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Archive for the ‘Cancer Consultation’ Category

From the Physician’s Desk … Weekly Blog!

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

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October is Breast Cancer Awareness Month. Although breast cancer is only one of many cancers, I am pleased of the exposure that the many “pink” ribbon brings. It gives me hope that other cancers can have a similar banner of awareness…in the near future. Despite our many progress and technological advances in medicine, cancer remains the second leading cause of death in the United States. For example, Breast Cancer has over 220,000 new diagnosis annually, and over 400,000 deaths each year. Many are surviving a longer time thank in the past.

  • Overall, cancer has taken on a more “chronic” long term debilitating effect, for those who survive initial treatment and are then diagnosed with recurrence/metastatic disease.
  • One the most feared symptom in this category of patients is pain. Overall, 50% to 70% of people with cancer experience some degree of pain, which usually intensifies as the disease progresses.
  • Less than 50% of these patients receive adequate relief of their pain, either because they are afraid to ask because they fear “addiction”, or physicians are unlikely to prescribe adequate medication to attain relief that will allow the patient continued good quality of life.
  • Suboptimal pain control can be debilitating and caregivers are often times unsure how to address this issue.

pm_general_cp_pain_approachThe World Health Organization program for cancer pain control recognizes that 1 in 5 patients with cancer has uncontrolled pain and has a ‘three-step ladder’ for the rational use of analgesics including morphine (recommended adaption to 4-step-ladder – see HERE).

Analgesic pain 4Morphine has long been the ‘gold standard’ for the treatment of severe cancer pain. However, its side-effects, particularly sedation/drowsiness, and cognitive impairment have led to ‘opioid rotation’ to alternatives such as methadone and hydromorphone. The one I like to use most in uncontrolled pain situation is the 72-h transdermal patch for Fentanyl, which offers advantages of reduced side-effects and increased convenience over oral morphine. Another novel pain medication is Intravenous (IV) strontium-89 and bisphosphonate therapy which are effective for both short- and long-term control of metastatic bone pain.

Pain Management Physician Review

Patient Discusses Pain

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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 … http://www.LegacyEducators.org and click on “Cancer Information”

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Ovarian Cancer is deadly. It is the 4th leading cause of death in women and the leading cause of gynecological cancer death. The average lifetime risk is 1 in 70 with median age of diagnosis of 63years. Like most other cancers, Ovarian Cancer is highly curable if diagnosed at an early stage, but 75% presents with more advance disease, at stage III or IV. Early diagnosis is usually very difficult, because patients often present with vague abdominal symptoms and there is a lack of good screening test with initial presentation.

Sister Mary Joseph Nodule w/Ascites

Sister Mary Joseph Nodule w/Ascites

Common Symptoms:

  • Abdominal discomfort/pain/bloating
  • Increasing girth (increase size around waist/abdomen region)
  • Change in bowel (movements) habits
  • Early satiety (feeling full after eating small amount of food)
  • Nausea
  • Sister Mary Joseph Nodes (associated with ovarian cancer and of gastrointestinal tract)
  • Ascites (fluid just under the abdominal skin, that shifts like a wave when tapped)

In addition to the basic blood, liver and kidney evaluation, some specific labs (blood work) that may assist with ovarian cancer diagnosis includes:

  • CA125 – elevated in 80% of ovarian tumors
  • CA 19-9 – low sensitivity, but could be positive in other cancers
  • CEA – elevated in 58% of advance stage ovarian cancers
  • AFP & βHCG – Measure if <30years old to help rule out other types of tumors

Ovaries-hurt-when-sneezeBecause of its presentation, diagnosis usually involves quite a number of imaging as well: Transvaginal ultrasound, CT scan and/or MRI, cystoscopy, sigmoidoscopy, endometrial biopsy if patient has abnormal vaginal bleeding, assessment of any ascites fluid, etc., Surgical exploration is also necessary to complete staging of disease (find out how advance and how far it has spread).

Treatment: As with most cancers, the treatment for ovarian cancer is dependent on the final staging, but majority involves surgery followed by chemotherapy. If not a chemotherapy candidate, then Whole Abdomen Radiation Therapy (WART) may be considered after surgery. However, WART is falling out of favor, due to the toxicity and side effect profile.

Can it be detected earlier? See videos below.

Dr. Oz’ brief review of Ovarian Cancer

Patient Education video w/diagrams

SEPTEMBER is Ovarian Cancer Awareness Month. For additional information you may also contact:

National Ovarian Cancer Coalition
2501 Oak Lawn Avenue, Suite 435
Dallas, TX 75219
(888) OVARIAN (682-7426)
(214) 273-4200
nocc@ovarian.org
www.whyteal.org External Links Disclaimer Logo
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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 … http://www.LegacyEducators.org and click on “Cancer Information”

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SEPTEMBER is National Blood Cancer Awareness Month

Whenever cancer is discussed, automatically, solid tumors are thought of – lung cancer, prostate cancer, breast cancer, liver cancer, etc., “How can you get cancer of the blood? Is that even possible?” That’s the question I am most commonly asked. The answer is yes!

Blood cancers affect the production and function of your blood cells. Most of these cancers start in your bone marrow where blood is produced. Stem cells in your bone marrow mature and develop into three types of blood cells:

  • Red blood cells
  • White blood cells, or
  • Platelets

bloodIn most blood cancers, the normal blood cell development process is hampered by uncontrolled growth of an abnormal type of blood cell, any of the cells in the diagram above. These abnormal blood cells, or cancerous cells, prevent your blood from performing many of its functions, like fighting off infections or preventing serious bleeding.

How common are these types of cancers? According to the Leukemia & Lymphoma Society an estimated 1,185,053 people are living with, or are in remission from, leukemia, lymphoma, myeloma, or another form of blood cancer, with an estimated 156,420 new cases expected to be diagnosed in 2015.

Leukemia, lymphoma, myeloma, and other blood cancers will kill an estimated 55,350 people in the United States this year alone. The most common types are:

  • Hodgkin’s Lymphoma
  • Leukemia
    • AML – Acute Myeloid Leukemia
    • CML – Chronic Myeloid Leukemia
    • Childhood ALL – Acute Lymphocytic Leukemia
    • Adult ALL – Acute Lymphocytic Leukemia
    • CLL – Chronic Lymphocytic Leukemia
  • Multiple Myeloma
  • Myeloproliferative Neoplasms
  • Non-Hodgkin’s Lymphoma

Please see videos below for more information.

Basics of Blood Cancer

Signs, Symptoms & Treatment of Blood Cancers

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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 … http://www.LegacyEducators.org and click on “Cancer Information”

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Last week we began on the topic of cancer recurrence. Usually, this is covered during workshops or one-on-one counseling sessions. This is an extensive and important topic for survivors.

It is difficult to address the fear of cancer recurrHopeence and give a definitive prescription on how to treat it. Every patient is different, and therefore, their needs in handling the tough topic of a cancer recurring will also be different. In order to individualize a patient’s care, the patient MUST be involved and willing to become their own advocate, though a love one may also be just as helpful.

  1. The Fear of the cancer coming back once treatment is complete, is absolutely normal.
  2. The Fear of cancer recurrence is usually link to one’s outlook on “Death and Dying”, so it is very important to openly discuss your thoughts about this topic (even if it is with yourself…first, to thine own self be true)
  3. Do not compare your treatment process with someone else’s or try to identify with someone else with a similar cancer (someone will always be doing better or and someone will always be worse)
  4. Be honest with yourself. Say out loud what your needs are…and then get it! Need a hug, need to laugh, need to cry, etc., These are normal range of emotions and needs. Don’t be afraid to fulfill them.
  5. Be ready and willing to let go of the fear. This will allow for healing and make the concerns and associated symptoms less traumatic each year. This too, takes time…
  6. Do not be afraid to seek help. Counseling and guidance from a professional, will ease the (perceived) burden of sharing with friends and family continually. It will also allow for venting, and provide personalized strategies on how best to handle anxiety, depression, etc., without repercussions.  Most cancer centers have such services available…please do ask!
  7. Know that your family and friends DO love and care for you. If they become tired, it is not just you. The care and concern for your well being also weighs heavily on them – in addition to work and other life stressors. Not communicating with them or not sharing, will not make their concern go away…it’s all a part of loving and caring for someone else.

hope-life-people-quotes-Favim.com-426177_largeThe Process: The process is rather extensive for this blog. However, I invite you to please take a moment to read and share this link from the American Cancer Society by clicking HEREThey did a great job of tackling different aspect of the fear of cancer recurrence.

Peace and Blessings!

 

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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 … http://www.LegacyEducators.org and click on “Cancer Information”

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A diagnosis of Cancer is a life changing event.

Once treatment is complete, the Fear of the Cancer Coming back (recurring)… is VERY common among cancer survivors…know that you are not alone.

recurrence1Many will attest that cancer diagnosis and treatment is (was) the most difficult thing to deal with.  HOWEVER, once the treatment is completed – surgery, months of chemotherapy, and weeks of radiation therapy, or a combination thereof – it is rather uncommon for a physician to use the other “C” word … Cure, because, the other “C” word would mean the cancer will never come back.

You see…no one can make such a guarantee. Oncologists (cancer doctors) truly does not know and cannot risk giving such a guarantee. Statistics can be given, but that too can be dangerous, as it truly depends on the patient’s personality. If the patients is an optimist (glass half full) then they will always think of being on the positive side of the equation, but if a pessimist (class half empty) then may be more self defeating.

Many patients live in ultimate dread of that post-treatment cancer evaluation/check-up. The mammogram for breast cancer, PSA’s for prostate cancer, colonoscopy for colon cancer, CT scans for lung cancer, the endoscope for head and neck cancer, the pelvic exam for gynecologic cancer, and so on, and so forth can be crippling. Patients often share that their thoughts include questions such as:

  • What if the cancer comes back?
  • What if I must go through those dreadful treatments again?
  • What if it becomes painful?
  • What if it comes back in a different area?
  • What if I ultimately die from this cancer?

New LifeSuch thoughts can be quite burdensome and may lead to heart palpitations, panic and anxiety attacks. These symptoms can occur days (and sometimes weeks/months) leading up to the follow-up appointments. Some patients may resort to living life to the fullest (sky diving, international travels, fulfilling bucket lists, etc.,) while others may abandon living (no plans for the future, no long term savings/retirement, depressed, etc..,). Both responses should be addressed.

While we can definitely do a better job at addressing the individual needs of each survivors… we are lacking the resources and staff. The Oncology community is working very hard to make a change. In the meantime, patients and their family can use an advocacy approach…how can they address their personal fear of cancer recurrence? What can they do to decrease some of the symptoms they are experiencing?

Stay tuned…next week we will review a few strategies to address some of the more common symptoms brought about by the Fear of Cancer Recurrence…

Consider the video below…more next week!

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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 … http://www.LegacyEducators.org and click on “Cancer Information”

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Earlier this year, we looked at “Why Your Thyroid Gland Matters” take a quick review HERE. For some, this may be a reason why there are issues with weight gain, fatigue, etc.,  As an Oncologist and being the cancer world, topics such as “over-diagnosis” always renders a reaction from me. If a life is being saved in the long run, can we truly quantify “over-diagnosis” in cancer?

thyroiddA new study published in the journal Academic Radiology lists reasons why thyroid cancer over-diagnosis.  Although there were an estimated 62,000 new cases of thyroid cancer in 2014, the number of fatalities was estimated at fewer than 1,900. Incidence rates have risen by 185% in 35 years, and surging rates and a mismatch between incidence and mortality signal a problem with over-diagnosis.

3 Key reasons considered for overdiagnoses of Thyroid cancer are:

  1. the imaging of incidental thyroid nodules. Such nodules are present on 16 to 25 percent of computed tomography (CT) scans, which is lower than other modalities. The malignancy rate of incidental nodules on CT and ultrasound is less than 12 percent.
  2. A second underlying reason is thyroid nodules are easy to biopsy. This suggests the biopsy threshold (reason to do a biopsy) is low and that decisions may not always comply with recommendations. The number of fine-needle aspiration biopsies for thyroid nodules doubled from 2006 to 2011, which was linked to a 31 percent gain in the number of surgeries for thyroid nodules.
  3. The third reason is routine processing of surgical specimens for other thyroid diseases such as goiter and thyrotoxicosis find incidental cancers in anywhere from 6 to 18 percent of patients.

Would you want to know if you have thyroid cancer or thyroid disease?

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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!

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

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Lung Cancer is the leading cause of cancer death among Americans and claimed ~160,000 precious lives in 2014. The Center for Medicare and Medicaid Services (CMS) has now mandated coverage for lung cancer screening and we are on the way to saving many lives! However, many “high risk” patients are not aware if their “risk” status and availability for lung cancer screening is available.

Should you have Lung Cancer Screening? You may be a candidate for lung cancer screening if you answer “YES” to ALL of the following:

  • Are you 55 to 74 years old?
  • Are you in fairly good health (no symptoms of disease)?
  • Do you have a long or heavy smoking history? (use this link HERE calculate packs per year smoking history- http://smokingpackyears.com/calculate)
  • Are you still smoking or have quit smoking within the last 15 years?

lung_anatomy_rizwan_nuraniThe National Lung Screening Trial (NLST) was a large clinical trial that looked at using a type of CT scan known as low-dose CT to screen for lung cancer. The cost for a low-dose CT scan as a screening test for lung cancer is generally about $300 for each test, but prices vary widely at different centers.

Medicare recently decided to cover the cost of lung cancer screening, but if you are privately insured ask if your insurer covers lung cancer screening – they just might!

If all of the criteria for lung cancer screening listed above was answered “YES”, then you and your doctor (or other health care provider) should talk about starting screening. I would encourage you to also discuss screening, even if only some of the criteria listed are met, especially if you are concerned. Discussion should include what you can expect from screening, possible benefits and harms, as well as the limitations of screening.

The main benefit is a lower chance of dying of lung cancer, which accounts for many deaths in current and former smokers.

CAN LUNG CANCER BE PREVENTED?

  • Not all lung cancers can be prevented, but there are some ways you can reduce your risk of getting lung cancer
  • The best way to reduce your risk of lung cancer is not to smoke and to avoid breathing in other people’s smoke
  • If you stop smoking before a cancer develops, your damaged lung tissue gradually starts to repair itself
  • No matter what your age or how long you’ve smoked, quitting may lower your risk of lung cancer and help you live longer
  • People who stop smoking before age 50 cut their risk of dying in the next 15 years in half compared with those who continue to smoke

After watching the videos below, you will know more about lung cancer and lung cancer screening than most. Take the time to become an advocate for yourself, family and your community!

Great Video: Learning About the Lungs and Lung Cancer

Is Lung Cancer Screening Right For 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…

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