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Archive for the ‘Metastasis’ 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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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 … www.LegacyEducators.org and click on “Cancer Information”

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Recently, while driving home, I was tuned into WTOP (Weather & Traffic station) and they were featuring a section on Cindy Finch with topic as noted above. She described how a patient may feel lost and alone after a period of regimented medical treatment. They survived cancer and all the medical treatments, now what?

Cancer SurvivorAs physicians, we are usually all about the art of “doing” to help our patients. Most patients appeared to be excited, elated, happy about completing treatment and look forward to moving on with their lives.

It is difficult for most Physicians to attend to required care beyond the immediacy of the medical treatment. So, to meet these needs of the patients, we do have a Behavioral Health team (Psychologist, Psychiatrist and/or Social workers) who attend to the  psychosocial aspect of post-treatment.

SurvivorHowever, in follow-up visit, I often times discussed the “new normal” and what that means after cancer treatment, or in the new survivorship role. Yet, I believe Ms. Finch revelation is a very worthwhile approach and a great sharing point (this may also be applicable to a love one after any drastic medical change/treatment, other than cancer).

What are your thoughts?

See Ms. Finch videos below

Her story…

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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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From the Physician’s Desk … Weekly Blog!

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cancerNext week, just about every town will be painted in pink…yeah! I am so very proud of the years of advocating and hard work done by many to bring awareness, not only to breast cancer, but CANCER in general. Breast cancer awareness and support programs, while not replete, has set the standard for many other less commonly known cancers to emulate. It would do my heart proud to see the country painted in BLUE during the Prostate Cancer awareness in JUNE each year. I believe one day, we will get to a place, where every cancer is equally represented…because every life is equally as important!

Fight cancerSometimes, despite our optimism, hope and prayers, the ugliness of cancer can re-manifest itself as a “recurrence” growing in other places than area of origin – This is called Metastasis. Example: A diagnosis of colon cancer treated with surgery and chemotherapy. Patient remained cancer free for ~7yrs, but then fainted at work and MRI of the brain revealed spots in the brain, likely metastatic colon cancer (the cancer that originated in the colon, traveled via the blood to the brain).

It is important to know that when/if this unfortunate instance of metastasis occurs, that all is not lost and different types of treatments are available. There are many people living “with” metastatic disease and are doing fairly well. Ofcourse, this depends on how aggressive the cancer is, where it migrated (bone, brain, liver, etc.,), and toxicity from some of the palliative treatment. Stay tuned for these upcoming discussions! In the meantime, help others by showing your support in the fight against cancer!

If you are in the DC area, join our church Cancer Ministry on

  • OCT 5, 2014 for the “Making Strides Against Breast Cancer” walk  and for
  • OCT 18,, 2014 Lymphoma & Leukemia Light The Night DC walk
  • Hope to see you there!

The Basics of Metastasis

Prostate Cancer Bone Metastasis

 

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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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