MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Dr.Kattlove's Cancer Blog' source. Mon, 17 Nov 2008 22:44:00 +0100 http://kattlovecancerblog.blogspot.com/2008/11/is-it-epidemic-pancreatic-cancer.html Recently I was called by a friend of a friend to ask about his wife’s pancreatic cancer treatment. He was wondering whether the care she was receiving at Kaiser Permanente was good enough. It was, I told him. His wife had been handled properly. When she began complaining of pain and weight loss, she had the proper x-rays. Then to make sure she wasn’t curable with surgery they did a laparoscopic procedure. With this approach, they could see if it had spread or whether it could be removed surgically. That would be a very big operation. Unfortunately, it had spread and curative surgery was not an option. If she were a candidate for surgery, then the quality and experience of the surgeon and the surgical team would be crucial and Kaiser might not be the best option – but it is tough to j... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1960676 Thu, 13 Nov 2008 18:40:00 +0100 1960676 http://kattlovecancerblog.blogspot.com/2008/11/want-to-help-fight-cancer.html The American Cancer Society is looking for you. If you or a loved one has had cancer, or you have some other connection with cancer, you can help the research program of the American Cancer Society.The American Cancer Society funds cancer research to the tune of over 3 billion dollars in the last 60 years. Usually the type of research they fund is small projects that can lead to big discoveries if these small projects pan out. Many of our breakthroughs began as small grants from the ACS.But the ACS doesn’t want to pick these projects on its own. They want input from people, who may not be scientists, but who may have had some personal connection to the disease. Nothing beats real life experience in knowing what is important. The ACS is looking for volunteers from around the U.S. who are ... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1939079 Wed, 05 Nov 2008 20:52:00 +0100 1939079 http://kattlovecancerblog.blogspot.com/2008/11/ask-your-doctor-if-mammosite-is-as-good.html This study led to the standard radiation treatment for women who have had a lumpectomy for breast cancer. The radiation is called “external beam” radiation meaning it is delivered by a large x-ray machine that is carefully aimed. Women receive around 6 weeks of treatment (5 days a week) to that breast. Now, that is an awfully long time to be going to the radiation oncologist’s treatment facility, especially for 5 days a week. It is especially troublesome if you live dozens of miles away from a facility, as do many women in rural areas. It has been particularly troublesome for Canadian women where the population is scattered over a huge area.So radiation oncologists, turning to evidence based medicine, began testing shorter courses of radiation therapy. They found in head-to-head tria... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1927812 Mon, 03 Nov 2008 00:22:00 +0100 1927812 http://kattlovecancerblog.blogspot.com/2008/10/toss-your-vitamin-e-and-selenium-guys.html They won’t save you from prostate cancer. The National Cancer Institute this week announces it was pulling the plug on the SELECT trial, a clinical study that was testing whether men who took one or both of these substances would have a lower rate of prostate cancer.Ten years ago, Finnish investigators reported the results of a trial to determine whether Vitamin E or carotene could prevent lung cancer in men. They didn’t lower the lung cancer rate. In fact, the men taking the carotene seemed to get more lung cancer than the others. And, although the vitamin E didn’t prevent lung cancer, men taking it had a lower rate of prostate cancer. In another study from 1996, researchers reported the results of a trial to see if selenium would prevent melanoma. It didn’t work, but in that stud... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1924480 Fri, 31 Oct 2008 22:49:00 +0100 1924480 http://kattlovecancerblog.blogspot.com/2008/10/its-not-just-lung-cancer.html Most people think that the only cancer caused by smoking is lung cancer. Not true. There are at least nine other cancers where the risk is increased by smoking. The most common of these are bladder cancer, kidney cancer and pancreatic cancer. Smoking will even increase your chance of getting acute leukemia.A recent report from the Centers for Disease Control found that in the five years from 1999 to 2004, 2.4 million cases of smoking related cancers were diagnosed. And, over half of these were NOT lung cancer. We always think that smoking causes lung cancer because the smoke directly contacts the lung. That is true, but cancer-causing chemicals in smoke can be just as deadly when they get into the blood and circulate to all our organs. That is why bladder and kidney cancer are common smoki... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1888121 Sat, 18 Oct 2008 17:53:00 +0100 1888121 http://kattlovecancerblog.blogspot.com/2008/10/how-good-is-your-surgeon.html When I was writing for the American cancer Society, I always included a suggestion that cancer patients try to get their care at a nearby cancer center, if that was possible. There isn’t anything magical about cancer centers except that they tend to attract doctors, including surgeons, who really know how to treat cancer.I practiced at community hospitals, where most of the surgeons made their living in repairing hernias and taking out gallbladders. Occasionally they would operate on a patient with cancer. Some of them should not have. Perhaps the most telling example of this occurred many years ago when a middle-aged woman with ovarian cancer was referred to me for chemotherapy. She had gone to the surgeon with a big tumor in her pelvis. He operated on her but only took a tiny peek insi... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1879859 Wed, 15 Oct 2008 17:23:00 +0100 1879859 http://kattlovecancerblog.blogspot.com/2008/09/know-your-recurrence-score.html Many years ago, I treated a young woman with what appeared to be very early breast cancer. Her tumor was small, and had not spread to lymph nodes under her arm. The cancer contained estrogen receptors, which meant that my giving her tamoxifen, a drug that suppresses cancer growth in cells with this receptor, would keep her cancer in check. I assured her that she was not likely to see her cancer come back and spread.Well, I was wrong. Within 2 years, the cancer had recurred, spread throughout her body and eventually killed her. I thought I had done the right thing for her for that time. She and I discussed chemotherapy and she was happy to know that the small size of her cancer, the fact that it had not spread to lymph nodes and its supposed responsiveness to tamoxifen made it unnecessary f... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1809762 Fri, 19 Sep 2008 21:44:00 +0100 1809762 http://kattlovecancerblog.blogspot.com/2008/09/what-should-you-eat-to-avoid-cancer.html This is a question everyone asks and no one can answer. First, why do we think that what we eat can lead to cancer? One major reason is differences in cancer rates between countries. For example, Japanese women have a much lower rate of breast cancer than do women in the West. Many have thought this is due to less fat in the Japanese women’s diet. Indeed Japanese-American women are not protected by their heritage and have breast cancer rates similar to women of European extraction. And, the breast cancer rate in Japan is rising concurrent with the “Westernization” of their diet. There are also many studies showing that people who eat certain foods – for example fruits and vegetables – and avoid others like lots of red meat, have lower cancer rates. But wait a minute. What about t... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1806279 Thu, 18 Sep 2008 18:10:00 +0100 1806279 http://kattlovecancerblog.blogspot.com/2008/09/it-even-hits-children.html We think of cancer as primarily a disease of the elderly and indeed it is. But children also get cancer. Right now there are about 150,000 survivors of childhood cancer living in the U.S. Most of these people had either leukemia, brain tumors, bone, or soft tissue tumors. And, many of them are living with some of the side effects of their treatment.This month, September, is Childhood Cancer Awareness Month. We have made a lot of progress in fighting childhood cancer. Right now, three-fourths of children diagnosed with cancer will be alive 10 years later and most of them will live a lot longer. This is a much better record than when I first started in oncology.Most of the progress has been in treatment. Early diagnosis plays no role. We don’t screen for childhood cancer because it is so u... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1775561 Mon, 08 Sep 2008 23:39:00 +0100 1775561 http://kattlovecancerblog.blogspot.com/2008/08/john-mccains-melanoma.html When I was in medical school, one of my finer teachers on the hospital wards was a young resident named Bob. He was bright and filled with information, eager to teach and kind. During that time, he had some minor surgery for a melanoma. Fifteen years later, while starring at another academic institution, the melanoma came back and spread quickly through his body. From what I learned, he only lasted a few months.I tell this story to point out that melanoma is a capricious cancer that can be out of sight for years and then reappear with deadly outcome. Melanoma is different from most skin cancers. It is a special kind of skin cancer, because it will kill about 10-15% of the people who get it. The other kinds are much more benign. This year, about 62,000 people will be diagnosed with melanoma... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1750137 Sun, 31 Aug 2008 21:46:00 +0100 1750137 http://kattlovecancerblog.blogspot.com/2008/08/tired-is-there-anything-to-do.html Many patients with wide spread cancer find that they tire easily and, in fact, wake up tired. If they are on chemotherapy, fatigue will take over even if their cancer hasn’t spread. Recently, a group of British doctors surveyed the world’s literature to see if anything has been discovered that would perk up these people with cancer.Surprisingly the single drug that seems to work the best and is the simplest is methylphenidate, better known as Ritalin. This is basically a stimulant like Dexedrine and maybe even like methamphetamine (the “meth” that lots of drug users like). And, the drug can be addicting. Who doesn’t want to feel full of energy? But for some cancer patients it seems a blessing. I remember one story of a pediatrician with lung cancer, who felt that Ritalin brought ... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1739135 Thu, 28 Aug 2008 19:24:00 +0100 1739135 http://kattlovecancerblog.blogspot.com/2008/08/breast-cancer-want-to-keep-your-breast.html Nothing is as good as MRI in detecting breast cancer. Because of this women who have had their breast cancer detected by the usual means – mammography or feeling a lump – often undergo MRI to see of there is any more cancer in the breast.MRI (Magnetic Resonance Imaging) is a complicated (and expensive) procedure that depends on the interaction of a very strong magnetized cylinder, radio waves and water molecules in your tissues to produce an image of your body. It has been used extensively and most effectively to examine the brain. However, it is also good at looking at other tissues and in the last few years has been used to look for breast cancer.At first, MRI was used to screen women with a high likelihood of developing breast cancer (those with the BRCA genetic mutation, for exampl... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1726356 Fri, 22 Aug 2008 23:13:00 +0100 1726356 http://kattlovecancerblog.blogspot.com/2008/08/can-we-prevent-stomach-cancer.html Yes we can! If you read these blogs very often, you will have learned that my experience as a practicing oncologist taught me that the old phrase “an ounce of prevention is worth a pound of cure” is doubly true when it comes to cancer. Stopping smoking, eating properly, keeping slim, can lower our cancer rate by as much as one-half.Now doctors from Japan have come up with a way for blocking our chances of getting stomach cancer. It may surprise you to know that some infections can cause cancer. We know, for example, that infections with the HSV virus cause cancer of the cervix and sometimes of the mouth. Infections with hepatitis B or C viruses can lead to liver cancer. And, stomach cancer is usually seen in people infected with the bacteria called h. pylori.Preventing stomach cancer h... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1677007 Sun, 03 Aug 2008 23:50:00 +0100 1677007 http://kattlovecancerblog.blogspot.com/2008/07/will-there-be-epidemic-of-kidney-cancer.html The other day, newspapers carried the story about James Levine having surgery for kidney cancer. Mr. Levine is the highly regarded conductor of both the Metropolitan Opera Orchestra as well as the Boston Symphony. He is also fat. I have never seen him in person, but on the tube, he looks pretty rotund.At one time his rotundity would have startled people because it would have been so unusual. Not now. Mr. Levine looks like a lot of Americans (except for his huge mane of curly hair). Fortunately, Mr. Levine’s cancer seems to have been caught early and was quite small. This almost certainly assures that he will survive his disease and be back on the podium in fine fettle in the fall.The U.S. and other “developed” countries have seen the rate of kidney cancer double in the last 30 years.... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1668405 Wed, 30 Jul 2008 16:33:00 +0100 1668405 http://kattlovecancerblog.blogspot.com/2008/07/what-about-your-risk-of-dying-from.html Many things increase a woman’s risk of developing breast cancer. Some she can control, others she can’t. Uncontrollable items are, starting periods at a young age, ending them at a late age, having few or no babies and having them late in life. Of course, the biggest uncontrollable gorilla in the room is what a woman inherits from her parents, but I’m not going to talk about that this time.High-risk items a woman can control are, whether if she has a baby she doesn’t nurse, whether she takes hormones after menopause, gets fat or drinks too much. Another important question is, if a woman gets breast cancer, how these factors affect her chance of surviving the cancer. It turns out that most of these don’t hurt her chances and some my even help.We know this because of research done ... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1605905 Thu, 10 Jul 2008 21:43:00 +0100 1605905 http://kattlovecancerblog.blogspot.com/2008/07/dont-believe-those-ads.html Recently, the FDA sent warning letters to a bunch of companies selling “cancer cures”, telling them to stop. The products contain ingredients such as bloodroot, shark cartilage, coral calcium, cesium, ellagic acid, Cat's Claw, an herbal tea called Essiac, and mushroom varieties such as Agaricus Blazeii, Shitake, Maitake, and Reishi. Some of the fraudulent claims were: * "Treats all forms of cancer" * "Causes cancer cells to commit suicide!" * "80% more effective than the world's number one cancer drug" * "Skin cancers disappear" * "Target cancer cells while leaving healthy cells alone" * "Shrinks malignant tumors" * "Avoid painful surgery, radiotherapy, chemotherapy, or other conventional treatments"All nonsense. None of these products have ever been proven to help save anyone�... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1582941 Sun, 06 Jul 2008 18:01:00 +0100 1582941 http://kattlovecancerblog.blogspot.com/2008/06/diagnosed-with-prostate-cancer.html What an enigma. Perhaps the best argument against intelligent design is a man’s prostate gland. It hardly serves any useful function. And it is likely to become cancerous (nearly half of elderly men have cancer in their prostate gland at autopsy). And treating the cancer often causes impotence and incontinence. I’m 70 years old and get my PSA done yearly. It tends to hover in the 4-6 range (anything above 4 is considered suggestive of cancer) and when it hit 6 a couple of years ago, I had a biopsy (not a fun experience but not as bad as I anticipated). Fortunately, no cancer. Before the result came in, I spent hours pondering my treatment if I had cancer. I could choose surgery or radiation or no treatment. The last choice would let me avoid the likely side effects of impotence and ... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1551352 Fri, 27 Jun 2008 22:20:00 +0100 1551352 http://kattlovecancerblog.blogspot.com/2008/06/more-on-chemobrain.html Chemobrain has always been an orphan of the side effects of chemotherapy. I never see it mentioned in the list of toxic reactions to a new drug program for cancer. One reason is that many oncologists doubt its existence. A second is that it is hard to measure, and finally, it’s a kind of vague symptom.But it is real. In 2007, Hurricane Voices Breast Cancer Foundation did an online survey of people who had received chemotherapy, asking them about the effect of the chemotherapy on their thought processes. Most of the 470 respondents were women who received treatment for breast cancer. Almost all reported some problem. The most common problems were lack of concentration, short-term memory loss, trouble recalling words and problems with organizing daily tasks and multi-tasking. And these wer... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1535738 Sat, 21 Jun 2008 20:13:00 +0100 1535738 http://kattlovecancerblog.blogspot.com/2008/06/calling-it-quits.html This may be the toughest issue I faced in all my practice. I saw this issue from both ends of the care spectrum, as a practicing oncologist and as medical director of a hospice program.Telling patients that their chemotherapy regimen was no longer working and that a new chemotherapy regimen would almost certainly not help was the same as telling them that they are going to die. Nothing more can be done to prolong their life. This isn’t easy to do. It is much easier (and more profitable for oncologists) to try something else. There is always another drug, although we oncologists know that after a patient’s cancer has grown back after two or three different regimens, a new one is almost certain not to help.As medical director of a hospice, I saw over-treatment all too often. Patients wou... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1518682 Fri, 13 Jun 2008 23:49:00 +0100 1518682 http://kattlovecancerblog.blogspot.com/2008/06/calling-it-quits_13.html This may be the toughest issue I faced in all my practice. I saw this issue from both ends of the care spectrum, as a practicing oncologist and as medical director of a hospice program.Telling patients that their chemotherapy regimen was no longer working and that a new chemotherapy regimen would almost certainly not help was the same as telling them that they are going to die. Nothing more can be done to prolong their life. This isn’t easy to do. It is much easier (and more profitable for oncologists) to try something else. There is always another drug, although we oncologists know that after a patient’s cancer has grown back after two or three different regimens, a new one is almost certain not to help.As medical director of a hospice, I saw over-treatment all too often. Patients wou... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1518681 Fri, 13 Jun 2008 23:49:00 +0100 1518681 http://kattlovecancerblog.blogspot.com/2008/06/more-mastectomies-these-days.html When I first entered practice, many of the women I saw who had surgery for breast cancer were treated with radical mastectomies. This meant that not only were their cancerous breasts removed, but the surgeon also took off the underlying muscle. This left them with a thin sheet of skin covering their ribs. They also couldn’t fully use the arm on the breast surgery side because of the extensive surgery in their underarm area. The reason for this surgery stemmed from the work of a surgeon from Johns Hopkins, named Halstead. He worked around the turn of the 20th century. At that time, women didn’t seek help till their tumors were big. In order to prevent the cancer from coming back, Halstead found that only radical mastectomy did the trick. But as women began hitting their doctor’s offic... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1512165 Thu, 12 Jun 2008 16:14:00 +0100 1512165 http://kattlovecancerblog.blogspot.com/2008/06/ted-kennedy-chooses-surgery-and-his.html As I write this, Senator Kennedy is undergoing surgery for his brain tumor, not in Boston where he was first diagnosed, but at Duke University in North Carolina. Then he will receive his expected radiation and chemotherapy in Boston. Why this change in venues for his treatment?The answer is simple. Kennedy was looking for the best surgeon. Yes, there is a difference in surgeons. Several years ago when a family member needed gynecologic surgery, I asked a local surgeon who would be the best to do this. He recommended a local expert not because he was exceptionally smart, or had done great research but because he had “good hands”. Great skill was the most important criterion.Surgery is like most sports. To be an expert a surgeon needs great hand-eye coordination and experience. Yes, smar... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1488204 Mon, 02 Jun 2008 23:30:00 +0100 1488204 http://kattlovecancerblog.blogspot.com/2008/05/new-treatment-for-constipation-curse-of.html One medical myth that I often hear is that it is possible to treat a cancer patient’s pain with opioids like morphine so that they can be completely comfortable. Not true. Doctors or nurses always need to balance the relief of pain with the side effects of these drugs - sedation, dry mouth, and that most major malady, constipation.At several times in my career, I helped out at hospices, where I was a volunteer medical director. At the weekly meetings with the rest of the team, the most talked about subject was patients’ symptoms. Usually pain came first, followed closely by their constipation. Most of the patients had pain and were receiving opioids and all of them were constipated. Opioids cause constipation. They paralyze the intestinal cells that cause the bowel to push stool throug... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1481845 Sat, 31 May 2008 20:49:00 +0100 1481845 http://kattlovecancerblog.blogspot.com/2008/05/what-i-would-say-to-ted-kennedy.html “Senator Kennedy, you have a malignant brain tumor called glioblastoma, which set off the seizures you had the other day. Although we can see a tumor on the MRI, there is more there than we can see. Along with the mass in the front of your brain, we know from years of experience in dealing with these that there are little fingers of cancer extending from this tumor into the rest of your brain.“How does this affect your treatment? Surgery cannot remove the cancer entirely. Although we can remove most of your tumor with surgery, we can’t cure you. Sometimes the surgery can help prevent some symptoms like headaches. But, with surgery, you may lose some normal functions, like speech and perhaps even understanding. And, although the seizures can be troublesome, they can be controlled with... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1466047 Fri, 23 May 2008 21:38:00 +0100 1466047 http://kattlovecancerblog.blogspot.com/2008/05/i-hate-to-preach-but.html It’s time to follow the get-better guidelines. The American Cancer Society recommends that all cancer survivors take better care of themselves. This means eat well, exercise and stop smoking. Specifically they want survivors to eat at least five servings of fruits or vegetables each day, exercise moderately strenuously two and one-half hours a week or vigorously one hour a week. And, of course, stop smoking.You would think that cancer survivors would follow this simple prescription. After all, not following this simple recipe may be what got them into trouble in the first place. So many studies have shown that a healthy life-style is associated with a lower cancer risk that no one bothers to do these studies anymore. And, as I have pointed out so many times, few of our modern treatments ... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1454384 Mon, 19 May 2008 18:53:00 +0100 1454384 http://kattlovecancerblog.blogspot.com/2008/05/promise-unfulfilled.html Judah Folkman died suddenly early this year. He was a super creative cancer researcher. His work promised a revolution in cancer treatment but it never happened.I first encountered him when I was training in Hematology at Montefiore Hospital in the Bronx. He presented his work at one of our research seminars. He had found that he could grow cancer cells within the eyes of rabbits. But they had to be planted on the iris. That allowed blood vessels to begin growing into the tiny tumors and once that happened the tumors took off. If the cancer cells were placed in the middle of the eye chamber without attachment to any eye tissue, blood vessels didn’t develop and the cancer didn’t grow.His theory was that the cancer needed blood vessels to supply it with nutrients and oxygen. A reasonable... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1436869 Mon, 12 May 2008 17:26:00 +0100 1436869 http://kattlovecancerblog.blogspot.com/2008/05/jake-quit.html Smoking! He gave it up over a year ago.I hadn’t seen him for a couple of years. I noticed that he stayed in during the party. Usually, he would disappear for a smoke. Not this time. I asked him why and he told me he gave it up.Jake has every reason not to smoke. He is happily married, retired with lots of money and a big house on the ocean, loves to play golf, and as far as I know and he looked, in good health. So I always puzzled about why he continued this health-robbing habit.Actually I knew. He was addicted to nicotine. Cigarettes are drug delivery devices and the drug is nicotine. Nicotine is one of the most powerfully addicting substances we know.When a smoker inhales, the nicotine in the cigarette reaches the brain in 10 seconds. There, it activates chemicals that produce pleasure... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1429020 Thu, 08 May 2008 16:37:00 +0100 1429020 http://kattlovecancerblog.blogspot.com/2008/05/jeremiah-wright-and-my-cancer-patient.html The controversy that the Reverend Wright is stirring up reminds me of an incident in my practice that remains with me 20 years later. Wright’s outrageous and perhaps paranoiac statements about the United States are especially telling when he questions whether the HIV virus, the cause of AIDS, is a man-made virus, perhaps created by the U.S. Government. Nuts, right? Well, a large number of African-Americans believe this according to a study published by Rand Corporation in 2005.Many African-Americans just don’t trust white doctors. This was brought home to me in that incident 20 year ago. I was treating a middle aged black woman for breast cancer. She came to me with advanced disease and no matter which drugs I used to treat her, the cancer kept growing. Finally, we ran out of drugs and... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1416239 Fri, 02 May 2008 18:46:00 +0100 1416239 http://kattlovecancerblog.blogspot.com/2008/04/more-is-not-necessarily-better.html Many oncologists believe that we can cure more patients’ cancers if we can just give the patients high enough doses of chemotherapy. For years, it has been a maxim in oncology that the more chemotherapy you give, the more cancer you kill. A colleague of mine, who didn’t believe this, compared this theory to the situation of a person in a foreign country trying to make himself understood by shouting instead of speaking the native’s language. This week’s Journal of the National Cancer Institute carried an article written by European investigators that confirmed my colleague’s skepticism. The researchers treated patients with a type of lung cancer called small cell cancer, with very high doses of chemotherapy and compared them with a group that received standard doses. By the end of... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1377972 Thu, 17 Apr 2008 00:21:00 +0100 1377972 http://kattlovecancerblog.blogspot.com/2008/04/is-it-your-personality-that-caused.html When I was starting out in medicine, I often heard people say about someone who developed cancer that she was a nice person and that’s why she was struck by this devastating disease. I’ve also heard other factors invoked as contributing, such as stress, anger, pessimism, or some other personality factor that could lead to cancer. In my experience, none of this held true. My practice consisted of nice people, rotten people (rare, I admit), passive people, aggressive people, optimists, pessimists – you get the picture. But I admit this isn’t a very scientific survey. Still I remained convinced that personality played no role in whether a person developed cancer and her survival from this disease.I distinctly remember a young man, a dentist with a cancer of the pancreas. This wasn’t... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1362425 Thu, 10 Apr 2008 00:31:00 +0100 1362425 http://kattlovecancerblog.blogspot.com/2008/04/even-shorter-radiation-method-after.html A few days ago I reported on a study of women who needed breast radiation after lumpectomy for breast cancer. The study found that 15 days of radiation was just as effective as the traditional 25 days, making it possible for women to get on with their lives earlier. But there is a technique that gets the treatment over with in 5 days. It is called brachytherapy (brachy from Greek meaning short). Several doctors used this approach when I was in practice. They would place thin tubes through the lumpectomy site and then fill the tubes with radioactive seeds. This would deliver radiation to the local area of the original tumor without involving the entire breast. And, it was over in a few days. Sounds good, but I never sent my patients for this because the doctors doing the procedure never had... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1349542 Thu, 03 Apr 2008 19:35:00 +0100 1349542 http://kattlovecancerblog.blogspot.com/2008/04/dont-sweat-it.html One of the most challenging complaints from patients in my practice came from older women who had been treated for breast cancer. Their complaint; “Dr. Kattlove, I can’t stand these hot flashes anymore”. And I would say, “Well, you know, hormone replacement therapy isn’t recommended in women who have had breast cancer”.Not good enough. These women were miserable. And so, I, as well as some of my partners would slip these women their hormones. Sometimes I felt like a crack dealer. Still feeling a little guilty (although none of these women suffered any ill effects and were definitely grateful) even after leaving practice, I was cheered by a study published in 1997 that found no increase in cancer recurrence in over 50,000 women who had received hormones after treatment for breas... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1347375 Thu, 03 Apr 2008 00:48:00 +0100 1347375 http://kattlovecancerblog.blogspot.com/2008/03/its-time-to-cut-back-on-radiation.html It must be frustrating for a woman with breast cancer to learn that after she has had surgery, she is only part way through her treatment. Often there will be hormone treatment or chemotherapy or both; and, if she has had a lumpectomy (about half of all women), she will also need radiation to the breast. Why do we give radiation to the breast if the cancer has been removed? It’s because the cancer often will come back in the breast and radiation cuts the chances of this happening by half. Clearly, in some women – about 5-10%, some cancer cells have dodged the surgeon’s knife. So traditionally, radiation oncologists have treated the breast with radiation 5 days a week for 5 to 6 weeks. That’s a lot of time out of a woman’s life and many doctors have wondered whether the radiation ... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1336286 Sat, 29 Mar 2008 18:56:00 +0100 1336286 http://kattlovecancerblog.blogspot.com/2008/03/where-did-that-come-from.html Every so often, a doctor would refer me a patient who had widespread cancer without any warning signs or symptoms. Usually, we could diagnose the origin of the cancer – lung, pancreas, testicle, stomach were often the likely sites. The cancer would start in these organs and then quickly spread throughout the body without any tip off. There it was!But sometimes, we were unable to figure out where the cancer started. These cancers are called “cancers of unknown primary”. We don’t know how often these occur, because no one keeps statistics on these. I would probably see one or two patients with this diagnosis each year. Usually, treatment wasn’t effective and they would die in a short space of time. Most publications say that about 2-5% of all cancers fall into this category. I susp... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1329069 Wed, 26 Mar 2008 17:02:00 +0100 1329069 http://kattlovecancerblog.blogspot.com/2008/03/lets-do-numbers.html The most recent update of cancer statistics has just been published, and the news is mildly encouraging. First, the bad news. If you are a man, the chance of developing cancer in your lifetime is nearly one in two. For women the chance is lower, at one in three. Cancer has replaced heart disease as the leading cause of death for people younger than 85. Over 85, heart disease wins, but cancer is slowly taking over. The reason cancer is overtaking heart disease is not because cancer rates are increasing. They are not (more on that later). Instead, deaths from heart disease are dropping quickly. Blame better treatment to lower cholesterol and blood pressure.But there is a lot of good news. Both the rate of new cancers and death rate in men have dropped. Most of this is due to a drop in the ra... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1314104 Wed, 19 Mar 2008 15:51:00 +0100 1314104 http://kattlovecancerblog.blogspot.com/2008/03/does-sunshine-cause-cancer-or-prevent.html Every cancer prevention message always emphasizes that you should limit your exposure to sunshine as much as possible. But is this the right message? Sure, we know that skin cancer is caused by sun exposure. Although the most common skin cancer, basal cell cancer, almost never poses a threat, the less common skin cancer, melanoma can be a killer.But how about other cancers? The National Cancer Institute publishes a document called the Cancer Atlas that portrays the rate for different states by colors. Red means a high rate and blue a low one. The map for melanoma naturally finds that southern states are red and northern one blue. No surprise – lots more sun in the South so expect more melanoma. But check out the maps for cancers of the breast, colon, ovary and prostate. Now the Northern ... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1300314 Thu, 13 Mar 2008 18:16:00 +0100 1300314 http://kattlovecancerblog.blogspot.com/2008/02/is-high-dose-chemotherapy-and.html I have been mulling this question over in my mind for years. I’ve never felt the evidence was that convincing. I’ve known of people who had the procedure and quickly crumped. Also, maybe the results look good because the people who go to these centers for the transplant have to be in pretty good shape just to get there. All this came to me today as I read of the death of the actor Roy Scheider, who made it big as the sheriff in the movie “Jaws” but who I admired as the Bob Fosse character in the movie “All That Jazz”. He died of multiple myeloma at the University of Arkansas Medical Center in Little Rock, only, I read, 3 years after his diagnosis. This is a major center of myeloma treatment and one where the stem cell transplant has been a favorite. In fact, these people have b... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1229246 Wed, 13 Feb 2008 17:26:00 +0100 1229246 http://kattlovecancerblog.blogspot.com/2008/02/chemobrain-time-for-treatment.html What is “chemobrain”? “Chemobrain” is another side effect of chemotherapy, which has only recently been recognized. It develops in some people after they have had chemotherapy. Their major complaint is that they have trouble thinking clearly. Most of the studies have been in women who have received chemotherapy after breast cancer surgery. The main finding in these women has been trouble with memory although other problems have also been described. The existence of “chemobrain” is still not settled, because some of these symptoms may actually be caused by the cancer itself. Some people with cancer have been shown to have memory problems even before they receive chemotherapy.But, more and more, doctors are recognizing the fact that “chemobrain” is real. Careful testing of me... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1219456 Fri, 08 Feb 2008 23:17:00 +0100 1219456 http://kattlovecancerblog.blogspot.com/2008/01/here-is-something-i-bet-you-didnt-know.html Birth control pills help prevent ovarian cancer. I didn’t know this either until I started working for the American Cancer Society. I always wrote about risk factors – things that increased the risk of cancer. It was rare that anything was proven to reduce the risk of cancer, other than avoiding the risk factors and leading a “healthy” life. But, to my surprise, I kept running across this fact – women who took birth control pills were less likely to develop ovarian cancer.Ovarian cancer is a serious problem. Most women who are diagnosed with it will die from it. Only about 40% live 5 years after diagnosis. It was estimated that in 2007, around 22,000 women developed ovarian cancer and about 16,000 women were killed by this disease. About a third of these women are younger than 65... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1191370 Thu, 31 Jan 2008 17:13:00 +0100 1191370 http://kattlovecancerblog.blogspot.com/2008/01/thoughts-on-genetic-test-for-prostate.html Last week, the New England Journal of Medicine published an article online about genetic testing for prostate cancer. The authors of the study, done in Sweden, found that men with prostate cancer had changes in one or more of 5 different genes, changes that are not found in men without prostate cancer. It was a great study and found clear-cut differences in the men with the cancer. But what does it mean for those of us who dutifully get our PSA’s checked every year? It doesn’t mean much. First of all, let’s talk about the results. The researchers found that if a man had one gene change, his risk of cancer would increase by 30%. Two gene changes doubled the risk, and 4 or more changes increased the risk 4-5 times. If there was a family history of prostate cancer, these numbers doubled... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1169685 Tue, 22 Jan 2008 23:44:00 +0100 1169685 http://kattlovecancerblog.blogspot.com/2008/01/whats-wrong-with-this-picture.html What if there were a pill that women who had surgery for breast cancer could take that would lower their chances of dying from the cancer? And what if the pill had few side effects and that after 5 years the women could stop taking it? Who wouldn’t go for it?Guess what? Lots of women won’t take the pill. The pill is a kind of drug called aromatase inhibitor or AI for short. It is given to women who have had breast cancer surgery to prevent the cancer from returning. It is only used in women who are past the menopause and works by blocking the production of the small amounts of estrogen that post-menopausal women normally make. Because most cancers in post-menopausal women feed on this estrogen, most oncologists prescribe AIs to prevent the cancer’s recurrence. In the past, oncologist... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1155874 Wed, 16 Jan 2008 22:15:00 +0100 1155874 http://kattlovecancerblog.blogspot.com/2008/01/whats-wrong-with-blood-transfusions.html Who wants a blood transfusion? Mention blood transfusion to most people and watch them scowl. Too dangerous they say. This attitude, which exists not only among patients, but also among doctors, has led to the huge popularity of the red cell-stimulating drug Epoetin and its recent long-acting cousin Aranesp. But today, Amgen’s (maker of Epoetin and Aranesp) announced the results of their own study of these drugs in women with breast cancer. They weren’t encouraging for those patients (or Amgen’s shareholders). The study found that women who received the drug to prevent anemia saw their cancers return more quickly and were more likely to die. This is bad news, especially because these drugs have been used for many years in cancer patients without any proven benefit, except to Amgen sh... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1131698 Sat, 05 Jan 2008 19:23:00 +0100 1131698 http://kattlovecancerblog.blogspot.com/2008/01/save-your-heart-ladies.html Yesterday, I was visiting a friend who had just had surgery for breast cancer. She showed me her pathology report and I was impressed by how thoroughly her cancer was examined and how carefully they measured her cancer’s HER2 status (which was negative).HER2 is a molecule present in about one-fourth of breast cancers. It is important for several reasons. Women whose cancers have this molecule are a little more likely to die of their cancer. They also will have a better outcome with adjuvant chemotherapy if drugs called anthracyclines (like Adriamycin) are included in the treatment. Finally, these women will also be helped by the drug, Herceptin, which specifically targets the HER2 molecule.The downside of all this treatment however, is a small but definite risk of heart failure. Anthracy... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1128699 Thu, 03 Jan 2008 17:18:00 +0100 1128699 http://kattlovecancerblog.blogspot.com/2008/01/whats-connection-between-high-dose.html Today, I read two articles that connected these two. The first was in today’s LA Times and talked about the controversy over Provenge, a new treatment for advanced prostate cancer. The FDA has held up its approval in spite of a study that showed that patients who received the treatment lived, on average, 4½ months longer. Many prostate cancer patients are protesting this decision and asking that it be overturned. There have even been death threats against members of the committee that made the decision.The second article was in the January 1 issue of the Journal of Clinical Oncology. It reported on the negative results of a study using high dose chemotherapy and stem cell replacement treatment for widespread breast cancer. The patients didn’t live any longer, in spite of this extremel... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1124237 Tue, 01 Jan 2008 19:43:00 +0100 1124237 http://kattlovecancerblog.blogspot.com/2007/12/avastin-not-for-breast-cancer.html The FDA advisory committee has recommended against Avastin for use in women with advanced breast cancer. Are they depriving these women of a life prolonging treatment? The simple answer to this question is no. Avastin is a drug that treats cancer by blocking the blood supply to the cancer. This way, the cancer starves to death because it is deprived of nourishment from the blood. For many years, scientists have known that one of the main steps in a cancers growth was the formation of new blood vessels to supply it with nutrients. Avastin, also known as bevacizumab, prevents this new blood vessel growth.Researchers have been attracted by the concept of treating cancer with blood vessel-blocking agents. It makes sense. Starve the tumor. But, in practice this hasn’t worked that well. The dr... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1081522 Sat, 08 Dec 2007 23:44:00 +0100 1081522 http://kattlovecancerblog.blogspot.com/2007/12/i-dont-feel-your-pain.html The other day in my class with second year medical students, one of them asked me how I handled the stress of oncology practice – namely caring for so many patients who would eventually die of their disease. He was planning to specialize in pediatric neurology, a specialty with a dismal success rate. At least we oncologists have a fair number of cures. Not so with brain damaged children.I often wondered myself why I didn’t get overly depressed by my practice. Sure, there were certain times that were quite sad, particularly with certain patients who did not survive. But, generally life went on for me. This question has actually been the subject of many articles in the oncology journals. Dealing with dying patients is a major stressor and many ways to deal with this have been proposed. T... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1070225 Tue, 04 Dec 2007 23:07:00 +0100 1070225 http://kattlovecancerblog.blogspot.com/2007/11/blood-test-for-cancer-dont-hold-your.html I thought of this when I read a paper that reviewed 93 articles that looked at the success rate of blood tests to detect colorectal cancer. So far no breakthroughs.We’ve been looking for a blood test to find cancer early for many years. And, many have been found that will spot different types of cancer, but almost never in its earlier stages. The first test that gained wide use was the CEA (carcinoembryonic antigen). CEA is a protein made in excessive amounts by the cancer cell. At first, it was found to be elevated in the blood of people with widespread colorectal cancer. But then researchers learned that its blood level can be high in people with many other types of cancers. Specific blood tests have been sought for other cancers. Probably no cancer has been scrutinized more than ovari... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1060014 Thu, 29 Nov 2007 17:54:00 +0100 1060014 http://kattlovecancerblog.blogspot.com/2007/11/dont-ask-dont-tell.html I remember an uncomfortable incident early in my practice when I was the weekend on-call doctor and seeing the hospitalized patients. One of them, an elderly lady with advanced cancer, asked me her diagnosis. Evidently, she hadn’t been told and her highly protective family didn’t want her to know. Being clueless, with a disturbing tendency toward truthfulness, I spilled the beans. That afternoon, my phone didn’t stop ringing with calls from outraged family members.This memory brings up a major problem that all oncologists face. How much should they tell the patient about their outlook? In general, unless the patient is quite sick and not going to undergo any treatment, I suspect nearly all oncologists tell their patients their diagnosis and how advanced the cancer is. The big issue i... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1040069 Tue, 20 Nov 2007 23:28:00 +0100 1040069 http://kattlovecancerblog.blogspot.com/2007/11/tired-because-of-cancer-treatment-join.html Fatigue was one of the most distressing symptoms that my patients complained of. Many of us feel tired some of the time, but usually a brief afternoon nap can handle the problem. Not so with cancer patients – especially those on chemotherapy. Their fatigue is bone deep and doesn’t get better with sleep. It pervades.I remember a small article written by a young man who was a resident in surgery in Boston about his fatigue during chemotherapy for lymphoma. He described a fatigue that was so intense that even usual activity like going up stairs became challenging. He felt so bad that he thought that the lymphoma must have been progressing. Months later, he was free of cancer and slowly recovering. Many times the fatigue doesn’t always go away. Near the end of my practice, a patient who ... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1030135 Fri, 16 Nov 2007 00:19:00 +0100 1030135 http://kattlovecancerblog.blogspot.com/2007/11/i-have-confession-to-make.html I used to smoke. I started when I was 16, continued through college and med school. I stopped for the first time in 1963 when the Surgeon General’s report came out on the harmful effects of smoking. Of course, I already knew smoking was harmful. My dad, a long time smoker, had emphysema. But, in 1963, I was a doctor and felt I couldn’t tell my patients to stop if I was smoking.About 2 years later, I started again. I thought I could smoke at parties or after meals, but soon the habit returned although I wasn’t smoking more than 5-10 cigarettes a day. I kicked the habit a couple of times more after that and finally became smoke-free in my mid 30s. Whenever I tried to stop smoking, I would take up cheap cigars to help me. After a couple of sickening weeks of those, I was ready to forego... Dr.Kattlove's Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=1021273 Mon, 12 Nov 2007 18:59:00 +0100 1021273