Cervical Cancer Awareness Month-January

January is the Cervical Cancer Awareness Month. Half the month has gone by and I have not heard much about this from hospitals, doctors or media. Probably my observational bias!
Without the support of the doctors, patients, media, pharmaceutical companies, awareness campaigns are a failure. The fact that Cervical cancer does not get the same kind of attention as breast cancer is because there is not much money in Cervical cancer. We all are aware of pink ribbon, October as Breast Cancer Awareness month and lot of celebrities endorse the campaign in October and throughout the year. Let me stop ranting and devote few lines towards Cervical cancer. You can also visit this http://www.nccc-online.org/index.php/january.
Cervical cancer is preventable. Without dwelling on risk factors and other things it is recommended that every female gets PAP smear  screening test done. If you are above 30 years of age please get a PAP smear done. This has the potential to save your life. Consult your doctor/hospital today.
If you are post menopausal lady get your annual checkup done. Post menopausal bleeding is an ominous sign and should lead to gynecological consultation.

Cervical cancer is preventable, prevent it!

Cervical cancer is curable if diagnosed early!

Are you at high risk for Breast Cancer?

Defining people at risk for cancer will become more refined and defined in days to come. To know the risk for breast cancer there are multiple tools. Once we know we are at high risk, what to do? Those who are at high risk for breast cancer are now officially being recommended tamoxifen. Most newspapers have covered this news of NICE's recommendation-Guardian, BBC, Telegraph.  As our attention span is getting shorter and shorter, let me highlight the safety and precaution. Nice is recommending that pre-menopausal women at high risk should be offered tamoxifen unless they have a history of thromboembolic disease or endometrial cancer,

So if you have thromboembolic disease or endometrial cancer, or history of same, or at risk for these, please ask question to your doctor before you take tamoxifen.

Markets, Prosperity Determine Research-Cervical carcinoma

Pharmaceutical companies focus their research on the most lucrative markets. This is nothing wrong but leaves a huge disparity in the kind of diseases suffered by the rich and the poor. I am tempted to say that some agencies or government should focus on health issues suffered by poor. I am referring to a recent report which mentions that the number of molecules in pipeline for cervical cancer is the least. Lung, leukemia and lymphoma are the top three. Cervical carcinoma is the second common cancer in females but the burden is in Asia and Africa. They are not lucrative markets!It can be argued that GSK and MSD have come up with HPV vaccine which should take care of cervical carcinoma in coming years. But the fine print is that the vaccine is effective against few variants of HPV, especially HPV 16, 18, 31 and 45. They are the risky ones but there is a possibility that other HPV strains can become more virulent when they do not have competition from the regular aggressive ones.
Let me change the direction of thought towards what can be done to decrease the diseases of the poor. The rich benefited  better health  because of various reasons. Cervical carcinoma, tuberculosis, malaria, dysentery etc decreased in the affluent much before effective treatment for the same emerged. Bill and Melinda Gates foundation is doing a great job by focusing on these diseases but at times I have my doubt. Improvements in sanitation, hygiene, living standards, housing, diet have helped the affordable to conquer these diseases. The rise in household income also brings in better female literacy, optimum marriage age!, lower fertility rate, better nutrition. I guess i have stressed my point. Better socio-economic conditions will help the cause of health.

So growth is what is urgently required in Asia and Africa. But how should one deal with the issue. They tend to go hand in hand. How does one allocate resources? What percentage should go towards building infrastructure, improving income of the people versus investing in the research of the diseases suffered by them. Much of this also related to governance and political will/systems, but that will be digressing too far!!

Chemotherapy-Patients' Expectations

We have made lot of progress in the last 40 years in treatment of cancer. The survival has improved for most stages in most cancers. We still have a long way to go as nothing short of cure from cancer is what we all are aiming at. It will be even better to nip it in the bed and do not allow cancer to happen in the first place.

Let us get back to present. Each person dreads the word cancer. When one is diagnosed of it, all one wants/hopes is that he gets cured of it. We go to great lengths to get this cure. Hope is good and it is documented that hopeful people respond better to treatment and live longer.
But at the same time is it justifiable to promise cure in metastatic cases?  Many metastatic patients receiving chemotherapy may take it under the false belief that it may be curative, when all that may be giving is few weeks to few months to live and in anecdotal cases few years!
An article published in NEJM, New England Journal of Medicine talks about the same. They report that 69% of patients with lung cancer and 81% of those with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer.

Bubbles in Education, Healthcare & Research?

Few years back we witnessed the housing bubble coming to an end. Its effects are still being felt. The internet bubble in 2000-2001 led to the creation of infrastructure.Japanese are still to recover from the bubble which ended in 1989.  There have been numerous bubbles and busts in history documented. Also considered as business cycle this is considered by some as inevitable and also beneficial. The governments try their best to avoid this as it brings the survival of the fittest to a very crude form! We are yet to learn the art of growing without creating bubbles. Trade, economics and financial market have made their contribution and we need to be thankful to them. In the new era we will have to learn the art of creating mini bubbles from which survival is easier and the pain is short lived.
The latest making the rounds is education bubble and healthcare bubble  in US. It will be interesting to see if there is a bubble, and when it will burst. Can we anticipate the consequences of this bubble burst?
There are lot of countries in the world which would aspire to have a bubble in their education and healthcare sector!
Similarly can scientific research suffer from bubbles? The link is to an article which predicted something like that in 2010 http://chronicle.com/article/Will-the-Biomedical-Research/124981/ Bubbles predicted too early have limited impact on the behavior of people. 
It is happening with respect to NIH funds. What will be the impact and when the impact will happen are questions which require more analysis and some speculative work. Does the nature of certain research demand that they have bubbles. Without the failures we would not have had our successes? How do i calculate the return on investment of Human Genome Project? What time frame should one be looking at?
Researchers do have fiscal responsibility. But how does one define it?

Similar thoughts can be expressed about healthcare. Solutions can be varied but difficult to implement as they require behavioral changes. Most behavioral changes happen because of pain or right incentives provided at the inflection point. What incentives can be provided to hospitals, doctors, pharmaceutical industry and patients to contain the so called emerging bubble?

The bubble in education will create bonded laborers new era. There are efforts to prevent this.

Why is it so difficult to learn from bubbles in other sectors? Why is it difficult to contain bubbles after having recognized their formation?
Does nature operate through bubbles?

"Unbridled growth in any sector acts as cancer to the ecosystem called life" Pruning either by nature or by humans, if they can, reduce malignant insults.

Head and Neck Cancer and HPV

As mentioned in the previous post there are multiple viruses responsible for malignancy. In recent years the role of HPV virus in head and neck cancer has become more clear. Patients having HPV positive cancer tend to be 10 years younger, non-smokers, non-alcoholics. They present in stage 3 or stage 4 but have better prognosis compared to non-HPV positive head and neck cancer. Treatments are getting better defined for this subgroup of patients.Trials will determine dose and other details of chemotherapy and radiotherapy for this patients.
It does appear that having HPV positive cancer has better prognosis but the real challenge will be in its prevention. Vaccines are being touted to do this but the pros and cons will have to be weighed.

Why did I get cancer when I do not smoke or drink?

Most of my male patients have used tobacco and/or alcohol and it has been blamed for their cancer. But, there are few patients both male and female who did not use the above carcinogens and have had cancer at an early age. They always have this question why did they get it when their friends with all the habits have been spared so far!
Cancer is a complex disease. It results from various factors at interplay. Ageing is the biggest risk factor!

VIRUSES, my dear friends are responsible for many cancers. Different viruses have been implicated in different cancers. HPV virus in carcinoma cervix and head and neck cancers, EBV virus in nasopharyngeal carcinoma, Hepatitis B and C virus in Hepatocellular carcinoma, HSV and HIV in Kaposi's sarcoma. We have vaccine for HPV virus which today is recommended for preventing carcinoma cervix. Who should take it, when they should take it, how many doses are better answered in the following link, Who and When?

Will discuss HPV positive head and neck cancer in the next post.

Tamoxifen 5 years or 10 years?

There is a recent trial result published in Lancet

Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61963-1/fulltext?_eventId=login

If you were a patient diagnosed of early breast cancer and had oestrogen positivity, in all likelihood you were/are taking tamoxifen(some of you may be on letrozole or anastrozole!). Your doctor would have suggested that you need to take this for 5 years. With the results of the above mentioned trial, now you will be recommended to take it for 10 years. Because the results suggest that 10 years of tamoxifen treatment can approximately halve breast cancer mortality during the second decade after diagnosis.

Consistency!

Lot has happened from the time I last wrote here. Significant advancements have happened in few cancers and others promise to catch up. I have had the good fortune of treating patients who have had good, moderate and bad outcomes. They have taught me a lot and i know my learning will never end. It has been a very emotional journey also. Malignancy makes one ponder more about life and death. It can make one philosophical or practical!
The bad part is my inconsistent writing. I am writing as if i have a great audience! Honestly a part of me desires for an audience. For feedback, but first for that i need to consistently post what i assimilate. But most of the writing and compilation is for self! As i read the previous posts i realized their relevance in terms of time and my own understanding.
My proposed way to catch up with myself is to write on each therapy area periodically. All views expressed here are personal and do not constitute medical advice.

How spicy foods can kill cancers

Scientists have discovered the key to the ability of spicy foods to kill cancer cells.

They found capsaicin, an ingredient of jalapeno peppers, triggers cancer cell death by attacking mitochondria - the cells' energy-generating boiler rooms.

The research raises the possibility that other cancer drugs could be developed to target mitochondria.

The Nottingham University study features in Biochemical and Biophysical Research Communications.

http://news.bbc.co.uk/1/hi/health/6244715.stm

Stem Cell Therapy Effective In Targeting Metastatic Cancer

Patients with advanced cancer that has spread to many
different sites often do not have many treatment options, since they would be unable to tolerate the doses of treatment they would need to kill the tumors.

Researchers at City of Hope and St. Jude Children’s Research Hospital may have found a way to treat cancers that have spread throughout the body more effectively. They used modified neural stem cells to activate and
concentrate chemotherapeutic drugs predominately at tumor sites, so that normal tissue surrounding the tumor and throughout the body remain relatively unharmed.

“This approach could significantly improve future treatment options for patients with metastatic cancer,” said Karen Aboody, M.D., assistant professor of Hematology/Hematopoietic Cell Transplantation and Neurosciences at City of Hope. “It not only has the potential to destroy residual tumor cells, but it should also improve patients’ quality of
life by minimizing toxic side effects such as nausea, diarrhea or bone marrow suppression.”

Patients with advanced cancer that has spread to many
different sites often do not have many treatment options, since they would be unable to tolerate the doses of treatment they would need to kill the tumors.

Researchers at City of Hope and St. Jude Children’s Research Hospital may have found a way to treat cancers that have spread throughout the body more effectively. They used modified neural stem cells to activate and
concentrate chemotherapeutic drugs predominately at tumor sites, so that normal tissue surrounding the tumor and throughout the body remain relatively unharmed.

“This approach could significantly improve future treatment options for patients with metastatic cancer,” said Karen Aboody, M.D., assistant professor of Hematology/Hematopoietic Cell Transplantation and Neurosciences at City of Hope. “It not only has the potential to destroy residual tumor cells, but it should also improve patients’ quality of
life by minimizing toxic side effects such as nausea, diarrhea or bone marrow suppression.”

For more ...
http://www.rxpgnews.com/cancer-research/Stem-Cell-Therapy-Effective-In-Targeting-Metastatic-Cancer_9759.shtml

Bonding with bacteria Ananda M Chakrabarty

From Business Standard Gargi Gupta / New Delhi December 14, 2006

RESEARCH: Ananda M Chakrabarty is in India, scouting for a pharma company that will help him develop a bacteria-based cancer drug.

Few Indians have heard of Ananda M Chakrabarty, but in biotechnology circles the distinguished professor of immunology and microbiology at the University of Illinois at Chicago is something of a hero.

His invention — a transgenic bacteria which breaks down crude oil into simpler substances easily consumed by marine animals — is, by itself, significant.

But Chakrabarty will go down in history as the first man to get a patent for a living micro-organism. It was in 1979, when he was working for General Electric in the United States, that Chakrabarty developed the oil-eating bacteria.

He applied for a patent, proposing to use his invention in mopping up oil spills. The application was turned down by the Patent Office Board of Appeals, but the battle went up to the US Supreme Court, which favoured Chakrabarty, saying that “A live, human-made micro-organism is patentable subject matter”.

That was 25 years ago and Chakrabarty has since moved on. His present interest is in using bacterial proteins to combat killer diseases like malaria, HIV and cancer using what he calls bacteria’s “evolutionary knowledge”.

“Unlike modern pharmaceutical industry which is content with arresting cancer along one pathway, bacteria consider cancer cells as intruders and work to stop them in their tracks,” explains Chakrabarty with the lucidity of a teacher.

He has even developed a potential drug for melanoma and breast cancer that has shown 60-80 per cent results in mice. “I don’t know if it’ll work in dogs and cats, much less monkeys before the FDA will allow me to use it on humans.”

In India to deliver a series of lectures, Chakrabarty will also make time to meet captains of the Indian drug industry to tell them, “Let’s do some of that here”. His proposal — “You put in the resources to set up a lab to develop a new generation of drugs. Let’s do clinical trials and design products for the global market”.

Chakrabarty is optimistic that the corporate houses will be more forthcoming than the academics and researchers, whom he’d talked to last year for collaborative research to check whether his promising drug could be used against cervical cancer, one of the most common cancers in India.

He even had a tentative funding commitment from the department of biotechnology for a small business innovative research company, formed for the project. But nothing came of it.

“Indians want to just publish papers on how cancers grow, how they proceed... they want to be known in the United States and Japan. But no one talks about trying to develop a drug against cervical cancer... Merck comes up with a vaccine but nobody in India does it.”

What Chakrabarty would ideally like is for India to have something like the Bayh-Dole Act in the US, which allows universities and small businesses to hold intellectual property rights over inventions resulting from government-funded research.

“I want to introduce the concept of academic start-ups which has contributed so much to the economic might of the US,” he says.

Like Genentech, Kyron and Biogen, all started by university professors, Chakrabarty too is a beneficiary of Bayh-Dole. It is his company, CDG Therapeutics, in which the University of Illinois has some equity, that is conducting the research into this potentially revolutionary drug and which will tie up with any Indian pharma company which is willing to check it out. Now if only Indian researchers saw the point.

Courtesy Business Standard.

Lamps 'used for cancer surgery'

Cancer sufferers in the developing world could soon have Western standards of surgery at a fraction of the cost, scientists in Israel have said.
A technique using an off-the-shelf lamp and fibre optics is being developed as an alternative to expensive laser surgery, New Scientist reports.

Researchers at Ben Gurion University in Beersheva say the method could be used for operating on malignant tumours.

A UK expert said the technique could have some uses in the developing world.

http://news.bbc.co.uk/1/hi/health/6162899.stm
Source: BBC News | Health | World Edition
© Copyright: (C) British Broadcasting Corporation, see http://news.bbc.co.uk/2/hi/help/rss/4498287.stm for terms and conditions of reuse

Abstract:
We report the first realization of interstitial surgery by ultrabright lamp light, on the kidneys and livers of live animals. A high-flux optic concentrates lamp emissions into an optical fiber for power delivery inside the body. The trials reveal surgical efficacy comparable to corresponding laser fiber optic treatments, as well as pronounced delayed tissue death.

Answers for few questions asked on yahoo answers

What is a Stem Cell Vaccine, its used to kill lung cancer?

Answer Stem Cell Vaccine is a type of vaccine where it is given as a prophylaxis. That is u vaccinate to prevent the disease. So it is incorrect to say that it kills lung cancer.
The experiment has been carried on mouse and it is long way away from being used in human beings.


Is there a treatment for Adenocarcinoma of G.E. junction (stoamch cancer). The cyst is of size 12/8/7 cm.?

Patient's age: M

Answer -

There is a treatment for adenocarcinoma of stomach.
First a list of investigations need to be done to determine the stage of the patient. Once it is staged , UR oncologist will be able to tell whether it immediately operable or not.
The treatment will include depending on the stage Surgery, Radiotherapy and Chemotherapy.
It will be advisable to get a PET-CT done or atleast a CT scan.
If it can be operated upon then, after the operation , depending on the histopathological report, post op radiotherapy and chemotherapy will be adviced.
Please consult an Oncologist.

Cancer Link: Gene regulates progesterone effect on breast cells

Since its discovery in 1994, the BRCA1 gene has given up its secrets grudgingly. Early on, scientists recognized that it kept cancer at bay. Women carrying a mutation in the gene face an extremely high risk of breast and ovarian cancer. Researchers have struggled to understand how the protein encoded by a normal BRCA1 gene works.

A study in mice now suggests one possibility: The BRCA1 protein moderates the hormone progesterone's effect in breast cells. The protein appears to calm those cells when progesterone urges them to divide and grow.

To read more....http://www.sciencenews.org/articles/20061202/fob1.asp

Quit Smoking

Quit Smoking

Poverty and Dilemma

Any person suffering from cancer has tremendous disadvantages. The financially well endowed atleast have resources to search and seek some answers. At times cancer makes a person poor, especially in India.
Yesterday I came across a 60 year old prostate cancer patient. He had underwent Prostatectomy in 2002 and Orchidectomy in 2005 and was put on Bicalutamide. From the time of initial diagnosis the tumor had invaded the bladder. Last month he underwent P-32 treatment for bone metastases with no pain relief. He was reffered to me by an urologist for possible consideration for hemostatic radiation. When I reportedly saw him he had bled for more than 12 hours, his Hb was less than 4 gm%, his platelet count was less than 80,000 and had deranged PT, BT.
I explained the grave prognosis and offered them hemostatic radiation as only a palliative measure. The need for blood transfusion was also explained. Initially the relatives agreed to do whatever possible but with in restricted financial considerations. I offered not to take any charges for radiation but they said they cannot afford the cost of blood transfusion and they decided to go without taking any treatment. I am still to recover from the whole episode. I have no judgements but as a Doctor it is difficult to reconcile with the fact that "nothing was done for the patient".

In Transit

My hibernation got extended on account of me shifting base from Mumbai to a peripheral cancer hospital at Belgaum.
I am amazed by the number of rural patients and the dearth of adequate facilities to treat them. We are developing a multidisciplinary team to offer our services in North Karnataka.

IN hIBERNATION

till jule end