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Archive for June, 2014

From the Physician’s Desk … Weekly Blog! 

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Greetings! Now that you are aware of the meaning of “Adjuvant” *smile* let us review a recent article from the New England Journal of Medicine (NEJM) on 1 JUN 2014 and some other recent changes for Breast Cancer treatments (not to worry! I will also cover other types of Cancers as information becomes available;).

In the diagnosis of breast cancer, the receptor status is very important (please review blog here on receptor status).  If, the Estrogen Receptor (ER) and/or the Progesterone Receptor (PR) are positive, then a medication in pill form (Endocrine/Hormone Therapy) is usually given for 5-10 years. Depriving ER-positive breast cancers of estrogen can slow their growth. Tamoxifen is an anti-estrogen that has long been a mainstay of hormonal (or endocrine) therapy for breast cancer.

The type of medication given in the adjuvant setting (after surgery and/or Radiation Therapy) to women who are still having monthly menstrual cycle (Pre-menopausal) is different from the medication given to those who are no longer have menstrual cycles (Post-menopausal – or as my elders refer to it as, having “gone through the change of life!” ).  A previous study showed that an AI decrease recurrence risk more than Tamoxifen in post-menopausal women and so AIs are commonly used in the post-menopausal setting.

breastIn general terms, the study question was – Can we decrease the recurrence risk for pre-menopausal women as we did for post-menopausal women with the use of an AI? If we made patients who are still having menstrual cycle become “post-menopausal” would their outcome also improve with an AI ? The study concluded that;

“…for premenopausal women with hormone-receptor-positive breast cancer, adjuvant treatment with ovarian suppression plus and aromatase inhibitor (AI) Exemestane … [as compared with ovarian suppression plus tamoxifen] … provides a new treatment option that reduces the risk of recurrence. Premenopausal women who receive ovarian suppression may now benefit from an AI, a class of drugs that until now has been recommended only for post-menopausal women.”        June 1, 2014 at the 2014 American Society of Clinical Oncology Annual Meeting and published online on the same day by the New England Journal of Medicine.

Read more about this study by clicking HERE

In essence, if you are diagnosed with estrogen receptor positive (ER+) Breast Cancer at a young age, that is, while still experiencing monthly menstrual cycle, a NEW option of AI plus ovarian suppression can reduce your risk of breast cancer coming back…the “suggestion” is that AI in this setting may be better than Tamoxifen.  Toxicity may be an issue for some patients, so should be taken into consideration. This is definitely worthy discussion with your Medical Oncologist to decide which option is best for you (or individual patient)!

So for pre-menopausal women in the adjuvant setting:

Tamoxifen OR

Ovarian Suppression plus Tamoxifen    OR

Ovarian Suppression plus Exemestane (AI) OR

 

MORE INFORMATION BELOW ON OTHER CHANGES IN BREAST CANCER TREATMENTS!

 

breast pink

 

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

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From the Physician’s Desk … Weekly Blog! 

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As physicians, we are sometimes entrenched in our medical verbiage, and often forget to slow down and explain clearly the medical concepts used while speaking with our patients. I ponder on this process quite often, and tend to use the patient’s area of occupation or hobby to relay an understanding of difficult topics – especially the science of radiation or cancer. So, as I sat and prepare to browse through a few articles, I came across titles such as:

whipple1

Surgery for Pancreatic Cancer

  • Management of borderline resectable pancreatic Cancer
  • Neoadjuvant vs Adjuvant therapy for resectable pancreatic cancer
  • The role of intraoperative radiation therapy in patients with pancreatic cancer, etc.,

…I shook my head in appreciation of the difficult task physicians have to explain these options to a patient recently diagnosed with Pancreatic Cancer. The patients are often times in sheer shock from the news/diagnosis are rendered unable to listen and/or process such technical, yet very important information. It is a daunting task, both for the physician to explain and for the patient to grasp.   Hhhmmm.

A Few Basic Cancer Terminologies

  1. Borderline resectable – there is a high probability that the cancer can be fully removed via surgery without leaving any parts of it behind (resected to a “negative” margin) but treatment with chemotherapy or radiation is usually required first, to shrink the tumor. (conversely, a “positive margin” means that there is a high probability that cancer cells are left behind). Borderline resectable is common term in Pancreatic Cancer, Sarcoma, and other cancer types.
  2. Adjuvant – refers to the treatment that is given after an “initial/first” tumor directed treatment. Such that “Adjuvant Chemotherapy” is given after surgery in some cancers, and “Adjuvant Radiation Therapy” can be given after surgery or after chemotherapy. Adjuvant = after
  3. NeoAdjuvant – in this case, “neo” means doing something out of the normal order and doing it “before/first” the usual treatment. Example: in breast cancer, usually the process is surgery, followed by chemotherapy and then radiation therapy. However, in some cases, if the tumor is large or close to the chest wall, chemotherapy can be done “before” surgery, in an effort to shrink the tumor. In this instance, it would be said that the patient is receiving “Neoadjuvant” chemotherapy.
  4. Intraoperative Radiation therapy – see and watch news news clip

IORT-procedure-4UP

 

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

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From the Physician’s Desk … Weekly Blog! 

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MAYHEM can occur to anyone (As the All-State commercials so aptly describes). However, you can decrease your likelihood of an ER visit with a few precautions/Safety tips!

JUNE is National Safety Month

Injuries are a leading cause of disability for people of all ages – and they are the leading cause of death for Americans ages 1 to 44. The good news is everyone can get involved to help prevent injuries.

burnDuring National Safety Month, Legacy Health Educator is working with community members to help reduce the risk of injuries. This June, we encourage you to learn more about important safety issues like prescription drug abuse, distracted driving, and slips, trips, and falls.

  • Prescription drug abuse: Prescription painkiller overdoses are a growing problem in the United States, especially among women. About 18 women die every day from a prescription painkiller overdose – more than 4 times as many as back in 1999.
  • Slips, trips, and falls: One in 3 older adults falls each year. Many falls lead to broken bones and other health problems.
  • Distracted driving: Doing other activities while driving – like texting or eating – increases your chance of crashing. Almost 1 in 5 crashes (18%) that injured someone involved distracted driving.
  • Watch out for motorcyclists … PLEASE!

You can make a difference. Find out ways to help reduce the risk of these safety issues.

See video below – may sound simple, but many of these activities lead to Emergency Room visits regularly!

Safety Starts With YOU!

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

Read Full Post »

From the Physician’s Desk … Weekly Blog! 

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It is almost summer time! Many are exercising excessively – running, cycling, cross-fit, etc., –  to attain that glistening, fit body with chiseled arms, legs and, dare I say firm abdomen (the ever elusive 6-pack for most)!

Urinary systemSo, what if after a hard work out, you notice your urine is “red”… on more than one occasion?  [This is more easily noted by males. Females may note a “bloody”  tissue paper while not on your menstrual cycle].  This, dear friends, is a cause for concern.  Make an appointment with your Primary Care Physician soonest!

Visible bloody urine is called “Gross Hematuria” as opposed to “Microscopic Hematuria” which is not visible to the naked eye and only seen on laboratory microscopic evaluation of a urine sample. Both gross and microscopic hematuria may represent serious underlying disease.

Gross Hematuria can be caused by trauma, menstruation, vigorous exercise, sexual activity/STD’s, kidney stones, kidney disease, cancer of kidney/ureter/bladder, prostate cancer, viral illness or infection, such as urinary tract infection (UTI), to name a few. A urine analysis should be done and can easily diagnose if an infection is present. However,  consultation with a specialist (Urologist) is recommended for further evaluation if not a simple UTI.

The extent of evaluation will also depend on if you are considered a “Low-risk” patient.  Low-risk patients are:

  • Age less than 40years
  • No smoking history
  • No history of chemical exposure
  • No irritative voiding symptoms
  • No history of gross hematuria
  • No previous Urologic history (urinary problems)

Needless to say, if Gross Hematuria is noted, make sure you have documentation of a diagnosis AND regular follow-up until and even after resolution. There is only one you … take care of your temple!

 

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

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