Feeds:
Posts
Comments

Archive for the ‘Medical Oncology’ Category

From the Physician’s Desk … Weekly Blog!

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

——————————-

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

——————————————–

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”

—————————–

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
 ——————————————–

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”

——————————

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!

——————————————–

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”

——————————

JUNE IS MEN’S HEALTH MONTH!

(Please see video below and share with family and friends!)

While there are many types of cancers, Prostate Cancer, is one of the few that has a somewhat “predictable” blood indicator: the Prostate Specific Antigen (PSA). Please Note: only men have PROSTATE  – women do not have a prostate gland!

prostate normalSo what’s the fuss? Men – your brother, husband, uncle, boyfriend, grandpa, cousins, friends – are dying needlessly from this disease. Prostate cancer is the second leading of cause of death in men in the United States.

There are debates among medical professionals that we may be “over-treating” prostate cancer, leading to some clinics no longer testing for PSA.  However, that concern may be a bit premature, as over 27,000 men die annually from prostate cancer…still. African Americans/Black male are at greater risk and many are not being tested and many others do not know their number, or what it (PSA) means.

KNOW YOUR NUMBER!

KNOW YOUR PSA!

psa-adjusting

If you are an African American/Black male over 40 or other race over 50, someone in your family had prostate cancer, etc., you should know your number. Ask your doctor about it!

The prostate gland gets larger with age…so the PSA will increase. However, you should be referred to Urology if:

  • prostate abnormal1The PSA number is above age range specified above
  • The Digital Rectal Exam (DRE) is abnormal (lump felt, see pic above) – this occurs in ~20% of cases
  • The PSA number doubles or increase drastically from base line (therefore MUST know baseline)
  • Incidental abnormality on scan taken for other reasons

Now that you know more, speak with your physician to know what’s best for you. Tell your family and friends to do the sam – spread the word!)

Please watch this video and share!

——————————————–

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”

——————————

It use to be that a cancer diagnosis lead to high mortality (death) rates and survivorship came at an extreme cost of post-surgical disfiguring features, neuropathy and other late effects from chemotherapy and radiation therapy as well.  With improved technology and clinical applications of (bench) research, many patients are surviving and doing much better than generation past. As survival continues to improve, quality of life, including fertility preservation has become increasing important to patients and their families.

fertility-preservation

Sperm Banking

I recently received my seasonal St. Jude magazine with the featured topic of preserving fertility. It was great to know that fertility preservation options are now being offered to children undergoing cancer treatments or those who are survivors.  Per their report, “…[it is] estimated that half of adolescent and young adult male cancer patients are at increased risk for infertility, with about 10% of female childhood cancer survivors having acute ovarian failure and an additional 15% entering menopause prematurely.”

fertility

Egg Harvesting

It was noted in their report, that St. Jude Children’s Research Hospital is currently the only hospital in the U.S. to cover the expense associated with harvesting and storing sperm and eggs until patients reach age 35. That policy eliminates one of the greatest barriers to fertility preservation for many childhood cancer patients:cost. This is GREAT news!

I remain and avid supporter of St. Judes Research Hospital!  Hope to be a visiting professor/clinician there one day. If you are looking for a charity to support, please consider St.Judes!

stjude1

 

 

Fertility Preservation for Young Women with Cancer

Fertility Preservation Options

——————————————–

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”

——————————

Survivor – An individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life. Family members, friends, and caregivers are also impacted.

repairman with the tool on a white background. 3D image

Once cancer treatment is completed, patients transition from regular (daily, weekly, etc.,) healthcare provider’s attention, to follow-up regimen that is once every 3-4 months, twice/year or annually.  This may seem like an “unknown abyss” and some patient may even suffer a form of separation anxiety. What to do?

Patients are encouraged to become their own advocate. That includes, knowing follow-up guideline recommendations for your specific cancer. One size does not fit all! Ask your doctor to give you an idea of the follow-up plan for the next 2-5yrs…yes, you can ask for that. Many organization, including The National Comprehensive Cancer Network (NCCN) provides an update and recommendations annually regarding follow-up.

advocacyWhat does SELF-ADVOCACY mean for a cancer survivor? Well, for starters, here is a list of things you should discuss with your doctor at the end of treatment and during follow-up appointments (not all listed below will apply, but should be tailored to be cancer site specific).

  1. Late Effects/Long-Term Psychosocial and Physical Problems – what should I expect? What symptoms should be reported?
  2. Anthracycline-Induced Cardiac Toxicity – Not all chemotherapy affects the heart, but will the chemotherapy used for me affect me heart 20-30yrs down the road? What can be done to lower the risk?
  3. Anxiety and Depression – What symptoms should be looked for and what signs should be reported?
  4. Cognitive Function – What changes should I expect? Is “chemo-brain” real?
  5. Fatigue – Is it associated with treatment? How long will it last?
  6. Talk with your Oncologist and ask questions!

    Pain – What pain level should be tolerable? Can over-the-counter pain meds suffice? Which ones can be taken?

  7. Sexual Function (female/male) – If viagra does not work, are there other options for ED? What can be used to increase sexual desire in a woman?
  8. Sleep Disorders – how do  know if my sleeping problems are associated with past cancer treatment? Will the treatment be any different?
  9. Preventive Health
  10. Healthy Lifestyles
  11. Physical Activity – What is considered low, moderate and intense activity? Any examples? Are there limitations?
  12. Nutrition and Weight Management
  13. Supplement Use – Any specific type to avoid?
  14. Immunizations and Infections – Any immunization that should be avoided?

Self-advocacy is a lot of work! BUT, it is your life..take charge of it!

 

——————————————–

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”

———————————

Seeking a second opinion is often exercised in many areas of life. It is often quoted that:

  • 70% of people consider a 2nd opinion for home improvement
  • 55% of people would consider a 2nd opinion on vehicle repairs.
  • What about Cancer diagnosis? How many get another opinion?

second-opinion-cartoonWhen it comes to cancer diagnosis and other serious chronic diseases, a second opinion is not only ok, it is recommended!

Your treating physicians should not mind, and in most cases, a good physician may even recommend that a second opinion be obtained. This recommendation is NOT a bad thing! As physicians, we are often very comfortable with our recommendations, but understand that there may be other ways of accomplishing what is best for you, the patient.

***Cancer is often a scary and frightening diagnosis! It is my recommendation to NEVER go to an appointment alone, if at all possible.***

PREPARING FOR A 2nd OPINION

Don’t wait too long after diagnosis – time is of the essence! Once you have completed your 1st set of appointments (or even during the process):

  • Tell your physicians that you would like to have a 2nd a opinion. They may recommend another hospital or physician and may assist with arranging an expedient 2nd opinion appointment. Alternatively, you may do this on your own, by seeking recommendations elsewhere/trusted sources
  • Sign release forms and/or gather all of your relevant medical records—including biopsy/pathogloy/test results, blood work, or any imaging test (CT scans, MRI, US, Mammograms, etc.,). This will prevent the need to repeat these exams – save time and money!
  • Create a list/time line of all the symptoms that lead to your diagnosis, if any was experienced
  • Write down and bring a list of all the medications you are currently taking (prescription and over the counter)
  • Write down and bring a list of all your questions. If you do not know what to ask, consider the things discussed at your first oncology appointment…AND please bring someone with you!

WHAT TO EXPECT

  •  The hospital/clinic may repeat their review of the pathology report to confirm the diagnosis
  • They will provide additional details about the type of cancer and its overall stage (a description of where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body)
  • Perspective from experts in different oncology disciplines, such as medical oncology, radiation oncology, and surgical oncology
  • Discussion treatment options (sometimes doctors may disagree with the original diagnosis or the previous proposed treatment plan – different chemotherapy, different radiation therapy approach, no chemotherapy or radiation, different type of surgery, etc.,)
  • The availability of clinical trials that you may want to consider
  • The favorite question most of my patient like to ask me – “What would you recommend if I was your…___(fill in the blank/relative)” … It never hurt to ask the same!

This is by no means an exhaustive list of recommendations in preparing for a 2nd opinion, but it is a start – for a blog *smile*.  Apply these recommendations to any other serious diagnosis. If possible, ask  questions before any surgeries or serious treatment. Oh, by the way, your research on the internet does not count as a second opinion!

Again, take someone with you on your appointments!

God’s speed!

——————————————–

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 »

Older Posts »