Cancer of the prostate usually requires androgen hormones for growth. This includes the hormone, testosterone. The suppression of these hormones is called androgen deprivation therapy, or ADT. ADT is sometimes used to decrease the size of a prostate cancer prior to treatment, such as radiation, or in male patients with advanced prostate cancer.

A study in the Journal of Clinical Oncology in 2014 (J.R Gardner and others), suggests that resistance training and aerobic exercise may improve muscle mass and strength, decrease cardiac risk, and decrease weight gain, which can be side effects of ADT (androgen deprivation therapy). Upper and lower body strength is improved. Improvement in endurance and perhaps, quality of life, is also possible. The exercise does not have to be vigorous or exhausting. A monitored exercise program may provide significant benefit to men with carcinoma the prostate – especially those with widespread disease.

In patients undergoing head and neck cancer radiation, using a humidifier may decrease the symptoms of mucous membrane inflammation in the mouth and throat. Head and neck radiation can result in pain, difficulty with swallowing, fatigue, and intolerance of foods with gagging. Use of a humidifier four hours daily seems to provide significant relief.

International Journal Radiation Oncology Biology Physics 2014, A. Macann and others

Here is an interesting piece of information: It would seem that a vitamin D deficiency with a recent diagnosis of carcinoma of the colon can result in a decrease in survival.*

Does this mean vitamin D supplements will help in the long-term survival of colon cancer? That is yet to be decided. Caution: At present, there is no evidence vitamin D supplements have any significant ability to prevent cancer or improve the prognosis associated with cancer of the colon.

If you take vitamin D as a supplement, be careful. An overdose could cause nausea, vomiting, diarrhea – even severe depression and irreversible kidney damage.

*L. Zgaga and others in the Journal of Clinical Oncology, 2014

If you or someone in your family has locally extensive small cell carcinoma of the lung, here’s something to discuss with your treating physician:

Small cell carcinoma of the lung continues to have a poor long-term survival. There are now some convincing studies that demonstrate delivering radiation after excellent response to chemotherapy provides benefit to patients with “extensive small cell lung cancer”. (‘Extensive’ can be defined as small cell carcinoma of the lung that is beyond the boundaries of traditional radiation fields of treatment.)

Slotman, et al.: Lancet; September 14, 2014

Cancer pain can be challenging for both the patient and the physician. There are many who believe they will become “addicted” to pain medications. Let’s first define what is meant by “addicted.”

Addiction is “illegal drug seeking.” You are not a “drug addict” if you are having cancer pain that requires narcotic management. Narcotic addiction, however, is a real concern of both the treating physician and the patient. Patients who have had a previous drug addiction or alcoholic history are certainly at risk for an addiction problem with cancer pain management. Both the patient and the treating physician should discuss the risks versus the benefit of narcotic management.

My approach to pain management is as follows:

• Identify the source of the pain. Is it organ related? That is to say, could something else be causing the pain?  I remember once seeing a patient who had excruciating abdominal pain. The pain was not consistent with the cancer related organ of involvement. In fact, further workup correctly diagnosed source of the problem as appendicitis!

• Is it possible the pain may be secondary to nerve transmission or nerve damage? The treatment may be non-narcotic, for example, a nerve block.

• Is it possible that the pain is secondary to the treatment? Again, non-narcotic management may be possible.

• Is it possible the pain may be secondary to nerve transmission or nerve damage? The treatment may be non-narcotic, for example, a nerve block.

• Is it possible the pain is secondary to the treatment? Again, non-narcotic management may be possible.

Not everyone who has cancer has the same intensity pain. The key to pain management is to identify the source of the pain and then individualize the pain management treatment.

Saw palmetto extract is taken in the hope that it will prevent/relieve symptoms of an enlarging prostate (benign prostatic hypertrophy). Some people believe it can also be part of the therapeutic approach with prostatic cancer.

Here’s the good news: If you wish to take saw palmetto fruit extract, it will not create a falsely low PSA that could affect treatment or diagnosis of prostate cancer.

Here’s the bad news: Saw palmetto fruit extract has absolutely no effect on the prostate. The CAMUS Trial (Complementary and Alternative Medicines for Urologic Symptoms) clearly demonstrates that the fruit extract of palmetto has no effect on the PSA.

Please, understand that I am not critical of alternative medicine. In fact, a “Do You Know?” review of alternative medicines would be interesting. If you think it’s worth pursuing, let me know.

Is it appropriate to ask for an estimate of what the cost of my cancer care will be?

Absolutely.  The National Institute of Health estimated the cost of cancer care in 2010 was $125 billion.  By 2020, the estimate will be $200 billion.  $20.5 billion will be spent on breast cancer care alone.

An estimate of out-of-pocket cost is not an unreasonable request.  (It is important to understand that no oncology department or oncologist can give an accurate dollar figure.  Side effects, complications or changes in treatment can all affect cost.)

Is it appropriate to ask my physician or health care professional for a financial disclosure? Does the health care professional receive any financial support for the medication or treatment prescribed? 

It is an appropriate question.  Most recently, a physician at Columbia Medical Center was involved, indirectly, in a financial scandal.  He was referring to others, in return for a $500,000 donation to his cancer research.  His research center has been closed by the Columbia Medical Center, once they became aware of this.

This is an unusual situation.  Just because a physician is receiving grant money for research, it does not mean there is anything underhanded.  In fact, almost all research is supported by some sort of grant money.  All protocol studies and research studies demand a full disclosure.  The concern I have always had is in regards to non-protocol or research type treatment.

The risk of developing cancer in my lifetime is less now than it was in the past, right?

Unfortunately, this isn’t true.  The risk of developing cancer for men born in 1930 in Great Britain was 35% versus 54% of men born in 1960. Men born in 1930 had a 37% risk of developing cancer versus 48% in 1960.  It may well be that because people today live longer than they did in 1930, they have a greater chance of developing a cancer in their lifetime.  Also, cigarette smoking doesn’t help!  (Change in diet may also be significant.)

Ahmad et al. British Journal of Medicine, 2015

You might have read that Medicare now pays for lung cancer screening with low-dose CT scan.  The basic eligibility guidelines are as follows:

High risk: People 55-74 years of age with a greater than 30-year history of smoking 1 pack of cigarettes per day (or a greater than 30-pack-year history of cigarette smoking who stopped smoking less than 15 years ago).  Those also of “high risk” are people 50 years of age with at least a 20-pack-year history of cigarette smoking and an additional risk factor (documented radon exposure, occupational exposure, cystic cancer history, family history of lung cancer, disease history of chronic obstructive pulmonary disease or pulmonary fibrosis).

If there are symptoms or signs of lung cancer, a lung cancer workup is required and low-dose CT scan screening is contraindicated.

Wow! It is even more complicated than that!  If you have any specific questions about low-dose cancer screening, please email me at [email protected].

What exactly is low-dose CT scan? 

This CT scanner takes several 3-D scans of the lung.  It is a lower radiation exposure than a traditional CT scan; however, it is a “screening” scan only.  A traditional CT scan has much better resolution.

The National Lung Screening Trial estimates that 8,100 lung cancer deaths can be prevented.  At a cost of $240,000 per death prevented, the price tag will be of $1.3–$2 billion dollars.

Guys, if you feel a lump or mass in your breast, it’s important to consider medical follow-up.  That’s because approximately 6 out of every 1,000 breast cancers occur in men.  Those cancers tend to present themselves in a more advanced stage then female breast cancers.  This is, most likely, because men have less breast tissue than women and fixation to the chest would be more frequent. The small breast size in men also makes the lymphatics and lymph nodes more readily accessible.  Since men do not have routine mammograms, it can be difficult to identify either early breast cancers or precancerous areas.

Early breast cancers have the same cure rate in men as in women.  The same is true for more advanced stages of breast cancer.

Many of you have heard about human papilloma virus (HPV) causing cancer.  There are at least 170 different types of HPV.  Types 16 and 18 seem to cause most of the HPV-related cancers.

The HPV virus enters the outer lining cells, called epithelial cells.  The virus then makes proteins that interact with the cells, so that the cells do not die and can rapidly grow.  The infected cells can then undergo further changes and develop into cancer.  It can take at least 10 years after an HPV infection for a cancer to develop.

Carcinoma of the cervix, anus, penis, vagina and vulva, as well as some cancers of the head and neck area, can be caused by a HPV infection.

The Centers for Disease Control and Prevention recommend HPV vaccination for both boys and girls age 11 or 12.  Young women can get the HPV vaccine through age 26 and young men through age 21.

This can be a touchy subject, but most HPV infections occur under the age of 25.  It is estimated there will be a decrease in 75%–90% of cervical, vaginal and vulvar, anal and penile cancers.  The same is probably true for cancers of the tongue, tonsil and palate for those who do not smoke and are not alcohol abusers.

Why take a chance? If you are eligible to have the vaccine, get it.

The PAP smear as a screening tool for cervical cancer since 1946 is being replaced with a DNA analysis. In a study reported in 2012 (Castle et al., Journal of Clinical Oncology, pgs. 3044–3050), over 19,500 women were evaluated by DNA testing.  All women were at least 16 years of age.  The DNA testing revealed that 14% were HPV positive.  Of this group, 5% had a positive PAP smear. Most of the women who were positive for both PAP smear and HPV were less than 35 years of age.

In another study called ATHENA, 47,208 women were evaluated. It showed that HPV/DNA testing was accurate and may be a better predictor in the development of cervical cancer than a PAP smear.

 In 2014 the FDA approved the use of the cobas HPV test for cervical cancer screening in women 25 years or older without a PAP smear. The test screens for high risk HPV/DNA infections, such as HPV 16 and 18, which account for 70% of cervical cancers.

If either a HPV 16 or 18 infection is present, a colposcopy should be done. (A colposcope is an instrument that magnifies and illuminates the cervix and vagina. This can result in more accurate biopsies.)

“How do I know that the doctors and hospital I select for my cancer treatment are good choices?”

Good question.  Don’t go by their advertisements.  Most cancer marketing will talk about their equipment and the treatments available.  Only 20% of them, however, mention cancer screening programs available in their institution.  Even fewer promote other cancers services, such as a smoking cessation program or support groups.

Advertisements can appeal on an emotional level. Beware of claims such as “Miraculous!”, “Amazing!”, “The other hospital told me my case was hopeless.”, etc.

You get the picture.

If you have had a positive experience from a previous hospital admission–that certainly is a good sign the hospital may be right for you.  You may also have a friend who was treated in a particular hospital and was well satisfied with treatment and the physician.

Ask questions, like: Is the physician compassionate?  Does the physician listen to his or her patients? Does the physician and staff answer questions appropriately?  Will I receive the physician’s attention? (There should be no interruptions during your consult time, unless there is an issue with another patient that needs to be immediately addressed.)

Treatment recommendations, treatment outcome, treatment side effects and complications, length of treatment, and costs are all of concern and need to be addressed.

A word of caution: Some of these questions might not be able to be answered until a further workup is accomplished.  If that is so, discuss them at that time, so you have a good understanding of what studies need to be undertaken.

“Will it hurt?” is not a dumb question. In fact, there is no such thing as a dumb question. Cancer treatments can be physically demanding. A rapport between the doctor and the patient is most important.  It is all about trust, isn’t it?

No, it is not.  It is also about the skill and professionalism of the physician and the hospital.  Competency is key.

Here are some tips for finding the wheat and avoiding the chaff:

The cancer unit should be accredited by the Commission on Cancer, American College of Surgeons.  There are over 1,400 hospitals in the United States with such accreditation.  To be accredited and stay accredited, all levels of competency are carefully reviewed by the American College of Surgeons.  The review and onsite exam covers every detail of the cancer program.  The cost to the hospital for this review is approximately $50,000.  To read more about this process, do an internet search for “ACOS accreditation of the hospital”.

My personal opinion is that if the hospital is not certified by the American College of Surgeons Commission on Cancer, that hospital has no business treating cancer.

The American Cancer Society has excellent worksheets I urge you to read and use.  They can be found on the American Cancer Society website under “Finding Cancer Treatment Centers”.

Do your homework.  Don’t be afraid to ask questions, and contact me if you need further help.

In 2014 the FDA gave a “break through therapy” designation to 13 anticancer medications.  This fast track is to allow these medicines to be available as quickly as possible.  This is because they have a “high likelihood” of being “life extending”.

At present, two-thirds of individuals who have been diagnosed with cancer live beyond 5 years.  In 1975, 49% of individuals with cancer lived beyond 5 years.  The total amount of American’s living with cancer is 14,500,000.

But cancer still accounts for one-fourth of all deaths in this country.

The average monthly cost of active cancer treatment is in excess of $10,000. There are some cancer treatments that average in excess of $40,000 per month.  Eight of the ten most expensive drugs in this country are cancer drugs. $37.2 billion is spent on cancer drugs in the United States.  This is 40% of the world’s total expenditure.

Ironically, the price of a cancer drug seems to have little relation to its overall effectiveness.  The initial treatment (“first line of treatment”) is the most effective.  The second or third lines of treatment, after progression of disease, may not improve survival.

There are 5 million cancer related hospitalizations every year in the United States.  The cost of this is approximately $20 billion.  It is estimated that 20% of these may not be required, since pain management and hospice care would be most appropriate.

Palliative care will be discussed in a separate “Do You Know?”

BRCA1 and BRCA2 are human genes that make proteins that repair damaged DNA or destroy cells that cannot be repaired.  If these genes mutate and become abnormal, it could lead to a breast cancer.

When a BRCA1 gene mutates in a female, there is a 60% increased lifetime risk of breast cancer and a 39% lifetime increase in ovarian cancer.  That’s because the mutated BRCA1 gene makes proteins that do not function properly and cannot fix the DNA damage. Accumulation of these mutations can result in breast cancer.  There is also a correlation between the mutated BRCA1 gene and prostate or fallopian tube cancer.

In a female with mutated BRCA2 gene, the lifetime risk of developing breast cancer is 45% and 15% for ovarian cancer.  For both women and men, there is also a correlation between prostate, pancreas or malignant melanoma and the mutated BRCA2 gene.

Bilateral breast removal seems to improve overall survival by 9%. A decrease in mortality rate secondary to breast cancer may be as high as 31%.

It is recommended that if a woman has a mutated BRCA gene, removal of the fallopian tubes and ovaries should be undertaken at 35 years of age or younger.  This is because at age 40, there is a 4% risk of developing ovarian cancer. At 50 years of age, it increases to a 14.2% risk.

The recommendations of BRCA 1 and 2 testing are complex and can be pretty scary. If you need help, I am here for you and available for a consult.

There are 30 major medical health organizations that have petitioned President Obama to regulate electronic cigarettes.

At present, there are over 7000 different flavors of nicotine in electronic cigarettes.  Many of these flavors, such as cotton candy and gummy bears, are used to attract young people.  The use of electronic cigarettes among high school students has gone from 14.5% in 2013-13.4% in 2014.  The use in middle school students has jumped from 1.1% to 3.9% from 2013-2014.

Nicotine is an addictive drug that can be life threatening.  It alters brain metabolism.  This results in a mood elevation with a pleasurable effect.  The metabolic mechanism is the same as that in heroin and cocaine.

According to the United States Department of Health And Human Services (publication number CDC–88–8406), “Nicotine is a potent and potential lethal poison.”  Medical emergencies in children, due to nicotine toxicity, have increased 1300% since 2011.  Over half of these children were under the age of 6.  At present, the Food and Drug Administration cannot regulate manufacturers to childproof liquid nicotine containers.

Nicotine can cause:

1.  Life threatening hypertension

2.  Coronary artery disease

3.  Life threatening cardiac arrhythmias

4.  Stroke

5.  Promotion of cancer growth

6. Reproductive disorders, such as lack of ability to conceive, increase in newborn mortality, and withdrawal symptoms in mothers who are heavy smokers

7. Peptic ulcers and reflux disorders

8. Nicotine addiction

If that doesn’t make you stop and think, maybe this will:

After World War II, nicotine was used as an insecticide.

Nicotine is an addictive poison, an insecticide, and a potentially lethal unregulated drug.  The same can be said for electronic cigarettes.

It is within the right of a cancer patient to request a second opinion from pathology.  There are also times when the pathologist will request a second opinion because of a difficult diagnosis.  It is my opinion that when the pathologist requests a second opinion, the patient should be informed.

Dr. Khoury suggests that second opinions be undertaken at another institution by a pathology specialist (The Breast Journal; April 10, 2015).  With difficult pathology interpretations, 20% had a change in the pathologic interpretation and 8% required a change in the treatment approach.

This does not mean that every cancer requires a second opinion from a pathologist.

If you are concerned about your particular cancer diagnosis, I can help. Please contact me to schedule a private consultation.

There was an excellent article in the Journal of Current Practice (Stern, The Growth of Complex Cancer Care; January, 2015) regarding alternative “therapy” and complementary medicine.

Less than 4% of individuals with cancer choose “alternative therapy” for the “treatment” of their cancer.  (Alternative therapy can be defined therapy that is outside the boundaries of safe medical practice.)  A 2006 report in the American Journal of Surgery shows that a delay or refusal of cancer surgery results in a 91% chance of progression of their cancer that would result in an inoperable malignancy.  If there is refusal for either chemotherapy or radiation, the risk of death increases by 47%.  There is no acceptable “alternative medicine”.  In oncology, management can be lethal.

The combination of complementary and traditional medicine is now called integrative medicine.  There are many cancer facilities that offer complementary medicine as part of the oncology therapy.

Complementary medicine can include diet, nutritional supplements, medication, acupuncture and exercise.

Diet and nutritional supplements do not “guarantee” success.  Good nutrition and satisfactory caloric intake is important.  If taken in excessive doses, some nutritional or vitamin supplements can result in profound complications.  Other supplements, such as antioxidants, can result in tumor growth.  Other supplements can interfere with chemotherapy.  The treating oncologist should be aware of any complementary approach that is taken.

Acupuncture has been proven to decrease pain relief, as well as nausea and vomiting.  It does not improve survival and is not curative.

Exercise, even light exercise, may improve cancer control as well as have an in impact on survival.  There is a considerable amount of data about exercise decreasing the risk of developing cancer; however, this does continue to be somewhat controversial.

The oncologist team should be an active participant in the integrative medicine program.

If all this appears a little overwhelming to you, I am here to help. Please contact me to set up a private consultation.

Dr. Voest (Journal of American Medical Association Oncology, April 2, 2015) demonstrated experimentally that fatty acids in fish oil induced resistance to some types of chemotherapy. “I would not take fish oil products surrounding my active chemotherapy, ” Voest says.

He recommends not to eat fish or take fish oil the day before chemotherapy, the days of chemotherapy, or the day after chemotherapy.

Looking forward to any comments about this.