Wednesday, August 24, 2016

Expert Advice on Colon Cancer Treatment and Prevention

Learn About Colonoscopies, Precancerous Polyps and More


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Colon cancer often has no symptoms, and can go undetected for years. The good news? It’s also one of the most slow-growing cancers, so with proper colonoscopies and screening, it’s highly preventable. A gastrointestinal oncologist explains risk factors, tests and options for treatment...
Colon cancer isn’t a subject most people are eager to think about, much less discuss with loved ones or doctors.

But each year in the U.S., more than 145,000 people are diagnosed with colorectal cancer and approximately 50,000 people die of the disease.

“It’s a very common form of cancer that remains under-diagnosed mainly because not enough people get screened for it,” says Veena Shankaran, M.D., an oncologist who specializes in gastrointestinal cancers at Fred Hutchinson Cancer Research Center in Seattle.

But the news on colon cancer isn’t all bad.

A 2009 report released by a group of leading cancer organizations revealed that from 1975 to 2000, colorectal cancer incidence rates dropped 22% and death rates dropped 26%.

“Colon cancer is highly treatable, regardless of its stage,” adds Dr. Shankaran, who is also an assistant professor of medical oncology at the University of Washington School of Medicine, in Seattle.

Tuesday, August 23, 2016

5 Things I Wish I Knew About Loving Someone Affected by Grief

AlexMacKinnonby Alexandra MacKinnon

Starting a new relationship with a guy who had just lost his brother and best friend had its difficulties. At 18 years old, love was new and exciting but never before had I come across the unique set of challenges that lay ahead of us. I actually met Toby after his brother had been diagnosed and a few wonderful months past us by before the bombshell was dropped – Robin wasn’t getting better. At that point I watched him change before my eyes into something unrecognisable and the romance was over, briefly… Of course issues were resolved and after his brother’s untimely passing we reconnected. The past five years since we met has been beautiful but knowing what I do now, I may have done some things differently – which brings me to this article: 5 things I wish I knew about loving someone affected by grief (in no particular order)…

  1. Grief has no time limit.
5 years ago when Toby first came into my life I could never have imagined the lasting impact the death of his brother would leave on him and his family. As someone lucky enough to have lived the first 23 years of my life without any real experiences of loss , I think deep down I believed that grief was just a process he needed to go through and that the process was text book. You go through the stages – denial, anger, bargaining, depression and acceptance – then it’s done, it’s over. But one thing I wish I knew then was it’s never really ‘over’. Of course over the years things have changed, I know that he doesn’t spend days mourning the loss of his brother and he’s no longer consumed by the loss, but from time to time the pain will rear its ugly head to remind us both how fragile life is.

  1. Loss of intimacy is normal.
One thing I certainly did not know to expect was that intimacy would be difficult. For a long time I tortured myself about why things weren’t the way I thought they should be – why didn’t he want to be close to me all the time as I did with him? The effect on my confidence was evident and a difficult thing for us to learn to talk about. After some time I learned to accept that Robin’s death had caused Toby to become numb, and I believe this was his way of dealing with day-to-day life, as it was too painful to feel anything. After a difficult few months we spoke and I encouraged him to accept grief counselling from our local Hospice, and sure enough as he learned to deal with the pain, those feelings returned and intimacy was regained.

  1. I have the right to be sad too.
Sadly, I never had the privilege to meet the man that gave my partner purpose. It was a difficult thing to hear so many wonderful stories and see so many people that I care for deeply in pain and yet not feel a part of it. I struggled a lot with seeing the person I love the most in the world in pain and only being able to empathize, but not really relate. Having never met the handsome and talented Robin thoughts crossed my mind that I had no right to feel sad. It has taken years for me to accept that although I can never take the pain away or fix my partner, it’s ok for me to share that sadness and acknowledge the influence Robin has had on both our lives.

  1. It’s not me he’s mad at
I can’t count the number of times I have experienced seemingly out-of-the-blue outbursts of rage, sometimes pointed in my direction. For a long time I could not accept that this was part of grief and that it wasn’t related to me or my actions. I repeatedly asked the same question – ‘What have I done?’ As time went on we learned to speak to one another in a more open way. He learned to tell me what was going on, if it was a bad day or he was particularly missing Robin. After time I learned to accept that I was not always the primary cause of his pain or his happiness.

  1. They cannot be replaced
It was a painful realisation when it hit me that I would never be able to change what has happened, and more importantly, I could never replace Robin. When you care for someone you desperately want to be able to give them whatever it is they are missing. For a long time I tried hard to fill a void that I was unable to fill.  I wanted to be able to take his pain away and bury it somewhere deep. Without realising it, I wanted to walk into his life and make everything better. Of course, to a degree we have helped each other through the pain but my outlook has changed – I have learned not to compare love but instead accept the beautiful uniqueness of the different relationships we have in our lives. I feel grateful he had such a wonderful influence in his life and although we love each other deeply and are soon to be married, I am happy knowing Robin is completely irreplaceable, and that’s ok.

Alex Mackinnon is a Care Sourcing Co-ordinator, dog enthusiast, loving aunty and cancer awareness advocate. She was introduced into the cancer community after meeting her now fiancĂ©, Toby Freeman, Founder & CEO of The Robin Cancer Trust, after his brother died. She has travelled with him over the past 5 years, experiencing the highs and lows of being in a relationship with someone affected by grief & loss, and offers a unique insight into their journey together.

Evidence of a cancerous tumor was found on a bone fossil dating back 1.7 million years.CreditPatrick Randolph-Quinney/University of Central Lancashire
Carcinogens abounded 1.7 million years ago in Early Pleistocene times when a nameless protohuman wandered the South African countryside in what came to be known as the Cradle of Humankind.
Then, as now, ultraviolet radiation poured from the sun, and radon seeped from granite in the ground. Viruses like ones circulating today scrambled DNA. And there were the body’s own carcinogens, hormones that switch on at certain times of life, accelerating the multiplication of cells and increasing the likelihood of mutations.
That, rather than some external poison, was probably the cause of a bone tumor diagnosed as an osteosarcoma found fossilized in Swartkrans Cave, a paleoanthropological trove northwest of Johannesburg. A paper in the current South African Journal of Science describes the discovery, concluding that it is the oldest known case of cancer in an early human ancestor.
“The expression of malignant osteosarcoma,” the authors wrote, “indicates that whilst the upsurge in malignancy incidence is correlated with modern lifestyles, there is no reason to suspect that primary bone tumours would have been any less frequent in ancient specimens.”
Perhaps the main reason there is more cancer today is that people live much longer, leaving more time for dividing cells to accumulate genetic mistakes. Osteosarcoma, however, occurs most frequently in younger people, as their limbs undergo adolescent spurts of growth. That and the fact that bones outlast softer organs make osteosarcoma a natural cancer to look for among early hominins, the zoological tribe that includes humans and their extinct kin.

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As I read about the Swartkrans find, I thought of the previous record-holder for oldest humanoid cancer, Kanam Man, a possible victim of osteosarcoma who lived in East Africa perhaps 700,000 years ago. All that we have of Kanam Man (or woman or girl or boy; the gender and age at death are unknown) is a tumorous jawbone.
Decades after its discovery by Louis Leakey in 1932, the fossil’s antiquity and provenance have remained in dispute, along with the medical diagnosis.
Some researchers have attributed the tumor to a different cancer, Burkitt lymphoma, which is endemic in parts of Africa, or to a bone infection calledosteomyelitis. Three years ago, after I wrote about the Kanam mandible and other ancient cancer cases in an article for Discover magazine, I heard from a dentist in Seattle who was confident that the tumor was a benign growth called a submandibular exostosis, which he had seen in his own patients.
In the case of the Swartkrans find, the specimen consists only of a foot bone. Again, the gender and precise identity cannot be determined. Homo ergaster and Paranthropus robustus have been found in the same stratum of the cave.
But diagnostic techniques have advanced since the first reports on Kanam Man. The Swartkrans tumor was initially described, in a doctoral thesis, as a benign growth called an osteoid osteoma. A scanning technology called microfocus X-ray computed tomography told a different story. After other diagnoses were considered and discarded, the strongest case was for osteosarcoma.
When you consider the biology of cancer, it is no surprise to find it in early hominins or any form of multicellular life. The oldest known example may be a metastatic bone cancer in a Jurassic dinosaur. (A slice of its skeleton was found by a keen-eyed doctor in a Colorado rock shop.) Errors in cellular division are inevitable and can lead to the development of a malignant tumor. Carcinogens and inherited genetic defects add to the risk.
A more difficult question is how much cancer there was in earlier centuries, compared with modern times. Almost six years ago, two Egyptologists made headlines with a paper in the journal Nature Reviews: Cancer concluding that “a striking rarity of malignancies” in the anthropological record suggests that cancer is “limited to societies that are affected by modern lifestyle issues such as tobacco use and pollution resulting from industrialization.”
That plays right into dystopian visions of cancer as a horror inflicted by a civilization gone amok. But other researchers, considering the same anthropological data, have rejected this view. In 2006, scientists studied the bones from two ancient Egyptian burial sites, dating to 3200 B.C., and a German ossuary, where bodies were deposited between 1400 and 1800 A.D. Those researchers concluded that cancer rates, adjusted for longevity, have probably held steady for centuries.
The seemingly small number of malignant tumors reported by anthropologists is probably an illusion. The only cancers that can be found in long-decomposed remains are those that originated in the skeleton or somehow left a mark there. They include cancers that spread from other organs or, like myeloma, could scar the skeleton in other ways. For most ancient cancers, the evidence rots away. Mummified bodies are rare, but here, too, an occasional cancer has been found.
If all of science’s excavated bones were examined as assiduously as the Swartkrans specimen, many more cases would probably emerge. All we can ever see is the tip of the iceberg.
The Swartkrans discovery was not far from Rising Star, a cave where the remains of at least 15 members of a new species, Homo naledi, were discovered in 2013 in what some anthropologists see as evidence of prehuman burial rituals. I wondered if any of them died from cancer.
“We don’t have anything to report on pathology from these fossils yet,” John Hawks, a senior member of the expedition, told me. “Some really interesting aspects of health leave only very subtle traces on bone, so we can’t definitively rule anything out.”
In any case, the odds of a find are low, no matter how prevalent cancer was. Today, the incidence rate for all bone and joint cancers is nine cases for every one million people. Barring good luck, one would have to scan a vast number of skeletons to find a single example.
Throughout the Cradle of Humankind, Dr. Hawks estimated, there are about 2,800 fossil specimens. “I believe we are looking at the remains of fewer than 150 individuals,” he said.

Saturday, July 30, 2016

A nurse prepared an immunotherapy drug at the University of Texas M.D. Anderson Cancer Center in Houston. CreditIlana Panich-Linsman for The New York Times
Some of the most promising advances in cancer research in recent years involve treatments known as immunotherapy. These advances are spurring billions of dollars in investment by drug companies, and are leading to hundreds of clinical trials. Here are answers to some basic questions about this complex and rapidly evolving field.

What is immunotherapy?

Immunotherapy refers to any treatment that uses the immune system to fight diseases, including cancer. Unlike chemotherapy, which kills cancer cells, immunotherapy acts on the cells of the immune system, to help them attack the cancer.

What are the types of immunotherapy?

Drugs called checkpoint inhibitors are the most widely used form of immunotherapy for cancer. They block a mechanism that cancer cells use to shut down the immune system. This frees killer T-cells — a critically important part of the immune system — to attack the tumor. Four checkpoint inhibitors have been approved by the Food and Drug Administration and are on the market. They are given intravenously.
Another form of immunotherapy, called cell therapy, involves removing immune cells from the patient, altering them genetically to help them fight cancer, then multiplying them in the laboratory and dripping them, like a transfusion, back into the patient. This type of treatment is manufactured individually for each patient, and is still experimental.
Bispecific antibodies are an alternative to cell therapy, one that does not require individualizing treatment for each patient. These antibodies are proteins that can attach to both a cancer cell and a T-cell, that way bringing them close together so the T-cell can attack the cancer. One such drug, called Blincyto, has been approved to treat a rare type of leukemia.
Cell Wars
Articles in this series are exploring the novel uses of immunotherapy to combat cancer.
Vaccines, another form of immunotherapy, have had considerably less success than the others. Unlike childhood vaccines, which are aimed at preventing diseases like measles andmumps, cancer vaccines are aimed at treating the disease once the person has it. The idea is to prompt the immune system to attack the cancer by presenting it with some piece of the cancer.
The only vaccine approved specifically to treat cancer in the United States is Provenge, for prostate cancer. Another vaccine, BCG, which was developed to prevent tuberculosis, has long been used to treat bladder cancer. As a weakened TB bacterium, BCG appears to provoke a general immune system reaction that then works against the cancer. Researchers hope that other vaccines may yet be made to work by combining them with checkpoint inhibitors.

Which types of cancer are treated with immunotherapy?

Checkpoint inhibitors have been approved to treat advanced melanoma, Hodgkin’s lymphoma and cancers of the lung, kidney and bladder. The drugs are being tested in many other types of cancer.
So far, cell therapy has been used mostly for blood cancers like leukemia and lymphoma.

Which cancer drugs are checkpoint inhibitors?

The four on the market are: Yervoy (ipilimumab) and Opdivo (nivolumab), made by Bristol-Myers Squibb; Keytruda (pembrolizumab), by Merck; and Tecentriq (atezolizumab), by Genentech.

How well does immunotherapy work?

Though immunotherapy has been stunningly successful in some cases, it still works in only a minority of patients. Generally, 20 percent to 40 percent of patients are helped by checkpoint inhibitors — although the rate can be higher among those with melanoma. Some patients with advanced disease have had remissions that have lasted for years. In some cases, combining two checkpoint inhibitors increases the effectiveness. But for some people the drugs do not work at all, or they help just temporarily.
Cell therapy can produce complete remissions in 25 percent to 90 percent of patients with lymphoma or leukemia, depending on the type of cancer. In some cases the remissions can last for years, but in others relapses occur within a year.

Have You Received Immunotherapy Treatment for Cancer?

The New York Times would like to hear from doctors and patients who have experience giving or receiving immunotherapy treatment for cancer.

What are the side effects?

Checkpoint inhibitors can cause severe problems that are, essentially, autoimmune illnesses, in which the immune system attacks healthy tissue as well as cancer. One result is inflammation. In the lungs it can cause breathing trouble; in the intestine it can cause diarrhea. Joint and muscle pain, and rheumatoid arthritis can also occur, and the immune system can also attack vital glands like the thyroid and pituitary. These reactions are dangerous, but can often be controlled with steroid medicines like prednisone.
Cell therapy can also lead to severe and potentially fatal reactions resulting from the overstimulation of the immune system. The reactions can usually be controlled, but patients may need to be treated in an intensive care unit.

What does immunotherapy cost? Does insurance cover it?

Checkpoint inhibitors can cost $150,000 a year. Many insurers will pay if the drug has been approved for the type of cancer the patient has. But sometimes there are high co-payments. Patients in clinical trials may get the drugs free.
Manufacturers have not said yet how much they will charge for cell therapies, assuming they win approval and reach the market. But experts expect the price to be as high as a few hundred thousand dollars.

Where can I get immunotherapy?

Any oncologist can prescribe the checkpoint inhibitors that are on the market. Patients with cancers for which the drugs have not been approved may find insurers reluctant to pay, but may be able to get the drugs for free by volunteering for clinical trials.
Cell therapies are available only through clinical trials now. Most of the study sites are major medical centers.

How can I find out about clinical trials in immunotherapy?

Information is available on the Cancer Research Institute website, or by calling 1-855-216-0127 (Monday through Friday, 8:30 a.m. to 6 p.m. E.T.). Another source is