Blog - Page 6 of 8 - HHO Hunterdon Hematology Oncology

Iron deficiency anemia is a condition where the blood has an insufficient number of red blood cells; it occurs when there is not enough iron in the body to produce them. The body uses iron to make hemoglobin, which is the primary carrier of oxygen within red blood cells. Since red blood cells are the carriers of oxygen throughout the body, not enough oxygen reaches the tissues of the body. This results in the two most common symptoms: tiredness and lethargy (lack of energy). The primary natural sources of iron are meat, dried fruit, and some vegetables.

What Are The Symptoms?

The most common symptoms of iron deficiency anemia include:

tiredness
lethargy (lack of energy)
shortness of breath (dyspnoea)
palpitations (irregular heartbeat)

Less common symptoms include:

tinnitus, the perception of a noise in one or both ears, such as a ringing in your ears or in your head
a sore tongue
headache
pica, a desire to eat non-food items, such as ice or clay
an altered sense of taste
difficulty swallowing
feeling itchy

You may notice additional signs of iron deficiency anemia, such as:

painful open sores in the corners of your mouth
a pale complexion
dry, flaking nails
spoon-shaped nails
an abnormally smooth tongue

What causes iron deficiency anemia?

As mentioned above, iron deficiency is a condition where the body (the blood) does not contain enough iron to effectively convey oxygen to the body’s tissues.

There are several potential causes for this condition.

Blood loss in the gastrointestinal tract.

The most common cause of iron deficiency anemia is bleeding in the stomach and intestines (gastrointestinal tract). There are several causes of gastrointestinal bleeding:

Heavy, prolonged use of non-steroidal anti-inflammatory pain-killing drugs (NSAIDs) such as aspirin and ibuprofen.
Bleeding stomach or intestinal ulcers. An ulcer is an open sore in the lining of the stomach or intestines, caused when the acid in the stomach eats into and through the stomach or intestinal lining. This can cause significant blood loss, leading to iron deficiency anemia.
Cancer. Rarely, gastrointestinal bleeding can be caused by cancer of the stomach or colon.

Causes in women

The most common causes of iron deficiency anemia in women are:

Menorrhagia, which is the name for a condition whereby women experience unusually or particularly heavy menstrual bleeding over several consecutive cycles. The heaviness of the bleeding causes the overall blood level to decline, triggering iron deficiency anemia.
Pregnancy. During pregnancy, the body requires extra iron to deliver the required amount of blood, oxygen and nutrients to the baby. Many women experience iron deficiency anemia because of this diversion of blood to the baby.

What complications can arise from iron deficiency anemia?

Generally, most people do not develop any serious complication from their iron deficiency anemia. But some people do, and here are the most common complications:

Tired/lethargic: Iron deficiency anemia can make you feel tired, weak and lethargic, making it more difficult to be productive and effective in the workplace. You might feel abnormally sleepy, and find it difficult to exercise normally.
Weakened immune system. Severe iron deficiency anemia can weaken the immune system, making you more susceptible to colds, the flu, and other illnesses, as well as infections.
Heart/lung complications. Severe anemia cases are at risk of developing tachycardia, which is an abnormally fast heartbeat, or heart failure, where the heart becomes unable to pump blood at its peak level of effectiveness. It has to work overtime to get the levels of oxygen where they should be.
Pregnancy complications. Women with severe iron deficiency anemia who become pregnant increase their risk for developing pregnancy complications during pregnancy and have a higher risk for post-natal depression.

Iron serves several very important functions in the human body. First and foremost, it is critical in the production of hemoglobin, the molecule in red blood cells that carries oxygen to the entire body. Second, iron is important in the maintenance of healthy cells, hair, nails, and skin.

Iron deficiency anemia occurs when the level of hemoglobin in the blood is lower than normal; thus, the level of iron in the blood is significantly lower than normal. Your entire body cannot receive the amount of oxygen it requires to function effectively and normally. Among several other symptoms, iron deficiency anemia may make you tired and short of breath.

Iron deficiency anemia symptoms

Iron deficiency anemia can often be effectively treated with the simple addition of an iron supplement to your diet. However, one challenge in addressing iron deficiency anemia is that initially there may be no discernable symptoms, or the symptoms may appear to result from unrelated conditions. Because of these complications, additional tests and/or treatments for IDA may be necessary. This is particularly true if your doctor thinks that you may be bleeding internally. This is why detection and treatment of IDA may not be as simple and straightforward as taking an iron supplement. IDA symptoms can include:

Shortness of Breath
Headaches
Dizziness
Fast Heartbeat
Weakness
Brittle Nails
Chest Pain
Ice Cravings
Fatigue
Pale Skin

Symptoms cannot be used to diagnose IDA; if you are experiencing these symptoms it is important to consult with your doctor about Iron Deficiency Anemia testing and possible options for treatment.

Possible Complications of Iron Deficiency Anemia

Blood Loss

Certain cancers that lead to blood loss can lead to IDA. This is because when you lose blood you also lose iron.

Anticancer Therapies

Certain anticancer therapies, such as chemotherapy, can affect your red blood cells which may contribute to iron loss.

Erythropoiesis Stimulating Agents

A medication that some patients may be prescribed to, to help them make red blood cells. However, erythropoiesis stimulating agents (ESAs) cause your body to use iron faster than normal. If you do not take extra iron you may develop IDA.

Inflammation

Inflammation in the body can drive up levels of hepcidin. Hepcidin is a hormone that helps regulate iron regulation. Cancer patients that experience inflammation may have trouble with iron absorption leading to IDA.

Nutrition Deficiencies

Common cancer symptoms and treatments can lead to appetite loss ultimately impacting the patient’s ability to take in food and absorb nutrients. If there is not enough iron being consumed in one’s diet it can raise the risk of developing Iron Deficiency Anemia.

Iron Deficiency Anemia Treatment

Iron-deficiency anemia treatment will depend on its cause and severity. Treatments may include iron supplements, procedures, surgery, and dietary changes. Severe iron-deficiency anemia may require intravenous (IV) iron therapy or a blood transfusion. Iron supplements generally take several weeks or even several months to work at their full effect, so be patient and continue to take them as ordered by your doctor. Your doctor will monitor your blood iron levels throughout your course of treatment.

It is possible that iron supplements will not increase your blood’s iron levels; in that case, it is likely that the cause will require further testing, investigation, and treatment. This might involve:

Oral contraceptives that lighten menstrual blood flow
Surgery to remove a bleeding tumor, fibroid, or polyp
Antibiotics and other peptic ulcer medications
As mentioned above, if the iron deficiency is severe, treatment may require intravenous blood transfusions to quickly replace hemoglobin and blood iron.

Intravenous (IV) iron is given as well under several different situations:

When the patient doesn’t tolerate oral iron very well
Iron blood levels need to come up quickly (like at times prior to pregnancy or before or after surgery)
When iron absorption in the gut is an issue (e.g. people who have had a gastric bypass).
Not responding to iron tablets (e.g. due to chronic health conditions)
Have chronic kidney or heart failure
There are also several types of IV iron that can be taken without too many side effects.

Contact Hunterdon Hematology Oncology to learn more about iron deficiency anemia today!

If you’ve been diagnosed with cancer, your head may be spinning with questions such as: How can I find out which cancer treatment center is best for my type of cancer? How can I locate the very best oncologist (cancer specialist) for my cancer diagnosis? What kinds of questions should I ask them? How should I go about choosing the best course of treatment when there are all sorts of options available? Let’s look at these questions, each in turn:

How to Choose a Cancer Treatment Center That Is Best for My Diagnosis

This question may seem a bit overwhelming at first, but it’s not really all that bad. It just takes a little bit of time and research effort, so start by relaxing and not worrying. Cancer care has improved so much that it’s nearly assured that you can find the best care available for your cancer diagnosis.

Start by asking around! Talk with friends, family, close co-workers, and especially your family doctor. Ask them if they can recommend any hospital or cancer treatment center highly, especially if they have some familiarity with your specific diagnosis. Your family doctor will probably know the most, but you never know.

Some important considerations to include in your search: First a very practical consideration: Is the hospital or cancer treatment center in-network for your health insurance? After all, unless you have unlimited resources, you don’t want to be left with a very large bill after treatment is completed. Then, locate a hospital or cancer treatment center, that has extensive (high volume) experience in successfully treating your specific cancer diagnosis. Generally, this will tend to be large hospitals (although not always) or a well-known cancer treatment center, like the Hunterdon Cancer Center at Hunterdon Hematology Oncology in Flemington, NJ!

Patients should make sure to ask whether the treatment center has access to the newest most precise medical options to treat their cancer. Further, its approach to treating your cancer should be multi-disciplinary, meaning that multiple kinds of cancer treatment specialists should work together as a unified team, focused jointly on treating your cancer with an approach that “passes muster” with all members of the treatment team. Here at the Hunterdon Cancer Center at Hunterdon Hematology Oncology in Flemington, NJ we focus on working as a team to offer you an optimal treatment experience.

One important-but-sometimes-overlooked factor to keep in mind is geography – i.e., distance. Some cancer treatments can potentially require a lot of visits to the treatment center. Some treatments require patients to come back to the infusion suite 2-3 times per week. Considering distance often turns out to be a big deal.

Finally, look for a hospital or center that is a National Cancer Institute (NCI) designated cancer treatment center, or one that is accredited by the healthcare-focused non-profit Joint Commission. Understanding the importance of these designations, Hunterdon Hematology Oncology is an affiliate of Fox Chase Cancer Center and also, as part of Hunterdon Regional Cancer Center’s Breast Program, has received full accreditation from the National Accreditation Program for Breast Centers (NAPBC).

How to Choose the Right Oncologist for My Cancer Diagnosis

Start with your family physician, who almost undoubtedly can refer you to one or more oncologists and/or surgeons who have extensive experience with your specific cancer diagnosis. Then, meet with at least two recommended oncologists/surgeons. Compare and contrast their recommendations. Find out whether they agree or not. If not, see another one (or two). Finally, meet once more with your family physician, who can help you sort through the options and select the right treatment and the right physician(s) for you.

What Questions to Ask Your Oncologist and/or Surgeon

In selecting your oncologist and/or surgeon, it is important to establish that he or she is board certified in your specialty area, how many patients they have treated with your kind of cancer, how many patients with this kind of cancer are seen at the center, and how many have you personally treated, and is there a multidisciplinary team that will work jointly to make decisions regarding the best kind of treatment for my cancer? Also, don’t forget to ask your oncologist if he/she can come to see you in the hospital if the diagnosis or symptoms/side effects of treatment result in an admission. The Hunterdon Cancer Center at Hunterdon Hematology Oncology works to make our patients feel comfortable and confident that they have made the right choice.

For surgeons, ask them: how many surgeries do you perform each year? (It’s important for a surgeon to have a minimum of 15 to 20 per year.) What are your complication rates? What is your 30-day operative mortality rate? (This is any death that occurred within 30 days after surgery, either in or out of the hospital.)

What Factors to Consider When Deciding on Your Cancer Treatment

A diagnosis of cancer can be very anxiety-inducing, but unless your cancer is very advanced, rushing immediately into the first kind of treatment that seems “right” can be a mistake. It is nearly always recommended to take a deep breath, let it out slowly, relax a tiny bit, and do some research.

The first consideration to weigh is the aim(s) of the treatment. These can include removing the cancer entirely or killing it entirely, stopping or slowing its rate of growth and spread, and/or palliative care (supportive care), i.e. managing symptoms and side effects. You need to have an in-depth discussion of these options with your physician and/or multidisciplinary team.

The next factor to consider is the type and stage of the cancer. From there the most important decision is deciding what treatment type best fits with your particular cancer situation. These options include surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapy, immunotherapy, active surveillance, also called watchful waiting, palliative care, and participating in a clinical trial.

Another key consideration to weigh the risks and benefits of each type of treatment. Some factors to consider include the chances for a complete cure, the likelihood that the cancer may come back, short and long-term side effects, chances of living longer with and without treatment, and (importantly) the effect(s) of treatment on your quality of life and independence.

The Hunterdon Cancer Center team is here to guide you, offer our utmost support and provide detailed information to make these difficult decisions easier on you and your family. Contact us today to schedule your appointment.

There are some unusual and interesting differences between men and women when it comes to the phenomenon of lung cancer. Not that cancer is interesting. It’s not. It’s disconcerting, to say the least. What we’re talking about are some thought-provoking differences between men and women when it comes to the rate of lung cancer and to the mechanism of how it develops, that are forcing the medical/cancer research community to reach some important conclusions about women and lung cancer treatment. Here are some important differences between men and women when it comes to lung cancer:

The rate of lung cancer among women who have never smoked is growing (15% – 20%), while the incidence of lung cancer among men who’ve never smoked is declining (10%).
The rate of lung cancer among women due to smoking is around one-half that of men.
Receptors for the female sex hormone estrogen have been detected on lung tumors among women.
Scientists studied populations of mice who underwent ovariectomies (surgical removal of ovaries). When treated with estradiol, they developed lung cancer; when treated with anti-estrogens, the process was reversed.
There is a growing body of research evidence pointing to the conclusion that combination hormone replacement therapy (HRT) may slightly increase the risk of both getting, and dying, from lung cancer.

One of the critical, fundamental differences between men and women is the presence and relative prominence of hormones; namely, estrogen and progesterone. Researchers began to wonder about whether the role of hormones might be a critical factor behind these differences in rates of cancer. The research data collected so far indicate that lung cancer in women is, at least in part, driven or conditioned or affected by the presence of female hormones.

Hormone Replacement Therapy (HRT)

In a study of 16,000 women, the Women’s Health Initiative (WHT) found that women with non-small lung cancer who are under a combined hormone replacement therapy (HRT) regimen, i.e. taking combined estrogen and progestin, are approximately 59% more likely to die from the disease. This effect was limited only to women who already had non-small cell lung cancer; it did not apply to women who did not have lung cancer or who had small-cell lung cancer.

Conclusions

Clearly, these results are very significant and important for every woman to know who has lung cancer, who has a higher risk for lung cancer (e.g. due to smoking), or who is considering HRT. The decision regarding what course to follow should be undertaken in close, intimate conversation with one’s doctor(s). There is no single “right” course of action to take, because it depends on one’s overall health, the nature of the condition being faced, and the risks of going in one direction versus another. The decision, while ultimately yours, should be an informed one, and that requires a frank, detailed discussion with your health team members. Contact us today to set up an appointment.

At one time in the not-so-distant past, a cancer diagnosis was something close to a death sentence. That is far, far less true these days. As our understanding of the wide variety of cancers grows, and the spectrum of treatment options widens, a cancer diagnosis is no longer regarded as a death sentence. In fact, there is now a great deal of realistic hope for a long and healthy prognosis.

While we may have a ways to go in fully understanding the underlying mechanisms of cancer and in creating effective treatment options for all of them, we have in fact learned much about how cancer works, about what makes some forms of cancer more survivable than others, about what diagnosis procedures have the most promise in helping to create a near-guarantee of survival, and what treatments provide an extremely positive prognosis (estimate of outcome). Here’s a snapshot: the following table illustrates how much has changed in the cancer landscape, and what cancers are most “survivable”.

Table 1. The most survivable cancers according to the US SEER database of cancers diagnosed between 2005 and 2011.

Cancer Type	Median age at diagnosis	5-year relative survival
Skin (basal & squamous)	unknown	99.9%
Prostate	66	99%
Thyroid	50	98%
Testis	33	95%
Melanoma of the skin	63	92%
Breast (female)	61	89%
Hodgkin’s Lymphoma	38	86%
All childhood cancers	0-14	83%
All cancers (excluding skin)	65	67%

So, what are the most important factors in determining whether a particular form of cancer has a higher (or lower) rate of survivability? Let’s take a look at 3 of the top factors.

Early detection of cancer means earlier treatment and a higher cure rate

In other words, how soon do you feel sick? If unpleasant, odd or unusual cancer symptoms manifest early on in its development, it has a much higher chance of being detected early on in its growth and development. Then, it has a much higher chance of being effectively and completely treated. This is very good news.

First, if the cancer is located in a solid tumor and has not spread when detected, it can much more easily be completely removed/destroyed by the surgeon’s knife or effectively treated with some type of targeted radiation therapy.

Second, if the cancer is a blood cancer (and thus not removable by surgery), if it’s detected early on, hope is quite high for an effective treatment. Blood cancers tend to manifest unpleasant symptoms early in their life, so they tend to be detected and diagnosed early on in the process of disease progression. Again, this contributes to a high probability of very effective treatment.

The more diverse a cancer’s acquired mutations, the more resistant the cancer is to treatment

This factor overlaps with the first one to a degree. The longer a cancer progresses along undetected, the larger the number and more diverse the acquired genetic mutations that will accumulate. And in general, the greater the diversity of genetic mutations, the more likely that one or more of those mutations will prove to be resistant to non-surgical therapy.

So, early detection means more effective treatments and higher rates of survival. Cancers that are detected early on tend to have a smaller, limited number of mutations, making it more likely that a non-surgical treatment (e.g. chemotherapy) will be effective in targeting and killing the cancer cells.

Thus, earlier detection of solid-tumor cancers means a smaller degree of diversity of mutations. This means that early treatment has a greater chance of success, whether that treatment is surgery or a non-surgical treatment such as chemotherapy.

As mentioned earlier, immune system (blood) cancers tend to have unpleasant symptoms quite early in the cancer’s progression, which results in early detection. Again, this means that the cancer has had only a relatively short time (a few months to a few years) to accumulate treatment-resistant genetic mutations. And again, this means that non-surgical treatments for blood cancer such as chemotherapy have a much higher chance of success.

Indolence (slow growth) is a good thing

Certain cancers, such as prostate cancer and thyroid cancer, tend to be very slow-growing. Autopsies done in the US have shown that around 80% of men over 70 years old have some cancer living in their prostate; however, few of them died from this! Small nodules (tumors) of cancer living in the thyroid are so commonplace that they are looked upon as “normal”! Autopsy studies have shown that around 8% of the US population have minute nodules of thyroid cancer, which were not the cause of death either. All of these cancers are very slow-growing.

Let’s look at how these factors play out in several common cancers.

Skin Cancer

Skin cancer has a 99.9% 5-year survival rate, and it’s not hard to understand why. First, while skin cancer is quite common, it is also very easy to remove surgically. Second, since they are on the surface of the skin, skin cancers are also quite easy to detect, early on in the progression of the cancer. Early detection means early treatment, which means a high survivability rate. Surprisingly, this includes melanomas, which are one of the most mutated forms of all the cancer types, and which spread easily to almost anywhere in the body. Yet, the overall 5-year survivability rate for skin melanomas is 98%. Again, this is due to early detection of a skin anomaly or lesion, early skin cancer diagnosis, and early skin cancer treatment (i.e. surgical removal).

Prostate Cancer

Prostate cancer has a 99% 5-year survivability rate. This is because prostate cancers tend to be indolent (slow-growing): they either grow very, very slowly or do not grow at all. This often results in a treatment regimen called “watch and wait,” which means frequent exams to determine if the cancer has changed in any way, such as getting larger or more aggressive. If no change is detected, nothing is done until the next exam. If any change is detected, prostate cancer treatment is generally addressed through surgery or targeted radiation therapy, such as tomotherapy.

Thyroid cancer

Thyroid cancer has a 5-year relative survival rate of 98–100 percent at stages 1 and 2. The thyroid is a gland in the neck that produces hormones to support healthy bodily functions.

Most thyroid cancers grow slowly, which allows more time for treatment to take place. Even when cancer spreads into surrounding tissues in the throat, removing the thyroid gland can be an effective method of eradicating it.

Conclusion

These three cancers are just a sample of those with a greatly improving outlook for a cancer diagnosis and its ultimate prognosis. We are no longer in the dark about many of the underlying mechanisms and processes of cancer and its development, and we are learning more about them every single day. New medications, new forms of chemotherapy, new forms of radiation therapy, immunotherapies, and even more forms of treatment are just beyond the horizon. And we are here to support you in accessing these new and powerful cancer treatments.

What is Vitamin D?

Vitamin D is the name given to a group of naturally occurring substances in the body which the body can convert into hormones. The body uses vitamin D to help it utilize calcium and phosphorus in making strong, healthy bones and teeth. Vitamin D also helps the immune, muscle, and nervous systems function properly. Chronically low levels of vitamin D in the body can lead to a weakening of the bones and the teeth; this condition is called rickets in children and osteomalacia in adults.

Where does Vitamin D come from?

The body naturally makes its own vitamin D when the skin is exposed to the sun. Sunshine exposure of even small but regular amounts, such as 15 minutes, only 3 times per week, is enough to allow the body to make all the vitamin D it needs. Of course, there is also the now-current knowledge that too much chronic sun exposure greatly increases the risk of skin cancers such as melanomas, so people today tend not to get enough sun to produce their own vitamin D.

Other ways to get enough vitamin D is through certain foods and supplements. Good food sources for vitamin D include salmon, steelhead trout, mackerel, catfish, herring, oysters, sardines, and eggs. The majority of vitamin D is obtained through consumption of “fortified” foods (i.e. the phrase “fortified with vitamin D” is contained somewhere on the food label) such as milk, yogurt, orange juice, and some brands of soymilk. You can also obtain a healthy level of vitamin D through dietary supplements.

Is there a relationship between Vitamin D and Cancer?

There is some data/evidence which suggests that chronically low levels of vitamin D may increase the risk for certain cancers (e.g. breast cancer), and that higher (but not too high) levels of vitamin D may inhibit the incidence or growth of certain cancers (e.g. breast cancer). However, the research study data available for all forms of cancer is not strong, and is not entirely conclusive.

Studies of cancer and tumors in mice have shown that higher levels of vitamin D may slow down or completely prevent the development of cancer. The research studies of human beings have been more inconsistent, mostly due to the focus and structure of the studies involved. Much more follow-up research will be required to firm up the data, evidence, and research conclusions; i.e. to clarify the exact nature of the relationship between vitamin D and human cancers.

What is PSA, and what is a PSA test?

PSA stands for prostate-specific antigen; it is a protein produced by the prostate gland. It is produced both by normal as well as malignant prostate gland cells. The PSA test is a blood test which measures the amount or level of PSA in a man’s blood. Because the PSA level tends to be elevated when a man has prostate cancer, the PSA test has been viewed as an important, but not completely determinative, indicator for the presence of prostate cancer. The final determination of whether prostate cancer is present will depend on the outcome of a digital rectal exam (DRE), possibly imaging tests, and ultimately on a prostate biopsy.

Multiple tests are generally required because other, benign conditions can also cause elevated PSA levels. Two of these frequently occurring, non-cancerous conditions include prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate). Presence of either of these does not rule out the existence of cancer, however, so further tests will still be called for to make a final diagnosis.

Does the PSA test determine whether cancer exists?

At one time, the PSA test, together with the DRE, were considered as providing a close to definitive determination of the existence of cancer. PSA results above 4.0ng/mL were regarded as “elevated” and would indicate the need for a prostate biopsy to make a final determination of the presence or absence of cancer.

More recent studies have cast some doubt on that iron-clad sureness. More recent research has demonstrated that some men with PSA levels below 4.0 ng/mL can have cancer, and that many men with elevated levels of PSA do not have cancer. So: what to do? While there are conflicting studies, the overall results indicate that, in general, the higher the PSA level, the greater the risk for cancer. Also, an ongoing, steady rise in PSA level over time is an indicator of elevated prostate cancer risk.

Because of these findings, the new wisdom is “watch and wait.” That is, if the PSA level is “elevated”, the new wisdom is to do PSA tests at regular intervals to see if it remains elevated, or if it continues to rise. If it does, then further tests may be called for, such as a DRE to check for a suspicious lump, and/or imaging tests such as a transrectal ultrasound, x-rays, or cystoscopy.

A final diagnosis still requires a prostate biopsy. This is a surgical procedure during which several samples of prostate tissue are extracted via insertion and withdrawal of hollow needles into the prostate gland. The extracted tissue samples are examined by a pathologist in a laboratory to determine whether or not cancerous cells exist in the prostate.

Does the PSA test have any limitations?

The primary limitation of the PSA test is that even when the PSA level is elevated, and a biopsy is performed, only 25% of men turn out to have prostate cancer. In other words, the PSA test is accurate only 25% of the time. So, by itself, the PSA test is simply not enough. More tests are required to make a final, accurate determination.

Further, sometimes small, slow-growing cancerous tumors are detected. They grow so slowly that they only rarely threaten the patient’s life. Sometimes these tumors are treated unnecessarily via surgery or radiation treatment; this is called “overtreatment”. In this case the patient is subjected unnecessarily to the risks of serious, life-altering side-effects such as urinary incontinence (difficulty or inability to control urine flow), bowel function problems, erectile dysfunction (E.D.), which means difficulty having or maintaining erections, or having erections that are inadequate for sex.

Sometimes, the PSA test can yield what are called “false-positive” results, which means that the PSA level result appears to indicate a significant risk of cancer, but in fact no cancer is present. This can subject the patient and his family unnecessarily to high levels of anxiety and can cause the patient to undergo unnecessary follow-up procedures such as a biopsy, which can bring serious side-effects such as pain, bleeding, and infections.

The opposite case can also happen, which is called a “false-negative” result. In this case, the PSA test levels are low, indicating that no cancer is present, when in fact a cancerous tumor is present. This can give the patient and his family false reassurance and a plan for no further treatment, when in fact the patient requires further treatment.

As you might have concluded, the PSA test situation, in isolation, is complex and somewhat cloudy. It is all-important that you find a top-notch urologist and prostate oncologist to have on your treatment team, and they need to be intimately familiar with the state-of-the-art research findings as well as treatment options. Only through consultation with both doctors will you be able to come up with an appropriate diagnosis procedure and comprehensive treatment plan.

You may have heard of immunotherapy, and at least understand that it represents a huge advancement in the treatment of cancer. You may also know that, in broad terms, immunotherapy works by helping the patient’s own immune system work more effectively in finding, attacking, and killing cancer cells. To learn more about what immunotherapy is, and how it works, click here.

Because immunotherapy simply trains the patient’s immune system to work more effectively, you might also think that immunotherapy has no side effects. What we are finding, however, is that that belief is incorrect. Immunotherapy does have a spectrum of side effects. Immunotherapy patients experience side effects approximately 5-10% of the time, and these cases of side effects are life-threatening around 1-2% of the time. Being forewarned is forearmed, so let’s explore the types of immunotherapy side effects that can occur.

Most common side effects: Fatigue & Inflammation

Just like other kinds of cancer treatment, fatigue is one of the most common side effects. Feelings of overall low energy, and/or becoming exhausted quickly and easily when exertion is required, are very common side effects. This kind of physical debilitation can occur within just a few weeks of commencement of treatment but can sometimes not happen until several months – or even years – have passed. Generally, this side effect tends to get better with enough passage of time. However, while this side effect does generally improve with the passage of time, you may not return 100% to your former levels of overall energy or stamina levels. There may be some lingering, low-level fatigue that remains.

Immunotherapy medications can also cause a variety of inflammations throughout the body. Skin inflammation can manifest as a rash, feeling itchy, or as pigment changes, sometimes without a rash. Inflammation of the colon may occur, causing diarrhea and/or abdominal pain. Inflammation of the lungs can occur, causing chest pain and a cough.

Rarer side effects: Diabetes, Endocrine system problems, and Hypophysitis

Side-effects that more rarely occur include development of diabetes (a chronic condition that negatively impacts how the body processes glucose, or in more severe cases, progresses to the point that the pancreas produces little-to-no insulin, the critically important hormone which regulates the amount of glucose in the blood).

Another rarely occurring side effect is damage to the body’s endocrine system, responsible for how the body produces and regulates hormones – all hormones, not just insulin. Another rare, but more concerning side effect is the inflammation of the pituitary gland, known as hypophysitis. Hypophysitis manifests in many different ways, so a definitive diagnosis requires blood work. Symptoms include headache, fever, or fatigue.

Side effects do not depend on cancer type

The side effects described above do not generally depend on the patient’s type of cancer. Rather, they depend more on the type of immunotherapy medication prescribed for cancer treatment.

Management of side effects

Research has found that the most appropriate treatment for the various side effects that occur depends on the severity of the effect. Many patients receiving immunotherapy have already received chemotherapy, so they have most likely already experienced the milder side effects like fatigue, rash, and/or cough. As a result, they have already developed the necessary coping skills and/or method of treatment for them.

When it comes to diarrhea, however, treatment approach is critical. The most highly preferred treatment approach is modification of diet. Limiting dairy products can be very important in this case. The reason that dietary changes are preferred is that anti-diarrheal medications can cause severe, even life-threatening, complications. If the diarrhea problem is severe, your doctor may recommend a temporary cessation of immunotherapy, and replacement with an immunosuppressant. This can help to reduce the inflammation behind the diarrhea to a safer level, yielding improvement in diarrheal symptoms.

Patients who develop diabetes may also require a temporary pause on the immunotherapy drugs, combined with insulin medication treatment. In any case, the temporary pause can help the body to recover, heal, and reduce the severity and/or existence of unwanted side effects. The ultimate goal, however, is to resume immunotherapy treatment; to attack and kill the tumor’s cancer cells.

Side effects have nothing to do with immunotherapy effectiveness

Patients often believe that the presence and severity of side effects is also a measure of the effectiveness of the immunotherapy treatment. This is not true. Patients whose immunotherapy treatment is highly effective often experience no side effects. This can lead them to suspect that they are only receiving a placebo medication in a secret clinical trial, or that the immunotherapy medication isn’t working at all. This is simply not true. Remember: only 5-10% of immunotherapy patients experience any side effects. So, 90-95% of immunotherapy patients have no side effects whatsoever!

Self-awareness is critical

So, the most important advice you can receive relative to the presence or absence of side effects is heightened self (and body) awareness. Pay attention to what your body is trying to tell you, right from the get-go! Make sure that your doctor, as well as your pharmacist, spend lots (and lots) of time with you, going over all the possible side-effects associated with your immunotherapy medication, and make sure you fully understand everything they are saying to you. Ask as many questions as you feel you need to and do not assume that you are a “burden” to them. After all, this is your treatment, and this is your life! You are the one whose life and well-being are being affected. It is your responsibility to ensure that you are completely comfortable with every aspect of your treatment. It is your doctor’s responsibility to ensure that you are, indeed, fully comfortable with all aspects of your treatment.

What is head and neck cancer?

Head and neck cancer is a collective label for cancers that develop in various areas of the head and neck. Most often they start to develop in the thin layer of moist, mucosal tissues that line the nose, throat, and mouth. These thin layers of tissue are made up of flat squamous cells. Most of the cancers that develop in these moist tissues are known as squamous cell carcinomas of the head and neck. More uncommonly, cancer can develop in the salivary glands, but this article will focus on the squamous cell carcinomas of the head and neck.

What causes head and neck cancers?

The two most important risk factors for developing head and neck cancer are drinking alcohol and using tobacco (in any form), particularly cancers of the oral cavity, oropharynx, hypopharynx, and larynx. 75% or more of head and neck cancers stem from alcohol and tobacco consumption. Also, as people get older, their risk of developing head and neck cancers increases. The majority of head and neck cancers develop in people who are older than 45. Further, head and neck cancers are more common among men. The reasons for this are not fully understood.

Another important risk factor for head and neck cancers is the human papillomavirus (HPV). HPV is most commonly known for causing cervical cancer, among others. HPV is particularly implicated in cancers that involve the base of the tongue and the tonsils. HPV-related head and neck cancers generally have a better prognosis (chance of recovery) than those stemming from alcohol and tobacco use.

What are the symptoms of head and neck cancer?

As noted earlier, head and neck cancers can develop in a variety of locations. Because of this, there are also a large variety of symptoms that may indicate developing head and neck cancers. These include symptoms such as:

Difficulty and/or pain when swallowing
A lump or a sore that does not heal
A lump in the neck
A sore throat or pain in the neck that does not go away
Changes in the voice or increased hoarseness of the voice
A white or red patch on the lining of the mouth, the tongue, or the gums
Trouble breathing or speaking
Sinuses that are blocked and do not clear
Chronic sinus infections that do not respond to antibiotics
Bleeding through the nose
Frequent headaches

It is important to note, however, that these symptoms can also be associated with other, less serious conditions. So, make sure that you first consult with your primary care physician or dentist to determine whether or not your symptoms are due to a less serious, non-cancerous condition or illness.

How are head and neck cancers diagnosed?

If less serious conditions are ruled out, and your doctor suspects that head and neck cancer is possible, the first steps in diagnosing it include an evaluation of your complete medical history, and possibly of your family’s history of cancer. Next will be a detailed physical examination of the entire head and neck area, including the mouth, throat and nasal passages, and possibly other diagnostic tests will be ordered. Ultimately, however, a conclusive diagnosis of head and neck cancer will require surgical removal and examination of a small sample of tissue (a biopsy) under the microscope.

Determining how advanced the cancer is (known as the Stage) will require further studies such as X-ray, other imaging studies such as computed tomography (CT scan) or a positron emission tomography (PET) scan, and laboratory tests. Determining the Stage (extent) of the cancer will aid your doctor or health care team in making an appropriate, effective treatment plan recommendation.

How are head and neck cancers treated?

Appropriate treatment depends on the exact nature of the cancerous tumor, and factors unique to the individual. These factors include the size of the tumor, its exact location, the stage (extent) of the cancer, and on the individual’s general health and age. Treatments for head and neck cancer include surgery, radiation therapy/treatments, chemotherapy, immunotherapy, and targeted therapy. It will often require a combination of more than one treatment. Effective treatment generally will involve an entire team of healthcare professionals, including doctors, nutritionists, and others.

What are the side effects of treatment?

The side effects of treatment for head and neck cancer depends on the type/location of the cancer, and on the type of treatment(s) followed. The most common side effects of radiation therapy can include fatigue, weight loss, difficulty and/or pain with swallowing, mouth sores, dry mouth, thickened saliva, redness and irritation. The common side effects of chemotherapy can include low blood counts, nausea, and changes or loss in taste (some foods may taste different, or be tasteless, after treatment). Loss of taste can have a negative effect on nutrition and needs to be watched carefully. Nausea generally improves soon after the chemotherapy treatments are over. Fatigue and problems with swallowing may take longer to get better.

Surgical removal of the tumor can change the patient’s ability to talk, swallow, or chew. The surgery may also cause swelling of the neck and/or face; however, the swelling generally dissipates after a few weeks. If lymph nodes were removed, this may cause additional swelling, which could last much longer. If the removed lymph nodes are in the neck, the neck and shoulder may become stiff and/or weak. If surgery includes removal of the larynx (laryngectomy) or involved other parts of the neck, the throat and neck may feel numb.

Long-term recovery requires the involvement of a competent team of medical professionals, not only in the treatment of cancer but also in managing recovery. Besides doctors, this team can include speech pathologists, dentists, dental hygienists, and dietitians/ nutritionists. They all play important roles in helping manage treatment side effects, both short and long-term. The patient may also choose to seek professional counseling and join a support group to aid in recovery.

Over many decades our understanding of how cancer starts and spreads has steadily improved. However, many myths and misconceptions about cancer remain and can be widespread. Here we try to dispel some of these myths that might cause you undue stress and lead you down the wrong road when learning about cancer.

Does Sugar Make Cancer Grow Faster?

Nope. While we do know that cancer cells “eat” (consume) more sugar than normal cells, there is no scientific evidence that eating more sugar will make your cancer worse, nor that eating less sugar will cause the cancer to grow more slowly. BUT – this is important – excess sugar consumption, which is epidemic in the United States, can increase the level of risk for gaining weight, and we know that obesity is a high risk factor for diabetes and for developing certain kinds of cancer. So, while sugar in itself does not cause cancer, is contributes to the development of conditions that can increase its risk and should be consumed within limits

How About Artificial Sweeteners (Chemicals)?

Nope. Scientists have conducted extensive research into this question and have discovered no evidence that artificial sweeteners cause cancer or cause it to grow faster. Studies have been done on aspartame (Equal®, NutraSweet®); sucralose (Splenda®); saccharin (Sweet ‘N Low®, Sweet Twin®, NectaSweet®); neotame; acesulfame potassium (Sunett®, Sweet One®) and cyclamate and found no evidence of cancer causation. All of these sugar substitutes (except cyclamate) have been approved by the Food and Drug administration.

Does My Attitude Help or Hinder Cancer Growth or Recovery?

A diagnosis of cancer can lead to a wide spectrum of emotions which are all perfectly normal. While your attitude doesn’t directly affect the growth or regression of a tumor, it can be very important in upkeeping physical activity (exercise), nutritional intake, and also maintaining a strong social support network which in turn can make an impact on how treatment is managed. We do know that with a positive attitude the treatment process can be easier to adjust to and can potentially make recovery itself better as well.

Can Biopsy or Surgery of a Cancerous Tumor Cause It to Spread?

Thankfully, the chance of that happening is exceedingly low. Nowadays, surgeons utilize methods and protocols and take many steps to ensure that that does not happen. As an example, if surgeons need to remove tissue from more than one place in the body, they use separate sterilized tools for each location to prevent this very thing from happening.

Is It Possible to “Catch” Cancer?

Not in general. Cancer is not contagious. You can’t “catch” it from another person and it doesn’t spread from person to person like a virus or bacterial illness. Remember, cancer is caused by a genetic mutation. The only exception to this is in the case of an organ transplant where the donor had cancer in that organ. This however doesn’t happen anymore since organ donors are screened for cancer and those organs cannot be donated.

There are certain viruses and bacteria (e.g. human papillomavirus, or HPV, and bacteria such as Helicobacter pylori) that can eventually lead to certain types of cancer. In some cases, like with HPV, there can be person to person transmission of the virus itself but not the cancer that it can lead to

Can My Cell Phone Give Me Cancer?

No, based on the scientific research studies done thus far. Cancer is due to genetic mutation and cell phone’s emission of low-frequency energy does not cause genetic mutations.

Can Power Lines Cause Cancer?

Once again, no, according to all the research done thus far. Just like cell phones, power lines emit low-frequency magnetic energy, and like cell phones, that magnetic energy does not cause genetic mutations. Besides, power lines are well-shielded and weakened by walls in homes or elsewhere.

Do Herbal Remedies Cure Cancer?

Contrary to certain belief systems that are widespread today, there are NO herbal products that cure cancer. There are a few studies that suggest that some herbal remedies may help patients to cope with cancer; however, they do not cure it. Before taking any herbal remedies, discuss it with your oncologist as some herbal products may in fact interfere with the effectiveness of chemotherapy or radiation therapy.

Can I inherit cancer?

90 – 95% of cancers develop because of cellular genetic mutations that take place during the patient’s lifetime – in other words, they are not inherited. They develop from the natural process of aging, or through repeated exposure to a carcinogenic substance in the environment, such as tobacco smoke. However, around 5 – 10% of cancers do result from inheriting a genetic mutation from a parent. In such relatively rare cases, multiple family members may develop the same type of cancer due to the inheritance of the harmful mutated gene from a parent. These are called “inherited” or “familial” cancers. Examples of this can be seen with breast and colon cancers.

Can Deodorants/Antiperspirants Cause Cancer?

In short, no. There is no scientific evidence that links the active ingredients in deodorants and antiperspirants to genetic changes resulting in cancer.

Does Hair Dye Cause Cancer?

To date, there is no scientific evidence that personal use of hair dye increases the risk of cancer. There are studies, however, suggesting that hairdressers/barbers who are more regularly and routinely exposed to hair dye in large quantities may have a greater risk of developing bladder cancer.

If Nobody in My Family Has Cancer, Am I Protected?

No. Remember that cancer develops from spontaneous genetic mutations that occur throughout life due to aging and repeated exposure to certain environmental factors, such as too much sun radiation, smoking tobacco, repeated exposure to dangerous chemicals, how you eat, whether or not you exercise, and simply the process of aging.

Is Cancer Practically a Death Sentence?

Not so fast. That may have been true during decades and centuries gone by. However, starting around the 1990’s, the likelihood of dying from cancer has steadily become less and less. For thyroid, breast and prostate cancers, the survival rate is now 90 percent or better. And the overall survival rate for all cancers combined has increased to around 67 percent.

Of course, this is aggregate data. In any individual case, several factors will alter those statistics, such as the rate of growth of the cancer cells, the degree to which the cancer has spread throughout the body, the availability of certain treatments, and your general health profile.

Sources:
National Cancer Institute: “Common Cancer Myths and Misconceptions”

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