According to Dr. Chen, changes to sunscreen labeling are a way of making sure that all sunscreens meet FDA required standards for safety and effectiveness. Labels will include specific and accurate information to help consumers select the right sun protection for themselves and their families.

When selecting the right sunscreen, “people should look for an SPF of 30. Anything higher than that doesn’t hurt, but it also doesn’t give you any real additional protection,” says Dr. Chen. “Proper coverage comes from reapplying sunscreen every two hours, especially if you’re in direct sunlight, have perspired and/or have gotten in and out of the water.”

Currently, the numbering system on sunscreens (SPF) only refers to protection against UV-B rays, which cause sunburn, but does not address UV-A rays, which can attribute to skin cancer and early skin damage. Under FDA regulation, all sunscreens have undergone “broad spectrum” tests to determine whether or not they protect against both UV-B and UV-A rays. Sunscreens that pass the test will now include the term “broad spectrum” on the label, to help consumers identify that they’re receiving coverage from both types of radiation.

The importance of using daily protection is crucial in the prevention of melanoma and other skin cancers. According to Dr. Chen, “only about 25% of melanomas come from a pre-existing mole, and about 75% of them occur in areas in which there was previously normal looking skin. Once sunburn happens, there are ways to treat the symptoms of the burn, but the damage to the skin has already been done.” For more sun safety tips, see part one of our Melanoma post series.

So if you plan on spending time outside this weekend, make sure to head to the drugstore first to load up on sun protection. Need a recommendation on a good product that you won’t have to break the bank for? After conducting their own series of “broad spectrum” tests, Consumer Reports recently revealed their top picks for reliable yet inexpensive sunscreens. Top products include: NO-Ad SPF 45 and Walgreen’s Continuous Spray Sunscreen Sport 50. Try them and let us know what you think in the comments field below!

For more information or to see a dermatologist, please call 404-778-777 or visit Winship’s website.

For those uncomfortable with participating in support groups, I often outline the benefits of using support groups as a method to cope and connect to others in similar situations. Research from The American Cancer Society provides the following about support groups:

• Support groups can enhance the quality of life for people with cancer by providing information and support to overcome feelings of aloneness and helplessness.
• Support groups can help reduce tension, anxiety, fatigue and confusion.
• There is a strong link between group support and greater tolerance of cancer treatment and treatment compliance.
• People with cancer are better able to deal with their disease when supported by others.

Dr. Sujatha Murali, Assistant Professor of Hematology and Medical Oncology at Winship, endorses the use of support groups. Dr. Murali states, “support groups are an integral part of treating the whole patient. At Emory, we believe in a multidisciplinary approach to cancer care, which not only includes physicians and nurses, but social workers, pharmacists, and nutritionists. We believe this approach results in the best chance of treatment success.”

Still not convinced joining a support group is right for you? Fortunately, support groups come in different forms and sizes. For those uncomfortable with face-to-face group settings, online or telephone groups are great alternatives. Some groups are lead by professional clinicians while others are organized by cancer survivors themselves. Groups can be disease, age or gender specific and some meet weekly, monthly or have no time limit at all.  With all these options available, there’s bound to be a support group to fit anyone’s needs! And if you’re still not sure where to turn, you can always contact me or other social workers at Winship with your questions or by using the comments field below. You can also join Joan Giblin, Director of the Survivorship Program at the Winship Cancer Institute in our upcoming online chat on the Cancer Survivorship and Peer Partners Program at Winship.

Interested in joining a support group, but do not know how to select the right one? The first step is to speak with your oncology social worker!  If you aren’t sure who your social worker is, simply ask your doctor or nurse to point him or her out. Most cancer centers have oncology social workers dedicated to support your psychosocial needs and overall well-being.  Some recommended and approved groups are available through the following sites:

• Winship at Emory Support Groups
• Saint Joseph’s Cancer Survivors’ Network
• The American Cancer Society Support Programs Services
• Cancer Care Support Groups

To close, I’d like to share a quote I often share with my patients. It’s out of Mr. Fred Rogers’s book, Life’s Journeys According to Mister Rogers: Things to Remember Along the Way. He writes, “Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we’re not alone.”

The cancer journey can be overwhelming, especially if traveled alone. The benefit of allowing others to provide support and care can be life-changing, and possibly life-saving. Join us as we kick-off some of our new support groups, including the Triple Negative Breast Cancer Support Group on Thursday, June 14, 2012. For more information, please see visit our website at http://winshipcancer.emory.edu/groups.

About the Author
Margaret “Maggie” K. Hughes is a Licensed Master of Social Worker at Winship Cancer Institute of Emory University. She works with Drs. Hawk, Murali, Kucuk, Carthon and El-Rayes. Maggie facilitates the Pancreatic Cancer Support group and co-facilitates the Triple Negative Breast Cancer Support Group at Winship.

Related Resources:

• Web Chat – Cancer Survivorship Peer Partners Program [June 20, 2012, 12:00 p.m. EST]

What is Melanoma?

Melanoma is a cancer of melanocytes, which are cells whose primary function is to make pigment. These cells are located in the layers of epidermis, or the outer layer of skin. Melanocytes are also responsible for making birthmarks and freckles; however, in those cases, the cells are not cancerous. Melanomas can form on any part of the skin but are most commonly found on the chest and back in men, and the legs in women. Melanomas can also develop on the neck and face, and they sometimes occur in the eye and in mucosal surfaces, such as the mouth and bowel.

Why do dermatologists recommend applying sunscreen daily?

Skin cancer is most commonly a result of excessive exposure to the sun’s ultraviolet (UV) rays. The sun contains two types of these rays: UVB, which are responsible for sunburns, and UVA, which cause cell aging and long-term skin damage. Both rays cause damage to skin cells’ DNA, resulting in abnormal cell growth. Here are some tips to protect your skin from the sun’s harsh rays and prevent skin cancer:

• Use a broad spectrum SPF of a level 15 or higher, which is a type of sunscreen that protects the skin from both UVA and UVB rays.
• Avoid outdoor activity between 10 a.m. and 4 p.m., when the sun’s rays are most intense.• Wear protective clothing as well as a hat and sunglasses to protect more sensitive parts of the body.
• Remember, the UV rays can go through light clothing, windshields, windows, and clouds.
• While shade offers some protection, the sun’s UV rays can still penetrate through clouds and trees and have harmful effects.

Check yourself!

Remember, skin cancer is generally treatable if detected early. If you haven’t done so, give your body a quick scan, and repeat this practice at least once a month. Get to know the pattern of moles, spots, freckles, and other marks on your skin. If you notice any new moles or changes in shape or color to existing ones, please contact your healthcare provider.

Have additional questions? Join Dr. Suephy Chen on May 14, 2012 at 11:30 AM EST for a live online discussion about diagnosing and treating melanoma.

For more information about melanoma and other skin cancers, visit Winship Cancer Institute of Emory University.

Related Resources:

• Melanoma Chat Sign Up
• Indoor Tanning & Tanning Beds – The Bad, the Ugly, and the Uglier
• Top 5 Skin Protection & Skin Cancer Prevention Tips

We had a great discussion on April 11th about nutrition with Tiffany Barrett, MS, RD, CSO, LD. She answered some great questions about the importance of maintaining a healthy diet to fight off cancer and enhance treatment. If you missed out on our live chat, the transcript is available here. Also, see below for highlights from the discussion.

Q: What are some good foods to eat during cancer treatment or to prevent cancer from reoccurring?

A: When it comes to reducing the likelihood of recurrence, reducing saturated fat intake is very important. This includes eliminating animal fat, butter, lard, etc. It is important to increase your intake of plant foods and grains while incorporating a variety of produce into your diet (i.e. leafy greens, berries, etc.).

Q: Is there a role that sugar plays in cancer?

A: First, it’s important to note there’s a difference between natural and refined/processed sugars. Unlike naturally occurring sugars found in fruit and dairy, processed sugars are significantly correlated with elevated bad cholesterol and triglycerides (fat in blood) and low good cholesterol. Eating too much added sugars can also result in excess body weight, which can increase the risk of cancer. It is best to limit your intake of sugar and sugary foods to protect your health, limit excess calories and make room for nutrient-dense foods that contain naturally occurring sugars (fruit, low-fat dairy).

Q: What is a good substitute for sugar?

A: There always are options like stevia, honey and agave nectar, but all of these are a bit sweeter than real sugar, so using less of them is advised. It’s important to understand that using moderation in any sort of sweetener is key. If you are having sugar cravings, focus on natural sources of sugar.

Q: Is there a connection between soy products and cancer?

A: There is evidence that soy intake (whole soy foods, rather than processed) prior to cancer diagnosis can have preventive effects. This has been found specifically with breast, prostate, and colon cancers. Whole soy food includes tofu, soy milk, edamame, and soy beans, whereas processed soy is found in things like soy hot dogs, soy burgers, soy powders, etc.

Q: Is food the best source for receiving nutrients? What about supplements and vitamins?

A: Our body best digests and absorbs nutrients through food consumption. There’s actually no hard evidence to demonstrate benefit from a standard multivitamin or other supplement use. Consuming nutrients through food allows for a wider variety of vitamins.

Q: Are meal replacement drinks a feasible option to getting proper nutrition during cancer treatment?

A: Meal replacement drinks certainly can be and often are helpful in combating or overcoming some of the side effects of treatment, such as loss of appetite. There are a wide variety of meal replacement drinks that provide a full balance of necessary nutrition, and also ways that people can make their own protein and meal replacement drinks at home to suit their taste.

Q: Is there any connection between physical activity and cancer prevention?

A: Absolutely. Regular, moderate physical activity: 4-5 times per week for 30-45 minutes each time, has been shown to have preventive effects.

Q: How important is it to start early with good nutrition to receive preventive benefits?

A: Starting young as far as introducing good eating habits to children is imperative. It’s also important to educate at a young age about the importance of maintaining a healthy weight. Good nutrition and maintaining a healthy weight are important in reducing not only your risk for cancer, but for a whole host of other conditions that are largely preventable.

For more information on diet and nutrition, please visit Winship Cancer Institute at Emory University.  To make an appointment, please call 404-778-7777.

Related Resources:

• Dietary Recommendations for Cancer Patients
• Nutrition to Fight Cancer Chat Transcript

We want to congratulate Emory University Hospital (EUH) and our physicians at the Winship Cancer Institute of Emory University for receiving a CoC Outstanding Achievement Award for 2011. EUH was the only hospital in Atlanta to be granted this award and only one of two in Georgia.

Rein Saral, MD, associate director for community affairs and outreach for Winship Cancer Institute of Emory University, said he is pleased because the award recognizes the “extraordinary excellence of the overall collaboration between Emory University Hospital and Winship Cancer Institute, Georgia’s only NCI-designated cancer center.”

The OAA is granted to facilities that demonstrate a Commendation level of compliance with seven standards that represent six areas of cancer program activity: cancer committee leadership, cancer data management, clinical management, research, community outreach, and quality improvement. The level of compliance with the seven standards is determined during an onsite evaluation by a physician surveyor. Awarded facilities must also receive a compliance rating for the remaining 29 cancer program standards.

For 2011, just 22 percent of the 489 programs surveyed received the award. A majority of recipients are community-based facilities; however, there were also teaching hospitals, NCI-designated Comprehensive Cancer Centers, and Veterans Affairs hospitals that received the award.

To see a comprehensive list of all the CoC OAA winners, visit: http://www.facs.org/cancer/coc/outstandingachievement2011.html

According to the American Cancer Society’s (ACS) Nutrition Guidelines, it’s best to eat a diet consisting of plant-based foods like fruits, vegetables, grains, and foods low in fat.

Omer Kucuk, MD and Professor of Hematology and Medical Oncology at Winship Cancer Institute of Emory University says, “there are bioactive compounds in foods, particularly in fruits and vegetables. These bioactive compounds have potent anti-cancer activities; for example, broccoli contains indole 3 carbinol, which has been shown to have anti-cancer affects, especially in prostate cancer and breast cancer.”

While certain foods have been show to help prevent cancer, evidence also shows that specific food compounds, such as soy isoflavones and curcumin, can increase the effectiveness of cancer treatment.

“We have found that soy isoflavones enhanced the efficacy of cancer treatment, specifically the efficacy of chemotherapy and radiation therapy. In addition to that, soy isoflavones may also prevent the side effects of these two cancer treatments,” reports Dr. Kucuk. Soy isoflavones are plant-derived compounds with estrogen-like activity that may help protect against hormone-dependent cancers according to ACS. Get more information on soy isoflavones and how proper nutrition can help during cancer treatments.

More in-depth studies are currently underway to find which bioactive compounds in foods aid in cancer treatment and reduce the risk of cancer recurrence. The American Cancer Society reports “that a higher intake of vegetables may have a helpful effect on recurrence or survival for breast, prostate, and ovarian cancers, but this is not definite.”

Still, ACS recommends that cancer survivors get at least five servings of colorful fruits and vegetables each day due to the overall benefit they provide. All cancer and cancer treatments affect the body differently. An individualized nutrition plan based on your likes and dislikes, and what your stomach can handle, is going to be beneficial during your treatment journey. A registered dietitian can help you and your family answer questions and address concerns about managing your diet, weight, treatment side effects, and supplement information.

If you’re looking for specific tips, ideas, and ways to incorporate cancer fighting foods into your diet, join us on April 11th for our online live chat, Nutrition’s Role in Fighting Cancer. Also, check out Emory Healthcare’s recipe page for some easy, tasty and healthy dishes!

Related Resources:

• Nutrition’s Role in Fighting Cancer Chat Sign Up

Colorectal Cancer Prevention

Receiving regular screenings is going to be the best way to prevent colorectal cancer. Catching cancer early while it is still curable and/or removing polyps before they turn cancerous are keys to survival.  According to the American Cancer Society, “people who have no identified risk factors (other than age) should begin regular screening at age 50.” If you have a strong family history of colon polyps or cancer, getting screened prior to age 50 is highly recommended. Other advice you’ll see for cancer prevention is similar across cancers. A few things you can do to help improve your health and fight off cancer, including colorectal cancer, include: quitting smoking, exercising regularly, eating a healthy, well-balanced diet, and maintaining a healthy weight.

Diagnosing Colorectal Cancer

While a colonoscopy is the most common method of diagnosing and staging colorectal cancer and/or other gastrointestinal disorders, there are several other procedures used including:

• Flexible Sigmoidoscopy: This test uses a flexible, lighted tube with a small video camera on the end. It can travel the full length of the rectum and half of the colon.
• Colonoscopy: This test allows the doctor to look at the entire length of the colon and rectum with a colonoscope, which is a longer version of a sigmoidoscope.
• Double Contrast Barium Enema: A type of x-ray test using barium sulfate, which is a chalky liquid, and air to outline the inner part of the colon and rectum, highlighting abnormal areas on x-rays.
• CT Colonography (Virtual Colonoscopy): This is an advanced type of computed tomography (CT or CAT) scan of the colon and rectum. It is non-invasive, can be done fairly quickly, and does not require sedation.

For more information on each of these procedures, please visit the Winship Cancer Institute of Emory University.

Treating Colorectal Cancer

After cancer is diagnosed and staged, your multidisciplinary colorectal cancer care team will create a treatment plan using one, or a combination, of these main treatment methods:

1. Surgery – Surgery is the main treatment method for colorectal cancer. This procedure involves removing the cancer, a section of normal tissue on either side of the cancer, and any local lymph nodes.
2. Radiation Therapy – A type of cancer treatment that uses ionizing radiation energy to kill cancer cells and shrink cancerous tumors. Colorectal cancer may be treated using external beam radiation before surgery to shrink the tumor or after surgery to kill any remaining cancer cells.
3. Chemotherapy – Chemotherapy is medication delivered to the body to eliminate cancer cells or greatly reduce their effect. It targets cells that divide rapidly, a characteristic of most cancer cells. Chemotherapy is often used to support and enhance other cancer treatment modalities.

If you are interested in learning more about colorectal cancer, or have questions not covered in this blog,  make sure to sign up for Dr. Bassel El-Rayes and Dr. Roberd Bostick’s colon cancer chat  tomorrow, March 20th (UPDATE – CHAT TRANSCRIPT). It’s bound to be a great discussion!

Contact us for more information about our colorectal cancer treatment programs: 404-778-1900 or request an appointment online.

Colorectal Cancer Statistics

According to the American Cancer Society, “excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States.” That means in 2012, estimates for the number of colorectal cancer cases that will be diagnosed in the United States are:

• 103,170 new cases of colon cancer
• 40,290 new cases of rectal cancer

But, if detected early enough, colorectal cancer is curable. So, how is colorectal cancer detected?

Colorectal Cancer Diagnosis

According to the Winship Cancer Institute of Emory University, “colorectal cancer usually starts in the innermost layer of the lining and slowly progresses through the other layers.”  There are several ways of diagnosing colorectal cancer, but the most popular method is a colonoscopy. A colonoscopy is a special type of cancer screening because it allows doctors to screen and intervene at the same time.

During a colonoscopy, the doctor will use a colonoscope, which is a flexible, lighted tube with a small video camera on the end. They use this instrument to look at the entire length of the colon and rectum. If the doctor finds abnormalities such as polyps or growths, he or she can remove them right away while patients are under sedation. Special instruments can be passed through the colonoscope to remove the suspicious looking areas before they have the chance to turn into cancer.

According to Roberd Bostick, MD, MPH and a professor in the Department of Epidemiology at Emory University’s Rollins School of Public Health, “most of the time, a colonoscopy is the most effective means for diagnosing [colorectal cancer].Certainly, if a person were to have symptoms that would be suggestive of colon cancer, then those symptoms might precipitate them wanting to have a diagnostic test, like a colonoscopy.”

For a full list of symptoms and risk factors of colorectal cancer, please see below. Watch the full video discussion with Roberd Bostick, MD, MPH. Also, bring your additional questions to Dr. Bassel El-Reyes and Dr. Roberd Bostick’s colon cancer chat on March 20th (UPDATE – CHAT TRANSCRIPT).

Colorectal Cancer Symptoms

If you are experiencing any of these symptoms, contact your doctor to be properly diagnosed and treated. It’s important to note that these symptoms may not necessarily be a result of colorectal cancer. Other health problems can produce similar symptoms, which is why it is important to contact your physician if you are experiencing any of the symptoms listed below:

• Change in bowel habits:
  • Diarrhea or constipation
  • Feeling that your bowel does not empty completely
  • Finding blood (either bright red or very dark) in your stool
  • Finding your stools are narrower than usual
• Frequent gas pains or cramps, or feeling full or bloated
• Loss of weight for no apparent reason
• Feeling very tired all the time
• Nausea or vomiting

Colorectal Cancer Risk Factors

The main risk factors for colorectal cancer are uncontrollable. They are heredity, family history and personal medical history. Other risk factors include:

• Presence of an inflammatory bowel disease (i.e. Crohn’s disease, ulcerative colitis, etc.)
• Diabetes
• Other controllable factors
  • Obesity
  • Red meat consumption
  • Processed meat consumption
  • Smoking
  • Alcohol consumption

Remember, early detection is the key to providing the best chance for a cure. It is important to contact your physician if you are experiencing symptoms or are at risk for colorectal cancer.  If your physician feels it’s appropriate, a screening test, such as a colonoscopy, will most likely be recommended to rule out the possibility of cancer.

With all this information, what can you do to stay healthy? Take action and make sure you are getting regularly screened! While a colonoscopy is bound to not be the most pleasant experience, it could potentially save your life by detecting colorectal cancer early when the disease is easier to cure.  If you are interested in learning more about colorectal cancer, make sure to check out the chat transcript the colorectal cancer chat.

Contact us for more information about our colorectal cancer treatment programs: 404-778-1900 or request an appointment online.

Because of the relatively high frequency of Lymphedema among cancer patients and its implications for potential decline in patients’ quality of life, Lymphedema is a condition that clinicians and survivorship programs have begun to place a larger emphasis on.  In the spirit of raising awareness around Lymphedema and helping those who suffer from it and the family members supporting them better understand it, Lymphedema therapist, Stephanie Kirkpatrick, of the Winship Cancer Institute will be holding an online chat on the topic of Lymphedema on “D” Day*.

Stephanie will cover Lymphedema causes, types, treatments, and coping strategies and answer questions from participants during the chat, which takes place on Tuesday, March 6 at noon EST.

*UPDATE: View the Lymphedema chat transcript.

With Heart Month upon us and roughly 17-18%  of adults in the United States continuing to smoke, this is important. Smoking is not only is the major cause of lung cancer, the nation’s number one cancer killer, but it’s also responsible for as many as 30% of all coronary heart disease deaths in the United States each year. Smoking is a major risk factor for more than two dozen other cancers, including head and neck cancer, bladder cancer and stomach cancer.

Berg says an important component can be providing support to someone who is trying to quit. The initiation, maintenance and cessation of smoking is strongly influenced by other family members, Berg says. Smokers are more likely to marry smokers, to smoke the same number of cigarettes as their spouse, and to quit at the same time. Smokers who are married to nonsmokers or ex-smokers are more likely to quit and remain abstinent. In addition, married smokers have higher quit rates than those who are divorced, widowed or have never married. Research shows that support from the spouse and from other family members and friends is highly predictive of successful smoking cessation. In particular, supportive behaviors involving cooperative behaviors, such as talking the smoker out of smoking the cigarette, and reinforcement, such as expressing pleasure at the smoker’s efforts to quit, predict successful quitting. Negative behaviors, such as nagging the smoker and complaining about smoking, are predictive of relapse. In fact, supportive behaviors have been associated with initial smoking cessation, while negative or critical behaviors have been associated with earlier relapse.

In addition, encouraging the establishment of smoke-free homes reduces exposure to secondhand smoke among all people living with smokers. Because secondhand smoke exposure has been found to have detrimental effects on the cardiovascular health of people living with smokers, particularly children in homes where smoking occurs, promoting smoke-free homes is critical. Research also has shown that creating smoke-free homes also encourages attempts to quit smoking and reduced cigarette consumption among smokers.

Do:

• Talk the smoker out of smoking the cigarette
• Express pleasure at the smoker’s efforts to quit
• Encourage smoke-free home policies
• Support attempts to quit

Don’t:

• Nag the smoker
• Complain about smoking
• Shun the smoker
• Shame or guilt the smoker

Related Resources:

• 7 Reasons to Quit Smoking Today
• Myths About Tobacco-Related Bladder Cancer Go Up in Smoke
• Quit Smoking, Your Heart Deserves a Break
• Quit Smoking to Save Your Life