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TUMOR RECURRENCE AND TAMOXIFEN RESISTANCE: HOW IS RECURRENT BREAST CANCER TREATED?

admin — Sun, 17 Jul 2011 08:46:14 +0000

For breast cancer that has recurred within the initially treated breast, an aggressive type of surgery is usually performed. If the earlier surgery was a lumpectomy or partial mastectomy, a complete mastectomy may now be required. Once the tumor and surrounding tissues have been removed, the tumor will be evaluated for the presence of estrogen and progesterone receptors. The decision to use chemotherapy, radiation, or hormone therapy will be based on the size and location of the tumor, nodal involvement, the presence or absence of receptors, and the prior use of chemotherapy drugs. For tumors considered to place the patient at high risk of recurrence, or when conservative surgery is performed, radiation is used subsequently to decrease the risk of another recurrence. As discussed earlier, for patients who have estrogen or progesterone receptors in their primary breast tumors, tamoxifen or another hormonal agent may be prescribed to control or prevent further tumor recurrence. Chemotherapy is also considered, depending on the kind of chemotherapy the patient received initially and how well she responded at that time.If the breast cancer has spread to a single site outside the breast, treatment depends largely on where the tumor is located. If the recurrence is in an area that is surgically operable and the tumor impairs the patient’s normal functioning, then the tumor may be surgically removed. For tumors of the bone or other tumors that are not readily operable, radiation may be used to reduce tumor size and alleviate symptoms.Chemotherapy is typically given to patients with rapidly progressing or receptor-negative breast cancer that has spread beyond the breast. At one time it was believed that patients with disseminated breast cancer had little chance of long-term response to chemotherapy. Drugs were given primarily to moderate the symptoms of the disease. Today we know that by using different chemotherapeutic combinations an improved quality of life can be achieved in at least 60 percent of these patients.Most beginning drug therapies will include either methotrexate or adriamycin. Once a patient no longer benefits from the first protocol, she may be given a different course of drugs. Typically, a patient responds to the initial course for 6 to 12 months. When she stops reacting to any of the conventional drug combinations, the patient may elect to take a new and untested drug or combination of drugs that seems promising. Some of these agents have had encouraging results in patients with advanced breast cancer.A patient with estrogen-receptor-positive breast cancer that has metastasized may be offered tamoxifen therapy before chemotherapy. Response to tamoxifen in patients with bone or soft-tissue metastasis is very good, and remission can last more than 12 months. Unfortunately, while response to tamoxifen may be as high as 75 percent in some groups, virtually all patients will eventually develop tamoxifen resistance and no longer respond. Once tamoxifen therapy fails to be effective, other hormonal agents such as aminoglutethimide, halotestin, megestrol, and leuprolide are available. As with tamoxifen, patients may initially respond satisfactorily, but eventually they develop resistance to all endocrine agents as well.*38\320\2*

A WORD ABOUT SOY INFANT FORMULAS – SOY AND TESTOSTERONE

admin — Thu, 30 Jun 2011 17:18:51 +0000

Soy’s estrogenic exposure may also be putting little boys a risk. Infant boys go through a “testosterone tide” during the first six months of their lives, during which they normally have testosterone levels nearly equal to those of mature men. This early surge of male hormones programs the reproductive system, brain and other organs to take on male characteristics at puberty. Researchers are now wondering whether the feeding of estrogen-rich soy formula to infant boys interferes with this process and is the explanation for a syndrome, becoming more and more frequent, in which the male sexual organs do not properly develop at puberty.
The New Zealand Medical Journal found that soy-based infant formula may adversely affect hormonal development in neonatal infants and should not be sold commercially. Since soy is the richest source of phytestrogens, a plant form of the female hormone estrogen, neonatal infants are particularly vulnerable. The NZMJ cautioned that there is insufficient research on the long-term health effects of phytestrogens, therefore warranting a ban on the nonprescription sale of soy formula.
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THE CAUSE OF CANCER: DESCRIPTIVE STUDIES

admin — Tue, 19 Apr 2011 10:11:32 +0000

Epidemiologists can gain valuable information from looking at carefully planned descriptions of the patterns of cancer within populations, usually national or regional populations. Because cancers do not occur uniformly in all populations, such studies have provided many important clues about the causes of cancer. Later, we will describe the distributions of different cancers in the European Community to illustrate how much variation can exist even between rather similar countries. Much greater variations exist between countries in different continents and between groups with very different social and economic standing. Some cancers, notably breast cancer, are strongly associated with the pattern of fife found in developed societies in Europe and North America. Others, notably cancer of the liver, are found much more frequently in the developing world. Clues can therefore be sought by seeing what factors might be most closely linked to the individual cancers under study. Not only can national, social and economic differences yield information. The incidence of cancer at different ages and in different sexes and different races and at different times in history can yield valuable facts and dues. By studying the pattern of cancers in these groups the epidemiologists will seek to identify factors in the environment or factors in the host (the person with cancer) which put that person at a greater risk of cancer and, when possible, to provide an accurate measurement of the size of that risk.
In any population the pattern of cancer can be described in a number of ways:
• Incidence – the number of new cases in each year per head of the population or usually, to make comparisons easier, per 100,000 or per million heads.
• Mortality – the number of people who die of that cancer in each year per head of the population or per 100,000 people.
• Prevalence – the number of cancers that exist at any one time in a particular population, which will depend both on the incidence (new cases developing) and the mortality.
At first glance it might seem easy to produce this information. In fact it can be surprisingly difficult. Death certificates ought to provide accurate information about the mortality from cancer in a whole population when records are kept. In fact death-certificate information can be quite inaccurate and is not always collected well.
Many countries have developed a system of cancer registration in order to collect information about cancer incidence. The information is collected from hospital records, death certificates and hospital laboratories, and great attention is now given to cross-checking and comparing information to ensure its reliability. Most European countries collect information on mortality. However, even within Europe, we find differences in national commitment to collecting such data (Luxembourg, for example, does not have cancer registration). Perhaps the countries with the most outstanding record of accurate collection of valuable information are Denmark and Scotland. In England and Wales the regional cancer registries are broadly accurate, but some registries arc better than others. Cancer registration is improving rapidly in the new southern European members of the European Community, such as Portugal and Greece.
IB the United States national cancer registration began towards the end of the nineteenth century, but it was not until 1933 that information was collected in all states and only as late as 1979 was a national registry of all cancer deaths established.
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PEDIATRIC ONCOLOGY: ASSESSMENT OF BIOCHEMICAL DATA

admin — Mon, 07 Feb 2011 09:20:34 +0000

A. laboratory tests that can be monitored before and during

repletion include the following

Obtain laboratory panel to screen for organ function to include: sodium, potassium, chloride, bicarbonate, glucose, creatinine, blood urea nitrogen (BUN), calcium, phosphorus, magnesium, total protein, albumin, triglycerides, cholesterol, alkaline phosphatase, alaline aminotransferase, y-glutamyltransferase, and total bilirubin.

Serum albumin <3.2 mg/dL may indicate decreased protein stores.

Serum prealbumin level can be increased with impaired renal function (normal value varies with age), and decreased with altered hepatic function.

B. Providing nutrition to patients who are depleted can result in

abnormalities such as:

1. The refeeding syndrome

This is seen in patients chronically deprived of adequate nutrition and is characterized by metabolic complications, severe fluid shifts, hypokalemia, and hypophosphatemia that occur in patients who are repleted enterally and par-enterally. Monitor sodium, potassium, chloride, bicarbonate, BUN, creatinine, calcium, magnesium, and phosphorus.

2. Tube feeding syndrome

This is characterized by hypertonic dehydration, hyper-natremia, and prerenal azotemia in patients receiving highly osmotic enteral feeds.

*65\168\2*

PEDIATRIC ONCOLOGY: ASSESSMENT OF BIOCHEMICAL DATAA. laboratory tests that can be monitored before and duringrepletion include the followingObtain laboratory panel to screen for organ function to include: sodium, potassium, chloride, bicarbonate, glucose, creatinine, blood urea nitrogen (BUN), calcium, phosphorus, magnesium, total protein, albumin, triglycerides, cholesterol, alkaline phosphatase, alaline aminotransferase, y-glutamyltransferase, and total bilirubin.Serum albumin <3.2 mg/dL may indicate decreased protein stores.Serum prealbumin level can be increased with impaired renal function (normal value varies with age), and decreased with altered hepatic function.B. Providing nutrition to patients who are depleted can result inabnormalities such as:1. The refeeding syndromeThis is seen in patients chronically deprived of adequate nutrition and is characterized by metabolic complications, severe fluid shifts, hypokalemia, and hypophosphatemia that occur in patients who are repleted enterally and par-enterally. Monitor sodium, potassium, chloride, bicarbonate, BUN, creatinine, calcium, magnesium, and phosphorus.2. Tube feeding syndromeThis is characterized by hypertonic dehydration, hyper-natremia, and prerenal azotemia in patients receiving highly osmotic enteral feeds.*65\168\2*

YOUR CANCER YOUR LIFE – PATTERNS OF SECONDARY GROWTH (PART 1)

admin — Tue, 12 May 2009 12:07:33 +0000

Your practitioner will know where your particular type of cancer usually spreads. This is very important in working out what tests are needed and what types of treatment are likely to be best. With many types of cancer, the first secondary growths to develop tend to be located in the lymph nodes closest to the primary cancer. Examples include cancer of the breast, colon and tongue. Sometimes enlargement of these nodes is noticed by the patient before there is any sign of the primary cancer.

Other types of cancers tend to release cells into the bloodstream right from the start. These include some types of lung cancer and bone cancer. For each type of cancer there is a typical pattern for locations of secondary growths. Cancers spreading through the lymph system often form secondary growths in the nodes closest to the primary. Cancers spreading through the blood often form secondary growths in the lungs, liver and bones. Although, of course, the blood goes to every part of your body, for some reason the cancer cells are much more likely to lodge and form secondary growths in some organs than in others. Thus, for example, the lungs, liver and bones are common sites while the muscles, heart and intestines are not usually affected by secondary growths.

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PREVENTING CANCER: FOODS PACKED WITH VITAMINS AND OTHER NUTRIENTS

admin — Thu, 23 Apr 2009 04:12:07 +0000

Biotin

Bean sprouts, brewer’s yeast, egg yolks, liver, meat, nuts, oatmeal, pecans, poultry, rice, saltwater fish, soybeans and wholegrains.

Choline

Brewer’s yeast, cereals, egg yolks, leafy greens, lecithin, legumes, liver, peanuts, wheat germ and wholegrain cereals.

Coenzyme QIO

Beef, broccoli, cabbage, egg yolks, leafy greens, mackerel, milk, oily fish, organ meats, peanuts, salmon, sardines, sesame oil, soybean oil, spinach, vegetable oils, wholegrains and yogurt.

Inositol

Beans, brewer’s yeast, cabbage, cantaloupe, citrus fruits, grapefruit, lecithin, legumes, lima beans, molasses, nuts, raisin, seeds, oats, wheat germ and wholegrains.

Vitamin A (Carotenes)

Apricots, cantaloupe, carrots, dark leafy greens, egg yolks, endive, fish and animal liver, fish oils, lettuce, mangoes, mint, papaya, peaches, prunes, pumpkin, sweet potatoes and yams.

Vitamin ÂI (Thiamine)

Beef, brewer’s yeast, brown rice, dulse, egg yolks, fish, green vegetables, kelp, lean pork, legumes, liver, milk, nuts, oats, peanuts, peas, rice bran, soybeans, spirulina, torula yeast, wheatgerm and wholegrains.

Vitamin B2 (Riboflavin)

Asparagus, avocadoes, beans, brewer’s yeast, broccoli, Brussels sprouts cashews and other nuts, fish, leafy greens, legumes, lentils, mushrooms, parsley, spinach, sprouted seeds, wild rice and yogurt.

Vitamin B3 (Niacin)

Almonds, bran, brewer’s yeast, broccoli, brown rice, carrots, dandelion greens, fish, leafy greens, legumes, mushrooms, nuts, potatoes, poultry, salmon, sardines, sunflower seeds, tomatoes, wheatgerm and whole wheat products.

Vitamin B5 (Pantothenic Acid)

Avocadoes, brewer’s yeast, cashews, cereals, egg yolk, leafy green vegetables, meat, pecans, rice-bran, royal jelly, soybeans and wheatbran.

Vitamin B6 (Pyridoxine)

Brewer’s yeast, cereals, dried beans, fish, legumes, liver, millet, nuts, oats, organ meats, poultry, salmon, soy beans, tuna, walnuts, wheat germ, wholegrains and yogurt.

Vitamin B9 (Folic Acid)

Almonds, asparagus, avocadoes, beetroot, broccoli, endive, fenugreek, leafy green vegetables, legumes, lettuce, mushrooms, onions, oranges, parsley, soybeans, sprouts, walnuts and wholegrains.

Vitamin Â12 (Cyanocobalamin)

Found mostly in meats. Small amounts are found in alfalfa, brewer’s yeast, egg yolks, leafy greens, meats, milk, mushrooms, oysters, salmon, sardines, sea vegetables, seafood, soy products, spirulina and yogurt.

Vitamin Â15 (Pangamic Acid)

Apricot kernels, brewer’s yeast, maize, oats, pumpkin seeds, rice bran and wheat germ.

Vitamin Â17 (Bioflavonoids)

Apple seeds, apricot kernels, berries, blueberries, buckwheat, cranberries, grains, legumes, lima beans, linseed, millet, mung beans, nectarines, peaches, plums, prunes, raspberries and young shoots of plants.

Vitamin Â Complex

Blackstrap molasses, brewer’s yeast, brown rice, dark leafy greens, nuts and seeds, sprouted seeds, wheatgerm and wholegrains.

Vitamin Ñ (Ascorbic Acid)

Apricot kernels, avocado, blackcurrants, broccoli, brown rice, cabbage, cheese, citrus fruits, guavas, nuts, oatbran, parsley, peppers, pineapple, potatoes, rosehips, sesame seeds, strawberries, sunflower seeds and wholegrains.

Vitamin E (D-Alpha Tocopherol)

Avocadoes, barley, cold pressed oils, corn, cotton seed oil, liver, nuts and seeds, oats, soy, sunflower seeds and wheatgerm.

Vitamin F (Essential Fatty Acids)

Cinnamon, cold pressed oils, corn, linseed oil, mustard seed oil, safflower, seaweed, soy, sunflower oil sunflower seeds and tofu.

• Alpha-Linolenic Acid (ALA, Omega-3) – canola oil, flaxseed oil, hempseed oil

• Linoleic Acid (LA, Omega-6) – evening primrose oil, flaxseed oil, hempseed oil,

lard, safflower oil

• Gamma-Linolenic Acid (GLA, Omega-6) – blackcurrant seed oil, borage seed oil

• Eicosapentaenoic Acid/Docosahexaenoic (EPA/DHA) – cod, haddock, halibut,

herring, mackerel, salmon, sardines

Vitamin Ê (Menadione)

Brewer’s yeast, broccoli, Brussels sprouts, cauliflower, chickpeas, molasses, seeds soybeans, sprouts (especially alfalfa) and turnip greens.

Vitamin U (Methylmethioninesulfonium Chloride)

Cabbage.

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