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Archive for the ‘Radiation’ 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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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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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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If you have never had a Computed Tomography, which is also called CAT or CT Scan, it will only be a matter of time before your physician recommend one. CT scan is painless and is considered a more advance/sophisticate X-ray machine. However, unlike an X-ray that shows only “2-dimension” images, CT Scan uses “3-dimensions” and allows us to see inside your body (see below).

One of the many fear, is that too many CT scans can cause cancer. However, as noted in this recently published article, the benefits of CT scans far outweigh the risks of the reasons why the CT Scan was ordered in the first place.

Excerpt from Medical News:

Like a donut - open at top

Like a donut – open at top

“In recent years, there has been widespread media coverage of studies purporting to show that radiation from X-rays, CT scans and other medical imaging causes cancer.

But such studies have serious flaws, including their reliance on an unproven statistical model, according to a recent article in the journal Technology in Cancer Research & Treatment. Corresponding author is Loyola University Medical Center radiation oncologist James Welsh, MS, MD.

“Although radiation is known to cause cancer at high doses and high-dose rates, no data have ever unequivocally demonstrated the induction of cancer following exposure to low doses and dose rates,” Dr. Welsh and co-author Jeffry Siegel, PhD, write.

CT showing tumor in a child

CT showing tumor in a child

Studies purporting to find a cancer link to medical imaging radiation have other flaws besides the questionable LNT model. For example, two recent studies suggested possible increased cancer risks from low-radiation doses associated with pediatric CT scans. But these cancers likely are due to the medical conditions that prompted the CT scans, and have nothing to do with the radiation exposure, Drs. Welsh and Siegel write.”

Read more HERE or http://www.news-medical.net/news/20150701/Low-radiation-doses-from-CT-scans-do-not-cause-cancer.aspx

No need to fear CT scans! There are so many other proven cancer causing elements you should be aware of – smoking, alcohol, obesity…and much more. Pay attention to and fix what you can!

 

Video: What is a CT Scan?

Video: Patient’s experience

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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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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!

 

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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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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!

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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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