Cancer Treatment

UNC scientists find missing link between players in the epigenetic code

2012-10-19T17:01:00.000-07:00

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Over the last two decades, scientists have come to understand that the genetic code held within DNA represents only part of the blueprint of life. The rest comes from specific patterns of chemical tags that overlay the DNA structure, determining how tightly the DNA is packaged and how accessible certain genes are to be switched on or off. Now, research from the University of North Carolina School of Medicine has established the first link between the two most fundamental epigenetic tags -- histone modification and DNA methylation -- in humans. The study, which was published Sept. 30, 2012 by the journal Nature Structural & Molecular Biology, implicates a protein called UHRF1 in the maintenance of these epigenetic tags. Because the protein has been found to be defective in cancer, the finding could help scientists understand not only how microscopic chemical changes can ultimately affect the epigenetic landscape but also give clues to the underlying causes of disease and cancer. UNC is home to the Lineberger Comprehensive Cancer Center.

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Among the research institutions NCI funds across the United States, it currently designates 67 as Cancer Centers. Largely based in research universities, these facilities are home to many of the NCI-supported scientists who conduct a wide range of intense, laboratory research into cancer’s origins and development. The Cancer Centers Program also focuses on trans-disciplinary research, including population science and clinical research. The centers’ research results are often at the forefront of studies in the cancer field.

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EKG and Echocardiogram - What to Expect

2012-10-19T12:57:00.000-07:00

An electrocardiogram (EKG or ECG) and an echocardiogram (also known as an echo) are tests that check your heart function and identify any issues that might be present. Some people with cancer who receive chemotherapy may need one of these tests, or a multigated acquisition (MUGA) scan, before cancer treatment to identify pre-existing heart conditions or during and after cancer treatment to identify chemotherapy-related heart damage. Survivors of childhood cancer who have had radiation therapy to the chest, spine, or upper abdomen and people who have had bone marrow/stem cell transplants or certain types of chemotherapy may need an EKG or echocardiogram as part of their follow-up care to identify potential heart-related late effects (side effects that occur months or years after cancer treatment). Learn more about late effects of childhood cancer.

Chemotherapy’s effect on the heart

Some types of chemotherapy, such as anthracyclines, may damage heart tissue during cancer treatment. Examples of anthracyclines include daunorubicin (Cerubidine, Rubidomycin), doxorubicin (Adriamycin), and epirubicin (Ellence). Heart damage from chemotherapy can cause an arrhythmia (irregular heartbeat) or weaken the heart, resulting in congestive heart failure (CHF; a condition in which the heart does not pump enough blood to the rest of the body). People who have an arrhythmia may experience lightheadedness, chest pain, and shortness of breath. People with CHF may experience shortness of breath, dizziness, and swollen hands or feet.

The medical team

EKGs and echocardiograms are usually performed in a doctor's office or at a hospital. Nurses or medical technicians typically perform EKGs, while ultrasound technologists, called sonographers (health care professionals who are specially trained to operate ultrasound machines), typically perform echocardiograms. The test results are interpreted by a doctor.

About the procedures

EKG. This is a painless, noninvasive test that checks your heart’s function by recording the electrical activity of different areas of the heart as wavy lines on a piece of paper.

An EKG may be performed to check for a variety of issues:

Irregular heartbeatDamage to heart muscle and tissueChanges in the thickness of the heart wallsChemical or electrolyte imbalances in the body

Echocardiogram. This is an ultrasound (also known as a sonogram) of your heart. An ultrasound uses high-frequency sound waves to create a picture of internal organs. The sound waves go out from and “echo” back to a wand-like device called a transducer. Like an EKG, the test is painless and noninvasive.

An echocardiogram may be performed before, during, or after cancer treatment to check for:

Blood clots in the heart’s vesselsPrevious heart attacks or other heart conditionsTumorsInfectionsProblems with heart valvesHow well the heart pumps blood

Questions to ask your doctor

Before having an EKG or echocardiogram, consider asking your doctor the following questions:

Why are you recommending this procedure?Do I need to do anything to prepare for this procedure?Who will perform the procedure?What will the procedure show?What will happen if I don’t have this procedure?When will I find out the results?Who will explain the results to me?If my results are abnormal, what is the next step?

Preparing for the procedure

Before having an EKG or echocardiogram, tell your doctor or nurse about all of the medications you are taking and ask whether you should take them on the day of the test because some may affect the results.

In addition, check your insurance plan to find out what it covers and whether you will have any out-of-pocket costs associated with the test.

Otherwise, no preparation is necessary before an EKG or a basic echocardiogram. However, in rare cases, your doctor may recommend a transesophageal echocardiogram (TEE; an echocardiogram in which the ultrasound device is placed at the end of a thin, flexible tube that is inserted through the mouth and down into the esophagus). In preparation for a TEE, you will be asked to not eat or drink anything for several hours before the test.

During the procedure

When undergoing an EKG or echocardiogram, you will need to remove your clothing from the waist up.

During an EKG, a nurse or medical technician will place stickers (called leads or electrodes) on your chest, and wires will be connected to them. These leads collect the information about your heart’s electrical activity. The activity is normal when the heart has 60 to 100 beats per minute and shows a normal rhythm and wave pattern.

You will be asked to stay still during the test, which typically lasts about five to 10 minutes. In addition, you may be asked to hold your breath or lie flat on your back to help get a better reading from the machine.

During an echocardiogram, you will lie on your side on a table. An ultrasound technician will then apply a small amount of gel to your chest and move the wand-like transducer around your chest to create images of your heart.

Like the EKG, you will be asked to stay still during the test, which typically only lasts for a few minutes.

After the procedure

You can expect to return to your normal activities, including driving, immediately after your EKG or echocardiogram.

More Information

Tests and Procedures

Late Effects

Additional Resources

National Heart, Lung, and Blood Institute: Electrocardiogram

MedlinePlus: Echocardiogram

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Stop tobacco after a diagnosis of cancer, with Graham Warren, MD

2012-10-19T08:47:00.000-07:00

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Positron Emission Tomography (PET) Scan - What to Expect

2012-10-19T04:43:00.000-07:00

Listen to the Cancer.Net Podcast: PET Scan - ??What to Expect, adapted from this content

A positron emission tomography (PET) scan is a diagnostic tool used to detect cancer and find out the cancer’s stage (a way of describing where the cancer is located, if or where it has spread, and whether it is affecting the functions of other organs in the body). Knowing the cancer’s stage helps you and your doctor decide what kind of treatment is best and helps predict prognosis (a patient’s chance of recovery). The scan can also be used to evaluate the effectiveness of cancer treatments, such as chemotherapy or radiation therapy. A PET scan is often used to complement information gathered from a computed tomography (CT) scan, magnetic resonance imaging (MRI), or a physical examination.

For the scan, a small amount of a radioactive substance is injected into a vein. This substance is absorbed mainly by organs and tissues that use the most energy. Because cancer cells tend to use more energy than healthy cells, they absorb more of the radioactive substance. A scanner then detects this substance to produce images of organs and tissues inside the body.

The radioactive substance only stays in your body for a short time. Although there is a small risk of exposure to radiation from a PET scan, these risks are usually outweighed by the benefits of having the scan.

In many cases, the doctor will recommend an integrated PET-CT scan. This combines the images from a PET scan and a computed tomography (CT) scan that have been performed at the same time using the same machine. Together, these two scans create a more accurate picture of what is going on in the body than either test can offer alone. Learn more about what to expect with an integrated PET-CT scan.

The medical team

A PET scan is given at the radiology or nuclear medicine department of a hospital or at an imaging center. It is performed by a nuclear medicine or radiologic technologist (health care professionals who are specially trained and certified to operate PET scanners) and interpreted by a nuclear medicine physician or a radiologist (doctors who perform and interpret imaging tests to identify problems in the body).

Preparing for the procedure

When you schedule your test, you will receive detailed instructions about how to prepare. For example, you may be told to drink only clear liquids beginning at midnight the night before your examination and instructed to not eat or drink anything for at least four hours before your scan begins. However, talk with a member of your health care team about restrictions on eating and drinking because they may not be necessary for scans of some parts of the body.

You should also tell your doctor or nurse about all of the medications you are taking and ask whether you should take them on the day of the test. In addition, discuss any drug allergies or other medical conditions you have. For example, women should tell their doctors if they are breastfeeding or if there is any chance they may be pregnant because a PET scan could put the baby at risk.

You will be asked to sign a consent form that states you understand the benefits and risks of the PET scan and agree to undergo the test. Talk with your doctor about any concerns you have about the scan. You may also want to ask whether you can bring your own music at this time because some facilities allow patients to listen to music during their scan to make them more comfortable.

Finally, check with your insurance provider to find out whether the PET scan will be covered and whether you will have to pay any out-of-pocket costs.

During the procedure

When you arrive for your PET scan, you may need to change into a hospital gown or remove clothing or jewelry that could interfere with the scan. A technologist or a nurse will then deliver the radioactive substance into your vein through an intravenous (IV) injection. The IV line will feel like a pinprick when it is inserted, but the radioactive material will not cause any sensation in your body.

After the injection, the radioactive substance will take 30 to 90 minutes to reach the tissues that will be scanned. During that time, you will need to lie quietly without moving or talking because too much movement can interfere with the normal distribution of the radioactive material and make interpretation of the study more difficult.

When it is time for the test to begin, a technologist will help position you on a padded exam table outside of the PET scanner, which resembles a large donut. The scanning process will take approximately 30 to 60 minutes, during which the table will slowly slide back and forth through the large hole in the center of the machine about six times while you lie still. The PET scanner does not make a lot of noise.

After the procedure

You can expect to return to your normal activities immediately after the PET scan, including driving. You will be advised to drink several glasses of water to flush the radioactive material out of your body.

Questions to ask your doctor

Before having a PET scan, consider asking your doctor the following questions:

Who will perform the PET scan?What will happen during the PET scan?How long will the procedure take?What are the benefits and risks of having a PET scan?What are the restrictions on what I may eat or drink before the examination?If I am pregnant or breastfeeding, should I have this test?Will I need to avoid any activities after the PET scan?Do I need to bring any other radiologic images (such as MRI or CT) to my appointment?When will I learn the test results? How will the results be communicated to me?Who will explain the results to me?Will I need any additional tests?

More Information

Tests and Procedures

Additional Resources

RadiologyInfo.org: Positron Emission Tomography - Computed Tomography.

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When to Call the Doctor During Cancer Treatment

2012-10-19T00:18:00.001-07:00

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Listen to the Cancer.Net Podcast: When to Call the Doctor, adapted from this content.

Cancer and cancer treatments may cause side effects that require immediate attention. However, it is often hard to know when to call the doctor. For example, you may struggle to differentiate between a common cold and a more serious infection. Therefore, it is important to ask your doctor to explain the potential side effects of your specific type of cancer and cancer treatment, as well as the circumstances under which you should call for help.

Some side effects that require immediate attention include infections, deep vein thrombosis (a potentially life-threatening blood clot), and tumor lysis syndrome (a condition that can cause organ failure).

Infection

An infection occurs when bacteria, viruses, and, less commonly, fungi (such as yeast) invade the body’s tissues, and the immune system (which fights harmful organisms) cannot quickly destroy them. Cancer and its treatment may make it more likely that you will develop an infection. For example, a tumor in the lung might prevent normal secretions in the lung, making it easier for you to develop pneumonia. Other common sites of infection include the bladder, urinary tract, and gastrointestinal tract (which includes the stomach and intestines). Meanwhile, cancer treatments may also weaken the immune system, increasing the likelihood of an infection. For example, chemotherapy lowers the number of neutrophils (white blood cells that help fight infection).

The signs and symptoms of an infection vary depending on which part of the body is affected and whether it is a bacterial, viral, or fungal infection. However, common symptoms include a fever (a temperature of 100.5°F or higher), chills or sweating, and a general sense of feeling unwell. If you feel fine one day but feel poor the next, monitor your temperature to see if you have a fever. Other possible signs of an infection include a new cough, a burning sensation when urinating, new episodes of diarrhea, or an ulcer (sore) on the skin.

If you show any signs of an infection, call your doctor immediately, particularly if you have a fever seven to 10 days after receiving chemotherapy. Your doctor will help you determine whether the infection is serious and will recommend treatment.

To help prevent infections, get enough sleep and proper nutrition, exercise, wash your hands regularly, and avoid contact with people who are ill. Not all infections can be prevented, though.

Deep vein thrombosis

Thrombosis is a blood clot inside a blood vessel. Deep vein thrombosis (DVT) occurs when a blood clot forms inside a vein deep in the body, usually in the legs. Although the blood clot may go away naturally, DVT becomes life threatening if the clot travels to the lungs and causes a pulmonary embolism (PE), which is a blockage of one or more of the lung’s major arteries. Signs and symptoms of a PE include shortness of breath, a cough, a fever, or chest pain that becomes worse if you take a deep breath.

A common sign of DVT is swelling in the arm or leg that becomes warm, red, and painful. Contact your doctor as soon as you notice any swelling. DVT can be treated with drugs called anticoagulants.

Some types of cancer, such as adenocarcinomas (cancers that form in gland cells), and cancer treatments, including surgery, chemotherapy, and hormonal therapy, increase your risk of DVT because they may activate the body’s blood-clotting system. Prolonged immobility (not being able to move) is another risk factor for DVT. To help prevent blood clots, get out of bed and move around as soon as you can after surgery or illness. In addition, when sitting for an extended time while traveling, periodically get up from your seat and flex your muscles. If you have had DVT before, ask your doctor about wearing compression stockings while traveling or taking blood-thinning medication before a trip.

Other risk factors for DVT include a family history of blood clotting disorders, a recent surgery, and other conditions, such as heart disease and lung disease. The risk also increases with age.

Ask your doctor about your risk of developing a blood clot or DVT and about what you can do to help prevent them. Learn more about bleeding and clotting problems and the American Society of Clinical Oncology’s guideline on preventing and treating blood clots.

Tumor lysis syndrome

Tumor lysis syndrome (TLS) occurs due to the rapid death of cancer cells in response to treatment. When tumor cells die, they release their contents—including potassium, phosphate, and parts of the tumor’s DNA—into the bloodstream, which may disrupt the body’s metabolism (the rate at which the body uses energy) and the concentration of electrolytes (salts in the body that conduct electricity and help the body function properly). These imbalances can damage organs—including the heart, liver, and kidneys—and may cause seizures, loss of muscle control, and death.

TLS usually occurs after chemotherapy for a fast-growing cancer, such as some types of leukemia (cancers of the blood) or lymphoma (cancers of the lymph system), and it is detected by blood and other laboratory tests.

Signs of TLS may include nausea and vomiting, shortness of breath, irregular heartbeat, cloudy urine, lethargy (lack of energy), or pain in the joints.

Risk factors for TLS include having a type of cancer in which the tumor cells divide rapidly, including Burkitt lymphoma and large-cell lymphoma (types of non-Hodgkin lymphoma), acute lymphocytic leukemia, acute myeloid leukemia, and chronic lymphocytic leukemia. TLS rarely develops in people with solid tumors. Other risk factors for TLS include having elevated levels of white blood cells and uric acid before treatment, kidney problems, and dehydration.

TLS usually occurs within 48 hours after starting chemotherapy. Rarely, TLS may occur before starting chemotherapy. Patients at the greatest risk of TLS receive chemotherapy in the hospital so that doctors can monitor them and deliver intravenous (IV) fluids to help prevent TLS. Medications such as allopurinol (Aloprim, Lopurin, Zyloprim) and rasburicase (Elitek) are also given to help prevent TLS by lowering the level of uric acid in the body.

Communicating with the doctor and other members of the health care team

Each type of cancer and cancer treatment causes different side effects, so ask your doctor whether you should watch for any other potential complications. It’s also important to discuss how and when to contact your doctor and other members of your health care team during your treatment. Ask your doctor the following questions:

What are the possible side effects of my treatment, and which ones are considered an emergency?Under which circumstances should I call you during my treatment? What is your contact information?Under which circumstances should I contact other members of the health care team, and what are those individuals’ telephone numbers?What telephone number should I call after normal business hours?When can I expect a return call?Under which circumstances should I use email to communicate with you and your staff?When should I go straight to the emergency room?

More Information

Managing Side Effects

Traveling With Cancer

Additional Resources

National Cancer Institute: Infection

National Heart, Lung, and Blood Institute: What is Deep Vein Thrombosis?

Last Updated: July 23, 2012

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UCSD study finds blocking tumor-induced inflammation impacts cancer development

2012-10-18T12:53:00.000-07:00

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Researchers at the University of California, San Diego School of Medicine report the discovery of microbial–dependent mechanisms through which some cancers mount an inflammatory response that fuels their development and growth. The findings are published in the October 3, 2012 Advanced Online Edition of Nature. UCSD is home to the Moores Comprehensive Cancer Center.

Click here to read full press release.

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Salk Institute study suggests cold viruses may point the way to new cancer therapies

2012-10-18T09:48:00.001-07:00

Cold viruses generally get a bad rap—which they've certainly earned—but new findings by a team of scientists at the Salk Institute for Biological Studies suggest that these viruses might also be a valuable ally in the fight against cancer. Adenovirus, a type of cold virus, has developed molecular tools—proteins—that allow it to hijack a cell's molecular machinery, including large cellular machines involved in growth, replication and cancer suppression. The Salk scientists identified the construction of these molecular weapons and found that they bind together into long chains (polymers) to form a three-dimensional web inside cells that traps and overpowers cellular sentries involved in growth and cancer suppression. The findings, published October 11 in Cell, suggest a new avenue for developing cancer therapies by mimicking the strategies employed by the viruses.
Click here to read full press release.
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Among the research institutions NCI funds across the United States, it currently designates 67 as Cancer Centers. Largely based in research universities, these facilities are home to many of the NCI-supported scientists who conduct a wide range of intense, laboratory research into cancer’s origins and development. The Cancer Centers Program also focuses on trans-disciplinary research, including population science and clinical research. The centers’ research results are often at the forefront of studies in the cancer field.

View the original article here