Targeted Therapy In Cancer Treatments

Targeting Cancer Treatment – Specific Factors Of A Patient’s Tumor
Medical News Today

Cancer treatment is depending more and more today on specific factors of a patient’s tumor, including gene mutations, or proteins that are commonly typical of certain cancer cells, rather than focusing on where in the body the cancer started. Before, treatment was based on finding where in the body the cancer originated, such as the breast or lung.

Targeted therapy is all about the cancer’s genes, tissue environment that contributes the tumor’s growth and survival, and its proteins. Nowadays, cancer therapy is designed to interfere with a signal that tells the cancer cells not to die or tells it to divide, while before, chemotherapies had the goal of interfering with cancer cells as division was already underway, when the cells were dividing into new ones.

The human body is made of various types of cells, including skin cells, brain cells, or blood cells. Each one has a specific function.

Cancer occurs when healthy cells change and start growing out of control; they eventually form a tumor – a mass. A benign tumor is noncancerous, whereas a malignant one is cancerous, it can spread to other parts of the body.

Cancer cells either divide too quickly or do not die when they should do
Specific genetic mutations within a cell change the way it behaves.

•  When the genes that control cell division mutate (change), they can multiply too quickly; the cell has become cancerous.
•  Cells are genetically programmed to die, when the specific genes that tell the cell to die mutate, and the cell does not die, it has become a cancerous cell.

Put simply, cancerous cells either divide too rapidly or do not die when they should, in both cases because their genes have changed.

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Merry Christmas-2010

Isaiah 9:6

For unto us a Child is born,
Unto us a Son is given;
And the government will be upon His shoulder.
And His name will be called
Wonderful, Counselor, Mighty God,
Everlasting Father, Prince of Peace.

The Dough Please, Next…

Patients Beware: Hospitals Are Increasingly Requiring Cash Up Front
U.S. News & World Report

A growing number of debt-burdened hospitals are demanding payment before treatment.

Sally Giovinazzo was 57 and employed but uninsured when five months of bleeding finally sent her to a doctor earlier this year. The gynecologist wanted $620 before seeing her; a reading of the lab results ($88) showed stage one uterine cancer. The doctor referred Giovinazzo to a specialist at the M.D. Anderson Cancer Center in Orlando, who said he would schedule surgery as soon as she could pay half the estimated $10,000 to $50,000 cost. Giovinazzo, of Dunedin, Fla., would not have been treated but for a stroke of luck: She had a connection who was a friend of Anderson’s chief operating officer. She found out her bills would be covered as “charity care,” which is doled out on a case-by-case basis.

For years, medical facilities have asked patients to hand over their insurance copayments—normally $10 to $25 per visit—when they sign in. But recently the business office has gotten more demanding. Many institutions, facing a growing mountain of bad debt, are no longer willing to take it on faith that the bills will eventually be paid and are demanding up-front payments in elective or nonemergency situations. “Large majorities of hospitals have organized their admission process where they want to see a check or credit card before they take you to your room,” says Ron Luke, a consultant to healthcare providers in more than 25 states. Among them are Inova Fairfax in Northern Virginia and North Shore in Manhasset, N.Y. Insured workers, too, are feeling the pain, as many are choosing high-deductible plans, and copays and coinsurance charges just keep going up.

Since the tax-exempt status of nonprofit hospitals hinges on their providing charity care, how and what they charge the needy has brought congressional scrutiny. “It’s one thing to charge underinsured or uninsured patients more than insured patients for the same service,” says Sen. Charles E. Grassley (R-Iowa), a vocal critic of such practices. “It’s another thing to charge patients up front…or even withhold treatment until they produce a check. This is like applying the principles of home or car sales to nonprofit health care.”

Full disclosure of how much hospitals spend on charity care, which will be required starting next year, may put pressure on administrators to back down a bit. But given the $260 billion that went to uncompensated care between 1999 and 2008, the desire for up-front payment won’t go away quickly, experts say. Indeed, a whole industry has sprung up to advise institutions on how best to collect. “Hospital executives across the country agree that upfront cash collections are the most immediate fix to improve the revenue cycle,” says a website promotion for Managing Upfront Collections: Strategies for Effective Cash Collections, a DVD offered for $299. “Your staff need to understand how to have conversations about money and learn how to manage patients’ responses.”

Under a 1986 federal law, hospitals cannot make payment a prerequisite for emergency room care, but that’s as far as patient protection goes. “I was a little surprised to have to pay up front,” says Clint Wolcott, 54, a Labor Department lawyer from Bethesda, Md., who was told when he scheduled carpal tunnel surgery at the Surgery Center of Maryland this spring to bring along a credit card to pay $225, his share of the center’s fee under his insurance. According to the center’s website, copayments, coinsurance, and deductibles are due the day of the procedure. Those signing up for cosmetic surgery must pay the total estimated cost then, and uninsured patients must pay in full beforehand. “We always try to collect up front,” says Charles Cohen, a vice president of operations for Ambulatory Surgical Centers of America, which owns 25 percent of the Maryland facility. “It’s like any other business. Once the patient walks out the door, your chance of collecting decreases.”

The pain would be lessened if consumers could shop around for the best deal, but medical charges can be almost impossible to discern. Even if hospitals and doctors posted their charges for a coronary bypass or a hip replacement, say, you couldn’t effectively comparison shop, says Gerard Anderson, director of the Johns Hopkins University Center for Hospital Finance and Management. “You don’t know how many minutes [you'll be] on the operating table or if you’ll need an MRI or CT, or how long you’re going to stay, or who’s making the decision.” Some websites do provide general comparisons, and at least 38 states post some form of pricing information. The Healthcare Blue Book says it uses billing and payment data to offer consumers a way to “determine fair prices in your area,” usually the average providers accept from insurers for given procedures. Consumer Health Ratings allows patients to compare charges by facility and location, and links to sites that offer price comparisons in a number of states.

Katie Dagenais, a spokesperson for M.D. Anderson in Orlando, said when asked that the hospital would not discuss the Giovinazzo case. “However,” the hospital said in a statement responding to a request for comment, “with regard to payment of services, M.D. Anderson shares in the community’s obligation to provide health care for the truly needy. To continue to fulfill this responsibility to our patients, and in the interest of fairness to all patients, M.D. Anderson must make every effort to obtain payment for services rendered and handles charity care on a case-by-case basis.” M.D. Anderson’s parent facility in Houston received negative publicity in 2008 when it required $45,000 before continuing care of a cancer patient. It later allowed her to defer payment of an additional $60,000. Money “can’t be taken out of the equation,” says Wendy Gottsegen, a spokesperson for the Houston center, or the burden becomes so great “we can’t do research that will ultimately cure cancer.” The parent hospital now discloses the amount it spends on charity care; Anderson in Orlando does not.

As for Sally Giovinazzo, her hysterectomy took 3½ hours and her hospital stay lasted from Wednesday to Friday. In the future, she says, “I won’t take my health so nonchalantly and [will] start saving money, because I can’t go through this again. It’s too stressful. I just got lucky.” She doesn’t expect that kind of providence twice.

Out Of The Storms

Can a horrific ugly disease like cancer produce something beautiful out of it? Before I was diagnosed, I would have given a definitive “no” to that question. But out of all the terror and ugliness, I have met some of the bravest people. People I never took notice of until this evil disease knocked on my door. People so brave, so caring; and yet they were hidden in shadows–as if in a different world.

I will never forget my radiation experience. My mother and I never had what I would call a close relationship. When I was diagnosed with uterine cancer, she went with me to every radiation treatment. She never missed a treatment. I had to drive myself (about a 3 hour round trip) daily, as my mother cannot do city driving. But for the first time in my life, I felt she really cared about me. It meant the world to me for someone to go with me to treatments –and more so, for her to go.

Then there were the people in the waiting room. People with all kinds of cancer: lung, brain, breast, esophageal, and other kinds. Some with a good prognosis, and some with a lousy prognosis. We all echoed the same thoughts amongst each other. “I never thought this would happen”…”I am going to fight this”…”I will be praying for you”…”Fight, you can win!” It makes me cry to think about it, despite the fact this happened nearly five years ago.

One lady and I hugged each other and cried after she finished her external radiation treatments. In fact, there were a lot of heart felt hugs in that waiting room. Strangers…hugging and crying over each other.

Fast forward.

Recently, we have been getting hit with tornadoes here in Oklahoma. I have had to take cover twice—not fun! Certainly no benefit to my high blood pressure. Last week, there was a tornado not too far from where I lived, thankfully it missed us (it was a few miles away—but only a few!).

The next morning, I went to my email, and saw I had a mail from someone I met on a forum in 2006. His wife had nasopharyngeal cancer, no insurance, and no where to get treatment. We began to correspond, and along with my sister and I, we went on an international campaign in an attempt to get his wife treatment. They live in Indonesia. For almost two years we labored contacting various medical organizations and charities. Eventually her husband found a medical professor at UCLA who agreed to treat her. If only they could had gotten the money and Visas to get here. Shortly after the professor offered their services, his wife passed away in February 2008. It was quite a journey, which ended so tragically.

Last week, that precious lady’s  husband emailed me and my sister from Jakarta, and said “I heard a tornado hit Oklahoma, and hope you are okay.” We rarely communicate anymore, still he reached out from overseas to see if we made it through the storms. Out of tragedy, a beautiful gesture of kindness.

There are so many people I have met along this journey I will never forget.

Obesity and Cancer

*Interesting article. Several studies have shown a link between obesity and endometrial cancer; as this article eludes too. The National Cancer Institute states on it’s website states “Obesity has been consistently associated with uterine (endometrial) cancer. Obese women have two to four times greater risk of developing the disease than do women of a healthy weight, regardless of menopausal status”.  The link between obesity and cancer is not strongly correlated among all cancers, and there is a difference of opinions amongst researchers.

Obesity’s Role In Cancer

By Devon Schuyler,
the Los Angeles Times, March 22, 2010

Packing on the pounds gets a well-deserved bad rap. Most Americans understand that excess weight contributes to heart disease and diabetes, not to mention the urge to hide behind the kids in family photos. But obesity as a risk factor for cancer?

That seems to be the case. An increasing number of studies are finding that overweight and obese people are more likely to develop cancer of various kinds. At least half a dozen types of cancer are believed to be directly affected by weight.

“As time goes on, we’re realizing that obesity is related to more cancers than we originally suspected,” said Dr. Donald Hensrud, an associate professor of preventive medicine and nutrition at the Mayo Clinic College of Medicine.

Researchers are unable to prove that obesity actually causes cancer because requiring people to either gain weight or keep their weight down in clinical trials would be impossible. Most of the data come from observational studies, in which people who are thinner are probably doing many things differently than their heavier counterparts. Any number of those factors might be responsible for the difference in cancer rates.

Still, the evidence is “convincing” for a cause-and-effect relationship between obesity and postmenopausal breast, colon, endometrial, esophageal, kidney and pancreas cancer, according to a 2007 report from the World Cancer Research Fund and the American Institute for Cancer Research. The report also cited obesity as a “probable” cause of gallbladder cancer.

Scientists aren’t sure how obesity might affect cancer risk, but “there are some plausible biological mechanisms by which this may occur,” said Dr. Patricia Ganz, director of cancer prevention and control research at UCLA’s Jonsson Comprehensive Cancer Center.

One popular explanation is that extra weight boosts the body’s production of hormones such as estrogen, insulin and insulin-like growth factor 1 — all of which have the potential to promote the growth of certain tumors. Another possibility is that fatness contributes to cancer growth by causing cells to divide more rapidly.

Mechanical factors may play a role in certain types of cancer. In the case of esophageal cancer, the culprit seems to be acid reflux. People who are overweight are more likely to experience chronic reflux, which can lead to precancerous changes by eroding the lining of the esophagus.

The suspected higher risk of gallbladder cancer might be explained by the increased tendency of obese people to develop gallstones. These stones cause inflammation that could promote cancer.

Putting a number on it

Rates of obesity have steadily increased over the past few decades, more than doubling from 15% of adults in the early 1970s to 34% of adults in 2005-06, according to data from the National Health and Nutrition Examination Survey. Cancer rates also increased somewhat during this period, from a rate of 4 in 1,000 in 1975 to 4.56 per 1,000 in 2006 —although rates peaked in 1992 and have since been on the decline.

Scientists don’t know how much of this increase in cancer is real. Much of it appears to reflect the fact that we now regularly go looking for cancer with mammograms and prostate specific antigen tests, which is one more reason why the relationship between obesity and cancer is so difficult to study.

The World Cancer Research Fund and the American Institute for Cancer Research made an attempt to quantify the relationship in a 2009 policy report. The report concluded that excess body weight has the largest effect on endometrial cancer, causing an estimated 49% of cases. This translates into an extra 20,700 people with endometrial cancer per year.

The policy report also calculated that being overweight or obese causes 35% of esophageal cancers (5,800 people per year), 28% of pancreatic cancers (11,900 people per year), 24% of kidney cancers (13,900 people per year), 21% of gallbladder cancers (2,000 people per year), 17% of breast cancers (33,000 people per year) and 9% of colon cancers (13,200 people per year) .

Dr. Moshe Shike, an attending physician at Memorial Sloan-Kettering Cancer Center whose research focuses on cancer prevention, said he was skeptical about the idea of putting a number on something so slippery, saying that this implies accuracy where none exists. “We don’t know the magnitude of the effect,” he said.

Dr. Michael Thun, head of epidemiologic research for the American Cancer Society, agreed that the percentages are imprecise, but pointed out that numbers are often the best way to get results. “Numbers carry a strong message, just as estimates of death caused by smoking were very important to tobacco control,” he said.

Most of the studies on weight and cancer risk define obesity using body mass index (BMI), a number that accounts for weight in relation to height. Someone who stands 5-foot-7 is considered “overweight” at 159 pounds and “obese” at 191 pounds. A third of Americans are overweight, and another third are obese.

But the real culprit is fat, not weight, so a football player-type with lots of muscle and little flab would not be at increased risk even if his BMI fell into the “overweight” category.

The effects of weight loss

If excess weight increases the risk of cancer, can losing weight reduce the risk? Preliminary research suggests that it might. At least two large, published studies have found that people who undergo gastric bypass surgery are significantly less likely to develop cancer or die from it than severely obese people who don’t undergo the weight-loss procedure.

People who have been diagnosed with certain cancers, including breast, prostate and colorectal cancer, also seem to have a worse prognosis if they’re overweight or obese, according to Dr. Jeffrey Meyerhardt, an assistant professor of medicine at Harvard Medical School. Preliminary studiessuggest that weight loss might reduce this risk.

For example, a clinical trial called the Women’s Intervention Nutrition Study that was published in the Journal of the National Cancer Institute in 2006 randomly assigned breast-cancer survivors to either a low-fat diet or their regular diet. Not only did the women on the low-fat diet wind up an average of six pounds lighter than their control-group counterparts, they had a reduced risk of cancer recurrence at five years.

Studies like this one fail to answer the question of which played a bigger role, the types of foods eaten or the amount of weight lost. But as randomized trials fail to find cancer-fighting benefits for specific dietary components, such as fiber (long suspected of decreasing the risk of colon cancer), the evidence increasingly points toward weight as the key factor.

“A healthy diet is good for avoiding obesity, but it’s not clear that diet itself impacts the prognosis of most cancers,” said Meyerhardt. A possible exception, he said, is colon cancer; his own research has linked recurrence and reduced survival to a diet high in red meat, refined grains and sugary desserts.

Shike said that the No. 1 lifestyle measure people can take to reduce their risk of cancer is to avoid smoking and secondhand smoke, followed by maintaining a healthy weight.
Physical activity and diet also play a role in cancer prevention, he said, primarily through their effect on weight. In addition, the American Cancer Society recommends no more than one alcoholic drink per day for women or two per day for men.

Now, the exceptions

Much remains unknown about the overall role obesity plays in cancer risk. For some cancers, of course, it appears to play little or no role. And for a few types of cancer, the incidence is actually lower in overweight people.

Much remains unknown about the overall role obesity plays in cancer risk. For some cancers, of course, it appears to play little or no role. And for a few types of cancer, the incidence is actually lower in overweight people.
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Contrary to its relationship with postmenopausal breast cancer, extra weight seems to offer women some protection against premenopausal breast cancer. A possible explanation is that obesity interferes with ovarian function in younger women, causing reductions in estrogen. Only about 20% to 25% of breast cancer cases occur before menopause, however, so weight control is still related to an overall reduction in breast cancer risk.

Another exception to the rule is lung cancer, for which the risk steadily increases as weight drops. The reason? “Smokers tend to be leaner than nonsmokers,” said Dr. Elizabeth Platz, an associate professor at the Johns Hopkins Bloomberg School of Public Health. Cigarette-induced slimness comes at a steep price, though: a dramatically increased risk of lung cancer, among other diseases.

The incidence of prostate cancer also seems to be lower for overweight men. In this case, the apparent decrease may occur because the extra weight makes screening and diagnostic tests less sensitive, according to Platz. If so, delays in diagnosis might explain why research has linked obesity to an increased risk of aggressive prostate cancer.

Childhood cancers and those of the brain, nervous system and musculoskeletal system appear to be unaffected or little affected by weight, according to the World Cancer Research Fund and the American Institute for Cancer Research policy report.

But don’t forget

No matter what researchers ultimately reveal about the role of weight in cancer, weight control remains an essential part of staying healthy.

“If body fatness were totally unrelated to cancer, the message would still be the same, because of the importance of weight control for heart disease, stroke, diabetes, joint pain and other conditions,” said Dr. Tim Byers, a professor of epidemiology at the Colorado School of Public Health.

He also emphasized that staying trim is no guarantee of a cancer-free life. “It’s a risk factor, that’s all, just like bad brakes and drunk driving are risk factors for traffic accidents.”