Cancer Treatment Archives - Page 2 of 2 - HHO Hunterdon Hematology Oncology

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.

According to the American Cancer Society, lung cancer is the second most common cancer among men and women and the leading cause of death in the United States. In 2014, it is estimated that 224,210 people will be diagnosed with lung cancer. Hunterdon Regional Cancer Center was selected as the only cancer facility in New Jersey to offer a clinical study on a new lung cancer investigational drug called Nivolumab, which is made by Bristol-Myers Squibb.

“This clinical study uses immuno-therapy as a new approach for treating lung cancer. This therapy uses the patient’s own immune system to attack the cancer cells,” stated Myron Bednar, M.D., Medical Oncologist, Hunterdon Regional Cancer Center. Dr. Bednar further explained, “Nivolumab works by blocking the protein called PD-1. The PD-1 antibodies stop lung cancer cells from blocking the body’s natural immune response to cancer. A drug that can inhibit PD-1 may be able to treat a variety of cancers, which is very exciting.”

Patients who may be eligible for the study have been diagnosed with advanced stage lung cancer and have undergone at least one therapy prior to entering this trial. “The benefit from standard therapy is limited for this patient population. Our hope is that this drug will keep the cancer from growing and have the patient’s immune system do the work of killing the cancer cells, versus drugs that may have many side effects, said Kenneth Blankstein, Medical Oncologist at Hunterdon Regional Cancer Center. Dr. Blankstein also mentioned, “We are pleased to be able to provide this trial in our community. We are not only the only cancer facility in New Jersey testing this drug in a clinical trial, but the only one in the tri-state area. The next closest facility is in Tennessee.”

Pictured left to right: Kathy Robbins, RN, MSN, OCN, Clinical Research Nurse at Hunterdon Regional Cancer Center works closely with patients on clinical trials. Kathy talks to Daria Shepherd and provides comfort and education during her treatment at Hunterdon Regional Cancer Center.

Daria Shepherd of Kingwood Township was diagnosed with advanced stage lung cancer in December. Ms. Shepherd had gone to her family doctor because of a pain she was having on her side. An ultrasound showed that the pain was the result of a cyst on her ovary, but the test also found a spot on her lung. A chest scan and a biopsy determined it was cancer. “I started chemotherapy, but it wasn’t effective for my type of cancer, so Dr. Bednar thought I would be an ideal candidate for the Nivolumab clinical trial,” stated Ms. Shepherd. Shepherd added, “This is my second week receiving the drug and I feel good, it has not had any side effects that have interfered with my life.” In fact, Ms. Shepherd was heading out to Spruce Run to fish with her family after her treatment.

Through Hunterdon Regional Cancer Center’s partnership with Fox Chase Cancer Center in Philadelphia, physicians have access to many clinical research trials, which are administered by specially trained staff. Current trials offered at Hunterdon Regional Cancer Center include new treatment protocols for lung cancer, breast, gastrointestinal cancers, as well as lymphoma and melanoma. To learn more about clinical trials at Hunterdon Regional Cancer Center, call Kathy Robbins, RN, MSN, OCN, Clinical Research Nurse at Hunterdon Regional Cancer Center at 908-237-2330 ext. 2.

Cancer immunotherapy uses the immune system or the body’s defense system to fight cancer. Before learning more about immunotherapy, you may want to read a quick overview of how the immune system works.

Immune System Overview

The immune system protects the body against diseases. Immune system cells called antigen-presenting cells patrol the body. When antigen-presenting cells find foreign cells, such as viruses and bacteria, they send a signal to special cells called T-cells, which attack the foreign cells. After all foreign cells have been killed, an immune system regulator called a checkpoint sends a signal to T-cells to stop their attack. This prevents T-cells from killing healthy cells.

What is immunotherapy for cancer?

Cancer cells are different than viruses and bacteria because they disguise themselves as normal, healthy cells. Antigen-presenting cells are not able to detect cancer cells, so a signal is never sent to T-cells. Thus, cancer cells multiply and spread and cancer progresses into more serious stages.

Immunotherapy stops immune cells from being tricked. There are different types of cancer immunotherapy. Each helps the immune system recognize cancer cells and start an immune response against them. This treatment approach is new and promising because it uses the body’s own resources, rather than surgery, radiation, or chemotherapy, to treat cancer. In many cases, this means there may be less unwanted treatment side effects.

How effective is immunotherapy?

Cancer immunotherapy may help cancer go into remission, or even cure it in some cases. It may not work for all patients and all cancers. And because it is a relatively new treatment option, more research needs to be done to determine exactly which patients can benefit.

Still, there are certain tests that doctors can perform that may help them decide if immunotherapy can help a patient. Protein level tests and genetic tests are the two most common. High protein levels and DNA changes in cancer cells may predict that cancer will respond well to immunotherapy.

What is the difference between immunotherapy and other types of cancer treatments?

Each cancer treatment option works differently. The five treatment options are:

Surgery. Cancer tissue is surgically removed.
Radiation therapy. X-rays break DNA in cancer cells, which prevents them from growing and spreading.
Chemotherapy. Drugs destroy cancer cells.
Targeted therapy. Drugs target cancer cells’ genes and proteins to stop them from working properly, which can stop cells from growing, or even kill them.
Immunotherapy. Different types of treatments are used to start an immune response against cancer cells.

Certain treatments may be used for certain cancers. In some cases, multiple treatments may be used.

Distinguishing features of each type of cancer treatment are:

Surgery may be effective for some early stage cancers
Radiation therapy and chemotherapy destroy healthy cells, which may cause unpleasant side effects
Targeted therapy and immunotherapy may only be effective for some patients and some cancers

A board-certified and fellowship-trained oncologist works with patients to find the most appropriate treatment option(s).

What types of cancer can be treated with immunotherapy?

Cancer immunotherapy has been tested on many of the most common types of cancer. An oncologist may recommend immunotherapy to treat:

Bladder cancer
Breast cancer
Head and neck cancer
Kidney cancer
Lymphoma
Prostate cancer
Small cell lung cancer
Melanoma/ Skin cancer

Research is being done to test immunotherapy on other types of cancer.

How is immunotherapy treatment given?

Cancer immunotherapy treatment is given at an oncologist’s office or an outpatient hospital unit. An overnight hospital stay is not necessary. Treatment may be administered:

Intravenously
Orally
Topically (for skin cancers)
Intravesical (through the bladder)

The patient’s response to treatment is closely monitored. Physical exams, blood tests, and scans are performed to see if cancer cells are responding to treatment.

How long does it take for immunotherapy to work for cancer?

Depending on the type of immunotherapy, treatment may be given daily, weekly, or monthly. There may be a break in treatment to give cells a chance to rest. Another therapy cycle may start after the break. The number of cycles a patient receives depends on the type of treatment and the type of the cancer. In some cases, immunotherapy may be combined with other cancer treatments.

The amount of time it takes for cancer immunotherapy to work is different for every patient. As previously mentioned, each patient’s response to treatment is closely monitored. Patients visit their oncologist frequently while undergoing treatment. The oncologist asks the patient questions about their symptoms and health. Answers to the questions and the medical study results give the oncologist important information about how well the immunotherapy is working.

More about cancer immunotherapy…

This article is the first of a three-article series on cancer immunotherapy. In the next article, you will learn more about different types of immunotherapy in detail.

Sources:
National Cancer Institute: “Immunotherapy to Treat Cancer“

Cleveland Clinic: “Immunotherapy: Is It Right for Your Cancer Type?”

WebMD: “How Immunotherapy Works to Kill Cancer Cells“

Strides in medicine have increased our understanding of its many forms

The American Cancer Society predicts that one in eight women will be diagnosed with breast cancer. Although much less common, they predict that in 2019, 2,670 new invasive breast cancer cases will be diagnosed in men. If you or a loved one has been diagnosed with breast cancer, it quickly becomes apparent the term ‘breast cancer’ can have a complicated definition. The last decade has seen huge strides in the disease’s diagnosis and treatment.

An important factor in making such progress has been an increased understanding of the different types of breast cancer. Two useful markers that differentiate the many types of breast cancer are the roles of hormone receptors in the disease’s growth and the location of the disease in the body.

Types of Breast Cancer Based On Receptors

Hormone Positive (HR-positive) and Hormone Negative (HR-negative) Breast Cancer

If a cancer has been labeled HR-positive, its cells have receptors for estrogen and progesterone hormones. Scientists believe these cancer cells grow because they are responding to signals sent by these hormones. If the cancer is labeled HR-negative, the estrogen and progesterone receptors are not present. In addition to isolating the type of hormones that may be driving cell growth, physicians also test for HER2 proteins.

HER2 Positive (Her2+) and HER2 Negative (HER2-) Breast Cancer

The HER2 protein indicates the activity of the HER2 gene. This gene plays a central role in breast cell growth. When there is too much protein present, the diagnosis is said to be HER2+. When little or no protein is present, the cancer is HER2-. HER2-negative cancers tend to grow at a slower rate that HER2+ cancers.

Triple Negative Breast Cancer

Triple negative breast cancer is both estrogen and progesterone negative, as well as HER2 negative. The term ‘triple negative breast cancer’ is not an official medical term, but it is commonly used to describe the approximately 10-20% of cancers that fit into this category. This cancer is associated with the BRCA1 gene and is more likely to affect young people.

Types of Breast Cancer Based On Location

Invasive Lobular Carcinoma

One of the most common types of breast cancer is invasive lobular carcinoma. This cancer is in the breast lobules, which are the areas that produce milk. This cancer most often occurs in women who are 60 years old or older. Unlike other manifestations of cancer that form in lumps, invasive lobular carcinoma spreads in lines though fatty tissue – which can sometimes make it more difficult to detect. Fortunately, it is common for this cancer to be HR+, which means medication can be taken to block the effect of hormones on the cells.

Invasive Ductal Carcinoma

Ductal carcinoma is the most common type of breast cancer and begins in the milk ducts. In many cases it is non-invasive. However, when the cancer spreads outside of the milk ducts, it is then invasive ductile carcinoma. Unlike lobular carcinoma, this disease usually manifests as a mass or lump.

Cancer Treatment

Fortunately, there are now many options available for cancer treatment, and they can be broken down into two broad categories: local and systemic.

Local treatments concentrate on removing or shrinking tumors in a specific location – without affecting other parts of the body. Surgery and radiation are standard methods for local cancer treatment, and they are frequently used in the early stages of cancer.
Systemic treatments are drugs taken by mouth or injection that reach cancer cells throughout the body. This type of cancer treatment includes chemotherapy, hormone therapy and targeted therapy. Depending on what is needed, they can be administered before, during or after local treatments. If treating the disease with surgery or radiation is not an option, they may be used as the primary form of therapy.

Have you or a loved one recently been diagnosed with one of the many types of breast cancer and have questions regarding diagnosis or treatment? Our cancer specialists are dedicated to making strides in the fight against cancer. Hunterdon Hematology Oncology is home to the nationally recognized regional breast-care program at the Hunterdon Regional Cancer Center. Call us today to schedule an appointment with one of our oncologists.

When we think of breast cancer, the prevailing thought is that it only applies to women. This, however, is not true. Men also experience breast cancer, even though it is much less common with only approximately 1% of all breast cancers occurring in men. In 2019, about 2,670 men are expected to be diagnosed with this disease. For men, the lifetime risk of being diagnosed with breast cancer is about 1 in 1,000.

Though men do not have what we typically think of as breasts from a physical perspective, they do still have breast tissue. Men typically will not grow entire breasts because of the lack of breast-stimulating hormones. As a result, their breast tissue usually stays flat and small. Men can sometimes develop real breast gland tissue because they take certain medicines or have abnormal hormone levels.

What Increases the Odds of Male Breast Cancer

When the man is between the ages of 60 and 70
A close female relative has breast cancer
History of radiation exposure of the chest
Enlargement of breasts (called gynecomastia) from drug or hormone treatments, or even some infections and poisons
Taking estrogen
When the man has Klinefelter’s syndrome, a rare genetic condition
Severe liver disease, called cirrhosis
Diseases of the testicles such as mumps orchitis, a testicular injury, or an undescended testicle

Symptoms of Breast Cancer in Men

Breast cancer symptoms in men are similar to those in women. A lump in the breast area is a symptom of breast cancers in men. Other symptoms can include nipple abnormalities such as inversion or nipple discharge which could even include blood. When this happens it is important to see your physician as soon as possible to be properly assessed to avoid any delay in diagnosis.

Diagnosis and Treatment

We use the same techniques that are used to diagnose breast cancer in women to diagnose men. These include physical exams, mammography, and biopsies. In addition, we employ the same forms of treatment for female breast cancer — surgery, radiation, chemotherapy, biological therapy, and hormone therapy — to treat breast cancer in men. The one major difference is that men with breast cancer respond much better to hormone therapy than women do. About 90% of male breast cancers have hormone receptors, meaning that hormone therapy can work in most men to treat the cancer.

Hunterdon Hematology and Oncology, as part of the Hunterdon Regional Breast Care Program (HRBCP), specializes in a coordinated approach to breast cancer care, in both men and women. If you or someone you know is in need of breast cancer care, contact us today to schedule a consultation

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