Cancer Treatment Information Center癌症資訊交流

Treatment

2011-08-13T00:31:00.001-07:00

Treatment can involve surgery, radiation therapy, and chemotherapy. Brain tumors are best treated by a team involving a neurosurgeon, radiation oncologist, oncologist, or neuro-oncologist, and other health care providers, such as neurologists and social workers.

Early treatment often improves the chance of a good outcome. Treatment, however, depends on the size and type of tumor and the general health of the patient. The goals of treatment may be to cure the tumor, relieve symptoms, and improve brain function or the person's comfort.

Surgery is often necessary for most primary brain tumors. Some tumors may be completely removed. Those that are deep inside the brain or that enter brain tissue may be debulked instead of entirely removed. Debulking is a procedure to reduce the tumor's size.

Tumors can be difficult to remove completely by surgery alone, because the tumor invades surrounding brain tissue much like roots from a plant spread through soil. When the tumor cannot be removed, surgery may still help reduce pressure and relieve symptoms.

Radiation therapy is used for certain tumors.

Chemotherapy may be used along with surgery or radiation treatment.

Other medications used to treat primary brain tumors in children may include:

Corticosteroids, such as dexamethasone to reduce brain swelling
Osmotic diuretics, such as urea or mannitol to reduce brain swelling and pressure
Anticonvulsants, such as evetiracetam (Keppra) to reduce seizures
Pain medications
Antacids or histamine blockers to control stress ulcers

Comfort measures, safety measures, physical therapy, and occupational therapy may be needed to improve quality of life. The patient may need counseling, support groups, and similar measures to help cope with the disorder.

Patients may also consider enrolling in a clinical trial after talking with their treatment team.

Legal advice may be helpful in creating advanced directives such as a power of attorney.

Support Groups

For additional information, see cancer resources.

Complications

Brain herniation (often fatal)
- Uncal herniation
- Foramen magnum herniation
Loss of ability to interact or function
Permanent, worsening, and severe loss of brain function
Return of tumor growth
Side effects of medications, including chemotherapy
Side effects of radiation treatments

Calling your health care provider

Call your health care provider if you develop any new, persistent headaches or other symptoms of a brain tumor.

Call your provider or go to the emergency room if you start having seizures, or suddenly develop stupor (reduced alertness), vision changes, or speech changes.

References

Buckner JC, Brown PD, O'Neill BP, Meyer FB, Wetmore CJ, Uhm JH. Central nervous system tumors.Mayo Clin Proc. 2007;82(10):1271-1286. [PubMed]
Stupp R, Roila F; ESMO Guidelines Working Group. Malignant glioma: ESMO clinical recommendations for diagnosis, treatment, and follow-up. Ann Oncol. 2009;20 Suppl 4:126-128. [PubMed]
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Central nervous system cancers. V.2.2009.
Wen PY, Kesari S. Malignant gliomas in adults. N Engl J Med. 2008 Jul 31;359(5):492-507. [PubMed]

Brain tumor - primary - adults

2011-08-13T00:30:00.001-07:00

Glioblastoma multiforme - adults; Ependymoma - adults; Glioma - adults; Astrocytoma - adults; Medulloblastoma - adults; Neuroglioma - adults; Oligodendroglioma - adults; Meningioma - adults; Cancer - brain tumor (adults)

Last reviewed: November 23, 2010.

A primary brain tumor is a group (mass) of abnormal cells that start in the brain. This article focuses on primary brain tumors in adults.

Causes, incidence, and risk factors

Primary brain tumors include any tumor that starts in the brain. Primary brain tumors can arise from the brain cells, the membranes around the brain (meninges), nerves, or glands.

Tumors can directly destroy brain cells. They can also damage cells by producing inflammation, placing pressure on other parts of the brain, and increasing pressure within the skull.

The cause of primary brain tumors is unknown. There are many possible risk factors that could play a role.

Radiation therapy to the brain, used to treat brain cancers, increases the risk for brain tumors up to 20 or 30 years afterwards.
Exposure to radiation at work or to power lines, as well as head injuries, smoking, and hormone replacement therapy have NOT yet been shown to be factors.
The risk of using cell phones is hotly debated. However, most recent studies have found that cell phones, cordless phones, and wireless devices are safe and do not increase the risk.
Some inherited conditions increase the risk of brain tumors, including neurofibromatosis, Von Hippel-Lindau syndrome, Li-Fraumeni syndrome, and Turcot syndrome.

SPECIFIC TUMOR TYPES

Brain tumors are classified depending on the exact site of the tumor, the type of tissue involved, whether they are noncancerous (benign) or cancerous (malignant), and other factors. Sometimes, tumors that start out being less invasive can become more invasive.

Tumors may occur at any age, but many types of tumors are most common in a certain age group. In adults, gliomas and meningiomas are most common.

Gliomas come from glial cells such as astrocytes, oligodendrocytes, and ependymal cells. The gliomas are divided into three types:

Astrocytic tumors include astrocytomas (less malignant), anaplastic astrocytomas, and glioblastomas (most malignant).
Oligodendroglial tumors also can vary from less malignant to very malignant. Some primary brain tumors are made up of both astrocytic and oligodendrocytic tumors. These are called mixed gliomas.
Glioblastomas are the most aggressive type of primary brain tumor.

Meningiomas are another type of brain tumor. These tumors:

Occur most commonly between the ages of 40 - 70
Are much more common in women
Are usually (90% of the time) benign, but still may cause devastating complications and death due to their size or location. Some are cancerous and aggressive.

Other primary brain tumors in adults are rare. These include:

Ependymomas
Craniopharyngiomas
Pituitary tumors
Primary lymphoma of the brain
Pineal gland tumors
Primary germ cell tumors of the brain

Symptoms

A doctor can often identify signs and symptoms that are specific to the tumor location. Some tumors may not cause symptoms until they are very large. Then they can lead to a rapid decline in the person's health. Other tumors have symptoms that develop slowly.

The specific symptoms depend on the tumor's size, location, how far it has spread, and related swelling. The most common symptoms are:

Headaches
Seizures (especially in older adults)
Weakness in one part of the body
Changes in the person's mental functions

Headaches caused by brain tumors may:

Be worse when the person wakes up in the morning, and clear up in a few hours
Occur during sleep
Be accompanied by vomiting, confusion, double vision, weakness, or numbness
Get worse with coughing or exercise, or with a change in body position

Other symptoms may include:

Change in alertness (including sleepiness, unconsciousness, and coma)
Changes in hearing
Changes in taste or smell
Changes that affect touch and the ability to feel pain, pressure, different temperatures, or other stimuli
Clumsiness
Confusion or memory loss
Difficulty swallowing
Difficulty writing or reading
Dizziness or abnormal sensation of movement (vertigo)
Eye abnormalities
- Eyelid drooping
- Pupils different sizes
- Uncontrollable movements
Hand tremor
Lack of control over the bladder or bowels
Loss of balance
Loss of coordination
Muscle weakness in the face, arm, or leg (usually on just one side)
Numbness or tingling on one side of the body
Personality, mood, behavioral, or emotional changes
Problems with eyesight, including decreased vision, double vision, or total loss of vision
Trouble speaking or understanding others who are speaking
Trouble walking

Other symptoms that may occur with a pituitary tumor:

Abnormal nipple discharge
Absent menstruation (periods)
Breast development in men
Enlarged hands, feet
Excessive body hair
Facial changes
Low blood pressure
Obesity
Sensitivity to heat or cold

Signs and tests

Most brain tumors increase pressure within the skull and compress brain tissue because of their size and weight.

The following tests may confirm the presence of a brain tumor and identify its location:

CT scan of the head
EEG
Examination of tissue removed from the tumor during surgery or CT-guided biopsy (may confirm the exact type of tumor)
Examination of the cerebral spinal fluid (CSF) (may reveal cancerous cells)
MRI of the head

Brain tumor - primary - adults

2011-08-13T00:29:00.001-07:00

Last reviewed: November 23, 2010.

A primary brain tumor is a group (mass) of abnormal cells that start in the brain. This article focuses on primary brain tumors in adults.

Causes, incidence, and risk factors

Primary brain tumors include any tumor that starts in the brain. Primary brain tumors can arise from the brain cells, the membranes around the brain (meninges), nerves, or glands.

Tumors can directly destroy brain cells. They can also damage cells by producing inflammation, placing pressure on other parts of the brain, and increasing pressure within the skull.

The cause of primary brain tumors is unknown. There are many possible risk factors that could play a role.

Radiation therapy to the brain, used to treat brain cancers, increases the risk for brain tumors up to 20 or 30 years afterwards.
Exposure to radiation at work or to power lines, as well as head injuries, smoking, and hormone replacement therapy have NOT yet been shown to be factors.
The risk of using cell phones is hotly debated. However, most recent studies have found that cell phones, cordless phones, and wireless devices are safe and do not increase the risk.
Some inherited conditions increase the risk of brain tumors, including neurofibromatosis, Von Hippel-Lindau syndrome, Li-Fraumeni syndrome, and Turcot syndrome.

SPECIFIC TUMOR TYPES

Tumors may occur at any age, but many types of tumors are most common in a certain age group. In adults, gliomas and meningiomas are most common.

Gliomas come from glial cells such as astrocytes, oligodendrocytes, and ependymal cells. The gliomas are divided into three types:

Astrocytic tumors include astrocytomas (less malignant), anaplastic astrocytomas, and glioblastomas (most malignant).
Oligodendroglial tumors also can vary from less malignant to very malignant. Some primary brain tumors are made up of both astrocytic and oligodendrocytic tumors. These are called mixed gliomas.
Glioblastomas are the most aggressive type of primary brain tumor.

Meningiomas are another type of brain tumor. These tumors:

Occur most commonly between the ages of 40 - 70
Are much more common in women
Are usually (90% of the time) benign, but still may cause devastating complications and death due to their size or location. Some are cancerous and aggressive.

Other primary brain tumors in adults are rare. These include:

Ependymomas
Craniopharyngiomas
Pituitary tumors
Primary lymphoma of the brain
Pineal gland tumors
Primary germ cell tumors of the brain

Symptoms

The specific symptoms depend on the tumor's size, location, how far it has spread, and related swelling. The most common symptoms are:

Headaches
Seizures (especially in older adults)
Weakness in one part of the body
Changes in the person's mental functions

Headaches caused by brain tumors may:

Be worse when the person wakes up in the morning, and clear up in a few hours
Occur during sleep
Be accompanied by vomiting, confusion, double vision, weakness, or numbness
Get worse with coughing or exercise, or with a change in body position

Other symptoms may include:

Change in alertness (including sleepiness, unconsciousness, and coma)
Changes in hearing
Changes in taste or smell
Changes that affect touch and the ability to feel pain, pressure, different temperatures, or other stimuli
Clumsiness
Confusion or memory loss
Difficulty swallowing
Difficulty writing or reading
Dizziness or abnormal sensation of movement (vertigo)
Eye abnormalities
- Eyelid drooping
- Pupils different sizes
- Uncontrollable movements
Hand tremor
Lack of control over the bladder or bowels
Loss of balance
Loss of coordination
Muscle weakness in the face, arm, or leg (usually on just one side)
Numbness or tingling on one side of the body
Personality, mood, behavioral, or emotional changes
Problems with eyesight, including decreased vision, double vision, or total loss of vision
Trouble speaking or understanding others who are speaking
Trouble walking

Other symptoms that may occur with a pituitary tumor:

Abnormal nipple discharge
Absent menstruation (periods)
Breast development in men
Enlarged hands, feet
Excessive body hair
Facial changes
Low blood pressure
Obesity
Sensitivity to heat or cold

Signs and tests

Most brain tumors increase pressure within the skull and compress brain tissue because of their size and weight.

The following tests may confirm the presence of a brain tumor and identify its location:

CT scan of the head
EEG
Examination of tissue removed from the tumor during surgery or CT-guided biopsy (may confirm the exact type of tumor)
Examination of the cerebral spinal fluid (CSF) (may reveal cancerous cells)
MRI of the head

Alternative Cancer Options with Vitamin C or Interleukin-2

2010-12-12T23:43:00.000-08:00

Integrative Regulatory Therapy with Vitamin C

Some patients have types of cancers that are inherently resistant to conventional cancer treatments; other patients express a preference for integrative cancer treatment approaches. For these patients, the IRT-C protocol offers a good option. IRT-C exploits the discovery that, in very high concentrations achievable only by intravenous administration, vitamin C (ascorbate) can generate large amounts of potential cytotoxic free radicals that many cancers are selectively sensitive to, owing to a deficiency ofantioxidant enzymes. By boosting tumor oxygenation and co-administering a catalytic form of vitamin K, the IRT-C regimen further amplifies the capacity of vitamin C to generate severe oxidative stress in tumors.

The very good news about the IRT-C approach is that it does not harm normal healthy tissues, which have adequate antioxidant defenses; thus, IRT-C is virtually free of side effects. The home treatment care program prescribed by the IRT-C includes measures to slow cancer multiplication, inhibit tumor-supportive angiogenesis, suppress the formation of new metastases, and fortify anti-cancer immune defenses.

Integrative Regulatory Therapy with Interleukin-2

Our recently introduced IRT-IL regimen is essentially a modification of the IRT-C protocol that exploits the recent exciting discovery that subcutaneous injections of the immune-boosting hormone interleukin-2 (IL-2) synergize with supplemental melatonin in amplifying anti-cancer immune defenses and prolonging high-quality survival. Patients in this protocol receive the high-dose intravenous vitamin C regimen, designed to kill antioxidant-deficient tumor cells, that is the centerpiece of the IRT-C regimen. But they also receive daily subcutaneous IL-2 injections as a complement to nocturnal melatonin supplementation. The at-home regimen employed with IRT-IL includes several injections of IL-2 per month (patients are trained to give their own injections, much like diabetics are trained to inject insulin), as well as other immune-boosting measures such as melatonin, probiotics, and cancer therapeutic measures (which actually enhances immune system capacities by selectively killing immunosuppressive Treg Cells which are immune cells resistance to treatment).

Although the at-home regimen used with IRT-IL, like that used with other Oasis protocols, is also intended to slow cancer growth, block angiogenesis, and prevent formation of new metastases, it has been slightly modified to exclude certain nutraceuticals and drugs that may not be compatible with optimization of immune capacities.

Stage 4 Cancer Treatment

2010-12-12T23:39:00.001-08:00

Alternative Cancer Treatments for Stage 4 Cancer Patients

A cancer is said to be in Stage IV when it has spread from its site of origin to distant organs, this progression is also known as metastasis. Unless a metastasis is singular—meaning it has only spread to one specific site—and accessible, it usually means that the cancer is no longer curable with localized therapies such as surgery or radiotherapy.

Some types of stage IV cancer can be attacked effectively with chemotherapy; other types are poorly responsive to the cytotoxic drugs that are currently available. Even when a cancer shows a good initial response to chemotherapy - shrinking or disappearing - in most cases the cancer eventually grows back, this time in a form that is less responsive to the chemotherapy. This evolution of chemo-resistance is not a mystery, because it is well known that the chromosomes of cancer cells are prone to undergo frequent changes (genetic and epigenetic). All cancer cells behave differently and thus their response to chemotherapy drugs varies. Successful chemotherapy will kill a high proportion of the responsive cells in a tumor - but the less responsive cells are prone to survive and give rise to new tumors that will be much harder to kill with the initial chemotherapy.

When stage IV cancer continue to progress despite repeated attempts of conventional cancer treatment, most doctors are prone to throwing up their hands, telling the patient that "I've done all I can", and suggesting that the patient find a good hospice and get his or her affairs in order.

A high proportion of the patients who come to Oasis of Hope have stage IV cancer and have already been through this discouraging process. But at Oasis of Hope they encounter doctors who are eager to work with them and to fight for them as long as they are willing to fight for themselves. At Oasis there truly is Hope for patients with stage IV cancer.

Survival Statistics | Cancer Treatment Center

2010-12-12T23:38:00.000-08:00

Survival Statistics |Cancer Treatment Center

Though the scientific basis for the IRT protocols have been substantiated in this book, for many, it all comes down to survival statistics. Recently, we analyzed the survival of the first group of patients who have been treated with our relatively new IRT-Q and IRT-C protocols. Because these protocols have been in place for only several years, we obviously have not been able to calculate 5-year survivals yet, but we have been able to determine meaningful 1- and 2-year survivals for the most common types of cancer treated with the IRT-Q protocol. For the current IRT-C protocol, which has now been in use for a little under 2 years, we have had enough experience to calculate 1-year survivals in breast, lung, and colorectal cancer. Since most patients who come to Oasis of Hope have advanced metastatic disease when they get here, we have restricted this analysis to patients who were stage 4 at the time of diagnosis, so that our results can be compared objectively with those of other medical centers. Stage 4 usually means that metastases are present in distant organs. Also, we have included only those patients who were sufficiently healthy to complete at least 3 courses of therapy, which usually takes about 3 months. In patients diagnosed with stage 4 breast cancer, we have also done a separate analysis for those patients who arrived at Oasis of Hope within 6 months of their diagnosis. For many of these patients, Oasis of Hope was their first treatment option.

Tables I, II and III display our results. The results of "conventional treatment" which we have included for comparison are derived from the National Cancer Institute's recent (2007) SEER Survival Monograph – "Cancer Survival Among Adults – U.S. SEER Program, 1988-2001". This publication provides average cancer survival rates in major regions of the United States. Unfortunately, this volume does not provide 2-year survivals rates for colorectal cancer, so in this case we have used the 2-year survival results of a major medical center in Toronto. The results seem reasonably concordant with the 1-year results published in the SEER monograph.

Table I. Survival Rates for Stage IV Cancer, IRT vs. Conventional Treatment
Type of Cancer	Oasis IRT-Q Survival %				Conventional Treatment Survival %*
Type of Cancer	1-yr	2-yr	3-yr	4-Year	1-yr	2-yr	3-yr	4-Year
Breast**	100	90	84	78	65	44	32	25
Breast	92	73	60	51	65	44	32	25
Lung	70	43	30	18	20	6	3	<2.0
Ovarian	94	88	76	65	62	43	30	23
Colorectal	66	46	32	26	43	22	13	10
National Cancer Institute: US SEER Survival Monograph 2007 *Oasis of Hope was the first treatment option

It is clear that, in terms of survival, Oasis of Hope patients are doing better than those receiving the average standard of care in the U.S. In particular, survival in lung cancer is strikingly better. We are not doing as well with colorectal cancer. This cancer is typically resistant to available chemotherapies. But, even here our results appear to be superior to conventional treatment. Note also that our results with stage 4 breast cancer patients who came to Oasis soon after diagnosis are quite good – a doubling of two-year survival relative to conventional therapy.

With respect to the admittedly preliminary results of the IRT-C protocol, it is encouraging that, even without chemotherapy treatments, our patients have been doing better than those on conventional therapy.

Admittedly, we can’t claim that many of these patients have been "cured" – in the sense that the cancer has been eliminated and won’t come back. But it does seem that we are making some progress toward the goal of turning advanced cancer into a chronic disease that can be managed in the long term – rather like diabetes – as opposed to a rapid death sentence. And remember that our IRT protocols are in a constant state of evolution – barely a month goes by that we don’t add some new element to our regimens, or modify them in a way that seems likely to improve their efficacy. So we are cautiously optimistic that we are on the right track, and that our results will continue to improve over the coming years.

SURVIVAL RATES FOR STAGE 4 CANCER IRT-C
Type of Cancer	Oasis IRT-C		Conventional Treatment*
Type of Cancer	1-Year Survival(%)	2-Year Survival(%)	1-Year Survival(%)	2-Year Survival(%)
Breast**	87	73	65	44
Breast	78	62	65	44
Lung	72	44	20	6
Colorectal	73	41	43	22
National Cancer Institute: U.S. SEER Survival monograph 2007 *Patients in whom Oasis of Hope was the 1st treatment options

SURVIVAL RATES FOR STAGE 4 IRT-Q vs. IRT-C
Type of Cancer	Oasis IRT-Q		Oasis of Hope IRT-C
Type of Cancer	1-Year Survival(%)	2-Year Survival(%)	1-Year Survival(%)	2-Year Survival(%)
Breast*	100	90	87	73
Breast	92	70	78	62
Lung	76	41	72	44
Ovarian	94	88	N/A	N/A
Colorectal	65	42	73	41
*Oasis of Hope was the 1st treatment options

These results are promising and suggest that Oasis of Hope should continue to evaluate new therapies and find ways to integrate new proven modalities into a comprehensive cancer management program that can improve the prognosis of a patient, his quality of life, and his ability to engage in normal activities. This is the commitment of the members of the Oasis of Hope Health Group.

Cancer Treatment Center | Oasis of Hope

2010-12-12T23:36:00.001-08:00

Cancer Treatment Center | Oasis of Hope
As one of the most renowned institutions for the treatment of cancer with integrativeand alternative cancer treatments, Oasis of Hope strives to provide healing through research, review and analysis of the most recent discoveries in oncology.

Our world-class research group and experienced medical staff collaborate to identify, develop and implement effective protocols for cancer treatment. Patients at Oasis of Hope are enrolled into the main protocol known as Integrative Regulatory Therapy. IRT is subdivided into three basic protocols: IRT-Q (Alternative cancer treatment with low dose chemotherapy),IRT-C (Alternative cancer treatment with megadose Vitamin C and K), and IRT-IL (Alternative cancer treatment with interleukin). These protocols are chosen based on the patient’s medical needs. At Oasis of Hope doctors and scientists work with you to develop a comprehensive andindividualized cancer treatment plan to help improve your prognosis and quality of life. To learn more about our Alternative Cancer Treatment Center, please read our book in our research page titled "Integrative Regulatory Therapy: A multi-focal strategy for cancer control".

Medical Support for Veterans with Mesothelioma

2010-12-07T11:37:00.000-08:00

diagnosis of mesothelioma is devastating for anyone. For veterans, it is also disheartening to learn that this deadly asbestos cancer is often the result of exposure to asbestos while serving their country. But while the diagnosis is hard to swallow, regardless of how the disease developed, getting medical support and care is of the utmost importance and should be in the forefront of the mind of anyone who develops the disease.

Mesothelioma is often diagnosed in its latest stages, so seeking appropriate treatment quickly is essential. Fortunately there is much medical support available for veterans with mesothelioma. First, it is necessary to locate an oncologist who is trained and skilled in the treatment of this disease. Because mesothelioma is a rare form of cancer, not everyone is trained to treat it. Look for a thoracic oncologist who can suggest not only the propermesothelioma treatment, but also recommend enrollment in clinical trials. The ailing veteran deserves every chance possible to extend his or her life.

Take time to find out where to receive the best medical support. Veterans don't need to limit themselves to VA hospitals. While veterans' networks may be able to suggest facilities where mesothelioma care is top-notch, it is largely up to the individual as to where to seek treatment. Specialists are located throughout the country. Generally, there are more meso specialists in urban areas and regions that have historically been most affected by the disease, including towns where naval shipyards are or were located.

Because mesothelioma cancer is most often diagnosed after it has done much damage, treatment options may be limited and medical support may include chemotherapy,radiation, or mesothelioma surgery and - in some cases - a combination of all three (multi-modality therapy). Many individuals also turn to alternative therapies, especially when seeking palliative care - which is treatment meant not to cure but to keep the patient comfortable. Palliative measures may include massage, meditation, acupuncture, and other non-traditional therapies.

Veteran-run organizations, like the Veterans Benefits Network, can help former U.S. Armed Forces members who are suffering from mesothelioma determine where they can seek treatment and how they can get the benefits they've earned, especially now that they are ill. Claim information is available from this network as are contacts for both medical and legal help. Many of these organizations also offer chat rooms or discussion boards where veterans with mesothelioma and other diseases can learn about and discuss their options for medical support with others like them.

Because mesothelioma has entered the spotlight more prominently in recent years, options for treatment and medical support for veterans with the disease continue to grow. Research also continues at a brisker pace, with more dollars being allocated to those who have dedicated their careers to studying the disease and coming up with new and better treatments for meso victims. Because of this, treatment has improved greatly over the last few years and stands to progress even further within the next decade or so.

Mesothelioma Treatment

2010-12-07T11:35:00.000-08:00

For your convenience, we have consolidated mesothelioma treatment information for your review. This section is updated on a weekly basis.

Conventional Therapies

Conventional therapies include mesothelioma surgery,radiation and chemotherapy. You should keep in mind that if you choose one course of action for mesothelioma treatment, you may preclude other courses. All of your options should be considered as soon as possible.

Stage of the disease at diagnosis, as well as general patient age and health, will determine what type of mesothelioma treatment each patient is eligible for. Surgery is more likely in those diagnosed with stage 1 mesothelioma or similarly early-staged disease. Diagnostic surgeries like mesothelioma biopsy, and palliative surgeries like pleurocentesis, are more common in patients with more advanced disease.

Chemotherapy options include the FDA-approved combination of Alimta and Cisplatin, as well as other drugs which are currently in active clinical trials. Other drugs showing positive results in trial include Gemcitabine and Navelbine. Conjunctive treatments include the approach which combines one conventional therapy with another such as surgery in combination with chemotherapy. Multi-modal mesothelioma treatment includes heated intra-operative chemotherapy which applies a potent dose of chemotherapy to the surface of the actual affected area.

Experimental Therapies

Several forms of mesothelioma treatment such as the drug Alimta®, gene therapy,immunotherapy, photodynamic therapy and multimodality therapy are still in their experimental stages. We invite you to read the following articles on experimental therapies for malignant mesothelioma.

Alternative Treatments

Many of those being treated for serious illness find comfort in different alternative therapies such as massage and acupuncture. These untraditional methods of disease management can complement conventional therapies and allow the patient to be more at peace and comfortable during this difficult time. Meditation and Yoga are common methods used by many to reach a state of relaxation, and release endorphins, our body's natural pain relievers.

The majority of these treatments are based upon patient preference but patients undergoing mesothelioma treatment are encouraged to utilize one or many of these options, which can dramatically improve patient stamina and strength while undergoing treatment for mesothelioma. Nutritional supplements and other health enhancers should also be considered by all patients undergoing mesothelioma treatment, as the disease can deplete strength and general immune health.

Treatment by Stage

This section lists typical treatment strategies based on the stage (using the Butchart staging system) of a pleural mesothelioma. Stage one mesothelioma can be treated with any number of different methods, depending on the patient's health, including surgical resection of the disease or more advanced procedures like extrapleural pnemonectomy and lung pneumonectomy. Patients diagnosed with advanced-stage disease will likely manage their disease and its symptoms through some combination of chemotherapy, radiation therapy, and alternative therapies.

Mesothelioma Doctors

We have become familiar with medical doctors who specialize in aggressively treatingmesothelioma cancer. Some of these doctors will review your medical records for free to see if you are a candidate for their mesothelioma treatment protocol.

Some of the more notable mesothelioma doctors include Dr. David Sugarbaker of the Dana Farber Cancer Institute, Dr. Valerie Rusch of Memorial Sloan-Kettering Cancer Center, andDr. Harvey Pass of the New York University Medical Center Division of Thoracic Surgery. Each of these oncologists have an acute knowledge of the behavior and pathology of malignant mesothelioma and its treatments. It is likely that if you are diagnosed with mesothelioma, you will be referred by your personal physician to a larger scale comprehensive cancer center like those discussed here.

Cancer Centers

Top Cancer Centers for mesothelioma treatment have been listed alphabetically by state for your convenience. Listings include contact information and Web site links where available.

Some of the most exciting and advanced mesothelioma treatment techniques are being researched and explored through the International Mesothelioma Program at the Dana Farber Cancer Institute's Harvard University Brigham and Women's Hospital in Boston under the auspices of Dr. Sugarbaker. Multi-modal therapies, including combination therapies including advanced surgical procedures in conjunction with chemotherapy are some of the many exploratory therapies being researched at the IMP. Exciting studies are also arising out of the University of Texas M.D. Anderson Cancer Center and the University of California San Francisco under the auspices of Dr. David Jablons.

Clinical Trials

Information about current studies of promising new or experimental mesothelioma treatments. Several clinical trials are actively recruiting patients of malignant mesothelioma. Patients undergoing mesothelioma treatment should strongly consider participating in a clinical trial. Mesothelioma survival rate can be dramatically extended in those who are treated with as-yet unapproved/experimental therapies. Given the lack of a mesothelioma cure, participation in clinical trials among mesothelioma patients is common. A patient's ability to participate in a clinical trial will be dependent on a number of factors including age, general health, and stage of disease at diagnosis.

Ask Your Doctor

As you deal with your cancer and the process of treatment, you need to have honest, open discussions with your cancer care team. We have listed some questions that you might want to ask in this section. We urge not only patients undergoing mesothelioma treatment, but also family members and loved ones to read this section carefully, and pursue answers not only these questions but all mesothelioma treatment-related questions with your oncologist or mesothelioma specialist.

Mesothelioma Research

Selected abstracts relating to malignant mesothelioma from PubMed, the National Library of Medicine's search service.

Mesothelioma Resources

There are a number of resources available to help you and your family deal with issues that arise when dealing with cancer. Get access to a wide range of information from financial consulting and counseling services to sleep disorder and patient hair loss resources. You can even find providers of these services in your geographic area.

Mesothelioma Alerts

We know how important it is for those diagnosed with mesothelioma to be kept informed about the latest mesothelioma research. This treatment alert section contains articles regarding the most recent advances in mesothelioma treatment and the medical breakthroughs that are helping to improve longevity and quality of life in mesothelioma patients.

Source

National Cancer Institute - Treatment Options for Malignant Mesothelioma
http://www.cancer.gov/cancertopics/pdq/treatment/malignantmesothelioma/Patient/page5

Asbestos Cancer

2010-12-07T11:32:00.000-08:00

sbestos cancer, or the type of cancer most commonly associated with asbestos exposure, is a malignancy that occurs in the lining of the lungs, abdomen, and heart. A mesothelioma diagnosis is generally classified as one of the following three types: pleural mesotheliomawhich occurs in the lining of the lungs, known as the pleura, peritoneal mesothelioma which occurs in the lining of the abdominal cavity, known as the peritoneum and pericardial mesothelioma which occurs in the lining of the heart, known as the pericardium.

Asbestos, which has been used for, quite literally, thousands of years as a fire-retardant and insulation material has long been connected to sickness, though not necessarily cancer until the last 50 years. Illnesses in those who were frequently exposed to asbestos could be traced back to ancient times, when slaves who were known to have worked with asbestos were valued less because of a high incidence of respiratory failure.

Once asbestos was classified as a known carcinogen, the Environmental Protection Agency and Consumer Product Safety Commission imposed strict regulation on its use in commercial and industrial products. Unfortunately, many of the companies producing asbestos products were well aware of the hazards which asbestos posed and continued to expose workers and laborers to the harmful fibers.

What Causes Asbestos Cancer

Asbestos cancer is referred to as such because development of mesothelioma is conclusively linked to asbestos exposure. Asbestos is a fibrous mineral that was used for centuries in a number of different industrial capacities and asbestos jobsites. While it was quite useful, unfortunately it was also carcinogenic, leading to most asbestos products being banned in the late 1970's.

Pleural mesothelioma is caused by inhaled asbestos fibers which lodge in the pleura and lung wall. Because they are quite durable, they cannot be broken down by chemical means or expelled by other body functions. Peritoneal mesothelioma is caused by either ingested asbestos fibers which lodge beneath the digestive tract or fibers which affect the lymph nodes. Pericardial mesothelioma's causal relationship with asbestos is uncertain but physicians and researchers believe the microscopic asbestos fibers actually enter the bloodstream through the lungs and become affixed to the lining of the heart in transfer. Asbestos fibers on this delicate tissue cause a sustained inflammation of the area, causing harmful scar tissue and asbestos cancer cells to develop.

Asbestos Cancer Treatment

A mesothelioma prognosis is not always encouraging in malignant mesothelioma cases. Often, many patients die within 18 months of their diagnosis, depending on the stage of the cancer at diagnosis and the extent to which the cancer has metastasized. Mesothelioma is an aggressive cancer and the locale of the disease within the body often restrictsmesothelioma surgery. In most cases, patients will be given chemotherapy and radiation to slow the disease and ease symptoms of the disease. Additional relief from asbestos cancer symptoms can often be found using alternative treatments.

Asbestos Cancer Surgery

Depending on the location of the cancer, generally asbestos related malignancies can be difficult to resect because the latency period over which the cancer goes undetected can often extend into the time period where the tumor develops through its preliminary stages. Later stage cancers, and particularly those related to asbestos, will often not be resectable malignancies. While diagnosis of early stage asbestos cancer is uncommon, certainly those eligible for surgical removal will often have the cancer resected. Adjuvant chemotherapy is often administered after surgery to complement the resection.

Pleurectomy and Extrapleural pneumonectomy, both extensive surgeries, are often used in the treatment of pleural asbestos cancer. Surgery is much less common in malignant peritoneal and pericardial cancer, as the origin of the tumor is difficult to access without endangering the survival of the patient.

Asbestos Cancer Chemotherapy

Chemotherapy is the most frequently utilized treatment mechanism for the control of asbestos cancer. Drugs like Alimpta, Cisplatin, and Gemcitabine have all been used with varying degrees of efficacy to halt or slow the spread of malignant mesothelioma and lung carcinomas. Ongoing clinical trials continue to test new drugs and drug cocktails for the management and treatment of asbestos cancer. Recent trends suggest that researchers are making strides in determining approved treatment regimens not only for malignant pleural mesothelioma, but also peritoneal and pericardial cancers.

Currently, the only FDA-approved chemotherapy regimen for the asbestos cancer malignant pleural mesothelioma is a combination of Alimta and Cisplatin, delivered intravenously, with 21 days between each subsequent injection. Asbestos lung cancer carcinomas are also treatable with chemotherapy. Because asbestos cancer incidence of this type is much more prevalent (and not necessarily directly attributable to asbestos exposure), there are many more chemotherapy options available to patients.

Asbestos Cancer Radiation Therapy

External beam radiation is popular among patients receiving treatment for pleural and peritoneal cancer. Pericardial cancer patients may also utilize radiation in the control of their cancer, but in lower dosages considering the region's proximity to the heart. Radiation therapy is considered useful for palliation as well to prevent malignant cells from taking hold again following surgery.

As part of developing studies into the control of asbestos cancer through radiotherapy, researchers have begun utilizing brachytherapy to control mesothelioma tumor spread and growth. Brachytherapy is an internal radiation source implanted in the affected area which has shown promise in clinical studies in reducing tumor mass and slowing. Every year,mesothelioma survival rates are extended further and more funding is now being invested in research to evaluate new options for treatment of mesothelioma. Researchers hope to one day find a cure for mesothelioma.

Diagnosis of Asbestos-Related Cancer

Asbestos cancer diagnosis, including diagnosis of mesothelioma and lung carcinoma, can be difficult because symptoms of the disease can closely mimic those of other more minor respiratory complications. Symptoms, such as shortness of breath, chest pain, or chronic cough may lead physicians to suspect mesothelioma, particularly if the patient has a knownasbestos exposure history.

Diagnostic tools include CT scans and MRIs for patients where asbestos cancer is suspected. In most cases, these imaging scans will be able to provide a picture of the tumor, but a biopsy will likely be required to determine a conclusive diagnosis of mesothelioma rather than other lung carcinomas. In cases where pleural or peritoneal effusions have manifested in the patient, draining these and extracting the fluid through pleurocentesis can allow oncologists to test the fluid for the presence of malignant cells.

Compensation for Asbestos Cancer

Unfortunately, it has come to light in recent years that many manufacturers of asbestos products were fully aware of the harmful nature of asbestos fibers and continued to expose hundreds of thousands of laborers to the toxic mineral. Asbestos products were prevalent in naval shipyards, power plants, oil refineries, and in ventilation/steam fixtures. Asbestos was also common in home construction materials, automobile parts, and thousands of other products.

While asbestos is now known to be highly toxic, there is a great deal of latency associated with asbestos cancer. Asbestos-related inflammation takes decades to develop within the lung and pleura before this inflammation translates into malignant tumor growth. Those exposed even forty to sixty years ago may still be at risk.

Fortunately, you may be eligible for financial compensation if you have been diagnosed with asbestos-related cancer or other injury. While prognosis for asbestos related cancer is often poor, those who have been exposed negligently are able to secure compensation for their treatment as well as for their families in their battle with terminal disease. If you or a loved one has been diagnosed with mesothelioma or other asbestos-related disease, we urge you to fill out the brief form on this page. We'll send you an up-to-date information packet on new treatment options for mesothelioma, how to obtain compensation for your injuries, and important timelines associated with legal recourse for asbestos cancer patients.

Additional Topics in this Section

Asbestos Disease

While the asbestos cancer mesothelioma is the most harmful of the illnesses causes by exposure, asbestos has also been linked to lung cancer, asbestosis, and other respiratory complications.

Asbestos Types

There are two major sub-classifications of asbestos types. These are serpentine and amphibole. The singular serpentine variety is called chrysotile. Crocidolite, amosite, anthophyllite, tremolite, and actinolite are amphibole varieties.

Asbestos Alternatives

Once the nexus was established between asbestos and cancer, companies were implored to utilize asbestos alternatives. Learn about specific alternatives in this section.

Asbestos History

As stated above, asbestos has been used for many years for the purposes of insulation, prevention of heat transfer, and durability in industrial and construction materials.

Asbestos Facts and Statistics

Learn more about specific asbestos facts and statistics in this comprehensive section of our website.

Asbestos Disease in Pets and other Animals

Asbestos disease is known not only to affect humans, but has also been known to affect domestic pets and other animals. Asbestos is easily inhaled, and pets are not immune to the harmful damage caused by asbestos fibers. Learn more about how asbestos can affect your pets or other animals in this section.

Sources

National Cancer Institute - Asbestos Exposure and Cancer Risk
http://www.cancer.gov/cancertopics/factsheet/Risk/asbestos

American Cancer Society - Asbestos - What Is Asbestos?
http://www.cancer.org/docroot/ped/content/ped_1_3x_asbestos.asp

Veterans & Mesothelioma

2010-12-07T11:30:00.001-08:00

Veterans & Mesothelioma

Among all those individuals in the United States stricken with mesothelioma cancer, veterans represent the group of people with the highest rate of the disease. The reason why is simple. Asbestos, the only known cause of mesothelioma, was used by the U.S. military for literally hundreds of applications. From the 1930s until the late 1970s, veterans - especially those who worked aboard ships or in shipyards - were regularly exposed to hazardous asbestos, a naturally-mined substance whose sharp fibers can be inhaled and can penetrate the lungs, causing scarring and, eventually, pleural mesothelioma. While pleural mesothelioma is the most common type of mesothelioma, veteran asbestos exposure has also been connected topericardial mesothelioma and peritoneal mesothelioma, which affect the lining of the heart and abdominal cavities.

The branch of the service one served in does not matter. Asbestos was present in many locations owned or frequented by members of the U.S. Armed Forces. Because exposure was unavoidable for some, mesothelioma remains one of the most serious diseases affecting veterans, particularly those who served between World War II and the Vietnam Conflict.

Navy

U.S. Naval veterans are the most seriously affected by asbestos of any group of military men and women. In fact, mesothelioma navy cases are among the most common incidence of the disease in the United States. This is because these were most often the individuals who worked both aboard ships and in shipyards. Ships were strewn with asbestos. The mineral could be found in many parts of each ship, from the galley to the gun rooms. Because of its excellent heat-resistant properties it was used in insulation, to cover pipes, as an adhesive, in floor and ceiling tiles, in gaskets and valves, and wrapped around boilers - just to name a few of its many uses. Members of the U.S. Navy were exposed daily and it was not unusual for them to breathe in airborne fibers, which would later result in a mesothelioma diagnosis.

Army

Even though members of the U.S. Army didn't generally serve aboard ships, they were still exposed to a variety of asbestos-containing materials. Asbestos was inexpensive and readily available, so the government used it in many of the buildings that lined the Army bases in this country and overseas, mainly as insulation. As buildings aged, the material became damaged or crumbly, resulting in airborne dust and the inhalation of tiny, sharp particles of asbestos. As a matter of fact, anyone living or working in an old or ill-repaired base facility - even today - may be susceptible to developing asbestos cancer.

Marines

Traditionally, the U.S. Navy and the Marines have enjoyed a close relationship, working side by side, especially in times of war. For that reason, many Marines served on U.S. naval ships, incurring many of the same dangers face by Navy veterans. Asbestos exposure in the tight quarters of ships caused some U.S. Marines to develop mesothelioma, an asbestos-caused cancer. As with members of the Army, Marines may have also encountered asbestos in buildings in their camps or bases.

Air Force

Members of the U.S. Air Force may have encountered asbestos-containing parts in airplane engines, brakes, and other pieces of equipment that were insulated with the mineral to make them more fire and heat resistant. Anyone who serviced or repaired these planes or machinery may have inhaled asbestos dust on a regular basis. In addition, the mineral was used in housing for members of the United States Air Force and their families, largely because it was cheap and easy to come by.

Those who have been affected by military asbestos exposure should seek help from one the many mesothelioma clinics and cancer centers across the United States. Those who have developed asbestos-related health complications may be eligible for financial compensation through the assistance of a mesothelioma attorney. To find out more about newmesothelioma treatment options, clinical trials, and financial compensation programs for those eligible, please fill out the brief form on this page and we'll rush you a detailed mesothelioma information packet free of charge.

Additional Topics in this Section

Veteran Mesothelioma

Mesothelioma has affected Veterans of the armed forces in great numbers. Even though their tour of duty occurred several decades ago many are just now discovering that they have developed this asbestos-related disease.

Veteran Asbestos Exposure

Learn more about the asbestos exposure risk that Veterans faced in shipyards, on ships and at U.S. military bases while serving their country.

Veteran Medical Support

There are many treatment options and avenues available to Veterans seeking medical support for mesothelioma. The number of mesothelioma Navy cases is high as many of our nation's Veterans worked aboard Naval vessels or in shipyards where asbestos was present.

Veteran Treatment Centers

Veteran hospitals and treatment centers run by the U.S. Department of Veterans Affairs offer a complete range of medical services for Veterans diagnosed with mesothelioma. Read more in this section.

Healing Resources for Veterans

There are a number of healing resources designed for Veterans who face specific post-deployment issues that can worsen with the development of serious health issues like mesothelioma.

Veteran Resources

The VA provides a range of resources for Veterans suffering from severe illnesses like mesothelioma or other diseases. Learn more about Vet Centers, Community Living Centers, Domiciliaries and more.

Veterans Blog

Read posts by Douglas Karr, Petty Officer Second Class, U.S. Navy Veteran on the Mesothelioma.com Veterans Blog.

Asbestos Exposure in Iraq

U.S. troops who served in Iraq may have been exposed to asbestos during their tour of service and may be at risk for developing mesothelioma.

Veterans and Hepatitis

Hepatitis C is a serious health concern for many of our country's Veterans. Learn more about the disease, how it gets transmitted and how it can be diagnosed and treated.

Veteran Legal Support

Veterans diagnosed with mesothelioma might be eligible to receive financial compensation for lost income or medical expenses. Read more about Veteran legal rights and how a mesothelioma attorney can help with Veteran-specific issues.

Veteran Support

2010-12-07T11:29:00.004-08:00

eteran Support

Although rare, mesothelioma affects veterans from all branches of service. Navy veterans who worked in navy shipyards and or served on our nation's warships and submarine's from WWII through the Vietnam War were exposed to high concentrations of deadly asbestos and are at a high risk for developing mesothelioma. Boiler rooms, engine rooms, sleeping quarters, and other areas of naval vessels were the most common areas where asbestos was present. As a result, Navy veterans are at a greater risk of developing mesothelioma. Mesothelioma navy cases are among the most common and thus any veteran exposed to asbestos should fill out the brief form on this page to receive a free mesothelioma and asbestos exposure information kit. Support systems are in place to make sure you receive the assistance you deserve.

Asbestos Exposure

2010-12-07T11:29:00.002-08:00

Asbestos Exposure

Asbestos exposure is the single known cause of mesothelioma. Inhaled or ingested asbestos fibers may cause an inflammation of internal tissue and disrupt organ function which leads to the development of mesothelioma. Asbestos products were used extensively throughout the 20th century in a wide variety of applications. Many of these products were responsible for asbestos exposure sustained by both the individuals who manufactured the products as well as those who used them at commercial and industrial jobsites including shipyards, refineries, power plants, steel plants and more. Several asbestos companies continued to produce these products even after they were known to be hazardous and harmful to workers and their families. Those who have become sick with mesothelioma because of exposure to these products may now be eligible for financial compensation if they were wrongfully exposed.

Asbestos was also used at many New York jobsites including Ground Zero and the formerWorld Trade Center site. Common asbestos exposure sites in New York include the Brooklyn Navy Yard, Todd Shipyard, and the Con Edison power plant in New York City.

Mesothelioma Treatment

2010-12-07T11:29:00.000-08:00

Once an individual has been diagnosed with mesothelioma, the next step is to discussmesothelioma treatment options with his/her physician. Recent scientific research has produced significant breakthroughs with regard to treatment protocols for mesothelioma patients and more options are now available for managing mesothelioma and supporting improved quality of life. Newly diagnosed mesothelioma patients always have many questions about the treatment options that would be most effective for them, including those about new treatment therapies like Alimta® and Cisplatin and other chemotherapy drugs. In addition to these newer drugs that are being used to treat asbestos cancer, mesothelioma patients also have a number of "conventional" treatment options to consider, including mesothelioma chemotherapy, radiation therapy and surgery.

Mesothelioma clinical trials and experimental treatments are still other options that some mesothelioma patients may be eligible to participate in. Our site features a comprehensivemesothelioma cancer treatment section that includes important information for patients and families. We've included resources on top mesothelioma doctors such as Dr. Sugarbaker, as well as a comprehensive list of questions that you may wish to discuss with your personal physician when preparing a mesothelioma treatment plan. We are always providing new and informative resources regarding mesothelioma treatment including: Clinical Trials, conventional treatments, experimental therapies, as well as alternative mesothelioma treatment options. Check back often for the most recent advances in mesothelioma treatments.

Who is at risk for Mesothelioma?

2010-12-07T11:28:00.003-08:00

The only recognized cause of mesothelioma is exposure to asbestos, though other factors such as smoking can make mesothelioma more or less likely in some individuals. Industrial laborers were widely subjected to asbestos exposure on the job, as the material was widely used throughout the 20th century. Few of these workers knew they were being exposed to asbestos and thus put at risk for mesothelioma, however, despite the fact that many manufacturers were aware the material was hazardous. In most cases, mesotheliomasymptoms will not appear in an individual exposed to asbestos until many years after the exposure has occurred. Those who believe they may have been exposed to asbestos are at risk for mesothelioma and should fill out our form to receive a free mesothelioma information packet, detailing treatment options, emerging therapies, and jobsite exposure information.

Mesothelioma

2010-12-07T11:28:00.001-08:00

What is Mesothelioma?

Malignant mesothelioma is a rare type of cancer that occurs in the thin layer of cells lining the body's internal organs, known as the mesothelium. There are three recognized types of mesothelioma. Pleural mesothelioma is the most common form of the disease, accounting for roughly 70% of cases, and occurs in the lining of the lung known as the pleura.Peritoneal mesothelioma occurs in the lining of the abdominal cavity, known as the peritoneum andpericardial mesothelioma originates in the pericardium, which lines the heart.

Who is at risk for Mesothelioma?

CDC and FDA Issue Alerts for Point-of-Care Testing

2010-12-07T11:09:00.001-08:00

November 18, 2010

Over the last few years, the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) have become increasingly concerned about the number of serious infections related to the use of fingerstick devices and point-of-care (POC) testing instruments. Improper use of these can lead to the spread of blood-borne infections such as hepatitis. While infections from misuse have been occurring in a wide variety of settings, such as clinics, health fairs and hospitals, an inordinate number have been seen in long-term care facilities, notes the CDC. Moreover, most have involved hepatitis B, an infection that can lead to serious complications, especially in the elderly and those with weakened immune systems.

Point-of-care testing instruments are convenient and quick because they are portable and can be used, for example, at a patient's bedside. They perform tests used to monitor blood glucose,hemoglobin, PT/INR and other substances in the body. Typically, a single drop of blood is the only sample required for testing. The sample is obtained by pricking a fingertip with a sharp lancet or needle-like device, often included as part of the testing kit. The drop of blood is then analyzed by a POC instrument or meter.

In recent alerts on their web sites, the FDA and CDC reminded those who perform point-of-care tests and people who undergo fingersticks to be aware of some important precautions:

Lancets or other devices that are used to prick fingertips in order to produce a drop of blood shouldNEVER be used for more than one person. Some fingerstick devices are referred to as single-use and are designed to be discarded after one test. Other fingerstick devices have handles that resemble pens and the tips or lancets are removed and discarded after each use. The handles may be used more than once but must be properly cleaned and disinfected after each use and, as stated above, should never be shared between people.

If you assist a patient in performing tests that monitor blood glucose, be sure that you use only fingerstick devices that are designed to be used once and then disabled automatically so that they cannot be reused. Note that such devices may be called "safety lancets," according to the FDA.

The FDA alert states, "Whenever possible, POC blood testing [instruments], such as blood glucose meters and PT/INR anticoagulation meters, should be used only on one patient and not shared. If dedicating POC blood testing [instruments] to a single patient is not possible, the [instruments] should be properly cleaned and disinfected after every use as described in the [instrument] labeling." This should be done to protect both the patient and the person performing the test.

If you are a patient or a loved one caring for a patient and you are unsure about the POC testing instrument, you can ask the health care professional who administers the test whether the instrument is dedicated to a single patient, and if not, when it last was cleaned and disinfected.

Again, the FDA states that health care professionals should "change gloves between patients, even when patient-dedicated POC blood testing devices [instruments] and single-use, self-disabling fingerstick devices are used." If you have any reason to suspect that the health care professional might have forgotten to change his or her gloves, you should ask just to be sure.

[Source: FDA, Use of Fingerstick Devices on More Than One Person Poses Risk for Transmitting Bloodborne Pathogens]

Point-of-care tests are valuable tools for testing and monitoring various conditions, if used properly. If you or someone you know is to undergo fingerstick procedures, whether at a clinic, nursing facility or health fair, be conscious of the proper precautions to ensure that they are followed and in order to be protected from potential harms.

The FDA points out that some fingerstick devices were previously approved and marketed for use for more than one person. Now, the agency plans to take steps to ensure that these devices are labeled with instructions that they are to be used on one patient only. It will be releasing a statement to this effect soon.

Lab Tests Help Evaluate Men for Osteoporosis

2010-12-07T11:08:00.000-08:00

December 2, 2010

Routine laboratory testing may reveal underlying causes of osteoporosis in men whose bone loss was initially thought to have no known cause, according to a study in the October Osteoporosis International.

The study of osteoporosis in men found that the overwhelming majority of subjects' osteoporosis was caused by low testosterone levels, vitamin D deficiency, the body's inability to absorb calcium, mildly underactive thyroid, or overactive thyroid.

Although it is more common in women, osteoporosis poses a significant threat to more than 2 million men in the United States. One in four men over age 50 will have an osteoporosis-related fracture in their remaining lifetime, according to the National Institutes of Health (NIH). There are two types of the disease: primary osteoporosis is age-related bone loss, while secondary osteoporosis is caused by lifestyle factors, some medical conditions, and use of certain drugs.

To investigate causes of osteoporosis in men, the researchers reviewed the charts of 234 men (mean age 70.6 years) previously diagnosed with osteoporosis. The men had been evaluated for osteoporosis using bone mineral density (BMD) testing by dual energy X-ray absorptiometry (Dexa scan) to measure bone density in hips and spines. Testing also included basic serum chemistries,25-hydroxyvitamin D, testosterone, luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, and spot urinary calcium-to-creatinine ratio.

At the beginning of the study, 45% of the men were thought to have primary osteoporosis, and 55% had at least one specific secondary cause of osteoporosis such as use of glucocorticosteroids, inadequate functioning of the sex glands (hypogonadism), or chronic kidney failure. Laboratory testing revealed secondary osteoporosis in a majority of the men studied overall (about 75%). Causes included low testosterone levels (24%), vitamin D deficiency (20%), and to lesser extents, inability to absorb calcium, sluggish thyroid, and mildly overactive thyroid.

Even in men known to have secondary osteoporosis at the time of referral to the study, the researchers found 52% to have additional causes of secondary osteoporosis upon laboratory investigation.

Osteoporosis can be effectively treated if it is detected before significant bone loss has occurred. A medical workup to diagnose osteoporosis may include a complete medical history, x-rays, urine and blood tests, and a bone mineral density test (BMD). This test can identify osteoporosis, determine fracture risk, and measure response to treatment.

It is increasingly common for women to be diagnosed with osteoporosis or low bone mass using a BMD test, often at midlife when doctors begin to watch for signs of bone loss. In men, however, testing and diagnosis often doesn't take place until after a fracture occurs or a man complains of back pain.

Once a man is diagnosed with osteoporosis, he should receive a complete blood count and tests forcalcium, phosphorus, creatinine and vitamin D levels in the blood, and calcium in urine, the researchers suggest. Tests for testosterone level and thyroid function might also be helpful. In a few cases, specific tests for multiple myeloma or celiac disease may be necessary, they add.

Men are often unaware of how healthy habits can help them avoid osteoporosis. These include not smoking, reducing alcohol intake, and increasing physical activity. Getting enough calcium and vitamin D are also important, according to NIH. It also suggests men discuss with their doctors use of medications that are known to cause bone loss, such as glucocorticoids, which are often prescribed to transplant patients and those with autoimmune diseases.

On this site

Tests: Testosterone, Vitamin D, Thyroid Panel, Calcium, Phosphorus, CBC
Conditions: Osteoporosis

Elsewhere on the web

National Institute of Arthritis and Musculoskeletal and Skin Diseases: Osteoporosis in Men

Article Sources

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Ryan C, Petkov V, Adler R. Osteoporosis in Men: The value of laboratory testing. Osteoporos Int DOI 10.1007/s00198-010-1421-0. Available onlin at: http://www.springerlink.com/content/t511307167178676/fulltext.html throughhttp://www.springerlink.com. Accessed November 2010.

Fact sheet. Osteoporosis in Men. NIH Osteoporosis and Related Diseases National Resource Center. Available online at http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/men.asp throughhttp://www.niams.nih.gov. Reviewed June 2010. Accessed November 23, 2010.

Laura Dean. Simple Laboratory Tests Identify Secondary Osteoporosis In Men. Medwire News. Available online at http://www.medwire-news.md/437/89724/Bone_Health/Simple_laboratory_tests_identify_secondary_osteoporosis_in_men.html through http://www.medwire-news.md. Published October 20, 2010. Accessed November 23, 2010.

Researchers Study Possible New Marker for Prostate Cancer

2010-12-07T11:07:00.001-08:00

November 5, 2010

The protein microseminoprotein-beta (MSMB) might someday serve as an important tool for prostate cancer screening, say British researchers from the Cancer Research UK Cambridge Research Institute and The Institute of Cancer Research.

MSMB is the second most abundant protein after prostate specific antigen (PSA) found in semen of healthy men and regulates prostate cell death. It is secreted from semen into the urine. Writing in the October issue of Public Library of Science (PloS) One, the researchers said low levels of MSMB are associated with higher prostate cancer risk.

Prostate cancer, the second most common cause of cancer death among men in the United States, killed an estimated 258,000 men around the world in 2008. Currently, the most widely used prostate cancer test looks for elevated levels of PSA in the blood. However, results of some recent studies have led to some uncertainty about the value of this test. [See the article, Prostate Cancer: To Screen or Not to Screen?]

To determine if MSMB tests could be useful in prostate cancer screening or diagnosis, the researchers took tissue and urine samples from more than 350 men, both with and without prostate cancer, to test MSMB levels and determine whether the men had a particular genetic variation in the section of that regulates the production of MSMB. This genetic variation, or , was identified during previous studies by the researchers and others when they examined the entire genomes of thousands of men both with and without prostate cancer. This common mutation, which results in decreased production of MSMB, was shown to increase men's risk for prostate cancer by about 30%. Up to 40% of men with European ancestry and up to 70% of men with African ancestry have the mutation.

In the latest study, the researchers measured levels of MSMB in the urine of participants and correlated them with levels of PSA in the urine, whether the men had prostate cancer, and whether they had the small genetic change, or mutation. They found reduced levels of MSMB in the urine of men diagnosed with the prostate cancer, especially those with aggressive disease. These findings suggest that levels of MSMB protein in urine could form the basis for a new test to help identify men at greater risk of developing the disease, say the researchers. It could potentially be used alongside PSA testing to improve detection of prostate cancer and for monitoring progression of the disease.

PSA screening tests are far from ideal because nonfatal cancers and conditions can increase PSA levels. A U.S. study published last year found that routine PSA prostate screening has resulted in prostate tumor diagnoses in more than one million American men who might otherwise have suffered no ill effects from them. An enlarged prostate, a noncancerous condition, can boost PSA levels. Some hormones altered by particular prostate cancer treatments can also interfere with PSA production and thus testing to monitor progression of the disease. In contrast, MSMB levels appear to be largely unaffected by an enlarged prostate or hormones.

But doctors won't be offering men MSMB tests any time soon. According to a published news report, researcher Hayley Whitaker predicts that it will take his team five years to develop a test for use in clinics. In the U.S., such a test would also be subject to a lengthy Food and Drug Administration approval process before doctors could offer it.

On this site

Tests: PSA
Conditions: Prostate cancer

Elsewhere on the web

American Cancer Society: Prostate Cancer, Early Detection

Article Sources

H.C. Whitaker et al. The rs10993994 Risk Allele for Prostate Cancer Results in Clinically Relevant Changes in Microseminoprotein-Beta Expression in Tissue and Urine. PLoS One. Available online at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0013363 throughhttp://www.plosone.org. Published October 13, 2010. Accessed October 20, 2010.

Press release. Urine protein could pave the way for new prostate cancer test. Cancer Research UK. Available online at http://info.cancerresearchuk.org/news/archive/pressrelease/2010-10-14-urine-protein-cancer-test through http://info.cancerresearchuk.org. Issued October 13, 2010. Accessed October 20, 2010.

Kate Kelland. Protein urine test may signal prostate cancer. Reuters. Available online at http://news.yahoo.com/s/nm/20101013/hl_nm/us_cancer_prostate_urine throughhttp://news.yahoo.com. Published October 13, 2010. Accessed October 20, 2010.

Evidence-Based Approach to Medicine Improves Patient Care

2010-12-07T11:06:00.001-08:00

It’s time for your annual physical and you’re confident. When your doctor told you that you were at high risk of a heart attack, you began watching your diet and exercising regularly. You did everything your doctor recommended to keep your cholesterol under control, and you’re relieved but not surprised when the lab results show that your cholesterol level is lower than it was on your last visit.

So, when your doctor suggests you start taking a cholesterol-lowering statin drug, you’re confused. Familiar alarm bells start ringing in your mind. What happened?

She explains that new clinical studies found that people at high or moderately high risk of a heart attack benefit from more aggressive treatment. The studies led the National Cholesterol Education Program to update its treatment guidelines to recommend that these people should do all they can to lower their levels of LDL (“bad”) cholesterol. If diet and exercise haven’t done it, this means initiating cholesterol-lowering drug therapy for many more patients.

Your physician’s approach to your treatment is known by the buzz words “evidence-based medicine” - applying the best evidence to specific cases to improve patient care. Isn’t that what doctors were supposed to be doing all along? Yes, but the information explosion that has affected so many segments of society is being felt particularly strongly in medicine.

Medical knowledge is accumulating—and changing—with such dizzying speed that the medical community has found it needs new methods to cope with it all. Novel tests, drugs, procedures, and treatments are constantly being introduced. Studies are published daily with fresh data that support or modify long-standing beliefs, and sometimes, that demand substantial changes in treatment and habits. One study found that an internal medicine specialist who read the five best journals in the field would be exposed to only one half of the most relevant articles in that specialty. Even the main literature databases include less than half of the world’s journals.

Evidence-based medicine (EBM) is a formalized system for helping the medical community to cope with this information explosion. It’s about formal protocols that are applied to the latest data to determine what data best support the best outcomes. This filtering and prioritizing process requires an enormous effort to sift through large volumes of information, but the end result helps doctors to identify the best diagnostic tests and treatments.

Treatments

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Treatments for heart disease depend on the condition and its severity. Acute conditions, such as aheart attack, require prompt medical intervention to minimize heart damage. For chronic conditions, doctors may recommend that their affected patients modify their diets, lose excess weight, exercise (under supervision), manage stress, and quit smoking. Conditions such as hypertension anddiabetes should be controlled to minimize their affect on the heart. Heart failure often requires treatment with low salt diet and diuretics (to try to reduce the amount of fluid accumulating) as well as drugs to improve the function of the heart muscle, such as digoxin.

Medications may be necessary to help manage symptoms and control heart diseases. Surgical procedures may be required to bypass blocked arteries, replace defective heart valves, or fix congenitalabnormalities. Those with infections may need to take antimicrobial drugs.

New medications, procedures, and guidelines for addressing heart disease continue to be developed. Patients should talk to their doctor about the best treatment options for their condition.

Tests

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The goals of testing for heart disease are to distinguish between symptoms that are heart-related and those that are due to another condition. Testing is ordered to help determine which heart disease is present, to determine whether the disorder is acute or chronic, to monitor a cardiac event that is in progress – such as a heart attack, and to determine the severity and extent of the disease.

When a patient presents to the emergency room with acute coronary syndrome – a group of symptoms that suggest heart injury due to lack of blood flow – they are evaluated with a variety of laboratory blood tests and other tests. These are used to determine the cause of the pain and the severity of the condition. Since some treatments for a heart attack must be given within a short period of time to minimize heart damage, an accurate diagnosis must be quickly confirmed.

Heart disease that is causing few symptoms may be detected during a visit to the doctor for nonspecific symptoms such as fatigue. Doctors may order a variety of blood and other tests to investigate possible causes for the patient’s symptoms. Diagnosis of heart disease in these people may take time and patience.

Testing patients for existing heart disease is not the same as cardiac risk testing (which actually mostly determines risk of coronary heart disease). Cardiac risk testing is performed to screen asymptomatic people – to help determine their risk of developing coronary heart disease.

Laboratory Blood Tests
Cardiac biomarkers, proteins that are released when muscle cells are damaged, are frequently ordered when patients have symptoms of acute coronary syndrome, such as chest pain, pain in the jaw, neck, abdomen, back, or that radiates to the shoulder or arms, nausea, dyspnea, and lightheadedness.

Tests include:

Troponin - the most commonly ordered and cardiac-specific of the markers; will be elevated within a few hours of heart damage and remain elevated for up to two weeks

CK-MB – one particular form of the enzyme creatine kinase that is found mostly in heart muscle and rises when there is damage to the heart muscle cells

Myoglobin – a protein released into the blood when heart or other skeletal muscle is injured

BNP or NT-proBNP – released by the body as a natural response to heart failure; increased levels of BNP, while not diagnostic for a heart attack, indicate an increased risk of cardiac problems in persons with acute coronary syndrome

Because BNP is also released by the heart when it is stretched, BNP is also measured in those who have swelling of the legs or abdomen, or shortness of breath, to see if heart failure may be present.

More general blood tests that may be ordered:

Blood Gases – performed to evaluate oxygen, carbon dioxide, and pH levels
Complete Metabolic Panel (CMP) – a group of tests used to evaluate organ function
Electrolytes – four tests that evaluate the body’s electrolyte balance
Complete Blood Count (CBC) – looks at the body’s cells, checks for anemia

Other Evaluations
A range of other evaluations and tests are used to assess chest pain and other symptoms. These include:

A medical history, including an evaluation of risk factors such as age, CAD, diabetes, and smoking
A physical examination
An electrocardiogram (ECG or EKG) – a test that looks at the heart’s electrical activity and rhythm
Echocardiography – ultrasound imaging of the heart

Based on the findings of these tests, other procedures may be necessary, including:

Stress testing
Chest X-ray
CT (Computerized tomography) scan
Continuous ECG monitoring (sometimes also called Holter monitoring) – the patient wears a monitor that evaluates heart rhythm over a period of time
MRI (Magnetic resonance imaging)
PET (Positron emission tomography)
Radionuclide imaging
Cardiac catheterization – in this procedure, a thin flexible tube is inserted into an artery in the leg and threaded up to the coronary arteries to evaluate blood flow and pressure in the heart and the status of the arteries in the heart
Coronary angiography – X-rays of arteries using a radiopaque dye to help diagnose CAD; this procedure is performed during coronary catheterization
Tilt table test – ordered to evaluate syncope

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