, LETS HOPE NICE AGREES !
Another targeted therapy has had a major impact on pancreatic
neuroendocrine tumors in a phase 3 clinical trial, so now everolimus (Afinitor,
Novartis) and sunitinib (Sutent, Pfizer) are set to offer new treatment options
in these patients.
Both drugs are already marketed for use in kidney cancer and for other
indications. The new data for pancreatic neuroendocrine tumors have already
been filed with regulatory authorities for sunitinib, and there are plans to file
for everolimus for this new indication.
Pancreatic neuroendocrine tumors affect the hormone-producing tissues
within the pancreas, and are relatively rare, affecting annually only 2 to 4
people per million worldwide. However, the incidence is rising, and has
quadrupled in the past 30 years, according to data from the National Cancer
Institute. The most common treatment is surgery, which can be curative, but
patients who are not suitable candidates have been treated with
chemotherapy. Targeted agents now stand to offer a new treatment option,
with lower toxicity and the convenience of oral dosing.
New Data With Everolimus
The latest results, reported at the 12th World Congress on Gastrointestinal
Cancer in Barcelona, Spain, show that everolimus significantly increased
progression-free survival in a placebo-controlled phase 3 trial of 410 patients,
the largest study ever conducted in this tumor type.
The results, presented at the meeting by James Yao, MD, from the University
of Texas M.D. Anderson Cancer Center in Houston, showed that everolimus
increased progression-free survival to 11 months, compared with 4.6 months
for placebo and best supportive care (hazard ratio [HR], 0.35; P < .0001).
This is similar to the improvement in progression-free survival seen with
sunitinib in a phase 3 trial reported earlier this year, which was stopped early
because of the benefit seen. That trial involved 171 patients, and sunitinib
Page | 24
improved progression-free survival to 11.4 months, compared with 5.5 months
for placebo and best supportive care (HR, 0.418; P = .0001).
New data from that trial, including results for overall survival, were reported at
the Barcelona meeting by the principal investigator, Eric Raymond, MD,
professor of medical oncology at Beaujon University Hospital in Clichy, France.
The 1-year median overall survival was 90% in the sunitinib group and 70% in
the placebo group, Dr. Raymond reported. The latest data, at 20 months, show
that the benefit in the sunitinib group was sustained, with overall survival
remaining at 90%, but it fell to below 60% in the placebo group (HR, 0.409; P =
.0204).
"In my opinion, it's great news, as tolerance can be different in patients" and it
is useful to have more than 1 agent to choose from, he added.
"Pancreatic neuroendocrine tumors are generally felt to be indolent, although
the majority do present at an advanced stage," Dr. Saif said. "In the past,
treatment options have been limited, with hormonal treatment with
octreotide being the primary therapeutic approach. Chemotherapeutic agents
have been used with limited efficacy; [they are] less effective in welldifferentiated tumors," he explained, adding that "targeted therapy has a clear
Page | 25
A LONG TIME COMING: NEW GUIDANCE ON "NORMAL
TISSUE EFFECTS" FOR RADIATION ONCOLOGY
WHO THOUGHT ONCOLOGY ALWAYS WORKED FROM AN
EVIDENCE BASE!
A group of international experts has published a new set of recommendations
for the irradiation of 16 different organs that are sites of potential collateral
damage from radiation therapy for cancers.
The recommendations, known as the Quantitative Analysis of Normal Tissue
Effects in the Clinic (QUANTEC), address a fundamental challenge in radiation
oncology treatment: the competing needs to limit normal tissue damage and
to deliver a therapeutic dose to the cancer.
QUANTEC is the first such set of comprehensive recommendations published in
radiation oncology in 19 years — since the study by Emami et al in 1991 (Int J
Radiat Oncol Biol Phys. 1991;21:109–122).
Why has it taken so long?
"There have been many reports on individual organs since 1991, so the field
has not been stuck using the 1991 data/report," said Lawrence B. Marks, MD,
from the University of North Carolina in Chapel Hill, and one of the editors of
QUANTEC. But he did admit that a QUANTEC-like report could have been done
earlier.
Mary Martel, PhD, also a QUANTEC editor, said the new report is a great leap
forward from the Emami work, in which recommendations were largely based
on a survey of clinicians' experiences.
QUANTEC is unprecedented in our literature because these are evidencebased guidelines.
"QUANTEC is unprecedented in our literature because these are evidencebased guidelines to limit the dose to normal tissue as much as possible," said
Dr. Martel, from the University of Texas M.D. Anderson Cancer Center in
Houston, in an interview with Medscape Oncology.
QUANTEC features individual chapters or reviews on 16 organs, including the
Page | 26
brain, ear, parotid, heart, bladder, rectum, and lung.
The 16 are "normal" organs and are not organs from which cancers arise, such
as the prostate or breast, Dr. Marks told Medscape Oncology. "The rectum and
bladder chapters are largely about patients with prostate cancer in whom
there is a risk of injury to the bladder and rectum," he explained.
One of the goals of QUANTEC is to provide "practical guidance allowing the
clinician to reasonably (although not necessarily precisely) categorize toxicity
risk based on dose/volume parameters or model results," according to one of
the essays that introduce the 16 chapters on individual organs.
But Bahman Emami, MD, lead author of the seminal 1991 paper, thinks that
QUANTEC fails in a key matter of practicality — the all-important summary
tables.
"The practicing community-based radiation oncologist needs something
simpler, a table that says, for each organ, 'don't go beyond this dose'," said Dr.
Emami, who is from the Loyola University Chicago Stritch School of Medicine in
Illinois.
That's why my tables became so famous.
QUANTEC's dose/volume/outcome tables present information in a graded
manner and are missing this simple and emphatic message, Dr. Emami told
Medscape Oncology. "That's why my tables became so famous," he said,
referring to the clearly stated limits in his paper's summary tables.
Page | 27
The QUANTEC report is published at a time when the field of radiation
oncology has been scrutinized by the media and regulators. A recent feature in
the New York Times exposed how software and operator errors in radiotherapy
have resulted in serious injuries and patient death, and the US Food and Drug
Administration has recently notified manufacturers of radiotherapy equipment
that the speedy, streamlined review processes of their products may no longer
be available to them
"It's definitely a coincidence," said Dr. Martel about the timing of the issuance
of QUANTEC and the eruption of negative publicity surrounding radiation
oncology.
But she also said that the aggressive marketing and rapid implementation of
new radiotherapy technologies have gotten "out of control."
Dr. Marks circumspectly acknowledged the tumultuous business environment.
"We are in an evolving field and we need to be careful to apply the new
technology in a reasonable manner," he said.
For all of the fancy technologies, one is always left with the same set of
issues.
But he returned his attention to QUANTEC. "For all of the fancy technologies,
one is always left with the same set of issues: How much can I give to the
tumor safely? What are the normal tissues at risk? What are the trade-offs?
For these questions, one needs good data on dose/volume/outcome."
Another prominent radiation oncologist believes that professionals in the field
need to be reminded that treatment with radiation, effective as it may be, has
inherent dangers for normal tissue.
We need to move beyond 'tolerance doses' and recognize that radiation
treats large anatomic segments of normal tissues.
"We need to move beyond 'tolerance doses' and recognize that radiation
treats large anatomic segments of normal tissues while concentrating, shaping,
and conforming the high-dose volume to the cancer," said Philip Rubin, MD,
from the University of Rochester Medical Center in New York. "There is total
body scatter radiation beyond the treated segments housing the cancer. Any
Page | 28
radiation or chemotherapy dose, even well below tolerance doses, can leave
an imprint on any cell in the body. A point mutation in a cell can result decades
later in very late carcinogenesis and a second malignancy," he told Medscape
Oncology.
"Cancer treatment is like life in general — there are no free lunches. The price
of being a long-term cancer survivor may very well be an adverse late effect,"
said Dr. Rubin.
Written by Nick Mulcahy
Page | 29
SPICING THE MEAT ALSO CUTS THE CANCER RISK,
RESEARCH SUGGESTS
MIGHT JUST BE BETTER TO AVOID THE BEEF!
Spices will do more than just enhance the taste of ground beef. They may also
cut down on the risk of compounds that can cause cancer.
J. Scott Smith, a Kansas State University food chemistry professor, has pursued
different projects in recent years seeking ways to reduce heterocyclic amines
(HCAs). HCAs are the carcinogenic compounds that are produced when muscle
foods, such as ground beef patties, are barbecued, grilled, boiled or fried.
Consuming HCAs through meat increases risk factors for colorectal, stomach,
lung, pancreatic, mammary and prostate cancers.
Smith, in research supported by the Food Safety Consortium, found that
certain spices containing natural antioxidants would reduce HCA levels by 40
percent when applied to beef patties during cooking.
"Cooked beef tends to develop more HCAs than other kinds of cooked meats
such as pork and chicken," Smith said. "Cooked beef patties appear to be the
cooked meat with the highest mutagenic activity and may be the most
important source of HCAs in the human diet."
Previous studies have shown that meat products cooked below 352 degrees
Fahrenheit for less than four minutes had low or undetectable levels of HCAs,
with HCAs increasing with higher temperatures and added cooking time. It's
not a good idea to lower cooking temperatures too much, so antioxidant spices
with phenolic compounds can block HCAs before they form during heating and
still allow high temperatures to be maintained.
Smith's research team investigated six spices -- cumin, coriander seeds,
galangal, fingerroot, rosemary and tumeric -- and found that the latter three
had the highest levels of antioxidant activity toward inhibiting the formation of
HCAs, with rosemary as the most effective.
Consumers can take advantage of the spices by integrating them into their
Page | 30
cooking regimen. Previous research in his laboratory has demonstrated that
some commercial rosemary extracts, available for purchase on the Internet,
can inhibit HCA formation by 61 to 79 percent. Smith's earlier work also
showed that Thai spices can inhibit HCA formation by 40 to 43 percent.
Smith said future research in this area will investigate what some marinades or
powders can do to inhibit HCAs when applied to a cooked patties. His earlier
project showed that marinating steaks with certain herbs, rosemary and other
antioxidant spices also reduces HCAs.
VITAMIN C CAN CURB CANCER GROWTH, SAY NEW
ZEALAND RESEARCHERS
PROGRESS TOWARDS REAL EVIDENCE FOR VIT C IS BEING
MADE, GREAT NEWS ON IT HELPING CHEMO!
Wellington (dpa) - Vitamin C can help curb the growth of cancer cells,
according to New Zealand scientists who claim breakthrough research to
provide the first real evidence of a connection between the vitamin and the
development of tumours.
"Our results offer a promising and simple intervention to help in our fight
against cancer at the level of both prevention and cure," Associate Professor
Margreet Vissers, of the University of Otago's Free Radical Research Group,
said recently.
She said the role of vitamin C in cancer treatment had been the subject of
debate for years, with many anecdotal accounts of the vitamin's beneficial
role.
While her previous research had demonstrated the vitamin's importance in
maintaining cell health and hinted at its potential for limiting diseases such as
cancer, the latest study looked at whether vitamin C levels were lowered in
patients with endometrial tumours.
Page | 31
She said the study found that tumours were less able to accumulate vitamin C
compared with normal healthy tissue and that this related to the ability of the
tumour to survive and grow.
"Tumours with low vitamin C levels had more of a protein called HIF-1 which
allows them to thrive in conditions of stress," she said.
"The findings are significant as they show, for the first time, a direct
relationship between HIF-1 and vitamin C levels in tumours and suggest it
would be beneficial for people with cancer cells to have more vitamin C."
"This could help limit the rate of tumour growth, increase the responsiveness
to chemotherapy and may prevent the formation of solid tumours."
Details of the research are published in the latest edition of the Cancer
Research journal
Deutsche Presse-Agentur (dpa)
Page | 32
ASPIRIN CUTS CANCER DEATHS: PAINKILLER CAN BOOST
BREAST CANCER SURVIVAL RATES BY 71%
GREAT, BUT NO PLANS FOR LARGE TRIALS — NO MONEY = NO EVIDEN CE,
ISN’T IT ABOUT TIME WE HAD MORE CLINICAL STUDIES OUTSIDE OF
THE CONTROL OF DRUG COMPANIES?
Women in the study who took two to five aspirins a week were far less likely to
die from breast cancer or for the cancer to spread
Women with breast cancer who take aspirin at least twice a week can more
than double their chance of surviving, researchers say. The greatest protection
comes from taking the drug two, three, four or five times a week, a study has
found.
They cut the risk of dying by 71 per cent and the risk of the cancer spreading by
60 per cent. Taking aspirin on six or seven days cut the death risk by 64 per
cent, but the risk of spreading fell only 43 per cent.
The findings of the U.S. study provide the most compelling evidence yet of the
power of the cheap painkiller. Previous research has suggested that aspirin can
protect against bowel cancer, although results for other cancers, such as breast
and prostate, were less clear-cut.
The latest dramatic results came from a 30-year project tracking the health of
238,000 nurses.
Lead researcher Dr Michelle Holmes, of Harvard Medical School, said: 'This is
the first study to find that aspirin can significantly reduce the risk of cancer
spread and death for women who have been treated for early-stage breast
cancer.
'If these findings are confirmed in other clinical trials, taking aspirin may
become another simple, low-cost and relatively safe tool to help women with
breast cancer live longer, healthier lives.'
Drugs in the same class as aspirin, including ibuprofen and naproxen, also
lowered the risks, but paracetamol did not.
Experts warned, however, that aspirin can have serious side effects, including
stomach irritation that can lead to ulcers and even fatal bleeding.
Page | 33
For some people the risk of harm is greater than potential benefits.
Women newly diagnosed with breast cancer are advised not to take aspirin for
the first 12 months as it can cause side effects while they undergo
chemotherapy or radiation. Researchers are uncertain exactly how aspirin
affects tumours but it could be by lowering inflammation. The study found that
there were no beneficial effects for people who took aspirin only once a week.
Despite its benefits, many cancer sufferers could also find themselves
struggling with severe side effects if they take aspirin regularly. Dr Holmes said:
'Aspirin cannot be considered a substitute for conventional cancer treatments,
and taking aspirin does have negative effects in some.
'More study is definitely needed to establish the cause and effect of aspirin on
breast cancer. But for now, if a woman has breast cancer and is taking aspirin,
she may take some comfort in knowing she might be doing something to help
prevent her breast cancer from recurring.'
Millions of people in the UK already take low-dose aspirin every day on
doctor's advice to reduce the chance of a repeat heart attack or stroke. Others
take it of their own accord for 'health insurance'. Most of the women in the
new study, published in the Journal of Clinical Oncology, were taking aspirin to
prevent heart disease.
The Harvard team identified 4,000 breast cancer patients between 1976 and
2002 and followed them until their deaths or the end of the study in June
2006.
Altogether 341 women died from the cancer.
The Harvard study falls short of the research 'gold standard', however,
because the women reported their aspirin use in questionnaires, rather than
going through a controlled clinical trial.
The next stage of drug development would normally be a large randomised
study, but this may never happen.
Not only is aspirin so cheap it will not make any money for drug firms, it could
be hard to find a group of women with breast cancer who were prepared
never to take aspirin during a trial.
Page | 34
Nick Henderson of the European Aspirin Foundation, which represents the
industry, said: 'The best evidence for aspirin in protecting against cancer has
been from studies on bowel cancer. 'But this latest report adds to growing
evidence that aspirin appears to have special effects in reducing cancer risk
through a mechanism which has yet to be scientifically explained.
'However, I doubt it will be possible to carry out a proper clinical trial because
everyone has heard aspirin may be useful. We're going to hold a conference to
plan the way forward.'
Ed Yong, head of health information at Cancer Research UK, said: 'Several
studies have found that taking aspirin and related drugs is associated with a
lower risk of breast cancer, and this new study suggests that they might also
help to stop cancer from spreading and improve a woman's chances of
survival. 'But aspirin has risks as well as benefits, so we need large clinical
trials to see if it can really save lives from breast cancer, and, if so, to work out
what doses to use and how long to use the drugs for.' By Jenny Hope
Page | 35