Studies show how fruits and veggies reduce cancer

Just three servings a month of raw broccoli or cabbage can reduce the risk of bladder cancer by as much as 40 percent, researchers reported this week.
Other studies show that dark-colored berries can reduce the risk of cancer too -- adding more evidence to a growing body of research that shows fruits and vegetables, especially richly colored varieties, can reduce the risk of cancer.
Researchers at the Roswell Park Cancer Institute in Buffalo, New York, surveyed 275 people who had bladder cancer and 825 people without cancer. They asked especially about cruciferous vegetables such as broccoli and cabbage.

These foods are rich in compounds called isothiocyanates, which are known to lower cancer risk. The effects were most striking in nonsmokers, the researchers told a meeting being held this week of the American Association of Cancer Research in Philadelphia.
Compared to smokers who ate fewer than three servings of raw cruciferous vegetables, nonsmokers who ate at least three servings a month were almost 73 percent less likely to be in the bladder cancer group, they found.
Among both smokers and nonsmokers, those who ate this minimal amount of raw veggies had a 40 percent lower risk. But the team did not find the same effect for cooked vegetables.
"Cooking can reduce 60 to 90 percent of ITCs, (isothiocyanates)," Dr. Li Tang, who led the study, said in a statement.

A second team of researchers from Roswell Park tested broccoli sprouts in rats.
They used rats engineered to develop bladder cancer and fed some of them a freeze-dried extract of broccoli sprouts. The more they ate, the less likely they were to develop bladder cancer, said Dr. Yuesheng Zhang, who led the research.
They found the compounds were processed and excreted within 12 hours of feeding. That suggests the idea that compounds are protecting the bladder from the inside, said Zhang.
"The bladder is like a storage bag, and cancers in the bladder occur almost entirely along the inner surface, the epithelium, that faces the urine, presumably because this tissue is assaulted all the time by noxious materials in the urine," Zhang said.
In a third study, a team at The Ohio State University fed black raspberries to patients with Barrett's esophagus, a condition that can lead to esophageal cancer.
Black raspberries, sometimes called blackberries or blackcaps, are also rich in cancer-fighting compounds.
Ohio State's Laura Kresty and colleagues fed 1.1 ounces (32 grams) of freeze-dried black raspberries to women with Barrett's esophagus and 1.6 ounces (45 grams) to men every day for six months.
They measured urine levels of levels of two compounds -- 8-isoprostane and GSTpi -- that indicate whether cancer-causing processes are going on in the body.
Kresty said 58 percent of patients had marked declines of 8-isoprostane levels, suggesting less damage, and 37 percent had higher levels of GSTpi, which can help interfere with cancer causing damage and which is usually low in patients with Barrett's.
(Reporting by Maggie Fox, editing by Julie Steenhuysen and Vicki Allen)

The Importance of a Second Opinion Following a Diagnosis of Cancer

A diagnosis of cancer is usually a critical event in a person's life because it carries with it the threat of premature death, pain and disability. Today, however, many cancers can be cured or palliated for extended periods of time if initial treatment involves the appropriate therapy. In order to receive appropriate treatment, patients must understand the type of cancer they have and the treatment options that are available. As the curative potential for cancer treatments has increased over the past several decades, so has the complexity of information needed to make appropriate treatment decisions. Since very few cancers require emergency treatment, it is important for patients, relatives and friends to allow themselves ample time to learn exactly what their diagnosis means.
Two of the most important things a patient can do following a diagnosis of cancer are to become educated about treatment options and to seek a second opinion. Historically, patients often relied upon a single physician recommendation or out-of-date print materials to make their treatment decisions. Now, the Internet has become a unique resource because it provides a vehicle for real-time distribution of information directly to cancer patients and their families. Currently, there are several Internet resources designed to educate patients. CancerConsultants.com, oncolink.com and the National Cancer Institute web site (www.cancer.gov) are all designed to educate patients and provide current, comprehensive, disease-specific information from screening to treatment.
Each individual involved needs to gather information on the nature of the cancer and how it can be treated (surgery, radiation or chemotherapy). This information educates patients and enables them to ask their physicians the right questions about their cancer treatment so that they can understand the options presented by the physician. However, the main source of information about treatment options comes from the physician who will be directing treatment. For a variety of reasons, it is frequently advantageous for patients with cancer to seek more than one opinion about how their cancer can be treated. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. Getting a second opinion allows patients to become more informed about their cancer and their treatment options and also provides reassurance.

What is a Second Opinion?
Getting a second opinion involves obtaining a review of the cancer diagnosis and the treatment recommendations of the physician who is treating the cancer. Either the patient or the primary physician can initiate the process of getting a second opinion. Usually, patients can obtain a second opinion by getting a referral to a second physician or to a multidisciplinary team of experts in a cancer center. This doctor or team of doctors will review the pathology (how the cancer looks under the microscope), the extent of cancer, the physical condition of the patient and the proposed treatment. The doctor(s) then communicate their opinion regarding treatment to both the patient and the primary physician. The only problem with referral by the treating physician is that there may be a tendency to refer to physicians with the same treatment philosophies, thereby ensuring a concurrent opinion.
A second opinion should be independent and may be best performed by a physician or team of physicians who do not have a close relationship with the treating physician. More and more cancer patients are being evaluated in larger centers where multidisciplinary teams involving surgeons, oncologists, radiation therapists and sub-specialist oncologists have a role in determining treatment recommendations. In this multidisciplinary setting, second opinions are more likely to be comprehensive.

Who Should Get a Second Opinion?
Although no one has precisely defined the specific situations that merit a second opinion, there are clearly situations where a second opinion would be helpful and most patients would benefit. Patients who feel that they may not fully understand the consequences of the diagnosis and the treatment options should consider a second opinion. The basic complexity of the diagnosis and treatment options, as well as failure of the physician to communicate with the patient, can interfere with the understanding of the situation. In some instances, a patient may experience denial, which can be overcome if a second physician or team of physicians offers similar advice.
Patients, relatives and friends need to keep in mind that second opinions are a normal part of cancer management and they should not be concerned about hurting the feelings of the primary physician. If a patient decides to obtain an independent second opinion, it is important to communicate with the primary physician not only to obtain needed information for review, but also to keep the treating physician informed. Most physicians welcome the opportunity to have another consultant review and approve their care decisions, or perhaps suggest another treatment that may be better. There are instances when a patient will have a basic disagreement with their physician and will need to change physicians, but this is not the main purpose of a second opinion. Most of the time, patients simply need to make sure they are getting the best advice.

Specific Situations Where A Second Opinion is Useful
Non-Cancer Specialist Treatment Recommendations: In the United States , doctors other than oncologists often diagnose and treat patients with cancer. Cancers are diagnosed and treated by family doctors, internists, pediatricians, gynecologists, urologists, ear-nose-and-throat doctors and other non-cancer specialists. In most instances, appropriate therapy is administered. However, patients not treated by specialists in cancer treatment should consider seeking a second opinion. In some situations, physicians will not refer patients for a second opinion because they may lose control and revenue from treatment, they may be threatened by having their patient believe some other doctor is more knowledgeable or often they are just too busy to bother with consulting other physicians. The patients of these types of physicians are probably the most in need of a second opinion.
Cancer Sub-specialists: Many types of cancers are treated by several different types of cancer specialists. For example, prostate cancer may be appropriately treated by urologists who are surgeons, radiation oncologists and/or medical oncologists who use drug treatment. Each specialist may think that the treatment they advise and are involved with is the best treatment for the patient. This is dramatically shown in recommendations for the primary treatment of localized prostate cancer. For localized prostate cancer, surgeons almost invariably advise surgery (radical prostatectomy) as the primary treatment and radiation oncologists invariably advise radiation therapy (either external beam or brachytherapy). A patient with early prostate cancer may want to consult an oncologist or multidisciplinary team who would not be treating this stage of prostate cancer as well as a surgeon and a radiation oncologist to obtain a thorough understanding of treatment options. Seeking a second opinion from a different type of specialist can be informative but it can also, unavoidably, create confusion about treatment options that will need to be resolved by having all of the available information and making an informed decision.
Apparent Lack of Treatment Options: A second opinion can be useful in some patients who are told that there is no appropriate treatment for their cancer and that there is no hope of survival or palliation. Such patients have nothing to lose by seeking a second opinion. In this situation, patients should seek out physicians and institutions that specialize in treating their type of cancer and perform clinical trials. Often, this is accomplished by finding out who is performing clinical trials of novel treatments for the type of cancer in question. Here again, information available on the Internet can help locate such physicians and institutions.
Clinical Trials: Progress in cancer treatment has come predominantly from participation in clinical trials. There are many types of clinical trials, some of which may benefit a patient with a specific cancer and some of which may not. Doctors who participate in clinical trials, whether from a single center or as part of a multi-center trial, need to put patients on these trials and often have trouble finding patients to participate. Unconsciously, such doctors may suggest a trial that may not represent the best treatment for a patient with cancer. When participation in a clinical trial is recommended by the treating physician, a second opinion should probably be obtained to make sure this is the appropriate treatment. The patient should also be aware of all the clinical trials that are available for his or her cancer before selecting the one the treating physician recommends. Two sources of ongoing information regarding clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute (cancer.gov) and eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients.
Rare cancers: If a patient has a rare cancer, it is usually best to seek a second opinion unless the diagnosis is made at a center that specializes in the treatment of this cancer. If a local expert is available, treatment should probably be switched to that doctor. If the expert is far away, which is likely, the treating physician can usually coordinate treatment by phone or e-mail communication. Even if your cancer isn't all that rare, there may be benefit from finding someone with a special interest in the specific type of cancer being treated. For instance, kidney cancer is not really rare, but it's not common either. Usually patients with kidney cancer are treated on multi-center protocols carried out in large institutions. This is because the newer treatment protocols require specialized treatment and clinical trial accrual has to be pooled from several institutions to be meaningful.
Surgery as Primary Treatment: If there is any doubt about the operability or inoperability of a cancer, a second opinion is in order. In this situation, patients are urged to seek second opinions in institutions where large numbers of patients are treated. For instance, esophageal cancer may be considered inoperable in a hospital that performs one such procedure a month, but may be considered operable in an institution that performs several per day. Just as important can be the determination that a cancer deemed operable is in fact inoperable and surgery would be harmful.
Small and Rural Hospitals: Patients who live in a rural area and get treatment at a small hospital probably should get a second opinion from a larger medical center before treatment is initiated. Although smaller hospitals typically deliver excellent treatment, it is prudent to ensure that the recommended treatment is appropriate and can be safely administered. Small and rural hospitals may not see a large volume of cancer patients, and while they are usually fully capable of delivering treatment, it is best to seek a second opinion to help determine what the appropriate treatment is. Sometimes, the recommended treatment will determine whether a patient should receive their treatment at their local hospital or travel to a larger medical center. For example, most small hospitals can effectively deliver chemotherapy; whereas patients requiring a complicated procedure, such as a stem cell transplant, may need to travel to a larger institution that treats a higher volume of patients.
Aggressive Treatment: Most of the cancers that can be cured with chemotherapy (acute leukemias, lymphomas, testicular cancers) require intensive treatment. Intensive treatment may consist of high doses of chemotherapy or radiation therapy and requires rigid adherence to prescribed doses of drugs to ensure that optimal treatment is delivered. Intensive treatment also requires careful monitoring for complications and aggressive supportive care. In many instances, intensive treatment can be administered locally, but such patients are usually best treated in centers that use state of the art protocols (clinical trials) and treat large numbers of patients. All too often, oncologists treat patients with curable cancer with lower doses of chemotherapy in order to decrease side effects. This practice can seriously compromise the chance for cure. Patients should determine how many patients are treated per year and what the results of local treatment are at the treating institution. Treating physicians should present patients with their own results and not results from patients treated in other institutions.
Specialized Treatment: In many instances, specialized treatment is required to achieve optimal cure or control rates. One example of this is stem cell transplantation. Allogeneic or autologous bone marrow or blood stem cell transplants can often offer the best result for patients with blood and lymphoid cancers such as leukemia, lymphoma and multiple myeloma and other cancers such as breast, ovarian and testicular. However, not all medical centers offer this type of therapy. If the treating center does not offer stem cell transplant, a second opinion may be in order. Another example of specialized treatment is treatment for liver cancer. Recent clinical trials have suggested that sophisticated treatment techniques such as intra-arterial chemotherapy, chemo-embolization, radiofrequency ablation, radioactive isotopes and conformal radiation therapy can be of major benefit for the treatment of liver cancers. However, not all centers have the capability of delivering this type of treatment. Patients with liver cancer and other cancers that can be treated by specialized methods require second opinions at specialized institutions.

Cost of Second Opinions
One of the problems with second opinions is that insurers may not cover the expense. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. In some situations, insurers will even insist on a second opinion. This is often the case when the primary physician advises an expensive treatment.
Health Maintenance Organizations (HMOs) have a vested interest in keeping patients within the system. This may cause a conflict of interest between the patient and the HMO, especially if very expensive treatment is only available outside the HMO system. The more money the HMO spends on second opinions and treatments outside the HMO system, the less money there is available to treat patients within the system and the less the HMO makes in profit. However, most reputable HMOs can deliver state of the art treatment for most cancers. It is a good idea, however, for HMO members with cancer to make sure they are informed about clinical trials or other promising new treatments. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. It is also important for HMO members undergoing cancer surgery to inquire about the number of such procedures performed each year by the HMO and the results. The best protection for an HMO member is to seek a second opinion even if she or he has to pay for it.
In summary, patients should become their own advocates and become as knowledgeable about their treatment options as possible. When there is any doubt about the diagnosis or treatment plan, patients should obtain a second opinion. Second opinions will not offend competent physicians. Second opinions will, however, provide reassurance to patients and family members and ultimately allow patients to receive the most appropriate therapy.

Understanding Cancer Treatment Options

Introduction
Very few cases of cancer require emergency treatment. Most patients benefit from taking the time to learn about their disease and explore all treatment options. Before choosing a treatment strategy it is important to understand the stage and extent of cancer, the different types of cancer treatment and the goal of treatment. Many patients decide to obtain a second opinion in order to help them make treatment decisions.
Staging
After cancer is diagnosed, a physician will perform several tests to determine the stage and extent of disease. Staging is the process of describing the location of the disease at the time of diagnosis. The American Joint Commission on Cancer is the most widely used cancer staging system. The stage is determined by measuring the size of the primary Tumor, the extent of lymph Node involvement, and the absence or presence of Metastases. This is referred to as the TNM staging system.
Staging provides invaluable information about the location and extent of the disease. After determining the stage of the cancer, physicians and patients can begin to explore treatment options. At this point, it is important for patients to gather as much information as possible about the treatment of their cancer.
Understanding the Different Types of Treatment
There are several different types of cancer treatment. One type of treatment may be best for some cancer patients, while another will be more beneficial for other patients. It is up to the individual to determine which course of action is most appropriate.

Conventional Treatment: In the West, methods of cancer treatment traditionally follow the medical, or allopathic, model. The term allopathy derives from two Greek words: allo meaning opposite and pathos meaning suffering. The basis of this medical system is to focus on disease and employ methods that oppose it. In the medical model, treatments are based on evidence, usually gathered in carefully controlled clinical trials that determine whether a new treatment is effective and safe for patients. In the United States, these conventional treatments are approved by the Food and Drug Administration (FDA) before they can be administered to patients. Conventional treatment can be divided into two categories:
Standard Treatment: Standard treatment refers to treatment that has been proven safe and effective in clinical trials and is approved by the FDA for a specific use. Standard treatment is the “accepted” best treatment for a specific type and stage of cancer.
Experimental Treatment: Experimental treatment refers to a potentially encouraging treatment that is under evaluation, but has not yet been approved by the FDA. Experimental treatment is offered through a clinical trial. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Often, clinical trials offer access to the newest and most promising treatment strategies. It is extremely important to decide whether or not to participate in a clinical trial before receiving any treatment from a physician. Once treatment has been initiated, this almost always excludes patients from participating in a clinical trial designed for patients in their circumstance. Even when there is evidence that a new treatment modality may be better than standard treatment, it takes years to change the existing standard treatment.

Complementary/Alternative Treatment: Complementary and Alternative Medicine (CAM) describes medical therapies practiced outside “mainstream” or conventional Western medicine. CAM contains a variety of healing philosophies and medical practices that are not currently accepted or used by conventional medicine, such as acupuncture, aromatherapy, biofeedback, herbal remedies and more.
Complementary medicine consists of medical therapies that are most often used to supplement conventional medical treatments. Because these treatments are utilized in addition to allopathic therapies, they most often focus on promoting wellness or managing symptoms. Most CAM therapies can be used as a complement to conventional medicine. A benefit of complementary therapies is that the patient can use well-researched conventional treatments against cancer while utilizing complementary medicine to reduce stress, enhance their immune system and/or reduce side effects of conventional cancer treatment. The vast majority of CAM practitioners and cancer patients who utilize CAM therapies use complementary medicine as a means of integrating the best of what both types of medicine have to offer.
In contrast to complementary medicine, alternative medicine is used in place of conventional medicine. Alternative medicine attempts to treat disease specifically, without use of any allopathic therapies. Therapies commonly used as complementary medicine are considered alternative medicine when used in place of conventional treatment. For minor health issues, alternative medicine is generally not dangerous. However, most practitioners of conventional medicine, and many who practice complementary medicine, are uncomfortable with the exclusivity of alternative medicine and its failure to utilize treatments that are known to benefit certain diseases when the illness is serious. In such instances, alternative therapies may delay conventional treatment and result in a more serious illness, complications or death. Many patients who do turn to alternative medicine do so only after conventional medicine has nothing more to offer or because they believe the risks of a mainstream treatment outweigh the risks of the alternative therapy they are investigating. In some instances, a very negative experience with conventional medicine leaves a patient in search of alternative forms of medicine.

Goals of Treatment
In order to explore treatment options, it is important to understand the goal of treatment. The ultimate goal of treatment is cure, which requires eliminating all detectable or measurable disease and any undetectable disease. Micrometastases are undetectable areas of cancer that have spread away from the original site of cancer. Primary treatment is an initial approach to remove detectable disease, but may not remove all micrometastatic disease. In many earliest stage cancers, primary treatment is curative if the cancer is limited to detectable disease.
Since there is a potential for micrometastatic disease even after all of the measurable disease is removed, the primary treatment for many stages of cancer is non-curative. When the potential for micrometastatic disease is significant, additional treatment is often necessary to eradicate any remaining cancer cells. Adjuvant therapy is treatment that is delivered following primary treatment and may include chemotherapy, hormonal therapy and/or biologic therapy. Neoadjuvant therapy refers to treatment that is delivered prior to primary treatment. Sometimes, cancer has grown so large that surgical removal of the entire cancer is difficult. The goal of neoadjuvant treatment is to shrink the cancer, thereby facilitating more complete surgical removal.
Sometimes with advanced cancer, primary and adjuvant treatment may not be beneficial because eliminating measurable disease is not possible. In such cases, patients may elect to receive palliative treatment. The goals of palliative treatment are to alleviate pain and side effects from the disease, prolong life and maintain quality of life.
Treatment Modalities
Cancer treatment may consist of one or more treatment modalities, depending on the type, stage and extent of cancer. Some treatment modalities, such as surgery and radiation, are local treatments used to eradicate visible tumors. Other treatment modalities, such as chemotherapy and biological therapy, are systemic treatments that circulate in the blood to eradicate cancer that has spread away from the original site.
Optimal treatment of cancer often requires more than one therapeutic approach. Often, one or more treatment modalities may be used in order to provide the most complete treatment for the patient. Increasingly, it is common to use several treatment modalities concurrently or in sequence, with the goal of preventing both local and systemic cancer recurrence. This is referred to as multi-modality treatment of the cancer. These modalities may include surgery, radiation therapy, chemotherapy and/or biological therapy. Thus, it is important for patients to be treated at a medical center that can offer multi-modality treatment involving medical oncologists, radiation oncologists and surgeons.

Surgery: Surgery is a local treatment used to remove visible tumors. In addition, surgeons frequently remove the tissue adjacent to the cancer during surgical resection of a tumor. Information gained about the tumor during surgery is useful in predicting the likelihood of tumor recurrence and the need for other treatment modalities.
Radiation Therapy: Radiation therapy, or radiotherapy, uses high-energy rays to damage or kill cancer cells by preventing them from growing and dividing. Similar to surgery, radiation therapy is a local treatment used to eliminate or eradicate visible tumors. Radiation therapy is not typically useful in eradicating cancer cells that have already spread to other parts of the body. Radiation therapy may be externally or internally delivered. External radiation delivers high-energy rays directly to the tumor site from a machine outside the body. Internal radiation, or brachytherapy, involves the implantation of a small amount of radioactive material in or near the cancer.
Chemotherapy: Chemotherapy is the general term for any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs. Chemotherapy can be administered through a vein, injected into a body cavity or delivered orally in the form of a pill. Chemotherapy is different from surgical or radiation therapy because it is considered a systemic treatment. The cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original tumor.
Biological Therapy: Biological therapy is referred to by many terms including immunologic therapy, immunotherapy or biotherapy. Biological therapy is a type of treatment that uses the body’s immune system to facilitate the killing of cancer cells. Types of biological therapy include interferon, interleukin, monoclonal antibodies, colony stimulating factors or cytokines and vaccines.
Hormone Therapy: Hormones are naturally occurring substances in the body that stimulate the growth of hormone sensitive tissues, such as the breast or prostate gland. When cancer arises in breast or prostate tissue, its growth and spread may be caused by the body’s own hormones. Therefore, drugs that block hormone production or change the way hormones work, and/or removal of organs that secrete hormones, such as the ovaries or testicles, are ways of fighting cancer. Hormone therapy, similar to chemotherapy, is a systemic treatment in that it may affect cancer cells throughout the body.

Choosing the Appropriate Treatment
Appropriate cancer treatment choices vary depending on many factors. What is appropriate for one patient may not be appropriate for another. Patients who understand the specific characteristics of their disease and understand the many different facets of cancer treatment will be able to make informed treatment decisions.

Understanding the Relationship Between Anemia and Cancer

Anemia, a common side effect of cancer treatment, is a condition in which there are fewer red blood cells than normal. The function of red blood cells is to transport oxygen to the tissues of the body. Without an adequate number of red blood cells, the body’s need for oxygen cannot be effectively met. Common symptoms of anemia include severe fatigue, shortness of breath, diminished activity level, reduced overall feeling of well-being, and possible mental dysfunction. Anemia may also exacerbate existing medical conditions. For example, the heart has to work harder in an anemic patient, which may aggravate a heart condition. Furthermore, severe anemia may cause a treatment delay or dose reduction, as well as reduce the effectiveness of some chemotherapy agents and radiation, thus jeopardizing the possibility of the best long-term results from treatment. Fortunately, there are treatments available to improve anemia and its symptoms.
Anemia in cancer patients may occur either as a direct result of the cancer or as a side effect of cancer treatment. Chemotherapy, radiation therapy, and blood loss during surgery are all common causes of anemia in cancer patients. Over 60% of patients treated with chemotherapy develop anemia. This is because chemotherapeutic agents kill rapidly dividing cells in the body, including cancer cells, as well as several types of normal cells like red blood cells.
Early detection and prompt treatment of anemia is the best strategy for preventing severe anemia from occurring and ensuring that when anemia does occurs, the duration is limited. Although healthcare providers try to monitor for anemia, patient observations are an important source of information on warning signs and they should notify their doctor or nurse if they are feeling abnormally fatigued.
The treatments available for chemotherapy-induced anemia in cancer patients are Procrit® and Aranesp®. These agents are FDA approved and have been safely used in cancer patients. They contain a synthetic erythropoietin, which stimulates the production and maturation of red blood cells, ultimately increasing red blood cell levels enough to correct anemia. Procrit® is approved to be given 3 times per week, while Aranesp® is approved for administration only once every 2 weeks. Every 2 week administration has the added advantage of reducing the burden of frequent doctor visits for patients and their caregivers.
Although most patients develop anemia as a direct consequence of chemotherapy, diet may also play a role in reducing the severity or duration of anemia in some patients. Iron, folic acid, amino acids, and vitamins B6, B12, and C are all important components to the development and maturation of red blood cells. Green leafy vegetables, eggs, fruit, legumes, grains, and meats should be included in the diet of a person that is diagnosed with cancer, or one that has already developed anemia. Additionally, patients should ask their physicians if supplementation is necessary to manage their anemia.
Although anemia can pose serious consequences, early identification and subsequent intervention with effective treatments such as Procrit® and Aranesp® may help to correct anemia, thereby improving patients’ quality of life and making it possible for them to receive optimal therapy.

Patient Action to Prevent Infection During Treatment for Cancer

Most patients would prefer to prevent infection rather than having to deal with its results. Your first line of defense should always be prevention. Below are some simple but effective steps to avoid infection:
-Always wash your hands with soap and plenty of water. Many infections are transmitted through hands and things that you touch, such as doorknobs. Washing your hands thoroughly is the most important thing you can do to prevent infection.
-Avoid people with colds or the flu.
-Avoid large crowds to reduce the likelihood of coming into contact with sick people.
-Bathe daily and carefully dry your skin.
-Take steps to prevent cuts or scrapes, as these provide entry points for infection.
-Use an electric razor instead of a blade to avoid cuts.
-Use caution with sharp objects.
-Wear gloves when appropriate.
-If you have a cut or scrape, keep it covered with a clean bandage until it heals.
-Prevent cracks in your skin by using lotion.
-Cook your food thoroughly to kill any potential microorganisms that may be on raw food.

If Cancer Runs in Your Family: Understanding Hereditary Risk and Genetic Testing

A genetic risk for cancer means that certain cellular mutations that increase an individual’s risk for developing cancer are passed down through generations, giving each new family member who inherits a cancer susceptibility gene a potentially increased risk for developing certain cancers. These hereditary mutations are responsible for about 5–10 percent of cancer incidence.
Although hope remains that research in the field of gene therapy may someday find a way to repair these gene alterations, for now we are at least able to identify gene mutations through genetic testing—an important step in understanding your genetic susceptibility for cancer and the first step in managing your risk. However, even though you may gain important information from a genetic test, the decision to be tested should be made carefully. Here are some things to consider as you decide whether genetic testing is an appropriate choice for you:
Genetic Counseling
Because the implications of genetic testing and its findings for you personally and within your family are potentially very complicated, you may wish to seek the guidance of a genetic counselor. Testing and its results are complex—for example, if a genetic mutation is revealed, it is not certain that an individual will develop the associated cancer nor is the absence of a mutation a guarantee that an individual will not develop cancer. Furthermore, genetic testing does carry certain risks and limitations, which should be considered before you undergo such a procedure. A genetic counselor can help you understand these issues as well as the following:
Whether genetic testing is the right choice for you
Your results and their particular significance for you
How to share your results with other family members, as these findings may indicate that they are also at risk for the same hereditary mutation
Is Genetic Testing Right for You?
Potential candidates for genetic testing have one or more of the following characteristics:
Diagnosed with early-onset cancer*
Experienced more than one cancer diagnosis
Have a strong family history of cancer or a family history of rare cancers**Consult with your physician to determine if you’ve been diagnosed with early-onset cancer or whether you have a strong family history of cancer and to learn which types of cancer are consider rare cancers.
What You Can Learn from Testing
If you do undergo genetic testing, you may learn the following:
Your high-risk status will either be confirmed or you’ll be able to rule out the presence of a genetic alteration found in other family members.
If you do test positive, you can increase your screening practices, which may detect cancer at an early and most treatable stage.
Some cancers may be prevented entirely with preventive surgeries.
Limitations and Risks of Genetic Testing
In some circumstances genetic tests don’t offer any benefit. For example, if you may be at genetic risk for a type of cancer for which there is no reliable screening method or effective treatment, knowledge of this alteration would be of little or no use. Additionally, because these tests are only predictive and not definitive, there are no absolute answers about the likelihood that you will develop cancer. As well, though these tests are technologically sophisticated, they are still not 100 percent accurate, allowing the possibility that they will fail to identify a cancer-causing mutation or that a gene may be incorrectly identified as mutated. Risks to further look into include the potential for employment or insurance discrimination based on high-risk status for developing cancer and the potential anxiety for the entire family that the knowledge of an inherited mutation may cause.
For more information about genetic testing, go to http://patient.cancerconsultants.com/Testing.aspx?TierId=1085&DocumentId=736.

Six Tips for Choosing a Doctor and Getting High-quality Care

If you’re like most people who have been diagnosed with cancer, you want the best care possible from the best doctor possible. But how do you know which doctor is right for you? The answer is not simple. Different people have different needs and different priorities that play into their choice of a doctor. The following six tips can help guide your search:

1.Understand Your Diagnosis
A great first step is to find out as much specific information as you can about the details of your diagnosis. Knowing exactly what type of cancer you have can help you find the best doctor to treat your specific case.
Understanding the extent to which your cancer has spread is also important. If you have localized cancer, your first encounter should probably be with a cancer surgeon. If you have widespread cancer, you may more appropriately be referred to a medical oncologist.
Once you understand your diagnosis, a next step is to learn about standard treatment options for your type and stage of cancer. If your doctor offers you a treatment plan that is inconsistent with what you’ve learned from your research, you may not be able to assess on your own whether it’s a better or worse approach, but it will allow you to initiate informed discussions with your doctor or to seek a second opinion.

2.Get Input from People You Trust
As you begin your own research into your diagnosis and treatment, you may also want to ask people you trust for a physician referral. For example, your primary care doctor or a local oncologist may be able to refer you to an expert in your type of cancer.
The first doctor you see for your cancer care may also be able to help you plan your subsequent care. If you have lung cancer, for example, you first see a surgeon. The surgeon can then refer patients to the physicians who will provide the post-surgery cancer care.

3.Get the Care That Your Diagnosis Requires
Keep in mind that though many doctors will be able to provide high-quality cancer care, those who focus on your specific type of cancer may have important additional expertise.
Finding a physician who focuses on your particular type of cancer may require some travel and visiting a large cancer center. Once your treatment strategy is developed, however, you may be able to receive the bulk of your care closer to home.
In particular, patients facing stem cell transplants and rare cancers these or similar may benefit from highly specialized care because most oncologists do not handle these situations on a regular basis.
All patients may want to consider choosing a doctor who is board certified in the specialty in which he or she practices.

4.Consider a Second Opinion
Another step that many cancer patients take when selecting a doctor is to get a second opinion. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options. Getting a second opinion allows patients to become more informed about their cancer and their treatment options and also provides reassurance.
For tips on when to seek a second opinion, go to When to Seek a Second Opinion.

5.Be Comfortable with Your Choice
In addition to finding a doctor with expertise in your type of cancer and pursuing a second opinion if you choose, keep in mind the value of finding a doctor with whom you feel comfortable. Some patients, for example, believe strongly in the role that complementary and alternative medicine plays in treatment. When choosing a doctor, these patients will need to consider how much it matters to them that their doctor either does or does not endorse those beliefs.

6.Remember: There’s No One Right Answer
There is no simple or one-size-fits-all formula for finding a doctor. Each patient—and each doctor—is unique. Finding a doctor who specializes in your type of cancer is a good starting point, but you may also wish to consider such factors as travel time and how comfortable you are with the doctor. You may be happiest taking the recommendation of a trusted individual, or you may want to research options on your own. Ultimately, you need to do what’s right for you.

Nutrition Tip: Green Tea

Research has been pointing to evidence of green tea’s powerful disease-prevention benefits for years. Now recent laboratory and human studies are starting to show that green tea may even have the ability to kill specific cancer cells.1,2
The component plentiful in green tea shown to be responsible for chemopreventive and chemotherapeutic actions in laboratory studies is the polyphenol called epigallocatechin gallate (EGCG). This compound has been found to prevent cancer cells by changing the way normal cells react to potential carcinogens entering the body. EGCG also appears to create chemical changes that kill active cancer cells in multiple myeloma, breast, cervical, and colon cancer tumors.3,4,5,6
In addition, recent observations from the Mayo Clinic suggest that green tea may fight chronic lymphocytic leukemia (CLL), and a clinical trial is now underway to test the effect of green tea in CLL patients.7 Clinical studies at the University of Parma in Italy have also produced statistically significant evidence of EGCG’s ability to treat precancerous changes in the prostate.8 As well, recent human studies at the David Geffen School of Medicine at UCLA have shown the effectiveness of green tea extracts in treating skin toxicity associated with radiotherapy for solid head, neck, and pelvic tumors. 9
While we wait for further confirmation from clinical trials that green tea both prevents and fights cancer, we can enjoy it knowing that it has no known side effects other than high doses delivering too much caffeine. By following the proper consumption and brewing instructions below, you can get maximum benefit while minimizing caffeine content.

How Much?
Drink three to six cups each day. Drink the tea throughout the day, as studies have found that continuous administration of the EGCG is more effective than a single dose.

Preparation Tip
The most important tip for steeping green tea is to use water that is just below the boiling point. Steep for under three minutes. This will draw out the maximum benefit from the tea and the least amount of caffeine.

Brewing Green Tea
Use one teaspoon of loose tea leaves for a small pot of tea. Use two teaspoons for a large pot of tea. Boil water, then pour into a porcelain teapot or mug and let cool for one minute. Add tea leaves and let brew for 1 to 3 minutes, depending on the desired strength. Serve or add to juice immediately.

Doctors urge cancer patient mental screening

Doctors treating cancer patients should try harder to help them deal with the emotional toll the disease exacts, an expert panel said on Tuesday.
The panel convened by the Institute of Medicine recommended that cancer care providers systematically screen patients for emotional distress and other mental problems and connect them with people who can help.
The medical establishment has worked hard to develop new and better ways to treat tumors while devoting less effort to patients' emotional needs, the panel said.

"We have spent gazillions of dollars for getting Cadillac treatments for the biomedical piece of it. But we haven't spent money on the gas to make it go," said Nancy Adler, a professor of medical psychology at the University of California, San Francisco who headed the panel.
Many cancer patients undergo harsh chemotherapy and radiation treatments and sometimes disfiguring surgical operations. They suffer prolonged nausea, fatigue, pain and hair loss and are unable to work or maintain social or family obligations.
Link patients to servicesAnd some often have little time left to live.
"Unmet psychosocial needs are common among cancer patients and their families. There are services available that could help them. But right now, they're not being linked up to these services," Adler said in a telephone interview.
Psychosocial health services are an integral part of cancer care, the panel said. Many such services already exist, often at no cost to patients, but care providers often fail to identify patients' needs and do not help them find and use these resources, the committee said.
Screening patients to find those who might need more support for emotional issues may be as simple in some cases as a short questionnaire that a patient would fill out while sitting in the doctor's office waiting room, Adler said.
The panel said it is important that cancer care providers not only screen patients for emotional issues but periodically re-evaluate them to see if their needs have changed.
Such needs might include more information about medical therapies they are undergoing and their possible side effects, treatment for depression and assistance with normal daily activities they can no longer do on their own, the panel said.
The Institute of Medicine advises U.S. policymakers on medical issues.

Quality of life is key to cancer survival

Having someone who cares may be more important than medical factors

Having someone to drive you to cancer treatments or make sure you are eating may be even more important than tumor size or other medical factors in predicting cancer survival, U.S. researchers said on Tuesday.
They found patients with a below-average quality of life before getting treatment for lung cancer — those in poor health or with inadequate support networks — had nearly a 70 percent higher death rate than those with a better one.
"It's intuitive that someone who is in better physical shape and has a support system will do better than someone who comes in already debilitated and doesn't really have anyone to help them go through treatment," said Dr. Nicos Nicolaou of Fox Chase Cancer Center in Philadelphia in a telephone interview.

"We have now shown this," said Nicolaou, whose study was presented on Tuesday at the American Society of Therapeutic Radiology and Oncology meeting in Los Angeles.
Doctors routinely consider factors such as tumor size, stage of the disease and other measures to predict how long a patient with cancer will survive.
But factors that make up a patient's quality of life — overall health, mobility, emotional stability, social support and financial resources — may make the most difference, Nicolaou and colleagues found.
"If you have someone to help you with your meals, transportation, give you your medications and take care of your daily needs, both physical and emotional, you will be able to get through the treatment better," he said.
Researchers at Fox Chase and Henry Ford Hospital in Detroit studied 239 patients with lung cancer enrolled in a treatment trial involving both radiation and chemotherapy.
The study was designed to evaluate the role of quality of life as a prediction for survival. Questions included things like: "Do you have trouble taking a long walk?" or, "In the past week, did you feel irritable? Did you feel depressed?"

The researchers also analyzed classic predictors of survival such as gender, race, age, marital status, state of disease and tumor location.
Some 91 percent of patients completed a standardized quality of life survey before treatment. All patients were followed for at least 17 months.
What they found is quality of life emerged as the most significant predictor of overall patient survival.
"We conducted two different statistical analyses including all the usual prognostic factors and either way, quality of life remained the strongest predictor of overall survival," Dr. Benjamin Movsas of Henry Ford Hospital said in a statement.
"What's more, if a patient's quality of life increased over time, we saw a corresponding increase in survival," he said.
People who were single, divorced or widowed had significantly lower quality of life scores, and fared far worse in the study.
For these patients, doctors may need to take a more active role in ensuring that support services are in place before a patient undergoes cancer treatment, Nicolaou said.
"It is incumbent on the treatment team to make sure the patient's needs are met and the patient gets the support he needs to get through the treatment," he said. "It has to be an integral part of decision-making."

Vitamin D may not lower cancer deaths

A large new study found no sign that vitamin D lowers the overall risk of dying from cancer, injecting a note of caution to the latest vitamin craze.
The exception: People with more vitamin D in their blood did have a significantly lower risk of death from colorectal cancer, supporting earlier findings.
Getting enough of the so-called sunshine vitamin — the skin makes it from ultraviolet rays — is vital for strong bones.

But vitamin D has made headlines in recent years because of research saying it may be a powerful cancer fighter, sparking a push for people to get more than currently recommended amounts, either through diet or sun exposure.
The first-of-a-kind government study released Tuesday shows the issue is far from settled.
National Cancer Institute researchers analyzed vitamin D levels measured in almost 17,000 people as part of a national study that tracked their health. About a decade after enrolling, 536 of those people had died of cancer.
Whether people had low or high vitamin D levels played no role in their risk of dying from cancer in general, they reported Tuesday in the Journal of the National Cancer Institute.
Then the researchers examined different types of cancer. There were just 66 deaths from colorectal cancer. Still, people with high levels of vitamin D appeared 72 percent less likely to die of colorectal cancer than people with the lowest vitamin D levels.
"While vitamin D may well have multiple benefits beyond bone, health professionals and the public should not, in a rush to judgment, assume that vitamin D is a magic bullet and consume high amounts," Johanna Dwyer, a dietary supplement specialist at the National Institutes of Health, cautioned in an accompanying editorial.
Indeed, there are numerous risk factors for colorectal cancer, including obesity and low physical activity, and it's unclear if low vitamin D levels play an independent role or are just a marker for those other risks, she said.

Scientists have been interested in vitamin D's effects for decades, since noticing that cancer rates between similar groups of people were lower in sunny southern latitudes than in northern ones. A handful of studies since then have found people given vitamin D supplements have less risk of developing certain cancers, but much of the evidence is circumstantial.
Experts are cautious because other vitamins and nutrient supplements once widely thought to prevent cancer didn't pan out when put to rigorous testing.
The NCI's study is the first to compare blood levels of vitamin D to cancer mortality, and "it's the best research we have on this topic," said Dr. Len Lichtenfeld of the American Cancer Society.
But a big weakness: It measured vitamin D at just one point in participants' lives, when levels can vary widely with dietary changes and especially the seasons.
Overall, most research "seems to be pointing in the direction that there is a role of vitamin D," Lichtenfeld said. Tuesday's study "puts a note of caution in there that says with all the explosion of information and advocacy on behalf of vitamin D, we need to be cautious. ... We really need some further studies that are well done to answer the question."

8 tips to cancer-proof your body:Straight from the lab: Stealth strategies for keeping the Big C at bay

The average mouse doesn't care much about skin cancer. Outside of Disney cartoons, you won't see one slathering on sunscreen before heading out to dodge cats and search for cheese. But Gary Stoner, Ph.D., a professor emeritus of hematology and oncology at the Ohio State University medical center, does care about cancer. That's why he spends his days in a lab, feeding rodents polyphenols from seaweed and learning how to shrink skin cancer–like tumors. He's a mouse's best friend. Maybe yours, too.
Stoner is just one of many researchers working to bring new weapons to the cancer battle. Some study humans to take a fresh look at existing theories. Others, like Stoner, are testing tactics so bold that, so far, their only subjects have tails and whiskers.
But all these approaches (seaweed included) have one very positive thing in common: They're just plain good for you and bad for cancer cells. Here are eight strategies that just may turn the Big C into the Big See-Ya-Later. (Or, better yet, See-Ya-Never.)

Drink pomegranate juice

Some say this luscious, lusty red fruit is Eve's original apple, but what the pomegranate truly banishes is cancer risk. The fruit's deep red juice contains polyphenols, isoflavones, and ellagic acid, elements researchers believe make up a potent anticancer combo. It's been shown to delay the growth of prostate cancer in mice, and it stabilizes PSA levels in men who've been treated for prostate cancer. And now University of Wisconsin at Madison researchers have learned that pomegranate may also inhibit lung-cancer growth. If you currently smoke, have smoked in the past, or hang around in smoky places (Cleveland, for instance), the juice of the fruit could bolster your defenses.
Use it: The mice in the Wisconsin study received the human equivalent of 16 ounces of juice per day, so quaff accordingly.

Eat blueberries

Got pterostilbene? Rutgers University researchers say this compound — found in blueberries — has colon cancer–fighting properties. When rats with colon cancer were fed a diet supplemented with pterostilbene, they had 57 percent fewer precancerous lesions after 8 weeks than rats not given the compound did. Eat blueberries and you'll also benefit from a big dose of vitamin C (14 milligrams per cup). In a study of 42,340 men, New England Research Institute scientists discovered that men with the highest dietary vitamin C intake (as opposed to supplements) were 50 percent less likely to develop premalignant oral lesions than men with the lowest intake were.

Use it: "About two servings daily is the human equivalent of what we fed the rats," says Bandaru Reddy, M.D., Ph.D., a chemical-biology professor at Rutgers. Load up at breakfast: A cup and a half of blueberries over cereal, plus 8 ounces of juice and half a grapefruit (for extra vitamin C), will do the trick. If that's too much to stomach at dawn, spread it out over the course of the day.

Relax a little

Purdue University researchers tracked 1,600 men over 12 years and found that half of those with increasing levels of worry died during the study period. Talk about flunking the exam. Only 20 percent of the optimists died before the 12-year study was completed. More anxiety-producing news: Thirty-four percent of the neurotic men died of some type of cancer. How neurotic are we talking? "Think of the biggest worrier you know — someone who stresses out over everything," says psychologist Daniel Mroczek, Ph.D., who conducted the study. "That man is probably above the 95th percentile in neuroticism. Then think of the most cool, calm, collected man you know. He's probably below the fifth percentile."
Use it: To develop that critical, casual Jeff Spicoli vibe, learn to slow down your fast times: "The more time you spend in the present moment, the more relaxed you'll be, because most mental anguish occurs over stuff that's already happened or that may or may not happen in the future," says Claire Wheeler, M.D., Ph.D., the author of "10 Simple Solutions to Stress." "For the most part, right now is pretty damn good. If you practice being present while shaving, for example, eventually you'll also be more present when eating, making love, and working."

Pop selenium

Selenium has long been thought of as a cancer fighter, but you can have too much of a good thing, says David J. Waters, Ph.D., D.V.M., director of the Gerald P. Murphy Cancer Foundation, in West Lafayette, Indiana. A study of almost 1,000 men, published in the Journal of the National Cancer Institute, found that when those with the lowest initial levels of selenium in their bodies received a daily supplement over a 4 1/2- year period, they cut their prostate-cancer risk by an impressive 92 percent. But men who started out with high selenium were rewarded with an 88 percent increase in total cancer risk when they took the supplements. Moral: It pays to get your selenium level right.
Use it: Selenium in the body is measured through toenail clippings. Send yours to the Murphy Foundation, and for less than $100 (price varies by state), they'll ship them to a lab and then inform you of your level 2 weeks later. If yours is out of range, the foundation will explain how to adjust your intake of Brazil nuts, tuna, meats, grains, and selenium supplements. Learn more at http://www.seleniumhealthtest.com/.

Order sushi

As mentioned, Gary Stoner is using seaweed to fight the Big C. When he fed the polyphenols from brown seaweed to mice that had been bombarded with UV rays, their incidence of skin tumors dropped 60 percent. And the polyphenols shrank existing tumors by 43 percent. Better still, the doses that produced these effects were the equivalent of only 1 or 2 tablespoons in a human being. "Seaweed is low in calories and fat, yet it provides heart-helping fiber, bone-building calcium and iron," says nutrition consultant Molly Morgan, R.D., C.D.N., owner of Creative Nutrition Solutions, in Vestal, New York. "Dried, roasted seaweed sheets used in making sushi also provide vitamins A and C."
Use it: "Eat more sushi rolls," says Stoner. "It's not quite the same seaweed, but it has some of the same compounds." As a bonus, sushi itself is a great muscle food. A typical spicy tuna roll has only 290 calories but packs 24 grams of protein. Also, look for a Korean-made, seaweed-fortified drink called EntroPower (entropower.com), which should be hitting U.S. health-food stores soon.

Spend more time outside

Scientists have viewed vitamin D as a potent cancer fighter for decades, but there's never been a gold-standard trial — until now. A Creighton University study published in the American Journal of Clinical Nutrition found that women who supplemented their diets with 1,000 international units of vitamin D every day had a 60 percent to 77 percent lower incidence of cancer over a 4-year period than did women taking a placebo. "I don't think the effect is limited to women," says Joan Lappe, Ph.D., the lead study author. "Vitamin D is necessary for the best functioning of the immune system — it causes early death of cancer cells."

Use it: Nature intended us to make vitamin D from the sun, but depending on where you live, the time of year, and how much of an agoraphobe you are, you may not reach the optimal level of 80 nanomoles per liter of blood that way. A blood test can give you a baseline. From there, Lappe recommends supplementing with 1,100 to 2,000 IU of vitamin D in a stand-alone pill every day. Vitamin D is also in sardines, salmon, shiitake mushrooms, and reindeer meat — which may explain Santa's longevity, despite the odd hours and jelly belly.

Clear your air

Secondhand smoke may be even worse for you than we thought. A recent American Journal of Public Health study reveals that nonsmokers working in smoky places had three times the amount of NNK, a carcinogen, in their urine than nonsmoking workers in smoke-free joints had. And their levels of NNK rose 6 percent for every hour worked. "There is no safe level of exposure to secondhand smoke, and the greater the exposure, the higher the risk," says the study's lead author, Michael Stark, Ph.D., principal investigator for the Multnomah County Health Department in Portland, Oregon.
Use it: Nine states have banned smoking in all workplaces, bars, and restaurants: Arizona, Delaware, Hawaii, Massachusetts, New York, New Jersey, Ohio, Rhode Island, and Washington. So change locations, change professions, or change the laws. As you sip your pomegranate juice, sign up with Americans for Nonsmokers' Rights at no-smoke.org.

Invest a little sweat equity

Study after study has pointed to the cancer-beating power of exercise. Now research from Norway has found that even a tiny dose of exercise has big benefits. A study of 29,110 men published last year in the International Journal of Cancer shows that men who exercised just once a week had a 30 percent lower risk of metastatic prostate cancer than did men who didn't work out at all. Increasing the frequency, duration, and intensity of the exercise correlated with a further, gradual reduction in risk.
Use it: Just one bout of weekend warriorism — a company softball game, pickup basketball, racquetball with your crusty uncle — might qualify you for inclusion in the cancer-free 30 percent.

Flower Power: A Cure for Cancer?

There is a flower in my garden that spreads so rapidly it has become a pest, and it has resisted all efforts to kill it.
Now it turns out that the flower — a common bachelor button — and it's more famous relative, feverfew, may have the power to kill cancer.
That's far from certain at this point, but clinical trials are set to begin soon in England to determine whether a modified derivative from this plant is safe to administer to terminal leukemia patients. If it does no harm to the patients, clinical trials will start in this country, possibly within six months, to determine whether the flower does indeed kill cancerous cells in the blood while leaving healthy cells alone.
A successful outcome would be an astonishing breakthrough in the fight against cancer because this type of treatment approaches the disease from a new direction, but because most new drugs fail during the rigorous trials this could turn into just another false hope. However, laboratory tests on cancer cells at the University of Rochester Medical Center have been encouraging enough to at least lead to a next step — testing the drug for safety.
"We don't want to raise false hopes here," said lead researcher Craig T. Jordan of the University of Rochester. "If something bad happens at the phase one trial, we won't go beyond that."
It has taken years to get this far because the road to cancer cures is littered with failed promises, but there were hints many years ago that there was something special about feverfew. The journey from the garden to the cancer ward involved many researchers, helped by some critical breakthroughs in our understanding of cancer. It's not the same battle today that it was just a decade or so ago.
This story begins a couple of centuries ago when people depended upon herbs for medical treatment. Certain plants were known to help alleviate pain and feverfew, which looks a lot like a daisy, was used to ease headaches and inflammation. An extract from the plant, parthenolide, was eventually isolated and packaged in pills, and it is sold today in health food stores as a treatment for migraine, arthritis and other ailments.
There were hints years ago that the chemical might also be useful in the fight against leukemia, but an early trial ended in failure because it was not absorbed into the blood and thus could not attack cancerous blood cells even if it had the power to do so.
Meanwhile, cancer research had turned up a surprising development. In 1977, John Dick of the University of Toronto made a remarkable discovery. He found that some of the cancerous cells in leukemia were stem cells, those magical cells that morph into different kinds of adult cells, like blood cells. Could it be, a few scientists wondered, that aberrant stem cells actually cause cancer?
If true, to have any hope of ever eradicating cancer scientists would need to figure out how to get to the stem cells and stop the disease at its roots. Scientists around the world began searching for stem cells in all sorts of cancers, and found them nearly everywhere they looked — in breast cancer, and later in the brain and bone. Those findings have led some scientists to conclude that many, and possibly all, tumors begin at the stem cell level.
The news electrified the University of Rochester's Jordan and his then-graduate student Monica L. Guzman. About 10 years ago, Guzman began studying the molecular structure of stem cells.
"We were trying to find differences between the normal stem cells and the leukemia stem cells," Guzman said. She found one key difference. The cancer cells had what the researchers call a "survival factor," a mechanism for staying alive.
"The normal stem cells don't have it," she added.
Bingo. If Jordan and Guzman could figure out how to inhibit the survival factor, the cancerous cells would die and the normal cells would be left alone.
Guzman's earlier work on the molecular structure of stem cells suggested a possible course. The researchers now knew enough about stem cells to try and match the cancerous cells with a chemical that could inhibit the survival factor. When they gave the cancerous cells a dose of parthenolide, they hit pay dirt.
"It was very effective on the leukemia stem cells without harming the normal stem cells," Guzman said.
Very encouraging findings, but there was still the problem of absorption. If the drug just passed through the body without remaining in the blood, it couldn't do its work. So Jordan and Guzman turned to colleague Peter Crooks, an internationally known biochemist at the University of Kentucky. Crooks has discovered scores of drugs and holds more than 100 patents. He combined parthenolide with dimethylamino, producing a water-soluble chemical that the scientists believe will attack leukemia at its roots.
A successful outcome will set it apart from other drugs because it would eliminate the source of the cancerous cells, thus there should be no relapses. But of course what works in a laboratory frequently doesn't work in the real world.
"This is a molecule that has never been introduced in a patient before," said Jordan, painfully aware that even discussing his research could lead to heartbreak for thousands of leukemia patients and their families.
So the first step is to ensure that the treatment does no harm. The patients that are awaiting the phase one trial have already been treated with virtually every cancer drug that's available, and all of them failed. They are hanging on mostly to hope. Phase one will begin by the end of this year, and could be completed in about six months.
"But if you say six months to one of these patients they think it's an eternity," Jordan said.
The initial trial will take place in England under the direction of a British colleague of Jordan's who has already been approved to test the drug for safety. If the drug's successful there, Jordan expects numerous trials to begin almost immediately in the United States.
Because the drug is designed to attack cancerous stem cells, it's possible it will be useful in the treatment of various cancers, including breast and prostate, but at this point that's very uncertain.
But if it works on any of those, it will signal a turning point in the fight against one of the most dreaded diseases on the planet. Unfortunately, that's a very big if.

SNM offers PET scan tips for patients during National Nuclear Medicine Week

The first week in October is Nuclear Medicine Week. This year, this awareness week comes just two weeks after the National Academy of Sciences (NAS) released the findings of its yearlong study into the future of nuclear medicine.
The study recommended that federal funding for basic nuclear medicine/molecular imaging research be enhanced. The report recognized the importance of nuclear medicine in the care of patients with many illnesses, including cancer, heart disease, and Alzheimer's and Parkinson's diseases. It helps diagnose disease, plan the best treatment and monitor the effectiveness of therapies. ('Advancing Nuclear Medicine Through Innovation,' NAS Summary)
SNM (the Society of Nuclear Medicine) applauds NAS for bringing light to the crisis in patient care that will develop if the United States lets this line of medical research fall dormant.
"Research funded by DOE over the last 50 years has led to many life-saving techniques that are now used daily, improving patients' outcomes. Positron emission tomography (PET) scans are one of the most important of these techniques. PET scans are used in the diagnosis and staging of cancer," said SNM President Alexander J. McEwan. "With proper funding, basic nuclear medicine research will continue to improve patient care through new therapeutic isotopes to cure disease, earlier diagnosis of Alzheimer's disease and cancer, detection of the effectiveness of cancer therapies, development of the next generation of imaging technologies and more," added McEwan, who speaks for more than 16,000 members of the world's largest society for molecular imaging and nuclear medicine professionals.
Currently, more than 20 million men, women and children need noninvasive nuclear medicine/molecular imaging procedures each year. These safe, cost-effective procedures include PET scans to diagnose and monitor treatment of cancer, cardiac stress tests to analyze heart function, bone scans for orthopedic injuries and lung scans for blood clots.
In light of National Nuclear Medicine Week, SNM offers patients the following tips to better understand what to expect if their doctor recommends a PET scan procedure.

-What is a PET scan? A PET scan is a biological imaging exam that provides information about how a patient's cells are 'behaving' or functioning.

-Why is the doctor recommending a PET scan? A single PET exam can provide information that once would have required many medical studies, and it can do so without the surgery that those studies might have required. PET scans are most often used to detect cancer and monitor response to treatment. PET scans are also used to evaluate heart disease, neurological conditions and other physiological problems.

-What should a patient expect? Most PET scans are done as outpatient exams. Patients receive a small dose of a radioactive pharmaceutical and remain on a bed while the radiotracers are detected or 'traced' by a special type of camera that works with computers to provide precise pictures of the area of body being imaged. The entire process can take as little as one hour. Because PET is noninvasive and does not involve the risks of surgery, PET scans can be performed repeatedly, if necessary, with minimal risk. The very small amount of tracer administered remains in the body for only a short period of time; there are no known long-term adverse effects from such low doses. After the scan, a nuclear medicine physician reviews the images, prepares a written report and discusses the results with the patient's doctor.

-What are the benefits? PET scans provide valuable information for cancer diagnosis (breast, cervical, colorectal, esophageal, head and neck, lung, lymphoma, melanoma, pancreatic, thyroid and others); evaluation of cancer therapy; and diagnosis of heart disease (and the potential effectiveness of treatment), Alzheimer's disease, Parkinson's disease, dementia, epilepsy and other neurological diseases. This type of imaging can show changes much earlier than other imaging tests like CT or MRI.

-Does insurance cover PET scans? Many PET scans are covered by insurance; pre-authorization is usually needed or advised. However, recent changes in legislation have limited access to PET scans for Medicare patients by decreasing reimbursements at outpatient facilities.
-What if my doctor wants me to have a PET/CT exam? Nuclear medicine researchers are investigating new radiotracers and new applications of PET that may reveal disease processes that have never before been imaged. PET is now being combined with other imaging techniques-such as computed tomography (CT)-to create 'fusion' images that provide functional information with anatomical context. PET-alone and in combination with other techniques-will continue to provide a unique closer look into the body and yield valuable information in the development of treatments and preventive health measures.

-Where can I learn more about PET, PET/CT and molecular imaging/nuclear medicine? SNM encourages patients to be their own advocates and talk to their doctors about whether a PET scan is right for them. To learn more about molecular imaging and nuclear medicine, visit SNM's Web site (www.snm.org) for information and resources on specific imaging procedures.