You should be talking to your doctor about supplements!

supplements and cancerJust the other day someone asked me about the use of herbs and supplements in their daily diet.

While we were talking, I mentioned I take several supplements, one of which is Vitamin D. My rational and evidenced based research points to the fact that I live in Michigan, one of the northern most states, known for its lack of sunshine during the winter months and therefore decreased sun exposure, which leads to decreased levels of Vitamin D. This sun exposure is what allows our bodies to make Vitamin D. Most people don’t have a nearly enough Vitamin Continue reading

From the ancient Greeks to modern medicine (part 1)

Ken Burns’ PBS documentary on cancer features U-M medical historian

A depiction of ancient Greek physician Galen treating a patient, by 20th century artist Robert Thom

A depiction of ancient Greek physician Galen treating a patient, by 20th century artist Robert Thom

If you look in the night sky at this time of year, you might see a constellation called Cancer. To the ancient Greeks, who gave it that name, the collection of stars looked like a crab. So they gave it the Greek name for crab: carcinos.

Later, the Romans kept that name for the same constellation, but used the Latin word for crab: cancer.

Both cultures also used those words for something else: a terrible disease that formed growths as hard as crab shells inside the body, and sent spindly legs out from a central body.

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A new diagnosis of colon cancer – what is next?

cancer diagnosis.fwThere are several paths that can lead patients to a diagnosis of colon cancer. You may have had symptoms that worried you, such as finding blood on your toilet paper. Or perhaps the doctor removed suspicious polyps during a routine colonoscopy. Either way, hearing that you have a diagnosis of colon cancer can be a shock, making it hard to process what the next steps might be or what decisions must be made. These tips can help you prepare for your first appointments with cancer specialists and understand what is going to happen over the next months: Continue reading

Treating breast cancer, saving the heart

Cardio-oncologists help keep hearts healthy during and after cancer treatment

My work at the University of Michigan Frankel Cardiovascular Center focuses on preventing and minimizing heart damage that can be caused by cancer treatment. It’s a risk faced by more than 2 million breast cancer survivors who have had either chemotherapy or radiation.

Dr. Elina Yamada is a member of the cardio-oncology team at the University of Michigan.

Dr. Elina Yamada is a member of the cardio-oncology team at the University of Michigan.

I recently had the chance to talk to a group at Gilda’s Club of Metro Detroit, a community that provides emotional and social support for adults, teens and children living with any kind of cancer, and in October they turned their attention to breast cancer.

Here are some of the common questions I hear from breast cancer survivors:

What’s my risk?   – Various cancer treatments can interact with the heart. Chemotherapy drugs, such as anthracyclines, designed to kill cancer cells can also harm heart muscle cells, causing a condition called cardiotoxicity. The risk can be low or high depending on the drug. Radiation therapy to the chest can lead to thickening or scarring of heart structures, such as the valves or pericardium (membrane surrounding the heart), and also affect the heart vessels, causing heart attacks. This could impact left-side breast cancer patients.

What kind of heart problems I can develop? Heart problems may develop during, or even years after cancer treatment. Cardiotoxicity can cause heart failure, high blood pressure, low blood pressure, heart attacks, irregular heartbeat, slow heart rate, or fluid around the heart. Radiation can cause heart valve disease, heart attacks, and thickening of the lining around the heart.

Is there anything I can do to prevent them? If you have cancer and want to avoid heart problems in the future, I recommend:

  • low-cholesterol diet to avoid developing blockages in the heart vessels
  • low-salt diet to avoid developing high blood pressure
  • Get daily exercises, such as walking at least 15 to 30 minutes, as tolerated
  • Avoid smoking and drinking alcoholic beverages
  • Maintain healthy weight to avoid obesity and diabetes which increase your cardiac risks

What symptoms should I worry about?  Symptoms caused by cardiotoxity can be common to the ones caused by cancer itself or treatment, such as fatigue, shortness of breath and leg swelling. In general, patients should tell their doctor if they have shortness of breath, chest pain, heart palpitations, fluid retention in the legs, distension of the stomach, dizziness or fainting. The Cardiologist should be able to examine you and run tests to determine if they are caused by heart problems or not.

Can I wait to treat my heart problems? Beating cancer is the first priority for women with breast cancer. Preventing and treating heart problems from cancer treatment can be coordinated with your Oncologist, so that you can conclude your cancer treatment. The goal of our Program is to ensure that breast cancer survivors have a healthy heart to enjoy the rest of their lives.


 

Frankel-informal-vertical-sigThe Cardio-Oncology Program at the University of Michigan Frankel Cardiovascular Center treats patients with cardiac tumors and collaborates with cancer specialists to prevent and minimize heart damage caused by chemotherapy and radiation.

How to Manage Skin Reactions to Targeted Therapies

Annette Schork, RN, BSN, OCN, CBCN, is one of four oncology registered nurses at the Cancer AnswerLine™

Annette Schork, RN, BSN, OCN, CBCN, is one of four oncology registered nurses at the Cancer AnswerLine™

Skin reactions to drug therapy are extremely common, and they are not signs of a drug allergy. Many of the targeted therapies can cause a rash or other skin changes. In fact, more than half the people taking these drugs have some skin effects. These problems usually develop slowly over days to weeks. Examples of targeted therapies are: cetuximab (Erbitux), panitumumab (Vectibix), erlotinib (Tarceva), gefitinib (Iressa), and lapatinib (Tykerb).

Why do targeted therapies cause skin changes?

Some drugs target the epidermal growth factor receptor (EGFR) protein, which tells the cancer cells to grow and divide. The problem is that normal skin cells also have a lot of EGFR, and they must grow quickly to maintain the skin’s surface layer. Drugs that target or block EGFR often affect skin cells, too. They turn off the signal for skin cells to grow normally and make it harder for them to retain moisture. A rash can mean that a targeted treatment is working effectively.

There are drugs that target other proteins, such as vascular endothelial growth factor (VEGF). These proteins help tumors build and keep a blood supply, but they also seem to be important to the very small blood vessels in the hands and feet. Damage to these tiny blood vessels can cause hand-foot syndrome, involving pain, redness, swelling, and sometimes blistering and peeling, on the palms of the hands and soles of the feet.

Here are some tips suggested by Cancercare.org for managing skin conditions caused by cancer treatment:

  • Be gentle with your skin. Use skin cleansing products made for sensitive skin. These products are usually fragrance-free and alcohol-free.
  • Keep your skin moist. To reduce skin dryness, shower in lukewarm water. Limit showers to one a day. After you shower, put moisturizing lotion on your skin while it’s still damp. Look for a moisturizer that’s “noncomedogenic”– that means it won’t clog your pores. Apply moisturizer to your skin at least twice a day.
  • Protect your skin from the sun. Some drugs used in cancer treatment may make your skin more sensitive to the sun. Ask your doctor if you should use sunblock every day. To protect your skin when you go outdoors, wear a broad-brimmed hat, long-sleeved shirt and long pants.
  • Take care of a skin rash. You may get an acne-like rash on your face, scalp, chest or elsewhere on your body. Your doctor can prescribe a cream to put on the rash.
  • Try to prevent pressure sores. If you spend a lot of time lying in bed or sitting in a chair, you may be at risk for pressure sores. Try to avoid lying or sitting in the same position for a long time. Shift your weight or change your position often.
  • Tell a doctor or nurse right away if you feel pain or burning during chemotherapy. Sometimes, drugs that are injected into a vein may leak out and cause skin damage.
  • Talk to your doctor about any skin concerns you have. If you notice any skin changes, always let your doctor know about them. With some newer cancer treatments, a rash or other skin side effect may be a sign that the treatment is working.  Early intervention is important for proper management, so patients should tell their health care providers about any skin changes as soon as possible.

Do you have any suggestions that may help other patients deal with skin reactions related to cancer treatment?  Please feel free to share with us and leave a comment.

Additional Resources:

National Comprehensive Cancer Network: Skin Rashes in Cancer Treatment

Chemocare: Skin Reactions

U-M Managing Side Effects and/or Late Effects of Treatment

Pregnancy and Cancer

Part 1 of 2

When a pregnant woman is diagnosed with cancer, her decisions are complicated by concern about how treatment may affect the baby’s health. Ideally, she can delay treatment until the baby is born, but sometimes a delay can allow the cancer to progress and make it harder to treat. The best time for beginning treatment to balance the baby’s and mother’s health needs isn’t always clear.

Diagnosis

Cancer during pregnancy is rare, occurring in approximately one out of every 1,000 pregnancies, and little research is available to guide women and doctors.  Breast cancer is the most common cancer in pregnant women; affecting approximately one in 3,500 pregnancies. The other common cancers in pregnancy are cervical cancer, lymphoma, and melanoma. A pregnant woman with cancer is capable of giving birth to a healthy baby, and some cancer treatments are safe during pregnancy. Cancer rarely affects the fetus directly.

If cancer is suspected during pregnancy, women may be concerned about diagnostic tests such as x-rays. However, research has shown that the level of radiation in diagnostic x-rays is too low to harm the fetus. When possible, women may use a lead shield that covers the abdomen for extra protection. Other diagnostic tests, such as magnetic resonance imaging (MRI), ultrasound, and biopsy, are also considered safe during pregnancy because they don’t use ionizing radiation.

Some diagnostic tests use liquid radioactive iodine to help stage cancer (figure out whether the cancer has spread to other parts of the body). Radioactive iodine cannot be used during pregnancy because it can damage or destroy the fetus’ thyroid gland.

Treatment

When making treatment decisions for cancer during pregnancy, the doctor considers the best treatment options for the mother and the possible risks to the fetus.

The type of treatment given will depend on the following:

  • The trimester of your pregnancy
  • The type, location, size and stage of the cancer
  • What the woman prefers

Because some cancer treatments can harm the fetus, especially during the first trimester (the first three months of pregnancy), treatment may be delayed until the second or third trimesters. When cancer is diagnosed later in pregnancy, doctors may wait to start treatment until after the baby is born, or they may consider inducing labor early.

Some cancer treatments may be used during pregnancy but only after careful consideration to optimize the safety of the mother and the unborn baby. These include surgery and chemotherapy.  Radiation is generally not utilized during pregnancy.  After evaluation your doctor will develop a treatment plan based on individual circumstances.

Read part 2.

Resources

U-M Women’s Health

American Cancer Society: Gestational Trophoblastic Disease