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Archive for the ‘Breast Cancer recurrence’ Category

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!

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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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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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