Congratulations Dr. Shah! We are excited to announce that our very own, Dr. Megha Shah, has been published in the Journal Of Endocrine Health. This article contains information regarding the SAT-358 Hypercalcemia-Induced Altered Mental Status as the Primary Manifestation of Classic Hodgkin Lymphoma. If you are interested in learning more, read the article here.
If you were recently diagnosed with breast cancer, your head may be swimming and swirling with questions, that all boil down to this: What’s next? The breast cancer care professionals at Hunterdon Hematology Oncology, a part of the Hunterdon Regional Cancer Center, are able to answer that question in a uniquely powerful way. Hunterdon Hematology Oncology has an entire practice focused solely on breast cancer detection, treatment and eradication, and part of that charge will focus on answering your questions and putting your worries to rest.
First, a word about cancer survivability. “What are my chances, doctor? Am I going to survive?” And the answer today is very much more positive that it was 30 or 40 years ago. Today, the overall survivability rate for breast cancer is in the neighborhood of 70%. Scientific research and early detection techniques are improving the overall trends of both survival rate and quality of life, particularly for breast cancer.
Second, a few words about the treatment process for breast cancer. You may be confused about what you should do next, but the actual treatment process for breast cancer has a certain regularity about it: it usually requires radiation treatment or hormone treatment to shrink the size of the tumor, or chemotherapy, and/or surgery or some combination of these treatment modalities. It depends on the biology of the breast cancer tumor and varies by stage (I – IV).
A little more about cancer staging: Cancer treatment depends on the stage (severity of the tumor). Clinical stage is based initially on mammogram imaging and ultrasound imaging of the suspected tumor. Pathological staging is determined after surgery; after the tumor has been removed and a sample of lymph node tissue is taken. The cancer’s stage is based on the size of the tumor, and whether the lymph node is involved in (affected by) the cancer, as well as the grade of the tumor.
You also might be wondering whether it would be worth it to go to one of those national treatment centers that advertise on TV. The answer is no. Research data indicate no difference in outcomes between national and local cancer centers. First of all, the therapeutic approach for treating breast cancer is standardized across the entire country. Second, HHO specializes in the treatment of breast cancer. HHO has a team of excellent breast surgeons who are dedicated to treating only breast cancer patients. Patients at HHO are assigned a Nurse Navigator who helps the patient coordinate care, navigate the entire process and answer any questions the patient might have.
Also, getting treated locally at HHO has certain advantages over going to one of these large national centers. While getting the exact same level of care and specialization found at a national center, HHO provides a level of personalized attention and care that is difficult to find at a larger center. Being local means that if any issues arise, if you need to come back to the hospital, we are right here and can see you immediately. We offer genetics counseling, and you can come in and out to see him/her very easily. If you need to come in to get a blood count checked, we are right here. Need extra hydration? Ditto. Feeling extra-nauseous? Come on in. We also offer an oncology-certified dietician, with whom you can arrange a visit pretty much any time you want.
And finally, there are actually certain disadvantages to using a large national cancer center. If anything detrimental were to take place, a patient using a large national center might find themselves needing to go to a local ER, and there will be nobody there who is familiar with the patient’s case or will understand what is going on. This can actually be detrimental to their care.
To learn more about Hunterdon Hematology Oncology’s cancer care treatment center NJ visit our breast cancer care page.
Thank you for your continued support and understanding during this unprecedented time. While we maintain our commitment and dedication to patients and caregivers, we also continue our efforts to optimize the health and safety of our staff, providers, and patients. As such, we are pleased to announce the introduction of more comprehensive telemedicine visits through OttoHealth that will allow us to continue caring for you from your own homes.
When appropriate, patients can be scheduled for a virtual visit (which will include video) with a designated provider as early as this week. Visit notifications will be sent directly to your email or via text message and will include login instructions.
More information on the login process can be obtained at the OttoHealth Patient Resources page.
Please let us know if there are any concerns or questions regarding telemedicine or your care in general. For more information about our response to COVID-19, click here
We ask that you let us know prior to your appointment if you or a family member are you or a family member are exhibiting or experiencing signs associated with COVID-19 (coronavirus) in which case we may ask that you seek medical attention from your primary care physician. These include:
If you have traveled to any of the known locations with confirmed cases of COVID-19 or have come in contact with anyone known to have the virus, please call our office prior to your appointment to determine if you need to be rescheduled.
Be assured that your health and well-being are extremely important to us, and we are taking all the necessary steps to ensure a safe environment for your care. Our staff will be screening all patients and visitors for any of the above symptoms, travel, and exposure history prior to being allowed into the waiting area.
The CDC is recommending the following preventive actions to help prevent the spread of respiratory diseases, including COVID-19 (coronavirus):
We will continue to monitor and update health advisories and policies as they are available.
We encourage you to visit these sites for information as well:
https://www.cdc.gov/coronavirus/2019-ncov/about/index.html
https://www.nj.gov/health/cd/topics/ncov.shtml
Our commitment to the safety of every staff member within our practice is unwavering. We will take care of COVID-19 patients and all patients following all the appropriate policies and procedures to keep them and our staff safe. That includes following the World Health Organization’s (WHO) evidence-based guidance for personal protective equipment. The WHO guidelines have been endorsed by the New Jersey State Department of Health and local health departments.
Please recognize that these policies and practices may require alterations to adapt to new developments in the community and guidance coming from our advisory bodies for this rapidly changing situation.
For the most up to date information you can go to:
https://www.cdc.gov/coronavirus/2019-ncov/about/index.html
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.
The most common symptoms of iron deficiency anemia include:
Less common symptoms include:
You may notice additional signs of iron deficiency anemia, such as:
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.
The most common cause of iron deficiency anemia is bleeding in the stomach and intestines (gastrointestinal tract). There are several causes of gastrointestinal bleeding:
The most common causes of iron deficiency anemia in women are:
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:
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 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:
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.
Certain cancers that lead to blood loss can lead to IDA. This is because when you lose blood you also lose iron.
Certain anticancer therapies, such as chemotherapy, can affect your red blood cells which may contribute to iron loss.
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 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.
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 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:
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:
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).
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.
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.)
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.
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.
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.
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.
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.
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.
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.
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.
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