Tag Archives: Cancer

MEDICINE: BASEBALL GREAT CAL RIPKEN JR.’S ‘ROBOTIC RADICAL PROSTATECTOMY’

Known as the Ironman, Hall of Famer Cal Ripken Jr. was diagnosed with prostate cancer during the COVID-19 pandemic. Partnering with the Brady Urological Institute, Mr. Ripken had a successful robotic radical prostatectomy to remove his tumor and is now deemed cancer free. Watch urologic surgeon Mohamad Allaf and Cal Ripken Jr. discuss his prostate cancer journey at Johns Hopkins and share his powerful message to men across the world.

PHYSICIAN Q&A: SCREENING FOR COLORECTAL CANCER

Colorectal cancer is comprised of colon cancer and rectal cancer, which originate in the lower portion of the large intestine and into the rectum. As with other cancers, screening for early detection should not be delayed. “The vast majority of the time, we don’t know exactly what causes any specific cancer,” says Dr. Jeremy Jones, a Mayo Clinic oncologist. “But there are a number of factors that can increase the risk of developing colon or rectal cancer.” Dr. Jones says one risk factor is increasing age. However, he adds that over the last 30 years younger patients have seen a 50% increased risk of developing colon and rectal cancers. In this Mayo Clinic Q&A podcast, Dr. Jones talks about risk factors, symptoms, treatment, health care disparities and the latest in colorectal cancer research. ____________________________________________

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #36: WARTS

Warts are so common as to have become a metaphor for any blemish. I have had several warts in childhood, most likely because my immunity was immature along with the rest of me. They went away, as do most warts. I have had a few warts on and off since, since the HPV that produces them is so widespread.

My immune reaction took care of them, For some reason, I now have a wart between my toes that bears watching. Hopefully it will go away like the rest. Warts rarely become malignant, They can cause problems with breathing if they block the airway, such as the larynx (voice box) or bronchi (breathing tubes). I had such a case in my Allergy/respiratory disease practice that sounded like asthma to the referring Doctor.

Elderly people can develop a variety of skin bumps, that my grandmother called “moles”. In the past month, I have developed a reddish bump on my nose. It looks a lot like the “intradermal nevus” pictured in an accompanying article from “consultant360”. Seborrheic Keratoses are common, and I have some of those too. Of course,

I have a regular crop of scaly “actinic Keratoses” for my Dermatologist to freeze with liquid Nitrogen during my twice yearly visits to prevent them from developing into cancer. I have a suspicion that many home remedies for warts, and the scraping and freezing efforts of dermatologists merely stir up the infected cells in the lesion and incite the immune system to mop up.

Time will usually do the job, but they are often annoying and there is always the temptation to treat them.

–Dr. C.

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WOMEN’S HEALTH: HOW ‘HPV (HUMAN PAPILLOMAVIRUS) LINKS TO CERVICAL CANCER’

This video tells the story of Ana, a cervical cancer survivor, who encourages women to recognize abnormal Paps as an opportunity to speak to your doctor about gynecologic health.

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Dr. C’s Journal: ‘Mutation’

Mutation is engrained in the very nature of life. Even if there were no X-rays, free radicals or toxic chemicals, mutation still would take place because of errors in the replication of DNA that occasionally escapes the proofreading mechanisms of meiosis and mitosis.

The majority of germline mutations produce LOSS OF FUNCTION, and are weeded out by evolution. In vertebrates, mutation is vital in producing the random changes in the DNA of germ cells of the ovaries and testes. If the mutation is beneficial, involving a GAIN OF FUNCTION, environmental selection acts to preserve the change, producing the diversity of organisms in the world, each exploiting a different environmental niche.

It is the rare species so versatile, like the shark, that can remain almost the same over eons without dying out. In the teeming unicellular world, mutation in the genome is similarly useful in allowing for variations which often prove useful for survival. The mutations thrive if the proper environment presents itself. For instance, antibiotic resistance may be encoded in a few members of a bacterial species, which become the dominant members in an infected patient on antibiotic treatment, and crowd out family members without the mutation.

In Viruses, RNA is often the Memory nucleotide. RNA is less stable than DNA. The resulting instability allows more mutations, and sometimes greater success. An example is the English Covid variant in the spike protein which leads to greater contagion. Hopefully, the spike protein change will not be so successful as to interfere with the effectiveness of vaccine-produced protective antibodies.

The Mutations we have been discussing refer to GERMLINE mutations, which occur in the gonads. In higher animals, germline mutations affect the offspring, which then carry the mutation. A GAIN OF FUNCTION mutation may confer greater adaptability and survivability, and perhaps may lead even to a different species, if the troop number is small and the environment demanding. Non-germ SOMATIC cell mutation may lead to undesirable effects like cancer, which is another discussion.

–Dr. C

THE DOCTORS 101 CHRONIC SYMPTOMS / CONDITIONS #29 UNEXPLAINED WEIGHT LOSS

Unexplained weight loss is rare in our society, where weight gain is so common. Weight loss usually occurs in the context of a causative illness, like prolonged diarrhea, where it is not the main symptom, but just an associated problem. However, sometimes the loss of 5 or 10% of the body’s weight can occur in a few months without explanation or clues, and a consultation is needed.

Proper Nutrition is critical for Health, including maintenance of “normal” weight. The Gastrointestinal tract extracts nutrients from the food we eat, and illnesses such as COELIAC DISEASE, or REGIONAL ENTERITIS can prevent proper absorption. Our HORMONES regulate energy and chemical balance, and Thyroid, Parathyroid, Pancreas and Adrenal malfunction can disturb weight Homeostasis.

Chronic infection, such as AIDS and TB can sap energy quietly. NEUROLOGICAL PROBLEMS such as Depression, Dementia or Parkinsons can result in an improper diet, and subsequent weight loss. CANCER is the first thing we worry about when we unexpectedly lose weight, but Neoplasms usually betray themselves with other, more dramatic symptoms.

It is a good idea to regularly check your weight at the same time every day. Almost always it will reassure you by staying the same. Sometimes it will warn you to cut your feasting. Occasionally an unexpected drop in weight will direct you to your Doctor to find an explanation.

–Dr. C.

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MEDICINE: NEW ‘SMART CELL’ THERAPIES TO TREAT CANCER

Finding medicines that can kill cancer cells while leaving normal tissue unscathed is a Holy Grail of oncology research. In two new papers, scientists at UC San Francisco and Princeton University present complementary strategies to crack this problem with “smart” cell therapies—living medicines that remain inert unless triggered by combinations of proteins that only ever appear together in cancer cells.

Biological aspects of this general approach have been explored for several years in the laboratory of Wendell Lim, PhD, and colleagues in the UCSF Cell Design Initiative and National Cancer Institute– sponsored Center for Synthetic Immunology. But the new work adds a powerful new dimension to this work by combining cutting-edge therapeutic cell engineering with advanced computational methods.

For one paper, published September 23, 2020 in Cell Systems, members of Lim’s lab joined forces with the research group of computer scientist Olga G. Troyanskaya, PhD, of Princeton’s Lewis-Sigler Institute for Integrative Genomics and the Simons Foundation’s Flatiron Institute. Using a machine learning approach, the team analyzed massive databases of thousands of proteins found in both cancer and normal cells. They then combed through millions of possible protein combinations to assemble a catalog of combinations that could be used to precisely target only cancer cells while leaving normal ones alone.

In another paper, published in Science on November 27, 2020, Lim and colleagues then showed how this computationally derived protein data could be put to use to drive the design of effective and highly selective cell therapies for cancer. “Currently, most cancer treatments, including CAR T cells, are told ‘block this,’ or ‘kill this,’” said Lim, also professor and chair of cellular and molecular pharmacology and a member of the UCSF Helen Diller Family Comprehensive Cancer Center.

“We want to increase the nuance and sophistication of the decisions that a therapeutic cell makes.” Over the past decade, chimeric antigen receptor (CAR) T cells have been in the spotlight as a powerful way to treat cancer.

In CAR T cell therapy, immune system cells are taken from a patient’s blood, and manipulated in the laboratory to express a specific receptor that will recognize a very particular marker, or antigen, on cancer cells. While scientists have shown that CAR T cells can be quite effective, and sometimes curative, in blood cancers such as leukemia and lymphoma, so far the method hasn’t worked well in solid tumors, such as cancers of the breast, lung, or liver.

Cells in these solid cancers often share antigens with normal cells found in other tissues, which poses the risk that CAR T cells could have off-target effects by targeting healthy organs. Also, solid tumors also often create suppressive microenvironments that limit the efficacy of CAR T cells. For Lim, cells are akin to molecular computers that can sense their environment and then integrate that information to make decisions. Since solid tumors are more complex than blood cancers, “you have to make a more complex product” to fight them, he said.

DR. C’S MEDICINE CABINET: THE BENEFITS OF “IRON”

Iron is the most common element, by weight, on earth, so it should come as no surprise that it has evolved to be an essential component in the mechanism that is life.

The ENERGY of the eukaryotic cell is dependent on the Iron in mitochondria, which are elaborate electron-transfer mechanisms. To quote Nobel Laureate Albert Szent Gyorgyi, “Life is nothing but an electron looking for a place of rest”.

Iron is essential, so it is possible to have too little of it. There is no physiologic pathway to get rid of it and so you can have too much iron in your body, which comprises a disease called Hemochromatosis. Excessive Iron can be TOXIC to the body, and produce damaging free radicals.

Deficiency of iron will produce ANEMIA. Regulation of incoming Iron is the body’s way of keeping excessive Iron out. It is absorbed only in the upper part of the small intestine, and a special protein called Hepcidin can block it from release into the circulation. It is carried through the blood by Transferrin and also Ferritin, which stores the iron that is not in the hemoglobin of RED BLOOD CELLS, the main storehouse of iron.

Blood loss is a common problem which leads to increased Iron requirement, This is reflected in the increase in RDA of Iron in Women during their menstruating years. Colonic Cancer, among other conditions, can also bleed and lead to the anemia of Iron deficiency. This is the reason for Doctors ordering a test for “occult”, or hidden, blood in the stools. My reason for taking Iron is a continuing loss of blood from the small intestine.

I have had multiple colonoscopies and Gastroenteroscopies to rule out cancer and other blood-losing conditions in the lower and upper intestinal tract. The small intestine is the “silent” area to gastroenterologists, and I cannot have the Capsule/camera examination because of my small bowel surgery.

I must take extra iron, and hope that this will be sufficient to keep me from developing anemia again. Green vegetables and red meat are more satisfactory sources, but insufficient for me. I worry a little about the recent finding that Heart Failure has been associated with Ferritin levels below 100 ng./ml.

I struggle to keep mine at 50 ng. by taking 2 tablets of feosol daily and dealIng with the subsequent constipation. An ANNUAL PHYSICAL and laboratory examination is important for the maintenance of health. Enough Iron and blood are important factors for vigorous Well-being. —

–Dr. C.

INFOGRAPHIC:

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS 21: PERIPHERAL NEUROPATHY

Peripheral Neuropathy is a common problem, and almost a quarter of the population will eventually suffer from it. It is very common in diabetes and metabolic syndrome, alcoholism, and in cancer therapy.

Even getting older is a risk; almost 10% of individuals 65 years old have some symptoms. There are more than 100 different types of peripheral neuropathy, and often it is just one feature of a primary illness.

Sometimes there is no known cause, such as in 2 of my older friends. I have a diminished vibratory sense in my feet, which causes me no noticeable problem. The longer nerves are more likely to be involved, except for the rare sensory ganglionopathy which is symptomatic of some cancers ( a “paraneoplastic disorder”) , some infections and autoimmune diseases.

When the sensory ganglia are involved, the numbness, tingling or pain can be more central, such as in the face or upper arm. There are 3 types of nerves that can be involved in peripheral neuropathy; Sensory, Motor and autonomic.

The sensory nerves deal with sensations, such as hot, cold, touch, pain, tingling, and numbness. Motor nerve involvement results in weakness or paralysis of an arm, leg or other area under Voluntary control. The autonomic nervous system coordinates activities beyond voluntary control, such as sweating, salivation, food propulsion and heart rate, which can be activated or inhibited.

The symptoms of neuropathy depend upon the type of nerve involved. Balance is a complex ability that can be disturbed by a lack of proper sensory nerve function (Position sense or proprioception) motor weakness, vision or coordination which involve higher centers.

The medical evaluation of peripheral neuropathy begins with a family practitioner or internist who does a detailed history, asking about such things as diet, medications, alcohol consumption, and injuries. Vitamin intake is important, but can be overdone.

Peripheral nerve symptoms can actually be caused by excessive B6, pyridoxine. The upper limit is 100 Mg.. A physical exam checks for weakness, sensory problems, reflexes and balance. Blood tests may reveal diabetic, kidney, liver, thyroid or immune problems problems.

A major disorder associated with neuropathy may be revealed and pursued. If nothing turns up, and the neuropathy is significant, referral may be needed to a neurologist, or other appropriate specialist. Many specialized tests and treatments may be needed.

Even with the best of care, a specific “cure” may not be found. Peripheral neuropathy can often be avoided by a healthy lifestyle.

–Dr. C.

Article on Peripheral Neuropathy