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Archive for October, 2014

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … www.LegacyEducators.org  and click on “Cancer Information”

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As October comes to an end and breast cancer awareness publicity winds down…many continue to live with, and fight this disease. Often, I am asked, “when can I say I am a survivor? When can I say I am disease free?” I use to think this was a difficult question. But, with maturity and experience comes wisdom. The answer is not a generic one…

Survivor JeannineWalston500

“I did not think I’d still be alive after diagnosed with a brain tumor in the spring of 1998 at age 24, 15 years ago.” Says Jeannine Walston in her blog.

During a recent cancer walk, the buzz was all about being a cancer  “over-comer” and not a “survivor” … Hhhmm.  I say, whichever phrase empowers you most…use it! The Merriam Webster dictionary defines both as:

Survive: To remain alive or in existence; live on. To continue to function or prosper; to continue to function or prosper despite … (Merriam-Webster)

Overcome: to defeat something. To successfully deal with or gain control of (something difficult). To affect (someone) very strongly or severely

Strong terms!

About 7 years ago while wrestling with the different faces and phases of cancer…I chose to express myself on paper (not sure I would call it a poem though). It never gets easier to handle…as physician, we need an escape too. I choose to download to Jesus daily…and leave it at the alter. Yes…I pray for my patients in private…

 

The identity of cancer1

 

To ALL the Survivors and Over-comers – Blessings, Peace and Love!

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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!

Don’t forget to visit … www.LegacyEducators.org  and click on “Cancer Information”

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malebreastRecently, I have noted a commercial about Men Against Breast Cancer (MABC), that advocate providing “caretakers” information to males who are taking care of their female love ones, who are diagnosed with breast cancer. How Marvelous! We cannot have enough advocacy relating to Cancer…period.  Breast Cancer is leading the way in publicity, support, advocacy and outreach that should be emulated by less commonly diagnosed cancers.

male breastWhat about men WITH breast cancer? Breast Cancer has been painted so pink (feminine) …that when a male is diagnosed with Breast Cancer, to some, it can be emasculating. Some have presented with advance stage breast cancer, simply because of refusal to believe that the growth on the chest was “breast cancer”…they would not have any part of that diagnosis.

So what to do? It is my belief, that ANY advocacy, publicity, support or outreach, about breast cancer should make it their responsibility to make it known that MEN ARE ALSO DIAGNOSED WITH BREAST CANCER! This would go a long way in removing the stigma.

Male-breast-cancer-man

After Mastectomy – removal of cancer from breast tissue

Yes…Men do have breast. There is “under-developed” breast/fatty tissue just below the nipple area in ALL males (see diagram above). The breast growth was stunted by hormones (lack of certain hormones) during puberty. Have you noticed any men with a “little extra tissue” below the nipple area? This is called “Gynecomastia” which simply means enlargement of a man’s breast, usually due to hormone imbalance, or hormone therapy.  Gynecomastia is just an overgrowth and is a benign condition (it is not malignant/cancerous) and can be seen temporarily during puberty or in overweight men.

Breast cancer in men is a rare disease. However, in 2014, about 2, 360 men are expected to be diagnosed with breast cancer (<1% of total breast cancer diagnosis). Many thanks and deepest gratitude to all who support breast cancer efforts! Let us take one more step and be more inclusive of ALL breast cancer diagnosis and survivors for BOTH sexes – Men and Women!

Thank you for all you do! Until next week …

Please share with the men in your life!

 

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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!

Don’t forget to visit … www.LegacyEducators.org  and click on “Cancer Information”

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TRIPLE NEGATIVE BREAST CANCER

Females are VERY vocal. If you were ever in doubt about the strength in numbers and just how vocal females can be regarding a cause of mutual interest … take a look at Breast Cancer.  Everyone knows pink = breast cancer.

However, despite the awesome global attention and exposure and the many research underway, there still exist a problem; patients are still not certain of the “labels” that physicians use in describing certain aspect of Breast cancer and are often times terrified by the information found on the internet – especially as it relates to triple negative breast cancer. The questions I am often asked are;

  1. What are receptors?
  2. What does “triple negative” breast cancer mean?
  3. Is “Triple Negative” breast cancer a good or bad thing?
Receptors - Complicated?

Receptors – Complicated?

What are receptors?  There are currently 3 receptors of interest in Breast Cancer: Estrogen Receptors (ER), Progesterone Receptor (PR) and Herceptin receptors (Her-2-neu)

Receptors are often times describe as, “little antennae’s” on the surface of cells that controls behavior, such as rate of growth, of the cell.  Clear as mud? Apologies, that is still “Doctor talk” that would not make sense to my non-medical Mom…so probably not for you either.

Uuhhhmmm….thinking, thinking…Lord Help me here…Hhhmmm. Got it! A bit overly simplified…but,

Think of Breast Cancer Growth being similar to a plant. There are 3 things required to make a plant grow;

  1. Soil
  2. Water
  3. Sun

Think of each of these components as a receptor, and things that make a cancer grow,

  1. Soil   (Estrogen receptor or ER)
  2. Water (Progesterone receptor or PR)
  3. Sun (Her2neu receptor)

When all 3 are present, the Plant grows (cancer grows).  We also have the ability to “block” each of these components in hopes of preventing the Cancer from growing.

  • If the soil is removed, the plant will be destroyed. (ER+, PR-, Her2Neu-)
  • If water is taken away from the plant, it will be destroyed. (ER-, PR+, Her2neu-)
  • If  Sun exposure is removed, the plant will be destroyed. (ER-, PR-, Her2neu+)

When there are positive receptors, we have available medications that will block the growth of cancer cells in addition to the regular treatment of surgery, radiation therapy and chemotherapy. Oncologist like this, because there are more options of Medications to use, and the more different types of drugs we have, it is believed that the chance of controlling the cancer, will theoretically improve. You may be familiar with some of these drugs Tamoxifen, Arimidex,  Herceptin, etc.,

Triple Neg How ChemoIn Triple Negative Breast Cancer (ER-, PR-, Her2neu-) … The example would be a plant that is not sustained by any identifiable component…yet it is growing; a plant in a dark room, without soil or water available…grows. What is causing it to grow? Other factors that are not hormone receptor related (Well research are ongoing in this area).  However, we are still able to offer the same Surgery, Chemotherapy and Radiation Therapy as for hormone positive tumors…we just lack that “extra arsenal” of hormone/Antibody blockade that we have for positive receptor tumors.  For this reason, triple negative breast cancer is sometimes considered more aggressive. BUT, others sees it as a Breast Cancer without the hormone treatment options…3 out of 4 still remains (surgery, chemotherapy, radiation therapy). Glass half empty or half full?

Now that you understand the basics, more will be explored next time! Questions? Let me know!

Click below to watch.

Robin Roberts speaks on Triple Negative Breast Cancer

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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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Please see previous weeks’ blog on the definition of “Metastases”…

Brain Metastases is the most common type of intracranial tumor with an incident of over 170,000/yr in the United States. The primary cancers most likely to metastasize to the brain are lung, breast and melanoma.

  • Solitary = one brain metastasis, only site of disease
  • Single = one brain metastasis, + other sites of disease also present
  • Multiple = more than one brain metastasis/lesion

In evaluating for brain metastasis, an MRI with and without contrast is used. If it is a solitary lesion, a biopsy to evaluate tissue, is usually recommended.

Brain mets RT

Response sometimes depends on “type” of Primary Cancer

Doctors are often asked, “how long do I have to live?” That is coined “Prognosis” in medical terminology…So a patient, after reading this blog may ask, “Doc, what is the/my prognosis?” While I am not a big believer in giving time line for survival, studies have been done to look at survival time after diagnosis of brain metastases, based on prognostic factors of – Karnofsky Performance Scale (KPS = how well are you able to carry on normal daily activities), is the primary cancer controlled, age <65>, is the metastases to brain only or other areas as well. This is then divided into classes of I-III. See video below for more information on RPA = Recursive Partitioning Analysis

TREATMENT:

  1. Steroids (Decadron/Dexamethasone) – improve headache and neurological function, but has no impact on survival. There is no role for steroids if the patient has no symptoms.
  2. Surgery – surgical removal of the lesion from brain. See below as combined as often combined with radiation therapy
  3. Radiation therapy – is recommended as whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS). In SRS, no actual surgery is performed. However, the beam of radiation is very focused and intense, that it is liken to “surgery”, though no scalpel or cutting – just a sharp, focused, “laser like beam” of radiation.

So who gets WBRT vs SRS? It all depends on the patients overall health status (KPS), number of brain lesions (less is better for SRS, but if have disease elsewhere, physician may opt for WBRT).

Example: Patient with history of stage 1 lung cancer treated with surgery 5 years ago, present to the ER after tripping over a rug at a party, and hitting his head on a table. Persistent headache in the morning prompted a visit to the ER. An MRI showed a solitary brain lesion with necrosis (likely mets vs blood based on central location). PET-CT of the body shows no active disease elsewhere.

This patient who otherwise has good KPS (function), no seizures, no disease elsewhere may be recommended for:

  1. Surgical resection + WBRT
  2. WBRT + SRS
  3. SRS alone (with SRS or WBRT for salvage later on, should additional brain lesion appear)
  4. WBRT alone

If there are multiple lesions (and or large size), then surgical resection would likely not be recommended and choices between WBRT and SRS remains on the table. An indepth discusiion with the Radiation Oncologists and Surgeon +/- Medical Oncologist (Oncology Team) is always recommended before such an important decision is made.

Complications: Neurocognitive deficits after WBRT in long term survivors (changes in memory, etc.,). There is an ~5% rate of symptomatic brain necrosis after SRS, generally treated with steroids, sometimes requires surgery for intractable symptoms. Of course, there are complications associated with long term use of steroids, surgery and chemotherapy as well.

As you can see, the treatment for Brain Metastases, is based on several factors and must be personalized. Please see videos below for more information.

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These are lectures presented mostly for Healthcare professional … if do not understand, please feel free to ask! No problem!

Radiation for Brain Metastases

Overall treatment approaches

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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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bonescanprepAs reviewed last week, a diagnosis of Cancer, may in some cases lead to Metastasis to different areas from origin, such as to the bone. Bone metastasis is a common cause of severe cancer pain that can be relieved 60-90% of the time with Radiation Therapy. Good pain control is important, as it also may lead to improved overall survival.

Primary cancers most likely to metastasize (spread) to bone are breast, prostate, thyroid, kidney and lung cancers. Most common sites of bone metastasis are to the spine (low back/lumbar region or mid/thoracic area), pelvis (hip bone), ribs, femur (long bone between the knee and the hip), and the skull.

In order to diagnose whether cancer has spread to the bone, the most common study is a Bone Scan (Not the same as a bone density/Dexa scan used in diagnosing Osteoporosis). A plain X-ray film may also be useful, as it is a good modality to look for fracture. MRI is the imaging of choice when evaluating if the bone is pressing on/collapsed on the spinal cord (spinal cord compression) – this is a very serious diagnosis which requires urgent care.

Treatment:

  1. If there is a pathological (Cancer causing) fracture, then surgery can be used. An Orthopedic Surgeon will stabilize the fracture with an expandable nail/pin (fixation/stabilization).
  2. bone stabilizationRadiation Therapy can be used for discrete painful lesion, and us usually given for 1, 5 or 10 separate, daily treatments. The single treatment (8Gy) is completed in one visit, but the choice of which treatment to use, usually depends on how ill the patient is, where the lesion is located, and discussions had with the Radiation Oncologist.
  3. Radio-pharmaceutical therapy is another option that is best for patients with multiple lesions, as identified on a Bone scan. This is an injectable radiation material/agent such as Strontium-89, Samarium-153.  Therefore, if there is a fracture, spinal cord compression, or a mass next to the bone lesion, then these injected radioactive agent would not be recommended. Additionally, labs must show that the patients blood counts are in an acceptable range. Response rate of 40-90%, pain relief at 2-3wks that last for up to 4mths, can make this treatment worthwhile for certain patients.
  4. A patient may also have options of treatment with Bisphosphonates (use to prevent bone loss and often used in treatment of osteoporosis) if there are multiple bone lesions (multiple metastasis). Hormone therapies are also very effective in breast and prostate cancer.
  5. Pain management is of the utmost importance, so the use of narcotics, steroids, nerve block, etc., should be used for maximal benefit to the patient. A personalized plan would be required. Additionally, precaution with braces, walkers and personal assistance, should be used generously to prevent an unwanted fall!

As noted above, the treatment options for bone metastasis can take many formats. Some may depend on type of original cancer (breast, lung, prostate, etc.,), location, may include hormone treatment, or radiation therapy or radiopharmaceutical. It is very important for patients to discuss with their oncologist (cancer doctors) which treatment is best suited for their particular presentation.

Great information below that put everything together! Breast Cancer mets..

 

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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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