Frequently Asked Questions

Fatigue after Ovarian Cancer Treatment My mother has stage 4 Ovarian Cancer. She can no longer eat and has a feeding tube. Since coming home she seems very tired, frustrated, and does not wish to engage in any activities. Do you have any hints how we could help her? It is a real exercise in tact. Thank you. Lora Packel MS, PT, Coordinator of Cancer
Questions about Chemotherapy-related Fatigue Can chemotherapy-related fatigue last 5 months after treatment has ended? I recently returned to work as a teacher and felt dizzy and off balance. Can the fatigue reoccur slightly after returning to work? Lora Packel MS, PT, Coordinator of Cancer Therapy Services for the Hospital of the University of Pennsylvania,
Exposure to People After Vaccines Dear OncoLink "Ask The Experts," How long should a neutropenic person stay away from someone who has received a vaccine, regular flu shot, H1N1, or infants who received their regular vaccinations? I see that it says to "avoid" recently vaccinated persons, but no indication for long. Thanks.Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse
Blood Counts An OncoLink visitor asks questions about blood counts (Neutropenia, Thrombocytopenia, Anemia). Why does chemotherapy affect my blood counts? Chemotherapy kills both cancerous cells and other normal cells in your body. The normal cells in your body that are most at risk for being killed by chemotherapy are those that are
Hair Loss/Alopecia An OncoLink visitor asks about hair loss due to chemotherapy: Why does chemotherapy cause hair loss? Do all chemotherapy drugs cause hair loss? Which chemotherapy drugs cause hair loss? Is the hair loss permanent? What can I do if hair loss is expected with my chemotherapy treatment? How do I care for my wig? Why
How can I protect my skin during and after radiation therapy? Dear OncoLink "Ask the Experts," How can I protect my skin during and after radiation therapy? Each time radiation therapy is delivered, small amounts are absorbed by the skin over the area being treated. Over time, redness and irritation similar to a sunburn may occur. Because of this, it is necessary for all patients
Constipation Dear OncoLink "Ask the Experts," What is Constipation? What can I do to prevent constipation? When should I call my doctor about my constipation? How is constipation treated? Karen T. Bruchak, RN, MSN, MBA responds: What is constipation? Constipation refers to a decrease in the frequency of bowel movements and/or
Diarrhea caused by disease or the side effects of the treatment Dear OncoLink "Ask the Experts," What is diarrhea? What can I do to prevent it? When should I call my doctor about it? How is it Treated? Karen Bruchak, RN, MSN, MBA, OncoLink Editorial Assistant responds: What is Diarrhea? Diarrhea refers to the passage of loose or watery stools three or more times a day. Often
Treatment for Alopecia Dear OncoLink "Ask the Experts," The literature is full of abstracts related to various forms of scalpcooling to prevent or minimize alopecia during chemotherapy. None of myoncologists seem interested in this. Can you provide any up-to-date info on this? Thanks, F.D. James P. Stevenson, MD Section Editor for
Spinal Cord Compression Dear OncoLink "Ask the Experts," My father recently developed spinal cord compression from his known lung cancer. My questions are: What are the major causes? How often do you see spinal cord compression in general? What are the treatment options? Thanks Li Liu, MD, OncoLink editorial assistant, responds:
Information about Frey Syndrome Dear OncoLink "Ask the Experts," My husband recently had a surgery to remove cancer in his parotid gland. Ever since, he has been having problems with excessive sweating and flushing in his cheek and behind his ear. His doctor told him that this is Frey Syndrome and suggested surgery to cut his nerve. What exactly is Frey Syndrome? Are
Hypercalcemia in Cancer Patients Dear OncoLink "Ask the Experts," My mother has breast cancer with spread to her bones. Recently she became disoriented and started to hallucinate. The doctor said that this is due to the high calcium level in her blood. Is this common in cancer patients? Why would cancer patients have high calcium level in their blood? Thanks.
Tumor induced hypercalcemia Dear OncoLink "Ask the Experts," I have searched your database for tumor induced hypercalcemia, and nothing exists on this subject.I would like to know if you have any current information on this metabolic disorder to read? Thanks J.M. Maggie Hampshire RN, BSN, OCN, Managing Editor of OncoLink, responds:
Nausea and Vomiting Dear OncoLink "Ask the Experts," What is nausea and vomiting? What can I do to prevent it? When should I call my doctor about it? How is it treated? Karen Bruchak, RN, MSN, MBA, of the Abramson Cancer Center of the University of Pennsylvania responds: What is Nausea and Vomiting? Nausea means being sick to
Hair Loss/Alopecia - OncoLink Nurse Notes General questions about hair loss due to cancer treatment. Gale Snyder-Port RN, MSN, OCN, CNA, Janice Gibson, RN, MSN, OCN and Kathleen Spurrier, RNC, OCN of the Abramson Cancer Center of the University of Pennsylvania respond: A common side effect of chemotherapy is hair loss. This "Helpful Facts" sheet answer
Neutropenic Precautions Dear OncoLink "Ask The Experts," Are there any standard protocols involving neutropenic precautions while in the hospital? Presently, at my hospital, they consider neutropenia a valid reason for isolation in leukemics only, and solid tumor patients with neutropenia can co-habit with another patient. I find this unsafe and I try to have all my
Exercise after mastectomy Dear OncoLink "Ask The Experts," I am looking for the latest information regarding exercise for a very recent postop mastectomy. Or is it doctor related preference as how much exercise how soon? Lora Packel, MSPT, Coordinator of Cancer Rehabilitation at the Hospital of the University of Pennsylvania, responds:
Chronic fatigue after bone marrow transplant Dear OncoLink "Ask The Experts," I work with bone marrow transplant patients who often complain about chronic fatigue even years after their transplant. Is there any research or articles written on this subject? These patients are in their 30's or 40's and the fatigue is very depressing to them. Lora Packel MS, PT, Coordinator of Cancer
Diabetes and Indigestion while Undergoing Chemotherapy and Radiation Therapy My 87-year-old Dad was just diagnosed with bladder cancer. He has indigestion every day now, even though he is on a low fat diet. He is also a recovering stroke patient, with hypertension and insulin diabetes. He starts chemotherapy and radiation soon. How will side effects of chemotherapy and radiation therapy affect his diabetes
Eating tips for head and neck radiation patients Dear OncoLink "Ask The Experts," My brother is receiving radiation treatments for his nasopharyngeal cancer. He is losing his taste buds and is very concerned that they will not return once his treatments are completed. He is in Stage 1 of this type of cancer. Will his taste buds return to normal? Also, what can I do in cooking for him
Hydrazine Sulfate I am searching for more information on Hydrazine sulfate. I am wondering whether or not it could help with cancer pain or is it of any benefit for survival. Jim Metz, MD and Kenneth R. Blank, MD OncoLink Editorial assistants reply: Thank you for your question on hydrazine sulfate. There has been interest in hydrazine
Nutritional Status and TPN My father has had a total small bowel and sub-total large bowel resection due to a carcinoid tumor. He is currently on a total TPN diet but continues to lose weight and is spending a lot of time in the hospital I feel he is not getting the proper amount of protein in his TPN. Any information on this subject would be greatly appreciated.
Vitamin Supplements I have been diagnosed with cancer. Should I take vitamin supplements? Katrina Claghorn, RD, Oncology Dietitian for The University of Pennsylvania Health System, responds: A well balanced diet should provide all of your vitamin and nutrient requirements. However, the side effects of chemotherapy and radiation therapy can
Liquid Nutrition Supplements Should I take liquid nutrition supplements during my cancer treatment? Katrina Claghorn, RD, Oncology Dietitian for The University of Pennsylvania Health System, responds: Maintaining your nutrition status during the course of cancer treatment is a goal shared by the medical team.However the side effects of the
Dealing with chemotherapy induced nausea Dear OncoLink "Ask the Experts," My 20-year-old niece was diagnosed with a fibrolamellar hepatoma with extensive metastasis to nodes and organs. She is having "aggressive"chemotherapy and has several negative side effects including nausea, low platelets and white counts. Any information available would be helpful. Thanks,DS
Post-Gastrectomy Nutrition Dear OncoLink "Ask the Experts," My father had a gastrectomy for his gastric cancer 3 weeks ago. He is currently undergoing chemotherapy. The main problem for him now is discomfort after eating even small amounts of food. We feel he is not getting enough nutrition. I would like to know what type of diet my father should be on? And
Herbal Therapies Should I consider herbal therapies for cancer treatment? Katrina Claghorn, RD, Oncology Dietitian for The University of Pennsylvania Health System, responds: It is claimed that herbs contain many compounds, which may prevent or treat cancer. These compounds have different properties, some stimulate the immune system,
Low Iodine Diet Dear OncoLink "Ask the Experts," I am about to receive radioiodine treatments and I need to follow a low iodine diet. Can you give me any direction? ThanksKB Katrina Claghorn, RD, Oncology Dietitian for The University of Pennsylvania Health System, responds: The point of a low iodine diet is to deplete
The Gerson Diet Have you heard anything about the Gerson Diet? If so, what opinion do you have regarding its success and validity? Katrina Claghorn, RD, Section Editor of OncoLink's Nutrition During Cancer Treatment and Diet and Cancer menus, responds: Dear Reader, Max Gerson, a German physician, developed the Gerson diet
Nutrition During Bone Marrow Transplant Dear OncoLink "Ask the Experts," I am a Staff Nurse doing a research project on nutrition and bone marrow transplant. I was wondering whether you had any up to date information inthis field. I am particularly interested in nutrition during the neutropenicstage. I appreciate your assistance in this matter. Thank youM.W.
Radiation Enteritis Dear OncoLink "Ask the Experts," What are some diet recommendations for cancer patients with radiation enteritis? Katrina Claghorn, RD, Oncology Dietitian for The University of Pennsylvania Health System, responds: The general diet recommendations for patients with radiation enteritis are a low fiber, low lactose and
Dietary recommendations for patients receiving chemotherapy Could you please send me some information on Chemotherapy & Diet? I believe that you have to have a special diet. Thank you Maggie Hampshire RN, BSN, OCN OncoLink's Managing editor replies: Chemotherapy does have an effect on a patients dietary intake. Someof the drugs given during the course of
Lung Cancer and Diet and Nutrition What would you recommend for a lung cancer patient, taking chemotherapy as far as diet and nutrition are concerned? Can diet and nutrition contribute to improvement? Katrina Claghorn, MS, RD, registered dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds: The goal during chemotherapy is
PEG Tube Replacement Dear OncoLink "Ask The Experts," The radiation treatment cured my Nasopharyngeal cancer 18 years ago but I also lost the ability to swallow food. Last March, a peg-24 tube was installed but the tube is worn-out and needs to be replaced now. Doctor told me new tube will have to be inserted from my mouth. I wonder are there other ways to
Herbal supplements while on chemotherapy Can you take any type of herbal supplements while on chemotherapy? Is it okay to take Moducare through chemotherapy? My daughter is 23 years old and is taking chemotherapy for Hodgkin's disease. Ellen Sweeney, RD, Clinical Nutrition Specialist at the Abramson Cancer Center of the University of Pennsylvania responds;
Macrobiotic Diet Dear OncoLink "Ask The Experts," My father has metastatic colon cancer. I've been researching different types of therapy, including nutritional therapy. What is your opinion regarding macrobiotics? Is this something safe and has there been any scientific study conducted on it? Katrina Claghorn, MS, RD,
Esophageal Reflux and gastric cancer in children Dear OncoLink "Ask The Experts," My daughter is 10 and suffers about four to five times a year of reflux and gastric problems. Her reflux and gastric problems are due to a lot of antibiotics that have been given with treatments of omeprazole and other medicines for more than a year. Can children suffer from cancer of the stomach or
Loss of appetite during cancer treatment Dear OncoLink "Ask The Experts," My mother in-law is undergoing chemotherapy for breast cancer. Her taste for food and her appetite are gone. She is becoming very weak. Is there anything we can do to boost her appetite, or what can we do to infuse the small portions of food she is eating to modify the nutritional value. Thank you in
Grapeseed during chemotherapy Dear OncoLink "Ask The Experts," I am considering taking grapeseed during chemotherapy. Are there studies that show whether the antioxidants in grape seed are beneficial in my situation? Thank you, any help or direction would be appreciated. Katrina Claghorn, MS, RD, registered dietitian at the Abramson Cancer
Gastrectomy Eating Hints Dear OncoLink "Ask The Experts," My father had a total gastrectomy 2 weeks ago. He has been tube fed up until a few days ago at which time they started giving him a pureed diet. What will his diet have to consist of long-term? Will he be able to eat meat without pureeing, etc? Since there is no stomach, how do things get digested? Do you
Dietary recommendations for low white blood cell count Dear OncoLink "Ask The Experts," Are there any supplements or foods that can help raise a White Blood Cell Count that is too low to allow the next round of chemotherapy? Is there any nutrition advice for a patient on neupogen? Thanks. Ellen Sweeney, RD, registered dietitian at the Abramson Cancer Center of the
Loss of appetite during lung cancer treatment Dear OncoLink "Ask The Experts," What should a lung cancer patient do if they are losing too much weight? How can they overcome a loss of appetite? Ellen Sweeney, RD, registered dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds: Many cancer patients lose weight during their
Dietary recommendations after a Whipple procedure Dear OncoLink "Ask The Experts," My husband was diagnosed with pancreatic cancer and had the Whipple procedure the middle of October 2001. This was followed by radiation and a week of chemo on either end for six weeks. The treatments ended the second week of January. My question is regarding diarrhea and type of diet to stop it. He is
Antioxidants during chemotherapy Dear OncoLink "Ask The Experts," My wife is set to begin chemotherapy treatment. We are working with a nutritional advisor. We will be following his 10-step program, which advocates exercise, low fat high fiber diet, meditation, and vitamin and mineral supplements. He is advocating continuing to use the vitamins during chemo because there
Oral glutamine for stomatitis Dear OncoLink "Ask The Experts," I am presently receiving topotecan for a recurrence of ovarian cancer. I developed mouth sores during my last treatment cycle. I've read that oral glutamine can decrease the severity and duration of stomatitis. Are there any reasons why I should not take oral glutamine during my next treatment cycle?
Chron's disease and Chemotherapy Dear OncoLink "Ask The Experts," How might chemotherapy affect crohns disease? Do you have any special dietary recommendations for a patient with chrons? Thank you. Ellen Sweeney, RD, registered dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds: As far as Crohn's disease and cancer
Dietary recommendations for liver cancer Dear OncoLink "Ask The Experts," My partner is about to under go surgery for liver cancer. Are there any recommendations for diet before surgery and after surgery for liver cancer? Ellen Sweeney, RD, registered dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds: There is no special pre-op
Antioxidant vitamin supplementation and cancer treatments Dear OncoLink "Ask The Experts," I administer chemotherapy and have recently heard of a new study that acknowledges vitamin therapy in cancer patients receiving chemotherapy as non-therapeutic. Some of my patients tell me that the study states that vitamins help enhance cancer growth and cell resistance to chemo. Do you know of this study and
Safety and efficacy of "natural" hormones Dear OncoLink "Ask The Experts," I am 61 years old, had a uterus-only hysterectomy at age 38 and have been using premarin for 10 years. My daughter is very concerned about "synthetic" hormones and is urging me to stop taking premarin and to start using "natural" hormones. Has any research been done on the safety and efficacy of
Glutamine powder Dear OncoLink "Ask The Experts," Do you have any information pro and/or con for Glutamine powder as a supplement for a rectal cancer patient during treatment? Katrina Claghorn, MS, RD, Registered Dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds: Glutamine is an amino acid. Generally the body
Eating hints for a diabetic on treatment Dear OncoLink "Ask The Experts," My father was diagnosed with colon cancer three months ago. Just last week he began chemotherapy. Radiation treatment begins in a couple of weeks as well. My father is also on several medications for diabetes and high blood pressure. Where can I find information on foods that he can eat? It looks like sweets
Increase calories and decrease nausea after esophagectomy Dear OncoLink "Ask The Experts," My mother had esophageal cancer 2 1/2 years ago and was treated with an esophagectomy. She is still using a J tube for nutrition. Nausea has been a constant companion since surgery, and has recently gotten worse. She is only using about 2 cans of Nutren per day, so caloric intake is under 1000 per day. She
Eating after radical head and neck surgery Dear OncoLink "Ask The Experts," Is there anything that can be done to regain a proper eating capacity, following operations to remove a tumor in my neck, followed by radical and extensive radiotherapy? I can take liquids and food such as Shepherds Pie, Sponge puddings, scrambled eggs, provided they have a good deal of sauces etc. I cannot eat
Total Parenteral Nutrition concerns Dear OncoLink "Ask The Experts," My mother is undergoing radiation and chemotherapy. She was placed on Total Parenteral Nutrition. Is this nutrition complete for her? Can it cause her cholesterol to skyrocket because of the fat included? Her nurse mentioned that it contains large doses of sugar therefore; insulin is also given to her. Can this
Can diet increase platelets? Dear OncoLink "Ask The Experts," What can you eat or do to increase the platelet count? My father has not stopped bleeding at the colostomy location. He is also diabetic. Katrina Claghorn, MS, RD, Registered Dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds: There really are no particular foods that
Dietary suggestions for diarrhea during chemotherapy Dear OncoLink "Ask The Experts," My father is 85 and is has stage IV colon cancer. He is currently undergoing chemotherapy and one of his biggest problems is diarrhea. My mother needs recipes that are easy to fix. Can you help? Katrina Claghorn, MS, RD, Registered Dietitian at the Abramson Cancer Center of the University of Pennsylvania,
Sugar and cancer Dear OncoLink "Ask The Experts," Does cancer feed off sugars in the body? In other words does sugar make the cancer grow faster? Katrina Claghorn, MS, RD, Registered Dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds:There has been increasing interest about the impact of sugar on cancer. Recent studies suggest
Neutropenic Diet Dear OncoLink "Ask The Experts," I am working at a small community hospital. Our hospital does not have a uniform policy on Neutropenic diets--would you be able/willing to share what the policy is at your hospital for in-patients and how you help transition these patients to follow any neutropenic guidelines as out-patients? Ellen Sweeney
Being proactive with your nutrition when receiving cancer treatment to the head and neck area Dear OncoLink "Ask The Experts," I have recently undergone surgery for removal of an encapsulated squamous cell tumor on the right side of my neck (and a small piece from the back of my tongue). The oral surgeons removed all of my remaining teeth as a precondition for the seven weeks of radiation and chemotherapy that I will begin next week. I am
Nutrition During Interferon Dear OncoLink "Ask The Experts," My brother has been diagnosed with melanoma, stage four. I will be his caregiver when he has his 30 days of Interferon. I know he will be very sick. I would like to know what foods we should stay away from and what I should include in his diet. Any suggestions on what to feed him and should he be taking a
Phytoestrogen Intake Dear OncoLink "Ask The Experts," I have been told that patients with estrogen dependent breast cancer treated with tamoxifen must avoid food high in phytoestrogen. How much phytoestrogen can a person take/day? Is there a set a reference amount? Katrina Claghorn, MS, RD, Registered Dietitian at the Abramson Cancer Center of the University of
Weight loss during chemotherapy Dear OncoLink "Ask The Experts," Due to severe arthritis in my knees I am overweight at 5'5"and 185 lbs. I recently had a mastectomy. I am about to begin chemotherapy. I need a diet for energy and replacement of vitamins and minerals, etc. Katrina Claghorn, MS, RD, Registered Dietitian at the Abramson Cancer Center of the University of
Progesterone Cream, Flax Seed, and a Soy Supplements Dear OncoLink "Ask The Experts," My breast surgeon strongly recommends that I use topical natural progesterone cream, flax seed, and a soy supplement to decrease my risk of recurrent Stage IIB breast cancer. I am incorporating soy into my diet via soymilk and am adding flax seed to my soy breakfast cereal. I'm unsure, though, about how safe
Soft Diet Dear OncoLink "Ask The Experts," Can you give me some suggestions for ways to increase calories and nutritional values for someone who must eat a very soft or liquid diet? My brother has end stage adenoid cystic carcinoma of the sinuses which has greatly affected his ability to chew. Ellen Sweeney Cordes, RD, Registered Dietitian at
Full Liquid Diet Dear OncoLink "Ask The Experts," My 79 year old father has had bladder cancer for 17 years. We have just been told that he will not survive until spring, and that he must be on a "full liquid diet". We want to keep him at home for as long as we can, but are having trouble finding full liquid diet suggestions. Can you
Vomiting during tube feeding Dear OncoLink "Ask The Experts," My brother has throat cancer. He is being fed by a stomach tube. He gets the bulk of his feeding at night. He has been vomiting. So much that he has lost 32 pounds. The doctors are saying the reason for his vomiting is that the radiation is making his saliva thick. I have worked with people who are being tube fed. I
Do Microwaved Plastics Cause Cancer? Dear OncoLink "Ask The Experts," I recently received an email claiming to have information written by Johns Hopkins University about the risk of cancer from plastic. The email claims that cooking in plastic containers in the microwave, putting water bottles in the freezer, or using plastic wrap in the microwave can all cause cancer. Is there any
Low Iodine Diet for Vegetarians Dear OncoLink "Ask The Experts," I saw your previous response to a low iodine diet. I will be undergoing radioiodine therapy soon and am a vegetarian. Most of my protein comes from dairy (which I won't be able to consume) and Indian lentils/dahls. Is it okay to eat dahls, for example, moong, toor, urad dahl? The packaging says that there is
Nutritional Supplements #19; Non-Mucus Forming Dear OncoLink "Ask The Experts," What are some liquid, non-mucus forming nutritional supplements, preferably over the counter? My relative has head/neck cancer, has completed radiation therapy, and has a feeding (PEG) tube. Ellen Sweeney Cordes, RD, Registered Dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds:Dairy
Reishi During Treatment for Colorectal Cancer Dear OncoLink "Ask The Experts," After 6 months of symptoms related to colorectal cancer, my father had a colonoscopy last week and a 2-inch tumor was found at the rectum. Blood test and x-ray results haven't come in yet. A CT scan has been scheduled for this week. He started taking the Chinese herbal medicine reishi (Ganoderma Lucida) this
Glyconutrients for Cancer Prevention or Treatment Dear OncoLink "Ask The Experts," Is there any value to adding products called "glyconutrients" to the routine of a patient undergoing chemotherapy for advanced prostate cancer? Or is this another example of "quackery" via the Internet? Katrina Claghorn, MS, RD, Registered Dietitian at the Abramson Cancer Center of the University
Short Bowel Syndrome Diet Dear OncoLink "Ask The Experts," I suffer from short bowel syndrome (SBS) due to extensive resection of my small intestines following damage caused by radiation therapy. I have been cancer free for the past 6 years. However, I have had a difficult time gaining weight after my initial loss of 25 pounds. I eat 5 small meals every day, or
Juice Plus Supplement Dear OncoLink "Ask The Experts," Can you please offer some expert opinion on the vitamin supplement, Juice Plus? It is being shamelessly promoted as a cure and prevention for cancer and what I have read about it, it has really shocked me. It looks like a total scam. Can you please comment on this product? Katrina Claghorn, MS, RD, Registered
Ginseng, Reishi Mushroom & Goji Berry Juice Dear OncoLink "Ask The Experts," My Mum is currently undergoing chemotherapy (ECF - Epirubicin, Cisplatin and 5FU) for Adenocarinoma of the stomach. Can she take the below herbals while undergoing chemotherapy? Gingseng tea Reishi Mushroom tablets Goji Berry juice Your help would be greatly appreciated. Sherri Cirignano,
Finding a Oncology Dietitian Dear OncoLink "Ask The Experts," I would like to meet with an oncology dietitian, but my doctor's office does not have one. How can I find someone in my area? Katrina Claghorn, MS, RD, Registered Dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds:The American Dietetic Association has a "find a dietitian" page on
Diet after Bowel Surgery Dear OncoLink "Ask The Experts," I'm a survivor of anal cancer and also had to have 6-8" of small bowel removed last year because my radiation treatment really messed it up. dietitians have told me is that plenty of fruits and veggies are good. My problem is I can't digest them or lots of other foodsl, so what am I supposed to eat to
Antioxidants During Radiation Therapy Dear OncoLink "Ask The Experts," I am starting radiation therapy for local recurrence of ovarian cancer following surgery and chemotherapy. I'd like to take supplements or antioxidants to boost my overall health, but the evidence seems to be conflicting on the benefits/risks. What is safe or unwise to take during radiation therapy? Karen Wagner
Low Iodine Diet & Mustard Dear OncoLink "Ask The Experts," My sister is going to have radioiodine treatments and must be on the low sodium diet. My question is, can she use the spice dry mustard? Katrina Claghorn, MS, RD, Registered Dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds: Mustard powder or seeds are allowed. However,
Soy & Antioxidants After Breast Cancer Dear OncoLink "Ask The Experts," I was told not to take antioxidant vitamins C and E while I was taking chemotherapy for breast cancer. Supposedly, they are taken up by the cancer and used for growth. Should I take them now that I am no longer on chemo and Herceptin? I take Arimidex daily. Also, soy products, are they out also?Katrina Claghorn, MS,
Cooking Oils Causing Cancer? Dear OncoLink "Ask The Experts," I was diagnosed with an early-stage hormone-positive, pre-menopausal breast cancer. I have been increasing my intake of veggies, fruits, omega 3's. Recently, I heard that olive oil loses its nutritional content at high heats and can actually be a carcinogen. Is this true? What are the best oils to use for high heat
Drug/Herbal Interactions with Arimidex Dear OncoLink "Ask The Experts," I am on Arimidex and was concerned about drug/herbal interactions. Are there any that I should be aware of? I have only heard about ones that counteract Tamoxifen. Katrina Claghorn, MS, RD, Registered Dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds:Herbal products are very complex
Flaxseed During Breast Cancer Treatment Dear OncoLink "Ask The Experts," I have been treated for the last 8 months for an invasive breast cancer (mastectomy and chemo). I am now on Tamoxifen and have been having quite the time with hot flashes. I have been reading about using flaxseed in your diet to help combat the hot flashes. I have found articles that are both pro and con on using
Mannatech Glyconutrients Dear OncoLink "Ask The Experts," For the last 4 years, I have had breast cancer secondaries in my liver. For a good period, Femara of letrozole kept them in check, but none of the aromatase inhibitors (AI) now work. I recently had Xeloda oral chemotherapy and this did very little good. I am trying Arimidex as it is the only AI, I have not tried.
Nutrition for Cancer Patients after Gastric Bypass Surgery Dear OncoLink "Ask The Experts," My friend has stage II ovarian cancer and is currently undergoing chemotherapy - 2nd treatment following debulking surgery. Prior to her diagnosis, she had stomach reduction surgery. She is having an exceptionally hard time post chemo treatments with dehydration and low potassium level. I am an OC Survivor
Lymphedema Prevention Dear OncoLink "Ask The Experts," If a person were treated for breast cancer four years ago andhad taken every precaution to avoid lymphedema, but recently had her blood pressure taken multiple times on the arm that was on the same side as the cancer, how much would that increase her risk for lymph edema, and when would it start showing up? Does
Is there a test for lymphedema? Dear OncoLink "Ask The Experts," Are there any diagnostics that can be done to better define (or stage) lymphedema for more specific treatment recommendations? Linda McGrath Boyle PT, DPT CLT-LANA, Cancer Rehab Specialist and OncoLink Lymphedema Team Editor, responds:A physician knowledgeable in the clinical practice of lymphedema management most
Staging System for Lymphedema Dear OncoLink "Ask The Experts," Is there a staging system for lymphedema?Linda McGrath Boyle PT, DPT CLT-LANA, Cancer Rehab Specialist and OncoLink Lymphedema Team Editor, responds:The International Society of Lymphology has established a staging system for persons with lymphedema. For persons with lymphedema of the limbs, the following stages
Cellulitis in the Presence of Lymphedema? Dear OncoLink "Ask The Experts," After having right axillary lymph node dissection (ALND) and radiation concluding in January for local recurrent melanoma, I developed lymphedema and what they believe is cellulitis. It took me probably 2-3 weeks to finally get my arm evaluated. I'm seeing a lymphedema therapist now and I've been bandaging my arm
What is Complete Decongestive Therapy? Dear OncoLink "Ask The Experts," I have had a radical hysterectomy for gyn-related cancer. I am experiencing severe abdominal swelling. My doctor has recommended complete decongestive therapy. Can you explain what is involved with that? Linda McGrath Boyle PT, DPT CLT-LANA, Cancer Rehab Specialist and OncoLink Lymphedema Team Editor,
Self-Care for the Person with Lymphedema Dear OncoLink "Ask The Experts," I developed lymphedema after a hysterectomy, with lymph node dissection 1 year ago. What are the precautions I should be taking in caring for my swollen leg? Linda McGrath Boyle PT, DPT CLT-LANA, Cancer Rehab Specialist and OncoLink Lymphedema Team Editor, responds:Lymphedema education consists of daily attention
How do I Find a Certified Lymphedema Therapist? Dear OncoLink "Ask The Experts," My physician has recommended treatment from a lymphedema specialist. How can I make sure the person is qualified? Linda McGrath Boyle PT, DPT CLT-LANA, Cancer Rehab Specialist and OncoLink Lymphedema Team Editor, responds:Lymphedema can be effectively treated by certified lymphedema therapists (CLT). Certified
Recurrent Cellulitic Infections and Lymphedema Dear OncoLink "Ask The Experts," I've had lymphedema for 7 years, following removal of a tumor in the right axilla. I've had recurring cellulitis and was hospitalized last month. Is it true that each episode of cellulitis makes the lymphedema worse? I've had MLD in the past, but according to my insurance company, I've exhausted therapy coverage for
Advocacy for Lymphedema Insurance Coverage Dear OncoLink "Ask The Experts," I've had lymphedema for 7 years, following removal of a tumor in the right axilla. I've had recurring cellulitis and was hospitalized last month. I've had manual lymphatic drainage (MLD) in the past, but according to my insurance company, I've exhausted therapy coverage for my arm. Also, I wear a compression sleeve
Lymphedema Alert Bracelets Dear OncoLink "Ask The Experts," I just read the inquiry about using a bracelet to alert caregivers about not using the surgical arm. For several years, I have been distributing alert bracelets to patients at our medical center. The bracelet we use is acceptable in the OR, whereas the National Lymphedema Network bracelet probably is not. They are
Lymphedema Therapies During or After Cellulitis Dear OncoLink "Ask The Experts," I have question about compression garment usage. I am currently treating cellulitis of an arm that has lymphedema and was told by my massage person that she could not do any lymphatic massage until a month after this clears up. Is this the same advice for wrapping and using a compression sleeve and gauntlet? Also,
Lower Extremity Lymphedema Dear OncoLink "Ask The Experts," Can you tell me the current data on the incidence of lymphedema in the legs and genitals following surgery, external and internal radiation and chemotherapy for uterine cancer? Is there good documentation? Linda McGrath Boyle PT, DPT CLT-LANA, Cancer Rehab Specialist and OncoLink Lymphedema Team Editor,
Axillary Web Syndrome (Cording) Dear OncoLink "Ask The Experts," I had a lymph node dissection and have developed lymphedema (mild), but have a painful condition which my physical therapist says is called roping or cording. The nerves were injured during surgery. I cannot find relief and no one seems to know what to do. In the meantime, I have to have radiation therapy and cannot
Body Mass Index and Lymphedema Dear OncoLink "Ask The Experts," Does a person’s weight affect risk for lymphedema? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds: Body mass index is a number used to evaluate weight. (BMI calculator) Researchers have seen that a BMI greater than 25 increases the risk of developing lymphedema, and also increases the risk
Shoulder Problems and Lymphedema Risk Dear OncoLink "Ask The Experts," Having had left mastectomy and lymph node dissection 12 years ago, I understand I will always have a risk of lymphedema in my left arm. After several months of left shoulder pain and decreasing range of motion, an MRI showed some fluid in the bursa and my Orthopedics Doctor diagnosed “impingement
Lymph after Node Removal Dear OncoLink "Ask The Experts," Where does the lymph of the left arm go when the axillary nodes have been removed?Linda McGrath Boyle PT, DPT CLT-LANA, Cancer Rehab Specialist and OncoLink Lymphedema Team Editor, responds: Lymph node removal and radiation therapy to the local tissue leave the lymph node bed less able to maintain fluid balance.
Nausea and Vomiting with Whole Brain Radiotherapy Dear OncoLink "Ask The Experts," After a 3 year remission from breast cancer, my sister was diagnosed with a single brain metastasis in November. This was surgically removed, and then a 10-day course of whole brain radiotherapy (WBRT) began on January 3. Within four hours of her first treatment, she began to feel nausea which progressively got
Pain relief for bone metastasis from prostate cancer Dear OncoLink "Ask The Experts," My father is 65 years old and is suffering severe shoulder pain from metastatic prostate cancer. Is there something we can do for his pain? Erin McMenamin, MSN, CRNP, AOCN, Pain Medicine Nurse Practitioner and Program Manager at the Abramson Cancer Center of the University of Pennsylvania, responds:He should
Neuropathic Pain After Chemotherapy Dear OncoLink "Ask The Experts," I am a male 36 years old I have ended my CHOP chemotherapy for Non-Hodgkin's Lymphoma. About two weeks after my chemotherapy ended and continuing to date, I have been suffering severe leg pain in both legs. The pain is from my upper thighs to my feet. It is a consistent deep bone pain with occasional sharp stabbing
Morphine Overdose or Normal Death Dear OncoLink "Ask The Experts," Can you delineate the differences between morphine overdose and normal death progression in an advanced-stage, terminal lung cancer patient? And further, with such advanced cancer, does one need to worry about overdose speeding death when making decisions about medication? Erin McMenamin, MSN, CRNP, AOCN, Pain
Terminal Restlessness or Delirium Dear OncoLink "Ask The Experts," My stepdad is dying of lung cancer. I was wondering if you can send me some information about terminal restlessness? Thank you.Erin McMenamin, MSN, CRNP, AOCN, Pain Medicine Nurse Practitioner and Program Manager at the Abramson Cancer Center of the University of Pennsylvania, responds:This condition is referred to
Physical Therapy Modalities and Cancer Patients Dear OncoLink "Ask The Experts," I work in an outpatient chiropractic and physical therapy center. My question is: Is it safe to treat a patient with physical therapy modalities (i.e. US, E-stem, etc.) if they had or have any type of cancer? (Note: these modalities are a variety of treatment tools used by therapists to decrease pain, inflammation
Morphine and the Cancer Process Dear OncoLink "Ask The Experts," If a patient has lung cancer, and morphine is administered for the pain, does the morphine speed up the process? Erin McMenamin, MSN, CRNP, AOCN, Pain Medicine Nurse Practitioner and Program Manager at the Abramson Cancer Center of the University of Pennsylvania, responds:Morphine will not speed up the process of
Dealing with Neuropathic Pain Dear OncoLink "Ask The Experts," My husband has peripheral neuropathy from cisplatin. What medications are recommended to treat this pain? It keeps him up at night. Are there specialists for this type of pain? Erin McMenamin, MSN, CRNP, AOCN, Pain Medicine Nurse Practitioner and Program Manager at the Abramson Cancer Center of the University of
TENS Use for Pain Control Dear OncoLink "Ask The Experts," My wife has a low-grade lymphoma, and the current treatment is ?wait and watch?. She has no pain from it. Right know she is having some unrelated back pain, and a pain management doctor are thinking of using a Tens Unit or EMS to help control that pain. We have previously been told not to use a Tens Unit or EMS if
Evaluating Pain in a Non-Verbal Patient Dear OncoLink "Ask The Experts," Is there a scale that can be used to evaluate pain in a patient who is nonverbal or unresponsive and cannot use the traditional number or face scales?Erin McMenamin, MSN, CRNP, AOCN, Pain Medicine Nurse Practitioner and Program Manager at the Abramson Cancer Center of the University of Pennsylvania, responds: If a
End of Life Dear OncoLink "Ask The Experts," My mother passed away 3 years ago from lung cancer. I have been trying to understand what happened in the last days of her life. When I came to see her, she was not responsive, but her eyes were open. Can you explain why this happens?Erin McMenamin, MSN, CRNP, AOCN, Pain Medicine Nurse Practitioner and Program
Cramping After BMT Dear OncoLink "Ask The Experts," My daughter had a M.U.D. bone marrow transplant 12 years ago to treat acute myelogenous leukemia. She is free of most GVH symptoms with one exception. She has frequent and sporadic muscle cramping throughout her extremities and occasionally in her abdominal muscles. Initially it seemed to worsen with
Gleevec and BMT Dear OncoLink "Ask The Experts," Our 14 year old son was diagnosed with Chronic Myelogenous Leukemia 6 weeks ago. He is on Gleevec. We have been considering Bone Marrow Transplant but heard that Gleevec may be contraindicated in doing a BMT. Can you shed any light on this?Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor
Medications After Allogeneic Transplant Dear OncoLink "Ask The Experts," I am post-transplant (non- related donor). I was just discharged with my meds. One medication is Zyvox. I don't know what this is for. I have no infections and my WBC (white blood cell count) is adequate. I looked it up online and it says something about myelosupression. What is that? Does myelosupression mean it
How Old is Too Old for BMT (bone marrow transplantation)? Dear OncoLink "Ask The Experts," Can you tell me what the age cutoff is for BMT? It seems to be increasing, and I was wondering if there is a standard. Thank you.Deana Potts, MSN, CRNP, Advanced Practice Oncology Nurse, responds:There is no standard age cutoff for Bone Marrow or Stem Cell Transplants. An autologous (self-donor) bone marrow/stem
Chromosomal Abnormalities and BMT Dear OncoLink "Ask The Experts," My friend has just undergone the induction phase of chemotherapy for AML (acute myelogenous leukemia), and has been advised she should get a bone marrow transplant soon, rather than going through a consolidation phase of chemotherapy. Her cytogenetics include a translocation of chromosomes 19 and 11. We presume
Donor Cells Versus Own Cells For Transplant Dear OncoLink "Ask The Experts," I have a friend with leukemia, and he started his second round of chemotherapy, hoping to get the remaining cancer cells. Then, after this secon0d round his doctor says he will take tests and undergo biopsy again to see if he is in remission. Our friend is going to use his own bone marrow cells rather than a donor.
Rituxan for Chronic GVHD Dear OncoLink "Ask The Experts," My brother has chronic GVHD and all other treatments have failed so far. His doctor now has decided to try Rituximab. What can you tell me about this? Deana Potts, MSN, CRNP, Advanced Practice Oncology Nurse, responds:B-cells and T-cells are part of the immune system. GVHD, or graft versus host disease, is caused by
Mylotarg vs. Stem Cell Transplant in Older Patients Dear OncoLink "Ask The Experts," My mom is 69 years old and was diagnosed with AML in Nov, 2005. She has gone through two induction phases and has not been able to go into remission. The doctors say that a stem cell transplant is not an option because of her age. Her options are to go on Mylotarg or to enroll in a clinical study. My question is:
Cord Blood Donation Dear OncoLink "Ask The Experts," My daughter's mother-in-law has multiple myeloma. My other daughter is 8 months pregnant. Is it a possibility that the cord blood can be used to treat this woman's cancer? Vicki Sherry, MSN, CRNP, Advanced Practice Oncology Nurse, responds:Since your daughter's baby and your other daughter's mother-in-law are not
Dental Consult before Bone Marrow Transplant Dear OncoLink "Ask The Experts," I was told by my new oncologist to see an oral surgeon before my autologous stem cell transplant. The surgeon took x-rays and said that all my teeth had to come out before I could have my transplant. He said 18 teeth were bad, and he would have to pull my good ones too. I saw other patients whose teeth were worse
Can a Person Have Multiple Transplants? Dear OncoLink "Ask The Experts," How many times can you get a bone marrow transplant? Can you get it more than once?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds: This depends on the type of transplant. For an autologous transplant where the patient is transplanted with his or her own cells, multiple transplants are common.
Becoming a Bone Marrow Donor Dear OncoLink "Ask The Experts," I have a friend with a family member in need of a bone marrow transplant at University of Pennsylvania . I would like to see if I am a match. Would you advise me on how to begin the process? Joanne Hinkle, BSN, OCN, Unrelated Bone Marrow Donor Program Coordinator at the University of Pennsylvania
Time Off Work for Bone Marrow Donation Dear OncoLink "Ask The Experts," What is the typical recovery period for the donor of a bone marrow transplant? How long of a work layoff should I expect? How long before I'm back to normal everyday life?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Well, first off, thanks for being a donor! The time for recovery depends on
Topotecan Dear OncoLink "Ask the Experts," I would appreciate it if you could send me any information that you might have to help me to decide about whether or not I should take Topotecan. I have AML and ALL acute leukemia. I am currently taking 5-AZA that seems to be helping me to some extent. Thank you, NS Bradley
Rituxan Dear OncoLink "Ask the Experts," I have a question regarding Rituxan. I am having difficulty finding information on this therapy. My father has non-Hodgkins lymphoma which was diagnosed in April of 1998. C.H.O.P. chemotherapy regimen was unsuccessful. He has now developed a tumor behind the pancreas with tremendous amount of ascites
Leucovorin My sister is 49 years old and has breast cancer. She underwent quadrantectomy and they found cancer cells in three lymph nodes. She is scheduled for chemotherapy and then radiation. Someone in her support group referred to a drug called a "rescue" drug. Is there any information you can provide on that drug? Does it have to do with the
Treatment for Peripheral Neuropathy I would like to know if there is any hope/help for peripheral neuropathy caused by chemotherapy (taxol and carboplatin)? I have experienced significant loss of feeling and sensitivity in both my feet and now tips of fingers; accompanied by significant pain. Is here anything I can do to limit this damage, or hopefully reverse it? I am
Combretastatin Clinical Trials Dear OncoLink: Through the electronic media I became aware of clinical trials being conducted on a promising cancer drug called combretastatin. I would like to volunteer for your clinical testing program. I am currently being treated on a one day a week basis for colon cancer via chemotherapy. James P. Stevenson,
CPT-11 (Irinotecan) and Radiation Side Effects Dear OncoLink "Ask the Experts," Does radiation in the pelvic area prevent the use of CPT-11? My wife is a stage 4 cancer patient and has received FUDR, FUDR and Leucovorin, then FUDR, Leucovorin and Gemzar®. She was allergic to the Gemzar and was due to start the CPT-11 when she developed a mass in her pelvic area that requires
Combretastatin I saw the TV news about Combretastatin. Can you tell me how this drug works? Bradley Somer, MD, OncoLink Editorial Assistant, responds: Combretastatin (A4 Prodrug) is a newly developed anti-angiogenesis drug. In the test tube and in mice it has been shown to limit the blood supply to the tumor. This eliminates the
Long-Term Effects of Chemotherapy and Radiation Treatments Dear Editors, I have been to many, web sites and libraries. I am not having any luck. I hope I will find my answer with you! I have had breast cancer. I have had a lumpectomy, chemotherapy & radiation therapy. I am trying to find is information on the long term effects from chemotherapy and radiation. Will my breast return to
Is grapefruit contraindicated during chemotherapy? Dear OncoLink "Ask The Experts," I am wondering if you clear up the mystery surrounding the contraindicated use of grapefruit/and or juice during chemotherapy? Katrina Claghorn, MS, RD, Registered Dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds:Grapefruit can block the activity of an enzyme in the intestine
Improving white blood cell count during chemotherapy Dear OncoLink "Ask The Experts," My wife has had surgery for Colon cancer and a Liver resection. Now the cancer has spread to her lungs. She has begun a new treatment, given through a porta-cath, with 5-FU and irinotecan. Blood tests showed very low white blood cell counts and the treatment was stopped. Is there any thing she can take or do to
Does chemotherapy make you toxic? Dear OncoLink "Ask The Experts," I am receiving chemotherapy and some of my friends are avoiding me because they say I am toxic. Is that true? Carolyn Vachani RN, MSN, AOCN, OncoLink's Medical Correspondent, responds:You cannot get toxic from your chemotherapy treatments, nor can you expose people to the chemotherapy by being near them. Many
Metallic taste after chemotherapy Dear OncoLink "Ask The Experts," The most difficult side effect of chemotherapy so far has been the metallic taste in my mouth. Nothing seems to help do you have any ideas? Carolyn Vachani RN, MSN, AOCN, OncoLink's Medical Correspondent, responds:The metallic taste, or other taste changes are quite common during cancer treatment. I can give
Chemotherapy and diabetic patients Dear OncoLink "Ask The Experts," I have a friend just diagnosed with ovarian cancer. She is a childhood diabetic. How does chemotherapy effect diabetic patients? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:In general, chemotherapy does not affect
Safe handling of bodily fluids after chemotherapy Dear OncoLink "Ask The Experts," After chemotherapy treatment, are there recommendations for safe handling of patient secretions, urine, etc for when they return home? Thanks. Carolyn Vachani RN, MSN, AOCN, OncoLink's Medical Correspondent, responds:Thanks for your question. At the University of Pennsylvania Medical Center we do not give
Recurrent or metastatic melanoma treatment options Dear OncoLink "Ask The Experts," I am a nurse taking care of an MS patient who has a recurrent melanoma on the side of her face. She was treated with Thalidomide and it was stopped because she could not tolerate it. The oncologist's next step will be to try Temadar. I am looking for your comments on how to proceed. Julia Draznin Maltzman, MD,
Exposure to environmental tobacco smoke during chemotherapy Dear OncoLink "Ask The Experts," I have a friend who is undergoing chemotherapy for breast cancer following a mastectomy. I have a problem with her family's continued smoking in the home and car with her. I have been looking for some research that I could show them demonstrating that passive smoke is harmful to chemotherapy patients. Can you point
Chemotherapy and osteoporosis Dear OncoLink "Ask The Experts," I had lung cancer in my left lung in 1987, and was treated with chemo and radiation for a year. I recovered and am doing great. I have been wondering: I thought I had heard that all the chemo and radiation can age your bones by about 10 years?? I would like to know what you think.Linda Jacobs, PhD, CRNP, AOCN, BC,
Flu Shots While on Chemotherapy Dear OncoLink "Ask The Experts," My wife has metastasis in the bones after she had breast cancer. Now she is taking Xeloda. I would like to know if she can have a flu injection while taking Xeloda?Carolyn Vachani RN, MSN, AOCN, OncoLink's Medical Correspondent, responds:We do suggest that our patients receive the flu shot, but to schedule the shot
Losing Fingernails After Chemotherapy Dear OncoLink "Ask The Experts," My sister has just finished all her chemotherapy and radiation treatments for breast cancer. Her fingernails are turning dark and separating from the bed. Is there anything she can do to help this situation? Will any creams or other products help to strengthen the nails? Carolyn Vachani RN, MSN, AOCN, OncoLink's
Birth Defects While on Chemotherapy Dear OncoLink "Ask The Experts," concern is about the likelihood of my getting pregnant while he's on chemo. We are certainly not planning on it, and I have been on the pill for 10 years, but what are the chances we would have an accident? And what kind of birth defects are expected? The drug guides don't really get that specific. Thank you! Vicki
Heart Damage and Chemotherapy Dear OncoLink "Ask The Experts," My father was recently diagnosed with synovial sarcoma in the lining of the lung. It was suggested that he undergo chemo therapy treatment with Doxil®. He's an older man with a heart condition, and based on what I read, I'm concerned about the cardiac ramifications. Carolyn Vachani RN, MSN, AOCN, OncoLink's
Coloring Hair After Chemotherapy Dear OncoLink "Ask The Experts," My hair is starting to grow back after chemotherapy and radiation treatments. I finished radiation a month ago and want to color my hair. Is that okay? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Although I could not find any actual, published guidelines, I queried a few of my colleagues and
Reimmunization after Chemotherapy Dear OncoLink "Ask The Experts," My daughter is almost 16 years old. She was diagnosed with Hodgkin's lymphoma with spine metastases. She has 5 sessions of local radiotherapy and will finish her 6th cycle (12th session) of chemotherapy shortly. I wondered if the chemotherapy negates all or any of the immunizations she has had to date, such as Hep
Administering Rituxan in R-CHOP Dear OncoLink "Ask The Experts," I've recently started a job administering chemotherapy . Does it matter in what order R-CHOP (R= Rituxan, CHOP = chemotherapy regimen of Cyclophosphamide, Adriamycin, Vincristine, and Prednisone) is given? I was told to always give Rituxan last, even if the MD writes for it first, due to the higher incidence of side
Predict Response to Chemotherapy? Dear OncoLink "Ask The Experts," I was diagnosed with Stage IIIC ovarian cancer in Nov. 2005. I had a hysterectomy and tumor debulking at that time. I have most recently been on IV Taxol and Carboplatin chemotherapy, and have responded best to this combination. What is the best predictable factor that will indicate how one person will respond to a
Arthritis and Chemotherapy Dear OncoLink "Ask The Experts," I'm a 26-year-old female diagnosed with Hodgkin's Lymphoma (Nodular Sclerosis type, stage IIIB) in March of 2006, and have been receiving 6 cycles of ABVD chemotherapy. I've been experiencing a lot of bone pain, and now a lot of joint pain. The pain in my hands even prevents me from holding a phone or menu at times.
Chemotherapy Exposure During Pregnancy Dear OncoLink "Ask The Experts," I am an oncology nurse in Seattle and am 21 weeks pregnant. I recently had a skin exposure to 5FU and was wondering about the implications of that. It was approx 5ccs and I washed the affected area well within 5 minutes. What concerns should I have? Christina S. Chu, MD, Assistant Professor of the Division of
Clean House while on Cancer Treatment Dear OncoLink "Ask The Experts," This may seem like an odd question. My mom is about to start chemotherapy for stage II breast cancer. The question is, will the condition/cleanliness of my mom's home impact her health during treatment? Mom has never been a neat freak as it's just not a priority for her, and up until now it hasn't caused her any
Safe handling of bodily fluids after cancer therapy Dear OncoLink "Ask The Experts," After chemotherapy treatment, are there recommendations for safe handling of patient secretions, urine, etc after the patient returns home? Thanks.Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:In most cases, chemotherapy is excreted in the body fluids for up to 48 hours after treatment,
Topical Chemotherapy Precautions Dear OncoLink "Ask The Experts," Recently I was treated to eradicate an intraepithelial lesion, grade I, by means of a LEEP procedure. Now I've been through two sessions of local chemotherapy (cream) in the vagina. The doctor says that because of the shape of the vagina, he cannot be sure if other lesions exist in this area that were not eradicated
Dose Dense Chemotherapy for Lymphoma Dear OncoLink "Ask The Experts," I have heard that giving CHOP chemotherapy every 2 weeks may be more effective than every 3 weeks (the standard). Can you provide any details? Babis (Charalambos) Andreadis, MD, Assistant Professor in Medicine in the Division of Hematology/Oncology at the Abramson Cancer Center and an Associate Scholar in the
Avastin Before or After Chemotherapy Dear OncoLink "Ask The Experts," Is there a therapeutic advantage to giving Avastin first or last in a regimen? Bruce Giantonio, MD, Assistant Professor of Medicine in the Hematology-Oncology Division at the University of Pennsylvania, responds:I am not aware of any clinical data that argues for one over the other, i.e. for a benefit to giving it
Pregnant Women Exposure to People Undergoing Therapy Dear OncoLink "Ask The Experts," I am 16 weeks pregnant and taking care of my mother who is being treated for pancreatic cancer. She will begin chemotherapy in a few weeks. Are there any risks for me or the baby to be around this situation? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:While receiving chemotherapy or external
Rash related to Erbitux Dear OncoLink "Ask The Experts," What recommendations do you have for treating skin rash associated with Erbitux? Beth Eaby, MSN, CRNP, OCN, Bboard certified nurse practitioner and nationally certified oncology nurse, responds:Skin rash from Erbitux can have varying severity, so treatment varies depending on this. Using a thick emollient cream to
Aprepitant (Emend®) for Ablative Regimens Dear OncoLink "Ask The Experts," Have there been any studies done on the efficacy of Emend for use in ablative chemotherapy? If not what is your recommendation for combating nausea from an 8- day regimen of Busulfan and Cyclophosphamide? Michael Vozniak, PharmD, BCOP, Hematology/Oncology Clinical Pharmacy Specialist, responds:At the 2007 ASCO
Dihydropyrimidine dehydrogenase (DPD) Deficiency Dear OncoLink "Ask The Experts," A family member was recently diagnosed with esophageal cancer. One of the chemotherapy treatments mentioned was Fluorouracil. We've read that if a person is DPD-deficient, the side effects could be severe, including death. Is there a test for this? Is this rare? Or should he avoid this drug completely? We've found
Hand Foot Syndrome Dear OncoLink "Ask The Experts," I am beginning Doxil chemotherapy this month for an ovarian cancer recurrence. Do you recommend Amifostine, B6, or Vitamin E to minimize the hand/foot syndrome? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:Most patients
Pregnancy While on Chemotherapy Dear OncoLink "Ask The Experts," My sister is two months pregnant, and conceived about one month after her husband had chemotherapy for testicular cancer. He had the affected testicle removed and has only had one chemotherapy treatment with Carboplatin. She is now concerned about the normal development of the fetus. Some doctors have advised her
Crushing Chemotherapy Pills Dear OncoLink "Ask The Experts," I had a gastric bypass banding a few years ago. I now have colon cancer and am scheduled to start chemotherapy with Xeloda, an oral chemotherapy. I have a lot of trouble swallowing pills since the banding. Can I crush the pills? Michael Vozniak, PharmD, BCOP, Hematology/Oncology Clinical Pharmacy Specialist,
Arimidex and Insomnia Dear OncoLink "Ask The Experts," My niece has just completed a five year course of Arimidex. She is now experiencing extreme difficulty sleeping, getting to sleep, and staying asleep. Are there any indications from other women that this is a side effect? Her oncologist says "no". Nancy Zieber, RN, MSN, CRNP, Oncology/Hematology Nurse
Male Sterility from Gleevec Dear OncoLink "Ask The Experts," My 27 year-old son was recently diagnosed with Chronic Myeloid Leukemia (CML). He is starting on the chemo drug Gleevec. What chance is there that would cause him sterility? Michael Vozniak, PharmD, BCOP, Hematology/Oncology Clinical Pharmacy Specialist, responds:Clinical experience with Gleevec (Imatinib) suggests
Fertility During Chemotherapy Dear OncoLink "Ask The Experts," Can a patient receiving chemotherapy for breast cancer get pregnant?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:A woman receiving treatment for breast cancer who was not menopausal (in other words, who is still premenopausal) before starting treatment can still get pregnant on therapy. This
Chemo-Brain Dear OncoLink "Ask The Experts," What treatments are available for chemo-brain? My doctor does not believe it is real, and I don’t know where to turn for help.Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds: Many survivors who have previously received or are currently undergoing chemotherapy report experiencing cognitive
ESHAP Regimen Dear OncoLink "Ask The Experts," My question is about the ESHAP protocol for lymphoma. The most descriptive protocol I've been able to find states to run cisplatin for 4 days with concurrent doses of etoposide during that time. I have oncology coworkers who are questioning the safety of running 2 chemo drugs concurrently, and would rather stop
Exposure to Children While Having Cancer Treatment Dear OncoLink "Ask The Experts," My mother-in-law was recently diagnosed with colorectal cancer. There is a 2 yr old child in the household, and I was wondering if her chemotherapy and radiation treatments will have any effect on the child being in that environment?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:This is a very
ONJ and Dental Procedures Dear OncoLink "Ask The Experts," I am on Zometa and need to have a crown done. Is this ok to do considering the concern of ONJ?Kendra Schaefer, DMD, Assistant Professor in the Department of Oral and Maxillofacial Surgery, Division of Prosthodontics at the University of Pennsylvania, responds:Osteonecrosis is a term that refers to exposed bone of
Order of Chemotherapy Administration Dear OncoLink "Ask The Experts," I am a 4th-year pharmacy student working on a project for a chemotherapy pharmacist. We are looking for a chart that shows what order chemotherapy agents should be administered. Do you have any advice/resources for us? Michael Vozniak, PharmD, BCOP, Hematology/Oncology Clinical Pharmacy Specialist, responds:I think
BCG Therapy Safety Dear OncoLink "Ask The Experts," I want to visit my mother, but her husband is undergoing BCG Vaccine treatment for bladder cancer. They are 87 and 85 years old, and do not use the best hygiene measures. I am concerned about my own health, as a 2-year breast cancer survivor. Am I at any risk while being in their home? Thank you for your
Number of Chemotherapy Cycles Dear OncoLink "Ask The Experts," I was diagnosed with colon cancer and am receiving Folfox chemotherapy. How many cycles of chemotherapy will I get? Gloria DiLullo, MSN, CRNP, OncoLink Medical Oncology Educational Content Specialist, responds: Thank you for your question, Sir. The number of chemotherapy cycles depends on the stage of the
Sexual Activity During Chemotherapy Dear OncoLink "Ask The Experts," I was diagnosed with colon cancer and am receiving Folfox chemotherapy. Can I have sexual relations with my wife? She is avoiding me with fear . What are the restrictions on sexual activity during treatment? Gloria DiLullo, MSN, CRNP, OncoLink Medical Oncology Educational Content Specialist, responds: In
Hypoglycemia on AIs Dear OncoLink "Ask The Experts," I completed taxotere, carboplatin, and Herceptin chemotherapy in October. I started just Herceptin in October and Arimidex in November. I am an insulin-dependent diabetic; I wear an insulin pump. I have been experiencing severe hypoglycemic episodes requiring emergency room treatment since I started the Arimidex. I
Medications that Interact with Tamoxifen Dear OncoLink "Ask The Experts," I have heard that anti-depressant medications interfere with tamoxifen. Are there any other medications- particularly over the counter meds that should be avoided as well? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:When you take tamoxifen, your body breaks it down, converting it into the
Taking AIs Beyond 5 Years Dear OncoLink "Ask The Experts," After bilateral mastectomies had chemo and radiation and then 3 years of Tamoxifen and will complete 5 years of Armidex in April. My oncologist says he will take me off Arimidex at that time although I am doing well on it and desire to continue taking it. Have you had any experience with women taking an aromatase
Alternative treaments Dear OncoLink "Ask the Experts," HI! I'm an Italian girl studyng psychology in University of ROME: I'm studying about alternative therapies for cancer. Can you help me??? I need more information about them. Thanks. Please answer me. Maggie Hampshire RN, BSN, OCN, Managing Editor of OncoLink responds: For
Antioxidants and Reducing Cancer Risk Dear OncoLink "Ask the Experts," Should I take antioxidants to reduce my risk of cancer? Katrina Claghorn, RD, Oncology Dietitian for The University of Pennsylvania Health System, responds: Antioxidants have been shown to have many health benefits. Besides reducing the incidence of heart disease and stroke,
Cancer Prevention Dietary Guidelines Dear OncoLink "Ask the Experts," What kind of diet should I eat to reduce my risk of cancer? Katrina Claghorn, RD, Oncology Dietitian for The University of Pennsylvania Health System, responds: The American Cancer Society has developed the following dietary guidelines: Choose most of the foods you eat from
Are Soy Products Linked to Cancer Prevention? Dear OncoLink "Ask the Experts," I read someplace that a woman trying to avoid breast cancer should have 35-60 grams of soy products per day. I bought some tofu powder (I can't abide the texture of real tofu!) and attempt to mask it in my morning oatmeal. How many grams of tofu powder is as effective as 35-60 grams of real tofu?
Information on Squalamine Dear OncoLink "Ask the Experts," I would like to know if you are familiar the drug squalamine? Can you give me some information on it? Kindly, J James Metz, MD, OncoLink's Associate Editor and Complementary Medicine section Editor, responds: Dear J, Squalamine is obtained from the liver of sharks and
Long-Term Complications of Whole Brain Irradiation Dear OncoLink "Ask the Experts," OncoLink has been a very helpful and informative resource to our family since my son was diagnosed with brain cancer. My question has to do with the long-term effects of whole-brain radiation. Thank you in advance. Li Liu, MD, Editorial Assistant for OncoLink, responds:
The Prostate Seed Implant Dear OncoLink "Ask the Experts," I have prostate cancer. PSA = 13.5. I'd like to know the pros and cons of seeding. Can you help? Thanks. J. Li Liu, MD, OncoLink editorial assistant, responds: Dear J: Thank you for your interest and question. The seed implant treatment for prostate cancer is also
Cervical Stenosis Caused By Radiation Therapy Dear OncoLink "Ask the Experts," I am a radiation therapist in Canada. My department has recently been tackling the issues of cervical stenosis caused by radiation therapy (external and internal) and the use of dilators to help this problem. Would you have any information on this? Thank you for you time. P. W.
Gamma Knife Radiosurgery Dear OncoLink "Ask the Experts," My mother has brain cancer. She is retired and is 50 years old. In March of 1998 she had CT and MRI scans, which revealed a tumor in her brain stem. Then she had routine treatment, but it did not show a significant effect. Experts in Nanjing, China suggested that she should be further treated with gamma
Can Graves Ophthalmopathy be treated with radiation? I have Graves' disease with bulging eyes. I have been taking steroids with some success initially but my eye problem appears to be worse. I am also suffering from the side effects of steroids. I heard that this type of eye problem could be treated with radiation. Can you provide me more information? Thanks! Li Liu,
Radiation-Induced Facial Hair Loss I recently received radiation therapy to my face and neck for treatment of squamous cell carcinoma of the oral tongue. I received a dose of 6000 cGy. One side effect that I have is that I have lost all growth of facial hair in the treatment area. Is this facial hair likely to grow back? Thank you. Li Liu, MD,
Post Radiation Pleural Effusions Dear OncoLink "Ask the Experts," My husband is a 30-year survivor of Stage IIIb Hodgkin's disease. He received radiation only. He has been having recurring pleural effusion in his chest cavity since 97. All tests are negative for cancer, TB, and HIV. Three months ago he had an episode of bradycardia (slow heart rate). He received a
Radiation Induced Hematuria Dear OncoLink: I need information on chronic radiation induced hematuria and any treatments used to correct this? Kenneth Blank, MD and John Han-Chih Chang, MD, Editorial Assistants for Oncolink, respond: Dear OncoLink Reader: Thank you for your question. Radiation treatments can cause
Hyperthermia Treatments for Liver Metastasis from Breast Cancer Dear OncoLink "Ask the Experts," I am trying to find information for a friend with breast cancer, which has spread to her liver. She had a bone marrow transplant that kept the disease at bay for six months. She now has a 3cm tumor in her liver. I saw that somewhere they are doing a new procedure which uses direct heat to the affected
Molecular Imaging What is molecular imaging? Thanks. Li Liu, MD, OncoLink editorial assistant, responds: Dear M: Thank you for your interest and question. Important developments in molecular sciences in the past decade have provided unprecedented opportunities in genome research, an understanding of the molecular mechanisms
Nasopharyngeal Radium Irradiation Could you please provide me with any information about a now discredited form of medical "treatment" called nasopharyngeal radium irradiation? J Li Liu, MD, OncoLink editorial assistant, responds: Dear J, Thank you for your interest and question. The nasopharyngeal (NP) radium applicator was
Radiating an Erythropoietic Mesenteric Mass Dear OncoLink "Ask the Experts," My wife has had polycythemia vera which was diagnosed in 1964. She was treated initially with frequent phlebotomies during the first decade of her illness. She developed splenomegaly and underwent surgical splenectomy in 1984. In the early 1990s she went into post polycythemic myeloid
Fibrosis of the Median Nerve after Radiation Treatments Dear OncoLink "Ask the Experts," Eleven years ago, I had radiation to the neck area. I now have numbness in my right hand and wrist due to scare tissue pinching the median nerve in the neck. Is there any solution to this problem? Thank you. Li Liu, MD, OncoLink Editorial Assistant, responds: Thank you for
Extra-cranial Stereotactic Radiosurgery Dear OncoLink "Ask the Experts," Is stereotactic radiosurgery used for inoperable tumors in non-brain areas? If so, where can I find further information about it, and where is such work taking place? Thanks for your consideration, A.S. Kenneth Blank, MD and John Han-Chih Chang, MD, OncoLink Editorial Assistants,
Post-Radiation Lower Motor Neuron Disease Dear OncoLink "Ask the Experts," Please, I am trying to find any information I can related to post radiation lower motor neuron disease. I had radiation for a clear cell carcinoma metastasis found in my lower spine. I have lost a lot of function in my legs/hips over the last 8 years. Thank you. M. Li Liu,
Long-term Side Effects of Radiation for the Treatment of Hodgkin's Lymphoma Dear OncoLink "Ask the Experts," I am looking for data or research that explains long term side effects for survivors of radiation therapy for the treatment of Hodgkin's Lymphoma IIA. I received this treatment in 1986 and have since developed a hypothyroidism and diabetes mellitis. What is the link between radiation and long term side
Radiation Dosages Dear OncoLink "Ask the Experts," I would like information on the specific dosage and the type and energy of the radiation used in treating Hodgkin's Disease. I would be most grateful for any information you can send about this. Yours sincerely, SK John Han-Chih Chang, MD and Kenneth Blank, MD, OncoLink's
Radiation Damage to the Heart After Treatment Dear OncoLink "Ask the Experts," I have heard that radiation of the left breast following lumpectomy for DCIS may damage one's heart. Is this true? If so, what are the odds of heart damage for a patient choosing radiation for DCIS? Thank You, RK John Han-Chih Chang, MD and Kenneth Blank, MD, Editorial Assistants
Radiation Recall Phenomenon Dear OncoLink "Ask the Experts," My dad has lung cancer that has spread to the brain. He had radiation treatment to the brain about 5 months ago and has been getting chemotherapy. The brain tumor was not very big and it was on the surface of the brain. It seemed that radiation treatment was successful on the tumor because it has reduced
Radiation therapy for breast cancer Dear OncoLink "Ask the Experts," My friend has lobular breast cancer and had six weeks of radiation treatment. She is wanting a source for understanding what to expect from her body as a reaction to radiation. Thanks for your help. Ken Blank, MD, and John Han-Chih Chang, MD, OncoLink Editorial
Neck stiffness and lack of saliva after radiation treatments for throat cancer Dear OncoLink "Ask the Experts," My dad had throat cancer about three years ago. He went through intensive chemotherapy and radiation treatments. His therapy has left him with no "real" saliva therefore making it almost impossible for him to swallow. He cannot eat or drink anything except for milkshakes and iced tea, no lemon. He has
Are patients undergoing external beam radiation treatment radioactive? Dear OncoLink "Ask The Experts," Can children be around family members that are taking radiation therapy for breast cancer? Lawrence J. Solin, MD, FACR, Professor of Radiation Oncology at the University of Pennsylvania, responds:Patients undergoing external beam radiation treatment are not radioactive after their treatments, and do not pose
Focal hair loss after partial brain irradiation Dear OncoLink "Ask The Experts," My 15 yr. old daughter has a choriod plexus carcinoma. She received chemotherapy & radiation to the ventricles two months ago. Her hair is coming in every where except where the radiation was directed. I'm wondering how long does it take to come back and how long before we know it's not going to come
Recurrent Cancer and Radiation Dear OncoLink "Ask The Experts," I've read that radiation therapy is seldom given to the same area twice. In this case, any recurrent cancer would have to be treated with chemotherapy, which seldom does more than provide temporary help. Is recurrent cancer thus fatal in most or all cases? Carolyn Vachani RN, MSN, AOCN, OncoLink's Medical
Blue Flash After Radiation to the Head Dear OncoLink "Ask The Experts," I've been diagnosed with GBM and have started radiation therapy (along with chemo - temodar). When I receive my dose of radiation (every day), I see a blue flash at the end of the cycle. My question is this: Is there increased risk of blindness as a result of this blue flash (i.e., retinopathy)? I'm assuming
Breast Feeding During Radiation Therapy Dear OncoLink "Ask The Experts," Is it safe to breastfeed your child if you are receiving radiation for 6 weeks for a brain tumor? Neha Vapiwala , MD, Senior Editor of OncoLink and Chief Resident in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:Yes, it is fine for a woman to breastfeed while
Bone Cancer Dear OncoLink "Ask the Experts," A friend has been diagnosed with bone cancer, but has decided to refuse any treatment. What are his chances? of recovery? of survival (and how long if diagnosed early)? He has taking up alcohol as pain relief. What overall effect will this have? He is obviously experiencing anger
Fibromatosis (Desmoid Tumors) Dear OncoLink "Ask the Experts," I am looking for an article I believe was published in International Journal of Radiation Oncology, Biology, Physics titled "Radiation therapy in the treatment of aggressive fibromatoses," written by Greenberg, Goebel, Weichselbaum, Greenberger, Chaffey, Cassady. I am sorry but I don't have the date. Is
Recurrent Desmoid Tumors Dear Oncolink: Is it possible for an extra abdominal desmoid in the leg to recur five times? Have you ever heard of this happening? Kenneth Blank, MD and John Han-Chih Chang, MD, Editorial Assistants for Oncolink, respond: Thank you for your question. Desmoid tumors are also called aggressive
Brain tumors & choosing a cancer center My cousin is affected by a brain tumor and is now under treatment at the European tumor center in Milan. We're looking for another center worldwide specialized in the treatment of such a tumor. Could you give your suggestion answering to this address please let me know if you need further information's to give your opinion. Thank
"Cereport" Treatment for Astrocytoma My uncle was diagnosed as having a malignant astrocytoma brain tumor. His physician suggested researching "cereport" treatment. We have been unable to access any information on this therapy. Can you please explain this treatment and where we may find additional information? Also, are you aware of any other new or alternative treatments for
Who's in Charge? I'm searching for information on plan of care and follow-up care for a patient who was diagnosed in 1991 with anaplastic astrocytoma (brain cancer). Who coordinates a cancer patient's care (oncologist, neuro-surgeon, family physician)? The patient has increased neurological dysfunctions (memory loss, imbalance, hearing loss) but has not
Treatment of a Chordoma Could you please reference me to an area where a patient with a chordoma could be treated? I have heard of a doctor from Harvard that may have the treatment that would be helpful to my friend. Respectfully, F Eric Shinohara, MD, MSCI Radiation Oncology Section Editor for OncoLink responds: Thank you for your
Treatment for Glioblastoma Multiforme My friend, aged 38, is suffering from glioblastoma multiforme for the past 2 years. He has undergone surgery, but the cancer in the brain could not be totally removed. Recently, he was diagnosed as having fluid accumulation in the brain and had another operation to remove the fluid. X-ray could not find the tumor anymore. The doctor has
Non-Surgical Approach to Removal of Brain Lesions I hope I am not troubling you, but I would be grateful for some information about your non-surgical methods of removing brain tumors. The lesions I suffer are Hemangio Blastoma. I have at least four lesions, two of which are in a delicate position. I am told that removal of these by surgery could cause speech problems and stroke. The
Oligodendrogliomas and Heredity My brother has recently died from anaplastic oligodendroglioma. One of his doctors said that although not hereditary, siblings may be susceptible. Is this true? Anything I can do to prevent or confirm? Li Liu, MD, Editorial Assistant for OncoLink, responds: Dear S: Thank you for your interest and
Stereotactic Radiosurgery for Brain Metastases My sister, who is 51, was diagnosed with inflammatory breast cancer in August of 1997. It metastasized to her brain in August of 1998. The tumor was removed, thought to be totally encased, and radiation therapy followed. There is now new growth around the original removal site and stereotactic radiosurgery is being considered. How long has
Hereditary Brain Cancer and Glioblastoma Multiforme Dear OncoLink, My mother has recently been diagnosed as having a glioblastoma. I wonder if you could suggest a source for information regarding genetic causes. I had an uncle die from the same tumor eight months ago. Can you make any suggestions? With Kind Regards, DS Nancy J. O'Connor, RN, MSN, CRNP,
White Blood Cell Counts Rising During Brain Radiation Therapy My father in law is in his last week of an intense six week radiation therapy . He has thus far had no major side effects a little bit of swelling in the face. He was diagnosed with Glioblastoma-Multiforme brain cancer. This week however his white blood count is 15+ (over 15,0000 white cells per cubic mm) Is this a sign his body is
Treatment options for grade III ogliodendroglioma Dear OncoLink "Ask The Experts," My 36 year-old brother was recently been diagnosed with a grade III ogliodendroglioma in his right temporal lobe. The tumor was large, 8.3 mm, and he had surgery to remove it. The neurosurgeon got 95% of the tumor out and put in Giadel wafers as well. We are considering treatment options and are confused. We have
Prophylactic (Preventative) Radiation of the Brain Dear OncoLink "Ask The Experts," Could you please give me some information on the use of preventative radiation therapy to the brain? My daughter is in remission from lung cancer, and the doctor suggests radiation therapy to the brain as a preventative measure. Thank you. Robert Lustig MD FACR, Clinical Associate Professor, Department of Radiation
Treatment for Glioblastoma multiforme Dear OncoLink "Ask The Experts," My brother has Glioblastoma multiforme and my research shows that it does not react well to chemotherapy and that he has approximately 10 months (median) to live. Are there new medicines? bone marrow transplants? Is he better off to not go through the radiation and chemotherapy after affects? Please help. What
Maximum Radiation in a Lifetime Dear OncoLink "Ask The Experts," Can you tell me if there is a maximum for the amount of radiation you can get in your lifetime? My brother has brain cancer (glioblastoma) which was removed, and the doctors think they got it all. He just finished radiation treatment #22 of 35. I was just wondering if they did not get it all, or if it re-occurs, can
Brain Metastases in Lymphoma Dear OncoLink "Ask The Experts," In December 2005, I completed 6 treatments of R-CHOP chemotherapy for non-Hodgkin's lymphoma. My "final" PET scan (skull to thigh) showed no evidence of residual active neoplasm - good news. I have recently read of the advisability of a brain scan in the management of essentially all cancers to detect
Brain Tumors, High Tension Wires and Other Risk Factors Dear OncoLink "Ask The Experts," My husband died of glioblastoma multiforme. Is there a link between this disease and exposure to the high tension electrical lines under which he worked? Robert Lustig MD FACR, Clinical Associate Professor, Department of Radiation Oncology, University of Pennsylvania, responds:There is no confirmed link between
Temozolomide for Brain Tumors Dear OncoLink "Ask The Experts," My friend has very recently been diagnosed with a grade 4 Glioblastoma. She begins radiation therapy (XRT) next week on a palliative basis. Is there any evidence that the use of the drug Temodar (temozolomide) would improve her survival, and if there is, what would a course of this drug entail? Robert Lustig MD
Hyper-Reflexia Dear OncoLink "Ask The Experts," I am a hand therapist working with a patient who had 2 separate cases of a brain tumor. She is now seeing us for treatment of an abnormal grasp reflex. She is showing the signs of the infant grasp reflex (stroking the palm causes an instant, very strong grasp). She is unable to actively release this grasp at times.
Development of Glioblastoma Multiforme Dear OncoLink "Ask The Experts," Our 16-year-old son died after being diagnosed with an astrocytoma; however, the autopsy confirmed GBM, or Glioblastoma multiforme. His only symptoms were headaches. Do GBM tumors start out as astrocytomas and then progress to GBM? How long would it take an astrocytoma to form into a GBM? Christopher Dolinsky, MD,
Stage 3 Astrocytoma Treatment Dear OncoLink "Ask The Experts," Our soon-to-be 29 year-old daughter has astrocytoma. One pathologist report said it was Stage 2; UCSF Med Center pathology report read it as having characteristics of Stage 3. Radiation/chemotherapy treatments were suggested. My question: Does the radiation have to be of the entire brain? Her tumor (what is left
Glioblastoma multiforme Dear OncoLink "Ask The Experts," My grandfather was diagnosed with Glioblastoma multiforme last August. He had as much of the tumor removed as possible. I am researching possible treatments to prolong his life. He’s been on radiation and chemotherapy. His oncologists have stopped chemotherapy and all other treatments. I’m confident that
Adenoid Cystic Carcinoma of the Breast Dear OncoLink "Ask the Experts," I am in search of information concerning Adenoid Cystic Carcinoma of the Breast, and for some type of protocol. My friend has this cancer. I am wondering if the anti-angiogenesis drugs, that are newly approved, would be beneficial for treatment of this rare breast cancer? Thank you, S.S.
How Family History Effects the Probability of BRCA1 or BRCA2 Dear OncoLink "Ask the Experts," I am wondering what the probability is of finding the gene alterations BRCA1 or BRCA2 in a family where: only one person in the family is affected by breast cancer or ovarian cancer; two persons in the family are affected by breast cancer or ovarian cancer; only one person in the family is affected
Breast Cancer Genetic Testing Dear OncoLink "Ask the Experts," I had genetic testing performed and they found a change called N6OS in BRCA2. This was the first time this change had been detected. Although they said it occurred in the area of the gene thought to be functionally significant, since it was a substitution rather than a truncation, it was
Obesity and Breast Cancer I learned from your site and others that there are many risk factors for breast cancer. My question is whether larger waist size is a risk factor for breast cancer. Thanks! Li Liu, MD, OncoLink editorial assistant, responds: Dear D: Thank you for your interest and question. Obesity (large waist
Laterality of Breast Cancer Incidence Dear OncoLink, I know that it is much more common for breast cancer to begin, or only take place, in the left breast. My question for you is do we know why this is and if not, are any studies being done to show us why this seems to be the case. If I recall, the percentages are up around 85 or 90% for occurring in the left breast as
Squamous Cell Carcinoma of the Breast Dear OncoLink "Ask the Experts," Please send information on squamous cell carcinoma of the breast. Anything you could tell us would help. BC John Han-Chih Chang, MD and Kenneth Blank, MD, Editorial Assistants for Oncolink, respond: Dear BC, Thank you for your interest and question. Not much is published
Tamoxifen Therapy for Estrogen Receptor Negative Breast Cancer Dear OncoLink "Ask the Experts," I am a medical student with a parent who is currently undergoing treatment for breast cancer. I understand that tamoxifen is used for breast cancers and is highly effective in preventing recurrence. However, what is the situation when a breast cancer is weakly estrogen receptor positive? What is the action
Nodal Status in the Treatment of Ductal Carcinoma in situ Dear OncoLink "Ask the Experts," I have a question regarding invasive ductal carcinoma in-situ (DCIS). I was first diagnosed with what my physicians assumed was DCIS, after my mammogram showed numerous calcifications. I had a biopsy, decided on a double mastectomy and reconstruction. When they went to do the mastectomy they
Ductal Carcinoma In-situ of the Breast Dear OncoLink, My mother has a diagnosis of ductal carcinoma in-situ and has been given an option for a mastectomy or lumpectomy followed by XRT. She is leaning towards mastectomy, but is still unsure. Can you help us weigh the options? Thanks, DT John Han-Chih Chang, MD and Kenneth Blank, MD, OncoLink
Ductal Carcinoma In Situ (DCIS) of the Breast I have just been diagnosed with breast cancer - labeled DCIS (Ductal Carcinoma In Situ). I understand this means that the cancer is still in the milk ducts and hasn't spread to other parts of my body. I have no family history of breast cancer, but now I am anxious that I am more likely to develop cancer in other parts of my body especially
Herceptin I am hearing alot about Herceptin lately. What is it and what does it do? Angela DeMichele, M.D., MSCE, Assistant Professor of Medicine and Epidemiology at the University of Pennsylvania and Senior Scholar in the Center for Clinical Epidemiology and Biostatistics responds: In certain types of breast cancer there is an
Does hormone replacement therapy increase the risk of breast cancer I have a very simple question. Does hormone replacement therapy increase the risk of breast cancer? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds: Hormone-replacement therapy (HRT) has been an issue for women's health since its introduction in the mid-1970s. HRT's proposed benefits included menopause symptom
Herceptin after CAF Treatment I would like to know whether giving Herceptin after CAF treatment is done as a prevention or does it stand alone? Thanks D Bradley Somer, MD, OncoLink Editorial Assistant, responds: Dear D, Herceptin (Trastuzumab) is one of a new class of cancer drugs called a monoclonal antibody. It is used for the
Invasive Ductal Carcinoma Versus Ductal Carcinoma In-Situ Dear OncoLink "Ask the Experts," I am trying to research the differences between invasive ductal carcinoma and DCIS (ductal carcinoma in-situ) to determine which form of breast cancer from which our client is suffering. I know that she has cancer in 12 of 21 lymph nodes and that the cancer is invasive. Please provide me with any
Lumpectomy vs. Mastectomy My mother who is 61 years old has a T1 (bordering on T2) breast cancer diagnosis which qualifies to be treated with a lumpectomy and radiation. What are the reasons for selecting a lumpectomy over a mastectomy? Carolyn Vachani, MSN, RN, AOCN OncoLink's Nurse Educator responds: Researchers began looking at this question in the
Breast Cancer Detection after Silicone Implants Dear OncoLink, Are mammograms safe to perform on silicon implanted breasts? Is it possible that silicone blocks visibility of tumors? Are there other methods in detecting cancer in such situations? Carolyn Vachani, RN, MSN, AOCN, OncoLink's Nurse Educator responds: Although silicone implants have not been approved for use
Effects of Idoxifene Dear OncoLink "Ask the Experts," Recently my sister who has breast cancer at an advanced stage, was invited to participate in a clinical trial: Title : A multicenter, ramdomized, double blind study of idoxifene 40mg/day versus tamoxifen 20mg/day as first line hormonal therapy in postmenopausal women with metastatic breast cancer.
Testing for BRCA1 Dear OncoLink "Ask the Experts," I am a 48-yr. old female who had breast cancer at age 29. I come from a family of high risk. My mother had breast cancer AND my 3 sisters. We were all pre-menopausal. My twin sister died of the disease. Last week my eldest sister (age 56) received her results from the test BRCA1 and her results
Mammogram Guidelines for Women with Prior Radiation Dear OncoLink "Ask the Experts," I received mantle radiation for Hodgkin's disease at the age of 26. I have been advised that radiation to the chest leads to an increased risk of breast cancer in patients treated under the age of 30. However, there seems to be some controversy over when female patients treated with mantle radiation
Mammographic Needle Localization Biopsies Dear OncoLink "Ask the Experts," In my last mammogram they found 9 microcalcifications in a cluster in my left breast, which was an increase over past mammograms. It was suggested to my husband and me that I have a biopsy procedure done. They explained that I would go for another mammogram, and the radiologist would insert a needle, then
Calcification Findings on a Mammogram My wife had a mammogram this week and was told that "calcifications" were seen in the left breast. She has been advised to see a surgeon and schedule a biopsy. Would you please explain "calcifications" and discuss the probability of malignancy. Thank you for your time and help, Carolyn Vachani, RN,
Breast Needle Biopsy Dear OncoLink "Ask the Experts," My mother underwent a needle biopsy on her breast today. Her doctor told her last week when he scheduled the biopsy that he was sure it was cancerous and started planning her surgery. Today he did the biopsy, told her it would be 3 or 4 days before results are in but he has scheduled her for a mastectomy
Paget's Disease of the Breast I have been having itching, burning, and redness on my left breast. The pain wakes my up at night. I did not feel any lumps in either breast. I was reading a magazine about breast cancer, and came across Paget's disease. I just had a mammogram, but I don't know the result yet. Would mammogram be able to detect Paget's disease? What is Paget's
Paget's Disease of the Breast and Bone Dear OncoLink "Ask the Experts," Is there such a disease as Paget's Disease of the nipple? I?m asking only because there is a strange e-mail being circulated about it and I?ve never heard of it, though our family has a history of Paget's. I always thought it was a bone deformation disease that had nothing to do with cancer, though I
Phantom Breast Syndrome I had a mastectomy 6 months ago. For some reason, I continue to feel pins and needles as if the breast had never been removed. Is this normal? What can I do with it? Thank you. Li Liu, MD, OncoLink editorial assistant, responds: Thank you for your interest and question. What you have described is
Pleural Effusion after Diagnosis of Breast Cancer and Pseudomyxoma Peritonei My wife has a history of breast cancer with left mastectomy in 1996 and diagnosis of pseudomyxoma peritonei in 1997. She now has right pleural effusion. Have you ever heard of the pseudomyxoma peritonei becoming more aggressive and growing outside of the peritoneum? Thanks, F. Li Liu, MD, OncoLink Editorial
Previous Breast Cancer and Secondhand Smoke I am a breast cancer survivor. I never smoked. But my husband smokes and often does it at home. Being a second hand smoker, am I at higher risk of dying from this? Thanks! Li Liu, MD, OncoLink editorial assistant, responds: Dear M: Thank you for your interest and question. Women who already have had
Sentinel Node Labeling What is sentinel node labeling? Can it be done AFTER an excisional biopsy of an invasive intra-ductal solid breast tumor or must this be done before the surgery? Carolyn Vachani, RN, MSN, AOCN, OncoLink's Nurse Educator responds: The lymph system's role is to fight infection or invasion by foreign materials in the body. This
Large Breasts and Breast Cancer Hello, My girlfriend believes that she has heard that there is an increased risk of breast cancer among women with larger than average breasts. She is also under the impression that having her breasts reduced would lower that risk. I am wondering if you (or someone you could refer me to) are aware of any studies which might
"Nuclear Grade" and "Stage" I had a simple mastectomy for ductal carcinoma in situ, comedo type, nuclear grade III. I would like information regarding "nuclear grade" and "stage". What is the relationship between these terms? What is nuclear grade, and how is it determined? Carolyn Vachani, RN, MSN, AOCN, OncoLink's Nurse Educator responds: Stage and grade
Complications from a TRAM flap breast reconstruction I had tram-flap reconstruction. A reaction to Morphine caused me to vomit. I pulled out a stitch at beginning of my incision as well as internally. I am not in any excessive pain but must wear a binder to hold my stomach when I stand up. It's been almost a month and my stomach is still extended. I feel I need to be up, and yet wonder if
Tamoxifen-induced Cancer? My sister has breast cancer. She has been on a drug called tamoxifen for about 2 years. She recently started bleeding as if having a period. She had a D&C and biopsy and the results showed she now has a tumor with some cancer cells in the uterus. I am curious about the medication: is it associated with cancer of the uterus?
Weight Gain After Chemotherapy Dear OncoLink "Ask the Experts," My sister was diagnosed with breast cancer about a year ago. She had the chemotherapy, radiation, stem cell transplant and mastectomy done. Her doctors are very optimistic about her outcome. Now she is now living her normal life. She is going through chemotherapy induced menopause. The only problem
Family History of Breast Cancer I have a strong family history of breast cancer in my family. My maternal grandmother had it, as did all three of her daughters, one of which is my mother. One of her daughters died from it, the other two, including my mother are still living. My grandmother is also still living. I am the only daughter out of the three daughters that have
Lobular Carcinoma in situ of the Breast Dear OncoLink "Ask the Experts," I have been diagnosed with lobular carcinoma in situ (LCIS). I can find no information on this and I am very confused. Can you give me any information? Your help would be greatly appreciated. Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds: Lobular carcinoma in situ
Mammography screening guidelines Dear OncoLink "Ask the Experts," Do you have suggested references for mammography screening guidelines? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds: The American Cancer Society provides guidelines for screening mammography, which were updated in 2007 to include information about women at higher
Prophylactic Mastectomy Dear OncoLink "Ask the Experts," I do not as yet, have breast cancer, however, I have so many signs and symptoms I am looking for information to help me decide if I should have a mastectomy before cancer develops. Please Help!!! I can't find much at all to aid me in this decision. Ken Blank, MD, and John Han-Chih
Timing of Radiation and Chemotherapy with Breast Cancer Dear OncoLink "Ask the Experts," In patients with node negative breast cancer undergoing radiation therapy after lumpectomy, what is the best timing for radiation therapy with respect to chemotherapy (such as eight 3 week cycles of CMF)? The optimal timing of radiation therapy and chemotherapy under such circumstances
Efficacy of Tamoxifen for Metastatic Breast Cancer Dear OncoLink "Ask the Experts," How can you tell if the anti-cancer drug you are taking is working? For, example, I am taking Tamoxifen for metastatic breast cancer. How will I know if it is effective? Carolyn Vachani, RN, MSN, AOCN, OncoLink's Nurse Educator responds: In the case of most anti-cancer medications, the best way
Tamoxifen Withdrawal My mother is a 5 year breast cancer survivor. Her oncologist recently took her off Tamoxifen after her 5 year anniversary. She gradually weaned herself off the drug. And approximately two months after she was completely off the medication, she had what she thinks was a mild monthly period. She is 66 years old, and this naturally alarmed her.
Frequency of Mammograms After Breast Cancer Hi, I am 39 and had breast cancer two years ago. Cancer is high on both sides of my family. I found a lump in my other breast nine months ago. Mammogram was done at that time and showed no cancer. How often do I need to have a mammogram? Lawrence J. Solin, MD, FACR, Professor of Radiation Oncology at the University of
Fibrocystic Condition of the Breast I am a 20 year old female who has had bilateral breast "cysts" since I was 11 years old. I went to the doctor for this condition 2-3 years ago and again this past August. My doctor claimed I had some type of fibrocystic disease. They have definitely gotten bigger over the years ... almost like it's a big clump of cysts. Lately (over the
Long-Term Herceptin Usage Dear OncoLink "Ask The Experts," My sister has stage IV breast cancer and is being treated with Herceptin and Tamoxifen. Assuming the treatment continues to work effectively, is taking Herceptin long after the chemotherapy treatment is over considered risky? Kevin Fox, MD Assistant Director, Clinical Affairs and
Genetic Nature of Anaplastic Breast Cancer What is the correlation between the type of breast cancer the mother had and the type of cancer the daughter will get? In other words, am I at risk for the same exact type of cancer my mother had? Jill E. Stopfer, MS Certified Genetic Counselor for the University of Pennsylvania Cancer Risk Evaluation Programs, responds:
Drive Through Mastectomy I've heard that insurance companies are trying to rush inpatient care. Is that going to happen to me? Maggie Hampshire, RN, BSN, OCN of the Abramson Cancer Center of the University of Pennsylvania, responds: Over the last ten years, public anger has been evoked over the move toward outpatient care after breast
Surgical Clips Dear OncoLink "Ask The Experts," In May 2000, I had a lumpectomy done. I had a clip left in my breast to mark the location of the procedure. Is it possible to be allergic to this clip? I am very aware of this breast and have the sensation that feels like I'm being pinched inside that breast or stuck with a pin. My recent mammogram says
Breast reconstruction after lumpectomy and radiation treatment Dear OncoLink "Ask the Experts," It has been a year since I received 25 radiation treatments for Stage II Breast Cancer. Though I had a lumpectomy, I would like to reconstruct the breast to make it look more symmetrical. The plastic surgeon feels that a standard breast lift should fix the problem, but I would like to use a submuscular
Fibrocystic Breast Disease and Mammogram My doctor last week diagnosed me with fibrocystic breast disease and ordered a mammogram. My mother also has this condition, and our family has no history of breast cancer. I am only 30 and do not think a mammogram necessary. What would be the benefit of the mammogram? Lawrence J. Solin, MD, FACR, Professor of Radiation
Herceptin: How Do I Know it's Working for Me? Dear OncoLink "Ask The Experts," How do you know if Herceptin is working? I have stage III, HER2+, ER/PR- breast cancer. I had neoadjuvant chemotherapy with 4 cycles of Adriamycin/Cytoxan and 4 of Taxotere, then bilateral mastectomy. I've been receiving Herceptin alone since June 2006 and wonder how I can tell if it is working. Suzanne M.
Bilateral calcifications in the breasts Dear OncoLink "Ask The Experts," My wife is a youthful 47. Nine years ago, a microcalcification showed up on a mammogram. The needle biopsy did not find a cancer. This past November, my wife had her annual mammogram at a new imaging facility. The findings showed bilateral calcification and she is to return tomorrow for a follow up
Treatment options for invasive ductal carcinoma Dear OncoLink "Ask The Experts," I am 48 years old and have been diagnosed with invasive ductal carcinoma of the breast, Stage 2B, ERPR negative. My oncologist feels that I need 4 rounds of AC chemo followed by 12 rounds of Taxotere followed by radiation. I went for a second opinion. That Doctor said I need 4 rounds of AC followed by
Radiation and Tamoxifen for DCIS Dear OncoLink "Ask The Experts," In August, I was diagnosed with ductal carcinoma in situ. I had a lumpectomy and am currently going through 38 days of radiation. Will the radiation make less the chances of it recurring? And would tamoxifen make a difference? I am currently 43 years old I have been told that I would not be a good
Secondary radiation exposure Dear OncoLink "Ask The Experts," My mother in law got a cancerous lump taken out of her left breast a few months ago, as well as the lymph nodes under her left arm. She is currently receiving chemotherapy (3 weeks cycles) and will be doing her last cycle in January. After that, the doctors are planning to give her radiation therapy. We
Tamoxifen and Radiation Therapy for Early Breast Cancer Dear OncoLink "Ask The Experts," I had a lumpectomy for a Grade 1 breast cancer of 12mm with lymph node clearance. I am now taking Tamoxifen and my surgeon and radiation oncologist are advising follow up radiotherapy, due to start within the next few weeks. My reading indicates this is probably beneficial. I would appreciate your
Treatment options for metastatic breast cancer Dear OncoLink "Ask The Experts," My mother was diagnosed with breast cancer in '99. She had a lumpectomy followed by 4 cycles of chemo (Taxol) and radiation therapy. The doctor told her the cancer was gone and she regularly did checkups. About 2 months ago my mother noticed her breast becoming red, swollen, and a rash developing. She
Sentinel Node procedure for DCIS Dear OncoLink "Ask The Experts," I am 45 years old, I have DCIS. I am scheduled for a lumpectomy. I have two different opinions on the sentinel node procedure. I am very afraid of the side effects. Is there any benefit to this? Kevin Fox, MD Assistant Director, Clinical Affairs and Associate Professor of
Differences between core biopsy of the breast and a stereotactic needle placement Dear OncoLink "Ask The Experts," What is the difference between a core biopsy of the breast and a stereotactic needle placement? Lawrence J. Solin, M D, F ACR, Professor of Radiation Oncology at the University of Pennsylvania, responds: A core biopsy is when a large size needle is inserted into the breast tumor
Sun exposure after radiation treatment to the breast Dear OncoLink "Ask The Experts," I have just finished my radiotherapy to my breast and would like to know if I can be exposed to the sun. I'm asking because I live in South America and now it's summer down here. I used to go to the beach every year, and I don't know if I can. My oncologist was not clear at this topic. Thank you!
Tamoxifen for DCIS Dear OncoLink "Ask The Experts," I recently was diagnosed with high nuclear grade, multifocal, comedo-necrosis type DCIS. I underwent a modified radical mastectomy. No invasive cancer was found, & all 13 nodes excised were negative. Estrogen receptor status was not done as the clinical guidelines in Canada indicate no further
Weight gain after breast cancer treatment Dear OncoLink "Ask The Experts," My mom was diagnosed with breast cancer a year ago in July. She underwent an axillary dissection along with a lumpectomy. She had aggressive chemotherapy for 9 months. She has been on Tamoxifen for about 3 months. She has gained about 65lbs since she had started the chemo. She went from a size 8 to a
Interpreting radiologic findings Dear OncoLink "Ask The Experts," I am a Stage 4 breast cancer survivor. I have been through chemotherapy. I also had a stem cell transplant. The cancer cells that were in my lungs and the tumor on my liver are not present. There have been hot spots on my spine and other bones in my body. They still show up on the bone scans. How do
DCIS diagnosis and treatment Dear OncoLink "Ask The Experts," My mother is 71 years old, and has a ductal carcinoma in situ. The doctors scheduled her for a sentinel node biopsy, and informed us that regardless of the outcome, she would have to have radiation therapy, because of the involvement of the lymph nodes. My questions are, is sentinel node biopsy useful
Radiation Recall Dear OncoLink "Ask The Experts," I would like to know any information regarding radiation recall. This was not mentioned to me when I underwent radiation therapy for breast cancer in 2001. Lawrence J. Solin, MD, FACR, Professor of Radiation Oncology at the University of Pennsylvania, responds: Radiation recall
Ductal carcinoma in-situ grade 3 vs. grade 1 treatment Dear OncoLink "Ask The Experts," If a diagnosis of ductal carcinoma in situ is made what is the significance of the grade. How is grade 3 treated differently from grade 1? Lawrence J. Solin, MD, FACR, Professor of Radiation Oncology at the University of Pennsylvania, responds: Ductal carcinoma in situ (DCIS)
Aromatase inhibitors after Tamoxifen Dear OncoLink "Ask The Experts," I am a male breast cancer patient who has just completed five years of Tamoxifen. I am trying to decide if starting on an Aromatase Inhibitor would be a prudent dedision and have many conflicting opinions. Is there any research or information that would help me decide? Kevin Fox,
Signs of breast cancer recurrence Dear OncoLink "Ask The Experts," I was diagnosed with inflammatory breast cancer in May 2001. I had a radical mastectomy. My surgeons tell me I am free of cancer. I would like to know what I should be looking for in case of reccurrence. I am aware that the best indicator of reccurrence is how well I know my body and to detect any
Breast feeding while receiving radiation to the pelvis Dear OncoLink "Ask The Experts," I am getting ready to take external radiation therapy to my pelvic region. Can I still breast feed my 5 month old? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds: If the radiation is
Tamoxifen after total hysterectomy and ovary removal Dear OncoLink "Ask The Experts," One year ago, I was diagnosed with DCIS. The tumor was excised successfully with free margins but the words "microinvasive" were used. To be on the safe side, my surgeon performed an axillary node dissection and all nodes were negative. I received 25 radiation treatments and was prescribed Tamoxifen.
Estrogen receptor negative breast cancers Dear OncoLink "Ask The Experts," Does breast cancer run along some continuum from estrogen-receptor positive to estrogen-receptor negative tumors? Are ER+ tumors a different disease than ER- tumors? I have been diagnosed with an ER- breast cancer and I am confused as to whether I am at increased risk of recurrence and general guidelines for
Radiation for recurrent breast cancer after prior radiation Dear OncoLink "Ask The Experts," My sister-in-law had breast cancer two years ago. It now has returned. She told me that she could never receive radiation again because she had it already. Is this true? Thank-you. Lawrence J. Solin, MD, FACR, Professor of Radiation Oncology at the University of Pennsylvania,
Blood draw after mastectomy Dear OncoLink "Ask The Experts," Twenty years post radical mastectomy, can a patient have an IV or blood drawn from the side of the mastectomy? Lora Packel MS, PT, Coordinator of Cancer Therapy Services for the Hospital of the University of Pennsylvania, responds: The issue is not the mastectomy itself, but the
Treatment for skin reactions during breast radiation treatment Dear OncoLink "Ask The Experts," I am getting conflicting stories on the effects of aloe to treat breast cancer radiation irritation. Several people tell me it is beneficial but my Radiation Oncologist prefers the use of only small amounts of talc powder. What is your opinion? Thank you for your consideration.
Tamoxifen and vaginal estrogen use Dear OncoLink "Ask The Experts," Over the counter lubricants do not alleviate the atrophic vaginitis that I am experiencing with tamoxifen use. Will using estradiol(25mcg) twice weekly inserted vaginally nullify the efficacy of tamoxifen? Kevin Fox, MD, Assistant Director, Clinical Affairs and Associate Professor of
Radiation timing Dear OncoLink "Ask The Experts," My wife has been diagnosed with breast cancer and I have read where radiation treatment should commence within 3 to 4 weeks after a lumpectomy is performed. How critical is the 3 to 4 week window? If it is started can it be suspended for a week and then resumed? We have reservations to see Mickey and Minnie
The use of tamoxifen in patients with DCIS Dear OncoLink "Ask The Experts," I underwent a lumpectomy recently (age 52). The pathology report said I had DCIS as well as LCIS. There's no testing to see if I'm estrogen receptor positive or negative. I'm scheduled to receive 6 weeks of radiation therapy. The oncologist suggested that I take tamoxifen for 5 years after radiation. My
Mortality rates from breast cancer Dear OncoLink "Ask The Experts," I understand that the mortality from breast cancer has dropped. I would be grateful if you could tell me the reasons for this and what is the most significant factor, which has caused this drop? Kevin Fox, MD Assistant Director, Clinical Affairs and Associate Professor of
Herceptin for Pre-Menopausal Women Dear OncoLink "Ask The Experts," I would like to know the reason that Herceptin is not appropriate for breast cancer in premenopausal women? Kevin Fox, MD Assistant Director, Clinical Affairs and Associate Professor of Hematology/Oncology at the Abramson Cancer Center of the University of Pennsylvania responds:
Risk of pregnancy after a diagnosis of breast cancer Dear OncoLink "Ask The Experts," Is it really a risk to become pregnant when diagnosed with metastatic breast cancer, which has been stable for 2 years? Is the breast cancer likely to "flare up" due to the increase in estrogen? Kevin Fox, MD Assistant Director, Clinical Affairs and Associate Professor of
Prophylactic compression garments following lymph node dissection during air travel Dear OncoLink "Ask The Experts," I had a mastectomy and lymph nodes removed in August 2001 because I had Paget's Disease. I am planning a trip and a friend told me I need to wear some sort of a arm bandage on my arm to prevent swelling in the arm where the nodes were removed. Is this true and where do I need to go to get the bandage?
Hair loss in rare patients on tamoxifen Dear OncoLink "Ask The Experts," Please advise whether the use of tamoxifen causes hair loss. I have used tamoxifen for 7 months and I noticed that I am losing quite a bit of hair in front. Should I continue to use tamoxifen? Thank you for your help. Kevin Fox, MD, Assistant Director, Clinical Affairs and Associate
Rash on the breast after cancer treatment Dear OncoLink "Ask The Experts," I had breast cancer 6 yrs ago. I had radiation at that time. Now I have a very sore rash in the same area. I have a high fever and flu like symptoms and fatigue. I take antibiotics but it comes back in 2 months time. The rash is also very painful. I want to know what is causing this. Lawrence
Safety of evening primrose oil for breast cancer patients Dear OncoLink "Ask The Experts," I had stage I breast cancer last year. I am presently on tamoxifen, and of course I began hot flashes and night sweats. I am premenopausal. My surgeon recommended I take evening primrose oil for the hot flashes, which works great. However, I'm getting conflicted reports lately that primrose oil has
Optimal treatment of breast cancer in an elderly patient Dear OncoLink "Ask The Experts," My mother was diagnosed with ductal carcinoma at the age of 85. A lumpectomy was performed and lymph nodes were clear. Radiation therapy has been recommended. We are trying to weigh the pros and cons to help her decide if radiation therapy is really necessary or appropriate at her age. Considering her age, can you
Diet after treatment for ductal carcinoma of the breast Dear OncoLink "Ask The Experts," I was diagnosed with Stage I Invasive Ductal Carcinoma 2 years ago at age 44. Chemotherapy of Adriamycin and Cytoxin followed my mastectomy. I am currently taking Tamoxifen (my cancer was estrogen positive and progesterone negative). I want to try to do everything I know to decrease my chances of recurrence. I
Sentinel Node Biopsy False Negative Rate Dear OncoLink "Ask The Experts," My wife was recently diagnosed with breast cancer after having an excisional biopsy performed. We are now facing additional surgery to determine whether the lymph nodes are involved. One option proposed by the surgeon was a sentinel node biopsy - however she pointed out that there is no long-term history with this
Recurrent breast cancer on the chest wall Dear OncoLink "Ask The Experts," Can you give me any information about breast cancer that has spread to the skin? I have recently been diagnosed with this recurrent disease after undergoing chemo and radiation plus mastectomy. James M. Metz, MD, Editor-in-Chief of OncoLink and Assistant Professor of Radiation Oncology at the Hospital of the
Tamoxifen and weight gain Dear OncoLink "Ask The Experts," How does one reconcile the clinical studies results that Tamoxifen does not cause weight gain with the anecdotal evidence of women who have taken or are on Tamoxifen and report weight gains of 20 to 30 to 50 pounds? I'm just starting on Tamoxifen today. Kevin R. Fox, MD, Assistant Director, Clinical Affairs
Taxol Reaction Dear OncoLink "Ask The Experts," I treated a 36-year-old Japanese woman with Taxol last week. She has the aldehyde dehydrogenase enzyme deficiency and, despite an extra dose of IV Benedryl, got very ill with the nausea, vomiting, flushing, and drunkenness. Have you run into this problem yet? Do you have any suggestions? Kevin R. Fox, MD,
Likelihood of Benign Disease Dear OncoLink "Ask The Experts," A 33-year-old friend of mine has found a lump in her breast. What proportion of breast masses turn out to be benign? Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate Professor of Hematology/Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:The likelihood of
Hormone Receptors Explained Dear OncoLink "Ask The Experts," I was told that my cancer is hormone receptor positive. Please explain what that means. Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate Professor of Hematology/Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:Hormone receptors are proteins that most breast
Open Biopsy After a Negative Fine Needle Aspiration Dear OncoLink "Ask The Experts," Please comment on when you should have an open biopsy after a negative fine needle aspiration (FNA). In 2001 I had a FNA, which was negative, and several months later the lump turned out to be breast cancer after an exisional biopsy. Now a year after treatment for a low-grade tumor (lumpectomy/radiation therapy), I
Sentinel Lymph Node Biopsy for DCIS Dear OncoLink "Ask The Experts," I have ductal carcinoma in-situ (DCIS) and lobular carcinoma in-situ (LCIS) in my left breast. My surgeon has recommended a total mastectomy and sentinel lymph node biopsy (slnb). I am concerned that the procedure is not necessary. Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate Professor
Chemotherapy Before Surgery for Breast Cancer Dear OncoLink "Ask The Experts," My mother has been diagnosed with stage 3-breast cancer. They are telling her that they want her to do chemotherapy before the surgery to remove her breast. Can you please explain to me why they would be doing this? Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate Professor of
Axillary Dissection Dear OncoLink "Ask The Experts," When one of the lymph nodes is positive out of four that have been removed, is a full axillary dissection always recommended? I have a positive node by sentinel lymph node biopsy, but no one has suggested that I need a full axillary dissection. Kevin R. Fox, MD, Assistant Director, Clinical Affairs and
Is the risk of breast cancer increased due to ovarian cancer? Dear OncoLink "Ask The Experts," My wife is an ovarian survivor. She finished chemo three years ago and we have been told she should live a long life. She is now Undergoing tests for Breast cancer. Is the risk of breast cancer increased due to ovarian cancer? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology
Breast Biopsy Options Dear OncoLink "Ask The Experts," What are the different ways to get a sample of my breast lump? Lawrence J. Solin, MD, FACR, Professor of Radiation Oncology at the University of Pennsylvania, responds:When an abnormality is found on screening mammography, the next step is to determine whether or not the abnormality is malignant (cancer).
Radiation after breast implant Dear OncoLink "Ask The Experts," My 52-year-old mother, who has silicone breast implants, has had a tumor removed from her breast (size 1cm). According to her surgeon, the tumor was a solid mass with "irregular" margins and the breast cancer cells were well differentiated. Her surgeon is recommending mastectomy with lymph node removal. He
Physical limitations after breast reconstruction Dear OncoLink "Ask The Experts," I teach fitness classes and am trying to find information on exercising after breast reconstruction due to cancer. Lora Packel MS, PT, Coordinator of Cancer Therapy Services for the Hospital of the University of Pennsylvania, responds:Women with breast reconstruction may have some physical limitations
Long-term effects of Taxol Dear OncoLink "Ask The Experts," Where can find out information on the long-term effects of Taxol? Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate Professor of Hematology/Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:Unfortunately, neither of the early studies of taxol use in
Exercise after a tram flap Dear OncoLink "Ask The Experts," I'm interested in knowing how tram flap breast cancer survivors handle exercise and muscle toning. I am a 5-year survivor with a tram flap and have gained 100+ lbs. and am now getting back in to the exercise mode and want to know what kind of exercises will help with my bending motion. Lora Packel MS, PT,
Lymphedema and air travel Dear OncoLink "Ask The Experts," Two years ago I had a masectomy and a sentinal node biopsy which removed 7 lymph nodes. I am planning a trip in a few months and will be on a plane for 20 hours. Does this trip increase my chances of lyphedema? Are there any precautions I should take? Lora Packel MS, PT, Coordinator of Cancer Therapy
CA15-3 Dear OncoLink "Ask The Experts," What is the significance of CA15-3 in the management of metastatic breast cancer? Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate Professor of Hematology/Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds: CA 15-3 and CA 27-29 are simply
Is Massage Safe for Breast Cancer Patients? Dear OncoLink "Ask The Experts," I have breast cancer and I would like to know if I could have reflexology and or massages done. I have been told not to do massages and I was wondering if that is true? Can you please tell me if this is true? Lora Packel MS, PT, Coordinator of Cancer Therapy Services for the Hospital of the University of
Optimal screening for a 23 year old with a family breast cancer history Dear OncoLink "Ask The Experts," What is the optimal screening for a 23 year old with a mother that was diagnosed with breast cancer at 29 years old? Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate Professor of Hematology/Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:Optimal screening
Average response to Femara Dear OncoLink "Ask The Experts," How long does the drug "Femara" last? What is the next drug of choice after that? I was on Tamoxifen for 18 months and I have been on Femara for 15 months with very good results. Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate Professor of Hematology/Oncology at the Abramson Cancer Center
Joint pain and Taxol reaction Dear OncoLink "Ask The Experts," I have recently finished treatment for male breast cancer, including a mastectomy with removal of some lymph nodes and 6 months of chemo with A/C and Taxol. Now, 2 months after very difficult treatment I am experiencing easy bruising all over my body, joint pain and swelling, and loss of strength in the hand of the
Follow up mammography Dear OncoLink "Ask The Experts," My mother was diagnosed with breast cancer. I am 36 years old, when I went for my yearly check up, they sent me to have a mammogram since I now have a family history. The results came back saying I have a 4 mm nodule in my right breast possibly negative, recheck in 6 months. I would like to have it checked
Treatment options for an ER+ premenopausal breast cancer patient Dear OncoLink "Ask The Experts," I have had a lumpectomy and lymph nodes removed, of 19 lymph nodes one was affected. The tumor was 1.2 cm; my cancer was diagnosed as ER+. I am now considering treatment specifically looking at the chemotherapy plus tamoxifen. I am premenopausal (46 years old). What are your comments based on this information.
Breast reconstruction after lymphedema Dear OncoLink "Ask The Experts," I had a bi-lateral mastectomy July 2002, the left side was cancerous, right side done for prophylactic reasons. Lymph nodes were removed on the left side only. I recently developed lymphedema. I see a therapist 3 times a week for exercise and massage. I exercise and massage at home and have bandages, and will
Nipple Reconstruction Dear OncoLink "Ask The Experts," I had a simple mastectomy 5 years ago. I had a tram flap and later a skate flap nipple-areola reconstruction. I have been satisfied with the outcome with the exception of the nipple projection, which has failed. I understand this is common. I had the procedure repeated 2 years ago with the same problem. I understand
Is implant removal necessary for breast cancer surgery? Dear OncoLink "Ask The Experts," I was diagnosed with stage 1 invasive ductal carcinoma in my right breast. I have already had a lumpectomy and now have to go for a wedge excision and lymph node axillary dissection. I have had saline breast implants since 1994 and my surgeon is concerned about the wedge excision surgery and the implant - mainly
Timing of first mammography after radiation treatment Dear OncoLink "Ask The Experts," Can you tell me when I should have my first mammogram after radiation treatments? Lawrence J. Solin, MD, FACR, Professor of Radiation Oncology at the University of Pennsylvania, responds:After lumpectomy and radiation treatment for breast cancer, routine bilateral mammography is important to look for the
Skipping the last chemotherapy cycle Dear OncoLink "Ask The Experts," I have breast cancer and am receiving adjuvant chemotherapy. I have been through 5 cycles and feel that I simply cannot take the last one. I am following up with radiation. There is no data on 5 vs.6 cycles. Anything enlightening you might be able to add? Barbara Campling, MD, Medical Oncologist at the
Blood pressures, IV's and fingersticks after mastectomy Dear OncoLink "Ask The Experts," As a Certified Nursing Assistant I have always been ordered to not take blood pressures, no finger sticks, no blood draws on the arm of a patient that has had a mastectomy. I can understand not doing it for a certain amount of time, to allow time for healing. However, is that for the rest of the patients life, or
Treatment after lumpectomy in small estrogen negative tumors Dear OncoLink "Ask The Experts," My wife has undergone a lumpectomy for a 0.8cm nodule, sentinel lymph nodes were clear. Pathology stated that the estrogen and progesterone receptors were less than 10% positive. We find very little information beyond the fact that tamoxifen probably will not help. Is there as clear a course of therapy in these
Fertility after breast cancer treatment Dear OncoLink "Ask The Experts," I was diagnosed with hormone negative, stage II breast cancer at age 29. I was treated with CEF ( cyclophosphamide, epirubicin and fluorouracil) chemotherapy and then radiation. I am now 32 and was considering getting pregnant. I have heard chemotherapy may harm the ovaries or hormone production. Is there a test to
Different approaches to radiation treatment of the breast Dear OncoLink "Ask The Experts," My mother was recently diagnosed and her first treatment will likely be radiotherapy. Is 3D conformal radiation overall better than conventional external beam radiation for breast cancer? Is 3D conformal radiation only in clinical trials right now? Should we bother to choose a treatment hospital based on it having
Conservative breast surgery with radiation vs. mastectomy for Paget's Disease Dear OncoLink "Ask The Experts," What are the pros and cons of choosing Conservative breast surgery with radiation over a mastectomy when Paget's disease of the nipple is suspected and no underlying cancer is detected by mammogram? My concerns are the side effects of radiation treatment but also the threat of recurrence. Lawrence J. Solin, MD,
Considering breast implants with a family history of breast cancer Dear OncoLink "Ask The Experts," My wife is 25 years old and considering breast implants. However, she has a family history of breast cancer (mother, grandmother, and great grandmother) Would the implants decrease or increase her chance of getting breast cancer? Should she just have both breasts removed and replaced with them? Don LaRossa,
Interpreting Mammography Reports Dear OncoLink "Ask The Experts," I recently had a mammogram and when I was mailed the findings it said "non-malignant findings" and that I should have another mammogram in a year to see if anything develops. Should I ask for the actual report so I can see what it says, before I ask for more opinions? Julia Draznin Maltzman, MD, Attending
Treatment for DCIS Dear OncoLink "Ask The Experts," I was recently diagnosed with DCIS and LCIS. I have had a lumpectomy and will soon start radiation. My concern is that it has been suggested that I take Tamoxifen. I am 43 and I have not yet gone through menopause. My ER was positive. I am very afraid of this drug after all my reading on it. I have also read that
Radiation to the chest after previous radiation for breast cancer Dear OncoLink "Ask The Experts," My mother had radiation for breast cancer two years ago. She now has been diagnosed with lung cancer. She will have the spot removed, but one doctor said she needs radiation and the other said she could not have it again. Can you give us some feedback? Stephen M. Hahn, MD, Associate Professor of Radiation
Peripheral Neuropathy while on Taxol Dear OncoLink "Ask The Experts," I was given Taxol as part of my chemotherapy treatment. My feet hurt so bad that I cannot walk. Is this normal?Julia Draznin Maltzman, MD, Attending Physician at the University of Pennsylvania School of Medicine, responds:One of the more important side effects of Taxol is peripheral neuropathy and this is often
Can trauma to the chest cause breast cancer? Dear OncoLink "Ask The Experts," I was in a serious car accident in January of 2004. I had massive trauma to my chest, so much that it collapsed my lung on the right side. Now I have lumps in both my breasts. On the right side the lump is about the size of a plum and on the left side it is about the size of a marble. Does trauma like this to the
Tamoxifen for weakly positive Estrogen and Progesterone breast cancers Dear OncoLink "Ask The Experts," I am a 31-year old ER negative and "weakly" PR positive breast cancer patient. I have had a mastectomy with no lymph node involvement and chemotherapy and now deciding whether to go on Tamoxifen. Does your practice recommend Tamoxifen for "weakly" PR positive patients?Julia Draznin Maltzman, MD,
Arimidex Dear OncoLink "Ask The Experts," What type of medication is Arimidex?" My mother was diagnosed with breast cancer, had tissue removed from one breast, lymph node biopsy negative, irradiation of impacted breast for @7 weeks, followed by estimated 6 month course of Arimidex. She also has rheumatoid arthritis, which is very painful. Is this one
Skin Sparing Mastectomy Dear OncoLink "Ask The Experts," What is your opinion of skin sparing mastectomy? Is there any sensation left?Don LaRossa, MD, Professor of Surgery at the University of Pennsylvania Medical School, responds:Skin sparing mastectomy is excellent for many patients who are suitable candidates. Your surgeon can review the options with you to determine
Timing of Breast Reconstruction Dear OncoLink "Ask The Experts," Is it advisable for someone who had stage III lobular breast cancer to seek reconstruction immediately or wait for a certain length of time?Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate Professor of Hematology/Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:
Detection of local recurrence after mastectomy and breast reconstruction using a tissue flap Dear OncoLink "Ask The Experts," Does breast reconstruction using the flap procedure interfere with early detection of breast cancer when having a mammogram, ultrasound or MRI. I have had a mastectomy and radiation after stage 3 and finished a year ago.Lawrence J. Solin, MD, FACR, , responds:The detection of local recurrence after mastectomy is not
DCIS: To radiate or not to radiate? Dear OncoLink "Ask The Experts," I have had the removal of a 1/2 centimeter, stage 0, DCIS (ductal carcinoma in situ) from my left breast. The second biopsy was clear of cancer in the surrounding area. Is radiation necessary, or can I take a chemo drug like tamoxifen for 5 years instead and be considered quite safe from a return of cancer? I am
Abdominal Exercise after Mastectomy Dear OncoLink "Ask The Experts," I was diagnosed with breast cancer about 4.5 years ago, and had a mastectomy and TRAM flap reconstruction. Since that time, I have had to wear a support on my abdomen. I originally gained weight, but have lost some of it. I started an intense exercise program about 6 months ago, and now my abdomen is much more
Radiation after Mastectomy with Reconstruction Dear OncoLink "Ask The Experts," I had a left-sided mastectomy with immediate reconstruction and tissue expander. I had DCIS with invasion and had a sentinel lymph node biopsy, which came back with 2 positive nodes out of 11. I'm undergoing chemo with A/C and Taxol for a total of 8 treatments, and my oncologist recommended radiation when I'm
Evista as adjuvant therapy Dear OncoLink "Ask The Experts," Can Evista (Raloxifene) be used as a substitute if someone cannot tolerate Tamoxifen for treatment after breast cancer?Angela DeMichele, M.D., MSCE, Assistant Professor of Medicine and Epidemiology at the University of Pennsylvania and Senior Scholar in the Center for Clinical Epidemiology and Biostatistics,
Breast reconstruction after radiation therapy Dear OncoLink "Ask The Experts," I had a mastectomy followed by chemotherapy and radiation therapy for my advanced breast cancer. I completed radiation 3 months ago and have healed fine. I would like to have reconstruction. My oncologist recommended waiting for 6 months total after radiation but did say that it's probably OK to go ahead now. I'd
Hot Flashes on Tamoxifen Dear OncoLink "Ask The Experts," I was diagnosed with LCIS (lobular carcinoma in situ) and osteoporosis 3 yrs ago. I am taking Tamoxifen as a breast cancer preventative and am experiencing frequent hot flashes. I would like to know if there are any natural vitamin or herb supplements to control the hot flashes that do not interfere with the
Neutropenic Fever Dear OncoLink "Ask The Experts," I have a friend who was diagnosed with breast cancer two months ago. She had surgery and has been going for chemo treatments. She was taken to the hospital today for fever and chills. They admitted her and are keeping her through the weekend- she is on strong antibiotics and fluids and no visitors are allowed
Screening Mammography and Radiation Exposure Dear OncoLink "Ask The Experts," My mother was diagnosed with breast cancer at 44 years old. As a result of this, I have been having routine mammograms annually since age 30 (I am currently 37). Am I doing more harm than good by doing this in terms of the long-term radiation exposure? Thank you.Lawrence J. Solin, MD, FACR, Professor of Radiation
Recurrent Breast Cancer Dear OncoLink "Ask The Experts," I am looking for treatment options for women who have had breast cancer, had a mastectomy, radiation, and chemo, only to find two years later that a cancerous tumor has appeared in the other breast. My aunt is the patient, and I know she tested negative for carrying the cancer gene. Her mother died at a similar age
Sentinel Lymph Node Biopsy Dear OncoLink "Ask The Experts," My mom is having a sentinel lymph node biopsy. Can you tell me what she should expect from this test?Nancy J. O'Connor, MSN, CRNP Oncology Nurse Practioner for Breast Surgery at the Rowan Breast Center of the Abramson Cancer Center of the University of Pennsylvania, responds:The lymph system is part of your body's
Axillary Lymph Node Dissection Dear OncoLink "Ask The Experts," I have been diagnosed with an invasive breast cancer on my left side. The doctor wants to do an axillary lymph node dissection. Can you tell me what this entails?Nancy J. O'Connor, MSN, CRNP Oncology Nurse Practioner for Breast Surgery at the Rowan Breast Center of the Abramson Cancer Center of the University of
Saline Implants and Breast Biopsy Dear OncoLink "Ask The Experts," I have had silicone implants for 33 years. I was told that there is a lump that will have to be removed. Are there risks of my implants being punctured during this procedure?Don LaRossa, MD, Professor of Surgery at the University of Pennsylvania Medical School, responds:These are very old implants, and you might
E-String Use After Breast Cancer Dear OncoLink "Ask The Experts," I had a lumpectomy on Sept 7th and have ended 16 radiation treatments. Prior to my diagnosis, I had been taking Premarin 0.3 mg for approx 18 years. I stopped cold turkey when diagnosed. I have been having problems with vaginal dryness and would like to know what your opinion is of the E-string? Nancy Zieber, RN,
Inflammatory breast cancer Dear OncoLink "Ask The Experts," Can you please give me some information on inflammatory breast cancer? I recently had a relative diagnosed with this condition and I am not sure if it is different from regular breast cancer . Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Inflammatory breast cancer (IBC) accounts for 1 to 4% of
Male breast cancer Dear OncoLink "Ask The Experts," I am a 69 year old male who was recently diagnosed with breast cancer. My doctor has never seen this before in a man. How is this treated compared to a woman with breast cancer? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Breast cancer in men accounts for about 1% of all breast cancers and
Pregnancy and breast cancer Dear OncoLink "Ask The Experts," How is breast cancer managed in a patient who just found out she is pregnant? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Approximately 1 to 3 patients out of 10,000 deliveries will be diagnosed with breast cancer during their pregnancy. It is the most common cancer seen during pregnancy.
Breast Implants and cancer Dear OncoLink "Ask The Experts," I have had breast implants for 15 years. Can breast implants cause cancer? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:The Institute of Medicine conducted a thorough report on the safety of silicone breast implants. The report states that breast cancer is no more common in women with breast
Chemo for Breast Cancer: Every 2 weeks or 3? Dear OncoLink "Ask The Experts," I am a 49-yr old woman who has just been diagnosed with breast cancer. Going for the whole wash, cut, and blow dry. My question is - reading about chemo, every two weeks works better than every three. One article says great, the other says the results were disappointing. What is the scoop? Kevin R. Fox, MD,
Aromatase Inhibitors or Tamoxifen Dear OncoLink "Ask The Experts," I am post-menopausal and have been prescribed an aromatase inhibitor. Why am I receiving this when it seems like tamoxifen is the more common prescription? How can I deal with the hot flashes caused by this drug?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Tamoxifen is the drug of choice for
Breast Cancer Recurrence in the Skin Dear OncoLink "Ask The Experts," I had breast cancer 12 years ago, treated with a lumpectomy and Adriamycin-based chemo plus radiation. The breast cancer has recurred as skin cancer with little lumps all over my body. It has been determined that it is treatable with hormone therapy. Are there resources for information on this recurrence? Suzanne M.
Gummy Bear Implants Dear OncoLink "Ask The Experts," Please explain the differences in scars and results if one chooses mastectomy with immediate implants or has tissue expanders with permanent implants placed 4-6 months later. I do not hear favorable comments about saline implants. Can I get silicone? Does HUP offer clinical trials for "gummy bear"
Screening for Metastases in Breast Cancer Dear OncoLink "Ask The Experts," Having presented with back, shoulder and ear pain, together with loss of balance, I was referred for x-rays and scans, and metastases from the same "non-aggressive" breast cancer I suffered ten years earlier were found in the bones. A prognosis of two months plus was given. I have survived three years!
Drinking Alcohol on Treatment Dear OncoLink "Ask The Experts," Are there any specific negative effects of drinking alcohol while taking tamoxifen after chemotherapy and radiation therapy? Is it OK to have small amounts of wine or alcohol? Nancy Zieber, RN, MSN, CRNP, Oncology/Hematology Nurse Practitioner, responds:The only problem or potential issue I see with drinking alcohol
Nottingham Score for Breast Cancer Dear OncoLink "Ask The Experts," I do not understand my Nottingham score of 9, or the histologic grade of III/III. Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate Professor of Hematology/Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:The Nottingham histologic score is simply a scoring system
Itching a Sign of Breast Cancer? Dear OncoLink "Ask The Experts," I have read that itching of the breast may be a symptom of breast cancer. Is this a myth or is it true? Angela DeMichele, M.D., MSCE, Assistant Professor of Medicine and Epidemiology at the University of Pennsylvania and Senior Scholar in the Center for Clinical Epidemiology and Biostatistics, responds:Itching can
Oophorectomy to Lower Breast Cancer Risk Dear OncoLink "Ask The Experts," I am at high risk for developing breast cancer and am contemplating having my ovaries removed. How much would I be decreasing my risk if having this procedure done? Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate Professor of Hematology/Oncology at the Abramson Cancer Center of the University of
Herceptin Weekly or Every Three Weeks Dear OncoLink "Ask The Experts," I was diagnosed with Stage 2 breast cancer, and am now receiving Taxotere, Cytoxan, and Herceptin every 3 weeks. Is there any benefit to doing Herceptin weekly? I've been given the option of weekly or every 3 weeks for the year I'll be taking it. Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate
Tamoxifen for Male Breast Cancer Dear OncoLink "Ask The Experts," Having had a mastectomy in July 2005, I was prescribed Tamoxifen. I am having difficulty in finding any information on the side effects in men. I appreciate that we are a small number , but information for breast cancer in men is limited. Can you please advise on any side effects of Tamoxifen in men? Carolyn
BI-RADS and Mammography Categories Dear OncoLink "Ask The Experts," The radiologist, after reading my mammogram, has classified me as a category 4. The nurse explained that there are 5 , but I neglected to ask what being a category 4 means. Does it mean that it's likely that I have cancer and they just need to confirm it, or are they just testing for it? Carolyn Vachani
Screening Under Age 40 Dear OncoLink "Ask The Experts," What can you tell me about testing for breast cancer under the age of 40? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Many women are now getting baseline mammograms at age 35, then another at 40 years old to start the annual ritual. At that age, the breast tissue is very dense, making it
Weaning Tamoxifen? Dear OncoLink "Ask The Experts," After 5 years on tamoxifen, my oncologist has told me that everything is fine now and to stop taking my Tamoxifen. I have been told to stop instantly, not gradually. Is this a good thing? What side effects am I likely to get by stopping instantly? Nancy Zieber, RN, MSN, CRNP, Oncology/Hematology Nurse
Breast Tenderness Dear OncoLink "Ask The Experts," I am having pain in my breasts (both of them, but more on the left side) at the base - towards the ribcage side. Should I be concerned? The pain is not regular, but is uncomfortable when it does come and has occurred off and on for over a year. Can a blood test show if I have cancer, or do you have to have a
Partial Breast Irradiation Dear OncoLink "Ask The Experts," Can you please tell explain Partial Breast Irradiation? Lawrence J. Solin, MD, FACR, Professor of Radiation Oncology at the University of Pennsylvania, responds: For patients with early stage breast carcinoma undergoing breast conservation treatment, the standard method of delivering radiation is to treat the
Underarm Care after Recovery from Lymph Node Removal Dear OncoLink "Ask The Experts," All my treatment has now finished, all body hair has grown back, and I am wondering about the hair under my arm where I had the lymph nodes removed with my mastectomy. What is the best method of hair removal, and should I avoid deodorant under this arm, or is roll-on ok? How do you care for this underarm? Nancy
ER Positivity Percentages Dear OncoLink "Ask The Experts," How do you determine if an ER or PR receptor is positive or negative when the results are reported as a percentage? I have seen 15% considered negative in some of the research, but positive in others. Is there a set definition for receptor positivity? Kevin R. Fox, MD, Assistant Director, Clinical
Starting Aromatize Inhibitors Years after Diagnosis Dear OncoLink "Ask The Experts," I have Stage I breast cancer and was treated with lumpectomy and radiation. I tried tamoxifen for about 9 months and then stopped because I was worried about stroke and didn't like the side effects. I was diagnosed in November of 2002 and stopped taking tamoxifen by December of 2003. All is fine, yet I went to the
Reconstruction Years after Therapy Dear OncoLink "Ask The Experts," Is it too late to get breast reconstruction after a 1986 lumpectomy with radiation? I have neck pain I think is from scarring from the cancer treatment. I have had the acute pain for over a year and want some solutions. I have had hyperbaric treatment and some medications to lessen the scarring, but both are risky
HRT for Breast Cancer Survivors Dear OncoLink "Ask The Experts," What is the current information regarding estrogen replacement therapy for former breast cancer patients? I am now in menopause and am affected both physically and emotionally. I was treated 12 years ago with radiation and chemotherapy for breast cancer with borderline estrogen receptor-positivity. Kevin R. Fox,
Pregnancy & High Risk for Breast Cancer Dear OncoLink "Ask The Experts," My mother died of breast cancer and secondary bone cancer in 1971, approximately a year after giving birth to my brother. She was 42. Her cancer was diagnosed 3 months after his birth. I am 40 and have 8-year-old twin girls. I have just discovered that I am pregnant, and am concerned about my increased risk of
Breast Irradiation and Respiratory Infections Dear OncoLink "Ask The Experts," Is there a connection between radiation (Right breast, ductal carcinoma in situ) and later increase of upper respiratory infections (URI)? Neha Vapiwala , MD, Senior Editor of OncoLink and Chief Resident in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:There is no
DCIS Hormone Therapy Dear OncoLink "Ask The Experts," Has any new information come out at recent conferences about the addition of aromatase inhibitors after 2.5 yrs. of Tamoxifen for estrogen-positive DCIS, after a lumpectomy with clear margins? A consultation indicated that it was not necessary in my case. In my research, I find that 5 yrs. of Tamoxifen is considered
Calcification Seen on Chest X-Ray Dear OncoLink "Ask The Experts," During a recent physical examination, my physician sent me for a chest x-ray, and the x-ray tech had me repeat the frontal chest x-ray. During the follow-up appointment, my doctor said that there was a spot on my lung, but not to worry because it had calcified. A co-worker whose wife was recently diagnosed with
Trouble Swallowing Pills Dear OncoLink "Ask The Experts," I have always had some difficulty swallowing pills, to the point that I have significant anxiety when I need to swallow a pill. I have completed surgery and radiation for DCIS and my doctor has prescribed 5 years of tamoxifen. While I know this is important to reduce the risk of another breast cancer, the thought of
Positive Sentinel Node Biopsy Dear OncoLink "Ask The Experts," I had sentinel node biopsy and had 1 of 4 positive nodes. From what I have read, dissecting more nodes does nothing to decrease mortality, can cause lymphedema, and would be an additional surgery. I understand doctors like it for a prognosis, but what possible good does it do for me to know that I have additional
Detecting Recurrence in Blood Work Dear OncoLink "Ask The Experts," I was diagnosed with breast cancer in October 2005 at the age of 43. It was Stage I breast cancer, had 4 rounds of chemotherapy, radiation therapy, and am now on tamoxifen. I recently went in to have routine blood work done. What kind of questions and what information from that blood work should I be looking at? Are
Radiation Timing after Chemotherapy Dear OncoLink "Ask The Experts," My wife has completed breast cancer treatment, specifically surgery and chemotherapy. My question is, after chemotherapy, how soon should radiation therapy start? We got an appointment with the radiation oncologist, and the total time gap is almost 6 to 7weeks - is this ok? Terry Styles, MD, Assistant Professor of
Tamoxifen after Mastectomy Dear OncoLink "Ask The Experts," I had a mastectomy at age 36. The pathology report indicated the presence of both DCIS and LCIS. No lymph node involvement was seen and the estrogen receptor status was negative, so I had no further treatment. Recently, at age 49, I was diagnosed with invasive ductal cancer of my other remaining breast and had a
Breast Cancer Screening Guidelines Dear OncoLink "Ask The Experts," What are the current guidelines for breast cancer screening?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:The American Cancer Society (ACS) and the National Comprehensive Cancer Network (NCCN) have both developed breast cancer screening guidelines which are quite similar. These recommendations
Sentinel Node Biopsy: Who is a Candidate? Dear OncoLink "Ask The Experts," I was diagnosed with DCIS (ductal carcinoma in situ), which the pathology report called grade II/III. Am I a candidate for sentinel node biopsy? Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate Professor of Hematology/Oncology at the Abramson Cancer Center of the University of Pennsylvania,
Tumor Marker for Breast Cancer Dear OncoLink "Ask The Experts," The Ca 27-29 blood test has a “normal” level below 30. Is it possible for the level to reach zero in a person who had invasive cancer with no lymph node involvement? Suzanne M. McGettigan, MSN, CRNP, AOCN, Board Certified Adult Nurse Practitioner and a Certified Oncology Advanced Practice Nurse,
Partial Breast Irradiation in Second Cancers Dear OncoLink "Ask The Experts," A friend has recently been diagnosed with invasive lobular breast cancer, HER-2/neu positive, ER/PR positive. She had invasive ductal cancer 10 years ago with a full course of radiation. She is considering lumpectomy + Mammosite OR mastectomy. Is there data on success rates for each choice for a person in her
Aromatase Inhibitor Joint Pain Dear OncoLink "Ask The Experts," I have been on Femara for 6 months, and it causes pain in my joints and the main nerve in my left leg. I know the importance of aromatase drugs, but would I get as much benefit and possibly eliminate the pain if I switched to Aromasin? Nancy Zieber, RN, MSN, CRNP, Oncology/Hematology Nurse Practitioner, responds:
Mammogram after Mastectomy? Dear OncoLink "Ask The Experts," I had a nipple-sparing mastectomy last year. Do I need to have mammograms because of the nipple sparing? I have seen reference to this in clinical practice guidelines, but I think they mean if you only had one breast removed. Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate Professor of
Treatment for Triple Negative Disease Dear OncoLink "Ask The Experts," Are there any specific recommendations for treating triple negative disease? My sister has had conflicting recommendations. Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds: Triple negative breast cancer gets this name because the tumor has tested negative for estrogen receptors, progesterone
Tips to Prevent Complications of Lymph Node Dissection Dear OncoLink "Ask The Experts," Other than choosing an experienced breast cancer surgeon, are there any preoperative or postoperative steps that can be taken by the patient to mitigate risk of side effects in axillary lymph node dissection? Linda McGrath Boyle PT, DPT CLT-LANA, Cancer Rehab Specialist and OncoLink Lymphedema Team Editor,
Stop Hormone Therapy After 5 Years? Dear OncoLink "Ask The Experts," After five years of Arimidex, I have now been told by my oncologist to stop taking it. Wouldn't it be better to take it just in case it might do some good? There are many problems I would prefer to a breast cancer recurrence. Nancy Zieber, RN, MSN, CRNP, Oncology/Hematology Nurse Practitioner, responds:It seems
Smoking After Diagnosis of Breast Cancer Dear OncoLink "Ask The Experts," Can you please provide more information on the subject of smoking while receiving chemotherapy and radiation treatment for breast cancer? What is the effect of continued smoking while receiving treatment, due to cigarette smoke containing over 4000 chemical compounds, hundreds of which are either poisonous or
TOP2A FISH Testing Dear OncoLink "Ask The Experts," What are your thoughts on the new genetic test TOP2A FISH pharmDx? For whom is the test appropriate? Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate Professor of Hematology/Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds: TOP2A FISH pharmDx is a genetic test
Exercise After Breast Cancer Dear OncoLink "Ask The Experts," Although my wife and I have been told that squash and tennis (which my wife played before her mastectomy) is not recommended, I am curious to know why? Whereas weight training seems to be getting a cautious 'green light', are there specific reasons why racket sports and the type of arm movement involved would
Risk of Heart & Lung Damage with Breast Radiation Dear OncoLink "Ask The Experts," What is the risk of damage to your heart or lung from radiation treatment for left breast DCIS? Terry Styles, MD, Assistant Professor of Radiation Oncology at the University of Pennsylvania, responds: After many years of radiotherapy and many types of cancer treated, it became obvious that radiation to the chest
Breast Cancer Recurrences Dear OncoLink "Ask The Experts," My oncologist once mentioned that roughly 75% of breast cancer recurrences are metastatic. If this is true, most patients who recur would eventually die after a recurrence. I can't find any substantiation for his remark. Can you tell me whether he is right or not? I am trying to decide whether or not to continue an
Radiation Tattoo Removal Dear OncoLink "Ask The Experts," I have just completed radiation therapy, following successful neo-adjuvant chemo and a lumpectomy (1.5 cm). Can I have my radiation tattoos removed with a laser, or do I need to keep them?Maggie Hampshire, BSN, OCN, Radiation Therapy Nurse at the University of Pennsylvania, responds:The ink used to tattoo you for
Breast Papilloma Dear OncoLink "Ask The Experts," I have a family history of breast cancer and am 38 years old. I had a workup for an abnormality found on mammogram and was seen by a surgeon. They have concluded that the area is a papilloma and recommend removal. Is this a precursor to cancer, and is it necessary to have it removed? Kevin R. Fox, MD, Assistant
Metastatic Breast Cancer to the Liver Dear OncoLink "Ask The Experts," My mom was diagnosed with metastatic breast cancer to her liver last year. Her oncologist tracks her alkaline phosphatase level monthly, recently the numbers are climbing up, but her AST/ALT are stable. What could this mean? Kevin R. Fox, MD, Assistant Director, Clinical Affairs and Associate Professor of
Radiation Therapy for Micrometastasis in Lymph Nodes Dear OncoLink "Ask The Experts," I was diagnosed with an invasive ductal breast cancer. I underwent a right mastectomy with sentinel node biopsy (which was negative at the time of surgery). My permanent biopsy report showed that out of 8 lymph nodes, one had a micrometastasis. I am currently undergoing chemo and will finish in July. I have had a
Can I Change Radiation Facilities for a Week? Dear OncoLink "Ask The Experts," How difficult would it be to temporarily transfer radiation treatment for 1 week? Chemotherapy is completed & a full mastectomy was done. The radiation is the last step to treat any cells remaining in the breast area. The patient has been looking forward to a vacation that was booked a year ago. The treatment
Onycholysis Dear OncoLink "Ask The Experts," I went thru 8 rounds of Taxotere & Xeloda for breast cancer, and finished the last treatment almost 90 days ago. I have the discolorations in my finger & toe nails, and my finger nails are somewhat loose. I keep my nails cut low for fear they may get pulled off. I have experienced some drainage in the finger
Reoccurrence in BRCA1 Patients after Lumpectomy Dear OncoLink "Ask The Experts," My wife was just confirmed to have the BRCA1 Gene. She is 2 weeks post lumpectomy. We start chemotherapy on Tuesday, Sept 10th for 8 weeks. She is 44 years old. The oncologist recommends that she have her ovaries removed, with which we have no problem. However, my wife would like to keep her breasts. I cannot find a
Swelling Under my Right Arm Pit Dear OncoLink "Ask The Experts," My recent mammogram revealed a stable nodule in the upper outer quadrant of the right breast, likely an intramammary lymph node. For many years, I have had a swelling under my right arm pit which doctors tell me is breast tissue. My mammogram was routine and I was told to follow up in l year. Should I wait or check
Swimming and Exercise While on Radiation Therapy for Breast Cancer? Dear OncoLink "Ask The Experts," I am about to start radiation therapy for breast cancer. Can I swim during this time? I have heard conflicting reports about exercise during therapy. Linda McGrath Boyle PT, DPT CLT-LANA, Cancer Rehab Specialist and OncoLink Lymphedema Team Editor, responds:Your doctors, including the surgeon, medical oncologist,
Risk with Negative Genetic Testing Dear OncoLink "Ask The Experts," My sister was diagnosed with DCIS and had mastectomy. My Mom was just diagnosed as well. My sister tested negative in the genetic testing to see if she carried the gene that would affect her daughters. Does that mean they can never get breast cancer? My sister said they are cleared, but I am not because of my Mom.
Do I need to have breast reconstruction after my surgery for breast cancer? Dear OncoLink "Ask The Experts," Do I need to have breast reconstruction after my surgery for breast cancer?>Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:It is never medically necessary to have breast reconstruction. This is considered an elective procedure,
What is the difference between immediate and delayed breast reconstruction? Dear OncoLink "Ask The Experts," What is the difference between immediate and delayed breast reconstruction?Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:Many patients prefer to have reconstruction done (or at least the process started) at the same time as their
Are all women candidates for immediate breast reconstruction after breast cancer surgery or treatment? Dear OncoLink "Ask The Experts," Are all women candidates for immediate breast reconstruction after breast cancer surgery or treatment?Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:The vast majority of women are candidates for breast reconstruction. There are a
What are the major types of breast reconstruction available to patients who have had breast cancer surgery? Dear OncoLink "Ask The Experts," What are the major types of breast reconstruction available to patients who have had breast cancer surgery?Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:There are 3 major types of breast reconstruction. The first is a tissue
I am interested in breast implant reconstruction after my breast cancer surgery. What is involved? Dear OncoLink "Ask The Experts," I am interested in breast implant reconstruction after my breast cancer surgery. What is involved?Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:Implant reconstruction is almost always at least a two-step procedure. At the time of
Do my breast implants last forever? Dear OncoLink "Ask The Experts," Do my breast implants last forever?Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:Implants are not lifetime devices, and both saline and silicone implants can rupture and leak. If you have saline implants, you will notice a slow
Why do you need to do tissue expansion for breast implants? Dear OncoLink "Ask The Experts," My friend had breast augmentation and they just put the implants without tissue expansion.Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:Placing implants after mastectomy is very different than putting in implants for cosmetic
I may need chemotherapy for my breast cancer. Can I still have breast implants? Dear OncoLink "Ask The Experts," I may need chemotherapy for my breast cancer. Can I still have breast implants?Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:Women who need post mastectomy chemotherapy are still candidates for implants. Sometimes we need to
I may need radiation to my breast area. Can I still have implants? Dear OncoLink "Ask The Experts," I may need radiation to my breast area. Can I still have implants?Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:Radiation and the impact on implants is something that needs to be discussed carefully with your surgeon. It is true
I keep hearing about TRAM flap breast reconstruction. What is this all about? Dear OncoLink "Ask The Experts," I keep hearing about TRAM flap breast reconstruction. What is this all about?Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:The TRAM flap stands for transverse rectus abdominus myocutaneous flap. This type of reconstruction is
Why do people choose flap reconstruction after breast cancer surgery? Dear OncoLink "Ask The Experts," Why do people choose flap reconstruction after breast cancer surgery? Doesn’t it take longer to recover from than breast implant surgery?Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:It is true that breast reconstruction using a
I do not want any muscle taken from my abdominal wall during my breast flap reconstruction surgery. Can my doctor guarantee this prior to surgery? Dear OncoLink "Ask The Experts," I do not want any muscle taken from my abdominal wall during my breast flap reconstruction surgery. Can my doctor guarantee this prior to surgery?Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:Although it is always a priority to
Are there different types of free flap breast reconstructions? Dear OncoLink "Ask The Experts," Are there different types of free flap breast reconstructions?Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:Yes, there are several different types of free flap breast reconstruction. Usually the tissue is taken from your lower
Hospitalization Period After Breast Reconstruction Surgery Dear OncoLink "Ask The Experts," Tell me about the hospitalization period after breast reconstruction surgery.Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:After surgery, you will be admitted to an intermediate care floor (level of care between a regular bed and
How long will I need to be out of work after breast reconstructive surgery? Dear OncoLink "Ask The Experts," How long will I need to be out of work after breast reconstructive surgery?Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:For implant reconstruction most women take 3-4 weeks off of work following the mastectomy and placement of
When can I drive after breast reconstructive surgery? Dear OncoLink "Ask The Experts," When can I drive after breast reconstructive surgery?Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:It is safe to resume driving when all the drains are out (more about these below), when you are off all pain medication and when
Surgical Drains After Breast Reconstructive Surgery Dear OncoLink "Ask The Experts," Tell me about the surgical drains after breast reconstructive surgery. Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:Jackson Pratt (JP) drains are placed under the skin during surgery to remove a collection of blood and other
Activity Limitations After Breast Reconstructive Surgery Dear OncoLink "Ask The Experts," What activity limitations do I have after breast reconstructive surgery?Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:While the drains are in you cannot take a bath or submerge yourself in water. Showering with the drains in is
Do I need to have any special supplies at home for my recovery after breast reconstructive surgery? Dear OncoLink "Ask The Experts," Do I need to have any special supplies at home for my recovery after breast reconstructive surgery?Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:Bring to the hospital a shirt that either buttons or zips up the front. Just after
Lump Not Detected on Mammogram Dear OncoLink "Ask The Experts," I was diagnosed 2 years ago with breast cancer. I had yearly mammograms and lived a healthy life. Eight months after my last mammogram, I found a lump. Following lumpectomy, the path report indicated a 6.3 cm tumor, the extent of which did not show on the MRI or ultrasound. My question is, what research is being
Precautions After Sentinel Node Biopsy Dear OncoLink "Ask The Experts," What restrictions should be followed after sentinel node biopsy? Do the same rules of lymph node dissection apply (no blood pressures, IVs, or blood draws in the arm)?Nancy J. O'Connor, MSN, CRNP, Oncology Nurse Practioner for Breast Surgery at the Rowan Breast Center, responds:In general, the surgeons at our
Previously Irradiated Skin Dear OncoLink "Ask The Experts," Thirty years ago, I was diagnosed with breast cancer and treated with cobalt-based radiation therapy and chemotherapy. A year ago, I was diagnosed with DCIS and had a bilateral mastectomy with reconstruction. The reconstruction has been difficult and required a second flap procedure due to the previously
Non-Estrogen Options for Vaginal Dryness Question I am interested in something other than low dose estrogen to help with vaginal dryness and spotting. Is there something 'natural' - no estrogen, no phytoestrogen, no xenoestsrogen for ER 100% positive patients? Answer Kevin Fox, MD, Medical Oncologist at Penn , responds: There does not appear to be an immediate need for vaginal
Possible Herceptin Reaction Question I am undergoing a year’s worth of Herceptin infusions. My question has to do with a possible side-effect, though none of my doctors seem to be able to help. When I get hot (typically outside in the heat), I get a stinging and prickly feeling that starts at various sites on my body. When I cool off, the sensation goes away. There is no
Ten Year Survival With Aromatase Inhibitor Use Question What are the statistics of 10-year survival of Arimidex based on? Low risk breast cancer patients having lumpectomies? Single mastectomies? Bilateral mastectomies? Locations of tumors? etc. What were the circumstances in the studies and are they all lumped together when arriving at the statistics of improving odds from 85% to 91%? Answer
What is Standard Course of Herceptin Question Please comment on the Finnish protocol of giving 9 weekly administrations of Herceptin versus the 18 - three-weekly administrations that are currently done in the US. Answer Kevin Fox, MD, Medical Oncologist at Penn , responds: The Finnish protocol treated a very small number of women, I believe fewer than 200. All of the other studies
Mammogram After Breast Cancer Treatment? Question Do I still need to get a mammogram after breast cancer treatment? If so, how often? Answer Kevin Fox, MD, Medical Oncologist at Penn , responds: If you have had breast conservation surgery for your breast cancer, then mammograms once per year are recommended. If you had a single mastectomy, with or without reconstruction, the opposite
Pregnancy and Breast Cancer Question Does pregnancy make you more likely to develop breast cancer? I have been hearing more and more about women who find out they have breast cancer when they are pregnant. Answer Kevin Fox, MD, Medical Oncologist at Penn , responds: Pregnancy does not increase the risk of getting breast cancer. Women do get breast cancer during
Safety of Pregnancy After Breast Cancer Question How long after breast cancer treatment is it safe to become pregnant? Will the hormones of pregnancy increase the risk of my cancer coming back? Answer Kevin Fox, MD, Medical Oncologist at Penn , responds: First, the hormonal situation during pregnancy does not appear to increase the risk of cancer coming back. Second, there is no
Non-Hormonal Treatments for Hot Flashes Question Can you recommend non-hormonal treatments for hot flashes/symptoms of menopause? Answer Kevin Fox, MD, Medical Oncologist at Penn , responds: The non-hormonal treatments, which have been shown conclusively to help with hot flashes, include low doses of antidepressants (venlafaxine is the one we prescribe the most) or gabapentin. They
Tamoxifen & Radiation at The Same Time? Question I will be getting radiation and also tamoxifen treatment following a lumpectomy T2N0. Is there a downside to concurrent treatment? Answer Kevin Fox, MD, Medical Oncologist at Penn , responds: There have been several studies that have looked at concurrent versus sequential radiation and tamoxifen in early stage breast cancer. There
Follow Up After Bilateral Mastectomy Question What is the current advice on post bilateral mastectomy follow up, short term and long term (mammograms, manual palpation, mri's etc.? Answer Gary Freedman, MD, Radiation Oncologist at Penn , responds: After a woman has undergone a bilateral mastectomy, the usual follow up is an examination by a heath professional twice a year and
Lumpectomy Versus Mastectomy Question I have been given the choice of lumpectomy and radiation vs. Mastectomy. Can you please give some advice to help me make my decision? Is one treatment better than the other? Answer Gary Freedman, MD, Radiation Oncologist at Penn , responds: Lumpectomy and radiation have been proven in large, well done clinical trials to result in equal
Risk of Breast Cancer With Family History Question How much more likely is a person with a family history of breast cancer to get it than the rest of the population? Answer Gary Freedman, MD, Radiation Oncologist at Penn , responds: In general, a woman in the United States has an approximate 1 in 9 chance of developing breast cancer by the age of 80. A family history in a first
Partial Breast Irradiation Versus Traditional Radiation Question Why do I have to come for radiation every day for weeks? I have heard about some radiation for breast cancer that is done in only 5 days- what is that and is it just as good? Answer Gary Freedman, MD, Radiation Oncologist at Penn , responds: The purpose of delivering radiation therapy in a relatively small dose once a day for about 6
Using Lotions During Radiation Question Is it ok to put lotion on the area that is getting radiation to help with the dryness and burning? Answer Gary Freedman, MD, Radiation Oncologist at Penn , responds: During radiation therapy to the breast, we recommend that you use a mild, unscented soap for washing each day. A gentle moisturizer can be used daily as long as not on the
How Long is Radiation Treatment? Question How long does it take to get a radiation treatment? Answer Gary Freedman, MD, Radiation Oncologist at Penn , responds: A daily radiation treatment will usually take about 5-10 minutes. There is more time needed to set up a patient into the treatment position, check and double check the patient alignment, take verification films on
Stiffness in Area of Radiation Treatment Question I feel stiffness in the area where I had radiation. What can I do about this? Answer Gary Freedman, MD, Radiation Oncologist at Penn , responds: Stiffness in the area of radiation is relatively common, depending on the site treated, the technique and equipment used, and the dose used. Most women with breast irradiation can have
Treating Blisters From Radiation Question What should I do for the blisters that I am getting from radiation treatment? Answer Gary Freedman, MD, Radiation Oncologist at Penn , responds: Radiation dermatitis can be treated with many approaches depending on the severity. Early mild redness can be treated with gentle lotions or creams. Areas of peeling or blistering can be
TRAM Flap and Future Pregnancy Question I am 31 years old and just diagnosed with an early stage breast cancer, but due to family history, my doctor is recommending a double mastectomy. If I have the TRAM flap surgery, will I still be able to have a successful pregnancy in the future? Answer Brian Czerniecki, MD, Breast , responds: In general with free flap reconstruction
When Must I Decide on Reconstruction? Question How long can I wait to make a decision regarding reconstruction after a mastectomy? Must I decide before I have my surgery? Answer Brian Czerniecki, MD, Breast , responds: You can do reconstruction at any point after treatment finished or can have immediate reconstruction at the time of mastectomy. You get best results with immediate
Chemotherapy Before or After Surgery Question Why did my friend get chemo before her surgery and I am supposed to get it afterwards? Answer Brian Czerniecki, MD, Breast , responds: We give chemotherapy prior to surgery to attempt to improve breast conservation surgery. You may or may not need chemotherapy after breast cancer depending on tumor size node status and receptor type
Nottingham Score and Recurrence Question My breast cancer came back just few months after lumpectomy. My pathology report says nottingham grade 3 of 3. What does this mean? Answer Brian Czerniecki, MD, Breast , responds: This means it is high grade. The significance of recurrence post lumpectomy and XRT depends on the type of radiation you received your age and other
Soy Foods After Breast Cancer Question I do not eat soybeans, tofu, tempeh, flax seeds. I do not consume any soy supplements. I am looking for a complete list of those foods that are no-no's for ER 100% patients re: estrogens, phytoestrogens, xenoestrogens. I have a list from www.dietaryfiberfood.com, which lists foods high in phytoestrogens and lignans (content and amounts
When to Get a Wig? Question I was just diagnosed with breast cancer and told I will lose my hair from treatment. When is the best time to find a wig? How do I know where to go? Are there any resources to help pay for one? Answer Jodi Sandos, MSW, LSW, Oncology Social Worker at Penn Medicine, responds: The best time to get a wig is before your start your
Talking to Your Employer About Cancer Diagnosis Question Can you help me in how to talk to my employer about my diagnosis? Answer Jodi Sandos, MSW, LSW, Oncology Social Worker at Penn Medicine, responds: It a good idea to know your options for employment whether or not you choose to work through your treatment. Many people continue to work through their treatment, while other people decide
Balancing Life and Cancer Question I would like some advice on how to balance work, family, kids, etc. while facing breast cancer and treatment. Where can I go for help/support? Answer Jodi Sandos, MSW, LSW, Oncology Social Worker at Penn Medicine, responds: Often trying to balance everything in our life while going through treatment can be quite challenging. It is a
Coping With Chronic Illness Question My Doctor mentioned that I should view my cancer (breast) as more of a chronic illness because there is no cure, however there are treatments and medicines that can help. What tips do you have for living with this uncertainty? Answer Jodi Sandos, MSW, LSW, Oncology Social Worker at Penn Medicine, responds: Cancer can become a chronic
Assistance With Medication Co-Pays Question I am self-employed and have no prescription coverage. I have not been able to work much since my diagnosis of cancer therefore my income has really been greatly reduced. One of my prescribed medication costs $30 per pill. Is there any help to receive medications at a reduced cost or at no cost? Answer Jodi Sandos, MSW, LSW, Oncology
Pheochromocytoma I am a 28 year old female currently being tested for an adrenal tumor with symptoms of hypertension and tachycardia. I am wondering whether or not this could be a pheochromocytoma. E.B. John Han-Chih Chang, MD Editorial Assistant for Oncolink responds: Thank you for your question. Pheochromocytomas are
Paget's Disease Dear OncoLink "Ask the Experts," As I am sure you are aware, Paget's disease is primarily a bone or breast disease. Unfortunately, there are several people in the Bay Area, specifically women, who are afflicted with Paget's of the anus, rectum or vulva. There is very little information of Paget's disease on these parts of the
Treatment Options for Peri-anal Paget's Disease In 1986 and l987 I was operated on twice to excise Peri-anal Paget's disease and obtain clean margins. Pathology revealed underlying adenocarcinoma and the sphincter was excised, but not destroyed. After the second operation there were still some underlying cancer cells, but I was told I would just be watched--and I was for every three
Radiation or Surgery? I would like to ask you a question. My father was recently diagnosed with anal cancer. The doctor said his tumor is about 3cm in size. He had a CT scan done which did not show any lymph node spread. The doctor is planning to do radical surgery and permanent colostomy. I read that this tumor can be treated with radiation without sacrificing
Resuming sexual relations after completion of chemotherapy and radiation therapy for anal cancer Dear OncoLink "Ask The Experts," I have just completed chemo and radiotherapy treatment for anal cancer I am worried about having sex again. Presently I have a yellow mucus discharge from my vagina and anus. It does seem to be getting better. Can I hope it will disappear and is it normal?James M. Metz, MD, Editor-in-Chief of OncoLink and Assistant
Proton Therapy for Anal Cancer Dear OncoLink "Ask The Experts," Is the new proton beam radiation a viable option for anal cancers? James M. Metz, MD, Editor-in-Chief of OncoLink and Assistant Professor of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:Proton beam therapy is being explored as a possible form of treatment for a number of cancers.
Traditional Radiation vs. IMRT for Treatment of Anal Cancer Dear OncoLink "Ask The Experts," If you would please explain the difference in types of radiation machines used specifically for treating anal cancer--the linear accelerator and the IMRT--if there is a difference and whether all cancer treatment centers would utilize the same equipment type.James M. Metz, MD, Editor-in-Chief of OncoLink and
Anal Pap Testing and Cancer Dear OncoLink "Ask The Experts," How effective are anal pap tests that are offered in the gay community? Najjia N. Mahmoud, MD, Assistant Professor of Surgery at the Hospital of the University of Pennsylvania in the Division of Colon and Rectal Surgery, responds:I'm unclear on the efficacy of anal pap tests. There is a lot of controversy in the
Information on 'Virtual Colonoscopy' Dear OncoLink "Ask the Experts," Can you give me any information on the "virtual colonoscopy"? Thanks, M.H. Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds: Virtual colonoscopy is currently being developed. It is a
Polyps and the Symptoms of Colon Cancer Dear OncoLink "Ask the Experts," Ten years ago I had polyps. They were not cancerous. Could they become cancerous? What are the symptoms of colon cancer? Thank you. JW James D. Lewis, MD, MSCE, Assistant Professor of Medicine, Senior Scholar at the Center for Clinical Epidemiology and Biostatistics, and Senior
Neurological Deficits and Colon Cancer Dear OncoLink "Ask the Experts," My mother underwent surgery for colorectal cancer 3 years ago. She was treated with chemotherapy as well as radiation. She did fine until one of her last radiation treatments. At that point, she started having pain in her hips, back and legs. She was diagnosed with a ruptured disk and had additional
Insurance Coverage for Colonoscopy Dear OncoLink "Ask the Experts," I am writing on behalf of my brother. He is 58 years old and has never had a colonoscopy. My mother had breast cancer that metastasized to her colon, requiring a colostomy. She died in 1984. My father has recently been diagnosed with colon cancer detected on a colonoscopy. He only had that one
Screening Options when Insurance Companies Refuse to Precertify a Colonoscopy Dear OncoLink "Ask the Experts," I have had constipation/with violent diarrhea for about 2 yrs, on and off constricted stools, bloating, it has steadily gotten worse over the last 6 months, no blood at this point. My physician referred me to a gastroenterologist to have a colonoscopy. My insurance company will not precertify a
Symptoms of Colon Cancer Dear OncoLink "Ask the Experts," I have abdominal discomfort, bloating, gas, constipation, nausea and pencil thin stools. I am 44 years old, female, and I have no insurance. Is it cancer? Do you have any idea what I can do without insurance to help find out what it is? Dr. Timothy Hoops, Clinical Assistant Professor
Questions about an Upcoming Colon Surgery Dear OncoLink "Ask the Experts," I have Colon Cancer, apparently at the beginning of my colon. I will soon be having surgery for this and diverticula surgery on the lower end of the colon. I have many questions. Can both procedures be done at the same time? Is there risk of spreading the cancer to the "open" wound where the
Increase in CEA After Colon Surgery Dear OncoLink "Ask the Experts," My husband had a colostomy almost 3 years ago. Right after surgery his CEA level was .8 or .9. His most recent CEA is ll. He has been on LIPITOR and MODUCARE. Could either of these drugs cause a high CEA level? Does an elevated reading necessarily indicate cancer growth? We have radiologic tests
Family History and Risk for Colon Cancer Dear OncoLink "Ask the Experts," I am 31-year-old male. I have been reading a lot about hereditary colon cancer due to some recent symptoms of lower right-sided abdominal cramps. My family history is both grandparents on fathers side diagnosed at age 50-55. Great grandfather on father's side diagnosed at 75. Mom has no colon cancer
Risks Of Radiation Therapy For A Lupus Patient Dear OncoLink "Ask the Experts," Can a patient with lupus and rectal cancer have a radiation therapy treatment? If so, what will be the risks? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds: The lifetime risk of colon cancer is
CEA Levels and Colon Cancer Dear OncoLink "Ask the Experts," What is a CEA test, how accurate or dependable is it? Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine at Radnor, responds: Carcinoembryonic antigen or
Intramucosal Polyp Dear OncoLink "Ask the Experts," Should I have a second opinion on the biopsy test to confirm the "intra mucosal" nature of the polyp? It sounds like, to my nonphysican ear, that the polyp tumor was confined to the polyp and had not spread. We apparently caught it in developing stage. Is this unusual? What should I do and did I catch
Family History Of Colon Cancer And Ulcerative Colitis Dear OncoLink "Ask the Experts," My mother suffered from ulcerative colitis from age 33-42. She finally had a j-pouch surgery in September.00 and is doing well. On her side, her brother and sister also both have ulcerative colitis... both diagnosed in their 30's. On my father's side, his father died of colon cancer at age 70, his
Radiation Prior to Surgery for Rectal Cancer Dear OncoLink "Ask the Experts," I have recently been diagnosed with rectal cancer. I was told that chemotherapy and radiation was required before surgery. The mass is approximately 10cm. Frankly I would rather have surgery first. I would appreciate your thoughts on this matter. Richard Whittington, MD, Associate
What is a polyp? Dear OncoLink "Ask the Experts," So much talk about polyps! What is a polyp? Please explain. Thanks. James D. Lewis, MD, MSCE, Assistant Professor of Medicine, Senior Scholar at the Center for Clinical Epidemiology and Biostatistics, and Senior Fellow in the Leonard Davis Institute of Health Economics at the
Treatment Options After Failed Chemotherapy Dear OncoLink "Ask the Experts," What can be done for a 60-year-old male with stage IV colon cancer with metastases to the liver and extra-hepatic disease? Multiple regimens of chemotherapy have failed. The patient currently has an elevated bilirubin and is receiving 5-FU via portable IV pump. Thank you, B.S.
Stage 1 Colon Cancer Dear OncoLink "Ask the Experts," Hello, I am a 35-year-old female. I was diagnosed with Stage I colon cancer last year. My sister who is 45 was diagnosed 4 years ago in stage 4. We just found out that the cancer has spread to her liver and lungs. I am very scared. Does this mean I will have a recurrence? 6 Months ago 2 polyps were
Can hemorrhoids lead to rectal or colon cancer? Dear OncoLink "Ask the Experts," Can hemorrhoids lead to rectal or colon cancer? Thank you. James D. Lewis, MD, MSCE, Assistant Professor of Medicine, Senior Scholar at the Center for Clinical Epidemiology and Biostatistics, and Senior Fellow in the Leonard Davis Institute of Health Economics at the University of
Is Colon Cancer Hereditary? Dear OncoLink "Ask the Experts," I have just been diagnosed with a Dukes B adenocarcinoma of the colon, which has now been removed, and I am about to start a course of chemotherapy (5-FU). I am only 26 years old and have been told it is very unusual for someone of my age to get bowel cancer. Doctors are saying that it is most likely a
Side Effects of Radiation to the Rectum Dear OncoLink "Ask the Experts," What are the side effects of radiation treatment to the rectum? Thank you, L Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds: This is a question with two answers, since there are early and
Prognostic Factors for Colon Cancer Including Genes Dear OncoLink "Ask the Experts," I understand that the presence or absence of some genes makes a significant difference in the effectiveness of therapies such as radiation and chemo. Is there a current test to determine whether these genes are present in an individual? I had Stage B colon cancer, last year, age 64, but I elected not to
The Frequency of Screening Colonoscopies Dear OncoLink "Ask the Experts," How often do you recommend having a colonoscopy? I previously lived in NJ and the doctor there recommended every two years. I now live in NC and the doctor recommends every 5 years. Since I have a history of color cancer on both sides of my family, I am concerned. Thank you, A.W.
Can Irritable Bowel Syndrome lead to Colon Cancer? Dear OncoLink "Ask the Experts," I am 33-year-old female diagnosed with Irritable Bowel Syndrome about 10 years ago. Can my condition lead to colon cancer? Dr. Timothy Hoops, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn
Rectal Cancer Treatment Options Dear OncoLink "Ask the Experts," My mother, who is 84 years old, was recently diagnosed with rectal cancer. The tumor is a flat malignancy that is attached to the back wall of her rectum. All test results show that the cancer has not spread, and is only isolated to the rectal wall. Her current surgeons see no alternative but to remove
Side-Effects and Recurrence Rates of Stage 3 Colorectal Cancer Dear OncoLink "Ask the Experts," I have a question for your panel regarding my father. He is 75 years old and is currently undergoing treatment for a Stage 3 colorectal cancer. The pathology report indicated the tumor to involve the full thickness of the mucosal wall, 2 of 25 local lymph node involved, and the tumor's position just below
Cutting Edge Cancer Treatments Dear OncoLink "Ask the Experts," I am currently being treated with oxaliplatin for metastatic colon cancer in the liver. Where do you think the most promising future colon cancer help will come from angiogenesis inhibitors, monoclonal antibodies, or vaccines? Thanks, B.M. James P. Stevenson, MD, Assistant
Guidelines for Colorectal Cancer Screening Dear OncoLink "Ask the Experts," I am a 26-year-old female. My grandmother was diagnosed with colon cancer at age 55 and died of the disease at age 60. My mother has been diagnosed with the disease at age 49. She was in Stage IV when her cancer was diagnosed. At what age should I have a colonoscopy? James D.
Rising CEA after Surgery Dear OncoLink "Ask the Experts," I am a 45-year-old non-smoking male who at 41 was diagnosed with colorectal cancer. My CEA at diagnosis was 57. I had chemo and radiation therapy followed by surgery. Post-op, I had 5-F/U for 3 months. Ten months after surgery, a tumor was detected in my liver and was removed. CEA at the time of liver
Chemotherapy for Mucinous Adenocarcinoma of the Colon Dear OncoLink "Ask the Experts," I was wondering what you could tell me about Mucinous Adenocarcinoma of the colon and a new treatment using CPT11-5FU-LUKOVORAN? Thanks, R.L. James P. Stevenson, MD, Assistant Professor of Medicine in the Hematology/Oncology Division of the University of Pennsylvania School of
Chemotherapy and Follow Up After B2 Colon Cancer Dear OncoLink "Ask the Experts," I was diagnosed with stage II colon cancer in September 2000 at age 39. 21 lymph nodes were removed, all negative. No apparent spread. Angiolymphatic invasion present; B2 tumor. Bowel resection surgery performed. I am just completing 6 rounds of 5FU & Leucovorin. Is there any other treatment available
Treatment Options for Dukes Level C Colon Cancer Dear OncoLink "Ask the Experts," My father has just had surgery to remove a malignant tumor from the right side of his colon (they removed "half" of the colon, according to the surgeon). In the removal, the surgeon took out 20 lymph nodes around the colon; 12 contained cancer cells. The oncologist has rated my Dad on a "Dukes" scale as
Treatment and Follow-up Options after Colon Cancer Dear OncoLink "Ask the Experts," Would appreciate your help and guidance. My wife under went a colon resection to remove cancerous growth. One lymph node tested positive. Subsequent chemotherapy treatment (5 FU & leucovorin ) administered over a six-month period. What are the follow up testing procedures? What are the follow
Laxative Use and Colon and Rectal Cancer Dear OncoLink "Ask the Experts," I've heard that chronic constipation and laxative use is associated with colon and rectal cancer. Is that true? Thank you. Li Liu, MD OncoLink Editorial Assistant, responds: This is an excellent question. It has long been suggested that low bowel movement frequency, by
Risk of Injury from Colonoscopy Dear OncoLink "Ask the Experts," I am having a colonoscopy, but I am very concerned that I might end up with a hole in my colon. How common is it for an accident to happen? James D. Lewis, MD, MSCE, Assistant Professor of Medicine, Senior Scholar at the Center for Clinical Epidemiology and Biostatistics, and Senior Fellow
Colonoscopy After Polyp Removal Dear OncoLink "Ask the Experts," My father underwent a colonoscopy at age 70. Polyps were removed. How often should he have a colonoscopy? Thank you, CG Dr. Timothy Hoops, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of
CEA Level Dear OncoLink "Ask the Experts," How long should it take for someone's CEA level to return to normal post surgery for colon cancer? Thank you, RH Todd Doyle, MD, OncoLink Editorial Assistant, responds: Dear RH: Thank you very much for your interest and question regarding carcinoembryonic antigen (CEA)
CEA and the Oncoscint Scan Dear OncoLink "Ask the Experts," I am hoping that you will be able to steer me in the right direction. I am a 26 year old female diagnosed with stage 3 rectal cancer in '96. My CEA has risen in the past 4 months from 0.4 to 3.7, to 5.8 and I am wondering what resources are available as to the validity of the CEA/and or what other factors
Invasive Colon Adenocarcinoma Dear OncoLink "Ask the Experts," I have a friend in his low 40's with recent diagnosis of invasive colon adenocarcinoma. He underwent a colectomy with tumor resection. The tumor invade bladder but without penetration. Surgical margins clear of tumor. There are 3/31 mesenteric nodes positive. My questions what is his prognosis, what the
Nutritional Changes Following Substantial Colon Resection Dear OncoLink "Ask the Experts," I am looking for information about changes in bowel habits, changes in diet, other practical hints, tips, etc. after substantial colon resection following surgery involving two synchronous cancers with many polyps. The rectum will remain intact. And colostomy is not anticipated. MF
Colon Cancer Screening Tests Dear OncoLink "Ask the Experts," I am at high risk for colon cancer because my mother had colon cancer at age 37, my maternal great aunt had colon cancer, and my father's mother died of colon cancer. My question is if someone is at high risk and has had a normal colonoscopy, how often after that should he or she considers having another
Hereditary Colon Cancer Dear OncoLink "Ask the Experts," I am looking for a clinical study on hereditary connections for Colon Cancer. I have an intensive family history of colon cancer. My paternal Grandfather died from it in his 50's. My father has had 7 colon polyps removed and his two sisters have had colon cancer recently. I also have had 3 colon polyps
Rectal Bleeding and Rectal Cancer Dear OncoLink "Ask the Experts," I have had rectal bleeding for about one week. This has happened before several months ago and stopped. I am seeing a Doctor about this later this month and am convinced I have rectal cancer. What are the other causes of rectal bleeding? The OncoLink Editorial Team responds:
Rectal Bleeding Dear OncoLink "Ask the Experts," Sometimes after a bowel movement, I notice blood on the tissue paper and a streak of blood along one side of the flat stool. I do plan on returning to see my doctor, but I still do not know the significance of this finding. Could someone please let me know? Thank You PS Ivor
Ulcerative Colitis and Non-colorectal Cancer Dear OncoLink "Ask the Experts," I learned from your site (and others) that ulcerative colitis is associated with colorectal cancer. My question is whether ulcerative colitis could cause other malignancies. Thank you. Li Liu, MD, OncoLink editorial assistant, responds: Dear M Thank you for your interest
Risks of Colonoscopy I am in the process of looking for a qualified professional to perform my first colonscopy. I am at risk because my sister had colon cancer at age 14. She is now 36 and has a colostomy bag. I spoke with a doctor here in NYC and she informed me that she has had 3 experiences where perforations took place and one person actually died (the
What is a Digital Rectal Exam? Dear OncoLink "Ask The Experts," What is a Digital Rectal Exam? Carolyn Vachani, MSN, RN, AOCN, OncoLink's Clinical Trials Coordinator, responds: Digital rectal exam is a technique used by physicians to assess rectal function, feel for rectal tumors or hemorrhoids, and check for blood in the stool. The physician inserts a
Villous adenoma Dear OncoLink "Ask The Experts," I am 38-year-old woman in excellent health. I have eaten fiber since age 15 every night (bran cereal). I am a long distance runner since age 14. I recently had a villous adenoma removed and remnants cauterized at initial removal 07/01. There was also a small polyp removed. I had the adenoma cauterized
Lynch Syndrome Dear OncoLink "Ask The Experts," I have just learned that a lot of our family members are carriers of Lynch Syndrome. I have looked everywhere and can't find anything on it. Is there anything you can tell us? I am told it is a form of colon cancer. My uncle was just told he is a carrier. Can you help me? Thank you.
Exercise for pelvic radiation fibrosis Dear OncoLink "Ask The Experts," One of the physiotherapists in our Agency has been asked to develop an exercise program for a lady who has radiation fibrosis in her abdominal & pelvis. She had her radiation treatments about 4-5 months ago. Thank you for any help you are able to provide. Lora Packel MS, PT, Coordinator of
Hereditary Nonpolyposis Colorectal Cancer Dear OncoLink "Ask The Experts," I was diagnosed with uterine & cervical cancer in 1997, at age 34. I was told that I needed a colonoscopy because this cancer is sometimes followed by colon cancer. Is this true? How often should I be screened? Also, my father (deceased at age 44) brother, sister and nephew have had colon cancer.
Considering genetic testing for colon and breast cancers Dear OncoLink "Ask The Experts," I am a 48 yr.old white female who was diagnosed with adenocarcinoma of the colon contained within a polyp. I have a strong family history. My father died of pancreatic cancer at the age of 79. My mother was diagnosed with breast cancer at the age of 46. She was cancer free until 1988 when she was
Risks and benefits of colonoscopy for elderly patients Dear OncoLink "Ask The Experts," I would like information concerning the risk/benefits of colonoscopy for elderly patients (>80 yrs). Does the risk of bowel perforation increase with the patient's age? When do the risks of the complications outweigh the benefits that might be derived? What if the patient is not in a high colon cancer
Diet and the prevention of colon cancer Dear OncoLink "Ask The Experts," What role does diet play in the prevention of colon cancer? Thanks. Katrina Claghorn, MS, RD, registered dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds: There has been a great deal of research on the impact of nutrition on colon cancer.
Frequency of colonoscopies with family history of colon cancer Dear OncoLink "Ask The Experts," My family has a history of colon cancer. I lost a younger brother to colon cancer when he was 48. I am 52. I had a colonoscopy at age 49 and no polyps were found. I have an older brother who had polyps at age 52 and a younger sister with polyps at 45. My grandfather on my father's side died of colon
Radiation Burns Dear OncoLink "Ask The Experts," My mom is 64 years old and was recently diagnosed with squamous cell carcinoma of the anus T2 tumor, 2cm. Treatment included 5FU and mitomycin along with external beam radiation begun 5 weeks ago. There is a difference of opinions between the doctors on the amount of grays (Gy) (radiation dose) required.
Looking for a surgeon to treat colon cancer Dear OncoLink "Ask The Experts," My mother has just been diagnosed with colon cancer. She has been referred to a surgeon. What credentials should we look for in determining if the surgeon has the appropriate training and skills to treat her? What questions should she ask the doctors? What answers to those Questions should she listen for?
Side effects of radiation to the colon Dear OncoLink "Ask The Experts," I had radiation therapy ending in December 2000 after a tumor was removed from my colon. Since then I have experienced irregular bowel movements, cramps, constipation & diarrhea. There is also a mucus discharge. My oncologists all agree that the problems are related to the radiation but do not give much other
Is it possible to miss a tumor during a colonoscopy exam? Dear OncoLink "Ask The Experts," Is it possible to miss a tumor during a colonoscopy exam if it is in the cecum? Where can a tumor be located if it can be felt through the wall of the lower colon but is not present during colon exam? Timothy C. Hoops, MD is a Clinical Assistant Professor of Medicine in the
What is Fecal Occult Blood Testing? Dear OncoLink "Ask The Experts," What is Fecal Occult Blood Testing? Carolyn Vachani, MSN, RN, AOCN, OncoLink's Clinical Trials Coordinator, responds: Fecal occult blood testing, also known as FOBT, is a test that can detect blood in the stool, even when it is not visible to the eye. This test involves placing a small amount
What is a Barium Enema? Dear OncoLink "Ask The Experts," What is a Barium Enema? Carolyn Vachani, MSN, RN, AOCN OncoLink's Clinical Trials Coordinator, responds: A barium enema uses barium sulfate, a radiopaque contrast that allows the bowel to be viewed with an x-ray. The test requires a bowel preparation the day before the procedure, which may
What is a Colonoscopy? Dear OncoLink "Ask The Experts," What is a Colonoscopy? Carolyn Vachani, MSN, RN, AOCN, OncoLink's Clinical Trials Coordinator, responds: A colonoscopy is a procedure that utilizes a colonoscope to examine the rectum and entire colon. The colonoscope is a long, slender, flexible tube that has a light and a camera, which
What is an Endoscopic Ultrasound? Dear OncoLink "Ask The Experts," What is an Endoscopic Ultrasound? Carolyn Vachani, MSN, RN, AOCN, OncoLink's Clinical Trials Coordinator, responds: Endoscopic ultrasound was first used in the early 1980's. It is essentially a scope (slender, flexible tube) that has an ultrasound on the end of it. Ultrasound technology uses
What is a Sigmoidoscopy? Dear OncoLink "Ask The Experts," What is a Sigmoidoscopy? Carolyn Vachani, MSN, RN, AOCN, OncoLink's Clinical Trials Coordinator, responds: A sigmoidoscopy is a procedure that utilizes a sigmoidoscope to examine the rectum and the first portion of the colon. It is important to note, this procedure does not evaluate the
Premature menopause and vaginal stenosis Dear OncoLink "Ask The Experts," I am a nurse treating a 36-year-old woman with stage 3 colorectal cancer who will be receiving concurrent radiation and chemo, and has been told she will be experiencing premature menopause and vaginal stenosis problems. I have information about vaginal dilation and sexuality issues, however, I am not having
Does aspirin use prevent the development of colon cancer? Dear OncoLink "Ask The Experts," Does aspirin use prevent the development of colon cancer? James D. Lewis, MD, MSCE, Assistant Professor of Medicine, Senior Scholar at the Center for Clinical Epidemiology and Biostatistics, and Senior Fellow in the Leonard Davis Institute of Health Economics at the University of Pennsylvania,
What is the risk of developing colon cancer in a person with Chron's disease? Dear OncoLink "Ask The Experts," What is the risk of developing colon cancer in a person with Chron's disease? James D. Lewis, MD, MSCE, Assistant Professor of Medicine, Senior Scholar at the Center for Clinical Epidemiology and Biostatistics, and Senior Fellow in the Leonard Davis Institute of Health Economics at the University
How can I prevent getting colon cancer? Dear OncoLink "Ask The Experts," How can I prevent getting colon cancer? James D. Lewis, MD, MSCE, Assistant Professor of Medicine, Senior Scholar at the Center for Clinical Epidemiology and Biostatistics, and Senior Fellow in the Leonard Davis Institute of Health Economics at the University of Pennsylvania, responds: The
What is my risk for other cancers after colon cancers? Dear OncoLink "Ask The Experts," What is my risk for other cancers after colon cancers? James D. Lewis, MD, MSCE, Assistant Professor of Medicine, Senior Scholar at the Center for Clinical Epidemiology and Biostatistics, and Senior Fellow in the Leonard Davis Institute of Health Economics at the University of Pennsylvania,
How long do I need to wait after surgery for radiation? Dear OncoLink "Ask The Experts," How long do I need to wait after surgery for radiation? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds: In general you wait until the surgeon says that healing is adequate to get radiation. this is generally 3
What is the best way to get 5-FU (fluorouracil) (by IV, continuous infusion, or pill)? Dear OncoLink "Ask The Experts," What is the best way to get 5-FU (fluorouracil) (by IV, continuous infusion, or pill)? Carolyn Vachani, MSN, RN, AOCN, OncoLink's Clinical Trials Coordinator, responds: This is a difficult question to answer, as the treatment should fit the patient's particular case. For example, an elderly
What are the Side Effects of Chemotherapy for Colon Cancer? Dear OncoLink "Ask The Experts," What are the Side Effects of Chemotherapy for Colon Cancer? Carolyn Vachani, MSN, RN, AOCN, OncoLink's Clinical Trials Coordinator, responds: Chemotherapy kills cells that divide rapidly. Unfortunately, this includes both good cells (hair follicles, mucosa of mouth and GI tract, red and white
Why do I need chemotherapy after my bowel resection? Dear OncoLink "Ask The Experts," Why do I need chemotherapy after my bowel resection? Carolyn Vachani, MSN, RN, AOCN, OncoLink's Clinical Trials Coordinator, responds: The answer to this question is dependent on the stage of the cancer. In stage II or III colon cancer, chemotherapy after surgery, also called adjuvant
Is impotence a side effect of radiation for colorectal cancer? Dear OncoLink "Ask The Experts," Is impotence a side effect of radiation for colorectal cancer? If so, how common and what is the usual time frame from completion of radiation until development of impotence? Is the impotence gradual or immediate? Thanks. Richard Whittington, MD, Associate Professor of Radiation Oncology at
Radiation after colon surgery Dear OncoLink "Ask The Experts," When is radiation used after colon surgery? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds: Cancer of the colon and rectum are actually the same tumor in different locations. When the surgeon takes out the
Radiation and chemotherapy at the same time Dear OncoLink "Ask The Experts," Why do I need to have radiation and chemotherapy at the same time? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds: Chemotherapy blocks many of the repair activities of tumor cells without having the same effect on
Radiation before surgery to "shrink the tumor" and avoid a colostomy Dear OncoLink "Ask The Experts," My doctor said I could have radiation before surgery to "shrink the tumor" and avoid a colostomy. Can you tell me more about this? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds: When surgeons operate they go
Rectal Bleeding and flat stools Dear OncoLink "Ask The Experts," Sometimes after a bowel movement, I notice blood on the tissue paper and a streak of blood along one side of the flat stool. I do plan on returning to see my doctor, but I still do not know the significance of this finding. Could someone please let me know? Carolyn Vachani, MSN, RN, AOCN ,
Are pets a concern during cancer treatment? Dear OncoLink "Ask The Experts," I was just diagnosed with colon cancer and I am about to begin chemotherapy. Will my "house pets" (cat) cause any problems during chemotherapy? Carolyn Vachani, MSN, RN, AOCN, OncoLink's Medical Correspondent, responds: The reason that pets may be a concern to patients undergoing chemotherapy
What are the standard colon cancer treatment options by stage? Dear OncoLink "Ask The Experts," What are the standard colon cancer treatment options by stage? Carolyn Vachani, MSN, RN, AOCN, OncoLink's Medical Correspondent, responds: Stage I Stage I colon cancer is a tumor that has begun to invade the wall of the colon. This tumor is removed surgically and requires no further treatment.
CEA as a screening tool Dear OncoLink "Ask The Experts," I have a question about the CEA (Carcinoembryonic Antigen) blood test. If this test is done to determine if cancer has returned in a patient, then why can't this test be done FIRST? I wonder if the CEA blood test could be used as a screening test to find colon cancer. Timothy C. Hoops, MD, Clinical Assistant
Survival after 5 years for colon cancer Dear OncoLink "Ask The Experts," Are there survival statistics available for review by the colon cancer patient beyond the "generic 5 year overview"? What are the age guidelines for my three sons to be screened? I had surgery for a B2 T3 tumor with no lymph node involvement after the routine sigmoscope exam given to 50 year old. Timothy C.
Colonic Enemas and Colon Cancer Dear OncoLink "Ask The Experts," I suffer from chronic constipation. My mother, who also has suffered from constipation, has recently been diagnosed with colon cancer. I have recently found that colonics help alleviate the symptoms, but I am unsure about how effective this therapy may be for prevention of colon cancer. Also, how often are
How villous adenoma relates to carcinoma Dear OncoLink "Ask The Experts," How are a villous adenoma and carcinoma thought to be related? Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine at Radnor, responds:It is accepted that most, if not all, colon
Can surgery spread cancer? Dear OncoLink "Ask The Experts," My husband was diagnosed with Stage III colon cancer-he has had chemo and radiation. He developed incisional hernias and is scheduled to have them repaired. I am paranoid about this surgery because someone told me that having surgery after you are diagnosed with cancer is a way for the cancer to spread -is this
Familial Adenomatous Polyposis (FAP) treatment Dear OncoLink "Ask The Experts," My 21-year-old son has been diagnosed with FAP. There is a strong family history from his father's side of the family. The doctor feels it would best to remove his entire colon and rectum which would involve a two-part surgery. This seems so uncertain involving the risk and not to mention the emotional fear. Please
Do you need a colostomy for colon cancer? Dear OncoLink "Ask The Experts," Do you always need a colostomy for colon cancer? What is the difference between a temporary and a permanent colostomy? Carolyn Vachani RN, MSN, AOCN, OncoLink's Medical Correspondent, responds:You do not always need a colostomy for the treatment of colon cancer. In fact this has become less and less common as
Risks of colon cancer after multiple polyp removals Dear OncoLink "Ask The Experts," I am in my mid 30's and have had numerous colonoscopies over the last 10 years with polyps removed each time. I am now going every 3 years to get checked. Am I still at risk to get colon cancer even though I have the polyps removed? Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the
Is it safe to do colonoscopies while on Coumadin? Dear OncoLink "Ask The Experts," My mother takes Coumadin and will be on it for the rest of her life. My question is: Is it too risky to perform a colonscopy? Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine at
Video Capsule Endoscope Dear OncoLink "Ask The Experts," I've got a fellow co-worker who has colon cancer and she's had a rough year and they've discovered that with the 1st surgery they didn't get it all. They've done scopes through her mouth and through her rectum and they say that there is a spot where the scopes can't see in the lower bowl and the doctors have
What are the risks of metastases to the brain with colon cancer? Dear OncoLink "Ask The Experts," My diagnosis is Stage III colon cancer. Lately I have been having severe headaches and have had no previous history of headaches. My question is whether or not there could be a connection. I have been told that the liver is the next target of colorectal cancer, but I'm wondering if colorectal cancer can
Detecting HNPCC Dear OncoLink "Ask The Experts," My family history involves non-polyp colon cancer: How is this type of cancer detected before it is too late if there are no polyps evident? My father had a "clean" colonoscopy 2 years prior to his diagnosis with terminal colon cancer (age 52). His father and 4 of his siblings along with their mother all died of
Hereditary Nonpolyposis Colorectal Cancer Surveillance Dear OncoLink "Ask The Experts," I was successfully treated at the age of 39, for uterine cancer. My father was successfully treated, at age 62 for non-polyps colon cancer. His mother was successfully treated for non-polyps colon cancer. Having had uterine cancer and coming from a family line of colorectal cancers, what are my risks of developing a
Frequency of colonoscopy after removal of cancerous polyp Dear OncoLink "Ask The Experts," I'm 54 years old and last October I had a routine colonoscopy and they found a medium size polyp and removed it. I was told the top part of the polyp contained cancer cells but not the stem so to be on the safe side my doctor recommended I have a sigmoid colon resection. Everything came out clean. I was told to
Is there an association between thyroid cancer and colon cancer? Dear OncoLink "Ask The Experts," I had thyroid cancer and have diverticulosis. What are my risks? Should I be tested more often? James D. Lewis, MD, MSCE, Assistant Professor of Medicine, Senior Scholar at the Center for Clinical Epidemiology and Biostatistics, and Senior Fellow in the Leonard Davis Institute of Health Economics at the
Relationship between HPV and rectal cancer Dear OncoLink "Ask The Experts," What can you tell me about the relationship between HPV and rectal cancer? Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine at Radnor, responds:HPV infection is more related to
Clinical presentations of colon cancers Dear OncoLink "Ask The Experts," I would like to know the differences, signs and symptoms, that patients present with left sided, right- sided and sigmoid cancers. Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine
Change in stool caliber Dear OncoLink "Ask The Experts," I'm a 57-year-old female. I was treated for breast cancer 9 years ago. For the past 9-12 months I've had a change in bowel habits in the form of narrow stool. (No other symptoms.) Six months ago my internist ordered a barium enema w/contrast--which came back clear. Narrow stools continue. Am I just a worrier,
Treatment options for a 95 year old with rectal cancer Dear OncoLink "Ask The Experts," My mother is a very youthful 95 year old who lives independently. She was diagnosed last week with rectal cancer, an adenocarcinoma within 6 inches of the anus. Surgery with the possibility of a colostomy is the option of choice by her surgeon. She indeed has atherosclerotic cardiovascular disease, and had a total
What is meant by "a change in bowel habits"? Dear OncoLink "Ask The Experts," Could you please better define what is meant by "a change in bowel habits"? For several months my husband has had an increase in the frequency of bowel movements He is 52, obese, sedentary, quit smoking a year ago, and has a family history of lung cancer. He is often fatigued but has not lost weight. He refuses to
Colon cancer screening for at risk children Dear OncoLink "Ask The Experts," My husband was diagnosed with colon cancer (stage 4) in 1998 at the age of 34 and had a total colectomy at the University of Pennsylvania. He had chemotherapy twice. He has been cancer free, even though he continues to find occasional polyps in his upper GI. We have three kids ages 15, 12, and 5. The 15 year
Transanal vs. abdominal surgery for rectal cancers Dear OncoLink "Ask The Experts," Is Transanal Endoscopic Microsurgery just as useful as the abdominal approach? I need to be sure that a cancerous polyp did not affect my blood vessels or lymph glands Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director
Rising CEA after colon cancer treatment Dear OncoLink "Ask The Experts," My mother had colorectal cancer 15 years ago. She had surgery, radiation and chemotherapy. She has been cancer free for the past 15 years. Her follow up has been to get her CEA levels checked every 6 months. After 15 years of these levels being at 1 or 1.5 they are now at 17 and climbing. My question is, is this a
End stage rectal cancer Dear OncoLink "Ask The Experts," I am a critical care nurse, with 17 years of nursing experience. My husband was diagnosed with recurrent rectal cancer 1 yr ago. He has undergone multiple Chemotherapy treatments, and due to growing tumors on lung, abdominal, and pelvic CT scans and the fact that his CEA is also rising. He may soon be starting
Young patient with colon cancer symptoms Dear OncoLink "Ask The Experts," I am 25 years old. I have tested positive for blood in my stool and my doctor has recommended that I have a colonoscopy. He told me that I definitely have small hemorrhoids. Would you consider me at risk for colon cancer? My symptoms have been stomach pain, extreme constipation and tiredness. Carolyn
Treatment for Stage IV Colon Cancer Dear OncoLink "Ask The Experts," My father was just recently diagnosed with Stage IV colon cancer. His oncologist has given him a good prognosis. He will start chemotherapy soon with 5-FU, Avastin and Oxaliplatin. He is very worried about this. How bad are the side effects? Do these drugs make you very sick? What can be done to lessen any negative
Colon Cancer Screening Methods for Young People with Family History Dear OncoLink "Ask The Experts," What is the most efficient and reliable method of screening, and is it possible for screening to be done too early in life for those with a history of colon cancer in the family?Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and
Immunochemical fecal occult blood test (iFOBT) Dear OncoLink "Ask The Experts," Is the immunochemical fecal occult blood test (iFOBT) currently being used for community-based colorectal screening that you know of? This test does not require the fasting needed with the gFOBT test and may be more attractive. Medicare currently covers the cost of the iFOBT but I wondered whether you had any
Correlation with uterine, colon and breast cancers Dear OncoLink "Ask The Experts," Is there any correlation with uterine, colon and breast cancers? My mother-in-law has had all three. She is currently anemic.Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine at Radnor,
Rising CEA after stage II colorectal cancer Dear OncoLink "Ask The Experts," I was diagnosed in July 2001 with Stage II colorectal cancer, at age 33. I underwent surgery, radiation & chemotherapy. I was running CEA's of 1.9, but the last blood work just came back at 3.6. I was just wondering if there are any other factors that can lead to an increase in my CEA level? Timothy C.
Stage IV colon cancer Dear OncoLink "Ask The Experts," My brother has been diagnosed with Stage IV Colorectal Cancer. The tumor is a Mucinous adenocarcinoma and has spread into his abdominal area. He is a 55 year old Caucasian non smoker who was fit and healthy. His cancer was diagnosed when he developed an intestinal blockage. My question is do you know if there are
Recurrence statistics for Stage III Colon Cancer Dear OncoLink "Ask The Experts," I am vast approaching my three year surgical resection anniversary. I was Stage III colon cancer with 1 out of 23 nodes tested positive (40 years old) Colon resection with all normal margins. (1 ½ inches of rectum removed 5-FU and Radiation. My health has been very good. All Scans clear for three years.
Radiation for T1 Cancerous Polyp of the Rectum Dear OncoLink "Ask The Experts," I am 25 years old and had a T1 cancerous polyp removed from my rectum in December. They are now recommending radiation therapy. I am wondering what the long-term effects of radiation therapy are and also whether or not it is really necessary.Richard Whittington, MD, Associate Professor of Radiation Oncology at the
Signet ring cell colon cancer Dear OncoLink "Ask The Experts," My mother was just diagnosed with signet ring cell colon cancer. She had a right colectomy. She has one lymph node involved. I'm wondering what her prognosis and treatment options are?Julia Draznin Maltzman, MD, Attending Physician at the University of Pennsylvania School of Medicine, responds: The most important
Magnification Colonoscopy Dear OncoLink "Ask The Experts," What can you tell me about magnification colonoscopy? Is it available in New York City, or some other center nearby?Carolyn Vachani RN, MSN, AOCN, OncoLink's Medical Correspondent, responds: Magnification colonoscopy uses fiberoptic technology to magnify the view of the colon to about 75 to 100 times its normal
Genetic testing for FAP Dear OncoLink "Ask The Experts," My family has familial adenomatous polyposis (FAP) on my mom's side. My mom has an ostomy & my brother had colon cancer 3 or 4 yrs ago. When he found out he had cancer, all of his siblings got a scope done. I had a colonoscopy done 2 yrs ago which came back normal, but my doctor wants to do genetic testing.
Anal Sphincter Preservation or Replacement after Rectal Cancer Dear OncoLink "Ask The Experts," My brother was operated on for rectal cancer and had the anal sphincter removed. I was wondering if you know if anyone does rectal and sphincter reconstruction? Thank you very much.Najjia N. Mahmoud, MD, Assistant Professor of Surgery at the Hospital of the University of Pennsylvania in the Division of Colon and
Retrograde Ejaculation Dear OncoLink "Ask The Experts," I am a survivor of colon cancer. I had a portion of my upper colon removed, went through chemotherapy, and now show no signs of cancer. For that I am extremely grateful, but I now am scheduled to reconnect my colon. I have a symptom from my first surgery called retrograde ejaculation, and am worried that I may
Nutrition for cancer patients after gastric bypass surgery Dear OncoLink "Ask The Experts," My friend has stage II ovarian cancer (OC) and is currently undergoing chemotherapy - 2nd treatment following debulking surgery. Prior to her diagnosis, she had stomach reduction surgery. She is having an exceptionally hard time with dehydration and low potassium levels after her chemo treatments. I am an OC
Symptoms After Colon Cancer Surgery Dear OncoLink "Ask The Experts," My father (65 years old) underwent a colon cancer surgery in December 2005. The proximal one-third of the colon (the cecum, ascending colon, and half of the transverse colon) was removed, and it was anatomized with the distal part of the small intestine. Although there was no lymph node involvement, he is
Cetuximab for Stage III Cancer Dear OncoLink "Ask The Experts," My father was diagnosed with stage III colon cancer earlier this month. He had surgery to remove the cancerous portion of the colon. He then consulted two doctors; one suggested using cetuximab in combination with the chemotherapy, and the other doctor ruled against it. The doctor who suggests using cetuximab felt
Rectal Mucus after Colostomy Dear OncoLink "Ask The Experts," I had surgery following the diagnosis of colon and bladder cancer in July last year. I now have a colostomy and an Indiana pouch. I had 8 cycles of chemotherapy. My last CEA was fine, and the oncologist is very pleased with me. However, I am still feeling that I need to sit on the toilet three or four times a day. I
Anal Sex After Treatment for Anal Cancer Dear OncoLink "Ask The Experts," I received chemotherapy and radiation for anal cancer in 2006. As a gay man, is it safe to resume anal intercourse? Najjia N. Mahmoud, MD, Assistant Professor of Surgery at the Hospital of the University of Pennsylvania in the Division of Colon and Rectal Surgery, responds: I don't see any reason why someone would
Anal Fissure Therapy Dear OncoLink "Ask The Experts," I am a hospice nurse working with an elderly patient who has excessive mucous from his stoma for over a year, and which causes erosion of the stoma seal. He has to change the seal several times a day. He is very active and is disgusted with this problem. He also has mucous from the rectum, which soils his pants. Is
Cancerous Polyp - Is Surgery Required? Dear OncoLink "Ask The Experts," I had my first colonoscopy last month at age 45. A malignant polyp was found and removed. I was told that I had a good chance it was contained to that polyp. However, because of my age and family history of colon cancer, I should have surgery, a colon resection, to make certain that there is no other malignancy
Flat Polyp Detection Dear OncoLink "Ask The Experts," Can you please comment on new techniques to identify flat growths on colon wall when under going colonoscopy screening procedure? Timothy C. Hoops, MD, Clinical Professor of Medicine and Director of GI, Penn Presbyterian Medical Center, responds:A recent article regarding flat polyps has raised a lot of interest
Deciding if Postoperative Therapy is Needed Dear OncoLink "Ask The Experts," Would you advise or think it necessary for any treatment following a colorectal resection for the following: adenocarcinoma, arising within a tubulovillous adenoma with high grade dysplasia, proximal and distal margins free of tumor, radial margin free of tumor, and 0 (zero) number of lymph nodes with metastatic
Gas After Bowel Surgery Dear OncoLink "Ask The Experts," I am almost 5 years from diagnosis and treatment for colon cancer. I am experiencing excessive gas emissions, some unable to be controlled. I do not eat salads or fruits but it seems no matter what is ingested it produces excess gas. I have tried beano and Gas-Ex with hardly any difference in symptoms. Any
Specialty Pharmacies Dear OncoLink "Ask The Experts," My doctor tells me that I should get my cancer medicine from a specialty pharmacy. What is that and what are the pros and cons of using a specialty pharmacy instead of my usual pharmacy?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:A specialty pharmacy has clinicians trained in certain disease
Esophageal Cancer Surgery Dear OncoLink "Ask the Experts," What are the options for esophageal cancer surgery? Thank you, M Kenneth Blank, MD, OncoLink Editorial Assistant, responds: Many surgical approaches exist for extirpation of esophageal cancer. The four most common are listed below, and differ in the location of the
Esophageal Cancer Dear Oncolink, My husband died 9 years ago of extensively metastatic esophageal cancer, which was found in a Barrett's Esophagus. He had a hiatal hernia, with many years of acid reflux. I'm very alarmed about our 12-year-old son, who has always burped easily and readily. Over the past 2 months, NOT RELATED to a full or semi-full
Gallbladder Cancer Treatment Options Dear OncoLink "Ask the Experts," My mother has just been told that she has gallbladder cancer and that the cancer also has spread to the liver. Her doctor tells her that she is incurable and he recommends no treatment other than pain treatment. She also has a gallstone and takes some type of analgesic to reduce her pain. She has no
Cholelithiasis and gall bladder cancer I recently had my gallbladder removed. The diagnosis was: "Cholecystitis" and "Cholelithiasi" I saw a reference to 'Cholelithiasis' and cancer. What is this? and is it related to/cause cancer? Maggie Hampshire RN, BSN, OCN, Managing Editor of OncoLink responds: The term cholecystitis refers to an inflammation of
Treatment Options for Metastatic Gastric Cancer I have a 33 year-old sister who has developed stage IV gastric cancer. The cancer was discovered last May 1999 and 85% of her stomach was cut out and 3/15 lymph nodes were positive. Recently, the cancer has come back outside of her stomach and has metastasized to her liver. Can you point me to any clinical trials? Li Liu,
Frozen Biopsy in the Diagnosis of Gastric Cancer Dear OncoLink "Ask the Experts," Is there a role for frozen section biopsy prior to definitive surgical resection in management of gastric cancer? Can the two procedures (frozen section and definitive resection) be done at the time of surgery or do they have to be done at different time intervals? Thank you, Dr. A.
Diagnosis of Gastric Cancer Dear Editors, My husband and I are stationed in England. We just recently received information from back home that my mother has been diagnosed with stomach cancer. We are in the dark being so far away from home. Could you help us find information about this disease and what complications may arise? If you could lead us in the right
Dumping Syndrome I am writing concerning my father who is 73 years old. He had a gastrectomy about 20 weeks ago. He had all of his stomach removed along with seven inches of his large intestine and his spleen was also removed. He had many complications after surgery. Since the surgery and his return home he has pain and abdominal cramps everyday. Attacks of
Is There a Correlation Between H. Pylori and Gastric Cancer? Dear OncoLink "Ask the Experts," My mother was diagnosed with positive H. pylori. I understand that there is a correlation with gastric cancer. Are there initial screening methods to detect the early stage of gastric cancer and how significant is this correlation? Thanks! Li Liu, MD, OncoLink Editorial
Eating disorders and cancer Dear OncoLink "Ask The Experts," I am recovering from Bulimia and Anorexia and am worried that I have caused damage to my throat. Is it possible to develop cancer from prolonged purging? Katrina Claghorn, MS, RD, Registered Dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds:You are to be commended for dealing
Blood Type A and Gastric Cancer Dear OncoLink "Ask The Experts," I have read that there may be an additional risk factor for gastric cancer for people with type A blood. If this is true, what if any preventive steps should be taken, and why is this true? Weijing Sun, MD, Assistant Professor of Medicine at the University of Pennsylvania, the Director of Upper GI and
Alcohol injections in the treatment of liver cancer Dear OncoLink "Ask the Experts," My mother is dying with advanced liver cancer. She is on chemotherapy. The pain and nausea are not presently a problem. they are under management. I was looking for treatment options. I have seen alcohol injected into liver tumors which had some effect on tumor growth. I have seem alcohol injection
Cholangiocarcinoma Dear OncoLink "Ask the Experts," I am trying to learn more about a diagnosis of cholangiocarcinoma. Can you suggest any readings or centers that might specialize in this area. Thank you S.P. Maggie Hampshire RN, BSN, OCN, Managing Editor of OncoLink replies: We are sorry that your first search was
The Etiology of Pancreatic Cancer Dear OncoLink "Ask the Experts," Hello. On Wednesday, I received the unfortunate news that my mother did indeed have a malignant tumor on her pancreas. The tumor has attached itself to the inferior vena cava and obviously cannot be removed. This is not the first time that I have experienced this in my family. Both of my mom's parents both
The Whipple Procedure Dear OncoLink "Ask the Experts," Please explain the Whipple operation and why resecting the head of the pancreas (pancreaticoduodenectomy) is often not technically feasible in pancreatic carcinoma patients. Thank you very much indeed. K.A. John Han-Chih Chang, MD and Kenneth Blank, MD, OncoLink Editorial
Intra-tumoral Colloidal Radioactive P32 Delivery Dear OncoLink "Ask the Experts," I understand there is a new treatment for pancreatic cancer, which involves injecting radioactive isotopes or pellets into the actual tumor with little or no side effects. Do you have any idea who may be treating the disease in this way? Thanks. BG Li Liu, MD Editorial Assistant
Heredity of Pancreatic Cancer Dear OncoLink "Ask the Experts," Is pancreatic cancer hereditary? What other risk factors are associated with pancreatic cancer? Thanks! Li Liu, MD, OncoLink Editorial Assistant, responds: Dear T, Thank you for your interest and question. It has been proven that pancreatic cancer is essentially
CA125 Cancer Antigen Test Dear OncoLink "Ask the Experts," My insurance company has denied payment for the CA125 cancer antigen test for my wife who died from pancreatic cancer. Her oncologist frequently used this test to provide an indicator of the effectiveness of the cancer treatment. My insurance company says that its value as a diagnostic tool for
Signet Ring Cell Cancer Dear OncoLink "Ask the Experts," My 72-year-old father is suffering from stomach cancer that has started to spread. It is a signet-ring cell cancer. The cancer was found incidentally, when he was undergoing surgery to remove a stricture in his duodenum. Unfortunately the disease is spreading rapidly. He will start with the chemo this
A Rise in CA19-9 Test Result Dear OncoLink "Ask the Experts," More than 4 years after an operation for gastric cancer my CA19-9 marker has gone up. Testing does not reveal any clue as to why this has happened. What is CA19-9 and why might this be happening? Thank you. JR Li Liu, MD, Editorial Assistant for OncoLink, responds: Dear
Appendiceal Tumors Dear OncoLink "Ask the Experts," Both my father and paternal grandmother have had "malignant neoplasm in the appendix." I have been told that "neoplasm" rarely starts at the appendix. Is this truly a rare cancer? M Li Liu, MD, OncoLink editorial assistant, responds: Dear M, Thank you for your interest and
Klatskin Tumor Dear OncoLink "Ask The Experts," What treatments are used for Klatskin tumors? Weijing Sun, MD, Assistant Professor of Medicine at the University of Pennsylvania, the Director of Upper GI and Pancreatic-biliary-hepatic Cancer Group and the Associate Director of the GI Cancer Program, responds: Klatskin tumors are a type of cholangiocarcinoma.
Therapy for Appendiceal Cancer Dear OncoLink "Ask The Experts," Weijing Sun, MD, Assistant Professor of Medicine at the University of Pennsylvania, the Director of Upper GI and Pancreatic-biliary-hepatic Cancer Group and the Associate Director of the GI Cancer Program, responds: There is no particular chemotherapy regimen for appendiceal cancers. In clinical practice, we
Is Hysterectomy for Cervical Cancer Necessary? Dear OncoLink "Ask the Experts," My sister has been diagnosed with cervical cancer and wasn't offered a hysterectomy. Every time we tell a doctor or nurse about this they seem to be shocked. Is there any reason a person with cervical cancer wouldn't be given a hysterectomy? Thank you. Christina S. Chu, MD, Assistant
Sexual Intercourse after a LEEP Procedure Dear OncoLink "Ask the Experts," I just had a LEEP procedure. My doctor said I should not have sexual intercourse for the next 3 weeks. Why is that? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds: A LEEP, or loop
Information on Carcinoma in Situ of the Cervix Dear OncoLink "Ask the Experts," I recently was diagnosed with Carcinoma in Situ of the cervix with both squamous and adeno cells. I never had an abnormal pap before this and have had pap smears every year. I have chosen to have a total hysterectomy. Am I at greater risk to develop other GYN cancers? I am worried about the virulence of
Side effects of radiation for cervical cancer Dear OncoLink "Ask The Experts," Could you give me any information on any possible negative outcomes using radiation to treat cervical cancer? Could scarring occur in the vagina? Where would I find information or statistics regarding a choice of radiation versus hysterectomy as treatment for this condition? Ruth Collins, MSN, CRNP, OCN,
Cervical Dysplasia Dear OncoLink "Ask the Experts," Hello, I have several questions about treatment of CIN 3. I have been treated for this three times in the past. Each time I had a biopsy and cryotherapy. I can not get my doctor to answer any of my questions. I hope you can help. I have three questions: I am wondering if my recurrences might be
Cervical Conization Dear OncoLink "Ask the Experts," What is cervical conization? How serious is it when the doctor recommends conization? How is conization performed? Why do the doctors do this? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
Signs and Symptoms of Cervical Cancer Dear OncoLink "Ask the Experts," What are the signs and symptoms of cervical cancer? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds: Patients with cervical cancer may experience a thin, watery vaginal discharge that can be
Is there a link between cervical dysplasia and HPV? Dear OncoLink "Ask the Experts," If a woman is diagnosed with cervical dysplasia, does that mean she also has a HPV (Human Papilloma virus) infection? Or are those two things separate from one another? Thank you for your time. D.H. John Han-Chih Chang, MD and Kenneth Blank, MD, OncoLink Editorial Assistants,
Colposcopy During Pregnancy Dear OncoLink "Ask the Experts," I have a question. I am 13 weeks pregnant, my nurse practitioner said I have abnormal cells from my pap. She has explained to me that I should get a colposcopy. Is this safe for me to have while I am pregnant? I have looked into the procedure and I am not feeling comfortable enough to want it done.
The Risks Of Colposcopy Dear OncoLink "Ask the Experts," I found your article on colposcopy very informative and interesting. I was concerned about the statements on injury and infection from the procedure. Could you please elaborate on the potential complications associated with a colposcopy and biopsy of the cervix. Before reading your article, I was
Cervical Cancer Dear OncoLink "Ask the Experts," My mother was diagnosed with advanced cervical cancer. She has had chemotherapy and radiation therapy. We were told that her prognosis is not good. Is there anything we can do to help her? Sincerely, EM Ivor Benjamin, MD, Former co-Editor-in-Chief of OncoLink, responds:
DES Exposure and Gynecologic Cancer Dear OncoLink "Ask the Experts," I found your information on cervical changes and treatment options for abnormal pap tests very informative. In 1996 I underwent a LEEP procedure for the treatment of mild dysplasia and squamous intra-epithelial lesions. The first PAP (3 months) after the procedure, was not entirely normal, and the test was
Pap Tests After Hysterectomy You may think me terribly stupid, although I'm not. I am just not informed. I have had two surgeries for what they called chocolate cysts in my ovaries. When I was 35 years old I had a complete hysterectomy, after a tumor was found in my uterus. My question is, do I still have a cervix? Is there a reason for a Pap smear? All things that I
PAP Smears After Age 65 If a woman is over the age of 65 and not sexually active, does she still need to continue to have regular Pap smear testing performed? Also, is there an actual age where Pap smear testing is no longer required? Ivor Benjamin, MD, Former co-Editor-in-Chief of OncoLink, responds: Most gynecologists would recommend an
Is Circumcision Related to Cervical Cancer Risk? Is a woman at a higher risk of developing cervical cancer if her spouse is uncircumcised vs. a spouse that is circumcised? Ivor Benjamin, MD, Former co-Editor-in-Chief of OncoLink, responds: Possibly. There is some medical evidence to support an increased risk for developing cervical cancer in women who have male
Timing of radiation after surgery for cervical cancer I would like to know the time gap required between radiotherapy and surgery regarding the management of a patient with cancer of the cervix. Thank you, Dr. S Ken Blank M.D., Editorial Assistant for OncoLink replies: The time interval between surgery and radiation is often at the discretion of the radiation
Risks of the LEEP procedure Dear OncoLink "Ask The Experts," I will be undergoing the LEEP procedure later this week, and was wondering what the risks are in this procedure, and how it could affect my chances of fertility later in life. Thanks in advance for your assistance. Christina S. Chu, MD, Assistant Professor of the Division of
Treatment for high-grade cervical dysplasia during pregnancy Dear OncoLink "Ask The Experts," I am 25 years old and I had a pap smear done this year but shortly after became pregnant. About six weeks later I received a call advising me that my pap smear was abnormal with severe dysplasia and a colposcopy was recommended. I was told by a midwife that due to my pregnancy she would not perform any
Hysterectomy to treat cervical dysplasia Dear OncoLink "Ask The Experts," I have been treated for dysplasia twice in 2 years. I had to have a cone biopsy and LEEP (loop electrocautery excision procedure). How many times should I be treated for dysplasia before a hysterectomy is an option. Christina S. Chu, MD, Assistant Professor of the Division of
Radical vulvectomy for Bartholin's gland cancer Dear OncoLink "Ask The Experts," I have just been diagnosed with Transitional cell cancer of the Bartholin's gland. It seems that my Oncologist's decision for a radical vulvectomy is the most effective procedure. Does radical mean both left + right side? Will there be a normal sex life with just an abnormal appearing or will I no longer
LEEP procedure and infertility Dear OncoLink "Ask The Experts," Is it true that LEEP can lead to infertility or make it more difficult to conceive? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds: One of the risks associated with the LEEP or loop
Monitoring adenocarcinoma in situ of the cervix Dear OncoLink "Ask The Experts," I was wondering what is generally considered to be the most effective way to follow-up and monitor adenocarcinoma in situ of the cervix after a cone biopsy with negative margins. My doctor is going to schedule me for quarterly Pap smears. I have read conflicting information that Pap smears are ineffective
Treatment options for low-grade squamous intraepithelial lesions of the cervix Dear OncoLink "Ask The Experts," I recently had a colposcopy, and had 4 biopsies taken from the four lesions found on my cervix. The results have come back as a low-grade abnormal type. I am being told to leave the lesions there, and be tested every six months. Isn't that a clue that I am a very high risk for these lesions to advance into
Link between cervical and ovarian cancers Dear OncoLink "Ask The Experts," Twenty-three years ago I had cervical cancer and a hysterectomy was done. Now I have been diagnosed with ovarian cancer. Is there a link between the two and is my ovarian cancer a secondary cancer. I have been on hormone replacement for the past 10 years. Stephen C. Rubin, MD, Professor and Chief
CIS "carcinoma in situ" and CIN Cervical Intraepithelial Neoplasia explained Dear OncoLink "Ask The Experts," I have just been diagnosed with carcinoma in situ. My gynecologist has Set up an appointment with a gynecological oncologist for tomorrow. They are telling me that it is stage CIN III. What does that mean? Does it mean my cancer is in stage III? Christina S. Chu, MD Assistant
LLETZ (Large Loop Excision of the Transformation Zone) for cervical cancer Dear OncoLink "Ask The Experts," I am a 24 year old with CIN III. My mum had cervical cancer 2 years ago when she was 48. I have been told that I need LLETZ (Large Loop Excision of the Transformation Zone) under general anesthetic. I understood that this was to be done under a local anesthetic and have not been able to find out why it is
Instructions after a colposcopy Dear OncoLink "Ask The Experts," I have just experienced a colposcopy procedure as I was found to have mild dysplasia. Is there any special information or precautions after the procedure? Thanks. Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania
Treatment for stage 1B cervical cancer Dear OncoLink "Ask The Experts," My wife has been diagnosed with cervical cancer stage IB. The pathology calls it adenosquamous carcinoma and poorly differentiated. A radical hysterectomy was performed. Twenty-three lymph nodes were removed and are free of cancer. The tumor depth was 0.6cm. The lower uterus was involved as well as the
Will cervical displaysia lead to cancer or infertility? Dear OncoLink "Ask The Experts," I have severe cervical dysplasia. How likely is the chance of cancer? Will this affect my chance of having children if properly treated? Thank you. Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
Pre-colposcopy instructions Dear OncoLink "Ask The Experts," I was wondering if there were precautions I should take before my colposcopy? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds: While instructions before colposcopy may vary, in general, you
Risk factors for cervical cancer Dear OncoLink "Ask The Experts," I have been diagnosed with cervical cancer. Two conflicting opinions have brought me to you. Is it true that the only way to get cervical cancer is through a sexually transmitted disease? Are there are other risk factors? I am a smoker, and I am sure that is a much bigger risk for me than catching an STD.
Stage IB1 cervical cancer Dear OncoLink "Ask The Experts," My sister has been diagnosed with Stage Ib1 cervical cancer. She has had her second cone biopsy performed about a week ago and the tumor has been removed. The Oncologist was not happy with margins so has suggested a radical hysterectomy with pelvic lymph node dissection, in case the cancer has spread.
Pap smears on patients who are not sexually active Dear OncoLink "Ask The Experts," I work with developmentally disabled individuals. Several local doctors see no need in doing Pap tests on our ladies since they aren't sexually active and some would have to be anesthetized to do the procedure. What is your opinion? Christina S. Chu, MD, Assistant Professor of the Division of
Risks and reasons for repeat colposcopy and cone biopsy Dear OncoLink "Ask The Experts," I have had an abnormal Pap smear, a colposcopy and a cone biopsy. The cone biopsy showed CIN III. I understand from my doctor that the biopsy did not remove all of the cells. I am currently awaiting repeat colposcopy. What will this show, if anything, and what may they do if all the abnormal area was not
Repeat Pap after Atypical squamous cells Dear OncoLink "Ask The Experts," My pap results came back as "A Typical" Squamous cells and my doctor said to return in 3 months for a repeat pap. Is 3 months typical to re-test for this type of result? Thanks. Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania
Treatment options for carcinoma in situ of the cervix Dear OncoLink "Ask The Experts," Last July I had a cone biopsy done for diagnosis and treatment of carcinoma in situ--I was told after surgery that my margins were clear. In January of this year my gyn resumed pap testing again. The results were ASCUS. He repeated the pap again in March and the results were ASCUS again. I've now been
Multiple sexual partners as a risk factor for cervical cancer Dear OncoLink "Ask The Experts," I've read that "many different partners" may be a contributing factor of cervical cancer. Why this is so? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds: In the past, having many different sexual
LEEP while pregnant Dear OncoLink "Ask The Experts," Is it safe to have a colposcopy or a LEEP (loop electrocautery excision procedure) while I am pregnant? Christina S. Chu, MD Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System. Colposcopy is a procedure that involves a close
ASCUS follow up Dear OncoLink "Ask The Experts," My doctor has performed three Colposcopies in the past three years and now wants to do a fourth. I feel this is excessive I have never had pre-cancerous cells or dysplasia. The Paps show inflammation and ASCUS. I feel that I should have more frequent Paps as opposed to yet another colposcopy. Any
Recurrence of cervical dysplasia (CIN) after treatment by LEEP Dear OncoLink "Ask The Experts," My regular GYN just called me to tell me that my repeat Pap 1 year post LEEP was back to CIN 1. What is the incidence of recurrence (my initial abnormals were CIN 1-2) and what would you recommend next? Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology,
Non-diagnostic results of endocervical curettage (ECC) Dear OncoLink "Ask The Experts," I recently had a colposcopy for a CIN abnormal pap. I was told I had 3 suspicious lesions. An endocervical curettage (ECC) was also done. The biopsy report states the (ECC) was "non-diagnostic" as well as one biopsy. What exactly does "non-diagnostic" mean? My family physician did this procedure. He recommended
Cervical cancer treatment while pregnant Dear OncoLink "Ask The Experts," I am 6 months pregnant and was told that I have cervical cancer. I go back to the oncologist in a month to have another colposcopy done, to see what grade the cancer is. I need to know what I should and shouldn't do everyday activities while I'm still pregnant? Christina S. Chu, MD, Assistant Professor of the
Are all cervical dysplasias associated with HPV? Dear OncoLink "Ask The Experts," If you are told that you have Mild Cervical Dysplasia do you have HPV? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:Most, but not all dysplasia lesions of the cervix are associated with an HPV infection. A biopsy or
Breast and Cervical cancer screening for teens Dear OncoLink "Ask The Experts," Is there a certain age that you should be worrying about breast cancer and cervical cancer or should I be worrying about it as a teenager too? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:While teenagers are at low
Is cervical cancer hereditary? Dear OncoLink "Ask The Experts," I have a question. My mother recently died from cervical cancer. I'm I at a higher risk of having cervical cancer because she had it? Can it be inherited? Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania Health System, responds:There is no evidence
Risk of other cancers after cervical cancer Dear OncoLink "Ask The Experts," Is there an increased risk for other types of cancer after a diagnosis of invasive cervical cancer, and if so what types of cancer? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:At this point, we do not know of any
Small cell cervical cancer Dear OncoLink "Ask The Experts," I was diagnosed with small cell cervical cancer. I underwent chemotherapy, a radical hysterectomy, and radiation. I have CT scans of the chest, abdomen, and pelvis every three months - is this enough? What is the chance of recurrence with small cell cervical cancer if the patient has had a
Lymphedema after cervical cancer treatment Dear OncoLink "Ask The Experts," I was diagnosed with cervical cancer in February 1998 and subsequently underwent a radical hysterectomy followed by cautionary radiation therapy. I now live with Lymphedema. I currently use a mechanical pump sleeve device; but it offers very little relief and I am still extremely limited in my mobility. Any
Sedation during a LEEP procedure Dear OncoLink "Ask The Experts," Is 1-2 months too long to wait for a LEEP procedure? Also, is there any sedation given during the procedure? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:Waiting 1-2 months for your LEEP (Loop Electrosurgical Excision
Causes for an abnormal Pap smear Dear OncoLink "Ask The Experts," Could my abnormal Pap smear result be due to having intercourse within 48 hours of my exam? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:While I cannot comment on the cause of your abnormal pap test without knowing
Inflammation on your Pap smear Dear OncoLink "Ask The Experts," Could you tell me what it means if you are told your Pap smear had benign cellular changes/inflammation? I was put on Flagyl for 7 days, and told to have another smear in 3 months. Is this common and is it serious? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the
Pros and Cons of Laser, cryotherapy, LEEP or cone biopsy Dear OncoLink "Ask The Experts," I am 30 years old. My post-pregnancy pap smear shows moderate-severe dysplasia. A month later I had a biopsy which confirmed this. I have been told that I will be treated with cryotherapy. My questions/concerns are: Did pregnancy hormones accelerate the growth of these abnormal cells? I hope to get
Pregnancy after LLETZ procedure Dear OncoLink "Ask The Experts," Assuming that the LLETZ procedure removes my dysplasia, and a normal pap result achieved. Is there a recommended time following a LLETZ procedure before, we should try to get pregnant. Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania Health System,
LEEP vs. Hysterectomy Dear OncoLink "Ask The Experts," I am 40 years old and have pre-cancerous lesions of the cervix. I will not be having any more children and would like to know if a hysterectomy would be a better way to go than the LEEP procedure? I would like to live without the fear that the pre-cancerous lesions could come back and could turn into cancer. Your
Does a combination of HPV and birth control increase your chance of cervical cancer? Dear OncoLink "Ask The Experts," I was diagnosed with HPV. I have read several studies showing that having HPV increases your chances of cervical cancer. Recently, I read that being on birth control and having HPV will increase your chances by 60%. My question is should I stop taking birth control due to the fact of having HPV? Or is the
Radiation after radical hysterectomy for cervical cancer Dear OncoLink "Ask The Experts," After undergoing a radical hysterectomy with the removal of lymph nodes and ligaments for cervical cancer with no evidence of spread, I am now faced with the possibility of 6 weeks of radiation therapy. This therapy has been recommended because of the position of the tumor (3 mm from the cervical wall). I am
Vaginal dysplasia after cervical dysplasia Dear OncoLink "Ask The Experts," I had a total hysterectomy in 1999 for persistent CIN III, despite 2 LEEPs. The post-op cervical biopsy failed to reveal "clear borders." My subsequent vaginal biopsies have all returned with "inflammatory changes" until last month, when it showed vaginal dysplasia. What treatment is advised for this?
Physician qualifications Dear OncoLink "Ask The Experts," My cervical biopsy results indicated that high-grade pre cancer cells were present and I am scheduled for surgery in a month. I was told that a gynecological oncologist would have a better success rate that the ob/gyn would. Is this true and if so, how would I go about having the gyn/oncologist do the procedure
Treatment options for high-grade cervical intraepithelial neoplasia Dear OncoLink "Ask The Experts," I had an abnormal pap with high-grade intraepithelial lesion and moderate dysplasia and was recommended a LEEP procedure but I would prefer a partial hysterectomy. What do you think would be better? I just don't want any recurrences. I am done having children. Christina S. Chu, MD, Assistant Professor of the
Pelvic exenteration Dear OncoLink "Ask The Experts," I was treated for cervical cancer a year ago with a radical hysterectomy. Six months went by and I had a recurrence and underwent radiation along with cisplatin chemotherapy. This treatment did not rid me of all the cancer and I am now facing a pelvic exenteration. I can't find much information about this surgery.
Is squamous cancer of the cervix hereditary? Dear OncoLink "Ask The Experts," I am a cervical cancer survivor. I am very concerned about my 14-year-old daughter contracting this horrible disease when she gets older. I have been told that it is not hereditary, but I am having serious difficulty believing this. My grandmother, mother, aunt and myself all contracted this disease at 32 years of
High grade squamous intraepithelial lesion of the cervix Dear OncoLink "Ask The Experts," I have just learned that I have a high grade cell change, following a Pap test. I am going for a colposcopy in a few weeks. Does this mean that I have cancer? How can they tell if it is not in the uterus too? Will a colposcopy be able to rule out uterine and ovarian cancer as well as cervical cancer? Christina
Vaginal discharge and pain after a pelvic exenteration Dear OncoLink "Ask The Experts," I had recurrent cervical cancer and a pelvic exenteration 1 1/2yrs ago. I have continued to have a foul smelling vaginal drainage and bleeding. I am now occasionally bleeding rectally. I did not have colostomy, only urostomy and have also had blood in my urine. CT scan and IVP show no problems. I am also having a
Adenocarcinoma of the Cervix Dear OncoLink "Ask The Experts," Through an irregular Pap smear, my daughter was diagnosed with adenocarcinoma. We can't locate much information on this type of cancer. Can you help? This tumor is supposedly very rare but how treatable? Where does it originate and what are chances of spreading to other areas? Christina S. Chu, MD, Assistant
Abnormal PAP smears and observation Dear OncoLink "Ask The Experts," I have had abnormal pap smears for 4 years now. I have had colposcopies and biopsies several times - however these show up little or no abnormalities, until recently when a minor abnormality was visible. My gynecologist advises that he 'keep an eye' on me - however I feel that I am going around in circles with no
HPV Reinfection Dear OncoLink "Ask The Experts," I was recently diagnosed with stage IB1 adenocarcinoma of the cervix. I received treatment and everything is clean. I am very frustrated that there are no tests to see if my husband still has HPV, as well as information stating that condoms may not be effective in preventing transmission. Can I be reinfected with
Treatment for Adenocarcinoma of the Cervix Dear OncoLink "Ask The Experts," Please tell me why hysterectomy is not usually performed and not recommended as initial treatment of adenocarcinoma of the cervix, Stage IIA or higher?Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania Health System, responds:The treatment of early stage
Lymphedema and Leg Weakness Dear OncoLink "Ask The Experts," I had cervical cancer in 1996 resulting in a radical hysterectomy and radiation treatment. The lymph nodes were also removed. I am experiencing weakness in one leg that will give out without warning or pain. Can lymphedema cause this weakness? I do have slight swelling but keep it at bay with exercise. Should I
Muscle Loss after Radiation for Cervical Cancer Dear OncoLink "Ask The Experts," I was treated for cervical cancer 18 months ago. During the treatments, I lost a good deal of muscle on the top of my thigh, in the back. I have been trying through exercise to rebuild it, but am not having much success. Is it possible for muscle to regenerate after treatments? If so, I would appreciate any help you
Calcifications of the Cervix Dear OncoLink "Ask The Experts," I had a vaginal ultrasound for heavy bleeding and they found calcifications on my cervix. What are these and what should I expect? Thank you. Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:Most causes of calcifications of
CIN I Dear OncoLink "Ask The Experts," I am 23 years old, and I went for the first time to get a Pap smear. It showed that I had CIN1, so a month later I went to another doctor and they performed another Pap smear. Their results were the same. So my question is: what would be the best inexpensive treatment you can recommend? Christina S. Chu, MD,
HPV (human papilloma virus) Infection and Dysplasia Dear OncoLink "Ask The Experts," I was recently told by my gynecologist that I have HPV, and that the HPV has caused me to develop moderate dysplasia of the cervix. I recently had a colposcopy performed and a LEEP procedure. I just have a few questions about HPV. 1) I have been told that HPV cannot be cured, yet I have read on numerous
Sex during Cervical Cancer Treatment Dear OncoLink "Ask The Experts," Is it safe to have sex while on treatment for cervical cancer? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:If you have completed treatment for cervical cancer, it is usually safe to have intercourse. Patients who have
Pregnancy after LEEP Procedure Dear OncoLink "Ask The Experts," Two years ago, I had a LEEP procedure for cervical intraepithelial neoplasia II (CIN II). All of my Pap smears have been normal since, until a recent Pap showed CIN I, which was biopsy-confirmed. I am thinking about becoming pregnant. Should I wait? I've heard that hormone changes can cause rapid progression of the
Sarcoma of the Cervix Dear OncoLink "Ask The Experts," I am 19 years-old and been diagnosed with alveolar soft part sarcoma of the cervix. They tell me I need to have my uterus removed, but recently they said if it has spread and that they might not be able to operate. How rare is my cancer? Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic
Abnormal Pap With Negative HPV Dear OncoLink "Ask The Experts," My recent pap results said I have precancerous lesions with mild dysplasia. I have read that HPV causes low-grade squamous intraepithelial lesions in 85% of cases. My test came back negative for HPV, so what else could have caused this? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic
Vaginal Reconstruction Years After Pelvic Exenteration Dear OncoLink "Ask The Experts," In 1993, I had a pelvic exenteration because of due to side effects from radiation for cervical cancer. My question is "Why didn't they do a vaginal reconstruction at the time of my surgery, and is it safe for me to have this surgery now, considering the amount of time passed, and the radiation that I had at
Vaginal Dysplasia Dear OncoLink "Ask The Experts," I had a total hysterectomy several years ago. I recently had a Pap smear that returned with HGSIL, yet I do not have a cervix. All of the information I find on the web discusses treatment modalities for cervical HGSIL, but not if located in the vaginal vault. Can you tell me what I can possibly expect for further
Bcl-2 Gene Expression Dear OncoLink "Ask The Experts," My wife, age 22, was diagnosed with stage IIIA clear cell adenocarcinoma of the cervix. Is it true that if Bcl-2 staining is found in the tumor, then that would make it more resistant to conventional treatments? Are there any approved therapies for such resistant tumors (i.e. targeting Bcl-2)? Christina S. Chu, MD,
Abnormal Pap test after Chemotherapy or Radiation Dear OncoLink "Ask The Experts," I read that chemotherapy can cause a Pap smear to be abnormal. How long should I wait to get a Pap after my last chemotherapy treatment for breast cancer (AC-T)? Could radiation have an affect also? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania
HPV Transmission to a Surrogate Dear OncoLink "Ask The Experts," I am a surrogate mother, and the woman in the couple I am dealing with has cervical cancer. She still has her ovaries and can produce eggs. Is there any chance by putting her egg in my body that I can get cancer? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of
HPV in Men Dear OncoLink "Ask The Experts," I recently entered into a relationship with a woman; we have not had intercourse yet. She told me that she has Human Papilloma Virus (HPV). I have heard of it, but never researched it. I would like as much information about it as I can get. I understand that I can contract it and there is no cure. Christina S. Chu,
Clearing HPV Virus Dear OncoLink "Ask The Experts," I read an article on HPV. It states," 80 percent of HPV is cleared by the immune system." Does this mean the body completely gets rid of the virus? I thought when you had a virus you had it for life. Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of
VIN vs. HPV Dear OncoLink "Ask The Experts," My 20 year-old daughter was just diagnosed with VIN 2 Differentiated Type and the pathology supports a high-risk HPV infection. It sounds like this is the rare differentiated/simplex VIN, which wasn't caused by the HPV right? Have you seen anyone her age with this, because I can't find anyone even close (others
Pregnancy after Cervical Conizations Dear OncoLink "Ask The Experts," I am pregnant with my first child, (15 weeks) but have had 2 cervical biopsies in the past. I had a LLETZ (large loop excision of the transformation zone) biopsy 10 years ago for Cervical Intraepithelial Neoplasia (CIN2), and a NETZ (needle excision of the transformation zone) biopsy 5 years ago for CIN1. Have been
Monitoring after Colposcopy Dear OncoLink "Ask The Experts," I had a hysterectomy after fibroids ten years ago but had also had colposcopy, biopsies etc for positive pap smears. My paps were negative until 6 months ago, when I had a colposcopy after a positive pap smear. Now I am having paps done every 3 months, and he wants to do another colposcopy in 6 months. This time he
Abnormal Pap After Cone Biopsy Dear OncoLink "Ask The Experts," I was diagnosed with CIN-3 after a cold cone knife biopsy for an abnormal Pap smear. I have heard that Pap smears after cone biopsy can be inaccurate and asked my physician to also test for HPV. Does this sound like a good idea? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the
Adenocarcinoma in Situ of the Cervix Dear OncoLink "Ask The Experts," My sister recently had a cold conization of the cervix after colposcopy. The pathology report results are adenocarcinoma in situ from 3 to 6 pm, 6 to 9 pm and 9 to 12. It says the margins are less than 1 mm. The endocervix had one fragment of adenocarcinoma in situ. She tells me the plan is a hysterectomy in 6
CIN 2/3 in Young Women Dear OncoLink "Ask The Experts," I am 23 years old and I recenty had my first abnormal pap smear. The cytology showed HSIL and I had a colposcopy done which showed CIN 2 in a background of CIN 1 with no endocervical involvement. I have received conflicting opinions regarding whether a LEEP is necessary or whether given my age I can wait and have
Is Hycamtin Viable Treatment for Endometrial Cancer? Dear OncoLink "Ask the Experts," I have read the article on Hycamtin as a treatment of ovarian cancer. Can you tell me whether or not it would also be a viable treatment for Endometrial Carcinoma? Sincerely, B. M. John Han-Chih Chang, MD, Editorial Assistant for OncoLink responds: Dear BM, Thank you for
Uterine cancer risk factors Dear OncoLink "Ask The Experts," I have a patient who has developed uterine cancer in her 40's, and there is no known family history. Do you know of any association between asbestos exposure and an increased risk for uterine cancer? I have been searching the literature and have not found anything, but I don't want to overlook anything
Estrogen use for early stage endometrial cancer patients Dear OncoLink "Ask The Experts," A recent study showed that ERT does not increase endomentrial cancer recurrence. Based on this info, my gynecological oncologist recommends estrogen, to relieve my menopausal symptoms and yet my local oncologist and primary care provider recommend an aromatase inhibitor. I am 40 years old and recently had
Management of stage IB uterine cancer Dear OncoLink "Ask The Experts," I am a 49-year-old premenopausal woman who recently had a total hysterectomy with removal of ovaries and tubes because of a diagnosis of Atypical Hyperplasia with significant bleeding. I have not experienced any signs of sudden menopause as yet. I was just informed that the pathology report from surgery found
Endometrial stromal sarcoma (low grade) Dear OncoLink "Ask The Experts," What is Endometrial stromal sarcoma (low grade)? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds: Endometrial stromal sarcomas are a rare type of uterine cancer. The normal endometrial lining of the
Is there a link between endometriosis and endometrial cancer? Dear OncoLink "Ask The Experts," My 68-year-old mother has Stage 2 endometrial cancer. She previously suffered from severe endometriosis, requiring extensive surgery. Could you please advise me of any links between endometriosis and endometrial cancer? My sister and I both have endometriosis. Thank you. Stephen C. Rubin, MD,
Endometrial stromal sarcoma Dear OncoLink "Ask The Experts," My 29-year-old wife was recently diagnosed with Endometrial Stromal Sarcoma, Stage IIIb. She's undergone TAH/BSO, was found to be ER/PR positive, and is currently taking Megace 160mg q d. The final grade was determined to be LOW. I can find very little in the literature about ESS and premenopausal patients.
Treatment for Stage IV uterine sarcoma Dear OncoLink "Ask The Experts," I am recently diagnosed with stage IV uterine sarcoma. I did not respond to my first chemotherapy with Adrimyacin and Cisplatin. Are there other drugs to treat me? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:This
Pelvic Washings Dear OncoLink "Ask The Experts," A very good friend and co-worker has just been diagnosed with Endometrial Cancer. She underwent a complete hysterectomy 2 weeks ago. At that time the doctor told us that everything looked "good", but that we had to wait for the pathology reports. Early reports showed no cancer, nothing in lympnodes, but now
Nutritional tips for radiation induced esophagitis Dear OncoLink "Ask The Experts," After radiation treatment of 2 weeks, my throat is so sore that even with painkillers, I cannot get food down. Now I have the added complication of nausea and vomiting. The medicine given for the nausea is sporadic in its affect. Can you suggest anything that I can drink or eat? Ellen Sweeney, RD,
Abnormal cells present in the uterine lining Dear OncoLink "Ask The Experts," If I have abnormal cells present in my uterine lining, do I need to be concerned for my partner to be exposed or can he contract anything during intercourse? I am going for a second opinion by recommendation of my GYN physician, so I haven't been diagnosed with cancer as of yet. Christina S. Chu, MD, Assistant
Surgical Options for Endometrial Cancer Dear OncoLink "Ask The Experts," I am 31 years old. I went to the doctor because I had a positive pregnancy test, but I was not pregnant. My doctor did an endometrial biopsy and those results showed I had hyperplasia. I had a hysterectomy. I was diagnosed with endometrial cancer. When he did the hysterectomy he just removed the endometrial. Now
Endometrial Cancer Staging and Surgery Dear OncoLink "Ask The Experts," My sister has just been diagnosed with stage I endometrial cancer. She is wondering that if she put off surgery for a month, would her cancer worsen dramatically? Is there a way to generally estimate the time between stage I to the next stage? Does endometrial cancer advance quickly? Thanks for any information you
Questions about Endometrial Adenocarcinoma Dear OncoLink "Ask The Experts," I would like to ask three questions if I might: Is it unusual for post surgical CA125 to elevate after cancer surgery? My sister's CA125 was 33 preop and 60 three-days post op. Her diagnosis is: Endometrial Adenocarcinoma, Endometroid Type, plus focal squamous metaplasia arising in a focus of endometriosis,
Treatment options for complex atypical hyperplasia of the endometrium Dear OncoLink "Ask The Experts," I was first diagnosed with complex hyperplasia with atypical hyperplasia in the endometrium in June 2000. I was given Provera 30mg for 3 months. The biopsy results remained the same so I was subsequently given 100mg for another 3 months. Almost immediately at the end of the course, I managed to conceive without
Endometrioid adenocarcinoma 30 years after a hysterectomy Dear OncoLink "Ask The Experts," My mother is 81 years old. She had total abdominal hysterectomy and bilateral salpingio-oopherectomy in 1973. Last month she was diagnosed with endometroid adenocarcinoma. The lymph nodes were positive 3 out of 5. If she had the hysterectomy 30 years ago how did the endometroid cancer develop? Could it have
Survival rates for endometrial cancer Dear OncoLink "Ask The Experts," My sister-in law was just diagnosed with endometrial cancer. She is having a CT, MRI, colonoscopy, hysterectomy and staging this week. The current rate of survival for stages 1-4 are not clear. I would just like an honest answer so that I can plan the direction of support for my family once she is staged. Thank
Metastatic Endometrial Cancer Dear OncoLink "Ask The Experts," My mother was diagnosed with Endometrial Cancer in 1993. She underwent surgery and went in remission. In 1998, they discovered that it had metastasized to her lungs and she was treated by chemotherapy. After chemo, she developed diabetes, and CHF. She was in remission until November 2003. A CT Scan then showed
Chemotherapy after Whole Abdominal Radiation for Endometrial Cancer Dear OncoLink "Ask The Experts," My partner has endometrial cancer - stage IIIA. She had a radical hysterectomy and has now completed whole abdominal and pelvic radiation. She is scheduled to have 3 rounds of brachytherapy starting next week. My question is that her radiation oncologist has suggested chemotherapy also. I know this is more
Atypical Hyperplasia Dear OncoLink "Ask The Experts," I had a partial laparoscopic hysterectomy in November 2006 (only my uterus was removed). After the surgery was done, it was discovered that I had complex atypical hyperplasia. I have since heard that a total abdominal hysterectomy is usually preferred in this case to ensure that none of the endometrial cells are
Just Diagnosed Endometrial Cancer Dear OncoLink "Ask The Experts," I've just found out from a biopsy that I have endometrial cancer, Grade 1. My gynecology doctor says the 1st thing that has to happen is a hysterectomy? Shouldn't I get a C T Scan first? Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania Health System,
Tamoxifen After Endometrial Cancer Dear OncoLink "Ask The Experts," Given the risk of endometrial cancer with tamoxifen use, is the drug contraindicated for women who have previously had endometrial cancer, but now face breast cancer? I was treated with TAH/BSO for stage IB endometrial cancer 7 months ago, and now face the decision of tamoxifen for a new breast cancer diagnosis.
Lymph Node Dissection at Time of Surgery? Dear OncoLink "Ask The Experts," I have a diagnosis of endometrial cancer based on biopsy. Robotic surgery is scheduled in 2 weeks. My question is related to whether or not it is wise to plan ahead and allow lymph node biopsy (removal of 10 - 20 nodes) at time of surgery or wait until uterus is dissected to determine spread. Should lymph node
Low Dose Chemotherapy with External Radiation Dear OncoLink "Ask The Experts," I recently received surgery to remove a 6” tumor, which appeared 3 years after surgery for a stage 1 endometrial cancer. Following this surgery, I received 3 chemotherapy treatments using taxol and carboplatin. I am now preparing to undergo external radiation, and my radiologist is recommending that I do a
Risk of Lymphedema with TAH/BSO & Lymphadenectomy Dear OncoLink "Ask The Experts," What is the risk of lymphedema following a complete lymphadenectomy accompanying TAH BSO? How well documented, prospectively, is the occurrence of lymphedema in this patient population? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System,
Risk of Secondary Cancers Dear OncoLink "Ask The Experts," What percent of heavily treated endometrial cancer patients (radiation and chemotherapy with carboplatin and taxotere) experience secondary cancers? At what sites? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds: Secondary
Abnormal Pap After Hysterectomy Dear OncoLink "Ask The Experts," My mother was diagnosed with endometrial cancer 2 years ago. She had a complete hysterectomy, followed with radiation. Her first Pap smears following this were normal. However, recently, she got an abnormal Pap back. The letter from the doc's office says it was probably due to radiation and another Pap will be done
Symptoms of Ovarian Cancer Dear OncoLink "Ask the Experts," What are the signs of ovarian cancer? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds: Patients with ovarian cancer often do not have symptoms until late in the disease process. Symptoms are
Consolidation Therapy for Ovarian Cancer Dear OncoLink "Ask The Experts," I have Stage IIIC ovarian cancer, had optimal debulking and then 9 rounds of IV/IP carbo/Taxol, the first three of which were all IV due to port problems. The oncologist is asking me to consider 24 weekly IV treatments of Taxol, which is said to have few side effects and may increase the disease-free interval. What
Clinical Trials for Ovarian Cancer Dear OncoLink "Ask the Experts," Do you have any information as to how I can be involved in the latest trials for ovarian cancer? My mother died 2 years ago with the disease and would therefore like to refer myself onto a screening program. Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology
Occurrence and Recommended Treatment of Lymphedema Dear OncoLink "Ask the Experts," I had a total abdominal hysterectomy, bilateral salpingioopherectomy, pelvic and peri-aotic lymph node dissection last year for left low malignant potential ovarian tumor. About 3 months after surgery I realized my left calf and ankle were enlarged. Ultrasound was negative for blood clot. My surgeon says
Oopherectomy I have recently tested positive for BRCA1 gene. My mother died of ovarian cancer 13 years ago at age 57. Although I am healthy, preventive oopherectomy has been advised. I am 49 yo, and perimenopausal. I have had regular CA 125 and ultrasound exams, all normal. Should I seek a second opinion? Stephen C. Rubin, MD, Professor
Elevated CA125 Level and Tamoxifen I am a 48-year-old ovarian cancer survivor. It is my fifth year of no recurrences. I have been having elevated CA 125 results. All diagnostic imaging comes back negative. My doctor wants me to start taking Tamoxifen, to lower the CA 125. I am worried that it is too risky and has too many side effects. Please help me. I am feeling to good to
What is CA125 Dear OncoLink "Ask the Experts," What is CA125? CA125 is a substance which is found in very low levels in the human body. In recent years, CA125 has become a widely used tumor marker which is measured most often in women with cancers of the reproductive system including the uterus, fallopian tubes and ovaries. Other
Treatment of Low Malignant Potential (LMP) Ovarian Tumors I wanted to ask a question about Low Malignant Potential (LMP) ovarian tumors. I was diagnosed with an ovarian LMP Serous tumor. I know that a hysterectomy is the common treatment. My question is, given the high survival rates for this kind of tumor, why such an aggressive treatment? AM Scott Kamelle, MD and Ivor
Ovarian Tumor With Low Malignant Potential Please send me any information you may have an ovarian tumor with low malignant potential. I am confused about this type cancer. My doctors disagree on whether or not it is actually a cancer. Any information would be appreciated. Thank you, R Ivor Benjamin, MD, Former co-Editor-in-Chief of OncoLink, responds:
Genetic link for Ovarian Cancer Dear OncoLink "Ask The Experts," Please can you tell me if there is a known genetic link for ovarian cancer? My daughter- in-law is concerned because her mother died with the disease. She lives in the UK. Is there any way of calculating the risk? As far as I know there have not been other affected family members. Thank you in
Elevated CA125 after ovarian cancer treatment Dear OncoLink "Ask The Experts," In 1986 I had ovarian cancer with total removal of ovaries and uterus. For 15 years, the CA125 test has been part of my physical. It has been normal until this year and is now elevated. Simultaneously, I have a positive test for occult blood in the stool. They just did an abdominal CAT Scan, on which I
Preventing ovarian cancer Dear OncoLink "Ask The Experts," What is the best way to prevent ovarian cancer? I have a very high possibility of contracting it as my mother and several other close family members have died from ovarian cancer. Is it total hysterectomy with removal of ovaries or just removal of ovaries? What evidence supports your answer? At present I
Follow up care after treatment for Borderline Mucinous Ovarian Tumor Dear OncoLink "Ask The Experts," My Mom is 58 years old, postmenopausal. She was diagnosed with Borderline Mucinous Ovarian Tumor (stage IC) last April. She had a surgery to remove uterus, ovaries, fallopian tubes and part of omentum, followed by four chemotherapies. Generally speaking, she recovered very well and her health situation is
Gemcitabine for the treatment of ovarian cancer Dear OncoLink "Ask The Experts," Have you or any of your colleagues used Gemzar in the treatment of ovarian cancer? I would like to know of any stats on the success of this chemotherapy for ovarian cancer. Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health
Ovarian cancer detection Dear OncoLink "Ask The Experts," What are the tests for ovarian cancer? I have a regular yearly check up with Pap smear and I understand that ovarian cancer will not show up on this test. I have had several tests done for loss of appetite and weight loss (I have lost approximately 45 lbs), upper GI, MRI. I am now 51. Should I ask my doctor
Ovarian cancers of low malignant potential Dear OncoLink "Ask The Experts," I am a 34 year old who has just been diagnosed with borderline malignancy tumor of the ovaries. I am getting married in 3 weeks and while this is very overwhelming I am concerned with my potential to have children. What is known about borderline malignancy tumors and the ability to conceive? Is there a waiting
Primary peritoneal cancer Dear OncoLink "Ask The Experts," My mom just had a hysterectomy and we were told her diagnosis of Peritoneal Cancer mimics Ovarian Cancer. This is very rare; do you have any information about this disease? Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania
Successful pregnancy after ovarian cancer Dear OncoLink "Ask The Experts," My friend had ovarian cancer when she was 16, had one tube and one ovary removed. She's 22 now and is trying for a baby, however she is concerned that her chances may be very low or non-existent. Could you tell me realistically what her chances are of becoming pregnant? Thank you for your time.
Birth control pills may lower your risk for ovarian cancer Dear OncoLink "Ask The Experts," My mother died of ovarian cancer so as a precaution my gynecologist placed me on birth control pills. I am 48 and have not gone through menopause. With all the news about estrogen being a link to breast and ovarian cancer is it really a good preventive measure to be on a low dose birth control pill? Christina
Fertility drugs and borderline ovarian cancers Dear OncoLink "Ask The Experts," I was recently diagnosed and treated for borderline ovarian cancer. I am 47 years old and was told by my gynecologist oncologist that this tumor (mucinous) probably arose due to the ferility drug (clomid) I was prescribed 20 years ago. Do you agree there may be a connection? Stephen C. Rubin, MD, Professor
Symptoms of endometriosis and ovarian cancer Dear OncoLink "Ask The Experts," I have been researching both endometriosis and ovarian cancer. They seem like they have the same symptoms. How can you detect the difference and also do the symptoms on both appear around your cycle only? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of
Treatment of borderline cancers of the ovary Dear OncoLink "Ask The Experts," A close friend of mine was diagnosed with a Low Malignant Potential/Borderline Ovarian Tumor after a laparoscopy and had a complete hysterectomy. She has now been told that the LMP was also in the ovary, the fallopian tube, and in at least 1 lymph node. What is the recommended treatment at this point? Should I
Ovarian Cancer Surveillance Dear OncoLink "Ask The Experts," I am a 33-year-old female and have had treatment for CIN1 cells, which affected 3/4 of my cervix. I also have had my mother and grandmother die from ovarian cancer. I have been advised that I should have DNA testing to determine if I carry "The Gene". Upon going to the Genetics Specialist, was advised testing would
Clear Cell Ovarian Cancer Prognosis Dear OncoLink "Ask The Experts," Three years ago I was diagnosed with early stage Ovarian Cancer (Clear Cell) at the age of 32. Had chemo and surgery. I would like to adopt a child in a couple of years but I'm afraid I won't have a normal life expectancy. I have three aunts who died of breast cancer prior to the age of 65 and one had colon
Ascites in Ovarian Cancer Dear OncoLink "Ask The Experts," My sister has been diagnosed with ovarian cancer. She recently under went surgery to remove a massive tumor four liters of fluid were removed. She remains very bloated with what the doctors call "ascites" What is this "ascites?" I have searched the web and can't find any information. Christina S. Chu, MD,
Does arthritis elevate CA-125 Dear OncoLink "Ask The Experts," Two years ago my mother was diagnosed with ovarian cancer. She underwent a course of chemo, had surgery to remove the tumor, and underwent a second round of chemo. She now has osteoarthritis in her hip and her CA-125 is elevated from 7 to 24. My question is: Could there be a correlation between the inflammation
Possibility of ovarian cancer after removal of the ovaries Dear OncoLink "Ask The Experts," I have had a complete hysterectomy with both ovaries and uterus removed 25 years ago. Yet I am experiencing severe bloating and unexplained weight gain. I need to know if a woman can get ovarian cancer if she has had a complete hysterectomy? Stephen C. Rubin, MD, Professor and Chief of the Division of
Malignant granulosa cell tumor Dear OncoLink "Ask The Experts," My 8-year-old daughter had a malignant granulosa cell tumor removed. I cannot find a doctor who has experience dealing with this type of ovarian cancer in children. I want to have a treatment plan in place in case we have a reoccurrence. I have read that treatment has not been successful for reoccurrences. She
Standard Treatment for Advanced Ovarian Cancer Dear OncoLink "Ask The Experts," My mother was recently diagnosed with ovarian cancer. She had significant ascites, which caused her presentation to the hospital. She is to have two cycles of taxol/carbo combination and scheduled to undergo surgery in May. We want the most aggressive treatment for my mother. What are some questions to ask
Treatment options for recurrent ovarian cancer Dear OncoLink "Ask The Experts," My mother is currently battling her 3rd recurrence of ovarian cancer. She will start "Doxil" next week. What other options do we have? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:Recurrent ovarian cancer is a
Premarin cream and the risk for ovarian cancer Dear OncoLink "Ask The Experts," My wife is 58 and experienced menopause 5 years ago. Her GYN suggested that she use Premarin Cream to relieve a dry vagina problem and help when we have intercourse. I have heard of a link between Premarin and ovarian cancer. I am afraid for my wife to use the cream. Is my fear justified? Is there a "safe" cream
Consolidation therapy for ovarian cancer Dear OncoLink "Ask The Experts," My sister-in-law has stage 3c ovarian cancer. She has had surgical debulking and is now undergoing 6 carbo/taxol cycles. Do you have an opinion on consolidation therapy? I know it's controversial but could you address it for the rest of us? Christina S. Chu, MD, Assistant Professor of the Division of
Ovarian Cancer Recurrence Dear OncoLink "Ask The Experts," I've never really understood how or why my ovarian cancer could come back, but I'm well aware of the risk. I've had a negative second look and am in remission. Is recurrence due to undetected cancer being left behind, or is it due to cells dividing uncontrollably again once chemo effects wear off. Or could it indeed
Family history of ovarian cancer Dear OncoLink "Ask The Experts," I have a family history of ovarian cancer from both my mother and maternal grandmother I am frightened of getting cancer too. What can I do to make sure that if I detect it early enough to be treatable? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of
BRCA1 and BRCA2 testing for Ovarian Cancer Dear OncoLink "Ask The Experts," My mother had ovarian cancer at the age of 50, I am now 49 and of Jewish heritage. It seems that the genetic testing is no longer easily accessible. How would I go about getting genetic testing? Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania Health
Malignant Mixed Mullerian Tumor (MMMT) of the Ovary Dear OncoLink "Ask The Experts," My mother (63 y.o.) was recently diagnosed with a multi-mullerian ovarian tumor. She had a complete hysterectomy and 21 biopsies. The tumor was on her right ovary and spread to her fallopian tube. She is staged at 2-a. I am aware that this type of cancer is rare and that there aren't a lot of statistically
Ovarian Mass Dear OncoLink "Ask The Experts," I am a predominately healthy 37 year old woman with two children, no recent birth control pill use and had a grandmother die with colon cancer. I've been scheduled for laparoscopy to remove a tumor on my left ovary described as being a solid mass with cell walls and internal structures measuring 3.2cm. My
Monoclonal Antibodies for Ovarian Cancer Dear OncoLink "Ask The Experts," My mother has had her first recurrence of ovarian cancer. I am trying to research the latest evidence for success with therapies using monoclonal antibodies. Can you tell me what the most recent evidence is or what your opinion is regarding this therapy? Christina S. Chu, MD, Assistant Professor of the Division
Chemoresistance in ovarian and primary peritoneal cancer Dear OncoLink "Ask The Experts," I have been fighting primary peritoneal cancer for 4 1/2 years with suboptimal debulking and continued chemotherapy. I had one 9 month remission in the beginning. At this point all the chemotherapies we have tried have not been working. I was told I am chemoresistant at this point. I am about to try etoposide. What
Testing for Ovarian Cancer Dear OncoLink "Ask The Experts," Would you please let me know what is the test or examination with the most accuracy to detect ovarian cancer? How efficient is the ultrasound to detect the malignancy? Thank you very much for your answer. Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of
The most commonly used chemotherapy treatment for ovarian cancer Dear OncoLink "Ask The Experts," My wife's mother will begin chemotherapy for ovarian cancer this Thursday and is petrified of the side effects. Her oncologist is treating her every week with carboplatin and paclitaxel and has told her this will reduce the expected side effects due to the lower more frequent concentrations. My question is should
Treatment for recurrent ovarian cancer stage III C Dear OncoLink "Ask The Experts," My wife has epithelial ovarian cancer stage III C. She underwent surgery in January 2001 and chemotherapy with the standard Carboplatin/Taxol (paclitaxel) treatment. She had a recurrence within 18 months and again underwent treatment with the same Carboplatin/Taxol combination beginning in December 2002. She again
Vaccines for Ovarian Cancer Dear OncoLink "Ask The Experts," My name is Marius and I am from Romania. My girlfriend is 26 yrs old, and has been diagnosed with ovarian cancer and had surgery. Doctors said that the cancer is stage IIA and the cell type is G2. She has had several chemotherapy treatments, but the doctors are not giving her a good chance of survival. I read an
Chemotherapy After Debulking Surgery Dear OncoLink "Ask The Experts," Following debulking surgery for advanced ovarian cancer, how soon should chemotherapy be commenced? Does early commencement compromise wound healing? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:Following extensive
OncoGel and Ovarian Cancer Dear OncoLink "Ask The Experts," Do you have any knowledge or experience with use of OncoGel to deliver paclitaxel directly into ovarian cancer masses? I have recurrent disease. Thank you.Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania Health System, responds:OncoGel is an experimental,
Hormone Therapy after Ovarian Cancer Dear OncoLink "Ask The Experts," I am 44 years old, and a 2-year survivor of Stage 1, grade 3 epithelial ovarian cancer (sporadic, as opposed to hereditary). You wrote that hormone replacement therapy does not increase the risk for ovarian cancer, therefore, why does my oncologist NOT want me on any hormones? Stephen C. Rubin, MD, Professor and
Normal CA-125 with Recurrence Dear OncoLink "Ask The Experts," Have you heard of anyone getting a recurrence despite having normal serum levels of CA-125? In other words, is the following possible: a patient has an elevated CA-125 before initial surgery, goes through treatment and the CA-125 decreases to normal, and then the patient gets a recurrence while the CA-125 stays in
Secretions and Oral Care Dear OncoLink "Ask The Experts," My sister is in the late stages of ovarian cancer, which she has had for 5 years. She is now on TPN because she can not eat or drink. Within the last week, she has developed thick mucus that seeps from her mouth. Is there something we can do for her, something she can take under her tongue, possibly? Erin
PET/CT for Ovarian Cancer Dear OncoLink "Ask The Experts," I was diagnosed with fallopian cancer January 2006 had surgery and 6 chemo treatments ending July 2006. My Gynecologic Oncologist ordered a PET/CT in February 2007. My insurance company is refusing to pay for the scan saying it is not a proven for my type of cancer. I'm looking for research data that will support
Follow Up With no CA125 Elevation Dear OncoLink "Ask The Experts," I had ovarian cancer 10 years ago. My CA-125 was never elevated and the cancer was found during a hysterectomy for other reasons. How can I be sure I haven't developed a recurrence, as I am having similar symptoms to those I had before the hysterectomy? Stephen C. Rubin, MD, Professor and Chief of the Division of
Follow Up for Primary Peritoneal Cancer Dear OncoLink "Ask The Experts," I am a Primary Peritoneal Cancer survivor (19 months in remission). I want to know which is best to have, CT scan or PET scan to check for recurrence of disease? Also if recurrence does occur, is it possible to have intraperitoneal (IP) therapy again? Stephen C. Rubin, MD, Professor and Chief of the Division of
Doxil and Leg Pain Dear OncoLink "Ask The Experts," My mom has recurrent ovarian cancer. When the cancer recurred, she was put on Topotecan, which kept her CA125 down for several months. When it started to creep back up she was put on Gemzar for two treatments, which did not impact the CA125. She is now on Doxil, and after one treatment her CA125 went up to 400 and
Vaginal carcinoma in situ Dear OncoLink "Ask The Experts," Is the optimum treatment for Vaginal Carcinoma in Situ laser surgery? Is there any other option? Is this early stage considered to be pre-cancer or cancer? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
Vaginal cancer treatment and causes Dear OncoLink "Ask The Experts," A friend of mine found out she has vaginal cancer. What is the best treatment today for this? Can this be related to her tonsil cancer from a few years ago? Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania Health System, responds:Vaginal cancer is
Options after vaginal closure Dear OncoLink "Ask The Experts," My mother-in-law had a radical hysterectomy seven years ago. Her doctor advised her do a vaginal closure to decrease the chances of infection or recurrence. She has been cancer free for seven years but she doesn't want to form relationships with men because she cannot have intercourse. I told her I would research
Small cell carcinoma of the vagina Dear OncoLink "Ask The Experts," My wife was diagnosed with small cell carcinoma of the vagina in early 2001. The tumor was surgically removed and she underwent radiotherapy in combination with cisplatnin. After the radiotherapy was complete she had six cycles of Carboplatnin and VP-16. In March of this year the cancer reappeared with four tumors
Inoperable stage II-B squamous cell carcinoma of the vagina Dear OncoLink "Ask The Experts," My niece had stage II-B squamous cell carcinoma of the vagina. After a remission following a combination of therapies, it relapsed. At surgery, the cancer was found to be localized, but inoperable because of its attachment to a critical blood vessel. The surgeon believes the situation is hopeless. Please let me know
Vaginal / Vulvar Graft Versus Host Disease Dear OncoLink "Ask The Experts," I'm a 35-year-old allogeneic bone marrow transplant patient (transplant was in May '04) who is having trouble with vaginal stenosis. I'm told that this condition is probably the result of the total body radiation that I was given, but that it could also have something to do with post-transplant Graft-Versus-Host
Diethylstilbestrol DES Exposure in Utero Dear OncoLink "Ask The Experts," I am a 31 year-old confirmed DES daughter. Are there any guidelines for my physicians to follow? I have had low-grade abnormal paps (CIN1 & VAIN1) a few times now and the most recent was VAIN2. Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania
Follow Up After Vaginal Cancer Dear OncoLink "Ask The Experts," I was diagnosed in 2004 with primary vaginal cancer. I had a vaginectomy with my lymph nodes removed. I also had reconstruction. I am followed up every 6 months with only Pap smears. Should I be getting any particular blood work, urinalysis, or scans other than my Pap smear to keep up with a cancer that may or may
Symptoms of Vaginal Cancer Dear OncoLink "Ask the Experts," I have a large lump in the vulva area. When I use the bathroom I have some mild pain there. Should I be concerned about having vaginal cancer stage 2? Peter Argenta, MD, OncoLink Editorial Assistant, responds: Fortunately, vulvar or vaginal cancers comprise a small percentage of
Vulvar cancer causes Dear OncoLink "Ask The Experts," Could you tell me if there have been any new findings as to the cause of vulvar cancer? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:There have been no recent new discoveries regarding the causes of vulvar cancer.
Difficulty with intercourse after radical vulvectomy Dear OncoLink "Ask The Experts," I had a radical vulvectomy 1 year ago. I am very grateful to be cancer free but intercourse is difficult and painful. Should we keep trying? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:There are many reasons why
Prognosis for cancer of the vulva Dear OncoLink "Ask The Experts," I have recently had a biopsy for a lump on my vulva. It is strongly suspected that this is indeed cancer. What is the prognosis for this type of cancer? Is the only option surgery, and is it usually cured with surgical removal? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology
Origins of Fallopian Tube Cancer Dear OncoLink "Ask the Experts," Is there such a cancer as fallopian tube cancer? Or, is it ovarian cancer that starts in the fallopian tube? Thank you, F. Ivor Benjamin, M.D., Former co-Editor-in-Chief, OncoLink, responds: Dear F. Thank you for your question and your interest. Yes, there are
Risk factors for fallopian tube cancer Dear OncoLink "Ask The Experts," Are there any environmental factors associated with the rare fallopian tube cancer? I am undergoing chemotherapy for this and have recently met two other women within a 10 mile radius that also are undergoing chemotherapy for fallopian cancer. Stephen C. Rubin, MD, Professor and
Fallopian Tube Cancer Prognosis Dear OncoLink "Ask The Experts," I was diagnosed with Stage 1A fallopian tube cancer in July. The surgery was performed by a surgeon specializing in GYN Oncology. Why does your website say that the 5-year survival rate for Stage 1A is 51% (or thereabouts), whereas all other websites I've found quote 91% 5-year survival for Stage 1A fallopian tube
Vaginal Cuff Smear Dear OncoLink "Ask the Experts," In March of 2000, I had a hysterectomy, leaving only my ovaries in place. Just last week I had my yearly follow up visit and they did a pap smear. The doctor's office called and told me my pap smear had come back abnormal and wants to do another pap smear in three months. I have been told that unless the
Colposcopy or a LEEP During Pregnancy Dear OncoLink "Ask the Experts," Is it safe to have a colposcopy or a LEEP (loop electrocautery excision procedure) while I am pregnant? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds: Colposcopy is a procedure that
Treatment for Bartholin Gland Cancer I have a rare type of Gyn cancer: metastatic squamous cell cancer of the Bartholin gland. I am currently receiving radiation to the pelvis and weekly Cisplatin chemotherapy to be followed by interstitial brachy implants. I fear most the implants, as it will be the second surgery, since the tumor was removed. I am now told that it was unwise
Treatment for CIN III Dear OncoLink "Ask The Experts," I had a biopsy and it came back with carcinoma in situ (CIN III) and adenocarcinoma in situ. I have seen two doctors. One (a regular gynecologist) tells me that I should just wait and have pap smears every three months and see what happens. The other (a gynecological oncologist) says that I should have a
Molar Pregnancy Dear OncoLink "Ask The Experts," I had a molar pregnancy in November of 2001. While in school, one of my teachers told me that molar pregnancies are "most of the time" linked to cancer. Is this true? If so why didn't my doctor tell me? I'm only 27 yrs. old and so far all my paps have been normal. Should I be worried?
Evaluation of abnormal uterine bleeding Dear OncoLink "Ask The Experts," I am 45 and having mid cycle bleeding. This has been happening for about 6 months. My doctor observed during my physical exam that my uterus was enlarged. I had an ultrasound and was told that I have multiple fibroids. Recently, I have been having constant lower left abdominal pain and leg aches. Much like
Is there a correlation between cancer and shingles? Dear OncoLink "Ask The Experts," My mother and father died of cancer and both developed shingles within 6 to 9 months of dying. My sister has been diagnosed with uterine cancer. She just found out she has shingles. Is there a correlation between cancer and shingles? Stephen C. Rubin, MD, Professor and Chief of the Division of
Normal pregnancy after having a molar pregnancy Dear OncoLink "Ask The Experts," My question is in respect to having a normal pregnancy after having a molar pregnancy and choriocarcinoma, have you had any patients in your practice that have had a normal pregnancy after all this. Also what are my chances? Stephen C. Rubin, MD, Professor and Chief of the Division of
SIL (Squamous Intraepithelial Lesion) Dear OncoLink "Ask The Experts," I am 32 years old and have been having pelvic pain and fullness, pain with intercourse, spotting throughout the month and white discharge, all of these for the past 2 years, worsening in the last 6 months. I chalked this up to female annoyances until my last pap came back with low grade SIL (Squamous Intraepithelial
Paget's disease of the vulva Dear OncoLink "Ask The Experts," I need surgery for Paget's disease of the vulva. Can you tell me about my treatment options? Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania Health System, responds:Paget's disease of the vulva is an unusual kind of skin cancer that arises from
Infection during Pap testing Dear OncoLink "Ask The Experts," I had a pap smear done about 2 weeks ago and they then treated me for a bacterial infection. When my test results came back they showed that I had mild dysplasia. Could this be due to the infection that I had during my pap smear? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic
Fertility Drugs and Cancer Dear OncoLink "Ask The Experts," Can you give me websites and information on the chances of getting cervical cancer from taking clomid? I took it for 1 1/2 years in the 1970's to help me get pregnant. Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:As far as
Prophylactic Oopherectomy for High Risk Dear OncoLink "Ask The Experts," I'm a 50-yr-old healthy female who has been having yearly intravaginal ultrasounds and CA125 tests because of my family history (my mother died of ovarian cancer at the age of 55). My Ca125 is considered normal (it is 31), but has been increasing every year over the past 10 years. Do you recommend removal of the
Fluoride during Head & Neck Radiation Dear OncoLink "Ask The Experts," In regards to patients undergoing head/neck radiation therapy, which type of fluoride gel therapy is recommended in the gel trays: stannous, sodium, or APF? Thank you for your recommendation. Kendra Schaefer, DMD, Assistant Professor in the Department of Oral and Maxillofacial Surgery, Division of Prosthodontics at
Management of Vulvar Dysplasia Dear OncoLink "Ask The Experts," Is there a protocol in regard to follow ups after a wide local excision of the vulva? My daughter who is twenty years old was diagnosed with VIN III caused by the HPV virus, and had to have a wide local excision with grafting. Right after the surgery, the doctor told us that she was not able to achieve free margins
Should I have a hysterectomy to avoid gynecologic cancers? Dear OncoLink "Ask The Experts," If a woman has already had breast cancer, wouldn't it make sense to have a hysterectomy to avoid getting other female types of cancer, i.e. ovarian and uterine cancer? I am currently 52 years old. Thank you. Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of
Is it Bartholin's Gland Cancer? Dear OncoLink "Ask The Experts," I have had Bartholin's cysts for over two years now on and off. Recently I had come across an article concerning Bartholin's gland cancer. How will I know if I have the cancer? Will it show up in the culture? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of
MRI Concerns Dear OncoLink "Ask The Experts," My daughter's last MRI showed a very bright thick ring - a complete circle - around her brain tumor that was not there just 8 months ago. The shape of the tumor has changed a bit, too. Her tumor was removed 7 years ago. The doctor said, worst case scenario would be that it is now malignant with no cure. But he
Stick With One Type of Vaccine Dear OncoLink "Ask The Experts," My international patient was given the first 2 doses of Cervarix in her home country. She is due for her 3rd shot but will not be returning there anytime soon. Can she get her 3rd shot as Gardasil, or does it need to be Cervarix, which is not yet available in the U.S.?Christina S. Chu, MD, Assistant Professor of the
Do I need a pap smear if I have never had sex? Dear OncoLink "Ask The Experts," I am 47 years old and never had sex. Do I still need a pap smear?Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:Pap smears are used to detect changes (dysplasia) or cancer in the cervical tissue, which is most often caused
Parotid Gland Cancer Dear OncoLink "Ask the Experts," My mother had noticed a lump in her right cheek for sometime. After a biopsy, she has just been diagnosed with cancer of the parotid gland. They are calling it an adenoid cystic epithelial carcinoma. On CT of the chest, there were two nodules in the right upper lobe of the lung. Please advise as to
Treatment Options for Mucoepidermoid Carcinoma of the Parotid Gland. Dear OncoLink "Ask the Experts," Would you please clarify the details of the latest treatment options for mucoepidermoid carcinoma of the parotid gland? The patient in question is a female of 35 years of age. Her disease is grade I and recurrent in nature. Also, could you please clarify the role of selective radiotherapy in this case.
Acinic Cell Adenocarcinoma of the Parotid Gland Dear OncoLink "Ask the Experts," I am a 34 year old female and in October 1993 I had an acinic cell adenocarcinoma removed from my left side parotid gland and it was felt that surgery alone was sufficient and I have had regular checks at the hospital since. In December 1998 I discovered a small nodule located on the same side but in
Acinic Cell Carcinoma of the Salivary Gland Dear OncoLink "Ask the Experts," I am a retired RN who does volunteer work. I am taking a new patient for an assessment of acinic cell carcinoma. I cannot find information on this anywhere. It appears to have been in the salivary glands. I am wondering if you have any information on this kind of cancer. Thanks.
Treatment Options for Adenoid Cystic Carcinoma Dear OncoLink "Ask the Experts," My mother had noticed a lump in her right cheek for sometime. After a biopsy, she has just been diagnosed with cancer of the parotid gland. They are calling it an adenoid cystic epithelial carcinoma. On CT of the chest, there were two nodules in the right upper lobe of the lung. Please advise as to what
Effects of Head and Neck Radiation in the Elderly Dear OncoLink "Ask the Experts," My father-in-law, age 87, recently had surgery to remove squamous cancer in his neck (just below jaw line). He is scheduled to begin radiation tomorrow but is now hesitant to undergo this treatment. His oncologist has told us that he has an 80% chance of survival following the surgery, and a nearly
Adenoid Cystic Carcinoma Dear OncoLink "Ask the Experts," I have recently been diagnosed with adenoid cystic carcinoma (cylindroma) minor salivary gland tumor but am unable to find any information. Can you help? Li Liu, MD, OncoLink Editorial Assistant, responds: Thank you for your interest and question. Malignant tumors in minor
Leukoplakia of the tongue, cheeks, and gums and cancer development Dear OncoLink "Ask the Experts," How long can a person have leukoplakia of the tongue, cheeks, and gums before cancer develops? Gregory S. Weinstein, MD, FACS, Founding Member and Associate Director of the center for Head and Neck Cancer, at the University of Pennsylvania Medical Center, responds: This is a good
Oral Cancer Dear OncoLink "Ask the Experts," My husband was told he has carcinoma of the tongue. Are there any articles on current treatment? He had chemotherapy for lg/small cell non-Hodgkin's lymphoma in 1998-1999. Will this affect any future treatment options? Thanks, EL David I. Rosenthal, MD, Director for Head and
Lymphoepithelioma Dear OncoLink "Ask the Experts," I am trying to find information regarding a type of cancer, and I'm not sure I've got the name correct. I am probably spelling this wrong, but its Lymphoepithelioma. My mother had a tumor removed from a tonsil 3 years ago, had radiation treatment, and I'm fairly sure that was what her doctor told her she
Dental Work Prior To Head And Neck Radiation Dear OncoLink "Ask the Experts," My mother had a tumor removed from a salivary gland in her lower lip. The margins were not free and she is to have radiation on the entire lower left jaw and chin. She is 79 years old and is scheduled to have all her lower teeth removed. They say she will probably not get false teeth for 6-12 months
Treatment Options after Total Parotidectomy Dear OncoLink "Ask the Experts," My husband has just had a total parotidectomy (L) where facial nerves had been sacrificed. The histopathology says that what he has is a high-grade mucoepidermoid carcinoma. The tumor extracted from him was 6 cm in size. We were told that he's in stage 3. Please tell us the possible treatments
Speech After Total Laryngectomy Dear OncoLink "Ask the Experts," I was recently diagnosed with throat cancer and scheduled for a total laryngectomy. Will I be able to speak again after my voice box is removed? J. Li Liu, MD, OncoLink Editorial Assistant, responds: Dear J, Thank you for your interest and question. Total laryngectomy (TL)
Radiation Treatment for Larynx Cancer Dear OncoLink "Ask the Experts," My mom, age 75 has chosen to take radiation treatments instead of having her voice box removed. She has stage 3 larynx cancer and is still smoking during treatments. What are her chances to be cured at this stage? L. David I. Rosenthal, MD, Director for Head and Neck Radiation
Voice Box Preserving Surgery Technique Dear OncoLink "Ask the Experts," How can one be certain that his surgeon is familiar with the voice box preserving surgery technique? Gregory S. Weinstein, MD, FACS, Founding Member and Associate Director of the center for Head and Neck Cancer, at the University of Pennsylvania Medical Center, responds: Simply put,
HPV a Cause of Oral Cancers Dear OncoLink "Ask The Experts," My sister is 26 years old and has had a hoarse voice for as long as I can remember. Recently though her voice went away and she could barely whisper, but she had no difficulties breathing. She went to see a speech specialist who told her she may have HPV Papilloma on the larynx and sent her to a head and neck
Stereotactic Radiosurgery for Nasopharyngeal Carcinoma Dear OncoLink "Ask the Experts," My father is receiving external beam radiation for his nasopharyngeal cancer. He will get stereotactic radiosurgery at the end of his regular radiation treatments. The doctor said radiosurgery improves tumor control. Where can I find more information on this? Thanks! T Li Liu,
Hot Tub Use with a PEG Tube in Place Dear OncoLink "Ask the Experts," I had a squamous cell cancer removed, via a radical neck dissection. The pathology was very clean, but the 6 cm size of the tumor (growing on my right tonsil) has my doctor recommending radiation follow up. I have been using a hot tub to relieve stiffness in my shoulder. Once I get the PEG tube, will
Esthesioneuroblastoma Dear OncoLink "Ask the Experts," I am trying to find information regarding esthesioneuroblastoma. What is it? How rare is it? What kind of treatment is recommended? What is the prognosis for one who has it? John Han-Chih Chang, MD and Kenneth Blank, MD, Editorial Assistants for Oncolink, respond: Thank you for
Swallowing Evaluation after Surgery for Head and Neck Cancer Dear OncoLink "Ask the Experts," Is it common for all patients to have a swallowing evaluation done after neck cancer surgery? Cesar Ruiz, MA, Speech Pathologist at the Hospital of the University of Pennsylvania, responds: Although we can not comment on a specific cancer diagnosis or surgery, since none is
Xerostomia After Radiation Dear OncoLink "Ask the Experts," I completed radiation and chemo treatments for head and neck cancer almost 2 years ago. I am now 37 and lead a pretty active and normal life—except, that is, for food! Everything is so dry and difficult. Is there anything I can do? Katrina Claghorn, MS, RD, registered dietitian
Feeding Tube Placement Dear OncoLink "Ask the Experts," My 73 y.o. father has Squamous Cell Carcinoma of the lymph Node on his neck. He had radiation treatments, which brought his weight down. The Doctor now says the cancer is spreading to his jawbone. He is scheduled now for surgery. He will have a feeding tube following surgery. What are the best
VATS (video assisted thoracic surgery) Dear OncoLink "Ask The Experts," Could you give me some information on VATS (video assisted thoracic surgery) and its use opinion for Stage I lung cancer? Joseph B. Shrager, MD, Assistant Professor of Surgery and Director of General Thoracic Surgery at the University of Pennsylvania School of Medicine, responds:
Importance of Completing Radiation Treatments Dear OncoLink "Ask The Experts," My mom was diagnosed with Cancer of the Nasopharynx. She needed to have radiation treatments twice a day for 5 weeks. She only made it through 28 treatments because the pain in her throat was very bad and she was exhausted. She has decided not to go for any more treatments. Can you give me any
Swelling of the mucous-lining of the head and neck after treatment for epiglottic cancer Dear OncoLink "Ask The Experts," My husband has just undergone daily radiation and chemotherapy for epiglottic cancer. While the treatment was rough, we are finding the side effects to be even more grueling. He has a very thick mucous-he says like glue that almost chokes him continuously. His doctor suggested robutussin to break this up. He's been
Management of Secretions Following Radiation to the Throat Dear OncoLink "Ask The Experts," Is there anything that can be given to help manage thick, ropey mucous following radiation to the throat? Any help would be greatly appreciated. Harry Quon, MD, MS (CRM), Assistant Professor of Radiation Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:The reason why the
Repairing radiation damage to the soft palate Dear OncoLink "Ask The Experts," I have had nasopharyngeal cancer twice 5 years apart. I was successfully treated with radiation therapy both times. I now have a severely damaged soft palate making it impossible to eat solid food and my speech nearly incomprehensible. Can this damage ever be repaired or improve?Kendra Schaefer, DMD, Assistant
Dental work during chemotherapy Dear OncoLink "Ask The Experts," Can a patient receiving chemotherapy have much-needed dental work?Kendra Schaefer, DMD, Assistant Professor in the Department of Oral and Maxillofacial Surgery, Division of Prosthodontics at the University of Pennsylvania, responds:Quite simply, the answer is yes, when timed correctly. The dentist should call the
Oral Trauma Causing Cancer Dear OncoLink "Ask The Experts," I am 28 years old and I have a bad habit of chewing on the inside of my cheeks, on the bottom inside of my mouth and on my tongue. I am really worried about getting oral cancer, but I just can't seem to control this habit. My PCP put me on an anxiety med that didn't help me stop the habit. What can I do to stop from
Barrett's Esophagus Dear OncoLink "Ask The Experts," I want to know what Barrett's Cancer is and if it is in the neck or throat?Carolyn Vachani RN, MSN, AOCN, OncoLink's Medical Correspondent, responds:Barrett's esophagus is not a cancer, but people who have it are at higher risk of developing cancer of the esophagus. The esophagus is the tube that connects your mouth
Long Term Effects of Radiation to the Head and Neck Dear OncoLink "Ask The Experts," I'm two treatments away from being done with 5 weeks of radiation treatments for head and neck cancer. I am wondering what the long-term effects of the radiation therapy to the head and neck area might be? Harry Quon, MD, MS (CRM), Assistant Professor of Radiation Oncology at the Abramson Cancer Center of the
Neck Stiffness & Pain after Surgery Dear OncoLink "Ask The Experts," I'm 29-years-old with squamous cell carcinoma of the tongue and neck. I have had 2 right neck dissections in the last year; with the second, I lost all my soft tissue on the right side and the sternocleidomastoid muscle. Now my right neck is hard as a rock (I guess due to scar tissue). I still cannot turn my head,
Dental Health and Radiation Therapy Dear OncoLink "Ask The Experts," I have a rare Interdigitating Dendritic Cell Sarcoma of the parotid gland and am starting radiation in a couple of days. I want to know if there is any type of protection I can use to protect my teeth from radiation damage. Someone has suggested putting foil over my teeth where the radiation is administered.Pinaki
HPV Testing in Head and Neck Cancers Dear OncoLink "Ask The Experts," My husband is a 54 year-old non-smoker, non-drinker with stage I moderately differentiated squamous cell cancer of the tonsil. He is about to begin radiation therapy. Should he request HPV testing in the tonsil biopsy, and would this change his treatment at all?Pinaki R. Dutta, MD, PhD, Resident in the Department of
Oral Trismus after Radiation to the Jaw Dear OncoLink "Ask The Experts," Five years ago, I had 35 radiation treatments for tonsil and tongue cancer. It was some time later that I discovered that the radiation had shrunk the muscles that control how much I can open my mouth. I have 3/4 of an inch opening. I have been told that nothing can be done to give me another 3/4 or 1 in opening.
Ethyol to Prevent Dry Mouth Dear OncoLink "Ask The Experts," My husband is a 54 yo non-smoker or drinker with stage I moderately differentiated squamous cell cancer of the tonsil. He is about to begin radiation therapy. Should he request Ethyol to reduce xerostomia (dry mouth)? His radiation MD thought the side effects weren't worth it.Pinaki R. Dutta, MD, PhD, Resident in
PEG Tube for Head & Neck Cancer Radiation Dear OncoLink "Ask The Experts," My husband is a 54 year-old non-smoker or drinker with stage I moderately differentiated squamous cell cancer of the tonsil. He is about to begin radiation therapy. He is 6 feet tall and 210 pounds and strong - is a PEG tube really needed? Pinaki R. Dutta, MD, PhD, Resident in the Department of Radiation Oncology
Alcohol Intake When Receiving Radiation for Head & Neck Cancer Dear OncoLink "Ask The Experts," When receiving radiation therapy for throat cancer, can you have a few beers on the weekend when you aren’t getting radiation? Pinaki R. Dutta, MD, PhD, Resident in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:Thank you for your question. It is a common
Inhaler Use While Receiving Radiation Therapy Dear OncoLink "Ask The Experts," My father is about to begin radiation for tongue cancer. Due to respiratory problems, he is unable to undergo surgery. He is on oxygen and uses Advair and Spiriva. Is it acceptable for him to continue these during radiation? Will they affect healing, tissue damage etc? Harry Quon, MD, MS (CRM), Assistant Professor
Nutritional Status Druring Treatment for Head and Neck Cancer Dear OncoLink "Ask The Experts," My father was recently diagnosed with epiglottis cancer, and he just had his first chemo treatment and the first week of radiation. Are there any suggestions that you have in regards to what he would be able to eat? Should we have a nutritionist? Your article was very informational, thank you. You told me things
Late Effects of Head & Neck Radiation Dear OncoLink "Ask The Experts," I had radiation for 8 weeks for nasopharangeal cancer that had also gone to a lymph node in my neck. Now over 4 years later, I have some problems with my voice and breathing. My tongue has recently started cramping up on me for 5 or so minutes at a time, and I can't talk or swallow during this time. My right
Thick Mucus after Radiation Therapy for Head & Neck Tumors Dear OncoLink "Ask The Experts," I am a 47 year-old who had cancer of the epiglottis. I had radiation and 2 years later, the tumor was back. I then had surgery and took the epiglottis, lymph nodes, and a piece of 1 vocal cord. I'm tube feeding and have gained about 10 lbs, some muscle mass, and all seems to be going well. The worst part is really
Difference Between T3 and T4 Thyroid Hormone Question What is the difference/what should I know about T3 and T4 thyroid hormone? Answer Kolin Hoff, MD, Endocrinologist at Penn Medicine responds: Most people only need T4. A few people may be better if they also take T3. T3 is difficult to take because it only lasts a few hours in the body and if used needs to be taken at the same time
Chance That Surgery Could Find Benign Tumor Question I am having surgery for a thyroid cancer found with a biopsy but I read online that they could do the surgery and find out it is benign. Is that really true? Answer Rachel Kelz, MD, MSCE, at Penn Medicine responds: The accuracy of the pre-operative diagnosis is dependent upon the cytologist that reviews the slides. It varies across
RAI After Surgery for Recurrent Thyroid Cancer Question I just had my third surgery for recurrent papillary carcinoma, this time found in two lymph nodes. What are your thoughts about RAI after this round for me? My surgery was a month ago. Endo suggests reviewing my thyroglobulin level in three months then deciding. Answer Marcia Brose, MD, Director of Thyroid Cancer Therapeutics Program at
Follow Up & Monitoring for Recurrence Question If I had surgery to remove my thyroid and cancer, can it come back? How will my doctor know if my thyroid cancer comes back after I finished all my treatments/procedures and things seem ok? Answer Rachel Kelz, MD, MSCE, at Penn Medicine responds, Thyroid cancer recurs in 25% of people. The likelihood for recurrence depends of the
Iodine and Iodized Salt and Cancer Risk Question Is it better to have a diet with or without iodine products to prevent thyroid cancer? Does using iodized salt increase your risk of cancer? Answer Kolin Hoff, MD, Endocrinologist at Penn Medicine responds, Iodine deficiency increases the risk of goiter but does not increase the risk of cancer. Nodular goiters have about a 5% or less
Thyroid Cancer Treatment After RAI Question What happens after my cancer stops responding to radioactive iodine? Answer Marcia Brose, MD, Director of Thyroid Cancer Therapeutics Program at Penn Medicine responds, There are many new agents in clinical trials and some that might be available outside of clinical trials. In the last 5 years, many patients have had successful
Accuracy of FNA Question Is a fine needle aspiration (FNA) sufficient to diagnose thyroid cancer or do should I have a biopsy of the nodule? Answer Kolin Hoff, MD, Endocrinologist at Penn Medicine responds, In most cases FNA can diagnose malignancy or at least a suspicious nodule. In some cases only surgery can definitively diagnose a cancer. A biopsy that is
Thyroid Hormone Replacement After Partial Thyroidectomy Question If only part of my thyroid is removed, will I still need to take thyroid hormone pills? Answer Kolin Hoff, MD, Endocrinologist at Penn Medicine responds, IF only half of your thyroid is removed and you did not have cancer and the remaining thyroid is normal then only 20% of people need thyroid hormone replacement. This question and
Importance of Low Iodine-Diet Question If you mess up your low-iodine diet will the treatments be less effective? I am so stressed out about this diet! Answer Marcia Brose, MD, Director of Thyroid Cancer Therapeutics Program at Penn Medicine responds, Yes! So if you have messed up your diet, let your physician know immediately so that they can reschedule your treatments.
Diet After Thyroid Surgery Question What kind of diet do I need to follow if I had surgery for thyroid cancer or have a recurrence of thyroid cancer? Answer Rachel Kelz, MD, MSCE, at Penn Medicine responds, Thyroid cancer surgery does not require a specific diet. You are usually instructed to avoid foods that worsen your sore throat. If you need treatment with
Timing of Radioactive Iodine (RAI) After Surgery Question If it is cancer and I need radioactive iodine, how long after surgery is that done? And is there a sort of time limit to how long you can wait and it still be helpful? Answer Kolin Hoff, MD, Endocrinologist at Penn Medicine responds: In most cases radioiodine if needed is given 6-8 weeks after surgery but in some cases longer or
RAI Restrictions Question How long will I be hospitalized for the I-131, & what does the isolation include? When can I go back to work after the I-131? How soon after the I-131 can I have sex? How long do I need to avoid pregnancy? Answer Rachel Kelz, MD, MSCE, at Penn Medicine responds: These questions are really import to address with your doctor who is
Taking Thyroid Hormone Replacement Question Will I have to take thyroid hormone pills for the rest of my life because I had thyroid cancer? When is the best time of day to take it? How does the drug interact with/ other medications I take? Answer Marcia Brose, MD, Director of Thyroid Cancer Therapeutics Program at Penn Medicine responds: If your whole thyroid was removed you
Partial Versus Total Thyroidectomy Question What is the difference between a total thyroidectomy and a partial thyroidectomy? What are the side effects of each? Where will the incision be made, how large will my scar be? Do I need a plastic surgeon? How long will I be in the hospital after surgery and when can I go back to work? Answer Rachel Kelz, MD, MSCE, at Penn Medicine
Thyroid Hormone Dosing Question In the last 12 months, I have gone from 125 micrograms up to 200 micrograms. Now I take 150 micrograms 4 days per week and 175 micros 3 days. Won't this adversly affect my bones? What is a comfortable dose and how can I tell if I am being "over treated"? Answer Kolin Hoff, MD, Endocrinologist at Penn Medicine responds: Usually if a
Symptoms and Diagnosis of Thyroid Cancer Question What are symptoms of thyroid cancer? How can thyroid cancer best be diagnosed? Answer Rachel Kelz, MD, MSCE, at Penn Medicine responds: Thyroid cancer is often asymptomatic. When symptoms occur, they can range from a visible mass to voice dysfunction. Thyroid cancer is rarely associated with symptoms that are typical of thyroid
Thyroid Cancer Specialist Question What kind of doctor do I go to if my family doctor thinks something is wrong with my thyroid? Answer Rachel Kelz, MD, MSCE, at Penn Medicine responds: If your family doctor believes that you have a thyroid problem. You should schedule an appointment with an endocrinologist. To make sure the appointment is as valuable as possible, you
Thyroid Nodule Question If I have a thyroid nodule, does that mean I will get thyroid cancer? If I have the nodule removed, will it come back or will cancer develop? Answer Rachel Kelz, MD, MSCE, at Penn Medicine responds: Ninety percent of thyroid nodules are benign. You should be seeing a specialist to get information regarding your specific nodule(s).
Thyroid Cancer Awareness Question My friend was just diagnosed with thyroid cancer. How can I help raise awareness about the disease? Answer Michelle LeBeau, Thyroid Cancer Survivor and Founder of REACT Thyroid Foundation responds: I think it's great that you are inspired to help create awareness for thyroid cancer. There are lots of ways to help but one idea could be
Support Organizations After Thyroid Cancer Question What are some good organizations for support of thyroid cancer patients and survivors? Answer Michelle LeBeau, Thyroid Cancer Survivor and Founder of REACT Thyroid Foundation responds: There are several organizations available for support but one of the best I have found is ThyCa (www.thyca.org). Their website is full of great content
Radiation Exposure Only Cause of Thyroid Cancer? Question Does getting thyroid cancer have to do with a history of it in your family? Answer Rachel Kelz, MD, MSCE, at Penn Medicine responds: Some thyroid cancers are associated familial cancer syndromes. Those are unusual. Most thyroid cancers are sporadic meaning they are not associated with a family history of thyroid cancer. That said, a
What is the Thyroid? Question What exactly does the thyroid do and what will happen if I have to have it all removed? What changes can I expect for my body/life if my thyroid has to be removed? How will it affect me? Answer Kolin Hoff, MD, Endocrinologist at Penn Medicine responds: The thyroid makes thyroid hormone. If the thyroid is removed the patient needs to
RAI Restrictions With Children Question My cancer has to be treated with radioactive iodine. Does this mean I will be radioactive? Is this dangerous? What precautions should I take if I have small grandchildren in the house? Answer Kolin Hoff, MD, Endocrinologist at Penn Medicine responds: After taking radioiodine you will excrete the radiation for the next several days to
RAI Side Effects Question What are the side effects of radioactive iodine? Is it always a cure for thyroid cancer? Answer Kolin Hoff, MD, Endocrinologist at Penn Medicine responds: The most common long term side effect of radioactive iodine in damage to salivary glands. Short term side effects are change in taste. Radioactive iodine is usually given to ablate
Support for Newly Diagnosed Question My sister was recently diagnosed with metastatic thyroid cancer. How can I help her? What can I do/say? Answer Michelle LeBeau, Thyroid Cancer Survivor and Founder of REACT Thyroid Foundation responds: As a metastatic thyroid cancer patient myself, I have relied heavily on the support from my family and my sister. Her just knowing that
Life After Thyroid Cancer Question Can you give me some advice on getting on with life after someone has gone through thyroid cancer? I feel like I just don’t fit into my life anymore. I am always worrying about my cancer coming back. Answer Michelle LeBeau, Thyroid Cancer Survivor and Founder of REACT Thyroid Foundation responds: I have found the best way to get on
Speech and Memory Problems while on a Long-term Chemotherapy Dear OncoLink "Ask the Experts," My mother has received chemotherapy for acute lymphatic leukemia for the past 8-9 years. Recently she began to have problems with her speech. Lately, she cannot find the right word(s) even though she may know what she wants to say in her mind. This is very frustrating to her. She read something
How kids can support their friends with Leukemia Dear OncoLink "Ask The Experts," Hi, my best friend is 14 and she was just recently diagnosed with Acute Lymphocytic Leukemia and I feel so bad for her and I was just wondering what exactly it was, what is going to happen to her, Is she going to die? Selina M. Luger, MD, Director of the Leukemia Program and
Testicular Relapse of ALL Dear OncoLink "Ask The Experts," Are you aware of any patients or statistics regarding ALL (Acute Lymphocytic Leukemia) with testicular relapse? We believe our son is in this position and we have yet to find a similar case. Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of Medicine
Physical development in an Acute Lymphocytic Leukemia (ALL) survivor Dear OncoLink "Ask The Experts," Height is determined by an individual's genetic make-up but sometimes it does not follow precisely the parents' heights. Also, treatment for cancer can reduce the growth potential. In order to learn whether your child was affected by treatment or leukemia, you should discuss this with her physician. An
Rituxan for ALL Dear OncoLink "Ask The Experts," My oncologist has started a treatment regimen of Rituxan for Acute Lymphocytic Leukemia, Ph+. I cannot find any research that indicates that Rituxan is used for treatment of this disease. I have only found where it is used for the treatment of lymphomas and to get patients ready for transplants. Can you clarify
Treatment for Acute Myeloid Leukemia My grandmother has just found out she has acute myeloid leukemia. I was wondering why she couldn't just have new blood put into her system. (Through one of the machines that cleans your blood when you have kidney problems...you could take out the blood like you were cleaning the blood and then put in "new" blood.) Thank you for you
Secondary Leukemia after breast cancer treatment Dear OncoLink "Ask The Experts," My Mom has been recently diagnosed w/ AML and I was wondering if there was any information on "therapy related AML". Her bone marrow biopsy showed that her leukemia was caused by chemotherapy she had in 2/95 for breast cancer. Thank you for your time. Selina M. Luger, MD,
Acute myeloid leukemia Dear OncoLink "Ask The Experts," A 27-year-old friend has been diagnosed with acute myeloid leukemia. What is the prognosis for the type of cancer he is fighting and how can members of the community help? Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of Medicine at the University of Pennsylvania,
FAB system for defining AML Dear OncoLink "Ask The Experts," Can you please tell me what M4 (FAB) means with AML? Is that type treated different or hard to treat? I am a little confused. Is one sub-type worse than the other? Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of Medicine at the University of Pennsylvania,
AML vs. ALL Dear OncoLink "Ask The Experts," My brother-in-law has been diagnosed with leukemia. Unfortunately, they have been unable to verify which one. They have done two bone marrow biopsies and several chromosome studies but can't conclusively say AML or ALL (although they are leaning toward AML). Is it possible to have both? Selina M. Luger, MD,
Pregnancy and AML Dear OncoLink "Ask The Experts," I received a stem cell transplant for Acute myeloid leukemia (AML) two years ago. I was told I'd never be able to have children and -- lo and behold -- I'm pregnant! I of course will be seeing a specialist who can monitor the baby, but I have a friend who has heard that pregnancy can cause a relapse of some cancers.
Chronic Lymphocytic Leukemia and Dementia Could there possibly be any causal relationship between Chronic Lymphocytic Leukemia (CLL) (or its associated high white cell count) and dementia? My mother was diagnosed with both at about the same time. I know this is most likely a coincidence, but has anybody studied this question? Selina M. Luger, MD, Director of the
Chronic Lymphocytic Leukemia My father has Chronic Lymphocytic Leukemia (CLL). He is 53 years of age. He was diagnosed in 1998, and since then his White Blood Cell count has been between 30,000 and 35,000. However, his last blood work test revealed a jump in the count to 46,000. I've researched his form of leukemia and have found him to be either in Stage 0 or 1. The
CLL in patients under 40 Dear OncoLink "Ask The Experts," I am 38 years old and in the past two weeks my local hematologist has diagnosed me with CLL. My white count is around 15,000 a bone marrow biopsy showed "subtle" infiltration and a CT scan showed no other involvement. I am awaiting appointments with a leukemia specialist at and a BMT specialist. My
Is CLL Hereditary? Dear OncoLink "Ask The Experts," I just wanted to know if I could inherit (CLL) from my mother. She got it when she was about 40, and she has had it for 21 years. Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of Medicine at the University of Pennsylvania, responds: Chronic
Chronic Lymphocytic Leukemia (CLL) Dear OncoLink "Ask The Experts," My mother-in-law has recently been diagnosed with chronic lymphocytic leukemia and I have been trying to research as much as I can about this disease. My mother-in-law has recently been diagnosed with chronic lymphocytic leukemia and I have been trying to research as much as I can about this disease. There is
Bone marrow biopsy for CLL Dear OncoLink "Ask The Experts," I had a blood test a few months ago and a moderately elevated white blood cell was reported "consistent with CLL". Approximately 6 weeks later, I had another test taken by another lab and the white blood cell count was unchanged. A bone marrow extraction was recommended to me after the 2nd test to provide a
Questions about CLL Dear OncoLink "Ask The Experts," My partner has CLL and is 40 years old. He was diagnosed 2 years ago and his white blood cell count has doubled each year for the past two years. His nodes, liver and spleen are enlarged and he is now on chemotherapy. Is CLL related to lymphoma(s)? He does not suffer from frequent infection or fevers will this
When to treat CLL Dear OncoLink "Ask The Experts," I was diagnosed with chronic lymphocytic leukemia (CLL) about 1 1/2 years ago. Today my white count is 27.5. I am going to start a five-week treatment of Rituxan. Is it really time to start? From what I have read, it seems early. Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of
CLL Prognosis Dear OncoLink "Ask The Experts," I am a 48-year-old male recently diagnosed with CLL ( chronic lymphocytic leukemia ). My white blood cell count is 14.05, my red count is 4.59, and my hemoglobin count is 14.1. I just had a bone marrow biopsy, but have not received the results yet. I am also scheduled for a CT scan. I am fairly active, I run 3
Information about Chronic Myelogenous Leukemia Dear OncoLink "Ask the Experts," My father has a form of CML (Chronic Myelogenous Leukemia), but does not have the Philadelphia chromosome. The doctors say this is very rare. He has had four different chemo treatments since he was diagnosed over a year ago and has recently been admitted to the hospital for shortness of breath. Apparently
Is Chronic Myelogenous Leukemia Hereditary? Dear OncoLink "Ask the Experts," I have a friend who is very worried about his adult daughter because his wife died from chronic myelogenous leukemia several years ago. He fears that it could be hereditary and wants to know if/who his daughter should see. Can you give me advice? Thank you. Selina M. Luger, MD,
Hospitalization for chronic myelogenous leukemia Dear OncoLink "Ask The Experts," One of my close friends has recently been diagnosed with Chronic Myelogenous Leukemia. Is there a possibility of them being hospitalized from the disease? Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of Medicine at the University of Pennsylvania, responds:CML or chronic
Myelodysplasia Dear OncoLink "Ask the Experts," My Mom was diagnosed with Myelodysplasia. Mom has been on various forms of medication to encourage her bone marrow into producing red blood cells. So far nothing has worked. Mom's hematologist is now putting her on Rituxan. Please explain why? Thank you. Selina M. Luger, MD,
Fertility after Leukemia treatment Dear OncoLink "Ask The Experts," I am a 24-year-old female who had APL leukemia in august 1999. I took Ara-C, Daunorubicin, and Retnoic acid pills. I would like to try to have a baby with my husband and need to know if the chemo could have caused damage to the eggs and or if the risks of having a handicapped child are very great. I am
Diagnostic tools used to detect leukemia Dear OncoLink "Ask The Experts," What diagnostic tools could have been used to detect leukemia? Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of Medicine at the University of Pennsylvania, responds: We usually investigate a patient for leukemia when there is an abnormality in the
What is the difference between CML (chronic myelogenous leukemia) become AML (acute myelogenous leukemia) and CMMoL (chronic myelomonocytic leukemia)? Dear OncoLink "Ask The Experts," My mother has been diagnosed with CML, however, due to a "negative" result of the Philadelphia chromosome, the doctors are having her examined for chronic myelo-monocytic leukemia. What are the risks for her CML to become AML? Thank you for your response. Selina M. Luger, MD,
Gleevec and the possibility of birth defects Dear OncoLink "Ask The Experts," My brother is taking Gleevec and his wife wanted a child. Now she is pregnant and my family is concerned that this chemotherapy can be a cause for fetal anomalies. Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of Medicine at the University of Pennsylvania,
Pancytopenia Dear OncoLink "Ask The Experts," My friend was diagnosed last night with Pancytopenia. Can you explain this condition please? Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of Medicine at the University of Pennsylvania, responds: Pancytopenia means that the blood counts are low. Normally there
Full remission in leukemia Dear OncoLink "Ask The Experts," My son was diagnosed with leukemia in April 2002 and he has completed his chemotherapy, radiation and he is now in maintenance. My question is "What do you mean by full remission? How can we determine whether my son will remain in full remission"? Selina M. Luger, MD, Director of the Leukemia Program and
Leukemia vs. Mantle cell lymphoma Dear OncoLink "Ask The Experts," My mother was told she has leukemia. Then they gave her a bone marrow test and told her she has mantle cell lymphoma. Everything I have read says she needed a lymph node biopsy. Tomorrow they are giving her a MRI on her pelvis. None of this seems right to me, could you help me please? Selina M. Luger, MD,
Myeloproliferative disorders Dear OncoLink "Ask The Experts," I have a friend who was just diagnosed with MPD. Could you please send me information on what the disorder is exactly? Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of Medicine at the University of Pennsylvania, responds:MPD means myeloproliferative disorder. In these patients,
Autologous Stem Cell Transplant: What to Expect Dear OncoLink "Ask The Experts," My 40 yr old son has just been diagnosed with stage III recurrent Hodgkin's disease. His oncologist has suggested a stem cell transplant as part of his treatment. Can you please tell us what to expect as a result of this in regard to how sick he'll be, what he will need in the way of care for how long, etc., so
Benefit of freezing stem cells if there is a compatible sibling donor Dear OncoLink "Ask The Experts," My partner has CML, and is taking Gleevec. His molecular response has been good. His doctor is suggesting he does a stem cell harvest to keep some stem cells frozen for if & when he needs them. My partner has a sibling donor (his sister). My question to you is, what is the benefit of freezing stem cells if there is
Risks of bone marrow donation Dear OncoLink "Ask The Experts," I am a match to donate bone marrow to my brother. My question is what are my risks, if any, as a bone marrow donor? Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of Medicine at the University of Pennsylvania, responds:From your question, I assume that they are going to collect
Precautions for children of a bone marrow transplant patient Dear OncoLink "Ask The Experts," My brother is about to undergo a bone marrow transplant and he has a 5 year old daughter in kindergarten. We are considering pulling her out of kindergarten when he comes home for fear of her being sick and bringing it into the house with him. What is regularly advised as a precaution here? How can we best protect
Cisplatin versus Carboplatin Dear OncoLink "Ask The Experts," Two respected oncology doctors have given conflicting advice for stage IIIa NSCLC (non-small cell lung cancer) and chemotherapy after surgery. One advised cisplatin, saying it was somewhat more effective than carboplatin. The other said cisplatin is not used much in the U.S. any longer because it has about the same
Auer Rods Dear OncoLink "Ask The Experts," What are auer rods and what do they do? Vicki Sherry, MSN, CRNP, Advanced Practice Oncology Nurse, responds:Auer rods are clumps of granular material found in leukemic blast cells, part of the diagnosis of leukemia. The presence of Auer rods are generally considered to be associated with acute myelogenous leukemia (
Chromosome Abnormalities in Leukemia Dear OncoLink "Ask The Experts," My son-in-law was recently diagnosed with leukemia. He is at Walter Reed Hospital in Washington, DC because he is serving in the U.S. Army. He and my daughter were told that he has an "inverted 16th chromosome". Where can I find additional information on this? Carolyn Vachani RN, MSN, AOCN, OncoLink's
Undifferentiated Acute Leukemia Dear OncoLink "Ask The Experts," My son was diagnosed with acute undifferentiated leukemia. We cannot find any information on this or on treatment options. Can you help shed some light on this, and why this type of leukemia is treated as AML (acute myelogenous leukemia)? Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor
Treatment for Mesothelioma Question My 67-year-old husband was recently diagnosed with Malignant Pleural Mesothelioma. He was and remains asymptomatic of any mesothelioma-associated problems. He underwent pleurectomy/decortication with 2 small malignant plaques, one of which included one mediastinal lymph node positive for mesothelioma metastasis. The next recommendation is
Clinical Trials for Mesothelioma Question Where can I learn how to participate in gene therapy or other clinical trials? How do I know if I could be eligible? Answer James Stevenson, MD, Medical Oncologist, responds: The most comprehensive resource to check is the clinicaltrials.gov website. There, you can search for clinical trials using a variety of filters, and the
Signs and Symptoms of Mesothelioma Question What are early signs or symptoms that I might have mesothelioma? Answer Joe Friedberg, MD, Thoracic Surgeon at Penn Medicine, responds: Approximately 90% of patient present with shortness of breath, chest pain, or both. Less commonly, patients can present with a collapsed lung and have sudden onset of significant difficulty with
Time from Exposure to Development of Mesothelioma Question How long after being exposed to asbestos does mesothelioma take to develop? Answer Joe Friedberg, MD, Thoracic Surgeon at Penn Medicine, responds: Most patients have an exposure to asbestos at least 10 years before their cancer developed, and usually twenty-five or more years after exposure. However, mesothelioma can even develop 50
Second Hand Asbestos Exposure and Mesothelioma Question If I worked in a factory that had asbestos, is it true that my family could be at risk too? Answer Joe Friedberg, MD, Thoracic Surgeon at Penn Medicine, responds: Yes, unfortunately, second hand asbestos exposure is a common cause of mesothelioma. The asbestos fibers can be carried home on clothes, and family members can be exposed.
Support Groups for Mesothelioma Question Are there any support groups that are for mesothelioma and not lung cancer? Answer Christina Bach, MSW, LCSW, OSW-C, Oncology Social Worker at Penn Medicine, responds: Honestly, support groups specifically for mesothelioma are few and far between, and they are often lumped together with lung cancer groups. A good place to start is by
Protecting Yourself While Immunocompromised Knowing that kids tend to be continuously sick, how can someone who is immune compromised be best protected but still spend time with their grandchildren? Christina Bach, MSW, LCSW, OSW-C, Oncology Social Worker at Penn Medicine, responds: You should ABSOLUTELY enjoy your grandchildren! The most important thing to remember is HANDWASHING
Caregiver Support Question It is really hard to take care of my husband, as he is getting sicker. What resources are there for me to help me not get burnout? Answer Christina Bach, MSW, LCSW, OSW-C, Oncology Social Worker at Penn Medicine, responds: Being a caregiver is at the same time an amazing and exhausting process. Taking stock of your resources is an
Radiation Therapy for Mesothelioma Question Is radiation used to treat mesothelioma or just side effects/complications from it? Answer Charles B. Simone II, MD, Radiation Oncologist at Penn Medicine, responds: Radiation therapy can be used in certain settings as potentially curative treatment in the post-operative setting. For patients that had surgery that removed the lung,
Dietary Recommendations for Mesothelioma Question Are there any dietary recommendations or sources that you can recommend? Answer Keith Cengel, MD, Radiation Oncologist at Penn Medicine, responds: There are no specific dietary recommendations at this time, although keeping in positive nitrogen balance (i.e. keeping enough calories so that the patient either gains or maintains
Cured from Cancer? Question At what point is someone considered cured from cancer? Answer Keith Cengel, MD, Radiation Oncologist at Penn Medicine, responds: That depends on the cancer. Typically, we have used 5 years for cancers of the lung or head and neck, but this is somewhat arbitrary. Other cancers, like breast cancer or certain lymphomas, have a pattern
Mesothelioma in Lymph Nodes Question If mesothelioma is found in the lymph nodes, does that mean that it has spread? Answer Keith Cengel, MD, Radiation Oncologist at Penn Medicine, responds: Having mesothelioma in the lymph nodes means the cancer has spread. If the lymph nodes are local (in the chest) this is different than if the nodes are elsewhere (e.g. the
Asbestos Removal Question How do you find a contractor who is trained in asbestos removal? Is there a way to detect if the asbestos in ones home is not contained? Answer Keith Cengel, MD, Radiation Oncologist at Penn Medicine, responds: This is a complex issue. There is an extensive EPA website with answers and helpful tips for asbestos detection, removal
Surgery for Mesothelioma Question Can surgery be done for mesothelioma? What are the side effects and recovery like? Answer Joe Friedberg, MD, Thoracic Surgeon at Penn Medicine, responds: Although most patients with mesothelioma do not undergo a definitive surgery with the intent of removing all sites of cancer, surgery can be done for some patients with
Peritoneal Mesothelioma Question Is mesothelioma of the lung and pleura different than that of the abdomen? Are they treated differently? Answer Joe Friedberg, MD, Thoracic Surgeon at Penn Medicine, responds: Mesothelioma in the abdomen is termed peritoneal mesothelioma. It is a much less common location for mesothlioma to present than the lining of the lung, which
Need a Lawyer With Mesothelioma Diagnosis? Question I see all these advertisements on TV and wanted to know if I need to get a lawyer if I have mesothelioma? Answer Joe Friedberg, MD, Thoracic Surgeon at Penn Medicine, responds: If you have mesothelioma, you need to see a doctor as your first order of business. It is probably a good idea to speak with a lawyer regarding your
Causes of Mesothelioma Question Is there anything other than asbestos that can cause mesothelioma? Answer Joe Friedberg, MD, Thoracic Surgeon at Penn Medicine, responds: Asbestos is far and away the most common. Known asbestos exposure is reported to account for 50-70% of cases of malignant pleural mesothelioma, although it is likely that asbestos play a role in
Lung Cancer and Mesothelioma Question Is it possible to have lung cancer and mesothelioma? Answer Melissa Culligan, RN, Nurse with the Mesothelioma and Pleural Disease Program at Penn Medicine, responds: Yes, is it rare but possible to have both lung cancer and mesothelioma? You can learn more about both types of cancer on OncoLink. This question and answer was part of
Asbestos in the Environment Question Is asbestos found naturally in the environment? I read it is more common in certain parts of the world. Answer Dan Sterman, MD, Interventional Pulmonologist at Penn Medicine, responds: Asbestos is a naturally occurring group of minerals that is indeed more prevalent in certain areas of the world. Large quantities of asbestos fibers
Safety of Gene Therapy for Mesothelioma Question How can I be sure gene therapy or T cell therapy are safe? Answer Dan Sterman, MD, Interventional Pulmonologist at Penn Medicine, responds: Currently, patients can only receive gene therapy, T cell therapy, and other immune-based therapy as part of a clinical trial. There is no guarantee of safety for participation in any clinical
Gene Therapy for Mesothelioma Question What results are you seeing in using gene therapy to treat mesothelioma? Answer Dan Sterman, MD, Interventional Pulmonologist at Penn Medicine, responds: The results of gene therapy trials for mesothelioma to date (from 1995 to the present) have shown that the delivery methods are safe, that we can get expression of the therapeutic
DIY Asbestos Removal and Mesothelioma Question What trials and treatment options have good results? Is there a campaign running for do-it-yourself removal since there is so much asbestos still in the homes? Does the Unites States have the same problems in schools that we have in the United Kingdom that the buildings are old and have asbestos? Answer Dan Sterman, MD, Interventional
All Asbestos Risk the Same? Question Do all types of asbestos have the same risks? Answer Dan Sterman, MD, Interventional Pulmonologist at Penn Medicine, responds: All forms of asbestos are capable of causing mesothelioma, and no form of asbestos should be considered "safe." There are, however, different degrees of the asbestos fibers being able to cause cancer. In
Websites for Mesothelioma Question How do I know if websites about mesothelioma are reliable? It seems many are sponsored by law firms. Answer James Stevenson, MD, Medical Oncologist, responds: This is a major issue for mesothelioma, as there is a lot of unreliable information on the Internet. A trustworthy website for mesothelioma information is curemeso.org,
Risk with Asbestos Exposure and Smoking Question Is a person more likely to get mesothelioma or lung cancer from asbestos exposure if they smoke? Answer James Stevenson, MD, Medical Oncologist at Penn Medicine, responds: You would be more likely to get lung cancer because we know that asbestos and cigarette smoking together significantly increases your risk of developing lung
Chemotherapy Resistance Question Why do chemotherapy drugs stop working or need a period of time before they can be used again? Answer James Stevenson, MD, Medical Oncologist, responds: Cancer cells can find ways to become resistant to chemotherapy through different mechanisms. This is an intensive area of research. Specific resistance mechanisms (such as a gene
Too Late To Treat Mesothelioma? Our current insurance provider has been disinterested at best in treating my father's condition. It seems they have the mindset that there is "nothing to do." We have pushed & pushed, but to nothing but a runaround. He is 8 months into diagnosis at age 59, post surgery. How do we know when it's too late to seek alternative
To Treat Mesothelioma or Not? Question My grandmother was diagnosed 2 weeks ago with mesothelioma, she's had liquid drained from her lung, and they had to unclog an artery. The doctor ruled out the surgery and chemotherapy because he says it will only make it worse, so she is on depression medication and painkillers. Should we just follow his advice and let her live on with
Screening for Mesothelioma Question Can I get some kind of screening test if I know I was exposed to asbestos? Answer Charles B. Simone II, MD, Radiation Oncologist at Penn Medicine, responds: Unfortunately, there is no proven screening method, either blood test or radiological study, for patients who have been exposed to asbestos, at least for early detection of
PET Scan for Lung Cancer Question I am a medical student. I heard a lot of discussion of using PET scans as a diagnostic tool for staging non small-cell lung cancer. Can you provide me more information? Thanks! Answer Li Liu, MD, OncoLink editorial assistant, responds: Lung cancer is the leading cause of death from cancer for both men and women in the United States.
Enrollment in a Clinical Trial? Question My husband was recently diagnosed with lung cancer and is considering other treatment options or even enrolling in a randomized trial. I would be worried that if he does enroll in a trial, he would receive a placebo and not be treated properly. I am desperately seeking help – I want him to get the best treatment in the country.
Treatment for Stage IIIB Non Small-Cell Lung Cancer (NSCLC) Question My mother has been diagnosed with stage IIIB non-small cell lung carcinoma with cancer also in the lymph nodes. There is a mass in her right upper lung and it is inoperable because of the stage it is in. They are treating her with radiation therapy and chemotherapy. I want to know what this treatment is going to do exactly – cure
Brain Metastases from Lung Cancer Question A good friend of mine was recently diagnosed with brain metastases from his lung cancer, adenocarcinoma type. The neurosurgeon said to him that surgery is the treatment of choice for his case. He was also seen by a radiation oncologist who claimed that radiation therapy is just as effective as surgery. Could you help him? Answer Li Liu,
Lung Cancer Surgery and Seniors Question Would you recommend lung cancer surgery on an 80 year old with non-small cell lung cancer who is in good health? What type of surgeon should do this procedure? What steps would you recommend for the most aggressive approach? How can a non-oncologist be knowledgeable enough to perform such an intense surgery? Answer Charles B. Simone
Surgery for Stage IIIB Non-Small Cell Lung Cancer (NSCLC) Question Our mother was just told that she has stage IIIB poorly differentiated non-small cell lung cancer. They cannot do surgery because it is too close to her aorta. We live in a small town and we are wondering if there is a chance that if we went to a larger hospital, or to a different doctor in a bigger town that they may consider doing
Treatment for Stage IIIA Non-small Cell Lung Cancer (NSCLC) Question My 69-year-old mother-in-law was recently diagnosed with Stage IIIA (T3N1) non-small cell lung cancer. She also has emphysema with low lung volume but very good lung function. She is going to undergo 3-4 weeks of chemo (taxol and carboplatin once a week) plus daily radiation therapy treatments. The thoracic surgeon will then perform
Progression of Non Small-Cell Lung Cancer Question My husband was diagnosed with stage IIIB adenocarcinoma, which presented with superior vena cava syndrome. He has received radiation treatment concurrent with chemotherapy and is now receiving full strength chemotherapy. We were told at the time of diagnosis that the treatments were to "buy time", not cure. I have searched many web sites,
Chemotherapy and Radiotherapy vs. Surgery Question Yesterday, my father was diagnosed with adenocarcinoma type of non-small cell lung cancer. A tumor the size of a lemon was found on his right lung and found to have spread to his lymph nodes. He will be receiving more tests next week to determine if has spread to his brain. The doctor recommends starting chemotherapy twice a week, every
"Remission" of Stage IIIB Non-small Cell Lung Cancer (NSCLC) Question My mother was diagnosed with non-small cell lung cancer stage IIIB. She has completed her 6 treatments of chemotherapy (taxol). The tumor has shrunk from 4cm to about the size of a thumbnail. Her doctor has now told us that he will do follow-up scans and blood work and that we will see him in 6 weeks. Is this stage considered remission or
Does lung cancer spread when exposed to air? Question My father has been diagnosed with Stage I non-small cell lung cancer. We are considering surgical resection. Is there any truth to the claim that cancer spreads when the "air hits it"? Answer Blair Marshall, MD, Thoracic Surgeon, responds: There is no scientific data that supports that theory. That concept stems from rumors, most
Treatment of Stage IIIB Non-small Cell Lung Cancer with Bevacizumab Question I recently discovered that my dad has stage IVA non-small cell lung cancer with a malignant pleural effusion. He is scheduled to undergo chemotherapy using carboplatin and paclitaxel, and his medical oncologist is also considering adding the angiogenesis (VEGF) inhibitor called Bevacizumab. Should he receive Bevacizumab with the
Bronchioloalveolar carcinoma Question My father was diagnosed with bronchioloalveolar carcinoma with bone metastasis. He passed away very quickly. He was told that this type of cancer does not respond to chemotherapy. Can you tell me why this type of cancer is so unresponsive? Also, is this a rare type of lung cancer and what are thought to be the causes of this in a
Non-small cell lung cancer with neuro-endocrine features Question I recently was diagnosed with metastatic non-small cell lung cancer with neuro-endocrine features. I am unable to find any information on the web about this type of cancer. Can you give me more definitive information? Answer Barbara Campling, MD, Medical Oncologist, responds: Some kinds of lung cancer have features of neuroendocrine
What is Bronchioloalveolar Carcinoma? Question What is differential bronchioloalveolar cancer? Answer Charles B. Simone, II, MD, Radiation Oncologist at Penn Medicine, responds: Bronchioloalveolar carcinoma (BAC) is a subtype of adenocarcinoma of the lung. The term BAC, however, has been replaced since it was found to comprise at least five different types of lung cancer with
Follow Up for Stage IIIA Non-Small Cell Lung Cancer (NSCLC) Question After therapy for stage IIIA NSCLC, my doctors said we would do follow up chest x-rays every 3 months for the next 2 years, and then twice a year for 3 years. I questioned why they would not do CT and or PET scans, and I was told that if metastasis is discovered, it would not change the result or the amount of time I would ultimately
Pleural Effusion with Negative Cytology Question My mom was treated for stage IIIA lung cancer (non-small cell lung cancer). She had chemotherapy combined with radiation therapy, finished treatment in March, and was declared in remission in May. In August, she had a pleural effusion, but a CT scan and PET scan showed nothing. They drained the fluid in her lungs and did not find cancer.
Brachytherapy at the Carina Question I have a patient status post chemotherapy and radiation therapy for non-small cell (squamous) carcinoma of the right upper lung. He now has a recurrence confirmed by biopsy in his carina, and brachytherapy has been suggested. Is there any literature out there on brachytherapy at the carina? I understand that this is a rare place for a
Treatment for Stage IIIB Non-Small Cell Lung Cancer (NSCLC) Question My wife has just been confirmed through a biopsy of having stage IIIB non-small cell lung cancer. Lymph nodes in her neck and chest are involved. We have yet to see an oncologist. Hope to this week. What treatments are recommended? What other questions should we ask? The pulmonologist stated that he thought treatment would be
Sheep Virus Linked to Lung Cancer? Question My husband lived and worked on a farm in South Africa with sheep for many years. He has just been diagnosed with Stage IV non-small cell lung cancer. I have been searching on the web and found a website about a disease that sheep in South Africa get called "jaagsiekte". It states that there might be a link to that sheep disease and human
Carboplatin/Taxol Weekly vs. Every 3 Weeks Question I was recently diagnosed with non-resectable Stage IIIB non-small lung cancer. My treatment to date has been 33 radiation therapy treatments concurrently with 7 low-dose carboplatin and taxol chemotherapy treatments given weekly with radiation therapy. There is a question as to the next course of treatment: low-dose chemotherapy (3 weeks
Small Cell Carcinoma Question I am trying to find information on small cell carcinoma. I was diagnosed recently with small cell carcinoma and am being treated with chemotherapy. I am a 44 yo male, non-smoker with no history of cancer in my family. CT's and a PET/CT did not find where the tumor came from before spreading to my lymph nodes. I was diagnosed with this
Small Cell Lung Cancer Concerns Question Recently my 58-year-old father was diagnosed with small cell lung cancer. He has undergone chemotherapy and radiation therapy. He smoked 40 of his 58 years. My father is unaware of the lifetime effects this cancer has, and that he has no chance of cure. The doctor has chosen not to tell him this information unless he asks. This is in an
Studies on the Effects of the Prophylactic Radiation Question I have limited-stage small cell lung cancer. I had four cycles of chemotherapy with carboplatin and etoposide, which was extremely effective. I will complete 30 treatments of radiation therapy next week to my lung area. My oncologist wants me to have 10 prophylactic cranial irradiation (PCI) treatments to my head. My mother also has lung
Small Cell Lung Cancer Metastasized to the Brain My mother was diagnosed with small cell lung cancer in January of 2001. She has been through Chemo and radiation and the tumor in her lung did shrink to approx 1 1/2 cm. She was doing well, went back to work part time. In November, she began to have tremors. I took her to the Emergency room where we were told that she has 4 tumors on her brain.
Treatment Options for Extensive-Stage Small Cell Lung Cancer Question My 51-year-old husband has just been diagnosed with small cell lung cancer that has metastasized to his liver. They are treating him with three days of chemotherapy every third Monday. No radiation therapy, no surgery. Yet the doctor says he has not probably had this even 6 months. What else should we do? Are they giving up on my husband
Causes of Small Cell Lung Cancer Question My spouse recently passed away from lung cancer at the age of 43. He was a smoker for many years. I understand that small cell cancer is microscopic. Are there any findings that small cell lies dormant? I am trying to understand why the small cell cancer all of a sudden developed in my spouse. Could some exposure, either recent or from his
Making Decisions about Radiation Therapy for Limited Stage SCLC I have been diagnosed with limited stage SCLC and have started chemotherapy. The doctors tell me that radiation will be combined with the chemotherapy during the 4th round. They tell me that after radiation a lot of scar tissue will result and that I may be on oxygen for the rest of my life. I am seriously considering not having the radiation but
Extrapulmonary Small Cell Tumors Question Yesterday, I heard from my male friend, who is 66 years old and who has been a smoker for at least 30 years. He has been diagnosed with a form of what is commonly called small cell cancer. It apparently started in his injured leg, not his lungs, and it has since metastasized through the bulk of his organs. He was told he has about six
Treatment Options for Recurrent Small Cell Lung Cancer Question I am a 42-year-old male who has been treated for small cell lung cancer. I had a large tumor in my right upper lobe, as well as cancerous lymph nodes on both sides of my neck. I received 6 cycles of chemotherapy with carboplatin and etoposide on a 3-week cycle, along with radiation therapy to my upper lung and chest beginning with my
Third-Line Treatment for Small Cell Lung Cancer Question I was diagnosed with small cell lung cancer with metastasis to the liver. After a couple of cycles of topotecan and paclitaxel, I improved, but my cancer later progressed. My chemotherapy was changed several months ago to cisplatin and irinotecan, which seemed to significantly help me. However, in the last month I started feeling worse,
Two Primary Cancers to Occur in the Same Patient Colon Cancer and Small Cell Lung Cancer I am writing about a male patient 61 years old who was diagnosed with cancer in two primary sites. The oncologist does not know how to treat this. The two sites are lung and colon (with the colon adenocarcinoma metastasized to the liver). Both lungs have been diagnosed by one pathologist as having oat cell or small cell carcinoma, but a second
Fatigue After Lung Cancer Treatment Question My father-in-law has received chemotherapy and radiotherapy treatment for small cell lung cancer in both lungs and his head. He has been told that the tumor in his lungs has been burned away with part of his lung. He is now anemic and very tired and constantly feels unwell. His doctor will not give him any medication to help even though
Prognosis for Extensive-Stage Small Cell Lung Cancer Question My Mom was diagnosed with small cell lung cancer in January. They found some spots around her aorta, in her lymph nodes, and in the spine. She is just completing her 4th cycle of chemotherapy. The doctor said now we stop treatment and watch and wait. My question is, what are the chances of recurrence? We were told that there is a 50%
Small Cell Lung Cancer Treatment and Prognosis Question My father-in-law has small cell lung cancer. He was treated with chemotherapy and radiation therapy. They then discovered a metastasis in his brain. So, he was started on radiation to his brain. As far as I know, the cancer is only in the left lung and one site in the brain. Will you please tell me what is the average time he may survive?
Paraneoplastic Limbic Encephalitis Question My mother was recently diagnosed with SCLC, limited stage. She started chemotherapy and was making good progress, but unfortunately had a complication called paraneoplastic limbic encephalitis. The doctors have said that it has reached a point where we should let nature take its course. Do you have any experience of PLE? We are trying to
Prophylactic Cranial Irradiation for Small Cell Lung Cancer Question Can you give me information and statistics on prophylactic cranial irradiation for prevention of small cell lung cancer? My husband is in remission and this procedure has been recommended. Thank you. Answer Barbara Campling, MD, Medical Oncologist, and Stephen M. Hahn, MD, Professor of Radiation Oncology at Penn Medicine, respond: It's
PET Scan for Small Cell Lung Cancer I would like to know the role of PET scan for small cell cancer. I was told by my doctor that small cell cancer not sensitive to FDG avidity. Please advise, thank you. Peeyush Bhargava, MD, Assistant Professor of nuclear medicine physician at both St. Luke's Roosevelt Hospital Center at the University Hospital of Columbia University College of
Treatment for Small Cell Lung Cancer My mother was recently diagnosed with extensive stage small cell lung cancer and has been offered chemotherapy with cisplatin and VP-16. What is the most up to date treatment for this disease? Barbara Campling, MD, Medical Oncologist at the Abramson Cancer Center of the University of Pennsylvania, responds:Small cell lung cancer occurs almost
Cure from Small Cell Lung Cancer Question I was a long-time smoker and diagnosed with small cell Lung cancer in 2003. I was told I could not have surgery on my lungs, but I did have a brain tumor due to this cancer that was removed with no difficulties. I had chemotherapy and radiation therapy shortly afterwards. It has been almost five years now and I want to know if I'm almost
Pulmonary Carcinoid Question I am looking for information on pulmonary carcinoid tumors. My brother has been diagnosed with this and we need information. Thank you for your time and attention to this matter. Answer Li Liu, MD, Editorial Assistant for OncoLink, responds: Pulmonary carcinoid tumors (PCT) are types of lung neuroendocrine tumors, cancers in which
Depression After Cancer Surgery Question My father recently had a surgery for his lung cancer. The doctor said his cancer was Stage I. I have noticed that he has been quite depressed since the operation despite his doctor's assurance of a high cure rate for his cancer. Is depression common in patients with lung cancer? Thank you. Answer Li Liu, MD, Editorial Assistant for
Mixed Small Cell/Non-Small Cell Lung Cancer Question My father was recently diagnosed with lung cancer, both small cell (limited stage) and non-small cell (Stage IIIA, T2N2M0). Apparently, it is rare to have both types of lung cancer at the same time. He is currently getting chemotherapy once per month for 3 days straight concurrently with daily radiation therapy for 7 weeks. My questions
Lung Cancer Screening I have learned from you site and others that lung cancer is the leading cause of cancer deaths. Does it make sense to screen general population with chest x-ray or CT scan so that patients can be detected earlier and hopefully cured? Thanks! P Li Liu, MD, Editorial Assistant for OncoLink, responds: This is an excellent
Why not radiate extensive stage lung cancer? Can radiation treatment be used on lung cancer? If so, to what dosage? To all areas of the lung? My father has small cell lung cancer that has responded well to chemotherapy. I'm wondering what would prevent treating his lung tumor with radiation? Mitchell Machtay, MD, Assistant Professor of Radiation Oncology at the Hospital of the
Reducing Secretions Related to Metastatic Lung Cancer Question What is the best way to reduce the copious secretions related to metastatic lung cancer? Answer James M. Metz, MD, Editor-in-Chief of OncoLink and Professor of Radiation Oncology at Penn Medicine, responds: The answer would depend on what type of secretions to which you are referring. You should discuss the secretions with your
Nausea During Lung Cancer Treatment Question My mother has lung cancer and is receiving radiation therapy, but she cannot receive chemotherapy until she is healthy enough. She has not been able to eat even before the radiation therapy started, and the cancer has spread so they need to hurry up and get her on to chemotherapy. She is taking Reglan for nausea but it is not helping. She
Loss of Appetite During Lung Cancer Treatment Question What should a lung cancer patient do if they are losing too much weight? How can they overcome a loss of appetite? Answer Ellen Sweeney, RD, Registered Dietitian, responds: Many lung cancer patients are noted to have lost weight prior to their cancer diagnosis, which is often due to the effects that the disease itself has on their body.
Side Effects of Pneumonectomy Question I had a lung removed this past October. My question is does removing a lung affect your ability to sing? I used to sing in church, but since just prior to the surgery I felt like there was a lump in my throat or that I strained my voice if I would sing and try to hit a high note. I have been to an ENT physician and have had my thyroid
Lung Cancer Stages Question My Father-in-law was recently diagnosed with Stage IV Lung cancer. Could you tell me what that means? Answer Mitchell Machtay, MD, Radiation Oncologist, responds: The "stage" of a cancer indicates how advanced someone's cancer is. Early stage means that the cancer is relatively small and well confined, while very advanced stage cancer
Itching associated with lung cancer with liver metastasis Question My cousin has been diagnosed with lung cancer and now has liver cancer and cancer in her lymph nodes. She has severe itching and has these little scabby spots all over her body from itching. Can the itching be connected with the cancer? Thanks for your help. Answer Barbara Campling, MD, Medical Oncologist, responds: It is hard to know what
Pipe smoking and the risk of lung cancer Question My husband smokes a pipe, and he is always dismissing the risks of getting cancer. Despite the recent death of a fellow pipe collector, he insists cancer is relegated to cigarette smoking. I am hoping you can connect me with some solid facts/ stats on cancer related to pipe smoking. He is now 50 years old, but he has been smoking for at
Smoking after Lung Cancer Diagnosis Question Does stopping smoking and/or drinking significantly improve lung cancer outcome? If a patient stops smoking after diagnosis, does his/her prognosis improve? Does smoking or drinking interfere with any cancer treatments? If a patient is terminal, will he/she then be permitted to smoke? At what point is the lung cancer patient allowed to
Treatments for Stage IV Adenocarcinoma of the Lung Question On October 2001, my dad was diagnosed with lung cancer (adenocarcinoma) Stage IV (brought on by asbestos contamination) with the tumor in his lung and liver. Last month, he finished 6 cycles of chemotherapy treatments (taxol and carboplatin) with mild improvements. Just this past weekend, though, he became very disoriented in his walk,
Smoking Cessation after Diagnosis of Lung Cancer Question My question is about terminal lung Cancer. What are the benefits of smoking cessation if the patient is terminal? I am wondering if the stress of withdrawal will reduce their quality of life. If you know of any references that could help me out, I would appreciate it since I have not been able to find any journal articles. Answer Mitchell
Can Stage 3B Lung Cancer Be Treated by Surgical Resection? I have a friend that was recently diagnosed with non-small cell lung cancer. He has a tumor within the sac lining the right lung. He has been told that this type of tumor is non-surgical b/c it is within the sac around the lung and not in the lung itself. His wife recently heard of a doctor that did some surgery on a friend's mother to remove
Support for Lung Cancer Patient Question How can I deal with a family member who has been told she has lung cancer? How can I help her and myself? Answer Barbara Campling, MD, Medical Oncologist, responds: One way to help would be to find out more about the type and stage of lung cancer that your family member has. There are a variety of types of lung cancer, but the most common
Lower Extremity Edema Question My mother was diagnosed three months ago with stage IV lung cancer with metastasis to the brain. She received radiation therapy for about 5 weeks and as of her last MRI, the tumors in both areas of the brain have shrunk. Her next MRI is coming up soon. She is on one liter of oxygen and can get around a little bit. Her biggest problem now
Does celecoxib boost the efficiency of chemotherapy? Question I read an article recently online that reported that celecoxib (Celebrex), a drug for arthritis, could boost the efficiency of chemotherapy. Would you recommend taking this drug along with chemotherapy even though the effects are still be investigated? Answer Barbara Campling, MD, Medical Oncologist, responds: Your question is a very
What to Expect in End Stage Lung Cancer My mother has lung cancer for the last several years and now has brain cancer. She has undergone radiation treatment and is currently still getting chemo treatment for her lung cancer. Our family understands that she only has a little time left with us but no one seems to know what she can expect in her final months. I don't want to focus on the
Treatment for Brain Metastasis Question My brother is 43 years old and had a non-small cell tumor removed from his lung. There was no follow-up treatment because they "got it all." Six months later, he was found to have a tumor in the brain that was thought to have spread there from his lung cancer. When he had a "stroke," they removed the tumor from the brain surgically. They
Quit Smoking Question I am a thirty-year-old woman who has smoked on and off for 10 years, with a 3-year break in between. I am a full-time student and worker, and I am currently a light smoker, but I realize I am relying on smoking for stress reduction (I also exercise at a high level most days). I am very interested in QUITTING smoking forever. I have noticed
If smoking kills, then why not ban it? Question Is there any real proof that smoking does kill? If it is so deadly, why isn't it banned? Answer Barbara Campling, MD, Medical Oncologist, responds: The evidence that smoking can kill comes from many sources, and the evidence is very strong and very compelling. There are literally thousands of substances in cigarette smoke, many of which
Age-Related Lung Cancer Risk Question At what age can you get lung cancer? Answer Barbara Campling, MD, Medical Oncologist, responds: The median age of diagnosis of lung cancer is in the mid 60's. This means that half of the people who get lung cancer are above this age and half are below it. This does not mean that only older people get lung cancer. The youngest patient that
Ex-smoker wants to decrease risk of lung cancer I smoked 1 pack of cigarettes between the ages of 17 and 26. I am now 37 years old, in good health with a good fitness regime. As an ex-smoker I am interested in my current risks of developing lung cancer and how I can continue to minimize those risks. Barbara Campling, MD, Medical Oncologist at the Abramson Cancer Center of the University of
Smoking with Recurrent Lung Cancer Question My father (53 years old) was diagnosed with non-small cell lung cancer nearly a year ago. He responded to first-line treatment of chemotherapy and radiation therapy but his tumor recently began growing again. He is now receiving docetaxel. My father's oncologist said that smoking did not cause his cancer, even though he smoked for 43
Pain after Lobectomy Question After having my lower left lobe removed, I have had continuing pain in my left side below my breast in the rib area. I have been improving over the last four months, but the pain is still consuming my attempt at a positive attitude. My doctors are not really given me any indication as to how long this healing will take. Is there any time
Follow-up X-rays after Lung Resection Question I had a lung removed, and my cancer was staged as T2N0M0. My course of treatment is a CT scan every six months. I have read about other people with the same stage who are receiving a CT scan every three months. I am nervous about the frequency of my CT scans but do not want my doctor to think I am questioning him unless I have to. Should I
Marijuana and cancer Question I am wondering if any cases of lung cancer (or other cancer) can result from smoking marijuana? Answer Barbara Campling, MD, Medical Oncologist, responds: Yes, there is evidence that marijuana smoking can cause cancer, in particular lung cancer. Smoke from burning marijuana contains many of the same carcinogens found in tobacco smoke, some
Inoperable Lung Cancer Question My brother-in-law was recently diagnosed with lung cancer. It has already spread to his brain, and they have told him it is inoperable. Could you tell me exactly what this means? If there is no hope of curing it, why does he have to go through chemotherapy and radiation therapy? Answer Barbara Campling, MD, Medical Oncologist, responds:
Targeted Therapies for Adenocarcinoma of the Lungs Question What drugs are available that use molecular targeting for adenocarcinoma of the lungs? Answer Barbara Campling, MD, Medical Oncologist, responds: "Targeted therapies" are pharmaceutical agents that have been designed to target and inactivate specific molecular pathways that are activated in cancer, as well as other diseases. The most
Treatment Options for Advanced Lung Adenocarcinom Question My father is 57 years old and was recently diagnosed with an adenocarcinoma in both lungs (not operable) and cerebral brain metastasis. The oncologists consider the condition not surgically treatable, while the neurosurgeon considers the condition treatable with traditional surgery or radiosurgery. The doctors decided that my father
Lung Cancer Treatment Question My friend quit smoking and then later was diagnosed with lung cancer. She is in her early 40's and had 1/3 of her lung removed, but now the cancer has spread into several small tumors in different places. Due to her mother and younger sister previously dying of breast cancer and having side effects from their cancer therapy, she has
"Localized" Lung Cancer Question My father-in-law has small cell lung cancer. When I asked the oncologist what stage it was, he told me it is localized. I am not sure what that means. Could you explain what a localized cancer is and what stage it is? Answer Anil Vachani, MD, Pulmonologist at Penn Medicine, responds: Small cell lung cancer is staged differently than most
Pleurodesis Question Is there such a thing as dusting a person's lungs to try to build a "dam" to prevent fluid from building up? Answer Carolyn Vachani RN, MSN, AOCN, OncoLink's Medical Correspondent, responds: The buildup of fluid in the lungs is called a pleural effusion. This fluid forms in the space between the actual lung and its lining, which is the
Marijuana Smoke and Cancer Risk Question Does smoking marijuana cause cancer? Answer Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds: This is an interesting question. There are a few things we know about marijuana smoke: It contains several of the same substances in cigarettes that cause cancer. Benzopyrene, a cancer-causing agent, is present in higher
Early Stage Lung Cancer Treatment Question I am a 49-yr-old white male in excellent health with a 35 pack-year history of smoking and a family history of lung cancer (father). I noticed blood in my sputum 5 weeks ago (the day I quit smoking). Three days later, I was told a CT scan revealed a mass in my lung. I since had a thoracotomy (of the right upper lobe) performed without
Secondhand Smoke and Lung Cancer Risk and Screening Question I am a 37-year-old female non-smoker. Although I have never smoked, both my father (at age 51) and paternal grandmother (at age 72) died of lung cancer and smoked heavily. I was exposed to years of second-hand smoke, as I lived in the same house as my father for 12 years and he averaged 3-5 packs of cigarettes a day. Am I at high risk for
Smoking and Exposure after a Diagnosis of Lung Cancer Question My father was diagnosed with stage IIIB lung cancer and will be undergoing chemotherapy. He quit smoking about 3 years ago and so did his wife. There are other individuals in the household that smoke and feel it is all right to smoke in a different room or when he is not home. My question is: Is this thinking logical? Will the residue
Low Sodium and Lung Cancer Question Is there a link between low sodium levels and adenocarcinoma of the lung? Answer Barbara Campling, MD, Medical Oncologist, responds: Patients with lung cancer can develop low sodium levels (hyponatremia) for the same reasons as other patients. These reasons can include heart failure, liver cirrhosis, use of diuretic medications, adrenal
Pulmonary Nodule on CT Question My wife was recently notified of the possibility of a "small malignancy" in the right upper lobe of her lung. The mass was categorized as a "subpleural, subcentimeter (8mm) pulmonary nodule" confirmed by a contrast CT scan. She is a smoker, age 46. We have seen a thoracic surgeon for consultation, and were told that nothing should be done
Prophylactic Cranial Irradiation PCI Long Term Effects Question My sister has gone through 5 cycles of chemo (1 more cycle to go) and 25 chest radiation therapy treatments. The doctor is suggesting PCI (10 treatments) when her chemo is finished. She has asked questions regarding long-term effects and was told to surf the net to find out (I find that unacceptable). If you can offer any information or
Blood Test to Detect Lung Cancer Question I recently saw a story on the news that a blood test can detect lung cancer early. Can you tell me more about this test? Answer Anil Vachani, MD, Pulmonologist at Penn Medicine, responds: Unlike other blood tests typically used to detect cancer, this test does not look for substances produced by cancer cells as they grow (such as PSA for
Esophagitis during Lung Cancer Treatment Question My father was recently diagnosed with stage IV lung cancer. He is undergoing chemotherapy and radiation therapy. He has started having severe pain in his esophagus and tried "magic mouthwash" unsuccessfully. Is there anything that can help relieve some of the pain for him? Answer Beth Sandy, MSN, CRNP, OCN, board certified nurse
Stage IV Lung Cancer Prognosis Question I would like to request assistance for my dad and me. He is under treatment for lung cancer, Stage IV, and the doctor said treatment will be chemotherapy delivered on one day, followed by another dose after 21 days. The doctor said there will be another 5 doses to complete therapy, and that my father's life span is not more than 6 months
Fiberglass and Lung Cancer Risk Question I would like to know if there is a link between breathing in fiberglass particles and lung cancer? Also, is glass fiber-reinforced epoxy resin harmful? Where I work, these are used and the dust is freely dispersed into the air, causing some of my fellow workers considerable breathing discomfort. My employer has said it is as safe as adding
Maintenance Chemotherapy for Lung Cancer Question My sister's doctor told her she would be getting "maintenance chemo." Can you explain what that means? I have tried searching the web, but I cannot find anything about it. Answer Tracey Evans, MD, Medical Oncologist at Penn Medicine, responds: Maintenance therapy is therapy given after the initial cycles of chemotherapy to keep the cancer
PET Scan in Lung Cancer Follow-up Question Can you address the use of PET scans for follow up after surgery? Answer Charles B. Simone II, MD, Radiation Oncologist at Penn Medicine, responds: There are no recommendations that are widely agreed upon for how to follow patients once they have completed therapy for lung cancer. The options are to use chest x-rays, CT scans, or CT-PET
Flu Shot on Chemotherapy? Question I have lung cancer and am getting chemotherapy. Can/should I get a flu shot? Answer Susie Stonehouse-Lee, MSN, CRNP, Nurse Practitioner at Penn Medicine, responds: Patients receiving chemotherapy should receive a flu shot. Compromise to the immune system, as chemotherapy may due by decreasing your blood counts, puts you in a higher risk
Coping With Co-Pays Question I am concerned about the cost of treatments. I have Medicare, but I am responsible for a 20% co-pay for every chemo infusion, not to mention other pills I take. What can I do? Answer Christina Bach, MSW, LCSW, OSW-C, Oncology Social Worker at Penn Medicine, responds: Thanks for asking such an important question. You are right to be
Detecting Lung Cancer Early (Screening) Question I smoked a lot for a long time, but I quit 5 years ago. Is there anything I can do to prevent getting lung cancer or to increase my chances of getting it detected early? Answer Anil Vachani, MD, Pulmonologist at Penn Medicine, responds: A recent large randomized study has demonstrated that CT screening can lead to decreased mortality from
Support Groups for Lung Cancer Question There are so many support groups for women with breast cancer, but I am a woman with lung cancer. A generic support group just doesn't get it- I feel like they don't understand the way other people make you feel since I was a smoker (many years ago!). Are there groups for lung cancer? Answer Christina Bach, MSW, LCSW, OSW-C, Oncology
Minorities and Lung Cancer Question Is it true that African-Americans are more likely to develop lung cancer than other groups and also more likely to die from it? If so, why? Answer Chanita Highes-Halbert, PhD, Racial Disparities Expert, adds: Studies show that African Americans are more likely than whites to develop lung cancer and to die from this disease. The reasons
How to Respond to the Smoking Question? QuestionThere are so many support groups for women with breast cancer, but I am a woman with lung cancer. A generic support group just doesn't get it – I feel like they don't understand the way other people make you feel since I was a smoker (many years ago!). Are there groups for lung cancer? AnswerChristina Bach, MSW, LCSW, OSW-C, Oncology
Draining Pleural Effusions at Home QuestionI have an effusion that keeps filling up, and I have been getting it drained every week at my doctor's office. They want me to have some type of catheter put in so it can be drained at home. That sounds risky – wouldn't I be more at risk of infection if I do it myself at home? AnswerAnil Vachani, MD, Pulmonologist at Penn Medicine,
Prophylactic Cranial Irradiation (PCI) Question My doctor is suggesting I have radiation to my brain to prevent cancer from going there. Is that standard practice? Should I be concerned about the effects on my brain's function? Answer Charles B. Simone, II, MD, Radiation Oncologist at Penn Medicine, responds: Radiation therapy to the brain when there is no known brain cancer there is
Quit Smoking Support Question How can I get help to quit smoking that actually works? How/where do I start? Answer Christina Bach, MSW, LCSW, OSW-C, Oncology Social Worker at Penn Medicine, responds: Congratulations on wanting to quit smoking! That is a very important first step. There are many options for getting help with quitting. I would first encourage you to
VATS Versus Open Surgery Question I had 2 surgery opinions – one would use !0VATS!1, the other would use a traditional open surgery. Are the two equal? I realize VATS may have fewer complications, but I wonder if that procedure compromises the treatment? Answer Taine Pechet, MD, Thoracic Surgeon at Penn Medicine, responds: Minimally invasive surgery using VATS, as
Dealing with Fatigue QuestionI feel so exhausted from my treatments. What can I do to give myself more pep? Some say I should exercise, but won't I get short of breath, since after all, I have lung cancer? AnswerCharu Aggarwal, MD, MPH, Medical Oncologist at Penn Medicine, responds: Keeping fit and staying healthy is important for you while you get chemotherapy. If
Chemo and Radiation Given Together Question Why can’t I get my radiation while I am getting my chemo? Why do I have to wait until I finish chemo? Answer Susie Lee, CRNP, Nurse Practitioner with Penn Medicine’s Lung Cancer Team, responds: In some instances, and it may depend on the stage of your lung cancer, it is recommended to give chemotherapy concurrently (at the same time)
Why Quit Smoking After Diagnosis? Question If I already have lung cancer, why should I stop smoking now? Anil Vachani, MD, Pulmonologist at Penn Medicine adds: Even if you have been diagnosed with lung cancer, you should still try and quit smoking. There is evidence to suggest that patients who continue to smoke may respond less well to their treatment and thus have worse
Lung CT for Screening Question I heard it is better to get a CT scan rather than an x-ray of your chest. If you are at risk for lung cancer, is this true? If so, why does my family doctor say my insurance will not pay for it? Answer Taine Pechet, MD, Thoracic Surgeon at Penn Medicine, responds: You are correct that the CT scan provides more information than the chest
Treatment for Stage IV Lung Cancer Question Are there any treatments for a person with Stage IV lung cancer? Answer Charu Aggarwal, MD, MPH, Medical Oncologist at Penn Medicine, responds: There are several treatments for patients with late-stage or metastatic lung cancer. While these treatments are not able to cure the cancer, treatments for Stage IV lung cancer can improve
Proton Therapy for Lung Cancer Question Is proton radiation used for lung cancer treatment? Will my insurance pay for it? Answer Charles B. Simone, II, MD, Radiation Oncologist at Penn Medicine, responds: Proton radiation therapy is a relatively newly utilized type of radiation therapy that has the potential to decrease the radiation dose to normal tissues that are next to the
Small Cell Lung Cancer Question What is the difference between small cell and non-small cell lung cancer? Are they treated the same way? How do I know which one I have? Answer Charu Aggarwal, MD, MPH, Medical Oncologist at Penn Medicine, responds: Small cell cancer of the lung is a subtype of lung cancer, which is different from non-small cell lung cancer. Non-small
How Much Chemo is Given? Question How much chemotherapy can a person do. I know sometimes the treatment has to be done more than once. Thank you. Answer Susie Lee, CRNP, Nurse Practitioner with Penn Medicine’s Lung Cancer Team, responds: This depends on the type of chemotherapy being administered. Some chemotherapy agents have a limited dose or number of cycles that
Radon and Lung Cancer Risk Question How is exposure to radon linked to lung cancer? Answer Taine Pechet, MD, Thoracic Surgeon at Penn Medicine, responds: Radon is the 2nd leading cause of lung cancer in the United States according to the Surgeon General's report, distantly following tobacco exposure. Radon is a colorless and odorless gas that results from the breakdown of
Neuropathy Due to Chemotherapy Question I have neuropathy in my feet from my chemo. Is there anything to help with this? Answer Christina Bach, MSW, LCSW, OSW-C, Oncology Social Worker at Penn Medicine, responds: Neuropathy can really impact quality of life during and after certain types of chemotherapy treatments. The symptoms of neuropathy often improve, as patients are
Side-effects After Lung Cancer Surgery Question What side effects will I experience after surgery to remove part of my lung? Answer Taine Pechet, MD, Thoracic Surgeon at Penn Medicine, responds: Side effects after surgery depend, among other things, on how much lung is removed, how the operation is performed, a given patient's preoperative condition and lung function, as well as any
On Oxygen for Life After Lung Cancer? Question If I have lung cancer, will I have to be on oxygen for the rest of my life? Answer Anil Vachani, MD, Pulmonologist at Penn Medicine, responds: Most patients that are treated for lung cancer do not end up requiring supplemental oxygen. There are some patients with underlying lung disease, such as chronic obstructive pulmonary disease or
Difficulty Swallowing During Radiation Question I have a hard time swallowing food since starting radiation. What would be some good foods for me that are nutritious and easy to eat? Answer Valaree Williams, MS, RD, LDN, Registered Dietician at Penn Medicine responds: Effects from radiation can irritate the esophagus and cause swallowing difficulty. Simple diet modifications can
Precautions After Splenectomy Question What do you do with a lung cancer patient who lost his spleen who is on chemo? Anything special? Answer Carolyn Vachani, RN, MSN, AOCN OncoLink Nurse Educator responds: We would treat someone with lung cancer and no spleen just like any other patient with lung cancer. However, people without a spleen have a higher risk for certain
Role of the Nurse Navigator in Cancer Treatment Question My cancer center has a nurse navigator. What can she do to help me get through treatment (stage III Non small cell lung cancer)? Answer Linda Miller, RN, BSN, Oncology Nurse Navigator at Penn Medicine responds: Each center functions a little differently in how their nurse navigator functions in relationship to the thoracic team. In
X-Ray Screening for Lung Cancer Question My father died of lung cancer at 57 years old. He was a 3 pack a day smoker. I am now 52 years old and have been an on-again, off-again smoker (1 pack a day) for 30 years. I had quit once for 7 years and two other time for 1-2 years. I no longer smoke. Would you suggest that someone in my position get an xray because I am at risk? Thank
Chemotherapy Pills Versus Intravenous (IV) Question Why are some lung cancer patients able to take chemo pills, but I have to get it in my veins? Is one kind better than the other? Answer Suzanne Walker CRNP, MSN, AOCN, Nurse Practitioner for Thoracic Malignancies at Penn Medicine responds: Some lung cancer patients are able to take a chemotherapy pill because they have a specific
Flu Shots for People on Cancer Treatment Question I recently finished my chemo after surgery. Wondering if I should have a flu shot or anything else preventive? Answer Suzanne Walker CRNP, MSN, AOCN, Nurse Practitioner for Thoracic Malignancies at Penn Medicine responds: It is usually safe to get a flu shot once the chemotherapy has finished. You can talk to your oncologist about it
Mutation to Guide Treatment in Lung Cancer Question The surgeon who did my biopsy said they will look for "mutation" and my treatment will depend on the result. What does this mean? Answer Linda Miller, RN, BSN, Oncology Nurse Navigator at Penn Medicine responds: Your physician is referring to the different molecular markers that your specific tumor may contain. Determining those
Supplements or Vitamins to Better Tolerate Chemo and Radiation Question Are there supplements or vitamins that can help me better tolerate radiation and chemo for lung cancer? Answer Valaree Williams, MS, RD, LDN, Registered Dietician at Penn Medicine responds: We often receive many questions about herbal, vitamin, and mineral supplements to assist with tolerating treatments. Research on the use of
Chemo Before or After Surgery Question When is it appropriate to get chemo before surgery versus after? Answer Suzanne Walker CRNP, MSN, AOCN, Nurse Practitioner for Thoracic Malignancies at Penn Medicine responds: Most people will receive their chemotherapy after surgery ("adjuvant therapy"). Some people may receive their chemotherapy before surgery in certain
Questioning Faith After Cancer Diagnosis Question Since my mother was diagnosed with lung cancer, I feel that my faith has been challenged. I feel angry and then guilty for feeling that way and for thinking what kind of God would make my mother be so sick. Can you help me? I feel I don't know what to think. Answer Kava Schafer, MDiv, MA, Chaplain at Penn Medicine responds: Rosanna, I
Navigating Care After a New Cancer Diagnosis Question What tips can you give a person with a new diagnosis on how to best navigate care, keep everything straight and go through treatment? Answer Linda Miller, RN, BSN, Oncology Nurse Navigator at Penn Medicine responds: You can look to see if the institution where you would be receiving treatment had a patient or nurse navigator who can
Hospice Care and Trouble Breathing Question My husband was recently put on hospice. He already had a lot of trouble breathing; will this get worse as he gets sicker/closer to death? What can we do to help him? Answer Suzanne Walker CRNP, MSN, AOCN, Nurse Practitioner for Thoracic Malignancies at Penn Medicine responds: The hospice team is usually very skilled at managing
Dealing With Life During the Stress of a New Diagnosis Question My sister was just diagnosed last week. It's like a whirlwind. Looking for ways to coordinate life for her (kids, house), manage appts. And just helping her through it all. Answer Linda Miller, RN, BSN, Oncology Nurse Navigator at Penn Medicine responds: The American cancer society has a great website that offers different resources.
Eating Well During Lung Cancer Treatment Question My son is being treated for lung cancer. He is surviving on crackers. I just want to help him eat to keep up his strength. What advice do you have to maybe improve his appetite or make foods that won't make him nauseous, hurt his sore throat from radiation or that he might think tastes good? Answer Valaree Williams, MS, RD, LDN,
Difficulty Breathing With Lung Cancer Question I have done ok through my chemo so far. My most bothersome problem is feeling like I can't get my breath. Is there anything I can do to help that feeling? Answer Carolyn Vachani, RN, MSN, AOCN OncoLink Nurse Educator responds: It is important to assess why you are having trouble breathing. The reasons could include anything from growth
Preventive Whole Brain Radiation Question My husband's doctor recommended whole brain radiation as a preventive treatment (he doesn't have tumor in his brain). What are the pros/cons to this? What about affect on memory, thinking, etc.? Answer Carolyn Vachani, RN, MSN, AOCN OncoLink Nurse Educator responds: The good news is that the fact that they are offering PCI
Controlling Pain in Cancer Question My mother had advanced lung cancer and is starting to have significant pain. She is very hesitant to take anything – she says she doesn't want to be an addict. I am pretty sure that is not a reasonable fear, but I am not expert. What are the facts? Answer Suzanne Walker CRNP, MSN, AOCN, Nurse Practitioner for Thoracic Malignancies at
The Role of the Chaplain in Cancer Treatment Question When I was in the hospital for lung cancer surgery and then with complications of treatment, I had a wonderful chaplain who provided me great support. I am glad to see a chaplain on your panel and would like to hear her thoughts on her role with the person with cancer. Also wondering, how many hospitals/cancer centers have chaplains
Neuropathy After Cancer Treatment Question I had chemo for lung cancer last year. I am doing well except that I have neuropathy in my feet from the chemo that makes it difficult to live life, work, etc. Are there any treatments/therapies that can help improve the neuropathy? I do take neurontin. Answer Linda Miller, RN, BSN, Oncology Nurse Navigator at Penn Medicine responds:
Hospice Consultation Question If I am followed by the palliative care team but I want to explore (and possibly go onto) hospice, can the palliative care team do that too? Answer Kava Schafer, MDiv, MA, Chaplain at Penn Medicine responds: If you are followed by the palliative care team, it would be appropriate at any time of your choosing to ask to have a hospice
How to Help Someone with Cancer Question What can I do to help my cousin who was just diagnosed with lung cancer? I feel I don't even know what to say to her, she is only 54 years old. Answer Carolyn Vachani, RN, MSN, AOCN OncoLink Nurse Educator responds: Please stay at the end and watch Donna Lee's video, she talks a bit about how just being there can be so helpful.
Anxiety and Depression After Finishing Cancer Treatment Question Even though I finished treatment now, I still feel depressed and anxious. Is this normal? What can I do about it? I just can't stop thinking, what if this comes back? Answer Kava Schafer, MDiv, MA, Chaplain at Penn Medicine responds: I appreciate your question and I am a chaplain and would like to weigh in on your question. Maybe I have at
Hodgkin's Lymphoma Dear OncoLink "Ask the Experts," We want know your opinion about a Hodgkin's Disease (HD) case. L.G., female, age 28, European, Medical Doctor (Surgeon). In December 1995 she was given a diagnosis of HD scleronodular type (SN 1) by cervical lymph node biopsy. The staging demonstred mediastinal and retroperitoneal nodes involvment.
Staging Laparotomy and Hodgkin's Disease Dear OncoLink "Ask the Experts," My 25-year-old daughter has been diagnosed with Hodgkin's Disease stage IIA. This was determined by biopsy and physical exam. The blood test, bone marrow extraction, CT-scans and x-rays are scheduled next week. Her oncologist has already planned for a laparotomy. I don't understand why, with so little
Hodgkin's Disease Dear OncoLink "Ask the Experts," I was surfing the Net and I thank you for the great Web site about Hodgkin's disease. My friend's dad was just diagnosed with Hodgkin's and while we were doing our research, we came upon some questions. How often does Hodgkin's occur in males in their late 30s or early 40s? Is this disease hereditary?
Hodgkin's Disease and Blood or Organ Donation Dear OncoLink "Ask the Experts," Hello! I have been treated for recurrent/refractory Hodgkins disease, first with ABVD, then with ICE, mantle field and total lymph node irradiation, followed by cytoxan and more etoposide and an autologous peripheral blood stem cell transplant. I have been told that I am no longer eligible to donate
Hodgkin's Disease and Chemotherapy Dear OncoLink "Ask the Experts," My husband was recently diagnosed with lymphocyte predominant Hodgkin's Disease (nodular type) and is presently undergoing ABVD chemotherapy treatment prior to radiation therapy. In trying to learn as much as possible about this I am wading through some confusing information. Please send information on
Radiation Therapy to the Chest and Cardiotoxicity Dear OncoLink "Ask the Experts," I am a 33 year-old who is in his 6th year of remission from Hodgkin's disease stage IIA. I was treated with ABVD chemotherapy followed by radiation therapy. In December of 1997, I suffered a heart attack. The cardiologist told me that I had a lot of blockages in and around the blood vessels in my heart.
Long-term Side Effects of Radiation Therapy for Hodgkin's Disease Dear OncoLink "Ask the Experts," Where can I find research information on long-term effects of radiation therapy for Hodgkin's disease to neck lymph nodes, lungs, and heart? Thank you. P Li Liu, MD, OncoLink Editorial Assistant, responds: Dear P: Thank you for your interest and question. Long-term
Radiation Therapy for Hodgkin's Disease and Breast Cancer Dear OncoLink "Ask the Experts," Your article on the long-term effects of radiation failed to mention the connection between radiation therapy and breast cancer. There have been many articles including the Journal of the National Cancer Institute, Journal of the American Medical Association, New England Journal of Medicine and the
Elevated ESR (sed rate) after treatment for Hodgkin's Disease Dear OncoLink "Ask The Experts," My Mom's Hodgkin's Disease (stage 2) has been in remission for 16 years, after both radiation and chemotherapy treatments. Her recent blood test revealed a sed rate of 45.She was also diagnosed as diabetic a few months ago. Her oncologist has scheduled a full body CAT scan for next week. I understand that
Treatment for Stage 4 Hodgkin's Disease Dear OncoLink "Ask The Experts," My daughter was diagnosed last March with Hodgkin's, stage 4. She had extensive tumors in the lungs, liver, and spleen. After 6 months of ABVD chemo they now show no activity on a PET scan. I have searched but have been unable to find much info on what might come next. She goes back next month for more.
Risk of abnormalities in pregnancies conceived after chemotherapy Dear OncoLink "Ask The Experts," My partner has been successfully treated for Hodgkin's disease. He his 27 years old and his treatment ended about 3 years ago. We are thinking about having children together. He tells me that after his treatment ended they checked his sperm count and there were no problems. However can you please tell me whether
Pregnancy after Hodgkin's Disease Dear OncoLink "Ask The Experts," I had treatments for Hodgkin's Disease almost three years ago. I have had very normal blood levels and clear x-rays and CT scans since the end of treatment. I recently found out I am pregnant; my concern is that this pregnancy will cause a relapse of my cancer. Selina M. Luger, MD, Director of the Leukemia
Hereditary Aspect to Hodgkin's Disease (HD)? Dear OncoLink "Ask The Experts," I would like to know if HD can be inherited? I had HD at 18 years old with a recurrence several years later. At 28 years of age, I had 2 children. My daughter is now 16 and has a "knot" in her neck (same place mine was found). Babis (Charalambos) Andreadis, MD, Assistant Professor in Medicine in the Division of
Follow-up Protocol for Hodgkin's Disease Dear OncoLink "Ask The Experts," I have Hodgkin's disease, stage 2, NS (nodular sclerosis) subtype. I have completed chemotherapy and radiation, but am not being scanned for about 7 weeks. I have only had one CT scan when I was first diagnosed, and worry that I should have had PET scans and bone marrow tests. What are the recommended follow up
Mono Leads to Hodgkin's? Dear OncoLink "Ask The Experts," I have been reading that there is a correlation between mono and Hodgkin's. Is there any screening for high-risk people to detect Hodgkin's very early? I read that there is a 1 out of 1,000 chance that a person who has had mono can get Hodgkin's. My son had mono at 15 and he is now 19. I also read that he can get
Alcohol Related Pain and Hodgkin’s Disease Dear OncoLink "Ask The Experts," My initial Hodgkin's symptom was arm pain. It took 9 months to get diagnosed. The pain was increased with minimal amounts of alcohol ingestion. I am 9 months in remission after ABVD. What does the alcohol do to cause the pain?Babis (Charalambos) Andreadis, MD, MSCE, Assistant clinical professor of medicine at the
Non-Hodgkin's Lymphoma TypeB stage II of the tonsils Dear OncoLink "Ask the Experts," I am looking for links or location of information on N-HL, Type B, Stage 2, of the tonsils. My sister in law has been so diagnosed and would like to follow up on info, particularly outcomes data and statistics. She is already undergoing treatment, but info on treatments will also be of help. Thank
Staging of Non-Hodgkin's Lymphoma Dear OncoLink "Ask the Experts," My girlfriend was recently diagnosed with Adult non-Hodgkin's Lymphoma. She had a bone marrow biopsy done and her doctor says she has lymphoma in her bones. Now the nurse said that she is in stage IV. Does the bone marrow having lymphoma mean stage 4? Exactly how much worse is stage IV than the other
Primary Central Nervous System Non-Hodgkin's Lymphoma Dear OncoLink "Ask the Experts," I have been searching for information about Non-Hodgkin's Lymphoma of the Brain. I can't seem to locate any information anywhere on the Internet. According to the oncologist that is taking care of my brother-in-law, he has only heard of one other case. Please let me know where I might find the information.
Pain Associated with the Treatment of Non-Hodgkin's Lymphoma Dear OncoLink "Ask the Experts," I would like to know more about non-Hodgkinís Lymphoma (NHL) classified as diffuse and follicular small cleaved cells and the associated pain (due to the cancer, chemotherapy, and filgastrim). I am told that the pain is so severe that at times you can't walk, write or apply pressure to any thing. I
Hodgkin's Disease and Fertility Dear OncoLink "Ask the Experts," If someone could please respond to my query, I would be most appreciative. My brother was first diagnosed with Hodgkin's disease at seventeen, he's now thirty-one. He's in remission, but had relapsed once before. Anyhow, during his first bout with the disease, he was approached by doctors for
Treatments for myelodysplasia Dear OncoLink "Ask The Experts," I am struggling with secondary myleodysplasia, resulting from being given CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone ), for non- Hodgkin's lymphoma. Doctors say that my prognosis is poor because secondary MDS is fairly intractable to treatment. I do have a sibling donor match for a mini stem
Vaccine Therapy for Lymphoma Dear OncoLink "Ask The Experts," I am a 53-year-old female, newly diagnosed with follicular Non-Hodgkin's lymphoma. I am taking Rituxan, and then will begin a vaccine made from my own cells and an immunity booster. This is a clinical trial. Please explain to me how the injection of my cells will help fight this cancer. Babis (Charalambos)
BMT in Mycosis Fungoides/Cutaneous T-cell Lymphoma Dear OncoLink "Ask the Experts," My brother, was diagnosed last August as having mycosis fungoides/cutaneous T-cell lymphoma (MF/CTCL) stage IV. Under the supervision of his doctor at, he received methotrexate, CHOP, 2-DCA without getting any temporary responses except from CHOP. The doctor who is treating him now has been suggesting
Allogeneic stem cells to treat Cutaneous T Cell Lymphoma CTCL Dear OncoLink "Ask The Experts," My boyfriend, age 31, was diagnosed three and a half years ago with Cutaneous T Cell Lymphoma. In the past he has undergone chemotherapy and radiation therapy, neither of which has helped. He is now being treated with interferon. I just read where there was some success in treating CTCL patients with stem
CTCL in Remission Dear OncoLink "Ask The Experts," I have CTCL (cutaneous T-cell lymphoma), and have had it for about 5 years (diagnosed). In the beginning, I was treated with PUVA, as often as 3 times per week. Then, as the cancer came under control, it was reduced to 1 time every two months. The cancer has been in remission for about a year and 1/2. The doctor
Mediterranean Lymphoma Dear OncoLink "Ask the Experts," I would like specific information on: immunoproliferative small intestinal disease. I am a practicing Medical Oncologist, and would be grateful if I could get the latest on the disease. Thank you, R.C. Ken Blank, MD, and John Han-Chih Chang, MD, OncoLink Editorial
Treatment of hepatitis C virus with interferon in a patient with lymphoma Dear OncoLink "Ask the Experts," I am in the very early stages of a low-grade B-cell Lymphoma, and have also been diagnosed with Hepatitis C. I will be having a liver biopsy and then have to make a decision as to whether or not to go on Interferon. None of my doctors have been able to locate information regarding the effects of
Lymphoma of the Heart Dear OncoLink "Ask the Experts," I need some information (opinion and biomedical literature) about: The metastatic involvement of cardiac structures in Hodgkin's and non-Hodgkin's lymphomas The cardiac complications with treatment (chemotherapy and its possible impact to the heart by a direct toxic effect on the heart muscle).
Toxoplasmosis and Brain Lymphoma Dear OncoLink "Ask the Experts," What does toxoplasmosis have to do with brain lymphoma? Are they related? Thanks! B. Li Liu, MD, OncoLink Editorial Assistant, responds: Dear B, Thank you for your interest and question. Toxoplasmosis and primary central nervous system (CNS) lymphoma are
Hodgkins and Non-Hodgkins Lymphoma Dear OncoLink "Ask the Experts," What is the difference between Hodgkins and Non-Hodgkins lymphoma? I read the web page,but did not see the difference between the two except that the cells look different. Why would the Hodgkins be the "better" of the two to have if you have lymphoma? Please let me know. C
Are swollen lymph nodes an indication of cancer? Dear OncoLink "Ask The Experts," Can you get a pretty good indication of whether a child might have lymphoma or a neuroblastoma from blood work? If a child has symptoms (swollen nodes-several and large, increasing in size). Would the blood work always show irregular if they had a Cancer that involves the Lymph nodes or could they still
Mantle Cell Lymphoma Dear OncoLink "Ask The Experts," My uncle has just been diagnosed with mantle cell lymphoma and we are not sure of the outcomes with this type of cancer. We would like more information on this disease. Babis (Charalambos) Andreadis, MD, Assistant Professor in Medicine in the Division of Hematology/Oncology at the Abramson Cancer Center and an
Maintenance Therapy With Rituximab Dear OncoLink "Ask The Experts," I was diagnosed with follicular non-Hodgkin's stage 3 lymphoma. After FND chemotherapy (F= Fludarabine, N = Nitoxantrone, D= Dexamethasone). I have received Rituximab and have continued on it every 6 months. How long should the maintenance doses be continued? Will this cause a resistance to the drug? Babis
Thymic Uptake Dear OncoLink "Ask The Experts," My daughter, age 26, had her 6-month post-treatment CT/PET scan after being clear of Nodular sclerosis Hodgkin's in August 2005. The 6-month scans show "thymic uptake". Is this common? Cause for worry? Babis (Charalambos) Andreadis, MD, Assistant Professor in Medicine in the Division of Hematology/Oncology
Mantle Cell Treatment Options Dear OncoLink "Ask The Experts," I have Mantle cell lymphoma and have been given 2 options for treatment, hyper-CVAD or R-CHOP. From my readings, both are considered first-line approaches for treating MCL, however, hyper-CVAD is quite demanding on the patient. Why is hyper-CVAD preferred by some cancer centers over the less physically demanding
Follow up for follicular lymphoma Dear OncoLink "Ask The Experts," I have follicular lymphoma, stage 2, in my abdomen with no symptoms. What is the protocol for follow up cat scan tests? I am scheduled for CT tests every 3 mo of my chest/abdomen/pelvis. I am concerned about the radiation risk.Babis (Charalambos) Andreadis, MD, MSCE, Assistant clinical professor of medicine at the
Speed of Tumor Growth Dear OncoLink "Ask the Experts," I found out two weeks ago that my father is suffering from incurable cancer. The cancer is classified as poorly differentiated carcinoma. I am told that it is very aggressive. It was first found in the lung and kidney area. It has since been discovered in the brain. I have found your information
Information sought on mucinous adenocarcinoma or pseudomyxoma peritonei Dear OncoLink "Ask the Experts," I was unable to find any information on your pages regarding an uncommon form of cancer known as "Mucinous Adenocarcinoma" or "Pseudomyxoma Peritonei." Do you have any information on these cancers? Or, can you refer me to other pages that might? Thank you for your time and response. SB
Myeloma Dear OncoLink "Ask the Experts," I recently spoke to a woman who has "myeloma". She claims that she gets tumors if she breaks bones or fractures parts of her body. She was calling the tumor a "bone tumor." How is this different from an osteosarcoma? Ken Blank, MD and John Han-Chih Chang, MD, OncoLink Editorial Assistants
Information About Myeloma Dear OncoLink "Ask the Experts," Please tell me what myeloma cancer is? My lifelong friend has myeloma at the 1st lumbar spine. They operated and removed the tumor, but could not reach all of the cancer cells. He is now getting radiation treatments to his abdomen. He experiences great pain. He has commissioned me to find out if
"M" Protein in multiple myeloma Dear OncoLink "Ask The Experts," I am currently in remission after a stem cell transplant for multiple myeloma. My M protein is 0.34. At what point would I need to start treatment again? The M protein was 6 at the time of diagnosis. I have not been on any maintenance therapy. Thank you. Selina M. Luger, MD, Director of the Leukemia Program
Effects of Whole Brain Radiation Dear OncoLink "Ask the Experts," Our son was diagnosed with brain cancer. My question has to do with the long-term effects of whole-brain radiation, as I have been unable to find much information concerning this. Could you provide some answers, please? Thank you in advance. Hui-Kuo G. Shu, MD, PhD, an Assistant
Pilocytic astrocytoma Dear OncoLink "Ask The Experts," My 20-month-old son was recently diagnosed with a pilocytic astrocytoma attached to his brain stem. The tumor was explained to me as being mildly malignant with a possibility of becoming more aggressive. During his surgery 2/3 of the tumor was removed. My question is; of the remaining tumor, are there any studies
Treatment for Primary rhabdoid tumors of the head and neck Dear OncoLink "Ask The Experts," My 8-month-old grandson has been diagnosed with a rhabdoid tumor. Can you lend any info on chemo or radiation that he may get to help him? It is located on his cheek and neck on the left side of his face and also in the right side of his brain over his right eye.Amit Maity, MD, PhD, Assistant Professor of Radiation
Behavior Patterns After Bone Marrow Transplant Dear OncoLink "Ask the Experts," Our son was diagnosed with Acute Myeloid Leukemia (A.M.L.) at 2 years, and is now 3 years+ since his Bone Marrow Transplant (B.M.T.). We are looking for information regarding behavior patterns, which have become evident. He is no longer on any treatment. Is there any information about social development in
Fever During Treatment for Acute Myeloid Leukemia (AML) Dear OncoLink "Ask the Experts," During the past two months my 5 years old grandson has undergone treatment for Acute Myeloid Leukemia (AML). Throughout this treatment his temperature has remained excessively high. On several occasions it reached 105.98 F (41.1C) and has regularly maintained 102.2 to 104.0 F (39.0 to 40.0 C). During the
Vincristine Toxicity Dear OncoLink "Ask The Experts," My son (6 yrs old) has been diagnosed with ALL (Acute Lymphblastic Leukaemia) just 2 months back (6th May 2004). The doctors here are following the CCCG 1991 protocol. At the end of the induction phase, he was paralyzed from hip below. The doctors stopped chemotherapy till such he improved. He is able to walk on his
Psychological Effects of Leukemia Upon Diagnosis Dear OncoLink "Ask the Experts," Has anyone ever conducted a study about the psychological effects of leukemia upon diagnosis in adolescents and then compared them to the psychological effects of leukemia upon diagnosis in children? If so, what were the conclusions? This interests me because I know that the psychological effects cannot be
AML in patients under the age of 20 Dear OncoLink "Ask The Experts," My daughter is 18 and has AML M5. I understand this disease is more aggressive in people under 20. Where can I find treatments and long-term results for younger people? Most of the info I find does not differentiate. Thank you. Selina M. Luger, MD, Director of the Leukemia
Stage 4 Hepatoblastoma Dear OncoLink "Ask the Experts," My son was diagnosed with stage 4 hepatoblastoma. I would like to know more information about hepatoblastoma, chances of survival after a series of chemotherapy, also the chances of recurrence. Thank you. Anna Meadows, MD, pediatric oncologist at the Children's Hospital of
Is Neuroblastoma a Genetic Disorder? Dear OncoLink "Ask the Experts," Is neuroblastoma a genetic disorder? K. Li Liu, MD, OncoLink Editorial Assistant, responds: Dear K, Thank you for your interest and question. Neuroblastoma is the most common malignant intraabdominal tumor in children. It constitutes 7-10% of all cases of childhood cancer. While
Stage IV Neuroblastoma Dear OncoLink "Ask the Experts," My son was diagnosed in '87 with stage IV, spread from adrenal gland to the aorta and vena cava arteries. He received 2 yrs of aggressive chemotherapy. All tumor scar tissue was NOT removed. He is now 13 years old, and has been cancer- free for almost 11 years. What is the longest survival time for
Radiation damage to the kidney Dear OncoLink "Ask The Experts," My son was diagnosed with neuroblastoma stage IV on June 12, 2001. He has just completed his stem cell transplant and is about to start radiation therapy. My question concerns the rebuilding of healthy tissue that has been radiated. Our radiation oncologist said that my son would lose the function of his
Signs of Relapse of Neuroblastoma Dear OncoLink "Ask The Experts," My daughter was diagnosed with Neuroblastoma Stage IV S, at two weeks old in November of 2000. The following 3 years she received aggressive chemotherapy, stem cell harvest, bone marrow transplant, and finally, the treatment that put her in remission: "HAMA Antibody". She has been in remission for the last
The Retinoblastoma Gene Dear OncoLink "Ask the Experts," I have a question regarding the heredity of retinoblastoma. What gene exactly is the cause and does it have to present in both parents for it to be transmitted to the offspring? I am concerned because I am about to marry a man who had retinoblastoma bilaterally as a child. What is the likelihood that our
Retinoblastoma and Secondary Cancer Dear OncoLink "Ask the Experts," I had bilateral (hereditary) retinoblastoma when I was a child. What is my risk of developing other cancers later in life? Janet L. Kwiatkowski, MD, OncoLink's Pediatric Oncology Section Editor, responds: Dear OncoLink Reader: Thank you for your question. Two forms of
Retinoblastoma Gene Dear OncoLink "Ask the Experts," I had bilateral retinoblastoma as a child. Would I, as a woman, be any more likely than a man to pass retinoblastoma on to my child if I were to conceive, or are the odds the same, regardless of which parent has the gene? Amit Maity, MD, Assistant Professor of Radiation Oncology at the
Retinoblastoma in an older child Dear OncoLink "Ask The Experts," My daughter had just turned 4 years old when diagnosed with unilateral Retinoblastoma had her right eye removed in August 2000. My understanding is that children much younger are diagnosed with this usually. How is it an older child develops this? Also, I'm told this is rare, but so far, 3 cases have been
Radiation to treat retinoblastoma in a young child Dear OncoLink "Ask The Experts," My eight-month-old grandson has retinoblastoma. Can you give me some information about the use of radiation in treating a child this young? Hui-Kuo G. Shu, MD, PhD, Assistant Professor Dept. of Radiation Oncology University of Pennsylvania, responds: The standard for the treatment of
Genetics of Retinoblastoma Dear OncoLink "Ask The Experts," I have two sons. They have two uncles, both of whom had bilateral retinoblastoma as infants. The uncles’ older brother (my boys’ father) did not ever develop it. He has never been tested. The uncles were born in the late ‘50s. My boys were born in the ‘70’s and had their retinas
Treatment Options for Osteosarcoma Dear OncoLink "Ask the Experts," My 18-year-old son was recently diagnosed with an osteosarcoma of the distal femur. What is the treatment? Janet L. Kwiatkowski, MD, OncoLink's Pediatric Oncology Section Editor, responds: Thank you for your question. Osteosarcoma is a malignant bone tumor with a peak
Treatment for Optic Nerve Glioma Dear OncoLink "Ask the Experts," My son has optic nerve glioma of his right eye. His doctor suggested that he should get proton beam therapy. Unfortunately it is not available in my country. Please let you know how this problem can be treated. Thank you in advance. F Eric Shinohara, MD, MSCI Radiation Oncology Section
Primitive Neuroectodermal Tumors (PNET) Dear OncoLink "Ask the Experts," My 8-year-old daughter had a Primitive Neuroectodermal Tumor (PNET) removed from her spinal cord at T4 &T5 just this past December. Information on this type of cancer and at this type of local is extremely difficult to find. What can you tell me about the cancer, her prognosis and her future?
Late Effects of Chemotherapy After Vaginal Cancer Dear OncoLink "Ask the Experts," My daughter had vaginal cancer at the age of 17 months. We have been clean of cancer for ten years but having a shortness of breath that doctors cannot explain. What are the late effects of bleomycin, etoposide and cisplatin? Thank you Anna Meadows, MD, pediatric oncologist at
Effects of Chemotherapy on a Child's Intellectual Development I am a clinical psychologist. I am seeing a child in play therapy who has received treatment for leukemia since the age of 4 years. She is now seven (treatment has been effective and stopped) and completing grade 1. Her teachers are concerned with her academic progress. On psychological tests her scores show a low I.Q. However, I am
Primitive Neuroectodermal Tumor (PNET) treatment options Dear OncoLink "Ask The Experts," My cousin's son, 20 months old was diagnosed with a Primitive Neuroectodermal Tumor (PNET). He has already had surgery. What are the general treatment options for this? Hui-Kuo G. Shu, MD, PhD, an Assistant Professor in the Department of Radiation Oncology at the University of
Eating tips for pediatric oncology patients Dear OncoLink "Ask The Experts," I am a pediatric dietitian on an oncology floor. Most of my patients have very poor oral intake. I try supplements, shakes, favorite foods, snacks, etc and sometimes nothing seems to work. Some patients go weeks w/out eating much. Do you have any suggestions on how to increase oral intake? Thanks.
Radiation for synovial cell sarcoma Dear OncoLink "Ask The Experts," My son is 9 years old and was diagnosed with synovial cell sarcoma in the right rear shoulder area in September 2001. He received 3 chemo treatments (doxorubin on ifosfamide) in September, October and November each 3 weeks apart. December 17th, 2001 the tumor was removed. The pathology showed the tumor
Neurofibrosarcoma Dear OncoLink "Ask The Experts," My friend's daughter is 2 and has been diagnosed with neurofibrosarcoma. The cancer is in the upper thigh, her sciatic nerve and thigh muscle have been removed before Xmas but they had to go back in 2 weeks ago (end of January) and take out more. It is still there (very small) and apparently in the spine.
Treatment for pineal germinomas Dear OncoLink "Ask The Experts," My 8-year-old daughter has been diagnosed with a germinoma. The primary germinoma was in the pineal region and 80% was resected by surgery. There also is another very small tumor located very near where the first was. We are now entering chemo treatment using carboplatinum and etoposide for a total of 3
Heart and lung problems after treatment for Hodgkin's Disease Dear OncoLink "Ask The Experts," I had Hodgkin's Disease 18 years ago when I was 8 years old. It was in stage 2 and I had radiation. What should I lookout for now as far as heart and lung problems? I do have a murmur and asthma. Amit Maity, MD, PhD, Assistant Professor of Radiation Oncology at the Hospital of the University of Pennsylvania,
Late Cognitive Effects of Therapy Dear OncoLink "Ask The Experts," My stepdaughter received treatment for leukemia at 9 months old. She is now in 4th grade, and as you might imagine, the cognitive late effects are significant. She is about to have a Neuro-Psychiatric evaluation by R. Butler at OHSU. What do you think of Cognitive Remediation? Anna Meadows, MD, Pediatric Oncologist
Radiation Effect on Growth Plates in Children Dear OncoLink "Ask The Experts," My son has ARMS (alveolar rhabdomyosarcoma), stage IV. The primary site is his calf, with metastases to lung and lymph nodes in the knee and hip. Chemotherapy has been able to dissolve the tumor after 2 treatments so that it is undetectable after MRI scan. We are concerned about radiation. Is there any way to
Undescended Testes and Testicular Cancer Risk Dear OncoLink "Ask The Experts," At 10 months old, my son had undescended testicle surgery. At that time, I was told he will have a higher chance to develop testicular cancer around 10 years of age. He is 8 years old now. How common is this? I have been looking for answers, none to be found. Please guide me, I would sleep a lot better with some
Ewing's Sarcoma and Microscopic Disease Dear OncoLink "Ask The Experts," We have a 5 year-old son who was diagnosed with Ewing's sarcoma with 2 mm lung metastases. The lung metastases were removed during the biopsy. He had 4 chemotherapy cycles (Vadriac and IE), and then he had fibular resection. His recent report says that there is microscopic disease left at the margin. Now the
Goserelin Before Radiation Dear OncoLink "Ask the Experts," I am on Goserelin (Zoladex) for 3 months and one renewal before radiation. Please advise what is the optimal time of Goserelin before radiation? S. Li Liu, MD, OncoLink Editorial Assistant, responds: Dear S, Thank you for your interest and question. The question you
Goserelin My brother (nearly 58 years old) has prostate cancer, stage T1. Due to a recent arterial operation, surgery is not a great option for him. Radiation therapy is the doctor's recommendation. We would like to be informed further about this in the following manner: What are the extra risks, mainly to sexuality, impotence, and incontinence,
Gleason Score Where can I find the explanation of the Gleason score for rating prostate cancer? J.K. Neha Vapiwala MD, Senior Editor for Oncolink, responds: Dear J.K. Thank you for your interest and question. The Gleason score is named after Dr. Donald Gleason, the pathologist who first studied and devised a scoring system to
Availability of the Free PSA Ratio Test Dear OncoLink "Ask the Experts," I recently read an article that states that the free PSA blood test is currently under study. What is the time frame for having this free PSA available to the physicians? What progress are they making? Thank you J Li Liu, MD, Editorial Assistant for OncoLink, responds:
Clodronate to Prevent Bone Metastases in Prostate Cancer Dear OncoLink "Ask the Experts," Are there any studies where clodronate has been used to prevent bone metastases in patients with advanced prostate cancer? In the situation to which I am referring, a radical prostatectomy has been performed, followed by radiation therapy. The use of Lupron and Casodex also has been instituted. Thus, the
Is Prostate Cancer Hereditary? Is prostate cancer hereditary? Thank you. T Li Liu, MD, OncoLink editorial assistant, responds: Dear T: Thank you for your interest and question. Familial patterns ("aggregations") of some cancers are not uncommon. Exposure to the same environmental factors within families and/or inheritance of cancer
Is there a link between hormonal therapy for prostate cancer and bone fractures? My father-in-law was diagnosed with prostate cancer. The doctor recommended hormonal therapy. He is very concerned of potential bone fracture as the side effect of hormonal therapy. Can you help him with this? Thanks. P Li Liu, MD, OncoLink editorial assistant, responds: Dear P: This is an excellent and
Impotence Post Radical Prostatectomy Dear OncoLink "Ask the Experts," Three years ago my husband had a radical prostatectomy, followed by radiation therapy. The good news is that no cancer has returned, the bad news is that he is still impotent. We tried Viagra & couple other things: nothing works. Please help us. AG Li Liu, MD, OncoLink
Impotence Rate After Prostate Brachytherapy Dear OncoLink "Ask the Experts," My concern is impotence rate 3-5 years post brachytherapy. It seems that this very serious quality of life issue is not discussed. Are there statistics available that are reliable? Looking forward to hearing from you. N Li Liu, MD, OncoLink Editorial Assistant, responds:
Reliability of the Prostate Acid Phosphatase (PAP) Test Dear OncoLink "Ask the Experts," Reliability of the Prostate Acid Phosphatase (PAP) Test My question is related to an elevated prostate acid phosphatase (PAP) of 22 ng/ml (normal = 0 - 5), and whether metastatic disease is a serious possibility since the capsule of the prostate was intact and the adenocarcinoma was well differentiated?
Post Radiation Treatment for Prostate Cancer Dear OncoLink "Ask the Experts," I am one of thousands of prostate cancer patients who have undergone treatment. An ultrasound biopsy detected a prostate cancer with involvement in both lobes. After consulting with several MD's, I decided to undergo radiation therapy. It has been 5 years since treatment and my PSA has slowly risen as
Early Detection and Screening for Prostate Cancer Dear OncoLink "Ask the Experts," I lost my husband in February of 1997 to prostate cancer. In April of 1995, he went to his doctor complaining of increased frequency of urination. The doctor did a PSA test and a digital rectal examination. The PSA test was 3.3. The doctor told my husband that he was fine. In December of 1997, he went for
Post-Radiation Therapy Treatment Options for Patients with Prostate Cancer Dear OncoLink "Ask the Experts," I have a question concerning radiation (external beam or seeds). If a man gets radiation for prostate cancer, can he have surgery after if the cancer comes back? If not, why? Li Liu, MD, Editorial Assistant for OncoLink, responds: Thank you for your interest and question. A
Prognosis After Prostatectomy Dear OncoLink "Ask the Experts," Even though he is 61 years old and has had extensive blood work done twice a year, my husband never had a PSA drawn until two months ago. His PSA was elevated, and he was found to have prostate cancer. He had a radical retropubic prostatectomy. The cells were found to be poorly differentiated, and the
ProstRcisionTreatment for Prostate Cancer I've heard a new treatment called prostRcision for prostate cancer that is being advertised by some radiation oncologists. Can you give me some inside view on this? Any information would be helpful. Thanks! Li Liu, MD, OncoLink Editorial Assistant, responds: The term "prostRcision" was first coined by Frank
Prostate Cancer Treated With External Beam Radiotherapy Dear OncoLink "Ask the Experts," I am requesting information on prostate cancer. I had surgery in March of 1993. The doctor was unable to get to the gland to remove it. He took out the lymph nodes and they were negative. I had 39 radiation treatments. My follow-up results were good. I then progressed from 3 month exam intervals to 6
The Value of PSA Screening Dear OncoLink "Ask the Experts," In the "Ask the Experts" article entitled Prognosis After Prostatectomy, a woman asked whether her family physician had erred by not routinely screening her husband for the past 10 years with a PSA. The answer given was that he should have had annual PSA testing in conjunction with a digital rectal exam
Rising PSA and the Effect of Radiation Therapy Dear OncoLink "Ask the Experts," I have a question about the following situation. My grandfather was diagnosed with prostate cancer in Aug. 95, and the PSA level was 71.8. At that time, the doctors surgically removed his testicles, and he took Flutamide for about 1-2 years. His PSA has risen from 0.40 in February of 1996 to 6.99 in
Rising PSA Level Dear OncoLink "Ask the Experts," My concern is with a good friend whose PSA has gone from 7 to 50 in the last five years. He has had numerous biopsies, a total of 50 core samples taken over the years. All have been negative. He has been treated for prostatitis with no effect on his PSA, and he has no obvious symptoms. The doctors are
Rising PSA Post-prostatectomy Dear OncoLink "Ask the Experts," My father is 65 and had a radical prostatectomy 2 years ago. His PSA is now up to 0.5. All of my research indicates he still has cancer and should undergo radiation. His urologist advised him to come back in 6 months. I am worried that this is too long to wait and he should seek further treatment now.
Transurethral Resection of Prostate or T.U.R.P. Dear OncoLink "Ask the Experts," Please direct me to information on the procedure called T.U.R.P. As I understand it, this procedure removes part of the prostate. I would like to know more about it? How is the procedure done? Is it possible to have it done by laser? What can the patient expect? Is it dangerous? Does it increase the
Treatment of Young Prostate Cancer Patients Dear OncoLink "Ask the Experts," Although there are comments and cases concerning younger (under 60) prostate cancer patients, there needs to be greater focus on these patients. As you well know, with PSA and free PSA tests, more and more younger patients are being diagnosed. The decisions that a younger man must face are a shift from
Implant Radiation for Prostate Cancer Dear OncoLink "Ask the Experts," What is Implant radiation (Brachytherapy) for prostate cancer? Maggie Hampshire, RN, BSN, OCN with Ken Blank, MD With Special Commentary from Dr. Richard Whittington, MD, Associate Professor of Radiation Oncology Respond: Implant radiation (Brachytherapy) for prostate cancer is
Support Groups and Prostate Cancer Dear OncoLink "Ask the Experts," My dad has prostate cancer. It is contained and his PSA is 15.9 - he has been offered two choices - radiation or surgery. We think we will go for surgery but would like to hear from other people who have had prostate surgery. We have a few questions: How did you feel after surgery, mentally &
PSA Status after Radical Prostatectomy Dear OncoLink "Ask the Experts," I had a radical prostatectomy 4 years ago for and early stage prostate cancer. I am concerned that my PSA is slowly rising. What should be my next steps? Am I able to have more treatment if necessary? Neha Vapiwala, MD Senior Editor of OncoLink and Assistant Professor in the Department
Three-Dimensional Conformal Radiotherapy Dear OncoLink "Ask the Experts," Is it wiser to begin three-dimensional conformal radiotherapy with my current PSA of 1.2 or continue to check the PSA regularly to determine if it will rise to 2.0 and then begin radiotherapy? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of
Laparoscopic Prostatectomy Dear OncoLink "Ask the Experts," My husband has been diagnosed with prostate cancer. His PSA count is only 3.7 and his Gleason count is 3+3(=6). It has not spread at all so they said he it is very early and he is "curable". A local hospital is doing laparoscopic surgery on prostate cancer. I cannot even find anything on the Internet
Prostate Cancer Screening Programs Dear OncoLink "Ask the Experts," Hi Dr. Wein, please let me know what is your perception of an ideal prostate-screening program, what barriers are usually encountered while providing cancer screening? Alan J. Wein, MD, Professor and chair of the Division of Urology at the University of Pennsylvania School of Medicine
Hematuria after Radiation for Prostate Cancer Dear OncoLink "Ask the Experts," Where would we find information about urinary bleeding following radiation? therapy for prostate cancer? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds: This happens for several reasons and it is
Prostate Cancer Screening Recommendations Dear OncoLink "Ask the Experts," Since free PSA tests are usually used in patients with total PSA values >4.0, what is the significance of a total value of <4.0 (2.8 in my case) with a free PSA of 15%? What type of screening would you recommend? Alan J. Wein, MD, Professor and chair of the Division of Urology at
Survival Rates Of Prostate Cancer When Treated With And Without External Beam Radiation And Seeds Dear OncoLink "Ask the Experts," My father was just diagnosed with prostate cancer and the impression is it's still in the early stage but aggressive. Radical prostatectomy is not recommended due to his past medical history. My father is 57 years old and re-occurrence rate is of major concern. His PSA level was 4, but the Gleason
Biochemical Failure Dear OncoLink "Ask The Experts," What does biochemical failure mean? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:Biochemical failure is the return of a previously treated prostate cancer, which is determined by a rising PSA (prostate specific antigen). This
Brachytherapy After External Beam Treatment for Prostate Cancer Dear OncoLink "Ask the Experts," I would like to know whether there are patients in America who have had brachytherapy for prostate cancer after external radiation treatment. What are the statistics on this? My husband would be the first person in Australia to under go this therapy. His PSA has risen sharply in the past 2 years and
Follow up after brachytherapy (interstitial radiation therapy) for prostate cancer Dear OncoLink "Ask The Experts," My father has undergone brachytherapy (interstitial radiation therapy) in combination with Lupron 5 months ago. We can find no information about the proper screening program to monitor for tumor recurrence. Is monitoring of PSA a useful modality? Should CT/MRI be done regularly? Thank you!
Proton Therapy vs. Conventional Radiotherapy Dear OncoLink "Ask The Experts," I would like your opinion regarding the risk/benefit of proton beam radiotherapy vs. conventional radiotherapy in a patient with a low-risk cancer status-post radical prostatectomy who now has rising PSA levels (biochemical failure) without any imaging evidence of recurrent tumor- hence, suspected local
Radiation proctitis Dear OncoLink "Ask The Experts," My treatment for Prostate Cancer consisted of 5 weeks of External Beam Radiation and then radioactive seed implants, which at this point appears to have been successful. The problem I'm having is with rectal bleeding which was diagnosed as Radiation Proctitis. The only treatment that has been offered to me
Significance of rise in PSA without a prostate cancer diagnosis Dear OncoLink "Ask The Experts," I am 53. My PSA has been in the mid 2's for several years. Last test jumped from a 2.3 to 7.1. Digital Rectal Exam (DRE) is normal. My question is: In prostate cancer, is it typical that a PSA would rise that fast in six months, or is this more likely something else? I will follow through with my doctor,
Penile implant Dear OncoLink "Ask The Experts," I had a radical prostatectomy and orchiectomy four and one half years ago. I have tried every thing on the market for erectile dysfunction and it has not worked. We have talked to my oncologist about an implant. She showed us the two-piece, and we have seen a three piece. Is there any hope of getting a
Incontinence after prostatectomy Dear OncoLink "Ask The Experts," I'm 63 years old male, in good health I had radical prostatectomy in September 2000. I had a normal recovery except that, to date, I've not recovered normal bladder control (at best still use 2 to 3 pads a day). I'm dry at night while sleeping and on average urinate 2 or 3 times. I've tried medication
Prostate cancer and flaxseed Dear OncoLink "Ask The Experts," Is there harm to adding flaxseed, linseed oil or any other phytoestrogen to the diet for the man with prostate cancer in watchful waiting? Katrina Claghorn, MS, RD, registered dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds: Adding flaxseed to
Transperineal Biopsy Dear OncoLink "Ask The Experts," What is the best way to get an accurate prostate biopsy when you do not have a rectum due to surgery for colitis? Alan J. Wein, MD, Professor and chair of the Division of Urology at the University of Pennsylvania School of Medicine and Chief of Urology at the Hospital of the
Intensity Modulated Radiation Therapy (IMRT) vs. 3D conformal Radiation for prostate cancer Dear OncoLink "Ask The Experts," I have stage B1 prostate cancer (PSA 7.1, Gleason 6). I am trying to decide whether to undergo IMRT at the considerable inconvenience of traveling to a distant location or to have the standard 3D conformal radiation that is available locally. I would appreciate any information.
Elevated PSA with negative biopsy Dear OncoLink "Ask The Experts," I have a friend who has repeatedly elevated PSA levels. He also has cirrhosis and is a hepatitis B carrier. His urologist has biopsied his prostate gland annually X 3 or 4 years with tissue reports consistently negative for neoplasia. Will cirrhosis or being hepatitis B carrier cause elevated PSA levels?
Prostate Seed implant side effects Dear OncoLink "Ask The Experts," My husband, age 64,was diagnosed with prostate cancer in mid November. He decided to have the seed implant. Both his radiation oncologist and urologist said the procedure went extremely well but his side effects still persist with great discomfort. He has had urinary retention and he is still quite
Mucinous Adenocarcinoma of the Prostate Dear OncoLink "Ask The Experts," My husband was recently diagnosed with mucinous adenocarcinoma or colloid cancer of the prostate. He was told that the type he has is rare and more aggressive. How rare is it? How much more difficult is it to treat this type of prostate cancer?Richard Whittington, MD, Associate Professor of Radiation Oncology at the
Biochemical failure after treatment of prostate cancer Dear OncoLink "Ask The Experts," A close friend of ours has been diagnosed with prostate cancer and had brachytherapy about 6 years ago. His PSA levels have been normal between that time and present, but a recent PSA test showed the level increased to 5.5. Bone scans show that there is some cancer present somewhere but cannot be pinpointed.
Is there a link between vasectomy and the diagnosis of prostate cancer? Dear OncoLink "Ask The Experts," Does the medical community feel that there is a link between vasectomy patients and prostate cancer? We are trying to make an educated decision about sterilization. Alan J. Wein, MD, Professor and chair of the Division of Urology at the University of Pennsylvania School of Medicine and Chief of
Safety issues to your spouse after brachytherapy for prostate cancer Dear OncoLink "Ask The Experts," I've had brachytherapy 2 weeks ago with I 125. My wife is a non-Hodgkin's lymphoma survivor for 10 yrs. She is extremely concerned that I will trigger her lymphoma. My reassurances that the seeds only radiate a few millimeters out and will not be of any consequence to her fall on deaf ears. The risks have been
Hematospermia Dear OncoLink "Ask The Experts," This morning my wife and I had sex and I found blood in my sperm. I am 65 and in good health. Is this something that I should be concerned about? Alan J. Wein, MD, Professor and chair of the Division of Urology at the University of Pennsylvania School of Medicine and Chief of Urology at the
Does androgen ablation therapy accelerate bone loss? Dear OncoLink "Ask The Experts," My father has been treated for prostate cancer for the past seven years with Lupron. He recently suffered a fractured vertebra. He has severe osteoporosis. He was prescribed Fosamax but now wonders what good that will do if he is still receiving the Lupron injections. I was wondering whether you might be
Cystitis after radiation to the prostate Dear OncoLink "Ask The Experts," I'm troubled with cystitis resulting from radiation for prostate cancer treatment 10 years ago. I've been passing clots and blood for a month. What treatment is available for this situation? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania
Burning and increased PSA after radical prostatectomy Dear OncoLink "Ask The Experts," My father had radical surgery done for his prostate cancer. Post the surgery, his PSA levels again went up albeit, to 8. Since then however, my father is having a burning sensation when he urinates. Is this normal? What can be causing it? He describes the pain as intense at times. Alan J. Wein, MD, Professor
Temporary seed implants versus permanent seed implants for prostate cancer Dear OncoLink "Ask The Experts," Do you know of any stats that show the relative effectiveness of high dose radiation (HDR) temporary seed implants versus the more traditional permanent seed implants? Is there any advantage that you know of in the HDR method? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University
Comparing Radical Prostatectomy with Brachytherapy Dear OncoLink "Ask The Experts," I have recently been diagnosed with prostate cancer. I have a T1C tumor, discovered during a biopsy. Malignancy is found only in the left lobe, where 30% of tissue sampled is malignant. Gleason score is 7. I am 59 years of age, and otherwise in good health. My urologist is recommending radical prostatectomy. My
Shielding from radiation Dear OncoLink "Ask The Experts," Why doesn't conformal radiation therapy for prostate cancer include coverage of the rest of the body with a protective lead shield to protect from x-ray exposure? You get zapped at the dentist's office and wear a vest, why not with conformal radiation therapy? Richard Whittington, MD, Associate Professor of
Day to day variation in the measurement of PSA Dear OncoLink "Ask The Experts," I had a radical prostatectomy in 1999 when I was 39 years old. I never had any symptoms. A digital rectal exam prompted the PSA. Prior to surgery, my PSA was 33, 100% of biopsy samples were positive with capsular penetration, Gleason 6-7. Other than surgery, my treatment included Zoladex beginning 3 days prior
The effect of ejaculation on serum PSA Dear OncoLink "Ask The Experts," The oncologist said that you should not have sex within 72 hours before a PSA test, as this would spike the results. Can you please explain how this occurs? And also how sex affects PSA in general. How could it be that sex spikes the PSA reading for the test, but in general it is not harmful for a prostate
Incontinence after radical prostatectomy Dear OncoLink "Ask The Experts," My husband had a radical prostatectomy 3 weeks ago. He has been totally incontinent since his catheter was removed five days ago, and he is extremely depressed. His primary concern is that he NEVER has the "urge" to urinate; he leaks constantly, without even realizing it. He CAN stop and start the flow when
Gleason score discrepancies Dear OncoLink "Ask The Experts," I am writing to you from Italy. A member of my family, a 62-year-old man, was diagnosed with prostate cancer. The biopsy showed Gleason score 1 + 2 and he was told to have radiation, due to his age. We consulted other experts, some recommended radiation therapy, the others even told him not to "wait and see".
Surgical experience for radical prostatectomy Dear OncoLink "Ask The Experts," I am considering nerve-sparing radical prostatecomy and radiation therapy. For the prostatecomy, I have found it difficult to find any "guidelines" to suggest what minimum number of prostatecomies annually and years of experience could contribute to a better outcome, and would minimize impotence and incontinence.
High PSA with negative staging results Dear OncoLink "Ask The Experts," My father has recently been diagnosed with PC, which includes an alarming PSA result of 168 ng/ml. Gleason score of 3+3 = 6. He was also given the "all clear" with respects to tests performed on his chest, abdomen, lungs and bones. Any further information you could provide would be greatly appreciated. Alan
Preventing Radiation Proctitis Dear OncoLink "Ask The Experts," I have been diagnosed with prostate cancer at an early stage. In my research to choose a procedure I have encountered a few patients who, after seed implantation (about a year), experienced proctitis. The cases have been difficult to treat and one case may require surgery. How common is this and what is done to
Prognosis at a young age for prostate cancer Dear OncoLink "Ask The Experts," My son is 41 yrs. old and has been diagnosed with prostate cancer. Does his finding prostate cancer so young necessarily mean it's a bad sign for his future? Alan J. Wein, MD, Professor and Chair of the Division of Urology at the University of Pennsylvania School of Medicine, responds:The answer is no.
Proton therapy vs. external beam radiation for prostate cancer Dear OncoLink "Ask The Experts," I am presently on hormonal therapy to shrink an enlarged prostate gland. Treatment plan is to follow with external beam radiation. I also have approval for treatment at the Loma Linda proton treatment center. Does data show conclusively that the proton treatment is a superior method to the external beam? Any
Getting a Second Opinion for a Prostate Nodule Dear OncoLink "Ask The Experts," My internist discovered a lump on my prostate during a digital rectal exam (D.R.E.) my PSA is 1.11. I was referred to a urologist. The urologist repeated the D.R.E. and stated that the lump is there but it is nothing to worry about. Should I get a second opinion? Alan J. Wein, MD, Professor and Chair of the
High PSA Dear OncoLink "Ask The Experts," My husbands PSA is 50. A DRE indicated an enlarged and hardened prostate with nodules. A biopsy is scheduled. What are the implications of a PSA of 50? Can I assume from this score that he has cancer and that the cancer has spread? Alan J. Wein, MD, Professor and Chair of the Division of Urology at the
Treatment for Stage IV Prostate cancer Dear OncoLink "Ask The Experts," I have been diagnosed with stage 4 prostate cancer. Is it better to start total androgen ablation right away or first just leuitinizing hormone? David J Vaughn, MD, Medical Director of the Abramson Family Cancer Research Institute and Associate Professor of Medicine, Hematology-Oncology at the Abramson Cancer
Can bone scans differentiate between metastatic disease and pelvic fractures? Dear OncoLink "Ask The Experts," Can a bone scan differentiate between changes due to an accident vs. cancer? A urologist scheduled the bone scan for my father who had a pelvic fracture in an accident after treatment for prostate cancer. Alan J. Wein, MD, Professor and Chair of the Division of Urology at the University of Pennsylvania School
Can prostate tumors spread from the biopsy? Dear OncoLink "Ask The Experts," Does puncturing a prostate tumor for biopsy cause the cancer to leak out of the tumor to other parts of the body? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:This is a common concern and it has been reported for some tumors
Radical Prostatectomy vs Brachytherapy Dear OncoLink "Ask The Experts," My brother was recently diagnosed with prostate cancer, Gleason score 3+4=7. He is 60 years old and otherwise healthy and works in an occupation doing physical work. His foremost concern is making a treatment decision to ensure his long term survival. For this reason, he is leaning toward surgery. He is somewhat
Retreatment for recurrent prostate cancer Dear OncoLink "Ask The Experts," A 62 year old friend of mine had a prostatectomy (age 57) for a grade 6 Gleason tumor 5 years ago. His PSA has increased from undetectable (<0.1ug/ml) to 0.2ug in the past year. His surgical specimen 5 years ago showed what appeared to be a positive surgical margin however he decided not to proceed with adjuvant
Rectal stenosis after radiation to the prostate Dear OncoLink "Ask The Experts," In 1993, I received radiation treatment for prostate cancer. In the last year, I have been having a problem with rectal stenosis. My oncologist gave me a dilator. I tried to use the dilator but it would not go in. What should I do?Richard Whittington, MD, Associate Professor of Radiation Oncology at the University
Interpreting the TURP Results Dear OncoLink "Ask The Experts," After receiving a TURP procedure, I was told that a T1B, 3+3 tumor was found in 19 out of the 99 slices of prostate tissue removed. The tumor's presence was not reflected in an elevated PSA score or a digital exam. What does the (B)3+3 rating mean?Richard Whittington, MD, Associate Professor of Radiation Oncology at
Taking Time for Treatment Decisions Dear OncoLink "Ask The Experts," I have been diagnosed with prostate cancer, Gleason score of 6, PSA level of 6.4. How much time can I take to consider treatment options? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:Although it may feel like an emergency, taking
Surgery for Cancer and Prostatitis? Dear OncoLink "Ask The Experts," I am a 69 year-old male in reasonably good health. I have just been diagnosed with prostate cancer, stage 1c. I have been looking at either radiation treatment or surgery. My urologist is suggesting surgery only because I also have prostatitis. I don't see how surgery will help me with my prostatitis. Can you assist
Burning and Blood with Ejaculation after Seed Implants Dear OncoLink "Ask The Experts," My husband is 79 years old and had radiation seed implants three years ago for prostate cancer. His PSA's since then have been 0.9 or less. He continues to have blood in his semen and burning with ejaculation. Is this common this long after the implants? He's asked his oncologist and urologist, and they just say
Infections after Urostomy Dear OncoLink "Ask The Experts," My husband had his bladder and prostate removed in April 2005. Both the bladder and prostate contained primary cancers. He now has a urostomy and is managing well, but he keeps getting urinary infections. I am concerned about him taking antibiotics and the strain of these infections on his kidneys. Is there any way
Robotic Laparoscopic Prostatectomy Dear OncoLink "Ask The Experts," My husband is 53-years-old and was diagnosed last week with T1c prostate cancer with a Gleason score of 6. Also, I would like to know your opinion of this procedure versus the open surgery. Thank you very much. Alan J. Wein, MD, Professor and Chair of the Division of Urology at the University of Pennsylvania
PSA After Prostatectomy Dear OncoLink "Ask The Experts," I had a radical prostatectomy in September 2006. Why would I have anything but a 0.0 PSA at this time? It's very low (PSA=0.08) but I'm not clear as to why ANY exists without a prostate. David I. Lee, MD, Chief of the Division of Urology at Penn Presbyterian Medical Center, responds:We aim for a serum PSA that is
Urinary and Bowel Incontinence after Radiation Dear OncoLink "Ask The Experts," My 80-year-old uncle had prostate cancer about 5 years ago. He was treated with external beam radiation therapy. The treatment was successful, and he is now cancer-free. His recent PSA test was in the normal range. However, he continues to have side effects for which there are no treatments, according to his current
Surgery After Radiation Dear OncoLink "Ask The Experts," I have heard that if I choose radiation therapy for prostate cancer treatment that I could not have surgery later if the cancer recurs. Why not? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:There are few surgeons who will do
High Frequency Ultrasound (HIFU) Dear OncoLink "Ask The Experts," I have recently heard about HIFU treatments for prostate cancer. What can you tell me about this? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:This technique uses focused ultrasound to heat small segments of the prostate.
Precautions for Seed Implants Dear OncoLink "Ask The Experts," My father-in-law has just gone through "seeding" for prostate cancer. Yesterday when he had this done, the doctor told him not to be around children for 30 days due to the radiation. Can you explain to me why? Is there something harmful that will happen to my child or him? Carolyn Vachani RN, MSN, AOCN,
What is Prostascint®? Dear OncoLink "Ask The Experts," What is Prostascint®?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Prostascint® is a radio-labeled monoclonal antibody, which is a type of medication that targets specific cells. In the case of Prostascint®, the antibody targets Prostate Specific Membrane Antigen (PSMA), a protein
PSA Level after Radiation Dear OncoLink "Ask The Experts," In June 2003, I finished receiving IMRT for prostate cancer. My PSA readings since then fluctuate between 0.5-2.0, but go up and down, not a consistent rise in the level. My pretreatment PSA was 3.1. I assume from the readings that the cancer has not been eradicated. Can you give me your judgment on how serious my
PSA Doubling Time Dear OncoLink "Ask The Experts," Can you please explain PSA doubling time? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:This is actually a fairly difficult question. PSA doubling time is supposed to reflect tumor growth, so the doubling time should reflect the
Timing for Hormone Therapy for Prostate Cancer Dear OncoLink "Ask The Experts," My father is currently being treated for advanced prostate cancer with a 10.8 mg depot of zoladex every 12 weeks. Is it essential that the renewal be given precisely within the 12 weeks indicated, or is it sufficient that the treatment be given roughly every three months? Michael Vozniak, PharmD, BCOP,
How High Can the PSA Go? Dear OncoLink "Ask The Experts," How high can the PSA go? Is it a reflection of how much tumor is present? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:It is possible for the PSA to go to very high levels. There is no absolute maximum value. In fact, I have seen
Reducing Prostate Cancer Risk Dear OncoLink "Ask The Experts," My father was diagnosed with prostate cancer at the age of 67. I am currently 40 years old. What types of things should I be doing to reduce my risk of prostate cancer?Neha Vapiwala , MD, Senior Editor of OncoLink and Chief Resident in the Department of Radiation Oncology at the Hospital of the University of
Chemotherapy for Prostate Cancer Dear OncoLink "Ask The Experts," I have prostate cancer that has progressed on hormone therapy. My doctor wishes to start chemotherapy. I know many men with prostate cancer and I have never heard of them receiving chemotherapy. What can you tell me about chemotherapy for prostate cancer?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator,
Satraplatin for Prostate Cancer Dear OncoLink "Ask The Experts," My husband has enrolled in a clinical trial for a drug called satraplatin. What can you tell me about it? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Satraplatin is a member of the platinum family of chemotherapy drugs, which includes cisplatin and carboplatin. Satraplatin is given in a pill
Can I get radiation to my spinal metastases while receiving docetaxel? Dear OncoLink "Ask The Experts," Can I get radiation to my spinal metastases while receiving docetaxel? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:You should discuss this directly with your radiation oncologist as it depends on the size of the area being treated and the dose of radiation being given each day. If radiation
How can I find out about clinical trials for my prostate cancer that is not responding to hormones anymore? Dear OncoLink "Ask The Experts," How can I find out about clinical trials for my prostate cancer that is not responding to hormones anymore?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:There are many clinical trials being conducted for patients with hormone refractory prostate cancer. OncoLink has a service, powered by
Who should I see about chemotherapy for my prostate cancer? Dear OncoLink "Ask The Experts," Who should I see about chemotherapy for my prostate cancer?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Chemotherapy is managed by a doctor called a medical oncologist. These doctors are trained in the administration of chemotherapy and managing of related side effects. You can find a medical
How is docetaxel given and what are the side effects? Dear OncoLink "Ask The Experts," How is docetaxel given and what are the side effects?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds: Docetaxel is a type of chemotherapy called a taxane, which is given intravenously (into a vein, through an IV). It is typically given every three weeks in your doctor's office or infusion
How is Mitoxantrone used for prostate cancer treatment? Dear OncoLink "Ask The Experts," How is Mitoxantrone used for prostate cancer treatment?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Mitoxantrone is a type of chemotherapy that is given through an IV (intravenous), typically every three weeks, when used for prostate cancer treatment. In clinical trials of men with hormone
When should chemo be started in an asymptomatic patient who has a rising PSA where hormones have failed? Dear OncoLink "Ask The Experts," When should chemo be started in an asymptomatic patient who has a rising PSA where hormones have failed?David J Vaughn, MD, Medical Director of the Abramson Family Cancer Research Institute and Associate Professor of Medicine, Hematology-Oncology at the Abramson Cancer Center of the University of Pennsylvania,
Incontinence After Surgery Dear OncoLink "Ask The Experts," I had a radical prostatectomy about a year ago. The cancer seems to be gone with a serum PSA of zero. I remain incontinent and seem to have control only when I am relaxing, sitting, or not involved in any activity at all. I go through 4 to 6 pads daily. When I am working or otherwise active, I leak constantly. My
Gynecomastia with Anti-androgens Dear OncoLink "Ask The Experts," My husband underwent 40 treatments of IMRT ending in December for locally advanced prostate cancer. He is seeing the radiation oncologist for very painful gynecomastia in the hopes of stopping that. Can you tell me about this treatment? Richard Whittington, MD, Associate Professor of Radiation Oncology at the
Scrotal Swelling after Radiation or Surgery Dear OncoLink "Ask The Experts," My husband underwent 40 treatments of IMRT ending in December for locally advanced prostate cancer. He also had a hernia repair done in February. Since last week he has had swelling of his right testicle and pain radiating to his suprapubic area. Today his hernia surgeon said the pain is the result of the radiation.
When to Start Hormone Therapy? Dear OncoLink "Ask The Experts," I have prostate cancer, had a radical prostatectomy in 1999, then 13 wks of radiation in 2004 with a serum PSA of 0.26 ng/mL. As of July 2007, my PSA is 3.3 ng/mL. I know that hormone therapy is my only treatment option, but when should I start?? I have gotten 4 different opinions, ranging from now, to waiting until
Testosterone after Prostate Cancer Dear OncoLink "Ask The Experts," I was diagnosed with prostate cancer about 18 months ago and had radiation treatment. My PSA has dropped, and all seems to be going well. But my libido, erectile function, and general energy level are not what I'd like them to be. I'm 74 and in good health. My testosterone level is at the low end of the normal
Brachytherapy and Size of the Prostate Dear OncoLink "Ask The Experts," Does the size of the prostate (e.g. greater than 90cc) automatically preclude brachytherapy? Neha Vapiwala , MD, Senior Editor of OncoLink and Chief Resident in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania, responds: No, a large prostate does not automatically preclude
Side Effects of Brachytherapy Dear OncoLink "Ask The Experts," I would like to know the side effects of brachytherapy for prostate cancer, particularly long term. Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:The tissue changes from brachytherapy are not that different from what you see with
What is Cryotherapy? Dear OncoLink "Ask The Experts," Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Cryotherapy is a procedure that uses freezing and thawing to kill cancer cells. This technique has been used to treat skin cancers for some time, but the experience with prostate cancer is not as well defined. Most doctors consider good follow up
What is High Frequency Ultrasound (HIFU)? Dear OncoLink "Ask The Experts," What is High Frequency Ultrasound (HIFU)?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:This technique uses focused ultrasound to heat small segments of the prostate. Hyperthermia units with similar heating effects were tried in the past and failed, but this new approach may result in better
PSA Level for Radiation Therapy after Surgery Dear OncoLink "Ask The Experts," I had a prostatectomy in December 2005 for prostate cancer. In August 2007, my PSA rose to .051 ng/mL, following a continuing increase from .01 ng/mL following surgery. I am seeking radiation therapy at a local hospital, where they offer 3DCRT for post-prostatectomy patients. Is this therapy necessary? Richard
No Surgery if Positive Lymph Nodes? Dear OncoLink "Ask The Experts," Why is a prostate cancer surgery stopped if the cancer is found in the lymph nodes? Why can't the lymph nodes be removed along with the prostate?Alan J. Wein, MD, Professor and Chair of the Division of Urology at the University of Pennsylvania School of Medicine, responds: The finding of positive lymph nodes during
PSA Bounce Dear OncoLink "Ask The Experts," Can you please describe what a PSA bounce is? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds: The “PSA bounce” has been described primarily after brachytherapy, but is also seen infrequently after external beam radiation
Increase in PSA after Hormone Therapy is Stopped Dear OncoLink "Ask The Experts," I finished external radiation in June 2005 and 2 years of hormone therapy about 9 months ago. In July, my PSA went from <.1 ng/mL to .1 ng/mL. They said this could be PSA bounce. Should I be concerned? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of
Field Plan for Radiation Therapy Dear OncoLink "Ask The Experts," I am undergoing 3dcrt for psa recurrence post prostatectomy. At the start of my treatment, I attended a presentation by a radiation oncologist who used 3dcrt with four dosage planes in the first part of the radiation treatment, but toward the end of the of the treatment period he switched to six dosage planes. I
Brachytherapy After TURP Dear OncoLink "Ask The Experts," I was told seed implants were not an option after TURP. Is this true?Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds: When brachytherapy (seed implant) is performed, the seeds are inserted throughout the prostate gland. After the
Radiation Versus Surgery Dear OncoLink "Ask The Experts," I am 59 years old, and just diagnosed with prostate cancer (T1c, Gleason 6). The surgeon recommended a prostatectomy, partly because he says that with radiation treatment, a second cancer may occur in 15-25 years, perhaps due to exposure to the exposure to radiation. He stated that the success rate between surgery
Radiation Seed Side Effects Dear OncoLink "Ask The Experts," Approximately 2 months ago, my male relative of 66 years of age got radiation seeds implanted in his prostate after a diagnosis of early stage prostate cancer. Since then, he has experienced terrible side effects: 1) cannot urinate without a catheter (he now catheterizes himself daily); 2) painful bowel movements;
Can XRT cause a “bump” in PSA? Dear OncoLink "Ask The Experts," My husband has had prostate cancer for 11 years, and it recently metastasized to 2 vertebrae and one spot on his hip bone. He is almost finished with radiation and his pain is gone. His PSA level has jumped from 28 before radiation to 60 almost 2 weeks into radiation. Is this due to dead cancer cells going through
Choosing a Proton Center Dear OncoLink "Ask The Experts," With a prostate cancer, Gleason score 7, I have chosen treatment with proton therapy. The question I have for you is: Loma Linda has the most experience, but they are not available for several months. MD Anderson and University of Florida are less experienced with about 2 years each. Should one chose to wait for
Anal Stimulation after Brachytherapy Dear OncoLink "Ask The Experts," I am 6 months post radioactive seed implantation, and doing very well. Is there any increased risk from anal stimulation/dildo play because of the procedure? Neha Vapiwala , MD, Senior Editor of OncoLink and Chief Resident in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania,
Peroneal Nerve Graft for Erectile Dysfunction Dear OncoLink "Ask The Experts," A fellow told me that when he had surgery at Sloan Kettering in NYC, they were prepared to graft nerve tissue from his heel if there was damage to nerves that would affect sexual function. That did not come to pass for him, but he said it did for another person and the result was good. This was a first and only I
Prostate Biopsy Spreads Cancer Cells? Dear OncoLink "Ask The Experts," A February 20, 2008 breaking news release entitled "Prostate Biopsy Spreads Prostate Cancer Cells" appeared in the Prostate/Prostate Cancer section on Medical News Today's web site. Is this news likely to revolutionize the way we diagnose and test for prostate cancer? Richard Whittington, MD, Associate
Ureteral Strictures after Radiation Dear OncoLink "Ask The Experts," Is it possible to develop a stricture of the ureter as a result of radiation damage ? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:Ureteral strictures are very rare because the ureter is generally not included in the prostate volume
TURP Specimens Dear OncoLink "Ask The Experts," I had a TURP done and prostate cancer was found. What will I find on my path report? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds: TURP, also called transurethral resection of the prostate or TUR, is a procedure that may be done to
Can the Calypso® System Be Used After Prostatectomy? Dear OncoLink "Ask The Experts," I had a prostatectomy and now have a recurrence. My doctor plans to treat with radiation therapy. I have read about the Calypso system, is this an option for me? Neha Vapiwala , MD, Senior Editor of OncoLink and Chief Resident in the Department of Radiation Oncology at the Hospital of the University of
D’Amico Risk Categories Dear OncoLink "Ask The Experts," Can you describe the D'Amico risk categories and how they relate to prognosis ? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds: Dr. Anthony D'Amico has shown that it is possible to estimate the biologic aggressiveness of prostate
Benefits of Robotic Prostatectomy Dear OncoLink "Ask The Experts," I have been diagnosed with stage 1 prostate cancer. I am 68 years old and have just these past 3 weeks experienced urinary retention to the point that I am now catheterized and awaiting further testing. I have a very large prostate which is causing the urinary blockage. Based on all my research, I believe my best
Proton Therapy for Prostate Cancer Dear OncoLink "Ask The Experts," I am seriously considering Proton Therapy for my recently diagnosed Prostate cancer. I am 55 years old, my Gleason Score is 6 (3+3), and my PSA is 4.5. The information I have been reading everywhere is very vague regarding side effects. Terms like "minimal" side effects or "largely spares surrounding
Drastic Drop in PSA Dear OncoLink "Ask The Experts," In February of 2007, I was diagnosed with prostate cancer, PSA 4.2; 2 out of 10 cores positive for cancer, 10% involvement in each core, Gleason score 7 (4+3). I underwent IMRT to 77.4 Gy with 4 months of Lupron. My last 3 PSAs – each one 4 months apart - have all been 0.2 ng/ml. What I would like to know is
Positive Margins and Robotic Prostatectomy Dear OncoLink "Ask The Experts," My husband was recently diagnosed with prostate cancer. He was so sure the DaVinci prostatectomy was the way to go, but after reading more online, some doctors say that the prostate can be burnt or the capsule broken , possibly leaving cancer behind and pathology margins not ideal. The one surgeon I was looking at
Rectal Bleeding After Radiation for Prostate Cancer Dear OncoLink "Ask The Experts," I had seed implants for prostate cancer 2 years ago. I have had rectal bleeding ever since. Sometimes it is with a bowel movement and sometimes I'll feel it running down my legs. It is bright red and it's enough to come through my pants. I had a colonoscopy and it did not reveal the cause. Have you had any patients
Recovery After Robotic Prostatectomy Dear OncoLink "Ask The Experts," My husband is scheduled for robotic prostatectomy soon. How soon afterwards can we expect him to have his strength back? When will he be able to fly, drive or walk a long distance, climb steps, carry groceries, or lift grandchildren?David I. Lee, MD, Chief of the Division of Urology at Penn Presbyterian Medical
Bowel Issues After Proton Therapy Dear OncoLink "Ask The Experts," I completed proton therapy for prostate cancer 3 months ago. Starting four weeks after I began therapy, I continue to experience bowel issues of urgency, frequency, mucus and occasional cramping. Is this likely caused by the proton therapy, and what treatment is needed?Richard Whittington, MD, Associate Professor of
Cancer Free if PSA is 0? Dear OncoLink "Ask The Experts," I had a radical prostatectomy approximately 12 years ago. My PSA level increased from 5.5 to 7.5 ng/mL over 3 months. My doctor stated that this means that I have metastatic cancer and he started hormone therapy with Lupron. It has been 3 mo. since I had the shot and a repeat PSA test was undetectable. Does this
Depression and Hormone Therapy Dear OncoLink "Ask The Experts," I have suffered from depression all my life and take several different medications and see a psychiatrist. Since starting Lupron therapy, I have been much more depressed. My psychiatrist has changed my medications around in the hopes of helping with the depression, but it does not seem to be working. Do you know
PSA Testing in Older Men My PSA test results have been 0.3-0.4ng/ml since testing started at age 55. Until age 70 PSA tests were every 5 years. Starting with age 70 my physician has done PSA tests every year with the same results. I am 75 andf when I ask why the increased testing, the answer was "This is an excepted standard, since there is a higher incident of Protate
Myxofibrosarcoma Dear OncoLink "Ask the Experts," My husband has a very fast spreading form of cancer — myxofibrosarcoma. He's had one tumor removed and now has another. Can you tell what it is and how to treat? Thanks K Li Liu, MD, OncoLink editorial assistant, responds: Dear K: Thank you for your
Is Heart Cancer Possible? Dear OncoLink "Ask the Experts," Could you please answer me why the heart is the only organ in the human body which is not attacked by cancer. What does the heart have to protect itself that the other organs don't? V Li Liu, MD, OncoLink Editorial Assistant, responds: Dear V: Thank you for your
Skin Cancer Dear OncoLink "Ask the Experts," I have a question about sun block products. What active ingredients should be present in a product to be effective and in what percentage. Also are their any products that you can suggest. Brand names can be helpful. Maggie Hampshire RN, BSN, OCN, Managing Editor of OncoLink replies:
Merkel's Cell Carcinoma Dear OncoLink "Ask the Experts," Please send me information on "Merkel's Cell Carcinoma." A friend of mine has been diagnosed with that illness and I'd like to find out about it. Kenneth R. Blank, MD, OncoLink Editorial Assistant, replies: Thank you for your question. Merkel's cell cancer is a
Tanning Beds and Skin Cancer Dear OncoLink "Ask the Experts," Do tanning beds cause skin cancer? Thank you. Li Liu, MD, Editorial Assistant for OncoLink, responds: Dear F: Thank you for your interest and question. Tanning beds use both ultraviolet A and B. Ultraviolet B, the middle wavelength, starts the tanning process,
Merkel Cell Carcinoma Dear OncoLink "Ask the Experts," I need a question answered. I have a friend whose husband has skin cancer. The doctors have mentioned something about Merkel Cells, which apparently are rare. Can you tell me something about these cells? I am curious as to what kind of cells these are, and what they mean if they are in the body.
Extramammary Paget's Disease Dear OncoLink "Ask the Experts," My father was recently diagnosed with Paget's disease of the scrotum. What are the treatment options for this disease? Thank you very much. S Li Liu, MD, OncoLink editorial assistant, responds: Dear S, Thank you for your interest and question. Paget's disease
Bowen's Disease Dear OncoLink "Ask the Experts," What is Bowen's disease and how do you treat it? Thank you. F. Li Liu, MD, OncoLink editorial assistant, responds: Dear F: Thank you for your interest and question. Bowen's disease is a skin cancer that is confined to the skin. The skin has three layers.
Actinic Keratosis Dear OncoLink "Ask the Experts," Is actinic keratosis a major or minor problem in the USA? Is there a simple solution to its elimination? Who can I contact in reference to this? Thank you. Li Liu, MD, OncoLink Editorial Assistant, responds: Dear Reader: Thank you for your interest and
Use of GM-CSF for the treatment of malignant melanoma Dear OncoLink "Ask The Experts," Do you have any current info on the use of GM-CSF for the treatment of malignant melanoma? I would appreciate any help in finding most current info on the effectiveness of this treatment. Julia Draznin Maltzman, MD, Attending Physician at the University of Pennsylvania School of Medicine, responds:The only
Kidney Transplant and Skin Cancers Dear OncoLink "Ask The Experts," I had a kidney transplant 26 years ago, and in the past 15 years, I have had many warts that have been biopsied and found to have basal or squamous cell cancer. These have been excised, but they heal very slowly. I wonder if there is anything I can do to prevent them? I am on immunosuppressive drugs (Imuran 100
Sun Safety Dear OncoLink "Ask The Experts," I have a question about sun block products. What active ingredients should be present in a product to be effective and in what percentage. Also are their any products that you can suggest. Brand names can be helpful. Suzanne M. McGettigan, MSN, CRNP, AOCN, Board Certified Adult Nurse Practitioner and a Certified
Mohs Micrographic Surgery Dear OncoLink "Ask The Experts," My father-in-law was recently diagnosed with melanoma of the eyelid. Could you please tell me how this is treated? Is it possible to remove one's eyelid? Christopher J. Miller, MD, Assistant Professor of Dermatology at the Abramson Cancer Center of the University of Pennsylvania, responds:The primary treatment for
SPF of Clothing Dear OncoLink "Ask The Experts," I have seen clothing that has SPF on the label. Is this effective? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:It’s good that you are thinking outside the sunscreen box for ways to reduce sun exposure. Most people do not use nearly enough sunscreen or reapply often enough to get the labeled
Risk of Skin Cancer After Basal Cell (BCC) Question If someone has a basal cell skin cancer, are they at risk to get other skin cancer spots or a more serious cancer like melanoma? Answer Christopher J. Miller, MD, Assistant Professor of Dermatology at the Abramson Cancer Center of the University of Pennsylvania, responds: Christopher Miller, MD, Dermatologist & Moh's Surgeon at
Combination Insect Repellents and Sunscreens Question Are the combination products of sun block and insect repellent as effective as sun block alone? Answer Rachel Woods, RN, Nurse for the Surgical Dermatology Program at Penn Medicine responds: The sun bock in a bug repellent combo should be as effective as its SPF. The thing to be cautious about is that a person would be reapplying sun
Sun Protection in an Infant Question Can you use sunscreen lotion on a young child, less than 1 year-old? Answer Rachel Woods, RN, Nurse for the Surgical Dermatology Program at Penn Medicine responds: The American Academy of Pediatrics has said to use sunscreen by 6 months of age but that limited use is all right for younger babies. The best protection is to avoid having
Does Sunscreen Expire? Question Does sunscreen really expire? If so, how do I know how long it is good for? Answer Rachel Woods, RN, Nurse for the Surgical Dermatology Program at Penn Medicine responds: Sunscreen does have an expiration date imprinted somewhere on the bottle. It is usually good for about a year. This question and answer was part of the OncoLink
Is Higher SPF Better? Question Is it always better to get the highest SPF sunscreen I can find? Answer Rachel Woods, RN, Nurse for the Surgical Dermatology Program at Penn Medicine responds: The American Academy of Dermatology recommends using sunscreens with an SPF no lower than 30. Once you go above 50, there is a very small difference in protection. The key is to
Cancer Risk With Actinic Keratosis Question I have been told I have some spots on my skin called"actinic keratosis." Does this mean I will get skin cancer? Answer Rachel Woods, RN, Nurse for the Surgical Dermatology Program at Penn Medicine responds: If you have an AK, you are at risk for developing squamous cell cancer. AKs are precancerous and can be treated easily but it is a
Skin Cancer Diagnosis & Treatment Question How is skin cancer diagnosed and treated? Will I need to see a dermatologist or a cancer doctor? Answer Rachel Woods, RN, Nurse for the Surgical Dermatology Program at Penn Medicine responds: Skin cancer is definitively diagnosed through a biopsy. Treatment differs with the type and severity of the cancer. See your dermatologist and he
Is a Cancerous Mole Painful? Question Are skin cancer moles usually painful? Answer Christopher Miller, MD, Dermatologist & Moh's Surgeon at Penn Medicine and Rachel Woods, RN, Nurse for the Surgical Dermatology Program at Penn Medicine respond: Skin cancer moles are usually not painful, especially in their early stages. Pain can associated with a dangerous mole.
Medications Causing Sun Sensitivity Question Are there special precautions to take if you are on a medication that says "may increase sun sensitivity?" Answer Christopher Miller, MD, Dermatologist & Moh's Surgeon at Penn Medicine responds: Certain medications, such as tetracycline antibiotics, can increase your sensitivity to the sun. The precautions when you take these
Family History of Melanoma Question Does having a family history of melanoma increase my chances of getting it? Answer Christopher Miller, MD, Dermatologist & Moh's Surgeon at Penn Medicine responds: A family history of melanoma does increase your chances of getting melanoma. If you have a first degree relative (e.g., mother, father, and sibling) with melanoma, your
White T-Shirt SPF Question A white cotton t-shirt is adequate coverage to protect against the sun if I'm sitting on the beach: Fact or Myth? Answer Rachel Woods, RN, Nurse for the Surgical Dermatology Program at Penn Medicine responds: MYTH!! A white cotton t-shirt only has an SPF of 5. Don't be fooled. Seek shade under the umbrella and wear your sunscreen.
Sunscreen Best Defense? Question Sunscreen should not be your first line of defense against harmful UV rays: Fact or Myth? Answer Rachel Woods, RN, Nurse for the Surgical Dermatology Program at Penn Medicine responds: FACT!! Sunscreen is always your last line of defense. Cover up with the appropriate clothing, hats, and sunglasses first and then seek shade before
If I Don't Burn, I won't Get Skin Cancer Question If you don't get burned, then you can't get skin cancer: Fact or Myth? Answer Rachel Woods, RN, Nurse for the Surgical Dermatology Program at Penn Medicine responds: MYTH!! Any person can get skin cancer. Fair skin, red hair, and blue eyes are the highest risk people, but even dark skin is susceptible. This question and answer was
What Does SPF Mean? Question A sun block with SPF of 30 will protect me from the sun for 30 minutes: Fact or Myth? Answer Rachel Woods, RN, Nurse for the Surgical Dermatology Program at Penn Medicine responds: SPF increases the time you have in the sun before your skin begins to turn red...about 20 minutes for a fair skin individual. So SPF 30 for that fair skin
Melanoma in Fingernail Question Melanoma can occur under a fingernail: Fact or Myth? Answer Christopher Miller, MD, Dermatologist & Moh's Surgeon at Penn Medicine and Rachel Woods, RN, Nurse for the Surgical Dermatology Program at Penn Medicine resond: It is a fact that melanoma can occur under the fingernail. The cells that make the nail plate (the hard part of
Sunglasses Protecting Against UV Rays Question Sunglasses are just fashionable. They don't actually protect against the sun's harmful rays: Fact or Myth? Answer Christopher Miller, MD, Dermatologist & Moh's Surgeon at Penn Medicine responds: Sunglasses can protect your eyes from ultraviolet light. However, not all sunglasses have ultraviolet filters in the lenses. Be sure to
Melanoma Removal and Work-up Dear OncoLink "Ask The Experts," I recently had a malignant melanoma removed. Is it important to do a wide excision and why? Do I need a sentinel node removal? Can anything else show cancerous cells in my body? Like a PET scan or MRI or CAT scan? Someone told me that every mole in your body could be found to have cancer cells. Is this true? Does
Ocular Melanoma Dear OncoLink "Ask The Experts," Can you please give me some information on melanoma of the eye?Suzanne M. McGettigan, MSN, CRNP, AOCN, Board Certified Adult Nurse Practitioner and a Certified Oncology Advanced Practice Nurse, responds:Ocular (eye) melanoma is not staged in the same manner as cutaneous melanoma (melanoma of the skin). It tends to
Radiation for Melanoma Dear OncoLink "Ask The Experts," Can a person with Xeroderma Pigmentosa (XP) use radiation therapy to treat melanoma?Carolyn Vachani RN, MSN, AOCN, OncoLink's Medical Correspondent, responds:There are a few issues here. For starters, melanoma is not very sensitive to radiation , meaning radiation does not usually work very well against melanoma
Leptomeningeal Cancer from Melanoma Dear OncoLink "Ask The Experts," What are the treatment options for someone diagnosed with leptomeningeal cancer from melanoma? Suzanne M. McGettigan, MSN, CRNP, AOCN, Board Certified Adult Nurse Practitioner and a Certified Oncology Advanced Practice Nurse, responds:I did a search and found a single case study of a primary leptomeningeal melanoma
Isolated Limb Perfusion Dear OncoLink "Ask The Experts," What is isolated limb perfusion? Can you tell me its indications, technique, and adverse effects? Suzanne M. McGettigan, MSN, CRNP, AOCN, Board Certified Adult Nurse Practitioner and a Certified Oncology Advanced Practice Nurse, responds:Isolated Limb Perfusion, or ILP, is a procedure used to treat locally
Mucosal Melanoma and Stereotactic Radiosurgery Dear OncoLink "Ask The Experts," My question is in regards to a periurethral melanoma. Do you know of any surgeries done for this problem using CyberKnife®?Suzanne M. McGettigan, MSN, CRNP, AOCN, Board Certified Adult Nurse Practitioner and a Certified Oncology Advanced Practice Nurse, responds:Periurethral melanoma sounds like it would be
Sentinel Node Biopsy During Pregnancy Dear OncoLink "Ask The Experts," I have recently been diagnosed with melanoma: 0.77 mm thick with Clark 's level IV. I am also 7 weeks pregnant. I am scheduled for a wide excision with local anesthetic for this Friday. Is there a time in pregnancy when the sentinel node biopsy (SNB) can be performed with minimal risk to the fetus from the
Interferon Treatment for Melanoma Dear OncoLink "Ask The Experts," I have had a block dissection of the lymph nodes, and the sentinel node was found to contain melanoma cells. I am shortly going on a treatment course of interferon. Is there anything else I can do to improve my chances of survival? What do the statistics predict as my chances of survival? Your advice in this regard
Mucosal Melanoma Dear OncoLink "Ask The Experts," My friend had a mole removed 2 years ago and was told it was one step away from melanoma. She had 4 surgeries until clear margins were obtained. She was told yesterday that she had melanoma of the colon -had several scans and this was the only area that looked hot. She will have a PET scan done soon. How rare is
Follow-Up Care for Melanoma Dear OncoLink "Ask The Experts," I am a 29-year-old female with melanoma, stage T2N0M0. I am getting every-3-month follow-up visits/exams with every-6-month chest x-rays & blood work. Is there any opinion on getting any routine brain scans, since melanoma's "favorite" metastasis sites are chest & brain? I do not presently have any
Recovery from sun damage Dear OncoLink "Ask The Experts," I was at the Penn melanoma conference and Dr. Elenitsas showed two slides of the dermis. One was damaged by the sun, and the other one did not have sun damage. My question is: does the dermis have the ability to recover from the damage of the sun? For instance, I have practiced safe sun habits for 5 years:
Melanoma Biopsy Results and Sentinel Node Biopsy Dear OncoLink "Ask The Experts," I recently went to my family practitioner about an odd-looking mole. He said he didn't think it was anything to be concerned about and shaved it off, but then the pathology report identified it as melanoma, Clarks level II and Breslow level 0.49 mm with involved margins. He then sent me to a dermatologist, who
Immune System after Melanoma Dear OncoLink "Ask The Experts," I recently had a superficial spreading melanoma removed that was quite small, approx half a millimeter in depth. (The procedure went well with) no problems and a fairly good prognosis. Since then, my immune system seems to be weakened, as I am catching every bug around. Is this an after-effect, and if so,
Types of Melanoma Dear OncoLink "Ask The Experts," Are there different types of melanoma? Suzanne M. McGettigan, MSN, CRNP, AOCN, Board Certified Adult Nurse Practitioner and a Certified Oncology Advanced Practice Nurse, responds:There are four general types of melanoma: superficial spreading melanoma, lentigo malignant melanoma, acral lentiginous melanoma, and
Leptomeningeal Melanoma Dear OncoLink "Ask The Experts," What is leptomeningeal melanoma? What medication can help? Keith T. Flaherty, MD, Assistant Professor of Medicine (Hematology/Oncology), responds:Leptomeningeal melanoma refers to the spread of melanoma cells to the tissue that lines the outside of the brain and spinal cord. It generally occurs in the setting of
Sentinel Node Biopsy Instructions Dear OncoLink "Ask The Experts," I had a sentinel node biopsy done in my right groin 8 days ago. At first, the nurse said I should walk, but my surgeon said 2 days ago to minimize walking. Since then, I have minimized walking, but it seems that the fluid (seroma) has built up more with less walking. I'm wondering what the right amount of
Link between Melanoma & Breast Cancer Dear OncoLink "Ask The Experts," I was diagnosed with malignant melanoma on my left wrist in June of 2005. Monday I had an OB-GYN appointment and a "lump" was found in my left breast. There is no history of breast cancer or melanoma in my family; however, there are numerous other types of cancer: colon, prostate and lung. Could the melanoma have
Mole Mapping Dear OncoLink "Ask The Experts," I have had melanoma twice in the past 15 years. I have hundreds of moles and have been diagnosed with dysplastic nevi. I live in a state with poor medical resources for my situation. I have gone without medical monitoring for the past 7 years, and my current Doctor is suggesting an aggressive course of biopsies
Choosing Therapy after Surgical Removal of Melanoma (Adjuvant Therapy) Dear OncoLink "Ask The Experts," I have been diagnosed with melanoma, stage IIIA. After a 4.5 mm lesion was removed, I had a sentinel node biopsy which came back "barely" positive. Two weeks later, I had a complete lymph node dissection of the left groin. ALL came back negative - Hooray! Now I am faced with the interferon vs. vaccine
Lower Extremity Lymphedema & Melanoma Dear OncoLink "Ask The Experts," What is the likelihood of developing lymphedema following a dissection of the external lymph nodes of the groin area for treatment of Stage III melanoma? Is lower extremity lymphedema more common or worse than arm lymphedema? Of the percentage of patients who develop lower extremity lymphedema after such a
Biopsy for a Second Melanoma Dear OncoLink "Ask The Experts," My husband had surgery for melanoma in October 2006 on his back. It was extensive surgery but no melanoma in lymph nodes. He had another spot close to where the original melanoma was that was biopsied and was pre-cancer. Now it has changed some, and the doctor wants to do another extensive surgery, but he hasn't
Melanoma Biopsy Report Dear OncoLink "Ask The Experts," I recently had a punch biopsy done on my left forearm. Could you please help me understand the pathology report? DIAGNOSIS: Atypical intraepidermal melanocytic proliferation, trailing to the lateral side margin. COMMENT: Sections demonstrate an intraepidermal proliferation of predominantly single and focally nested
GM-CSF for Melanoma Dear OncoLink "Ask The Experts," I was diagnosed with melanoma on my left foot, Stage Ib, in 2005. In 2009, I was found to have a recurrence in the left thigh. This was removed and there appears to be no organ involvement. I do not want to take any toxic treatments and am wondering about your thoughts on GM-CSF, which is my plan for treatment.
Alpha-fetoprotein Levels After Treatment for Testicular Cancer Dear OncoLink "Ask the Experts," Our 24 year old son has stage I non-seminomatous testicular cancer. Part of the follow-up is a check on the alpha-fetoprotein (AFP) in the blood every two weeks. The AFP is considered a marker for this type of cancer. We have not been able to pinpoint the acceptable level of AFP. To add to the confusion,
Seminoma Dear OncoLink "Ask the Experts," One of my best friends has been diagnosed with seminoma. It has been two weeks since his orchiectomy. For some reason, he has not had radiation therapy (RT) yet. His seminoma is still in Stage I according to his doctor's opinion. I would like to know when the RT should be done after removal of the
Treatment Options for Metastatic Seminoma Dear OncoLink "Ask the Experts," My husband was diagnosed with Metastatic Seminoma today. I have been reading up on testicular cancer, and I don't really find his condition described. The doctor said it was advanced, I'm assuming it is Stage III. There is no mass in either testicle, so there will be no surgery (at this time?). It has
Signs and Symptoms of Testicular Cancer Dear OncoLink "Ask the Experts," Will you please tell me what are the signs and symptoms of testicular cancer? I know a lump might be one sign, but what else could there be? Kenneth Blank, MD, Editorial Assistant for Oncolink, respond: Dear OncoLink Reader: Thank you for your question. You are correct. A
Variocele and Hydrocele Dear OncoLink "Ask the Experts," It would be useful if you could post some information relating to the co-incidence of variocele/hydrocele and testicular cancer since: It is unclear what, if any, relationship exists between them Information about testicular self-examination techniques for people who have either variocele or
BCG Treatment for Bladder Cancer and Hepatitis Dear OncoLink "Ask the Experts," I was diagnosed with bladder cancer in 1990, and had two transuretheral removals of tumors. After the second recurrence I received BCG treatment and had good results. This year I was diagnosed with Hepatitis C. A friend of mine, who is receiving the BCG treatment directed me to OncoLink Web site where
Bladder Cancer Dear OncoLink "Ask the Experts," I would like to find out any information you have on radical cystectomies for bladder cancer. I, specifically, would like to know what the red flags are indicating bladder cancer. How soon should they be investigated (i.e. does hematuria more than once usually tell a doctor to send you to a urologist
Inherited Tendencies of Urachal Cancer Dear OncoLink "Ask the Experts," My daughter died in 1994 of urachal cancer. Is this cancer inherited? Is there a cure? AB Ken Blank, MD and John Han-Chih Chang, MD, OncoLink Editorial Assistants, respond: Dear OncoLink reader: Thank you for your question. Urachal carcinoma is an extremely rare
BCG Treatment for Bladder Cancer Dear OncoLink "Ask the Experts," I am presently being treated with a drug named BCG for bladder cancer. The drug is placed into the bladder once a week for six weeks. The instructions make the material seem contaminating. Why does this material need to be treated so carefully? Thank you, TF John Han-Chih
Treatment options for stage III bladder cancer Dear OncoLink "Ask The Experts," My brother was diagnosed with stage three bladder cancer. He began a chemotherapy program scheduled to last three months. Within the last week he had a CT scan to determine if the cancer had spread and a visual scope of his bladder to determine the effect of the chemo. The scan showed no spreading and
Bladder Cancer: Side Effects of Radiation Dear OncoLink "Ask The Experts," My father is 76 yrs old and has bladder cancer. The family is concerned about the side effects of radiation therapy. I know the radiation may give him diarrhea & tiredness, but is urethral stricture & bowel adhesions a common side effect? Are there any other side effects we should be aware of while trying to
Ciliary body tumor in a dog Dear OncoLink "Ask The Experts," My dog is only 4 years old. I have learned that my dog has an "epithelial tumor of the ciliary body" in the eye itself, a"ciliary adenocarcinoma". I am concerned about metastatic rate for this type of tumor, and the recommended best way to monitor on a continuing or long-term basis. My local vet suggested a
Visceral Mast Cell Tumor in Cats Dear OncoLink "Ask The Experts," My cat was diagnosed with a mast cell tumor in his abdomen and prescribed cyproheptadine twice a day. I would like to know how this drug works against this disease. Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu, responds:Mast cells are white blood cells that play a role in allergic
Spay or Wait One Heat Cycle Dear OncoLink "Ask The Experts," I have an 11-month-old female white German Shepherd dog who I do not plan to breed. I was told by the breeder to allow her to go through one initial heat cycle before neutering her, so that she could fully develop her bone structure, muscle, and size. I am now hearing that my dog may pay the price by being prone
Companion Animals and Cancer Dear OncoLink "Ask the Experts," Do you have any statistics as to how many companion animals are diagnosed with cancer in their life time? What treatments are used? And, what is average cost of treatment? Thank you. Lili Duda, VMD, Editor of the OncoLink Veterinary Oncology Section Menu, responds:
Traveling with a Companion Animal with Cancer Dear OncoLink "Ask the Experts," I have a question. My parents have a cat that has cancer of the liver. She is currently getting chemotherapy once every 3 weeks. They are going to be traveling around the country in an R.V. soon with the cat. They are trying to figure out how to make sure the cat receives her chemo treatments as needed.
Treatment options for a dog with osteogenic sarcoma, metastasized to the lungs Dear OncoLink "Ask the Experts," I know that you can't give a medical opinion but I wonder if you could offer any advice? I don't expect a miracle but I need to try to find something that may help - I have a 7-year-old female Rottweiler who has osteogenic sarcoma. She was diagnosed 4 months ago and has had surgery to remove the affected
Treatment Options for a Dog with a Nerve Sheath Tumor Dear OncoLink "Ask the Experts," Recently I was told that my 13-year-old dog had nerve sheath tumor on her front right leg. It is a huge growth that looks like cauliflower. What are the treatments? They said I had an option for amputation, and radiation. She is my world and I hate to see her pain. What other options might I have?
The Role of Hormones in the Development of Mast Cell Tumors in Animals Dear OncoLink "Ask the Experts," I was wondering if any research has been done on the effects of hormones like estrogen on keeping dog Mast Cell Tumors (MCT) in check? I know it may just be coincidence, but my Rhodesian ridgeback had one MCT for 3 yrs, and after she was spayed, developed 4 more within the next year (which have been
Feline Leukemia Virus (FeLV) Dear OncoLink "Ask the Experts," My cat was diagnosed with FeLV (feline leukemia virus) with associated lymphosarcoma. His eye is affected. The vet said he will never see out of it again and that it should be taken out. Any information on this would be greatly appreciated. Lili Duda, VMD, Editor of the OncoLink
Modifying a Dog's Chemotherapy Protocol Dear OncoLink "Ask the Experts," I wonder what current chemotherapy protocol information is available for canine lymphoma. My dog was diagnosed in March 1999 and put on a chemotherapy protocol. Are there modifications, which can be made to her protocol to account for both her tolerance of the drug and my financial abilities?
Canine Radiation Therapy Prognosis Dear OncoLink "Ask the Experts," We are owned by a 4 3/4 year old, Chocolate Labrador retriever. On December 9, 1999, he had a fairly large lump excised from the soft tissue area between his shoulder blades (non-metastisized fibrosarcoma). He recovered admirably from the surgery. Unfortunately, last week we discovered the lump had
Thyroid Cancer in Dogs Dear OncoLink "Ask the Experts," Would you please direct me to information regarding thyroid cancer in dogs? I appreciate your time and effort. Thank you very much. J Lili Duda, VMD, Editor of the OncoLink Veterinary Oncology Section, responds: Thank you for your interest and your question.
Treatment Options for Canine Transitional Cell Carcinoma of the Bladder Dear OncoLink "Ask the Experts," Our 5 and a half-year-old male Cocker Spaniel was recently diagnosed with transitional cell carcinoma of the bladder. The tumor is located in an area where surgical removal is a possibility, but not recommended. My wife and I have opted to begin treatment for him by administering Cytosec daily, along
Invasive Scirrhous Carcinoma in Dogs Dear OncoLink "Ask the Experts," My parents' dog has just been diagnosed with a tumor and a life expectancy of 6 months. The tumor is an invasive scirrhous carcinoma with a predominantly solid pattern of growth. Has anyone out there heard of any "miracle stories" of treatments or alternative medicines that may provide a ray of hope for
Poorly Differentiated Sarcoma Dear OncoLink "Ask the Experts," Our 11-year-old miniature schnauzer recently had a biopsy to remove a mass on his front leg. The diagnosis was: "Poorly differentiated sarcoma, possible fibrosarcoma". The veterinarian has recommended amputation as quickly as possible. This seems so radical since the report was "possible
Accuracy of Fine Needle Aspirate in Sarcoma Diagnosis Dear OncoLink "Ask the Experts," Our 10-year old neutered mixed-terrier was diagnosed with sarcoma of the front left elbow by x-rays and a fine-needle aspirate. He then had chest x-rays (which showed no evidence of macroscopic pulmonary metastasis), and a biopsy, including a bone sample. However, the biopsy results were negative in all
Rhinectomy in Dogs Dear OncoLink "Ask the Experts," My 8-year-old Labrador Retriever had a rhinectomy on due to squamous cell carcinoma. I am very worried about how he will adapt and if there are any particular things I should keep him from doing, like swimming. I would love to hear anything about this procedure. Lili Duda, VMD, Editor
Treatment Options for a Dog with Salivary Gland Tumors Dear OncoLink "Ask the Experts," My 8 1/2 year old Cocker Spaniel (female, spayed) has cancer in her salivary glands. We were told that this is a very uncommon cancer as it is in the glands and is not a sarcoma. Could you possibly ouline a treatment plan? Lili Duda, VMD, Editor of the OncoLink Veterinary
Human Pregnancy and Canine Chemotherapy Treatment Dear OncoLink "Ask the Experts," Can chemotherapy given to a dog with lymphoma cause any problems to a human female owner who is pregnant? I have heard there could be toxins in the body fluids of the dog during treatment that can cause harm to a baby? This sounds crazy to me. Have you ever heard of such a thing?
Low Platelet Counts in Animals Dear OncoLink "Ask the Experts," Can you please tell me what kind of cancers in animals often lead to a drop in platelet counts and how that can that be treated? Also, do cancer treatments for such cancers lead to drop in platelet counts due to their effects on the bone marrow? Lili Duda, VMD, Editor of the OncoLink
Pancreatic Cancer in Dogs Dear OncoLink "Ask the Experts," I have a 12-year-old female doberman. She has been diagnosed with cancer of the pancreas with lesions in the liver also. She also has a low level heart condition. These problems have been diagnosed through ultrasound only. A biopsy is not recommended. They have given her 1 to 3 months. Is this an
Canine Papillary Cystadenocarcinoma Dear OncoLink "Ask the Experts," I am looking for information regarding papillary cystadenocarcinoma (Ovary) in canines. If you can give me a source or direction. I am curious to know if CA-125 (human) is a viable screen in follow up. Also what are the most likely sites of metastasis? Thank you for your attention.
Treatment for Canine Osteochondrosarcoma Dear OncoLink "Ask the Experts," Hello, I am a small animal veterinarian who is looking for information on osteochondrosarcomas in dogs. I have recently had a patient diagnosed with osteochondrosarcoma of the rib cage in a 4 year old, male neutered Golden Retriever. My boss and I are looking for information on this type of cancer.
Treatment Options for Dogs with Nasal Tumors Dear OncoLink "Ask the Experts," My 11-year-old springer spaniel has been diagnosed with a tumor in his sinus. In his case, the vet said radiation therapy would only add about 5 months to his life. Can you give me some direction? Lili Duda, VMD, Editor of the OncoLink Veterinary Oncology Section, responds:
Neurofibrosarcoma in Dogs Dear OncoLink "Ask the Experts," I am a veterinarian. I have a patient with neurofibrosarcoma. She is a 2-year-old female dog. This diagnosis is new for me, please send me information about this disease. Lili Duda, VMD, Editor of the OncoLink Veterinary Oncology Section, responds: Neurofibrosarcomas are one
Myxosarcomas in Dogs Dear OncoLink "Ask the Experts," My dog was just diagnosed with myxosarcoma. Could you offer any information on treatment, etc.? Thank you. Lili Duda, VMD, Editor of the OncoLink Veterinary Oncology Section, responds: Myxosarcomas are a type of generally "low grade" soft tissue sarcomas that arise from
Treatment Options For A Dog With Myxofibrosarcoma Dear OncoLink "Ask the Experts," Our dog has been diagnosed with myxofibrosarcoma. Given the tumor's size, location and aggressiveness, and the consequent difficulty of securing a tumor-free margin without extensive penetration into the chest, we are considering palliative care options. This is where the questions arise: The
Monoclonal Antibody Treatment in Dogs Dear OncoLink "Ask the Experts," Please tell me about the use of Monoclonal Antibody Treatment for treating lymphoma in dogs once remission is achieved. Lili Duda, VMD, Editor of the OncoLink Veterinary Oncology Section, responds: Monoclonal antibody (MAb) therapy (drug name CL/MAb 231, Synbiotics Corporation) is
Treatment Options for Mast Cell Tumor of the Eyelid in Dogs Dear OncoLink "Ask the Experts," Our 4 1/2 year old mixed breed female dog was recently diagnosed with a small intermediate grade mast cell tumor on her left eyelid. We understand that diagnosis of such a tumor in this location is quite rare. Some of the tumor was removed surgically (when it was presumed to be a cyst). Chest x-rays
Metastatic Hemangiopericytoma in Dogs Dear OncoLink "Ask the Experts," My female lab (9 yrs. old) was diagnosed with a hemangiopericytoma this past February. Two days prior to the surgery, the vet took a chest x-ray, which identified two small (golf ball size) masses/tumors in separate lobes of the dog's lungs. The vet indicated that given the way the tumors presented they
Multiple Mast Cell Tumors in Dogs Dear OncoLink "Ask the Experts," I have a 5-year-old female Pitbull mix. I took her to the vet about 5 months ago to look at her "warts." She had one on her eye, and forearm. He told me they were just warts, and not to worry. Well, it turns out, they were mast cell tumors. Anyway, she had 13 different little warty things removed, 12
Lymphoblastic Lymphosarcoma in Dogs Dear OncoLink "Ask the Experts," My six-year-old Terrier mix, has symptoms consistent with your description of lymphoblastic lymphosarcoma. My local vet, who seems suspiciously eager to put my dog to sleep, insists that my dog has nearly zero chance of survival yet has not done a complete staging procedure (only a single biopsy). What
Treatment for Dog with Mammary Gland Tumors Dear OncoLink "Ask the Experts," Recently, I found out that my lab has mammary tumors. Some may be benign some may be cancer. My vet recommended a complete mastectomy. I would like to know what other options are available. Please include any information about the tumors and the breed. Thank you! These are not just pets,
Osteosarcoma in Dogs Dear OncoLink "Ask the Experts," I have a dog that has been diagnosed with osteosarcoma and I have a choice between full amputation or nothing. I would like to know if I could obtain more information about the procedure described as "Limb Salvage." I am interested in presenting evidence and preferably a procedure to my vet to
Dog Hemangiosarcoma Dear OncoLink "Ask the Experts," My dog, a 13-year-old cocker spaniel, has developed a hemangiosarcoma in his right atrium, which has spread to his right ventricle. We are advised not to do surgery because the cancer is in his heart. In two days, we must decide whether or not we want chemotherapy. Are any of the new treatments in humans
Hemangiopericytoma in Dogs Dear OncoLink "Ask the Experts," My 12-year-old doberman has been diagnosed with both hemangiopericytoma and mast cell cancer. I find very little information on hemangiopericytoma. This tumor was incompletely removed from a hind leg. What is usual recommended treatment? Would 5-FU be beneficial in this type of cancer? Thanks
Treatment Options for a Dog with Fibrosarcoma Dear OncoLink "Ask the Experts," My 12-year-old doberman has been diagnosed with both hemangiopericytoma and mast cell cancer. I find very little information on hemangiopericytoma. This tumor was incompletely removed from a hind leg. What is usual recommended treatment? Would 5-FU be beneficial in this type of cancer? Thanks
Treatment of Fibrosarcoma in Dogs My dog was just given the results of her biopsy last week from a tumor on the lower jaw (under the bottom back molar) in the soft tissue-- it was fibrosarcoma- and the vet did remove it! My questions are; Why does she need radiation? If the tumor is removed-- why can't we think that the cancer is gone? I would like some information about
Treatment Options for Canine Fibrosarcoma Dear OncoLink "Ask the Experts," I have a question regarding a diagnosis of fibrosarcoma in my 5-year-old Rottweiler. I searched your site on fibrosarcoma, but the only two cases discussed were both in the leg. My dog had a well-defined fibrosarcoma removed from the area of her sternum — the report indicated a low-grade
Diagnosis of Fibrosarcoma in Dogs Dear OncoLink "Ask the Experts," We were notified today that our 7 year old Boston Terrier, has a well differentiated fibrosarcoma located in his back right leg near his knee. We were told that there is moderate to high potential for local recurrence and progression. There is low potential for regional and systemic metastasis.
Feldene to Treat Transitional Cell Carcinoma Dear OncoLink "Ask the Experts," I would like to know what your thoughts are on using feldene/piroxicam as opposed to prednisone in the treatment of Transitional cell carcinoma (TCC) in my dog. I am frightened about the side effects of prednisone and I do not know anyone who has used feldene with their pet. My own veterinarian is not
Treatment Options for Possible Acanthomatous Epulis Tumor and Pleural Effusion Dear OncoLink "Ask the Experts," Last year you answered a question regarding our 10-year-old setter male neutered dog regarding his diagnosis of a recurring Acanthomatous Epulis tumor in his mouth. In January of 1999, he had a rostral mandibulectomy performed. The pathology report after surgery showed clear margins. He was doing
Chemotherapy and Metastasis to the Lungs Dear OncoLink "Ask the Experts," My 14-year-old Walker Hound has a leg tumor that was diagnosed as an undifferentiated sarcoma in June. It had already metastasized to his lungs. He's been undergoing chemo for it since then. I noticed in your FAQ that chemo isn't recommended for metastatic cancers which have spread to the lungs. What
Epilepsy and Cancer in Dogs Dear OncoLink "Ask the Experts," My beagle, Sassy, was diagnosed at the age of two with epilepsy. She very recently had an episode where she collapsed, lost the use of her back legs, the reflex in her left eye and several other distressing symptoms. She was taken to an animal emergency room, and then examined by a veterinarian
The Effects of CCNU on Dogs Dear OncoLink "Ask the Experts," I would like to get information about an oral chemotherapy drug called "CCNU". I would like to know the pros and cons before giving it to my 10 year old Boxer. She has been diagnosed with a mast cell tumor on the lower part of her hind leg, near the foot. Any information you give me would be greatly
Bladder Cancer in Dogs Dear OncoLink "Ask the Experts," Our 10 year old Sheltie was just diagnosed with bladder cancer. The tumor appears to be about 1 1/2" and is located near the opening of the urethra. The bladder appears to be abnormally shaped. Could you possibly outline the likely treatment options? Lili Duda, VMD, Editor of the
Treatment for Dogs with Osteosarcoma Dear OncoLink "Ask the Experts," I Would like more information/direction on the topic of bone tumor in a Great Dane. Currently, the only treatment being administered is homeopathic. We are also doing acupuncture. Please help. Thanks LVG Lili Duda, VMD, Editor of the OncoLink Veterinary Oncology Section,
Biopsy Results - Possible Fibrosarcoma in Dogs Dear OncoLink "Ask the Experts," Our 11-year-old miniature schnauzer recently had a biopsy to remove a mass on his front leg. The diagnosis was: "Poorly differentiated sarcoma, possible fibrosarcoma". The veterinarian has recommended amputation as quickly as possible. This seems so radical since the report was "possible
Treatment Options for a Dog with Adenocarcinoma of the Apocrine Gland Dear OncoLink "Ask the Experts," Our 7-year-old male Westie recently had surgery for adenocarcinoma of the apocrine gland. We were interested in additional information since it is apparently rather rare. Lili Duda, VMD, Editor of the OncoLink Veterinary Oncology Section, responds: Treatment depends in part on the
Anal Sac Cancer in Dogs Dear OncoLink "Ask the Experts," My dog has been diagnosed with anal sac cancer. What should I expect from his treatment? Thank you, D Lili Duda, VMD, Editor of the OncoLink Veterinary Oncology Section, responds: Dear D., Anal sac adenocarcinomas are tumors arising from the apocrine glands
Recurrent Acanthomatous Epulis Tumor in Dogs Dear OncoLink "Ask the Experts," Our 10 year old Irish Setter/St. Bernard mix had an Acanthomatous epulis tumor removed from his front right lower gum line. We found that the tumor had regrown extremely rapidly and is now much larger than the original tumor that was removed. It is now the size of a gumball. The original tumor was
Leg Amputation Due to Cancer Dear OncoLink "Ask the Experts," I would like to find out info on helping my dog adapt to a front leg amputation due to cancer. Are there resources where I can get info or talk with people who may have had the experience? Is there rehab training for this? Lili Duda, VMD, Editor of the OncoLink Veterinary Oncology
Stage 1 Mast Cell Sarcoma in Puppies Dear OncoLink "Ask the Experts," My 8-month-old New Foundland has just been diagnosed with Stage 1 Mast Cell Sarcoma on her right elbow. Her genetic history is free of cancer. My vet recommended that we remove the Mast Cell to get clear margins and that that should be curative. How unusual is it for puppies to have this type of
Intracavitary Chemotherapy Dear OncoLink "Ask the Experts," I recently joined an on-line canine cancer "support group", after our dog was diagnosed with hemangiosarcoma. Someone in the group posted that University of Pennsylvania had done a study on intercavity chemotherapy as a treatment for hemangiosarcoma. I can't find it. It was supposed to be a very new
Treatment For Dogs With Recurrent Cutaneous Plasmacytomas Dear OncoLink "Ask the Experts," My 6-year-old Flat Coated Retriever has had 2 cutaneous plasmacytomas removed in 3 months. Can you steer me towards suggested treatment? Thank you! Lili Duda, VMD, Editor of the OncoLink Veterinary Oncology Section, responds: Cutaneous plasmacytomas are relatively benign
Chondrosarcoma in Dogs Dear OncoLink "Ask the Experts," My dog, Kaya, was recently diagnosed with a chondrosarcoma in his left nasal cavity. The tumor extends from the middle of the nose to the ocular socket. There is no bone deterioration present. The oncologist recommended high dosage radiation followed by chemotherapy. My question is regarding
Squamous Cell Carcinoma in Dogs Dear OncoLink "Ask the Experts," My chocolate lab has been diagnosed with squamous cell carcinoma. The tumor is on the front left side of his mouth directly above a tooth. His first diagnosis was a papilloma. It grew back and his last biopsy was determined to be squamous cell carcinoma. Radical surgery to partially remove part of his
Use of Prednisone in Cats' Cancer Treatment Dear OncoLink "Ask the Experts," My cat was diagnosed with mammary cancer 3 years ago and had surgery but no other treatment was suggested. Tumors recurred with a second surgery recently. She is now on a chemotherapy schedule but prognosis is poor. One of the drugs she is taking is prednisone (daily) and I would like to know what
Loss of a Dog with Adenocarcinoma Dear OncoLink "Ask the Experts," Last week, I lost my 2.5-year-old chocolate lab to Adeno Carcinoma. We had her since she was 6 weeks old and raised her on a healthy diet. She had three tumors the smallest the size of a softball. This has been a great loss and part of trying to deal with it is getting the big question WHY answered.
Peritoneal Mesothelioma in Cats Dear OncoLink "Ask the Experts," My cat has a peritoneal mesothelioma. My vet says that this pathology is very rare in cats and is studying a protocol for the chemotherapy (possibly intracavitary chemotherapy). My vet attended two dogs with cisplatin, with good results, but this drug is lethal for cats. Can you send me information
Mast Cell Tumors in Cats Dear OncoLink "Ask the Experts," I need specific information on mast cell tumors in cats. My cat was presumed to have a mammary tumor, and your information was very helpful. After surgery and biopsy, however, she was diagnosed with a mast cell tumor and I am now unsure as to what more should be done. The borders appeared to be free
Feline Nasal Fibrosarcoma Dear OncoLink "Ask the Experts," Our 5 yr old male Maine Coon was first diagnosed with an eosinophilic granuloma, which was removed. It grew back. We began treatment with Strontium and Leukeran. The growth was responding until the Leukeran was reduced. Then it began to grow and an oro-nasal fistula was discovered. The growth was
Treatment and Prevention of Skin Cancer in White Cats I am a cat lover and owner of two geriatric cats. I have a question about how to prevent and treat skin cancer for a white kitty. Can you help us to help our feline friends? Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu, responds: Skin cancer in white cats is due to excessive sun exposure
Canine Tumor Treatment Options Dear OncoLink "Ask the Experts," My miniature schnauzer, Hans, was recently diagnosed with a tumor. It is fairly large and located under his left leg, near his chest. My veterinarian has x-rayed it and has the following plan. Place on antibiotics for the next two weeks, hoping he is wrong, and the lump will shrink. If this
Treatment of Canine Lymphoma Dear OncoLink "Ask the Experts," I've been trying to gather as much information as possible on treatment of canine lymphoma. I'm wondering if there are recommendations from oncologists for whole gland biopsy vs. needle aspirates. The two vets that I use in the same practice have conflicting opinions and I've been unable to find anything
Canine Fibrosarcoma and Radiation Dear OncoLink "Ask the Experts," Our vet did a biopsy to remove a mass from our 7-year-old Boston Terrier. He has a well-differentiated fibrosarcoma located in his back right leg near his knee, she indicated that she did not think that it was cancerous. Therefore, she was not careful about getting all of the tissue around the mass on
Lymphangiosarcoma in Dogs Dear OncoLink "Ask the Experts," My 6 year old Dalmatian was just diagnosed with cancer. The good news is that what we originally thought was an osteosarcoma turned out to be a soft tissue tumor on the leg (ankle joint). They called this a Lymphangiosarcoma. I caught this early and amputation is the recommended course of treatment. I
Lipomas in Dogs Dear OncoLink "Ask the Experts," Our German Short-haired Pointer, Sherbet, has a lipoma affecting her left shoulder. It is invasive and has been operated on twice now. I was looking for a bit more information on her condition. I want to know if continued operations are the only way to help her, or if there are other procedures.
Treatment Options for Dog Liposarcoma Dear OncoLink "Ask the Experts," My 7 year old Australian Shepherd has been diagnosed with a liposarcoma on his upper left thigh. The vet could not guarantee good surgical margins with removal of the limb and portion of the pelvic area. Despite the absence of any spread of the disease to other portions of the body, I am reluctant to go
Treatment Options for a Dog Liposarcoma Dear OncoLink "Ask the Experts," My dog has Liposarcoma Grade 2. We had the tumor removed and my vet says to just keep an eye out for more tumors to arise. Is this "laid-back" approach the best way to handle his condition? I just want to do what is best for him. Lili Duda, VMD, Editor of the OncoLink Veterinary Oncology
Dog Lymph Node Biopsy Dear OncoLink "Ask the Experts," My 12-year-old dog is currently being tested for Lymphosarcoma. The lymph nodes are swollen from her throat to the back of her legs. Aspirates were taken a week ago and the pathology came back that there are cells indicative of cancer in the lymph nodes but they aren't actually able to determine which
Feline Lymphoma vs. peripheral lymph node enlargement Dear OncoLink "Ask The Experts," I have a FIV FeLV negative two-year-old male cat undergoing chemotherapy and radiation. He has lymphoma; it is located only in the lymph nodes in his hind legs. My vet says this is not a common place to find lymphoma. She feels he has a very good chance of being one of the few cats that go into remission
Synovial cell sarcoma in dogs Dear OncoLink "Ask The Experts," I have a 7-year-old German Shepard. He just had swelling on right elbow removed, and biopsy showed synovial sarcoma (grade 1). I'm distressed and don't know what to do. My vet suggested amputating the leg - which I'm not really in favor of. Could you tell me please, what is the best course of action? Is
Salivary Gland Tumors in Dogs Dear OncoLink "Ask The Experts," My dog as just been diagnosed with adenocarcinoma cancer of the salivary gland. The vet says it is a rare cancer and as not much information on the cancer but says it does not look good for him. Lili Duda, VMD, Editor of the OncoLink Veterinary Oncology Section Menu, replies: Based
Limb salvage in dogs with prior amputation Dear OncoLink "Ask The Experts," In March of 2000, my beloved canine companion was diagnosed with osteosarcoma. His Right rear leg was amputated, and after 3 months of chemo, we had an amazing survival. Unfortunately, a recent x-ray revealed cancer in the humerus. Because his right rear leg was already amputated, I understand that
Cancer in pot-bellied pigs Dear OncoLink "Ask The Experts," Can you please tell me what different types of cancer a pot-bellied pig can get? Besides surgery, what are some of the treatments? Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu, responds: Cancer in the pig is very rare. Melanoma has been reported to be
Leukeran side effects for dogs Dear OncoLink "Ask The Experts," Our dog is being treated for lymphoma. He is currently taking leukeran along with prednisone. We have noticed some side effects such as confusion, disorientation, excessive drowsiness, muscle spasms, and loss of balance. Could his dosage of leukeran be too high? We asked our vet but they don't link it to the
Canine nasal tumors Dear OncoLink "Ask The Experts," My Bichon Frise companion has just had his 14th radiation for a nasal fibrosarcoma at the Veterinary Medical Teaching Hospital of UC Davis. He has quite severe radiation dermatitis on the opposite (distal to the beam) side of his face. I need a better idea of what I should look for in order to consider
Parrot with melanoma Dear OncoLink "Ask The Experts," I am an avian practitioner in and am treating a 6 month old African Grey Parrot with a rapidly growing melanoma below the eye. Complete excision was impossible due to infiltration into the facial muscles. I am getting conflicting advice on whether to refer the bird for radiation, chemo, or to give up due
Treatment of lymphoma in dogs Dear OncoLink "Ask The Experts," My 7-year-old cocker spaniel had a tumor removed from her intestine last week. The path report found a high-grade lymphosarcoma in the tumor but that the nearby node was negative. What are the chemotherapy options for non-metastatic lymphosarcoma in dogs? Lili Duda, VMD, Section Editor of the
Veterinary Chemotherapy precautions Dear OncoLink "Ask The Experts," My wife is pregnant with our second child, and she is in her second trimester. Our Golden Retriever is starting chemotherapy on Friday. The vet advised my wife to "avoid metabolites" as they could be teratogenic due to the metabolized chemotherapeutic agents in them. Can you give us some concrete advice on
Budget chemotherapy for mast cell tumor in dogs Dear OncoLink "Ask The Experts," I foster rescued dogs for a small shelter here in Manhattan. 3 yrs ago, an elderly neighbor adopted a wonderful lab mix male thru me, which has just been diagnosed with mast cell cancer (III). She's quite impoverished and I'm trying to help her with the treatment of her sweet dog. I've had the tumor removed
Radical removal of one ear due to squamous cell carcinoma Dear OncoLink "Ask The Experts," We have a rescued 10-month-old kitten scheduled to undergo radical removal of one ear due to squamous cell carcinoma. The ear is to be removed to the skull. We're very concerned about the impact of such a radical excision on the kitten's quality of life. What will this mean to her hearing and comfort?
Wisconsin Protocol as treatment for canine lymphoma Dear OncoLink "Ask The Experts," Can you please explain the Wisconsin Protocol? I understand it to be the most effective treatment for canine lymphoma. Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu, responds: The most effective protocols for canine lymphoma combine several drugs, each of which has
Cutaneous T-cell lymphomas in dogs Dear OncoLink "Ask The Experts," My dog recently had a biopsy of a growth on his lip/gum and the results were Epitheliotropic Cutaneous T-Cell Lymphoma (Mycosis Fungoides). It has been extremely difficult getting information about this cancer. I am most concerned with the following: I have been told that it is localized now and most likely hasn't
Multiple myeloma in cats Dear OncoLink "Ask The Experts," Our 15 1/2 year old cat recently has been diagnosed with Multiple Myeloma. Can you tell me a little about the diagnosis and possible treatments? Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu, responds:Multiple myeloma is an uncommon cancer of a type of white blood cell known as a
Canine and Feline Fibrosarcoma and Trauma Dear OncoLink "Ask The Experts," I would like to know if there is a link between fibrosarcomas in animals and tissue trauma? Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu, responds:The short answer is yes--there is a definite link between chronic tissue inflammation and sarcoma formation, including inflammation
Heredity of animal cancer Dear OncoLink "Ask The Experts," I lost my dog to cancer. I would like to get another dog from the same breeder. I am unsure how much of a role genetics plays into the likelihood that a dog will develop cancer. I know there is no guarantee of a completely healthy dog (regardless of the breed) but I also do not want to set myself up for another loss
Feldene for dogs with poor renal function Dear OncoLink "Ask The Experts," My dog has been diagnosed with renal carcinoma. It was suggested to use Feldene (piroxicam) to help slow down the progression of the cancer. I have concerns due to the fact that my dog has only one kidney. Her Vet removed the other due to the cancer/tumor. I read in the article that was e-mailed to me that
Herbicides and Lymphoma in Dogs Dear OncoLink "Ask The Experts," My dog developed lymphosarcoma. I saw articles linking the 2,4-d herbicide chemical to lymphoma in dogs. I realized I used a fertilizer weed control mix that contained this chemical. I only used it once, but she loved to eat the crab grass at the edges. I feel this may have triggered the cancer. Do you think this
Canine Multicentric Subcutaneous Hemangiosarcoma (HSA) Dear OncoLink "Ask The Experts," My dog was diagnosed with hemangiosarcoma. She also has a history of mast cell tumor grade II. She is a 13 year old mixed shepherd. Her tail was amputated, because the tumor was on the base. She also had 4 superficial tumors removed. They all came back as Multicentric Subcutaneous Hemangiosarcoma. The tail mass
Nasal Tumors in Dogs Dear OncoLink "Ask The Experts," I had previously owned 2 dogs, both of which developed nasal/sinus tumors and had to be euthanized. I now have a toy breed, which has very recently developed this severe sneezing. He is only 2 years old. I am very concerned that he also has developed a nasal tumor. Is this type of severe sneezing a symptom of nasal
Metastatic Melanoma in Dogs Dear OncoLink "Ask The Experts," I have just learned that my 3-year-old chocolate lab has melanoma. I thought melanoma was skin cancer, however, hers is between her heart and her lung. I do not understand this. Thank you for any information you can provide. Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu,
Palliative Chemotherapy for Liposarcoma in Dogs Dear OncoLink "Ask The Experts," My Irish Wolfhound was diagnosed a little over a year ago (at age 3) with a very large, very invasive liposarcoma in the left lumbar region, effacing the musculature in this region, eating into several lumbar vertebrae and extending into the abdominal region. She received palliative radiation a year ago and was
BCG for Bladder Tumors in Dogs Dear OncoLink "Ask The Experts," Do you have any information on using BCG to reduce the size of bladder tumors in dogs? Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu, responds:BCG, or bacillus Calmette-Guerin is a bacterial vaccine that is a non-specific immunomodulator--in other words, it generally stimulates the
Treatment for Recurrent Canine Lymphoma Dear OncoLink "Ask The Experts," Our dog Foxy is 13 years old although she gives the appearance inside and out of a much younger dog. She was diagnosed with stage one lymphoma. She was in remission and on maintenance protocol. She did great and her quality of life was excellent. At our visit last week, we found that the cancer is back. The
Osteosarcoma in Pit Bulls Dear OncoLink "Ask The Experts," I am a small animal vet who is currently working up potential bone cancer in a pit bull. What are the incidences of osteosarcoma in pit bulls? The owners found something on the Internet about using tetracycline to treat osteosarcomas, while I have never heard of this treatment. I was wondering if there was any new
Leukemia in Dogs Dear OncoLink "Ask The Experts," Our 9-yr-old dog has been diagnosed with lymphoblastic leukemia. He is currently on 2 mg/day of Leukeran and 20 mg/day of prednisone. His most recent CBC showed almost normal platelets and hematocrit of 22%. His lymphocytes were originally 100,000, came down to 9,000 after 2 wks on leukeron, but have now
Tonsillar Squamous Cell Cancer in Dogs Dear OncoLink "Ask The Experts," I have 8-yr-old English Springer spaniel that was just diagnosed with anaplastic tonsillar squamous cell carcinoma with metastasis to a submandibular lymph node. Can you send me info regarding this disease, and if there is any form of radiation or other therapy? Lili Duda, VMD, Section Editor of the OncoLink
Neural Sheath Tumors in Canines Dear OncoLink "Ask The Experts," My 7 year-old Italian Greyhound male just had a cherry-sized lump removed from the outer elbow of his front leg. It grew within 2-3 weeks. The biopsy showed neural sheath tumor. I want to know, what is the prognosis for this type of cancer, and what is the best possible treatment I can get for him? His current vet
Cancer in a Horse Dear OncoLink "Ask The Experts," My 4 year-old mare has just had a growth removed from her throatlatch. The pathology report showed the growth as "spindle cell sarcoma". The growth was apparently benign. My local vet has not dealt with this before. Any suggestions? Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu,
Eliminate Dietary Fiber From A Dog with Sarcoma? Dear OncoLink "Ask The Experts," In researching info about my dog's sarcoma and his care, most experts recommend eliminating grains from his diet. Most quality dog foods do not have much fiber. How can I add additional fiber to his diet without also using cheaper foods containing peanut hulls? Lili Duda, VMD, Section Editor of the OncoLink
Aromatase Inhibitors in Mammary Tumors Dear OncoLink "Ask The Experts," Can aromatase inhibitors be used to prevent reccurrence of malignant mammary tumors in dogs? If so, which one is indicated, and what dose do we use? Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu, responds:We are not aware of any studies published on the effect of aromatase inhibitors in
Kidney Cancer in Cats Dear OncoLink "Ask The Experts," My 12.5-year-old cat was just diagnosed with cancer in his right kidney. Apparently there is a tumor, and the kidney biopsy showed that the kidney tissue was dying. What is the best next step to take? We were told it was carcinoma. Does Prednisone help at all? I have read a lot about that medication. Lili Duda, VMD,
Piroxicam and Bladder Cancer in Canines Dear OncoLink "Ask The Experts," Is there anything new related to the diagnosis and treatment for canine bladder cancer (transitional cell cancer, or TCC)? Our vet recommends surgery, then Piroxicam. After reading what I can find on the Web, I am reluctant to go the surgery route and have started her on Piroxicam instead. I read about a urine test
Fibrohistiocytic Nodules Dear OncoLink "Ask The Experts," My 9-year-old boy Freeway (dog, labrador) has been diagnosed with intermediate grade fibrohistiocytic nodule of the spleen. His spleen and a 7 cm mass that was removed, and he is recovering from the surgery extremely well. Canada West Veterinary Specialists in Vancouver BC are trying to find a chemotherapy regimen
Canine Acanthomatous Epulis Dear OncoLink "Ask The Experts," My 13-year-old Dalmatian, Pepper, has been recently diagnosed with having an acanthomatous epulis on the front lower-jaw gum line. It was removed a few weeks ago and sent for biopsy with the above results. It has been about 2 weeks since its removal, and it has regrown rather rapidly, now as big -- or bigger than --
Diarrhea in a Dog on Cancer Therapy Dear OncoLink "Ask The Experts," My Labrador has been diagnosed with lymphosarcoma in the lower colon area and is undergoing chemotherapy treatments. However, she is experiencing chronic diarrhea. We hope the cause is the chemotherapy, however Imodium has not worked. I have read that Lomotil has been successful with dogs in this situation. Our
Environmental Link to Canine Cancers Dear OncoLink "Ask The Experts," My 52-year-old husband was diagnosed with multiple myeloma last year. Now, our 14-year-old Labrador retriever likely has some bone marrow cancer. Coincidence? Perhaps, but I want to be as sure as possible. Before we decide against a bone marrow biopsy (BMBx) for the dog, I want to make sure there is no connection
Tumor Recurrence in Dogs Dear OncoLink "Ask The Experts," Ten weeks ago my 4 year old male golden retriever had a tumor removed from his paw. Biopsy stated benign subungual keratoacanthoma. Xray taken during surgery showed no bone involvement. The incision healed well, no infection or post-op problems. The tumor is growing back at the same place. Is this unusual? Could it
Kidney Cancer in a Dog Dear OncoLink "Ask The Experts," My four-year-old black lab had her left kidney removed due to an abnormality on ultrasound, and at the time of surgery, a 3 cm tumor was found with pathology revealing a renal papillary adenocarcinoma. Radiographs were taken prior to surgery showing no apparent spread of the cancer, and she has showed 100%
Canine Fibrosarcoma Dear OncoLink "Ask The Experts," After our 12-year-old dog's neutering and perianal adenoma surgical removal, we found out that one of the growths was a low-grade fibrosarcoma. Is more surgery usually required in these cases? What do you think about Carravet Acemannan Immunostimulant? Lili Duda, VMD, Section Editor of the OncoLink Veterinary
Cost Saving Lymphoma Protocol for Canines Dear OncoLink "Ask The Experts," I'm a Veterinarian and professor of small internal medicine at the Universidade Estadual de Londrina, Paraná, Brazil. We work with dogs and cats that present with lymphoma. Sometime, owners don't have enough money to treat their animals with the protocol called COAP, so we suggest that the animal may be
Exposure of Other Pets to Chemotherapy Dear OncoLink "Ask The Experts," My 5-year-old Border Collie/Lab mix Annie was recently diagnosed with stage III lymphoma. We started chemotherapy treatments with Asparaginase (Elspar), Prednisone, and Vincristine, followed by 4 days of Cytoxan and 6 daily doses of Prednisone, which will eventually scale back to once every other day. So far Annie
Lung Cancer in a Dog Dear OncoLink "Ask The Experts," My 3-year-old Australian healer has been diagnosed with squamous cell carcinoma in the lung. What does this mean exactly, and what are the survival rates? Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu, responds:Primary lung tumors in dogs, or tumors that arise directly from the lung
Vaccinations in Dogs with Cancer Dear OncoLink "Ask The Experts," My 8-year-old cocker spaniel was diagnosed with Epitheliotropic Cutaneous T-cell lymphoma in February of this year, following a biopsy of a small lump on his lip. We declined chemotherapy after the vet advised that few dogs survived and that he may only live for around 3 months. Eight months later, he is healthy
Early Stage Canine Lymphoma Dear OncoLink "Ask The Experts," My 8-year-old cocker spaniel was diagnosed with Epitheliotropic Cutaneous T-cell lymphoma in February of this year after a biopsy of a small lump on his lip. We declined chemotherapy after the vet advised that few dogs survived and warned that he may only live for around 3 months. Eight months later, and he is
Canine Thyroid Cancer Dear OncoLink "Ask The Experts," I have an 11-year-old neutered male Labrador retriever. He has a markedly elevated FT4 and very low TSH picked up on routine lab exam. His only noticeable symptom of hyperthyroidism is a 7-pound weight loss in a year. What is the efficacy of therapy for thyroid cancer? Is I-131 the only systemic therapy for canine
NSAIDS for Cancer Therapy Dear OncoLink "Ask The Experts," My wheaten terrier (11 yrs old) was diagnosed with TCC yesterday. She is prescribed Deramaxx. Is there any better treatment? Is this the same as Piroxicam? Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu, responds:Piroxicam, an NSAID, is a non-selective Cox-1 and Cox-2 inhibitor and has
Use of Anti-oxidants with Chemotherapy in Pets Dear OncoLink "Ask The Experts," Would you please comment on the administration of antioxidants (vitamins A, C, E) as supplementation to doxorubicin chemotherapy for canine mammary gland tumors, namely the ranges of allowed doses and routes of administration? Karin Sorenmo, VMD, Director of the Medical Oncology division at The Ryan Veterinary
Bone Marrow Transplant in Canines Dear OncoLink "Ask The Experts," My 1 and 1/2 yr old English Springer was diagnosed with lymphoma and lymphoblastic leukemia. He has been receiving weekly chemotherapy with prednisone, vincristine (Oncovin), cyclophosphamide (Cytoxan), and initial treatment with asparaginase. He has very few cancer cells in his blood now and all but two lymph nodes
Round Cell Tumors Dear OncoLink "Ask The Experts," My dog Max is around 7-8 yrs old. He is a very active Labrador mix. For about 6-7 months he has been biting at his back leg. He developed a lump in the area, so we took him to the vet. They removed the lump and the toe, checked his lymph nodes, and said it had spread there. We are taking him to an oncologist. They
Lymphoid Reactive Hyperplasia Versus Lymphosarcoma Dear OncoLink "Ask The Experts," My Austrian Sheppard, Ozzie Blue, was just diagnosed with "lymphoid reactive hyperplasia". His vet thought at first that it was lymphosarcoma, but a punch biopsy diagnosed it as lymphoid reactive hyperplasia. What is the best treatment for him? For two weeks now he has been on a treatment of Doxycycline
Transdermal Medications Dear OncoLink "Ask The Experts," Some animals are very stressed by pilling and oral dosing of meds. The pharmacies will make many compounds in transdermal form but there seems to be very little definitive information on the efficacy of transdermal delivery versus oral. Is transdermal a viable option for critical medication such as chemotherapy for
Tumor of the Spleen Dear OncoLink "Ask The Experts," My 12 year-old miniature schnauzer recently had a splenectomy due to a large, rapidly growing tumor. The pathology report calls the tumor a "Splenic Stromal Sarcoma". Can you tell me anything about this type of tumor?Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu,
Alternative to Oral Anti-emetics Dear OncoLink "Ask The Experts," Are there suppository options for anti-emetics? My dog has nausea associated with cancer and refuses food. I was hoping options like compazine (in suppository form) are available for canine use. Oral medications are vomited up. Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu,
Long Term Side Effects of Radiation Therapy Dear OncoLink "Ask The Experts," My Jack Russell Terrier had radiation on his face about 2 years ago. Since the treatment finished, his nose is dry and scaly, and his nostrils are full of mucus. I have to clean his nose out several times a day, and I put vitamin E oil on it daily. I have been trying to find a cure or at least something to help
Brachial Plexus Tumor Dear OncoLink "Ask The Experts," My 10-year-old Basset hound has been having some problems with lameness in her left front leg for about 3 weeks. An x-ray of the leg showed no bony changes or evidence of arthritis or tumors. After some testing, my vet is inclined to think she has a brachial plexus tumor, as does the surgeon with whom he consulted.
Mycosis Fungoides in a Dog Dear OncoLink "Ask The Experts," Our Bernese Mountain Dog was diagnosed with cutaneous lymphoma or Mycosis Fungoides. We are not sure that stage yet, but he has scabs on 3 of his 4 paws and his left eye is significantly affected. As this diagnosis was only given to us today, I am doing research to determine the best course of therapy. Lili Duda,
Pain Relief Options for Veterinary Bone Cancer Dear OncoLink "Ask The Experts," My Yellow Lab just turned 9 (June) years old and was diagnosed back in March with bone cancer - front leg, upper part of her shoulder. She is on Gabapentin, Tramadol, and Previcox. She is still eating, drinking and in good spirits, but is walking with a considerable limp. Is there any other pain medication or
Canine Lymphoma Alternative Treatments Dear OncoLink "Ask The Experts," My dog Parker (a Pitbull who thinks he's a Lamb) is about 7 years old (I adopted him in '03 from my local animal shelter so I'm not sure of his age). He was diagnosed with Lymphoma in April '07. He has been through the Madison WI protocol twice. Reacted very quickly to the first round and went almost directly into
Canine Parotid Salivary Gland Cancer Dear OncoLink "Ask The Experts," I have been told my dog has parotid salivary gland cancer. He is a mini American Eskimo. His chest x-ray was clean for metastasis and his blood work was excellent. I have been recommended to get the gland removed and do radiation. I am not going to do radiation and am nervous about the surgery. I would do the
Heritability of Susceptibility to Mammary Carcinoma Dear OncoLink "Ask The Experts," My champion bichon frise age 12 recently died of a mammary gland tumor with adenocarcinoma which wound up in aggressive tumors in the front leg joints. Can you tell me if there is any evidence of mammary gland tumors having any hereditary links? I have a grand daughter with a pea sized lump which will be excised
Spinal Tumor in a Dog Dear OncoLink "Ask The Experts," My 5 year-old Golden Retriever became suddenly unable to control his back legs. A neurosurgeon did an MRI and told us he saw what looked like a tumor in his spinal column starting to press on his spinal cord. He gave him 20 mg of prednisone twice a day and recommended we put him down. He's 90% better on the
Clinical Trials for Pets Dear OncoLink "Ask The Experts," How can I find clinical trials for my dog who has been diagnosed with cancer?Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu, responds: That's a good question. Clinical trials can give you access to new therapies and help those animals who are diagnosed in the future - including humans, as
Radiation Schedule in Companion Animals Dear OncoLink "Ask The Experts," I have an 8 year-old labrador who was recently diagnosed with a mast cell tumor. The surgeon removed all that he could, but could not remove all of it. I am taking her for radiation therapy next week. The more I read about it, most physicians would give her radiation 3 days a week. This particular vet will give
CCNU for Canine Lymphoma Dear OncoLink "Ask The Experts," My 11 yr-old Yorkshire Terrier has T-cell lymphoma. He was treated with the Wisconsin protocol and has gone into remission. Our oncologist is suggesting we start a pill called CCNU or Lomustine for the next 12 weeks. I have read about this medication and am concerned about the side effects. What can you tell me
Immunizations and Boarding for Pets with Cancer Dear OncoLink "Ask The Experts," Can a pet receiving chemotherapy for lymphosarcoma receive regular immunizations? Can they be boarded?Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu, responds:In general, cats and dogs receiving chemotherapy for lymphoma or any other cancers should have their routine vaccinations deferred
Alternatives to Chemotherapy Question Our English Mastiff was very recently diagnosed with lymphoma and started on prednisone. I'm looking for alternatives to chemotherapy and wondering if there are any successful alternatives? I've also read that a diet free of grains may slow the cancer, is this accurate? what are the panel's thoughts on the Budwig diet or flax oil/cottage
Raw Diet for Pets with Cancer Question I've read that a diet free of grains may slow the cancer, is this accurate? what are the panel's thoughts on the Budwig diet or flax oil/cottage cheese combination? Erika Krick, VMD, DACVIM, Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer There are no clinical studies of grain free diets in dogs with cancer.
Common Symptoms of Pet Cancer Question What are signs and symptoms that my pet may have cancer? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer Some common signs of cancer in pets include a lump that you can see or feel, wounds that do not heal, and unexplained weight loss, decreased appetite, or loss of energy. More
Cancer Symptoms in Cats Question Do cats have different symptoms of cancer than dogs? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer Cats sometimes act more ill compared to dogs, but overall the common signs of cancer are similar between the 2 species. Cats are more likely to have intestinal tumors, so they are
Diagnosing a Lump on a Dog Question I noticed a lump on my dog's abdomen. I am concerned it could be a tumor, but I am worried about opening a can of worms by finding out. I just don't have the money to have all sorts of tests and treatments. But I feel like I should do something. Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds:
Radiation Therapy for Pets Question My dog's oncologist recommended radiation therapy (I didn't even know they did that in animals!) How can you get them to stay still? And what kind of side effects should we expect? Lili Duda, VMD, MBE, DACVR Veterinary Radiation Oncologist- University of Pennsylvania, responds: Answer Radiation therapy is a standard treatment for many
Do Cats Lose Hair from Chemotherapy? Question Will my cat loose her hair from chemotherapy? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer Cats often lose their whiskers from chemotherapy, and we don't usually see any problems as a result. In addition, cats that are receiving chemotherapy can lose some of their coarse guard
Side Effects of Chemotherapy in Animals Question What side effects could I expect my dog to have from chemotherapy? When do they start and how long will they last? Are there medications to treat these or make them not as bad? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer The most common side effects of chemotherapy in dogs
Tests to Diagnose Cancer in a Pet Question My dog has a new lump growing on his leg. What tests can be done to find out if it is cancer? Can they be done economically? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer Tests that your vet may recommend (after examining the lump and your dog) include a needle aspirate or a
VDI-tkcanine Test Question A comment and link was recently posted on Facebook regarding a test for cancer in canines. The test was VDI-tkcanine and was reported to be able to diagnose cancer with a blood test. Since my vet was not familiar with this test, I was wondering if it is an acceptable/valid test and in use by oncologist vets. Lili Duda, VMD, MBE, DACVR
Diagnosing Primary Bone Tumors in Dogs Question Can primary bone cancer in dogs be adequately diagnosed with radiography? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer Radiographs can look very suspicious for osteosarcoma, but like with many other cancers, a tissue sample is required to make the diagnosis. Learn more about bone
Is FNA Adequate to Diagnose a Bone Tumor in a Dog? Question Fine needle aspirates obtained from a bony lesion on my dog's front leg came back negative for osteosarcoma. Can I be confident that he doesn't have bone cancer or could he have it and it's not showing up in the test. I don't want to put him through a biopsy if it's not needed? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist,
Where to Get Veterinary Oncology Care Question Do I have to go to a specialty center like the University of PA to get treatment for my dog's cancer or is that something all vets do? Lili Duda, VMD, MBE, DACVR Veterinary Radiation Oncologist- University of Pennsylvania, responds: Answer The best place to start with your pet is your primary care veterinarian. They know your pet best,
How Animals Tolerate Cancer Treatments Question How do dogs tolerate cancer treatment? Do they get sick like people do? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer Dogs tend to tolerate cancer treatments (surgery, chemotherapy, radiation therapy) relatively well compared to people, but they can certainly still have side
Dealing with Cost of Cancer Treatment for Pets Question This treatment must be expensive. Does pet medical insurance cover cancer treatments? What if I don't have insurance for my pet- how do people afford this? Christina Bach, Oncology Social Worker at Penn Medicine, responds: Pet insurance is a fairly new and rapidly developing and changing business. There are many plans available, and
Canine Mammary Tumors & Spaying Question My dog has a mammary tumor and is having surgery next week. I have been advised to spay her at that time- is there a benefit to that since she already has the cancer? I have 2 1-year old pups from her- are they at higher risk with a mother with the cancer? And does spaying now reduce their risk Erika Krick, VMD, DACVIM Veterinary Medical
How Frequent is Cancer Treatment in a Pet Question How frequently (number weeks or days per week?) will a dog have to get radiation or chemotherapy? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer That depends on the type of cancer and treatment options. Learn more about treatment options for animals with cancer. This question and
Is My Pet Suffering? Question How do I know if my pet is suffering? Lili Duda, VMD, MBE, DACVR Veterinary Radiation Oncologist- University of Pennsylvania, responds: Answer Suffering is a hard thing to define and quantify, whether it is happening in a pet or a person. For our veterinary patients, we assume that if something would hurt or distress a person, it would
Clinical Trials for Animals with Cancer Question Are there clinical trials for pets with cancer? If so, how do you find them? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer There are multiple ongoing clinical trials for pets with cancer. You can go to the Veterinary Cancer Society website at vetcancersociety.org for more
Children Around Pets Getting Cancer Treatment Question If a pet is getting treated for cancer, can he be around my small children? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania responds: It depends on the type of treatment your dog is receiving. The potential concerns would be any exposure of your children to vomit, urine, or feces after a pet has been
Diet Needs for Dog Being Treated for Cancer Question My dog is starting on chemo for lymphoma. Do you have suggestions for a diet that might help manage any side effects or keep him from losing weight? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer Hill's has a diet for dogs with cancer called n/d that you could discuss with your
Pain Management for Pets with Cancer Question My dog was just diagnosed with primary bone cancer (yesterday in fact). She is already 3 legged so amputation is not an option and the vet said that the best we could is to just keep her comfortable until we feel it is time to put her out of her pain. Could you address pain management options and any suggestions as to how/ when to make
What NSAID is commonly recommended? Question What NSAID is commonly recommended? My vet is currently recommending Neurontin and gabapentin. Might Tramadol be a better option in your experience? Lili Duda, VMD, MBE, DACVR Veterinary Radiation Oncologist- University of Pennsylvania, responds: Answer We typically recommend a combination of medications, with frequent monitoring and
Treatment Options for Canine Lymphoma Question Is the Wisconsin protocol the most effective treatment for lymphoma? What are the chances of a cure or is this therapy really to buy her time? Is there a less expensive but maybe not too less effective treatment? I read something about using CCNU alone. Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania,
Which Canine Breeds Get Cancer? Question Do certain breeds of dogs get cancer more often? Do they have genetic tests like the ones used in people (BRCA, etc.)? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer Some breeds of dogs are predisposed to certain types of cancer. For example, Golden Retrievers, Boxers, German
Can All Animals Get Cancer? Question Can all animals get cancer- like snakes, turtles, etc? We don't have your "usual" pets! Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer Many different types of animals get cancer, including reptiles, birds, etc. This question and answer was part of the OncoLink Brown Bag Chat
Can Feline Leukemia Affect a Human? Question Is it true that feline leukemia can be spread to humans? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer Feline leukemia is caused by a virus that affects cats and can be spread from one cat to another. It is not an infection that can be passed on to people. This question and answer
Common Cancers in Pets Question What are common types of cancer in pets? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer Lymphoma is common in both dogs and cats. Other common cancers in dogs include mast cell tumors, bone cancer, hemangiosarcoma, and mammary tumors, and other common cancers in cats include
Mast Cell Tumors in Dogs Question My dog had a lump biopsied yesterday. My vet thinks it is a mast cell tumor. What can you tell me about mast cell cancers? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer The behavior of mast cell tumors can be quite varied. Often staging is recommended after the diagnosis is made,
Considering Surgery for Sarcoma Question My dog has a soft tissue sarcoma just distal to his stifle. It is about the size of the end of your small finger. I am concerned about having surgery and not getting all the margins...is surgery the best option? Lili Duda, VMD, MBE, DACVR Veterinary Radiation Oncologist- University of Pennsylvania, responds: Answer When considering
Veterinary Social Workers Question What is the role of the social worker in veterinary oncology? Christina Bach, Oncology Social Worker at Penn Medicine, responds: Veterinary social workers and bereavement counselors are available at many large academic veterinary hospitals. There are also many bereavement counselors who specialize in pet loss counseling and support.
When to Stop Treatment in a Pet Question How do we know when it is time stop any treatment and to say good-bye to my pet? Christina Bach, Oncology Social Worker at Penn Medicine, responds: Knowing when to stop treatment and say good-bye to your pet is a challenge. It is important to talk with your veterinarian about signs and symptoms to be aware of that could mean your
Hospice Care for Pets Question Do they have hospice for dogs? He is older and I don't want to put him through chemotherapy, but I also don't want him to be in pain. What can I expect it to cost to keep him comfortable? Christina Bach, Oncology Social Worker at Penn Medicine, responds: Veterinary Hospice is also relatively new and still developing. It is not offered
Bereavement Support for Pet Owners Question Is there bereavement support for pet owners? Christina Bach, Oncology Social Worker at Penn Medicine, responds: Bereavement support is available through many veterinary offices and hospitals as well as through private practice. Many large academic veterinary hospitals offer pet loss support groups. Here is a listing of pet loss
Euthanasia at Home Question Can my pet be euthanized at home? Christina Bach, Oncology Social Worker at Penn Medicine, responds: The availability of in home euthanasia varies state to state based on laws and regulations. You should talk with your veterinarian if this is an option for you (if he/she can provide this or if he/she knows someone who does). There is
Helping Kids Cope with Loss of a Pet Helping Kids Cope with Loss of a Pet Question How can I help my kids cope with the loss of a pet? Christina Bach, Oncology Social Worker at Penn Medicine, responds: It is important to be open and honest with your children about what has happened to their cat/dog, while be age appropriate. Young children (under 4) don't always understand the
Coping with Pet Loss: Hotlines Question Are there any hotlines to call and talk to someone about Pet Loss? Christina Bach, Oncology Social Worker at Penn Medicine, responds: There are hotlines available for pet loss support. Here is a helpful link to pet loss hotlines: http://vet.osu.edu/vmc/pet-loss-support-hotlines-and-helplines This question and answer was part of the
Donating a Pet's Body to Science Question Can I donate my pet's body to veterinary science? Lili Duda, VMD, MBE, DACVR Veterinary Radiation Oncologist- University of Pennsylvania, responds: Answer Many veterinary schools have Educational Memorial Programs through which owners can donate their pets' bodies to veterinary medical science. Typically these donations are used to
Cancer Risk in Dogs Question My dog is 12. Is there a certain age when there is greater risk of cancer? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer Older dogs in general are at higher risk for cancer, but specific age cutoffs depend on the type of cancer. This question and answer was part of the OncoLink
Cancer Prevention Research in Animals Question Is there any research into cancer prevention in animals? Erika Krick, VMD, DACVIM Veterinary Medical Oncologist, University of Pennsylvania, responds: Answer Most research related to cancer in veterinary patients focuses on cancer causes and treatment, not prevention yet. Currently there is no specific recommendation to prevent cancer
Foods to Avoid for Pets with Cancer Question For a dog with a history of mast cell tumors, are there any foods that should be avoided? I've read that there are certain foods that contain high levels of histamine? Lili Duda, VMD, MBE, DACVR Veterinary Radiation Oncologist- University of Pennsylvania, responds: Answer There are no specific diets we recommend for prevention or
Hospital Bills for a Stereotactic Biopsy Dear OncoLink "Ask the Experts," I was diagnosed breast cancer last month. They performed a stereotactic biopsy. The hospital told me that the procedure was a minimum of $1150.00. When I received my bill it was for $2209.00. Since I do not have any insurance, I was overwhelmed by this bill. Is this what is a normal charge for this
Getting Insurance to Pay for Screening Procedures Dear OncoLink "Ask the Experts," My family is being followed by two universities for Hereditary Non-polyposis Colon Cancer (Lynch Syndrome II). My insurance will not pay for the screening colonoscopies that are recommended yearly. They say without symptoms, it is merely a screening procedure. I say it is early detection
Dealing with Outstanding Medical Bills and Coverage for Screening Procedures, and Preexisting Conditions Dear OncoLink "Ask the Experts," I am a 33 y/o white male with a history of testicular cancer treated with chemotherapy followed by lymph node dissection. I have been in remission since Dec. 1993. At the onset of my disease, I did not have insurance and was treated as an indigent patient. Currently, I am left with a large number of
Obtaining Coverage for Pre-Existing Conditions After Insurance Dear OncoLink "Ask the Experts," I was diagnosed two year ago in April with AML (M3). I have been in remission since July of that year and have been out of treatment since November of 1994. Due to the situation (I am in Graduate student at a State University) and the limited nature of the group health insurance available to me
CHAMPUS coverage for Bone Marrow Transplants Dear OncoLink "Ask the Experts," CHAMPUS initially said they do cover bone marrow transplants for some conditions but not for metastatic breast cancer. Does anyone know of a way to "get around" the bureaucracy? It is our understanding that CHAMPUS will usually cover NCI sponsored or based protocols. OncoLink
Switching from COBRA to individual coverage Dear OncoLink "Ask the Experts," My mother was diagnosed with stage II breast cancer in January 1996 and underwent lumpectomy, chemotherapy and radiation therapy. During the process, she was covered by the HMO plan provided by my father's employer. However, my father just recently took a job overseas and my mother decided to stay in the
Oopherectomy and Insurance Coverage Dear OncoLink "Ask the Experts," My present health insurance company will not cover a proposed bilateral oopherectomy even though my mother and mother's mother died from ovarian cancer. They did cover one lady's surgery in this area, then refused to cover any more. Do you have any suggestions? Key issues are whether
Obtaining referrals for providers outside HMO networks Dear OncoLink "Ask the Experts," To what entity or person can I appeal that has higher authority to help press my case for psychological counseling as part of my cancer therapy? I thought somewhere that HMO's were obliged to go outside their list of providers if none of the providers could provide the services (my primary physician
Coverage for Child Dear OncoLink "Ask the Experts," To what entity or person can I appeal that has higher authority to help press my case for psychological counseling as part of my cancer therapy? I thought somewhere that HMO's were obliged to go outside their list of providers if none of the providers could provide the services (my primary physician did
Usual, Customary or Reasonable? Dear OncoLink "Ask the Experts," Hi and thanks for offering this most useful service. My husband has lung cancer, Stage IV adenocarcinoma. He was diagnosed in mid-September, largely by accident, and has since been treated with 3.5 weeks of radiation to the brain and spine and three rounds of cis-platinum chemotherapy. My insurance
Obtaining Financial Assistance for Cancer Therapy Dear OncoLink "Ask the Experts," A doctor has asked, on behalf of a patient who cannot afford treatment for diagnosed cancer, where to apply to find financial assistance. If the patient is being evaluated by a physician who is affiliated with a hospital-based practice, they may have access to social workers who could
Financial Issues Pertaining to Chemotherapy and Testicular Cancer Dear OncoLink "Ask the Experts," I am currently entering chemotherapy for early Stage III testicular cancer. There will be some days where I will have to take a private service to and from therapy sessions. I would like to know if there is any reimbursement programs or services available for transportation? My insurance carrier
Extending Medical Coverage Upon Relocation Dear OncoLink "Ask the Experts," My father has lung cancer and lives in New York with my mother. He has been out of work for two years. My mother is employed and has insurance that covers both of them. My wife and I and their only grandchild live in Ohio. My father desperately wants to move to Ohio for his limited time. We
Insurance Change and Pre-Existing Conditions Dear OncoLink "Ask the Experts," I am considering changing from my current health insurance coverage (BC/BS of the National Capital Area) to my husband's insurance (BC/BS government employee) coverage during open enrollment. Since I was diagnosed with localized malignant melanoma 6 months ago, I was concerned that changing health
Insurance Changing from BC/BS to HMO Dear OncoLink "Ask the Experts," In a few months my Blue Cross & Blue Shield insurance policy will change to a BC&BS HMO policy. The policy I am holding now will no longer be offered by the company I work for and as I understand it, by Blue Cross itself. I need to know the things I can do to safeguard my health during this
Obtaining Financial Assistance Dear OncoLink "Ask the Experts," My sister has cancer and needs financial aid, how does she go about it? We recommend that your sister inquire as to her eligibility for Medicaid in the state where she lives. The physician and/or hospital who are taking care of her should be able to give her guidance as to the
What is the cost of cancer therapy in the US? Dear OncoLink "Ask the Experts," It is difficult to provide cost estimates for the treatment of cancer without having a more definitive idea of where and how a patient will be treated. The charge structure for medical services varies fairly significantly across the country. Even on a regional basis, you will find sizeable
Finding Medicare RBRVS (Resource Based Relative Value Scale) Information Dear OncoLink "Ask the Experts," Hello. I am in search of the Medicare reasonable and customary fees. I have called everyone under the sun and surfed till I can surf no more. Can anyone please help me find the Medicare reasonable & customary or RVU's. I am also looking for McGraw Hill and RBRVS (Resource Based Relative Value Scale)
RBRVS Listing from the Federal Register Dear OncoLink "Ask the Experts," How can I obtain the RBRVS listing from the Federal Register? Can I download it off the Internet? Can you give me the URL to accomplish this? Regards, DR, PhD (Houston) The Government Printing Office now provides on-line access to the Federal Register. The G.P.O. address is as
Insurance reimbursement for peripheral stem cell transplants Dear OncoLink "Ask the Experts," I am interested in finding any information re: insurance reimbursement for peripheral stem cell transplants. In general, what oncologic diseases are usually covered? What about coverage for "experimental" protocols? Are their general guidelines re: what will be covered as inpatient vs. outpatient?
PET for breast cancers and melanoma Dear OncoLink "Ask The Experts," Can you explain why PET is used in breast cancer and melanoma? Peeyush Bhargava MD, Chief Fellow in the Department of Nuclear Medicine at the University of Pennsylvania, responds:PET scans are very useful in both patients with breast cancers and patients with melanoma. In patients with breast cancers,
The role of PET scanning in lymphoma Dear OncoLink "Ask The Experts," I would like to have some idea about the role of PET scan in lymphomas. Should we use PET even if CT scan is normal? Does a negative PET Scan exclude and positive confirm residual disease? Peeyush Bhargava MD, Chief Fellow in the Department of Nuclear Medicine at the University of Pennsylvania, responds:PET
PET scan for evaluation lung nodules Dear OncoLink "Ask The Experts," I have a nodule in my right lung. Please tell me about the advantages of having a PET Scan test done to determine if this nodule is cancerous or not. Is this a painful test? Please tell me what will be done to me during this test - Is similar to a CAT Scan, hopefully not similar to the MRI of which I fear going
The Role of PET in Melanoma Dear OncoLink "Ask The Experts," My Aunt (age 58) just got diagnosed with Malignant Melanoma on the back of her shoulder. I think it is a good idea for her to get tested to make sure it did not spread to her lymph nodes and lungs. Would a PET scan be the best way to detect the spread of cancer to my Aunts lymph nodes and lungs? Are there any
Usefulness of PET scans Dear OncoLink "Ask The Experts," I have heard that there is a new scan for cancer patients? that is called a PET scan. They say that it lets doctors detect the exact location of the cancer. This keeps patients from having to have surgery to locate the cancer. Can you tell me more? Peeyush Bhargava, MD, Chief Fellow in the Department of
Measuring the SUV (Standardized Uptake Value) for PET scans Dear OncoLink "Ask The Experts," I have had three PET scans for my malignant melanoma. My first one was April 2000 to evaluate me for Interferon; it was negative. The second was October 2001 because I had another lymph node swollen. That PET was negative except for that node. My last one June 2002 showed low activity in legs and neck. What is
Can cancer patients be evaluated annually with PET scanning? Dear OncoLink "Ask The Experts," Why can't cancer patients be evaluated annually with PET scanning? If it is simply a matter of cost, can't a patient pay for one his/herself? It would be worth the cost for the peace of mind gained. Peeyush Bhargava, MD, Chief Fellow in the Department of Nuclear Medicine at the University of Pennsylvania,
FDG PET for Sarcoma Dear OncoLink "Ask The Experts," Is pet imaging helpful for people with scarcoma? 8 weeks ago I had a large uterine leiomyoscarcoma tumor removed. Peeyush Bhargava, MD, Chief Fellow in the Department of Nuclear Medicine at the University of Pennsylvania, responds:Although Medicare does not reimburse for PET imaging in patients with sarcoma, it
F-18 FDG PET in the Evaluation of Hepatocellular Cancer Dear OncoLink "Ask The Experts," I just found out that I have liver cancer and the oncologist wants to do a PET Scan. She told me the reason for this test, but I'm not sure I understand. Can you explain? Peeyush Bhargava, MD, Chief Fellow in the Department of Nuclear Medicine at the University of Pennsylvania, responds:PET scans using FDG have
PET Scans with a Pacemaker Dear OncoLink "Ask The Experts," My 88 yr. old mother is scheduled to have a PET scan this week but has a pacemaker. Can this test be performed on a patient with a pacemaker?Peeyush Bhargava, MD, Chief Fellow in the Department of Nuclear Medicine at the University of Pennsylvania, responds:Patients with metallic implants, prostheses, pacemakers, or
PET Sensitivity and Lymph Nodes Dear OncoLink "Ask The Experts," I am from Australia and I was hoping you may be able to point me in the direction of any relevant research articles (or give your advice). My husband had a PET scan before his surgery for squamous cell carcinoma of his lung. The PET scan did not identify any lymph node involvement, but when he had the surgery, 4
Can PET Scan Tell Type of Tumor? Dear OncoLink "Ask The Experts," My father had a surgery for stomach cancer three years ago. Recently, he was found to have some tumor around his neck. His PET scan result shows that he has tumor. Can the PET test check out whether the tumor is malignant or not? Can it also tell whether the tumor around the neck indicates the same stomach cancer
PET Scan after Surgery or Radiation Dear OncoLink "Ask The Experts," I know a woman who had a lobectomy after being diagnosed with lung cancer. She was told that she did not need adjuvant chemotherapy. She just had a PET scan which showed at least one lymph node that was "glowing". She has been told that the PET should not have been done so soon after surgery and that the
PET Scan Sensitivity for Colon Cancer Dear OncoLink "Ask The Experts," My husband was diagnosed with Stage 3 signet ring cell adenocarcinoma in December 2005 and had 5 months of chemotherapy. Within the past month, his CEA level has risen from 1.5 to 3.4. His doctor ordered a PET scan, and the results came back clear. It showed absolutely nothing. Are there any cancers that don't show
Pet Scan and Lung Cancer Size Dear OncoLink "Ask The Experts," How large does a lung nodule have to be for a PET scan to be accurate or the test of choice? Anil Vachani, MD, Attending Physician at the University of Pennsylvania Medical Center, responds:Pet is generally not recommended for lesions under 8mm. See Pulmonary Nodule on CT for more information.
IMRT^TM: Patient Information and Frequently Asked Questions Copyright © 2001 Varian Medical Systems, Inc. How does radiation therapy work? Cancer cells grow and divide more rapidly than many of the normal cells around them. High doses of radiation can kill cells or keep them from growing and dividing, and it has proven to be particularly effective in killing cancer cells and shrinking tumors.
Skin care for radiation therapy patients Dear OncoLink "Ask The Experts," Is it always necessary to remove the dressing on a radiodermitis wound during radiation therapy? What kind of products can be used during therapy and which products and dressings cannot be used? Ruth Collins, MSN, CRNP, Research Nurse Coordinator Department of Radiation Oncology at the University of
Late cardiac side effects of Hodgkin's treatment Dear OncoLink "Ask The Experts," I had Hodgkin's disease 15 years ago and had full mantle radiation. I know two women who also had Hodgkin's. They both had to have open-heart surgery this year. One doctor told one of my friends it was due to the radiation she had many years ago - that scar tissue from the radiation caused a problem. Is this
Whole brain radiation therapy for CNS lymphoma Dear OncoLink "Ask The Experts," My mother has Primary Central Nervous System (CNS) Lymphoma. After 6 IV methotrexate treatments, her doctor has recommended radiation. What type of radiation procedures do you provide? I assume whole-brain radiation is no longer used? Hui-Kuo G. Shu, MD, PhD, Assistant Professor in the Department of Radiation
Radiation Colitis Dear OncoLink "Ask The Experts," What is radiation colitis? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:Radiation Colitis is a manifestation of inflammation and damage to the colon and it is caused by radiation. It presents with spasm, cramping pain,
Treatment for Esophagitis Dear OncoLink "Ask The Experts," My brother in law's last radiation treatment was 2 weeks ago. He still has pain and trouble swallowing. I believe the term is acute esophagitis. Can you tell me how long this lasts after radiation treatment is stopped? Ruth Collins, MSN, CRNP, OCN, Advanced Practice Nurse in the Research Division of the
IMRT for squamous cell carcinoma of the tonsil Dear OncoLink "Ask The Experts," My son had a squamous cell carcinoma removed from his tonsil. Radiation has been recommended. New IMRT equipment has come into the equation but it is not yet available within the facility where my son is being treated. Given the advice that salivary glands may well be impacted by "regular" equipment, is IMRT
Vaginal stenosis after radiation to the rectal/lower abdomen area Dear OncoLink "Ask The Experts," Can you tell me please if it is unusual for radiation to the rectal/lower abdomen area to cause vaginal stenosis? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:Most women getting radiation to the pelvis develop vaginal drying as
Why not radiate 7 days a week? Dear OncoLink "Ask The Experts," My brother in Taiwan has stage IV colon cancer. He is currently undergoing radiation on his spine, 5 days/week. He is also receiving chemotherapy. He wants me to ask if 7 days/week of radiation treatment works better? He is scared that cancer will spread faster by not treating everyday. Thank you very much for your
3D- Radiation versus IMRT versus Proton Therapy Dear OncoLink "Ask The Experts," What are the differences between IMRT, 3-D radiation, and proton therapy? What is the best choice for a patient? Eric Shinohara, MD, MSCI Radiation Oncology Section Editor for OncoLink responds: The issue of IMRT vs. 3-D conformal radiation is a hot one, and unfortunately there are no randomized trials
Does Obesity Affect Radiation Treatments? Dear OncoLink "Ask The Experts," I had a biopsy of my prostate, Gleason 7 , after a digital rectal examination (DRE) revealed a nodule on the left side of my prostate. I think I am a stage T2a or b, not sure. I'm 51 years old and obese, 6'1" and about 400 pounds with a 58-inch waist. How does my size affect the choice of radiation as a
"MacDonald Option" in Radiation Therapy Dear OncoLink "Ask The Experts," A friend was told that he would be treated for cancer using the "MacDonald option". Could you please elaborate? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:It would be helpful to know the primary tumor type with which
How Long After Radiation Can Tumor Keep Shrinking? Dear OncoLink "Ask The Experts," How long after stopping radiation can you continue to see tumor shrinkage? Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:This is a complex question. The first point to be made here is that, with the exception of spermatozoa and
Sun Exposure After Radiation Dear OncoLink "Ask The Experts," I had 35 radiation treatments about five years ago and was told not to go out in the sun. After this length of time, is it OK to be in the sun if I apply sunscreen with a SPF 15 or above? Neha Vapiwala , MD, Senior Editor of OncoLink from the Department of Radiation Oncology at the Hospital of the University of
Hair Growth after Radiation to the Head Dear OncoLink "Ask The Experts," I have had 14 radiation treatments to my brain and have lost a lot of my hair. Will my hair loss from radiation grow back? I understand that hair lost after chemotherapy will eventually come back, but what about when radiation causes the hair loss? Thank you.Neha Vapiwala , MD, Senior Editor of OncoLink and Chief
Prevent Hair Loss with Tempol Dear OncoLink "Ask The Experts," I saw the article on Tempol and alopecia and was wondered about the follow-up data on that study. I already had whole brain radiation at a high dose (3750cGy). I am wondering if researchers have found anything to help with regrowth in this type of case. James M. Metz, MD, Editor-in-Chief of OncoLink and Assistant
Radiation Exposure to Others during I-131 Therapy Dear OncoLink "Ask The Experts," My mother-in-law received radiation treatments to her thyroid some time ago, and it somehow affected her husband's thyroid function. Their doctors informed them that their proximity to one another during/after treatment had a ?transferred? effect on him. Is this possible, and if so, for how long? Robert Lustig MD
How Long Does Radiation Work? Dear OncoLink "Ask The Experts," After completing 25 external radiation treatments for a pineal region tumor, how long does the radiation keep working to destroy a tumor in the brain: is it weeks, months, or years? MRI 's have shown my tumor has continued to grow in size, and I was told it could be swelling from the radiation treatment. I
Raditaion Therapy and Obesity Dear OncoLink "Ask The Experts," I am a 60 year old female diagnosed with breast cancer, for which I underwent lumpectomy. I am 300 pounds and have been turned down by several radiation facilities due to my weight and the ability of the machine to support me. Am I destined for a mastectomy or is there somewhere that can treat me? Neha Vapiwala ,
Considerations for Choosing Partial Breast Irradiation Dear OncoLink "Ask The Experts," What factors need to be considered when choosing partial breast irradiation (type of tumor, size, and stage)? My doctor told me my age (44yo) was also a factor. Terry Styles, MD, Assistant Professor of Radiation Oncology at the University of Pennsylvania, responds:Partial breast irradiation is just one of many new
PSA After Proton Therapy for Prostate Cancer Dear OncoLink "Ask The Experts," Prior to commencing 44 treatments of proton radiation therapy at Loma Linda Medical Center in January 2007 for prostate cancer, my PSA was 8.5 and Gleason score was 5. Almost 4 months after my last proton treatment, my PSA is 9.59. I never had symptoms before being diagnosed and still don't have any. When can I
CyberKnife for Bone Metastases Dear OncoLink "Ask The Experts," Is there any information on the use of CyberKnife to treat bone metastases in the chest area associated with recurrent NSCLC? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:There have been quite a few studies using CyberKnife for spinal metastases (vertebral bones), mostly because this system
Exercise during radiation Therapy Dear OncoLink "Ask The Experts," I am currently having radiotherapy for invasive breast cancer. I had surgery 12 weeks ago and the tumor was removed within a 1 mm margin of healthy tissue and very close to the muscle. I would like to play tennis and wondered whether it would be beneficial or not. Is it better not to do exercise of the chest area
Radiation Pneumonitis Dear OncoLink "Ask The Experts," My husband has lung cancer; it was a tumor in an area of the lung that made surgery impossible. He had radiation treatments about six months ago and the tumor shrunk a lot. He has recently developed terrible problems with breathing. The doctors say it is radiation pneumonitis. He is on Prednisone and uses oxygen at
Radiation Safety Issues Dear OncoLink "Ask The Experts," If someone is receiving internal radiation therapy (brachytherapy) for cervical cancer treatment, is she emitting rays that would affect other people? Is it safe for the patient to be close to a baby?Neha Vapiwala , MD, Senior Editor of OncoLink and Chief Resident in the Department of Radiation Oncology at the
Dating after breast cancer Dear OncoLink "Ask The Experts," I am 28 years old unmarried and going through breast cancer treatment. How will I ever be able to feel "normal" enough to date again? Linda Jacobs, PhD, CRNP, AOCN, BC, Clinical Assistant Professor at the University of Pennsylvania School of Nursing, responds:You have many things to cope with during
Fertility after testicular cancer Dear OncoLink "Ask The Experts," I am a 23-year-old man who has been diagnosed with testicular cancer. I know I should be grateful for an opportunity to survive but I am stuck on wondering whether or not I can have kids after treatment. I need surgery and chemo...can you help? David J Vaughn, MD, Medical Director of the Abramson Family Cancer
Can radiation to the upper mantle affect fertility? Dear OncoLink "Ask The Experts," I was diagnosed with Hodgkin's disease when I was 24. I am now 27 and have been in remission for 2 years. I was stage 1B and had surgery, then radiation to the upper mantle. I've read as much as possible about what the future may have in store for me, but I'm wondering if there has been any recent research
Birth defects and fertility after radiation for testicular cancer Dear OncoLink "Ask The Experts," I was diagnosed with stage I seminoma in December 2002 and had my left testicle removed shortly after. In March 2004, I was told I had to get radiation treatments because the cancer reappeared in the para-aortic lymph nodes. I received 27 treatments covering an area beneath the sternum to the pelvis. This
Familial/Genetic Risk for Testicular Cancer? Dear OncoLink "Ask The Experts," My father died of untreated testicular cancer at 63 years old. My brother was diagnosed and treated successfully 5 years ago for testicular cancer. What risk does that pose for myself (37 year-old female), for my younger brother, and for my son and nephews? There is very little info available on the web regarding
Pregnancy after Chemotherapy Dear OncoLink "Ask The Experts," My husband is 30 years old and was diagnosed with testicular cancer (stage II, 100% embryonal carcinoma). He immediately had surgery and chemotherapy (BEP for 3 cycles). His last chemo treatment was about 8 months ago. Prior to the cancer, my husband and I had been trying to start a family. We would really like to
PDT (Photodynamic Therapy) for Breast Cancer of the Chest Wall Dear OncoLink "Ask The Experts," Can PDT be used to treat recurrence of breast cancer on the chest wall (the site of the mastectomy)? Do you know of any clinical trials for this use? Robert Lustig MD FACR, Clinical Associate Professor, Department of Radiation Oncology, University of Pennsylvania, responds:PDT has been used to treat the chest wall
Paronychia (Nail Infection) Due to EGFR Inhibitors Dear OncoLink "Ask The Experts," My 52-year old husband has received two treatments of Panitumumab in his fight against metastatic colon cancer. Within the past two weeks, the skin on the sides of his fingernails have become infected and hurt like an ingrown fingernail. If you can just imagine 3-4 ingrown fingernails on each hand! He takes 100 mg
Protocol for Continuous Infusion Pumps Dear OncoLink "Ask The Experts," Our institution recently began using continuous infusion 5-FU via pump for outpatients. Can you please tell us how your protocol works for these pumps? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:When our patients use these pumps, they are controlled (that includes all programming, refilling,
Best Practice Guidelines for Advanced Lung Cancer Dear OncoLink "Ask The Experts," I am an APRN working in palliative care - inpatient and some homecare. I also have a special interest in lung cancer. I was wondering if there exist any "best practice guidelines" for advanced lung cancer? I am already aware of the NCCN guidelines. Beth Eaby, MSN, CRNP, OCN, Bboard certified nurse
Acne-form Rash Caused by Tyrosine Kinase Inhibitors Dear OncoLink "Ask The Experts," Are there any practice standards that have been adopted by ASCO or NCCN for the acne-form rash caused by tyrosine kinase inhibitors? I am referring to a standard drug therapy for the rash in oral or topical form? I know many things are tried, but what do you find that is working the best? Do you prophylactically
Running Incompatible Agents Through a Double Lumen Catheter Dear OncoLink "Ask The Experts," Is there a problem with running oxaliplatin through one side of a double port while running normal saline through the other? My understanding is that one side's opening is proximal to the other side's opening and the two solutions would not mix. Gloria DiLullo, MSN, CRNP, OncoLink Medical Oncology
HNPCC and Endometrial Cancer Dear OncoLink "Ask The Experts," I have recently been diagnosed with HNPCC after a resection of the transverse colon, at age 48. The genetic counselor has pulled quite a bit of information, and I see the recommendation is to possibly have a hysterectomy to avoid uterine cancer. My doctor. feels this would be the only way to avoid having to go
Genetics of Duodenal Cancer Dear OncoLink "Ask The Experts," My 28 year-old triplet daughter found out she has duodenum cancer. She had surgery last month. She has an identical sister who doctors want tested. They did a CT scan and ran blood work and she appears to be cancer free. How often should the unaffected sister be tested? Should the girls’ triplet brother be tested
Family History of Cancer Dear OncoLink "Ask The Experts," I come from a family of five: 3 girls and twin boys. My Mom is currently on Hospice; she started with stomach cancer and to the uterine and spots on the liver. Recently, she had two sisters die in the last 6 months, 15 days apart. One died from breast cancer that spread to her lymph nodes, bone, and brain, and the
Family History of FAP Dear OncoLink "Ask The Experts," FAP (familial adenomatous polyposis) is very prevalent in our family. I lost my husband at 33 y.o. and his brother at 38 y.o. to colon cancer, at which time it was discovered that FAP was the culprit. Two of my sons were diagnosed, one died of the disease, and one is alive and well today. I also lost one grandson
Genetic Testing for FAP Dear OncoLink "Ask The Experts," FAP is very prevalent in our family. My son has had 3 genetic tests done in an effort to locate his mutation so that other family members could get blood tests to see if they have it, but they have not been able to locate the mutation in any of the affected family members. I have heard that it matters where the test
Depression and Cancer Dear OncoLink "Ask The Experts," How can I tell if my spouse is "depressed" over his diagnosis or if what he is feeling is "normal"?Tracy Lautenbach, MSW, LCSW, Social Worker in the Radiation Oncology Department at the Hospital of the University of Pennsylvania, responds:Some degree of depression is common in people who are
Finding Counseling Support Dear OncoLink "Ask The Experts," I am having difficulty dealing with the devastation breast cancer has brought to my life. I have been referred to several therapists who did not have any experience working with people after a cancer diagnosis. Where can I turn?Tracy Lautenbach, MSW, LCSW, Social Worker in the Radiation Oncology Department at the
Advanced Directives Dear OncoLink "Ask The Experts," What is an Advanced Directive and how can I make sure my wishes are known?Tracy Lautenbach, MSW, LCSW, Social Worker in the Radiation Oncology Department at the Hospital of the University of Pennsylvania, responds:An Advanced Directive is a legal document that allows you to state what type of medical care you wish
Proton Therapy For Prostate Cancer Dear OncoLink "Ask The Experts," My friend is getting treated with proton therapy. What is the difference between that and regular radiation? Is it better?Neha Vapiwala , MD, Senior Editor of OncoLink and Chief Resident in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:Proton beams are considered a
Quitting Smoking After Lung Cancer Diagnosis Dear OncoLink "Ask The Experts," What is the point to quitting smoking when I already have lung cancer? My family is on my case to quit, but it seems pointless.Jared Weiss, MD, a Fellow in Hematology & Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:In the case of surgically curative disease, quitting decreases
Electronic Cigarettes Dear OncoLink "Ask The Experts," I looked into this question recently and the quality of data is poor and does not allow a definitive answer to this question. The FDA recently evaluated the question and expressed concern. I'm also not an expert on e-cigs (I'm not sure that anyone properly is), but I do know that nicotine itself is a confirmed
Dietary Soy After Breast Cancer Dear OncoLink "Ask The Experts," I had an ER+ breast cancer that was treated 2 years ago. Is there any danger to eating soy products or other plant estrogens, like flax?Karen Wagner MS, RD, LDN, Clinical dietitian specialist for the Abramson Cancer Center, responds:The issue of soy and ER+ breast cancer is certainly confusing and we don't have all
Living Far From Treatment Facility Dear OncoLink "Ask The Experts," I am getting radiation therapy for breast cancer at a facility many miles from home. Are there organizations that can help with getting a ride to treatment or finding a place to stay that might be cheaper than a hotel?Tracy Lautenbach, MSW, LCSW, Social Worker in the Radiation Oncology Department at the Hospital of
What foods can I eat that are easy to swallow since my throat is so sore from radiation? Dear OncoLink "Ask The Experts," What foods can I eat that are easy to swallow since my throat is so sore from radiation?Katrina Claghorn, MS, RD, Registered Dietitian at the Abramson Cancer Center of the University of Pennsylvania, responds:Radiation can make your throat sore and impact your ability to swallow. Some foods may be hard to swallow
Fatigue During Radiation Dear OncoLink "Ask The Experts," My husband got radiation treatment 10 years ago. He sailed through it and worked full time. I am getting radiation for breast cancer now and am so tired I can hardly get out of bed some days. Am I feeling tired from the radiation and why did my husband not have these problems? He thinks I’m being dramatic!Tammi
Getting Back to Normal Dear OncoLink "Ask The Experts," My doctor says I am done treatment and can get back to normal! I don’t feel normal at all! When will I feel like my old self again?Neal Niznan, MSW, LCSW, Social Worker in the Radiation Oncology Department at the Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, responds:This is a
Chemo Brain Dear OncoLink "Ask The Experts," I have had problems paying attention and remembering things. I have heard the term "chemobrain", but I dont know what to do about it. Some people say it is real. Some people say it is not. Anyway, I have sure felt it. Any recommendations on things that can help?Carolyn Vachani RN, MSN, AOCN, OncoLink's
Weight Gain After Breast Cancer Dear OncoLink "Ask The Experts," I have been gaining weight on tamoxifen, though my doctor says it is not related, I am sure it is. Do you have any tips for managing my weight for the next 5 years that I am on this drug?Karen Wagner MS, RD, LDN, Clinical dietitian specialist for the Abramson Cancer Center, responds:We are seeing more and more
New Therapy for Lung Cancer in the News Dear OncoLink "Ask The Experts," My wife is a never-smoker with metastatic lung cancer of the adenocarcinoma type. I saw the ABC news show on EML4/ALK. Is this an option for her? , , responds:EML4/ALK is an exciting discovery that I think shows where we are going in lung cancer therapy in that understanding a bit about how the cancer works is
Breast Self Exam Dear OncoLink "Ask The Experts," Why do the guidelines now say don’t do breast self-exam? My sister had breast cancer and found it by doing self-exam and best of all it doesn’t cost a thing! Self exams can save women’s lives- right? "Stress" is a reason not to? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator,
New Pap Testing Guidelines Dear OncoLink "Ask The Experts," What exactly are the guidelines for pap testing now? Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:The new guidelines from the American College of Obstetricians and Gynecologists recommend screening for cervical cancer
Lung Cancer Spread to the Brain Dear OncoLink "Ask The Experts," My cousin had lung cancer and now has brain cancer- but he says it’s not brain cancer - is he just trying to make me feel better? , , responds:When you as an American travel to Mexico, we don’t start calling you Mexican. You’re still an American, you’ve just relocated yourself to Mexico. The same holds true for
Smoking Cessation Aids Dear OncoLink "Ask The Experts," What medications will give me the best chance at quitting smoking?Anil Vachani, MD, Attending Physician at the University of Pennsylvania Medical Center, responds:Quitting smoking is one of the most difficult things to do given the very addictive effects of nicotine. There are several treatments available for
HPV Vaccines Dear OncoLink "Ask The Experts," Are there any differences between the two vaccines and can you please comment on the side effects? The recent reports of side effects had some “TV doctors” saying they wouldn’t get their daughters vaccinated.Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of
HPV Vaccines Prevent Head & Neck Cancers Dear OncoLink "Ask The Experts," Does the same HPV cause oral & cervical cancer and does the vaccine protect you against oral HPV?Harry Quon, MD, MS (CRM), Assistant Professor of Radiation Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:There are many subtypes of HPV viruses much like the flu virus. The answer
HPV Spread During Kissing Dear OncoLink "Ask The Experts," Since HPV is a skin to skin...if I have HPV can I give it my children when I kiss them?Harry Quon, MD, MS (CRM), Assistant Professor of Radiation Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:The HPV virus seems to need some break in the mucosa for it to start the infection.
HPV Treatment Dear OncoLink "Ask The Experts," Can HPV be treated?Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:Currently, we do not have treatments for the HPV vaccine itself. The good news is that 70% of women with low grade abnormalities on their pap tests caused by
Giving HPV Vaccine at Young Age Dear OncoLink "Ask The Experts," Why do the vaccines have to be given at such a young age?Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:The Gardasil vaccine is a prevention vaccine. It is not a treatment vaccine. It is much more effective when given
HPV Vaccines After Exposure Dear OncoLink "Ask The Experts," Can/should you get the vaccine if you have already had HPV?Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:If you already have HPV, you can certainly get the Gardasil vaccine. The vaccine gives protection against 4
Talking to Kids About HPV Dear OncoLink "Ask The Experts," What do I tell my daughters about prevention of HPV infection? Is abstinence the only answer?Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:About 70-80% of women have been exposed to HPV. There are even studies documenting
Preventing HPV Spread During Oral Sex Dear OncoLink "Ask The Experts," In general, condoms help to prevent the risk of HPV infection as does circumcision, but cannot prevent the spread 100%. Dental dams can be effective as well. (See reference at bottom about circumcision.)Harry Quon, MD, MS (CRM), Assistant Professor of Radiation Oncology at the Abramson Cancer Center of the
Vaccinating Boys Against HPV Dear OncoLink "Ask The Experts," Why don’t we vaccinate teen boys against HPV as well as girls? Especially given the cancer risk for them.Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:In general, men are at low risk for penile cancer. The exception is for
Proving HPV Cause Dear OncoLink "Ask The Experts," Can HPV be proven as the cause of a non-cervical cancer- if so, how?Harry Quon, MD, MS (CRM), Assistant Professor of Radiation Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:It comes from many studies of large populations or what we call epidemiologic studies. These show
Exercise During Chemotherapy Dear OncoLink "Ask The Experts," I saw a story on the news about something called heat shock protein. They said that stress (including strenuous exercise) the day before chemotherapy could protect cancer cells from chemotherapy. Is there any truth to a danger to exercising the day before chemo treatment? Kathryn Schmitz, PhD, MPH, cancer
Weight Gain on Tamoxifen Dear OncoLink "Ask The Experts," I am taking tamoxifen for five years. Along with the annoying hot flashes I have gained 10lbs, which is the bigger of the problems for me. I've heard conflicting stories as to if this is really related to the tamoxifen. What are your thoughts on this? Karen Wagner, MS, RD, LDN, Registered Dietitian at the
Lifting Weight After Breast Cancer Dear OncoLink "Ask The Experts," There was a recent news story that it is ok for women to exercise and lift weights after breast cancer (which I had been told not to just 2 years ago). What guidelines can we follow? Andrea Richtel-Baranas, MSE, MPT, Lead Therapist at the Abramson Cancer Center of the University of Pennsylvania, responds:
Diet to Improve Blood Counts Dear OncoLink "Ask The Experts," My platelet and white blood counts are low and my chemo is being held until they improve. Is there anything I can eat or take (vitamins or supplements) to help increase them?Karen Wagner MS, RD, LDN, Clinical dietitian specialist for the Abramson Cancer Center, responds:This is a question that I get asked quite
Compression Sleeve Use with Lymphedema Dear OncoLink "Ask The Experts," Do I need to wear my compression sleeve (for arm lymphedema) when flying? Is it ok to lift with the affected arm as I was told not to lift more than 10 lbs and read somewhere that lifting is o.k. Andrea Richtel-Baranas, MSE, MPT, Lead Therapist at the Abramson Cancer Center of the University of Pennsylvania,
Why No Weight Loss During Treatment? Dear OncoLink "Ask The Experts," I am getting radiation therapy for pancreatic cancer. I have been told for years that I am a little overweight, but now they tell me not to lose weight. Why?Karen Wagner MS, RD, LDN, Clinical dietitian specialist for the Abramson Cancer Center, responds:This issue is often very confusing for people going through
Options for Nutritional Supplements Dear OncoLink "Ask The Experts," My husband gets diarrhea from Ensure Plus. He has NOT lost weight yet but we are trying to be proactive. Can you please recommend a nutritional product less likely to cause diarrhea?Karen Wagner MS, RD, LDN, Clinical dietitian specialist for the Abramson Cancer Center, responds:Many, many people report diarrhea from
Diet and Preventing Recurrence of Breast Cancer Dear OncoLink "Ask The Experts," I take a great deal of interest in my diet and want to do what I can to prevent relapse of my breast cancer. I was treated 6 years ago. I see that you speak about weight loss, changes in bone density and info on changes that may affect weight. I am interested in understanding these dynamics, so I can make the right
Fatigue Continues After Treatment Dear OncoLink "Ask The Experts," Can chemotherapy-related fatigue last 5 months after treatment has ended? I recently returned to work as a teacher and felt dizzy and off balance. Can the fatigue reoccur slightly after returning to work?Lora Packel MS, PT, Assistant Professor of Physical Therapy at the University of the Sciences in Philadelphia,
Soy Products After Breast Cancer Dear OncoLink "Ask The Experts," Do you reccomend that women with active breast cancer stay away from soy products (not whole soy foods)?Karen Wagner MS, RD, LDN, Clinical dietitian specialist for the Abramson Cancer Center, responds:The issue of soy during treatment for breast cancer is certainly confusing and we don't have all the information
Phytochemicals Dear OncoLink "Ask The Experts," I am being treated for colon cancer with chemo. My friend told me I need phytochemicals. What are they and where do I get them?Karen Wagner MS, RD, LDN, Clinical dietitian specialist for the Abramson Cancer Center, responds:Thank you for the great question. Let me first explain what phytochemicals are, and then
Exercise Precautions During Cancer Treatment Dear OncoLink "Ask The Experts," I had stage 3 breast cancer, surgery and am now getting chemo. Surgeon has cleared me to resume working out- I always went to the gym at least 4x a week. I am sure I will need to do less and not as intense, but it will help me get a little normalcy back. My question is for precautions. Everyone mentions infection
Insulin Resistance and Breast Cancer Dear OncoLink "Ask The Experts," Is there any evidence that breast cancer is linked to higher insulin levels or insulin resistance? Should survivors of breast cancer eat like diabetics? Karen Wagner MS, RD, LDN, Clinical dietitian specialist for the Abramson Cancer Center, responds:These are great question. There is limited evidence that breast
Neuropathy During Chemotherapy Dear OncoLink "Ask The Experts," Is there medicine for neuropathy (nerve damage during chemo)? I am starting to have some in my thumb and index finger and don't want to interrupt chemo because of it. Gloria DiLullo, MSN, CRNP, OncoLink Medical Oncology Educational Content Specialist, responds: Yes, there are some medications that can help
Colon Cancer Screening Guidelines Dear OncoLink "Ask The Experts," How often do you recommend having a colonoscopy? I previously lived in NJ and the doctor there recommended every two years. I now live in NC and the doctor recommends every 5 years. Jenia Jenab-Wolcott, MD, PhD, Gastroenterologist at the Hospital of the University of Pennsylvania, responds: Recommendations for
Interpreting CEA Levels Dear OncoLink "Ask The Experts," I have stage 4 colon cancer. At the beginning of chemotherapy, my CEA number was 180. After two series of chemo, the CEA number is 2.0. I know it doesn't mean that I'm cancer free, but can you tell me what it really means? Does it mean remission? Typically, how long am I likely to stay at that level? (2.0)James M.
Stool Testing for Colon Cancer Screening Dear OncoLink "Ask The Experts," What is the latest on stool testing to screen for colon cancer? Is this ready for prime time yet? Jenia Jenab-Wolcott, MD, PhD, Gastroenterologist at the Hospital of the University of Pennsylvania, responds:Jill Stopfer, MS, CGC, Certified Genetic Counselor, responds:Several tests are available for colorectal
Caregiver Exposure to Chemotherapy Dear OncoLink "Ask The Experts," My mom has cancer and I just want to know if there are any effects of chemotherapy agents to us caregivers? Thank you.Jill Stopfer, MS, CGC, Certified Genetic Counselor, responds:Gloria DiLullo, MSN, CRNP, OncoLink Medical Oncology Educational Content Specialist, responds: As more and more chemotherapy is given in
Alternative Therapies for Treatment Dear OncoLink "Ask The Experts," Just recently my wife's brother, who is severely handicap and 48yrs old was diagnosed to have a Mass in his Colon. Where we can get help as far as non-Chemotherapeutic and more natural products to combat this if it turns out to be Cancer? I also wanted to know if there are certain drugs that promote the growth of
What Age to Stop Screening for CRC? Dear OncoLink "Ask The Experts," My 82 year old cousin is due for colonoscopy. The last one was 8 years ago. Her previous 2 colonoscopy procedures revealed precancerous polyps each time. There is no family history of colon cancer. She had a mastectomy 45 years ago. She has diabetes. Is a colonoscopy indicated at her age, or does the risk of
Restrictions With A Port Dear OncoLink "Ask The Experts," Can I run with the port in my chest? I ran 2 Marathons last year and I was a very active runner until I was diagonosed with stage 3c colon cancer. I have only had one Chemo session so far. Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:I see no reason why you cannot run with the port. My only
Colonoscopy After Polyps Dear OncoLink "Ask The Experts," I had 2 polyps found on colonoscopy that were removed. When do I need to have my next colonoscopy?Jenia Jenab-Wolcott, MD, PhD, Gastroenterologist at the Hospital of the University of Pennsylvania, responds: As you may know there are different types of colonic polyps. Some polyps (called adenomas) have the
Continuing Drug After Allergic Reaction Dear OncoLink "Ask The Experts," I have stage 3B rectal cancer. I am currently in the first chem/radiation session(5.5 weeks) Taking Oxaliplatin 1X week and Xeloda 5X week. I had an allergic reaction to the Oxaliplatin and the oncologist stopped it. Is there something I can take in place of oxaliplatin during the second (5 months) course of
PET Scans Following CRC Treatment Dear OncoLink "Ask The Experts," My father (60 year old male, reasonably healthy, diabetic) underwent a colon resection and removed a tumor from the rectosigmoid junction. His cancer is graded Stage IIIB and he got chemotherapy after. His follow up is with CT scans- Is this reliable? Would a PET scan be more sensitive? His doctors have indicated a
Cancer Caused By Exposures At Work Dear OncoLink "Ask The Experts," I think my cancer was caused by exposure to chemicals at work. What can I do about it?Rodney N. Warner, Staff Attorney at The Legal Clinic for the Disabled, Staff Attorney at The Legal Clinic for the Disabled, responds:If it is a work related exposure, you would fall under your state’s workers’ compensation system.
Can I Keep My Job? Dear OncoLink "Ask The Experts," I’ve just been diagnosed with cancer. Will I be able to keep my job?Rodney N. Warner, Staff Attorney at The Legal Clinic for the Disabled, Staff Attorney at The Legal Clinic for the Disabled, responds:You are covered under the Americans with Disabilities Act, if there are 15 or more employees. You may be covered by
Power of Attorney Dear OncoLink "Ask The Experts," If I want my son to be able to manage my financial accounts while I am undergoing treatments, is it best to put him as a joint owner of the accounts? Is there a temporary way to do that? William J. Wahl III, Financial Advisor at Rockwell Associates and Friend of OncoLink, responds: Depending on the types of
Pre-Planning Funeral Arrangements Dear OncoLink "Ask The Experts," Am I able to make arrangements to pay for a funeral while I am alive, so that should I pass, my children will not have to worry about that?William J. Wahl III, Financial Advisor at Rockwell Associates and Friend of OncoLink, responds: Many funeral homes offer advanced planning services, which allow you the
Considering Tax Implications in Financial Planning Dear OncoLink "Ask The Experts," I have terminal cancer and I want to be sure that my possessions and what little money I have goes to my only son with as little interference from Uncle Sam. Are there groups that help people with cancer make financial arrangements & decisions at discount cost?William J. Wahl III, Financial Advisor at Rockwell
Medication & Co-Pay Assistance Dear OncoLink "Ask The Experts," My oncologist prescribed chemotherapy “pills”. The medication is very expensive and my co pay is in the hundreds of dollars. Is there any financial assistance with co pays for medications? Tracy Lautenbach, MSW, LCSW, Social Worker in the Radiation Oncology Department at the Hospital of the University of
Do I Have To Tell My Employer I Have Cancer? Dear OncoLink "Ask The Experts," Do I have to tell my employer I have cancer?Rodney N. Warner, Staff Attorney at The Legal Clinic for the Disabled, Staff Attorney at The Legal Clinic for the Disabled, responds:This shouldn’t be a topic of discussion during an interview. The employer can ask if you can perform the essential functions of the job,
Expediting an EEOC Case Dear OncoLink "Ask The Experts," What can I do to expedite an EEOC case I have involving my former employer. I really think they are stalling...waiting for me to die!Rodney N. Warner, Staff Attorney at The Legal Clinic for the Disabled, Staff Attorney at The Legal Clinic for the Disabled, responds: I looked at the EEOC website, and the
Traveling for Treatment Dear OncoLink "Ask The Experts," I am going to need treatment and will need to travel a distance everyday from my home to the treatment center. Is there any financial assistance to defray the cost of travel? Tracy Lautenbach, MSW, LCSW, Social Worker in the Radiation Oncology Department at the Hospital of the University of Pennsylvania, responds:
Underinsured and Help With Treatment Costs Dear OncoLink "Ask The Experts," I have Medicare as my primary insurer but no supplemental coverage. I recently completed treatment. I am responsible for 20 percent of the cost of treatment and or hospitalization. What are my options for help with the bills I have been receiving? Tracy Lautenbach, MSW, LCSW, Social Worker in the Radiation
Someone To Care For My Children Dear OncoLink "Ask The Experts," I’m a single parent being treated for cancer. How do I make arrangements for someone to care for my children?Rodney N. Warner, Staff Attorney at The Legal Clinic for the Disabled, Staff Attorney at The Legal Clinic for the Disabled, responds:Many states (PA and NJ included) have standby guardianship laws. They
Tapping into Life Insurance Value Dear OncoLink "Ask The Experts," I have stage 4 lung cancer and my health insurance is not too good. the bills are adding up and I fear that my wife could lose our home by the time I finish treatment or die. I read that I could "tap into" my insurance policy for money that my wife and I need to keep her in our home. Can you tell me more about
FMLA Dear OncoLink "Ask The Experts," How much time am I allowed to take off from work for treatment? Rodney N. Warner, Staff Attorney at The Legal Clinic for the Disabled, Staff Attorney at The Legal Clinic for the Disabled, responds:The federal Family Medical Leave Act covers employers with 50 or more employees. You may live in a state where a similar
SPF of a T-Shirt Dear OncoLink "Ask The Experts," Does a t-shirt (long sleeve) block the sun's rays?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Studies on the sun protection offered by summer clothing found that almost half provided less than the equivalent of an SPF of 30. A typical white t-shirt has a sun protection factor around 7, and
Understanding SPF Dear OncoLink "Ask The Experts," Is an SPF of 75 really any better than 50- I have heard it's not? Christopher Miller, MD, Assistant Professor of Dermatology at the Abramson Cancer Center of the University of Pennsylvania, responds: SPF numbers can be confusing. "SPF" stands for Sun Protection Factor. If the sunscreen is applied
Safety of Tanning Booths Dear OncoLink "Ask The Experts," Really- how unsafe are tanning booths? If they really caused cancer wouldn't they be regulated better?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Tanning beds are so unsafe, the US Department of Health and Human Services and other groups have declared tanning beds and sun lamps as known
Risk to Self Tanner Lotions? Dear OncoLink "Ask The Experts," Are their any risks in using spray tans or self-tanner lotions? Christopher Miller, MD, Assistant Professor of Dermatology at the Abramson Cancer Center of the University of Pennsylvania, responds: Self tanners are safe to use. You should look for self tanners whose main ingredient is DHA, or dihydroxyacetone.
Should people with melanoma stay out of the sun at all times? Dear OncoLink "Ask The Experts," Should people with melanoma stay out of the sun at all times? Christopher Miller, MD, Assistant Professor of Dermatology at the Abramson Cancer Center of the University of Pennsylvania, responds: It is impossible for any of us to stay out of the sun all of the time. Therefore, we recommend a more practical
Spray on Sunscreen Dear OncoLink "Ask The Experts," Does the spray on sunscreen work as well as a lotion?Christopher Miller, MD, Assistant Professor of Dermatology at the Abramson Cancer Center of the University of Pennsylvania, responds: There are currently many formulations of sunscreen, such as sprays and lotions. The completeness of application is more
Life Insurance After Cancer Can I still get life insurance if I am a cancer survivor?Gloria DiLullo, MSN, CRNP, OncoLink Medical Oncology Educational Content Specialist, responds: There are two great and very detailed articles available on OncoLink.org. One is entitled: "What Cancer Survivors Should Know About Obtaining Life Insurance" and the other, which is
High Cholesterol After Treatment Dear OncoLink "Ask The Experts," Can Chemo and, or Radiation cause a hike in your Cholesterol? On one of my blood test it was 553... Now on meds.Christine Hill-Kayser, MD, Assistant Chief Resident in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:Some chemotherapy drugs can indeed cause increase
Balancing Vitamin D Needs and Sun Exposure Dear OncoLink "Ask The Experts," How do you balance getting enough vitamin D if you are constantly wearing sun screen? Is it OK to spend some time in the sun without sun screen?Christopher J. Miller, MD, Assistant Professor of Dermatology at the Abramson Cancer Center of the University of Pennsylvania, responds:Vitamin D deficiency is a hot topic
Ingredients to Look for in Sunscreen Dear OncoLink "Ask The Experts," Is there a specific ingredient to look for in sunscreen that makes it better?Christopher J. Miller, MD, Assistant Professor of Dermatology at the Abramson Cancer Center of the University of Pennsylvania, responds:There are currently 17 FDA approved ingredients for sunscreen in the United States. Some ingredients
Expiration of Sunscreen Dear OncoLink "Ask The Experts," I am wondering how long the SPF value lasts in the tube of sunscreen! I do tend to save it from year to year. Thank you.Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Look on the bottle for an expiration date and don’t use after that. The FDA requires that the product be stable at the
Survivorship Resources Dear OncoLink "Ask The Experts," What are some good resources for cancer survivors?Gloria DiLullo, MSN, CRNP, OncoLink Medical Oncology Educational Content Specialist, responds: The Oncolink website has a page of links with useful resources, such as conferences, general information, news, reviews of books and videos specific to survivorship,
Fear of Recurrence Dear OncoLink "Ask The Experts," I am finished with treatment and currently cancer-free. Yet I am fearful that the cancer will comeback. What can I do to lessen my anxiety?Tracy Lautenbach, MSW, LCSW, Social Worker in the Radiation Oncology Department at the Hospital of the University of Pennsylvania, responds:It is perfectly understandable to have
How Much Sunscreen to Use? Dear OncoLink "Ask The Experts," How much sunscreen should you use? And how often do you need to apply it?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Experts say one ounce (enough to fill a shot glass) is enough to cover exposed areas. Sunscreen should be applied 15-30 minutes BEFORE you go outside- not when you get to
Moving On After Treatment Dear OncoLink "Ask The Experts," What should I do to take care of myself now that I am done with cancer treatments and "cancer-free?"Rodney N. Warner, Staff Attorney at The Legal Clinic for the Disabled, Staff Attorney at The Legal Clinic for the Disabled, responds:Enjoy yourself. Veggies, sun screen and medical tests are all well and
Returning to Work Dear OncoLink "Ask The Experts," Now that I am done with cancer treatment, I have a lot of financial concerns and am concerned about returning to work. Can you help me?Rodney N. Warner, Staff Attorney at The Legal Clinic for the Disabled, Staff Attorney at The Legal Clinic for the Disabled, responds:This is a double-barreled can of worms you're
Feeling "Back to Normal" Dear OncoLink "Ask The Experts," Friends and family say "it must be nice to be getting back to normal," but I don't really feel "normal" after surviving cancer and treatment. Do others experience these feelings?Rodney N. Warner, JD, Staff Attorney at The Legal Clinic for the Disabled, responds:As they say in Wisconsin, you
Osteoporosis Risk Dear OncoLink "Ask The Experts," My friend told me I was at a greater risk to get osteoporosis because I had cancer, is this true? If so, what should I do about it?Christine Hill-Kayser, MD, Assistant Chief Resident in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:Risk of osteoporosis can be a real
Should people with melanoma stay out of the sun at all times? Dear OncoLink "Ask The Experts," Should people with melanoma stay out of the sun at all times?Christopher J. Miller, MD, Assistant Professor of Dermatology at the Abramson Cancer Center of the University of Pennsylvania, responds:It is impossible for any of us to stay out of the sun all of the time. Therefore, we recommend a more practical
"Base Tan" in a Tanning Booth Dear OncoLink "Ask The Experts," Does a tanning booth give you a base tan so you won't burn in the sun?Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:Absolutely not! You can still burn even after getting tan in a tanning bed. Tanning bed companies promote their products as using UVA rays and falsely say that this type of
Telling a Prospective Employer About Cancer Dear OncoLink "Ask The Experts," I am graduating college this December and starting to job hunt. I finished breast cancer treatment in January. What are my rights or what do I have to tell prospective employers about my cancer or what can they ask?Rodney N. Warner, JD, Staff Attorney at The Legal Clinic for the Disabled, responds:You don’t have to
Employer Says I Shouldn’t Work During Treatment Dear OncoLink "Ask The Experts," I am 32 years old and was diagnosed with rectal cancer. I am going to need surgery, radiation, and chemo. My chemo has to be given 24 hours a day by a pump that I wear like a fanny pack. I am a flight attendant for a major airline and they are saying that they would prefer I did not fly with the pump. I want to keep
Working Long Hours During Treatment Dear OncoLink "Ask The Experts," I am a lawyer (out of college only 3 years)- my job demands lots of long and late hours. I recently started treatment for Hodgkin’s disease. I don’t know where to start- do I tell people at work? How can I keep up the schedule? I don’t want to jeopardize my career. Any suggestions?Rodney N. Warner, JD, Staff
Friends Stop Coming Around Dear OncoLink "Ask The Experts," My friends don’t come around much since my diagnosis. I think they probably don’t know what to say but I just want them to hang out like we used to. How can I get them to understand I am still the same old Brianna?Helen L. Coons, PhD, ABPP, Clinical Health Psychologist, responds: It sure is hard when friends stop
Fertility Preservation Options Dear OncoLink "Ask The Experts," I am 32 and just diagnosed with rectal cancer. I am going to need surgery, radiation, and chemo. My husband and I have only been married for 3 months and don’t have any kids. What are the options for me to possibly preserve my ovaries? My doctor says the chemo (5FU) probably will not ruin my fertility, but the
Sperm Banking Dear OncoLink "Ask The Experts," Recently diagnosed with testicular cancer and need to have surgery to remove my right testicle. doc says it probably will not effect my sperm count, but I am still worried. Can I donate sperm? He did not even mention it. What are the procedures for that? Is it expensive and does insurance cover it?Clarisa Gracia,
Am I Fertile? Dear OncoLink "Ask The Experts," I was treated for cancer when I was 9 years old and I am 26 now. I am curious about my fertility- can I have a baby? I’m not at that point in a relationship, but I want to know before getting to that point.Clarisa Gracia, MD, Oncofertility specialist at the University of Pennsylvania Health System, responds: The
Trouble Concentrating & Studying After Cancer Dear OncoLink "Ask The Experts," I just started my freshman year in college. I was treated for leukemia 2 years ago. I am having trouble studying and concentrating. I wonder if this is because of all my treatments. Do you have any suggestions of how I could find out more about this and get help? Rodney N. Warner, JD, Staff Attorney at The Legal
YAs and Parent’s Health Insurance Dear OncoLink "Ask The Experts," How does the health care reform affect how long I can stay on my parent’s insurance? I am in college, but probably have to drop out this semester cause the chemo is kicking my butt. Really worried about losing coverage- I know my parents are really stressed about it.Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse
Oral Cancer & HPV Dear OncoLink "Ask The Experts," I was just diagnosed with cancer at the base of my tongue. I am a 37 year old woman. I looked it up on the Internet and it says the risk factors are smoking and drinking. I've never smoked and I only drink occasionally. My doctor says this may be a sexually transmitted disease. Is that true? How could that
Body Image Concerns for Men Dear OncoLink "Ask The Experts," I am 20 was diagnosed last year with testicular cancer. I thought it was a groin pull from wrestling so I waited months before I told anyone. I had to have surgery, radiation & chemo. I am one year out of treatment. I have a new girlfriend who is awesome! I have told her about my cancer stuff and she says
Pregnant with Breast Cancer Dear OncoLink "Ask The Experts," I'm not sure whether I have breast cancer or not, and I also just found out I'm pregnant. Is this going to affect my baby in any way if it happens that I have breast cancer? Carolyn Vachani, RN, MSN, AOCN, OncoLink Nurse Educator, responds: Unfortunately, breast cancer is found in about 1 in every 3000
Testing Pre-Mastectomy Dear OncoLink "Ask The Experts," I will have a double mastectomy next week. Someone told me I should get a bone density test and a range of motion (for arms) test. Is that correct? Kathryn Schmitz, PhD, MPH, cancer rehabilitation researcher at the Abramson Cancer Center of the University of Pennsylvania, responds: I would very much agree
Soy and Wine After Breast Cancer Dear OncoLink "Ask The Experts," I am so confused when reading about soy and if this should be avoided when being treated for breast cancer. Also- is an occasional glass of wine ok? So many conflicting points of view in my reading! Karen Wagner, MS, RD, LDN, Registered Dietitian at the Abramson Cancer Center of the University of Pennsylvania,
Lung Cancer in Non-Smokers Dear OncoLink "Ask The Experts," Do we know why people who didn't smoke get lung cancer? Jared Weiss, MD Medical Oncologist & Assistant Professor at University of North Carolina's Lineberger Cancer Center, responds: This is a great question because it gets to the very nature of what cancer is. One of my patients once told me that she
So, Did You Smoke? Dear OncoLink "Ask The Experts," I was diagnosed earlier this year with lung cancer. I never smoked, but that is always the first thing people ask me. It makes me want to punch them- how do people handle that question- whether you smoked or not!? Donna Lee Lista, Lung Cancer Survivor, Advocate and OncoLink Blogger, responds: Hi, I am also a
Results from Lung Cancer Screening Trial Dear OncoLink "Ask The Experts," Results from Lung Cancer Screening Trial I saw a news story last week about the lung cancer screening study. Does that mean those of us who are/were heavy smokers should be getting screened now? Anil Vachani, MD, Attending Physician at the University of Pennsylvania Medical Center, responds:The news story last week
Caregiving From a Distance Dear OncoLink "Ask The Experts," My mom is being treated in Pennsylvania and I live in Texas. How can I be a good caregiver from so far away? Tracy Lautenbach, MSW, LCSW, Social Worker at the University of Pennsylvania, responds: Friends and family who live a distance from a loved one going through treatments for lung cancer often find it
Getting Back to Your Old Self Dear OncoLink "Ask The Experts," I recently finished surgery and chemo for nscl cancer. My family seems to think I should be back to my old self- I am a stay at home mom, but that has a lot of responsibility- cooking, cleaning, shopping, etc. I just don't feel ready or up to it. Am I unusual- do people really get right back to their old self?Donna
Working During Treatment for Lung Cancer Dear OncoLink "Ask The Experts," I was just diagnosed with stage 3 lung cancer. i feel great, but have to start chemo next week. can I keep working? I am the breadwinner for the family and not working will just add to everyone's stress. Rebecca Nellis, Director of Programs at Cancer and Careers (www.cancerandcareers.org), responds: There is
Checking Blood Counts During Radiation Dear OncoLink "Ask The Experts," Is it normal to undergo radiation treatment 15 of them with out any follow up blood work during those treatments? John Christodouleas, MD, Radiation Oncologist and Assistant Professor at the University of Pennsylvania, responds: Whether or not to get blood work during a short course of radiation
Can I Stop Chemo? Dear OncoLink "Ask The Experts," My mom is 76 and getting chemo for lung cancer. She is so sad, crys daily about how bad she feels from the drugs- hair loss, nausea, exhausted. She just wants to go out and enjoy life, but is too physically exhausted. The chemo was to buy her some time, but I am feeling like it is making her feel worse. Can you
Side Effects of Whole Brain Radiation Dear OncoLink "Ask The Experts," My husband's doctor suggested radiation to the brain to prevent tumors from growing there. Does that work and are there long term problems to getting brain radiation?John Christodouleas, MD, Radiation Oncologist and Assistant Professor at the University of Pennsylvania, responds: Regarding your question about
When to Start Hospice? Dear OncoLink "Ask The Experts," My Mother is 75 and has been diagnosed with stage 4 lung cancer in August that’s moved and broke her hip. That’s how they found it. We decided against Chemo and did 10 rounds of radiation. The radiologist gave her less than a year. 3 months later she is feeling better than she has in a while. She also has
Small Nodule on CT Scan Dear OncoLink "Ask The Experts," I have a ct scan once a year because of asbestos exposure years ago. Earlier this month a small spot- 2mm - showed up. My lung doctor wants to wait six months and take another ct scan. I am 60 years old and in fair shape. I did smoke but now have quit. What would you do?Anil Vachani, MD, Pulmonologist &
Working During Cancer Treatment Question I have cervical cancer and will need weekly chemotherapy and daily radiation for six weeks. I am wondering if I should take time off from for the entire treatment course or try to work part time. Can you please give me some advice? Answer Tracy Lautenbach, MSW, LCSW, OSW-C, Oncology Social Worker at Penn Medicine, responds: There are
Coping with Loss During the Holidays Dear OncoLink "Ask The Experts," My sister passed away a few months ago and I was her caregiver. She was only 38 years old. I am devastated still and do not know how to cope with the Holiday season that is approaching.Tracy Lautenbach, MSW, LCSW, Social Worker in the Radiation Oncology Department at the Hospital of the University of
Financial Pressures of the Holidays Dear OncoLink "Ask The Experts," How do I deal with financial pressures associated with the holidays - when I’m already broke from my cancer treatment?Christina Bach, MSW, LCSW, Social Worker at the University of Pennsylvania, responds: Get creative and put less emphasis on the amount spent on gifts as being a sign of how much you care for
Caregiving From a Distance: Finding Local Resources Dear OncoLink "Ask The Experts," I have a relative in another city that is coping with chemo treatments and having a very hard time. We can't be there to support her but want to somehow help her maintain her nutrition or her home. Are there food delivery services, cleaning services or other helpful support options available? We can pay for
Just Not "Up" for the Holidays Dear OncoLink "Ask The Experts," I am the caregiver for my husband who has Lung cancer. I have no interest in participating in the Christmas Holidays. I know this is probably a disappointment to the children but I just don't care about shopping and decorating. What can I say to tell them how I am feeling?Tracy Lautenbach, MSW, LCSW, Social
Costs for Getting to Treatment Dear OncoLink "Ask The Experts," Money is so tight and I am traveling quite a distance for treatments. Is there anybody who helps with gas for travel? Gas is so expensive right now!Christina Bach, MSW, LCSW, Social Worker at the University of Pennsylvania, responds: The American Cancer Society (in Philadelphia and our 5 surrounding
Training to Prevent Lymphedema: Starting Slow? Dear OncoLink "Ask The Experts," I was not very active before my breast cancer diagnosis. I want to try to help myself now. Is there a way to "start slow"? Or...is there an exercise program you recommend? Kathryn Schmitz, PhD, MPH, Cancer Rehabilitation Researcher at the Abramson Cancer Center of the University of Pennsylvania,
Vitamin C Dear OncoLink "Ask The Experts," Is vitamin C good to cure cancer or take during a lot of during treatment?Karen Wagner MS, RD, LDN, Clinical dietitian specialist for the Abramson Cancer Center, responds:Vitamin C use during and after cancer treatment is currently being researched in a number of ways. At this point Vitamin C does not appear to cure
Lung Cancer Support Online Dear OncoLink "Ask The Experts," Where can I find online support for people with lung cancer?Tracy Lautenbach, MSW, LCSW, Social Worker in the Radiation Oncology Department at the Hospital of the University of Pennsylvania, responds:There are a variety of helpful resources for people with lung cancer. The American Cancer Society, American Lung
Training to Prevent Lymphedema with a PT? Dear OncoLink "Ask The Experts," I had surgery (including lymph node dissection) and radiation for breast cancer 8 years ago. I am doing great, but always worry about developing lymphedema. Is it too late for me to prevent it through weight training? And can I start training with the help of a personal trainer or do I have to see a PT?
Training to Prevent Lymphedema: Sentinel Node Biopsy Dear OncoLink "Ask The Experts," I had a sentinel node biopsy- how high is my risk of lymphedema and would weight training help me?Kathryn Schmitz, PhD, MPH, cancer rehabilitation researcher at the Abramson Cancer Center of the University of Pennsylvania, responds: The risk for lymphedema is linear in relation to the # of nodes removed. That means
Lung Cancer Recurrence Dear OncoLink "Ask The Experts," My mom had small cell lung cancer last fall and this late summer she came down with a brain tumor. The doctors tried radiation to the brain. This seemed to lessen the brain tumor but she has been diagnosed with lung cancer again. She is losing weight, no appetite and is coughing alot. Doctors have not given us a
Young Adult Online Resources Dear OncoLink "Ask The Experts," What are some good resources for young adults online?Tracy Lautenbach, MSW, LCSW, Social Worker in the Radiation Oncology Department at the Hospital of the University of Pennsylvania, responds:There are a variety of great websites for support organizations, scholarships and financial aid, online forums and chat
Shark Cartilage Dear OncoLink "Ask The Experts," Can you tell me if shark cartilage has any effects on tumors? I have read some articles stating that it does, but they weren't written by an oncologist. James M. Metz, MD, Editor-in-Chief of OncoLink and Assistant Professor of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:Thanks for
Nutritional Supplements During Cancer Therapy Dear OncoLink "Ask The Experts," Are there any herbals or other nutritional supplements that should be avoided during chemo/radiation? Do any help?Karen Wagner MS, RD, LDN, Clinical dietitian specialist for the Abramson Cancer Center, responds:The area of herbal medicine use during cancer treatment is exciting, but still very understudied.
Acupuncture When Blood Counts are Low Dear OncoLink "Ask The Experts," Can I get acupuncture if I am neutropenic or have low platelets? Jun Mao, MD, MSCE, Assistant Professor of Family Medicine and Community Health at Penn Medicine, responds: Yes, in general it is OK. It is better to work with an acupuncturist who has experience treating cancer patients. Please tell your
Reiki in Cancer Care Dear OncoLink "Ask The Experts," What is Reiki and how can it help with cancer treatment? Kimberly Fleisher, RMT, M.S.Ed, Reiki Practitioner and Teacher at The Reiki School, responds: Reiki is a practice that comes from Japan and is primarily facilitated through gentle touch. There is nothing to ingest, no needles, and no physical manipulation,
Special Diet During Treatment? Dear OncoLink "Ask The Experts," Should I follow a special diet during or after treatment to make my treatment work better or prevent cancer from coming back? Karen Wagner MS, RD, LDN, Clinical dietitian specialist for the Abramson Cancer Center, responds: Again, please do try to speak with your doctor first on any special instructions
Supplements For Hot Flashes Dear OncoLink "Ask The Experts," Are there any supplement suggestions for hot flashes for ER+ cancers?Jun Mao, MD, MSCE, Assistant Professor of Family Medicine and Community Health at Penn Medicine, responds: Good question. We ran a clinical trial of black cohosh for hot flashes and found it did not help. These results were similar to a study
Ginger & Sea Bands For Nausea Dear OncoLink "Ask The Experts," Can massage be done during your chemo treatment? Will "sea bands" or ginger gum help with nausea?Jun Mao, MD, MSCE, Assistant Professor of Family Medicine and Community Health at Penn Medicine, responds: You can definitely incorporate massage during treatment and there are some studies to suggest massage helps
Massage After Lymph Node Dissection Dear OncoLink "Ask The Experts," Can I get a massage if I had lymph node dissection or have lymphedema?Andrea Richtel-Branas, MSE, MPT, Lead Therapist at the Abramson Cancer Center of the University of Pennsylvania, responds: Massage itself is not indicated to treat lymphedema. Deep tissue massage in the quadrant where someone had an AND
Activity Restrictions Prior To PSA Testing Dear OncoLink "Ask The Experts," What steps should be taken prior to a PSA test? More specifically, are there any restrictions or recommendations on food or activity? Thank you.Alan J. Wein, MD, Professor and Chair of the Division of Urology at the University of Pennsylvania School of Medicine, responds:There are no specific restrictions or
Imagery and Cancer Dear OncoLink "Ask The Experts," I have heard of meditation and visualization as proven to help fight the cancer cells. Is there any truth to this and can you please explain how the visualization could possibly work? Thank you. Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:There are no scientific studies to support
Is Prostate Cancer More Common in African-American Males? Dear OncoLink "Ask The Experts," Is prostate cancer more prevalent in African American males rather than Caucasian males?Neha Vapiwala , MD, Senior Editor of OncoLink and Chief Resident in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:Looking at data over the 10-year period from 1997-2007,
Normal PSA Zero? Dear OncoLink "Ask The Experts," Is a normal PSA result zero? John Christodouleas, MD, Assistant Professor of Radiation Oncology at Penn Medicine, responds: What we consider "normal" depends on a patient's prostate size, age and prior treatments. A patient who has never had surgery to remove his prostate or is not on androgen suppression
Can I Have Surgery After Radiation? Dear OncoLink "Ask The Experts," I have heard that if I choose radiation therapy for prostate cancer treatment that I could not have surgery later if the cancer recurs. Why not?Alan J. Wein, MD, Professor and Chair of the Division of Urology at the University of Pennsylvania School of Medicine, responds:You can have surgery after radiation therapy.
Can I Ask About A Surgeon’s Personal Complication Rates? Dear OncoLink "Ask The Experts," Is it okay to ask your surgeon what their rates of complications are- is that something they know off hand and should be willing to share? Daniel Eun, MD, Director of Robotic and Minimally Invasive Urologic Oncology and Reconstruction at?PENN Urology at Pennsylvania Hospital, responds: Absolutely, and
PSA After Radiation? Dear OncoLink "Ask The Experts," I had radiation therapy for prostate cancer- finished 4 weeks ago. My psa was just checked yesterday- should it be 0?Neha Vapiwala , MD, Senior Editor of OncoLink and Chief Resident in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:The answer is that it depends. If
ED After Surgery Dear OncoLink "Ask The Experts," It has been a year after my husband's surgery, he still has sexual difficulty is this normal?Alan J. Wein, MD, Professor and Chair of the Division of Urology at the University of Pennsylvania School of Medicine, responds:It could take up to two years for erectile function to return, in the meantime, you might
Seeds Or IMRT? Dear OncoLink "Ask The Experts," I am going to have radiation for prostate cancer. I have been offered seeds and IMRT. Is one better than the other?John Christodouleas, MD, Assistant Professor of Radiation Oncology at Penn Medicine, responds: Unfortunately, there is no simple answer to the question: are seeds or IMRT better? The answer depends on
Gleason Differs On Biopsy & Pathology Report Dear OncoLink "Ask The Experts," My husband had prostate removed and the final gleason score was higher than the biopsy had showed. Is that common? It makes you think the biopsy isn’t really reliable.Alan J. Wein, MD, Professor and Chair of the Division of Urology at the University of Pennsylvania School of Medicine, responds:The biopsy represents
When To Start PSA Screening? Dear OncoLink "Ask The Experts," If I have no family history of cancer of any kind - do I really need to have a PSA? And at what age?Alan J. Wein, MD, Professor and Chair of the Division of Urology at the University of Pennsylvania School of Medicine, responds:There is some disagreement about this. My felling is age 50, age 40 for African American
Treatment Recommendations By Age? Dear OncoLink "Ask The Experts," Treatment recommendations for prostate cancer (of similar grades) seem to vary by age. Is that due to otherwise differing life expectancies or because the cancer cells are expected to grow faster the younger one is? Some other reason? (I am a recently diagnosed 55 yr old with a low-grade cancer).Alan J. Wein, MD,
What Is Free PSA? Dear OncoLink "Ask The Experts," What is the free PSA test and how does that differ from regular PSA test?Neha Vapiwala , MD, Senior Editor of OncoLink and Chief Resident in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:So prostate specific antigen (PSA) circulates in the blood in two forms: free
Robotic Versus Open Prostatectomy Dear OncoLink "Ask The Experts," I am deciding between regular prostatectomy and robotic version. What do you see as the pros and cons in making this decision?Daniel Eun MD, Director of Robotic and Minimally Invasive Urologic Oncology and Reconstruction at PENN Urology at Pennsylvania Hospital, responds: I always tell patients that regardless of
What Does the Prostate Do? Dear OncoLink "Ask The Experts," Does the prostate do anything important? Or is it like the appendix that you won’t miss it after it is removed?Neha Vapiwala , MD, Senior Editor of OncoLink and Chief Resident in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:The prostate is an organ that has
Sigmoidoscopy Versus Colonoscopy Dear OncoLink "Ask The Experts," Is a sigmoidoscopy the same as colonoscopy? If not, which is better? David Metz, MD, Professor of Gastroenterology at Penn Medicine, responds: A colonoscopy examines the entire colon from the rectum to the cecum including the rectum, sigmoid colon, descending colon transverse colon, ascending colon and cecum.
Never Had Colonoscopy Makes Risk Higher? Dear OncoLink "Ask The Experts," My mother has never had a colonoscopy and she is 58 years old. I understand she should have had one at age 50. Does this put her at higher risk to develop colon cancer? David Metz, MD, Professor of Gastroenterology at Penn Medicine, responds: Her risk for colorectal cancer is not higher because she has not had a
Colon Cancer Risk With No Family History Dear OncoLink "Ask The Experts," I heard if I do not have anyone in my family who has had colon cancer that I don't need to do the screening. Is that true? Carmen E. Guerra, M.D., M.S., Associate Professor of Medicine at Penn Medicine, responds: Even if you do not have a family history of colon or rectal cancer, you have a lifetime risk of
Colonoscopy Under 50 Years Old Dear OncoLink "Ask The Experts," I have several family members who have had colon cancer. I want to have screening (I am 35) but my insurance company doesn't want to pay for it. Any advice? Carmen E. Guerra, M.D., M.S., Associate Professor of Medicine at Penn Medicine, responds: Technically, screening colonoscopy are for patients who are over
Familial Colorectal Cancer Dear OncoLink "Ask The Experts," I was diagnosed with colon cancer at age 36, but have no family history of it. I am concerned for my 2 small children. When should my children start screening for colon cancer? Carmen E. Guerra, M.D., M.S., Associate Professor of Medicine at Penn Medicine, responds: Your young age at diagnosis is concerning for
How does having colitis affect colon cancer screening? Dear OncoLink "Ask The Experts," How does having colitis affect colon cancer screening?David Metz, MD, Professor of Gastroenterology at Penn Medicine, responds: People with long-standing colitis (especially ulcerative colitis but also Crohn's disease if it affects the colon) are at higher risk for colorectal cancer that develops after
Men And Colon Cancer Risk Dear OncoLink "Ask The Experts," Are men more likely to have colon cancer than women?David Metz, MD, Professor of Gastroenterology at Penn Medicine, responds: Yes, slightly higher. Please look at this link from the Centers for Disease Control showing the distribution according to gender and ethnicity. Note that the reason there is a
Red Meat & Colon Cancer Risk Dear OncoLink "Ask The Experts," Is it true that eating a lot of red meat causes colon cancer?David Metz, MD, Professor of Gastroenterology at Penn Medicine, responds: Eating a Western diet which includes a high proportion of red meat is probably associated with a higher incidence of colorectal cancer than not. However, it is difficult to
Adenomatous Polyps Dear OncoLink "Ask The Experts," My 62-year-old father had adenomatous polyps on a recent colonoscopy. Does this mean he has colon cancer?Carmen E. Guerra, M.D., M.S., Associate Professor of Medicine at Penn Medicine, responds: If your father had adenomatous polyps on a recent colonoscopy, it does not mean he has colon cancer. However, his risk of
Ride Home After Colonoscopy Dear OncoLink "Ask The Experts," Are there programs for people who need transportation home following a colonoscopy?Carmen E. Guerra, M.D., M.S., Associate Professor of Medicine at Penn Medicine, responds: Since a mild sedative is given to patients who undergo colonoscopy, having an escort to take a patient home after colonoscopy is necessary for
Risk Factors for Melanoma Dear OncoLink "Ask The Experts," What are the biggest risk factors for developing melanoma? Christopher Miller, MD, Assistant Professor in Dermatology and Director of the Moh's Surgery Program at Penn Medicine, responds: Multiple factors increase the risk for melanoma, some of which are in your control and some of which are out of your
BRAF Gene in Melanoma Dear OncoLink "Ask The Experts," I've seen in the media recently the new drug that targets the BRAF gene in melanoma and how it is having unprecedented success for this patient population. Can you talk to what exactly this means and how patients can find out if they are eligible for these clinical trials? Leslie A. Fecher, MD, Assistant
Recovery Time From Moh's Surgery Dear OncoLink "Ask The Experts," What is involved in the recovery from Mohs Surgery? How long until I can go back to work? Rachel Woods, BSN, RN, Nurse in Mohs micrographic surgery at Penn Medicine, responds: Mohs surgery is under local anesthesia and has minimal down time. Most people take a couple of days off of work but some take none
How Do You Perform a Skin Exam? Dear OncoLink "Ask The Experts," I know regular skin exams are important, but are there any "instructions" on how to do one? Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds: When checking your skin, you want to examine your entire body, as skin cancer can occur anywhere- even in areas not exposed to sun. It can be
Protection After Melanoma Dear OncoLink "Ask The Experts," How do I protect myself against the sun if I already had skin cancer? Rachel Woods, BSN, RN, Nurse in Moh's micrographic surgery at Penn Medicine, responds: Sun safety is always a concern. Think of sunscreen as your last line of defense. Cover up with clothing as much as possible and seek shade in prime
Vigilant Sun Protection and Still Got Melanoma Dear OncoLink "Ask The Experts," I have been very vigilant about sun protection for over 20 years. Why did I develop skin cancer now after I have stopped tanning so long ago?Rachel Woods, BSN, RN, Nurse in Moh's micrographic surgery at Penn Medicine, responds: That is a great question that many people ask. Sun damage incurred in your younger years
Moles That Have Never Seen the Sun Dear OncoLink "Ask The Experts," I have a mole in a place that has "never seen the sun". It has been there as long as I can remember. Lately it has gotten slightly larger. Should I be worried? I mean...I am confused as to why a mole that has never been exposed to sunlight can become a cancer?Christopher Miller, MD, Assistant Professor in
Can Non-Melanoma Turn Into Melanoma? Dear OncoLink "Ask The Experts," If I have non-melanoma skin cancer, will I get melanoma someday or can it turn into melanoma? Christopher Miller, MD, Assistant Professor in Dermatology and Director of the Moh's Surgery Program at Penn Medicine, responds: Non melanoma skin cancers (eg. basal cell and squamous cell cancers) are much more common
What SPF and Ingredients to Use? Dear OncoLink "Ask The Experts," What is the recommended SPF in sunscreens by dermatologists to avoid melanoma? Do you recommend certain brands?Rachel Woods, BSN, RN, Nurse in Moh’s micrographic surgery at Penn Medicine, responds: The American Academy of Dermatologists recommend no less than SPF 30. Make sure it is broad spectrum (covers UVA and
Risk For Darker Skinned People Dear OncoLink "Ask The Experts," What is the risk of melanoma for darker skinned people/African Americans? I've heard they have to look for melanoma on palms of hands/feet etc? Rachel Woods, BSN, RN, Nurse in Moh’s micrographic surgery at Penn Medicine, responds: Darker skinned individuals have a lower innate risk but are not immune. Bob Marley
Toddlers & Sun Screen Dear OncoLink "Ask The Experts," My pre-schooler spends a bit of time on the playground in the spring. I don't send her to school wearing sunscreen. Should I?Rachel Woods, BSN, RN, Nurse in Mohs micrographic surgery at Penn Medicine, responds: It is recommended that sunscreen use begins as early as 6 months of age. For children there are many
Skin Cancer After Radiation Treatment Dear OncoLink "Ask The Experts," Will radiation treatments for other cancers give me skin cancer?Suzanne McGettigan, MSN, CRNP, Oncology Nurse Practitioner at Penn Medicine, responds: Thanks for your question. Radiation can increase your risk for skin cancers in the area that received radiation. The most common types of skin cancers seen are
Skin Cancer Come Back In The Same Place? Dear OncoLink "Ask The Experts," Does skin cancer come back in the same place?Christopher Miller, MD, Assistant Professor in Dermatology and Director of the Moh's Surgery Program at Penn Medicine, responds: Skin cancer can grow back in the same place, if the original surgery failed to remove it all. The risk that the original surgery will fail to
Past Melanoma, Could I Develop Others? Dear OncoLink "Ask The Experts," If I have a melanoma lesion removed, could others develop?Christopher Miller, MD, Assistant Professor in Dermatology and Director of the Moh's Surgery Program at Penn Medicine, responds: About 11% of people who have a melanoma have a second melanoma diagnosed within the next 2 years after their diagnosis. The
Sun-Safe Clothing Dear OncoLink "Ask The Experts," Is "sun-safe" clothing necessary to protect you from the sun? In other words, can one just wear clothing that protects the skin (i.e long sleeved shirts) or should one look for clothing that is made specifically to protect the skin?Carolyn Vachani, RN, MSN, AOCN, OncoLink’s Nurse Educator, responds: If you want
CAM Makes Me More Anxious? Dear OncoLink "Ask The Experts," I have such a hard time trying to relax and feel that many complementary therapies, like guided imaginary, meditation, mindfulness, only make me more anxious. It seems like more quiet, makes my mind race more. How can I overcome this?Wayne Mylin, Dipl. ABT (NCCAOM), AOBTA-CP is an Asian Bodywork Therapist
Can CAM Treat Cancer? Dear OncoLink "Ask The Experts," Are CAM treatments to help with side effects or can they also help treat your cancer?Tony Meadows PhD MT-BC FAMI LPC is Director of Music Therapy at Immaculata University and Music Therapist at the Joan Karnell Cancer Center at Pennsylvania Hospital, responds: There are two different schools of thought. One
Avoid Certain Yoga Poses? Dear OncoLink "Ask The Experts," Should I avoid certain types of yoga moves if I had surgery for breast cancer in the past?Kathryn Schmitz, PhD, Penn Medicine researcher who specializes in the role of physical activity in lymphedema development and prevention, responds: Yoga moves that ask you to place any of your weight on your hands or
Does Massage Help Relieve Pain? Does Massage Help Relieve Pain? Can massage help to relieve pain from cancer? Wayne Mylin, Dipl. ABT (NCCAOM), AOBTA-CP is an Asian Bodywork Therapist specializing in Shiatsu and Acupressure at Pennsylvania Hospital, responds: Many types of massage and bodywork (shiatsu, acupressure, etc.) can be very helpful for pain from cancer. Depending
CAM For Hot Flashes Dear OncoLink "Ask The Experts," I was thrown into menopause by my cancer treatment- Is there anything to treat or help with these hot flashes that isn’t a medication? Jun Mao, MD, MSCE, Family Medicine and Community Health Physician and Acupuncturist at PENN Medicine, responds: Many of the cancer treatments (chemotherapy, surgery) can induce
How To Relax During Cancer Treatment? Dear OncoLink "Ask The Experts," I am feeling very stressed about my cancer diagnosis. What is the best way to relax? Michael Baime, MD, Director, Penn Program for Mindfulness, responds: It's a really good question, and like most good questions, there isn't a simple answer. Here are some thoughts. First of all, take some time to think about
Difference Between Complementary, Alternative & Integrative Therapy? I have heard people talk about complementary, alternative, and now integrative therapy for cancer – are these terms interchangeable? Tony Meadows PhD MT-BC FAMI LPC is Director of Music Therapy at Immaculata University and Music Therapist at the Joan Karnell Cancer Center at Pennsylvania Hospital, responds: Complementary and integrative are
Credentials Of Therapists How do I know if a practitioner of acupuncture or reiki is reputable? Are there certifications to look for or anything? Jun Mao, MD, MSCE, Family Medicine and Community Health Physician and Acupuncturist at PENN Medicine, responds: Acupuncture is licensed in most but all states in the U.S. Many of the cancer centers begin bringing
Foods To Prevent Nausea Are there any foods or supplements that can relieve nausea from chemo? Debra DeMille, MS, RD, CSO, Dietician at the Joan Karnell Cancer Center at Pennsylvania Hospital, responds: Anti nausea medicines have greatly improved and I highly recommend those. In addition, stay well hydrated, and you may try ginger products such as ginger tea. There
Is Massage Ok With Lymphedema? I have lymphedema in my leg after cervical cancer treatment. A friend bought me a gift certificate for a massage. Can I do that? Andrea Richtel-Branas, MSE, MPT, Lead Therapist, Good Shepherd Penn Partners, responds: Relax and enjoy your gift. While you should avoid deep tissue massage in the leg and trunk that has lymphedema, you can have it
Reducing Risk Of Lymphedema? Can I prevent lymphedema after breast cancer treatment with complementary therapies? Andrea Richtel-Branas, MSE, MPT, Lead Therapist, Good Shepherd Penn Partners, responds: The best way to prevent lymphedema is to minimize your risk for getting lymphedema. Minimizing your risk involves good skin care, avoiding limb constriction, activity
Can I Eat Red Meat If I Have Colon Cancer? Is it ok to eat red meat if I have colon cancer? Karen Wagner, MS, RD, LDN, Registered Dietician at Penn Medicine, responds: The research into red meat and colon cancer is certainly confusing. The strongest link between colon cancer risk and meat consumption seems to be particularly with processed or cured red meats, such as bacon, sausages,
Is It OK To Exercise On Day Of Treatment? Is it ok to exercise on days when I get chemo or radiation? Kathryn Schmitz, PhD, Penn Medicine researcher who specializes in the role of physical activity in lymphedema development and prevention, responds: If you feel up to doing exercise on days when you get chemo or radiation, yes, it is safe to exercise on those days. There is one 'in
Is Massage Ok With Lymphoma Can I still get massage if I have lymphoma? Won't it spread the cancer? Wayne Mylin, Dipl. ABT (NCCAOM), AOBTA-CP is an Asian Bodywork Therapist specializing in Shiatsu and Acupressure at Pennsylvania Hospital, responds: Yes, it is ok to get a massage if you have lymphoma. You will want to find a massage therapist that has experience in
Natural Remedies For Constipation & Diarrhea Are there any natural ways to treat constipation/diarrhea from chemotherapy? I don't want to take any more pills! Karen Wagner, MS, RD, LDN, Registered Dietician at Penn Medicine, responds: There are some great tips for treating constipation and diarrhea naturally, but it can depend on the reason for the bowel changes. In general, for
Massage Therapist Get Special Training To Work With Cancer Patients? Can a massage therapist obtain special training to work with cancer patients? Wayne Mylin, Dipl. ABT (NCCAOM), AOBTA-CP is an Asian Bodywork Therapist specializing in Shiatsu and Acupressure at Pennsylvania Hospital, responds: There are some massage schools that provide 'certificate' programs to work with cancer patients - but not many and
Finding The Right Music Therapy Can you recommend music that will help me to relax and would be good music therapy? Where can I buy this music? Tony Meadows PhD MT-BC FAMI LPC is Director of Music Therapy at Immaculata University and Music Therapist at the Joan Karnell Cancer Center at Pennsylvania Hospital, responds: You can find Board Certified Music Therapists (always
What Are Energy Blocks? Can you talk about emotions, energy blocks and how complementary therapies can help cancer patients? Michael Baime, MD, Director, Penn Program for Mindfulness, responds: We can hold painful or unpleasant memories and emotions in the body, and these emotions can create difficulty in our bodies and our minds. Although different complementary
What Are The Best Foods For Cancer Prevention? How do you know what foods are really good in terms of preventing cancer. It seems there is a new food every week that I should run out and fill my fridge with and then the next week the same food is no longer good for me! Debra DeMille, MS, RD, CSO, Dietician at the Joan Karnell Cancer Center at Pennsylvania Hospital, responds: Yes, the
What is Complementary Therapy? What does complementary therapy mean exactly? I hear it so much, but am not sure what it entails. Tony Meadows PhD MT-BC FAMI LPC is Director of Music Therapy at Immaculata University and Music Therapist at the Joan Karnell Cancer Center at Pennsylvania Hospital, responds: This is a very good question and evokes quite a lot of different
How Efficacious Is Acupuncture? What sort of efficacy have you seen with acupuncture in helping to alleviate chemo and radiation symptoms like nausea and fatigue? Jun Mao, MD, MSCE, Family Medicine and Community Health Physician and Acupuncturist at PENN Medicine, responds: One trial found that acupuncture reduced persistent chemotherapy-related fatigue by about 40%.
What Type of Exercise During Cancer Therapy? What kind of exercise is good to do while undergoing chemo and/or radiation? Kathryn Schmitz, PhD, Penn Medicine researcher who specializes in the role of physical activity in lymphedema development and prevention, responds: According to the American Cancer Society, the American College of Sports Medicine, and the National Comprehensive
What Type Of Massage Is Better During Cancer Treatment? Are certain types of massage better than others if you are undergoing cancer treatment? Wayne Mylin, Dipl. ABT (NCCAOM), AOBTA-CP is an Asian Bodywork Therapist specializing in Shiatsu and Acupressure at Pennsylvania Hospital, responds: It is less a matter of what type of massage or bodywork, than it is a matter of the experience and
What Herbal Supplements During Cancer Therapy? What herbal supplements are good to take during chemotherapy? Karen Wagner, MS, RD, LDN, Registered Dietician at Penn Medicine, responds: The current research does not support taking any particular herbal supplement during chemotherapy. Some herbal supplements may be helpful for particular issues that can arise with chemotherapy, for
Listening to Music during Chemotherapy Just wondering if listening to music during chemo infusions is considered music therapy - or does it need to be something formal? Tony Meadows PhD MT-BC FAMI LPC is Director of Music Therapy at Immaculata University and Music Therapist at the Joan Karnell Cancer Center at Pennsylvania Hospital, responds: Using music during chemo is, for
What Types Of Cancer Can Benefit? What types of cancer can be helped by acupuncture and reiki? Is it just solid tumors? Jun Mao, MD, MSCE, Family Medicine and Community Health Physician and Acupuncturist at PENN Medicine, responds: Acupuncture and reiki have potential benefits to help individuals with cancer regardless of cancer types (solid or liquid tumors). The benefits
See a PT After Surgery to Prevent Lymphedema? Should I see a physical therapist after cancer surgery to prevent lymphedema? Andrea Richtel-Branas, MSE, MPT, Lead Therapist, Good Shepherd Penn Partners, responds: A physical therapist can help to educate you on your risk for lymphedema. At this time we do not know how to prevent lymphedema - but we do know ways to minimize your risk.
Finding A Music Therapist Is there a website where I can find a reputable music therapist in my area? Tony Meadows PhD MT-BC FAMI LPC is Director of Music Therapy at Immaculata University and Music Therapist at the Joan Karnell Cancer Center at Pennsylvania Hospital, responds: You should always look for the MT-BC designation - Board Certified Music Therapist. This
Getting Back to Work After Cancer I had to stop working when I started cancer treatment. How can I get back into the work force, especially during this bad economic time? Will having a history of cancer really look bad for employment? Carolyn Vachani, RN, MSN, AOCN, OncoLink Nurse Educator, responds: Getting back to work can be very challenging. You want to be honest, but
Housing When Treatment is Far From Home Where can I find inexpensive housing so I can stay closer to the hospital where I am being treated? Trish Gambino, RN, MSN, Nurse Navigator, responds: The American Cancer Society (800-227-2345) has a resource search feature on line that may help you find something in the area of your treatment. Hosts for Hospitals is a Philadelphia based
Help at Home How can I get help at home to take care of myself, like a visiting nurse or nurse’s aide? Trish Gambino, RN, MSN, Nurse Navigator, responds: Most insurance companies will pay for skilled nursing visits to teach you how to do certain procedures (such as wound care), physical therapy or occupational therapy. This will only be for a
Disability Resources I need help with disability and legal issues. Christina Bach, MSW, LCSW, OSW-C, Oncology Social Worker at the Abramson Cancer Center at Penn Presbyterian, responds: Applying for disability is a big decision when diagnosed with cancer; and also a very personal one. Many people feel up to working throughout their treatment plan; others cannot
Getting Insurance After Cancer I am looking for information about life insurance policies when one has a diagnosis of cancer. Christina Bach, MSW, LCSW, OSW-C, Oncology Social Worker at the Abramson Cancer Center at Penn Presbyterian, responds: Accessing life insurance is not out of the question after a cancer diagnosis, but it will require some extra leg work and effort
Paying for a Wig Can I get help paying for a wig for when I lose my hair from chemotherapy? Christina Bach, MSW, LCSW, OSW-C, Oncology Social Worker at the Abramson Cancer Center at Penn Presbyterian, responds: Some health insurance policies cover the cost of wigs; you just have to know their language---usually they are referred to as "cranial hair
Helping Kids Deal With a Parent's Diagnosis Where can I go to get help for my kids in dealing with a parent's cancer? Christina Bach, MSW, LCSW, OSW-C, Oncology Social Worker at the Abramson Cancer Center at Penn Presbyterian, responds: Kids Konnected is a great place to start; as well as the American Cancer Society and CancerCare. All these organizations offer great resources.
Fertility and Cancer I would like to know more about Fertility and cancer. What are my options after treatment? Trish Gambino, RN, MSN, Nurse Navigator, responds: Fertile Hope is a great resource. Fertility should be addressed before you start your cancer treatments. However, sometimes this is not possible, due to the urgency of starting treatments. Many cancer
Bereavement Resources What are some resources for bereavement support? Christina Bach, MSW, LCSW, OSW-C, Oncology Social Worker at the Abramson Cancer Center at Penn Presbyterian, responds: Public television recently published this list of bereavement resources. Also, contact local hospice organizations; even if you didn't receive services from them. They often
Accessing the American Cancer Society Resources How can I get access to the many services offered by the American Cancer Society? I hear they offer so many things, but I just don't know where to go on their website or what would be good for me. Christina Bach, MSW, LCSW, OSW-C, Oncology Social Worker at the Abramson Cancer Center at Penn Presbyterian, responds: The American Cancer Society
Managing Diarrhea With Pancreatic NET Dear OncoLink "Ask The Experts," Can you recommend foods that could help to relieve my diarrhea? Also, if I have a pancreatic NET, do you think pancreatic enzymes would help me? Karen Wagner MS, RD, LDN, Clinical dietitian specialist for the Abramson Cancer Center, responds: Diarrhea can be an especially complicated issue with
Foods With Tyramine and Carcinoid Dear OncoLink "Ask The Experts," Why are foods with tyramine not good for carcinoid patients? What are examples of foods containing tyramine? Karen Wagner MS, RD, LDN, Clinical dietitian specialist for the Abramson Cancer Center, responds: Foods with tyramine can cause carcinoid symptoms for some patients. Foods containing tyramine are
Screening a Young Child With MEN Mutation Dear OncoLink "Ask The Experts," My son has inherited my MEN I mutation (according to a lab done at UNC in April 2011). What are some things I need to look at before he turns five, if any? And what are the specific tests that need to be done at age five? Kate Nathanson, MD, assistant professor in the division of Medical Genetics at Penn
Bone Metastases in Pheochromocytoma Dear OncoLink "Ask The Experts," In metastatic pheo, what is the current thinking about treating/removing tumors and bone lesions as they are identified? My understanding is that the concern with bone lesions is the deterioration of the bone. Can bone lesions also be the cause of further spreading of the disease? Giorgos Karakousis, MD,
Carcinoid Patients & Kids at Higher Risk For Cancer? Dear OncoLink "Ask The Experts," Are carcinoid patients at higher risk for other cancers? Are children of carcinoid patients more likely to develop the disease? Weijing Sun, MD, Medical Oncologist at Penn Medicine, responds: Not necessarily. For patients with a genetic mutation (such as MEN I), then yes, they have increased risks as well
Support on Balancing Work & Family and Cancer Treatment Question I would like some advice on how to balance work, family, kids, etc. while facing cancer and treatment. Where can I go for help/support? Answer Tracy Lautenbach, MSW, LCSW, OSW-C, Oncology Social Worker at Penn Medicine, responds: Balancing work, family, children and cancer treatment can be very challenging for some. This would be
Talking With Family & Friends About Cancer Diagnosis Question Can you help me in how to talk to my friends and family about my diagnosis of such a personal issue? Answer Tracy Lautenbach, MSW, LCSW, OSW-C, Oncology Social Worker at Penn Medicine, responds: Speaking with family and frineds may seem scarey but remember that if you dont share with them what is going on or how you are feeling then
Nearing End of Treatment Fears Question I am nearing the end of my treatments and finding myself anxious and worried about my future. What if the cancer returns? Answer Tracy Lautenbach, MSW, LCSW, OSW-C, Oncology Social Worker at Penn Medicine, responds: Fear of recurrence or fear of your cancer coming back is one of the most common worries that anyone with a cancer
Cancer As A Chronic Illness Question My Doctor mentioned that I should view my cancer (ovarian) as more of a chronic illness because there is no cure, however there are treatments and medicines that can help. What tips do you have for living with this uncertainty? Answer Tracy Lautenbach, MSW, LCSW, OSW-C, Oncology Social Worker at Penn Medicine, responds: Cancer can
Pap Smear After Hysterectomy Question Do I still need to get a PAP test and gyn exam if I had a hysterectomy? Answer Stephen Rubin, MD, Gynecologic Oncologist at Penn Medicine, responds: Current recommendations are that women who have had a total hysterectomy (both uterus and cervix removed) for benign conditions and have no history of abnormal Paps do not need Paps.
Intimacy After Cervical Cancer Question Can I still be intimate with my partner after radiation for cervical cancer? Answer Nicole Ross, RN, MSN, OCN - Radiation Oncology Nurse at Penn Medicine, responds: YES! You can still be intimate with your partner after radiation for cervical cancer. During the first few weeks after radiation, the vagina can have changes that may
Feeling Tired After Treatment Question I have felt so tired since finishing my treatment, what can I do to get some energy back? Answer Nicole Ross, RN, MSN, OCN - Radiation Oncology Nurse at Penn Medicine, responds: Fatigue is a very common side effect of chemotherapy and radiation therapy. Typically, energy levels should start increasing slowly a few weeks after
Vaginal Dilators After Radiation Therapy - Are They Necessary Question My mother is a 70 year old widow who had endometrial cancer and had radiation. Now she is being told to use a dilator, but she is uncomfortable doing this. Is it really necessary? Answer Nicole Ross, RN, MSN, OCN - Radiation Oncology Nurse at Penn Medicine, responds: It is recommended that all female patients who receive radiation
How Long Is A Radiation Treatment? Question How long does it take to get a radiation treatment? Answer Nicole Ross, RN, MSN, OCN - Radiation Oncology Nurse at Penn Medicine, responds: A daily radiation treatment will take about 15 minutes. However, expect to be in your Radiation facility for about an hour every day, in the door to out the door. The first trip to your
Diarrhea A Year After Radiation Question It is a year after radiation finished and I am still experiencing diarrhea. What can I do to manage this better/decrease incidence of it? Answer Nicole Ross, RN, MSN, OCN - Radiation Oncology Nurse at Penn Medicine, responds: We would typically not expect that you are would have diarrhea one year after radiation. You may find it
Osteoporosis Risk After Cancer Treatment Question My doctor told me I am at risk for osteoporosis because of my cancer treatment. Why is this and what should I do about it? Answer Nicole Ross, RN, MSN, OCN - Radiation Oncology Nurse at Penn Medicine, responds: Cancer treatments can put you at risk for osteoporosis. Osteoporosis is a weakening of the bones, that can put you at risk
How Does Radiation Work? Question How can radiation kill cancer cells and not cause more cancer to develop? Answer Michael Corradetti, MD, PhD, Radiation Oncology Resident at Penn Medicine, responds: Radiation treatments kill cancer cells primarily via damage to their DNA. A variety of technologies have been developed to deliver radiation therapies that maximize the
Does Radiation Make You Radioactive? Question Does radiation make you or your body fluids radioactive? Should I take any precautions at home since I have children? Answer Michael Corradetti, MD, PhD, Radiation Oncology Resident at Penn Medicine, responds: Radiation therapy for gynecologic malignancies is typically delivered in two ways. External beam radiation therapy involves
Tandem & Ovoid Therapy Question Can you explain the procedure for high dose radiation for cervical cancer? From what I understand, it seems like it will be painful. Will I have any kind of anesthesia? Answer Michael Corradetti, MD, PhD, Radiation Oncology Resident at Penn Medicine, responds: You are referring to tandem and ovoid brachytherapy for cervical cancer.
Radiation Therapy For Ovarian Cancer? Question Why didn't I get radiation for ovarian cancer? I just had surgery and chemo. Would radiation have decreased the chance of my cancer coming back? Answer Michael Corradetti, MD, PhD, Radiation Oncology Resident at Penn Medicine, responds: Unlike surgery and chemotherapy, radiation therapy is not typically employed as part of the
Getting Back To Life As A Survivor Question Can you offer some advice on how to get back to life in a non-cancer treatment world for someone who has finished treatment and is now a "survivor?" I feel a bit disjointed and unsure how to get back to normal. Also, can you recommend some resources? Answer Michael Corradetti, MD, PhD, Radiation Oncology Resident at Penn Medicine,
Risk If Family Member Had Ovarian Cancer Question If my grandmother had ovarian cancer, what is my risk of developing it? Are my kids at risk? Answer Jill Stopher, MS, Certified Genetic Counselor at Penn Medicine, responds: Just having a grandmother with ovarian cancer has only a minimal impact on your risk of developing this unless there is a more extensve family history of cancer.
Do I Need Genetic Counseling & Testing? Question How do I know if I need genetic testing for a cancer? Answer Jill Stopher, MS, Certified Genetic Counselor at Penn Medicine, responds: In general, people who are good candidates for genetic testing have these features: they may be diagnosed at an earlier than typical age for their cancer there may be multiple people on the same side
Family History Of Breast Cancer On Father's Side Question Does family history of breast cancer on my father's side put me at risk for cancer? Answer Jill Stopher, MS, Certified Genetic Counselor at Penn Medicine, responds: Even though breast cancer mostly affects women, risk for breast cancer can be passed down from both your mother and your father's side of the family. There are a number
Tumor Markers QuestionWhat does "tumor marker" mean? Is it the same test for all cancers? How often should it be tested? AnswerCarolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:A tumor marker is a substance that is produced by the body in response to cancer, or is produced by the cancer itself. Some of these markers are specific to one cancer,
If Tumor Marker Is Higher, Does That Mean I Have More Cancer? Question If my tumor marker number is higher than another patient's, does that mean I have more cancer in me? Answer Carolyn Vachani, RN, MSN, AOCN, OncoLink Nurse Educator, responds: Not at all- these results are specific to each patient and should only be compared to your own previous results, taking into consideration your condition,
Should My Tumor Marker Go To Zero? Question Should my tumor marker go to zero when I am done treatment? Answer Carolyn Vachani, RN, MSN, AOCN, OncoLink Nurse Educator, responds: This really depends on what the marker is (some are normally found in low levels in the body), what the treatment was (taking hormone therapy for metastatic breast cancer can take several months until
Can other things besides cancer cause a tumor marker to be high? Question Can other things besides cancer cause a tumor marker to be high? Answer Carolyn Vachani, RN, MSN, AOCN, OncoLink Nurse Educator, responds: Can other things besides cancer cause a tumor marker to be high? Absolutely, quite a few medical conditions can affect markers. Learn more about tumor markers affected by medical conditions:
What is the difference between PET and PET/CT? Question I need to know What is the difference between PET and PET/CT? Is it better to get the PET/CT? Answer James Metz, MD, OncoLink Editor-in-Cheif, responds: A PET scan (positron emission tomography) looks at the biologic activity of a tumor, not the shape and size of a tumor. A CT scan give anatomic information like exact location, size,
What is nadir and neutropenic? Question What is meant by nadir and neutropenic? Answer Carolyn Vachani, RN, MSN, AOCN, OncoLink Nurse Educator, responds: These are 2 terms used to describe levels of blood cells in the body. The nadir is the time point after cancer treatment when your blood counts (white blood cell, hemoglobin and platelets) are at their lowest. This is the
Do Polyps Mean I Have Colon Cancer? Question I recently had a colonoscopy and my doctor told me I had some polyps, does this mean I have colon cancer again? Answer Carolyn Vachani, RN, MSN, AOCN, OncoLink Nurse Educator, responds: No. This is good news- screening worked to find a polyp before it progressed to cancer. Not all polyps can become cancers. The majority of tumors
What is staging? Question Can you explain the different stages of cancer 1-4? Answer Carolyn Vachani, RN, MSN, AOCN, OncoLink Nurse Educator, responds: Staging is the way doctors define how much the tumor has grown or spread. There is a staging system for almost every type of cancer. The majority of these are based on "TNM", which takes the tumor size (T),
Breast Cancer Pathology Question I hear all these terms so often in regards to breast cancer: HR-positive/negative, HER-2/neu receptor, triple negative breast cancer. What do they mean and what is a "good" one to have? Answer Carolyn Vachani, RN, MSN, AOCN, OncoLink Nurse Educator, responds: These are all terms used to describe the activity of the cells and how they
MSI High and Low Question What does MSI high/low mean? Which has a better prognosis in colon cancer? Answer Carolyn Vachani, RN, MSN, AOCN, OncoLink Nurse Educator, responds: Tumors are identified as MSI-H (i.e. MSI-high), meaning they are MMR deficient (dMMR), or MSI-stable and MSI-low, meaning they are considered MMR proficient (pMMR). Studies have found
With or Without Contrast? Question My doctor has ordered test sometimes with contrast and sometimes not. Why are some tests with "contrast" and some not? What does that mean to have a test with contrast and is it better? Answer James Metz, MD, OncoLink Editor In Chief, responds: Contrast may be utilized at certain times to get a better view of the blood vessels or
Bone Scan Results Question My doctor recently showed me a bone scan result and said that some darkened areas were cancer and others were not. How could she tell the difference? Answer James Metz, MD, OncoLink Editor In Chief, responds: Interpretations of bone scans are very individualized and the final report takes into account the clinical situation. It also
Grade On Pathology Report Question What does the grade of cancer mean on a pathology report? Answer James Metz, MD, OncoLink Editor In Chief, responds: The grade of cancer is typically noted on a pathology report. This is related to how closely the tumor looks like a normal cell. The higher the grade, the more ugly the tumor looks. However, this is just a single piece
Pathology Report Shows "Slow-Growing" Cancer? Question How can my doctor tell from the pathology report that a cancer is "slow-growing?" Answer James Metz, MD, OncoLink Editor In Chief, responds: It is difficult to tell how quickly a tumor is growing based on a pathology report. Some tumors can look more benign then others. However, the true test is time. If there are serial scans over
Non-Invasive Tumor Question What does "non-invasive tumor" mean? Answer James Metz, MD, OncoLink Editor In Chief, responds: A 'non-invasive' tumor really means that the tumor has not invaded through layers of the organ. However, non-invasive, does not necessarily mean a tumor cannot cause a problem. Like real estate, it is all about location. A non-invasive
Blood Cell Counts Bouncing Back Question I've been on chemo for about two years and my white blood cell count has always bounced back either to normal or close to normal. Does that indicate something about my overall health? Answer James Metz, MD, OncoLink Editor In Chief, responds: This really depends on many factors. It is great your white blood count has bounced back
CT Scan Versus MRI Question What is the difference between at CT scan and MRI? How does my doctor decide what is best for monitoring my cancer? Answer Christine Hill-Kayser, MD, Radiation Oncologist, responds: A ct scan is a test that uses xrays assembled in many directions to view a patient's body in three dimensions. An MRI also uses three dimensions but uses
Sentinel Node Biopsy Question What is a sentinel node biopsy? Answer Christine Hill-Kayser, MD, Radiation Oncologist, responds: When a surgeon performs a sentinel node biopsy, he or she uses a blue dye or mild radioactive tracer to identify the lymph nodes that are most likely to have drained the area of a known tumor. For example, there are as many as 100 lymph
Benefits of Quitting Smoking After Long History Question I have smoked for about 20 years, would it even matter if I quit now? Will I still get lung cancer? Answer Gloria DiLullo, MSN, CRNP, OncoLink Content Specialist, responds: Quitting is beneficial, no matter how long a person has smoked. While it is true that your risk of having lung cancer and other smoking-related illnesses and
Calcifications And Dense Tissue On Mammogram Question What is meant by calcifications and dense tissue on a mammogram? Are these normal results? Does it mean I am at risk for getting cancer again? Answer Christine Hill-Kayser, MD, Radiation Oncologist, responds: Calcifications may be normal, but are sometimes associated with breast cancer. Certain types of calcifications, called
What is meant by "clear margins?" Question What is meant by "clear margins?" Answer Christine Hill-Kayser, MD, Radiation Oncologist, responds: A clear margin means that a tumor was removed and was surrounded by a rim of normal tissue that did not have cancer cells. This means that the likelihood of cancer cells remaining behind is low. This question and answer was part of
Necrotic Tumor Question My doctor said that my tumor was the same size on the CT scan, but that it looked "necrotic" and he said this was a good thing. How could it be good if my tumor didn't get smaller since starting chemo? Answer Christine Hill-Kayser, MD, Radiation Oncologist, responds: Necrosis is another way of saying that the tumor cells look as if
What is meant by "4 out of 10 nodes positive?" Question What is meant by "4 out of 10 nodes positive?" Answer Christine Hill-Kayser, MD, Radiation Oncologist, responds: This means that 10 total lymph nodes were removed, and cancer cells were seen within 4 of them. You can find this information on your pathology report. If you have breast, prostate, colon cancer or melanoma, you can find
Surgery Necessary for Biopsy? Question Do I have to have a surgery to get a biopsy for possible breast cancer? Answer Christine Hill-Kayser, MD, Radiation Oncologist, responds: Not necessarily. Sometimes the initial biopsy can be done with a large needle; however, your doctor may still recommend a surgery if the needle biopsy is negative for cancer or inconclusive. A
FNA Biopsy (Fine Needle Aspiration) Question What is an FNA? Answer Christine Hill-Kayser, MD, Radiation Oncologist, responds: This stands for fine needle aspiration. This is a biopsy method during which a large needle is used to withdraw fluid and cells. The cells are then examined under a microscope to assess whether a cancer is present. This question and answer was part of
Safety of E-Cigarettes Question Are smokeless, electronic cigarettes harmful in terms of causing health problems? Answer Carolyn Vachani, RN, MSN, AOCN, OncoLink Nurse Educator, responds: Jared Weiss, MD, an oncologist at UNC Cancer Center, previously addressed this for us: I looked into this question recently and the quality of data is poor and does not allow a
Resources to Quit Smoking Question I know cigarettes are bad, but I don't even know how to begin to quit smoking. Can you help? Answer Gloria DiLullo, MSN, CRNP, OncoLink Content Specialist, responds: Quitting tobacco is not easy, but you can do it! Whether you are a smoker or someone who uses smokeless tobacco, to have the best chance of quitting and staying
Cancer Risk with Cigars Question My friends and I enjoy a few cigars when we get together, is there a risk of lung cancer with cigars? Answer Gloria DiLullo, MSN, CRNP, OncoLink Content Specialist, responds: Many people view cigar and pipe smoking as safer than cigarette smoking, but this is not true. Cigars are often thought to be safer than cigarettes because
Dangers of Smokeless Tobacco Question My son uses "chew" (smokeless tobacco), is this harmful even though there is no smoking involved? Answer Gloria DiLullo, MSN, CRNP, OncoLink Content Specialist, responds: Chew as well as dip, spit, oral/spitless tobacco and dry/moist snuff (snus) are all still tobacco products. Many people mistakenly think smokeless tobacco is a safe
Occupational Radiation Exposure and Cancer Risk Question I work as a radiologist, am I at increased risk for getting cancer? Answer Carolyn Vachani, RN, MSN, AOCN, OncoLink Nurse Educator, responds: People in certain professions may be at increased risk for cancer due to occupational radiation exposure. These professions include medical radiologic technicians, aircrews, radium dial
Radiology Tests and Cancer Risk Question Are patients who get a lot of Ct scans and MRIs at increased risk for cancer? Answer Carolyn Vachani, RN, MSN, AOCN, OncoLink Nurse Educator, responds: Recently, there has been much talk in the media about the risk of developing cancer due to radiation exposure from radiology tests, such as CT scans. While there have not been studies
Health Risks of Radon Question We are buying a house and the basement was tested and found to be high in radon. How is this harmful for my family? What should I do? Answer Gloria DiLullo, MSN, CRNP, OncoLink Content Specialist, responds: After tobacco use, radon is the second leading cause of lung cancer in the United States. If radon is detected in levels above 4
Radiation for Cancer Treatment and Second Cancer Risk Question Does getting radiation for one cancer, put me at risk for developing more cancer? Answer Charles B. Simone, II, MD, Radiation Oncologist at Penn Medicine, responds: Unfortunately, yes. Anytime radiation therapy is received by an individual, that individual is at a small but real increased risk of developing a second cancer from that
Microwaved Foods and Cancer Risk Question Do you think microwaving foods causes cancer? Answer Charles B. Simone, II, MD, Radiation Oncologist at Penn Medicine responds: This is another great question. The short answer is no, there is no definitive evidence to suggest that microwaves cause cancer. However, microwaves to emit radiation that can theoretically be harmful.
Homosexuality and Cancer Risk Question Does being a gay man put me at a higher risk for cancer? I have heard that may be true, but I am unsure of what the reasoning is. Can you explain? Answer Carolyn Vachani, RN, MSN, AOCN, OncoLink Nurse Educator, responds: What sexual practices increase risk? Higher numbers of sexual partners and earlier age of first sexual encounter,
Plastic Baby Bottles and Cancer Risk Question Do plastic baby bottles cause cancer? I heard I should get some special baby bottles but was not sure if that is true or not. Answer Charles B. Simone, II, MD, Radiation Oncologist at Penn Medicine responds: There has been some evidence that drinking from bottles with bisphenol A (BPA) can be harmful. This chemical is similar to a
Reducing Risk of HPV-Related Oral Cancers Question How can you reduce the risk of HPV related oral cancers? Answer Carolyn Vachani, RN, MSN, AOCN, OncoLink Nurse Educator, responds: That is a great question - you cannot protect yourself 100% but this previous answer talks about prevention using dental dams. Answer Gloria DiLullo, MSN, CRNP, OncoLink Content Specialist, adds: While
Hormone Replacement Therapy and Cancer Risk Question I am worried about taking hormone pills to help with menopause symptoms. Do they cause cancer? Answer Gloria DiLullo, MSN, CRNP, OncoLink Content Specialist, responds: Hormone replacement therapy (HRT) was commonly prescribed for menopausal women to reduce hot flashes, vaginal dryness, and risk of bone fractures and heart disease. In
Weight and Cancer Risk Question I know being overweight can lead to many health problems, how is it connected with cancer? Answer Gloria DiLullo, MSN, CRNP, OncoLink Content Specialist, responds: While what we eat is probably linked to cancer development, being overweight and having a diet high in fat is clearly related to the development of certain cancer types.
Reducing Your Risk of Colon Cancer Question I have a distant family history of colon cancer, aside from colonoscopies, what else can I do to decrease my risk of getting cancer? Answer Gloria DiLullo, MSN, CRNP, OncoLink Content Specialist, responds: Colorectal cancer is the third most common type of cancer in the Western world. About 80% of colorectal cancers are diagnosed in
Evaluating Breast Cancer Risk Question How do I know if I am at risk for breast cancer? Answer Charles B. Simone, II, MD, Radiation Oncologist at Penn Medicine responds: Breast cancer is the most common solid cancer in women. Approximately 1 in 8 women will developed breast cancer during their lifetime. Other than female gender, the most common risk factor for developing
Sun Exposure and Cancer Risk Question I work outside most of the year, how can I avoid getting skin cancer? Answer Gloria DiLullo, MSN, CRNP, OncoLink Content Specialist, responds: Even though you must work outside, can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad-spectrum
Safety of Tanning Salons Question My daughter and her friends go to the tanning salon. Is this safer than being out in the sun? Answer Gloria DiLullo, MSN, CRNP, OncoLink Content Specialist, responds: Tanning salons are not a safe alternative to the harmful rays of the sun. Studies have found that tanning salons are very harmful and lead to an increased risk of
Alcohol and Cancer Risk Question My husband is a heavy drinker and I am concerned for his health. Is there a link with alcohol and cancer? Answer Gloria DiLullo, MSN, CRNP, OncoLink Content Specialist, responds: Many people are aware that heavy alcohol use can cause health problems such as cirrhosis of the liver, hepatitis, high blood pressure, heart disease and
Cell Phones and Cancer Risk Question Has there been a definite conclusion with cell phones causing cancer? Answer Charles B. Simone, II, MD, Radiation Oncologist at Penn Medicine responds: That is a great question, but a very controversial topic. Cell phones emit radiofrequency energy, which is a non-ionizing electromagnetic radiation that can be absorbed by your tissues
Cancer Screening Tests Question What is meant by "cancer screening tests"? Who should get them? Answer Gloria DiLullo, MSN, CRNP, OncoLink Content Specialist, responds: Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. Various organizations have developed
Child Bearing after Cancer Treatment Question I'm getting radiation for rectal cancer and am concerned about being able to have children after treatment. What should I do before I start treatment to make sure my fertility is preserved? Can it be preserved? Answer Maggie Hampshire, RN, Oncology Nurse at Penn Medicine, responds: There are a few possibilities to help you stay fertile
Quitting Alcohol and Tobacco Use After Cancer Diagnosis Question My father was recently diagnosed with esophageal cancer and was told to quit smoking and drinking alcohol by his doctor. My father feels it won't make a difference at this point. What can I tell him to help him realize that quitting is important and why it is so important? Answer Christina Bach, Oncology Social Worker at Penn Medicine,
Nutrition and Chemotherapy after Gastric Bypass Surgery Question I had gastric bypass surgery about 5 years ago. Now I am about to start treatment for colon cancer with chemo. I am really worried about how to manage nutrition with this combination. Any advice appreciated! Answer Katrina Claghorn, Registered Dietician at Penn Medicine, responds: Managing your nutritional status during treatment may
Chemoebolization for Liver Cancer Question My husband is getting "chemoembolization" for liver cancer. Why does he have to have this procedure rather than getting actual chemotherapy? What are the risks involved in this procedure? Answer Bruce Giantonio, MD, Medical Oncologist at Penn Medicine, responds: That is a good question. One of the remarkable things about
Lynch Syndrome and Colon Cancer Question Due to Lynch Syndrome, I had my colon removed and a complete hysterectomy. 3 tumors were found in my colon, 1 in my uterus. Since then my adrenal glans have shut down (Addison's) and I have been diagnosed with R/A. Are the 3 somehow connected? Is there any way to treat me as a whole? Answer Bruce Giantonio, MD, Medical Oncologist at
Cancer Treatment and a Living Will Question I am getting ready to start cancer treatment; do I need a Living Will? If so, how do I go about getting one? Answer Christina Bach, Oncology Social Worker at Penn Medicine: Indicating your wishes for medical care is important information for both your family and your healthcare team to have. It is not REQUIRED for you to have a living
Feeding Tubes and Radiation for Esophageal Cancer Question I had a consult with a radiation doctor for esophageal cancer. He said I need a feeding tube. That seemed kind of premature to me- do I really need that? Answer Liz Prechtel-Dunphy, Oncology Nurse Practitioner at Penn Medicine, responds: Feeding tubes are important in patients with esophageal cancer whether they are getting single
Out of Pocket Expenses during Cancer Care Question I'm worried about my out of pocket expenses for my cancer care. Where can I go to for help? Answer Christina Bach, Oncology Social Worker at Penn Medicine responds: Financial issues and the cost of cancer care are fast becoming one of the greatest sources of distress for cancer patients and caregivers. You should start with REALLY
Safety of Clinical Trials Question My doctor has asked me to consider a clinical trial as my treatment. Are these trials safe? Could it really be better than the treatment that most people get for pancreatic cancer? Answer Christina Bach, Oncology Social Worker at Penn Medicine responds: Participating in clinical trial is a personal decision but also an opportunity to
Nutrition and Diarrhea After Whipple Surgery Question I have had such a hard time with eating after Whipple surgery. Can you help me to get better nutrition and to deal with the diarrhea? Do certain foods make it worse? Is this going to be a permanent problem? Lauren Ginipro, Registered Dietician at Penn Medicine responds: After a Whipple procedure you will need to follow a low fat diet-
Pancreatic Cancer and Genetics Question My mother recently passed away at the age of 49 after a 4-week battle with pancreatic cancer. I have read that certain types of pancreatic cancer can be genetic. What should my family watch out for? Ursina Teitelbaum, MD, Medical Oncologist at Penn Medicine responds: There are familial cancer syndromes that can increase one's risk of
Safety With Oral Chemotherapy Medication Question I was given an oral chemotherapy to take at home. What should I know about safety regarding having a medication like this at home? Gloria DiLullo, Oncology Nurse Practitioner at Penn Medicine responds: Many people receive this type of chemotherapy at home and there are some important things you should know. We have some great
Pancreatic Enzymes and Suggested Doses Question Why is it important to take pancreatic enzymes? My doctor said I may have to adjust them and take more than initially prescribed. Why is this? How do I know when to increase my dose? Answer Lauren Ginipro, Registered Dietician at Penn Medicine responds: Pancreatic enzymes are necessary to breakdown the food we eat so that it can be
When to Take Pancreatic Enzymes Question When is the best time to take pancreatic enzyme tablets- before, during, or after a meal? Answer Lauren Ginipro, Registered Dietician at Penn Medicine responds: Pancreatic enzymes should be taken at the beginning of the meal or snack. This is very important for proper enzyme functioning. When taking multiple enzymes, take some at the
Spousal Support Groups for Cancer Treatment Question How can I find a support group for my wife going through cancer treatment? What about for spouses? Answer Christina Bach, Oncology Social Worker at Penn Medicine responds: There are support groups available in many communities, but also online. You can start by contacting the American Cancer Society (800-ACS-2345; www.cancer.org),
Rash From Tarceva Question I have a rash from Tarceva that looks like acne. Should I use acne products on it to make it go away? Ursina Teitelbaum, MD, Medical Oncologist at Penn Medicine responds: The rash from Tarceva can be an odd rash - both oily and dry - so you have to be careful with traditional over the counter acne medications. I would ask your
Weight loss and Pancreatic Cancer Question Could you discuss weight loss and pancreatic cancer? Lauren Ginipro, Registered Dietician at Penn Medicine responds: Pancreatic patients often have difficulty with early satiety and loss of appetite which in turn results in weight loss. Typically we promote small, nutrient-dense meals throughout the day. If you experience early satiety
"Warning Signs" of Pancreatic Cancer Question My grandfather was just diagnosed with metastatic pancreatic cancer. He was feeling completely fine until just few weeks ago. We are all so surprised by this. Could there have been any "warning signs" or test that could have been done before the cancer got to this point? Ursina Teitelbaum, MD, Medical Oncologist at Penn Medicine
Help Finding Resources During Cancer Treatment Question If my cancer center doesn't have a social worker, who can help me with financial concerns, insurance problems, co-pay assistance? Answer Christina Bach, Oncology Social Worker at Penn Medicine responds: You can access assistance with coping with financial concerns, insurance problems and co-pay assistance from a variety of
Hospice Care for Pancreatic Cancer Question My wife was just diagnosed with metastatic pancreatic cancer. There are no options for treatment and the doctor is recommending hospice. Can you help us find some resources for dealing with this and how we tell our family? Ursina Teitelbaum, MD, Medical Oncologist at Penn Medicine responds: I have many patients that live longer with
The Effects of Chemotherapy and Radiation Therapy Given Together Question My doctor wants me to take chemo and radiation at the same time. Won't this make me too sick? Answer Ursina Teitelbaum, MD, Medical Oncologist at Penn Medicine responds: When we deliver chemo-radiotherapy, the chemotherapy is dosed lower than we treat with chemotherapy alone. My patients have very few side effects attributable to the
Estate Planning and Legal Advice During Cancer Question Where can I go for help with legal issues in terms of estate planning and making sure my family is taken care of when I die? Answer Christina Bach, Oncology Social Worker at Penn Medicine responds: It is important to think about advance care planning early on in your cancer journey. Talk to an attorney who specializes in estate
Pancreatic Cancer and Family History Question I've heard that pancreatic cancer is rare. If that is true, what are the odds that I would have two relatives who both passed away from this disease? Answer Ursina Teitelbaum, MD, Medical Oncologist at Penn Medicine responds: Pancreas cancer is not among the most common cancers (breast, lung, prostate, and colon) but it is among the
Diabetes After Pancreatic Cancer Question If I have pancreatic cancer, will I have diabetes? Answer Ursina Teitelbaum, MD, Medical Oncologist at Penn Medicine responds: Some patients develop diabetes after pancreatic surgeries but usually only if they have had a total pancreatectomy. There are a certain population of patients that might be predisposed, that do develop
Finding Support for Kids During Cancer Treatment Question How can I help my kids deal with their dad's illness? Some say to keep things as normal as you can, but I feel nothing is "normal" anymore. Answer Christina Bach, Oncology Social Worker at Penn Medicine responds: I know it is really hard to maintain normalcy after a cancer diagnosis---especially with your children. I talk to my
Daily Radiation Question Why do I have to come in everyday for radiation? Can't it be more spaced out? Answer Ursina Teitelbaum, MD, Medical Oncologist at Penn Medicine responds: Radiation requires daily visits with an absolute minimum of interruptions to acheive its goal of cell death - it tackles the tumors cell cycle and blocks ability to grow and
What To Say To Family Members With Cancer? Question If a member of my family has pancreatic cancer, what should I do? I feel so worthless. I want to help, but don't know what to do or say. Please help. Answer Ursina Teitelbaum, MD, Medical Oncologist at Penn Medicine responds: The question regarding a family or friend with cancer is a very important one as well and I really appreciate
Are my Kids at Risk for Colon Cancer? Question I am 43 years old and was recently diagnosed with stage III colon cancer. Are my kids or other family members at risk for colon cancer since I am so young? How do I know if they should have genetic testing? Answer Liz Prechtel-Dunphy, Oncology Nurse Practitioner at Penn Medicine responds: Being diagnosed with colon cancer at a young
Making a Survivorship Care Plan Question Now that I completed chemotherapy for my cancer, I am nervous to not have as much contact with my oncology team. What should I know about being a "survivor" and what to look for that would be concerning? Answer Carolyn Vachani, RN, MSN, AOCN OncoLink Nurse Educator responds: It is not uncommon to have feelings of uncertainty when you
Chemotherapy Safety at Home Question I am taking chemotherapy (5-FU) via a pump connected to my port at home. What should I know about safety regarding having chemotherapy at home? Answer Gloria DiLullo, Oncology Nurse Practitioner at Penn Medicine responds: Many people receive this type of chemotherapy at home. Most pumps are pretty sophisticated and will alarm to let
Is 5FU Safe for Cardiac Patients? Question My mother is in her late 60s and has had heart problems in the past. Is it safe for her to get 5-FU for colon cancer treatment? Answer Liz Prechtel-Dunphy, Oncology Nurse Practitioner at Penn Medicine responds: There is no contraindication to 5-FU treatment in patients with heart disease. Patient's can experience angina like symptoms
Life after Stomach Cancer Question Are there any long term concerns of having your stomach removed for stomach cancer? Answer Carolyn Vachani, RN, MSN, AOCN OncoLink Nurse Educator responds: You can create a survivorship care plan to learn more at: www.livestrongcareplan.org Removal of all (gastrectomy) or part of the stomach (partial gastrectomy) leads to changes in
Helping your Children Cope During your Cancer Treatment Question Could you help us find some resources for support for our children to help them deal with my wife's cancer diagnosis? Answer Christina Bach, Oncology Social Worker at Penn Medicine responds: Being a well prepared parent is an important part of your family's coping with your wife's cancer diagnosis. The first advice I can give is to
African Americans should have Colonoscopy Screening at a Younger Age Question I recently heard that the screening age for African Americans to get a colonoscopy is starting at age 45. Why is it not 50 like other people? Answer Carolyn Vachani, RN, MSN, AOCN OncoLink Nurse Educator responds: African Americans are diagnosed with colorectal cancer at a younger age than other ethnic groups, and African- Americans
Treatment Options for Stage II Colon Cancer Question I was diagnosed with a stage II colon cancer. I am really just ok with only surgery? How can my doctor be sure I don't need chemotherapy or radiation? Answer Liz Prechtel-Dunphy, Oncology Nurse Practitioner at Penn Medicine responds: Most often in patients with stage II colon cancer, chemotherapy is not recommended. The oncologists
Dietary Recommendations after Esophageal Cancer Treatment Question My husband is undergoing treatment for esophageal cancer and is losing a lot of weight. He barely has an appetite and finds it hard to eat when he does want something. Can you please give us some suggestions for nutrition? Katrina Claghorn, Registered Dietician at Penn Medicine responds: Unfortunately loss of appetite often occurs with
Cancer Treatment and Workplace Disclosure Question Do I have to notify my employer about my cancer diagnosis? I am worried about losing my job. Christina Bach, Oncology Social Worker at Penn Medicine responds: You are not legally obligated to inform your employer of your cancer diagnosis. If you are applying for FMLA coverage (which protects your job for up to 12 weeks), you will need
Retrograde Ejaculation after Radiation for Rectal Cancer Question My doctor said that a side effect of radiation for rectal cancer is retrograde ejaculation. What does this mean? Will it hurt me? Will it go away? Answer Bruce Giantonio, MD, Medical Oncologist at Penn Medicine responds: That is a good question. Retrograde ejaculation means that when you have an orgasm, instead of the sperm and other
"Dumping Syndrome" after Surgery Question Can you help me better manage "dumping syndrome?" I have had such a hard time with eating after my stomach cancer surgery. Do certain foods make it worse? Is this going to be a permanent problem? Answer Katrina Claghorn, Registered Dietician at Penn Medicine responds: Dumping Syndrome is usually a temporary problem experienced after
Dry Mouth during Cancer Treatment Question I have such dry mouth. What can you recommend to help me with this? Sometimes it is so hard just to chew my food and get it down. Answer Patricia Dooley, Associate Director of the Division of Speech Language Pathology at Penn Medicine, responds: There are many different things that you can do to relieve dry mouth. One way is by using
Side Effects of Smoking and Drinking during Treatment Question The doctor said my husband has to stop smoking and drinking or it could make his side effects worse. Is this true? If so, how do I get a guy who has smoked for over 25 years and also drinks alcohol to quit? Is it true that smoking can increase the side effects of cancer treatment? Answer Alexander Lin, MD, Radiation Oncologist at Penn
Risks of developing Lymphodema Question My doctor told me I am at risk to get lymphedema because of them taking out so many lymph nodes in my neck, how can I prevent myself from getting this? Answer Carolyn Vachani, RN, MSN OncoLink Nurse Educator at Penn Medicine, responds: Unfortunately, although there are some things that can be done to reduce one's risk, there is no
Feeding Tubes During Treatment Question Why do I need to get a feeding tube before I even start treatment? Can't I just wait and see how it goes? Answer Valaree Williams MS RD LDN, Clinical Dietitian Specialist, Department of Radiation Oncology at Penn Medicine, responds: Adequate nutrition before, during, and after treatment is essential. Based on the individual's
Issues with Swallowing During Treatment Question I have a lot of trouble swallowing and feel like there is a lump in my throat. What can I do about this? Answer Patricia Dooley,Associate Director of the Division of Speech Language Pathology at Penn Medicine, responds: If you are having difficulty with swallowing, I would suggest talking to your doctor about your symptoms. A
Chemotherapy and Pharyngeal Cancer Question Is it safe to go to a dentist when I am getting radiation or chemotherapy for pharyngeal cancer? Will my dentist know what to do or even want to see me? Answer Alexander Lin, MD, Radiation Oncologist at Penn Medicine, responds: We recommend seeing a dentist prior to starting chemotherapy and radiation. The known side effects of
Effects on the Tongue after Surgery Question Since my surgery, I feel like my tongue gets in the way of me speaking. Can you help me with this? Answer Patricia Dooley, Associate Director of the Division of Speech Language Pathology at Penn Medicine, responds: I would suggest an evaluation by a speech pathologist to determine the reason why your speech is affected. Oral
Simulation for Radiation Therapy Question What is "simulation" for radiation therapy mean? Is it painful? How long with this take? Answer Alexander Lin, MD, Radiation Oncologist at Penn Medicine, responds: Simulation is simply the acquisition of a scan (such as a CT scan or PET/CT scan). These images are used by your radiation oncologist to identify areas which need to be
Effects on the Arms after Neck Surgery Question How can the surgery I had on my neck affect my arm? I feel such tightness and have trouble raising my arm like I did before? Is there anything I can do about this? Answer Alexander Lin, MD, Radiation Oncologist at Penn Medicine, responds: In an effort to remove the cancer from your neck in a neck dissection, one of the nerves which
Chemotherapy and Radiation at the Same Time for Laryngeal Cancer Question I have to have chemotherapy and radiation at the same time for laryngeal cancer. Why do them at the same time (seems like it will be pretty hard) and why is this done before my surgery? Answer Alexander Lin, MD, Radiation Oncologist at Penn Medicine, responds: A large study has shown that chemotherapy and radiation, given at the same
Dangers of Extended Radiation Treatment Question My sister is getting radiation every day- well, supposed to be- but at least once a week or more she takes a day off. Is this harmful? Answer Alexander Lin, MD, Radiation Oncologist at Penn Medicine, responds: Yes. All efforts should be made to avoid treatment delays or interruptions. For each day that radiation is extended due to
Dry Skin and Radiation Question I have very dry skin on the side of my face/neck where I had radiation. What kind of lotion can I use on this that would actually help? Answer Alexander Lin, MD, Radiation Oncologist at Penn Medicine, responds: As long as the area is completely healed, you might find a mild lotions such as Eucerin to be of help. If in doubt, feel free
Disfigurement after Throat Cancer Surgery Question Can you help me cope with the disfigurement I have and feel after surgery for throat cancer? I know I should be grateful to have made it this far, but I am having a hard time thinking of myself looking like this and I am afraid of how my husband feels looking at me. Answer Tracy Lautenbach MSW, LCSW, Oncology Social Worker at Penn
Nutritional Supplements Drinks after Radiation Question My husband has trouble with thick secretions after radiation, but also we are trying to maintain his weight. People had suggested Boost, but I am worried that" a milk-like product" will only make things thicker. Are there other options? Answer Valaree Williams MS RD LDN, Clinical Dietitian Specialist, Department of Radiation Oncology
Thyroid Issues after Radiation Question How can radiation for my throat cancer affect my thyroid? What should I do to make sure I don't have a thyroid problem after treatment? Answer Alexander Lin, MD, Radiation Oncologist at Penn Medicine, responds: Radiation, when delivered to the neck, can often lead to impaired thyroid function (hypothyroidism). In fact, some studies
Swallowing and Thick Liquids Question My sister was told to have only thick liquids to prevent her from choking since she can't swallow correctly. Wouldn't it be harder to swallow thick things than water or soup? Answer Patricia Dooley, Associate Director of the Division of Speech Language Pathology at Penn Medicine, responds: For some patients, based on the cause of the
Trouble Swallowing after Treatment Question I have an appointment with a speech and swallowing person next week in the hopes of getting help with my trouble swallowing since treatment for pharynx cancer. Can you give me some idea of what they can do for me or what to expect? Answer Patricia Dooley, Associate Director of the Division of Speech Language Pathology at Penn Medicine,
HPV and Head and Neck Cancers Question How does HPV virus cause cancers of the head and neck areas? How can you protect yourself from HPV? Answer Alexander Lin, MD, Radiation Oncologist at Penn Medicine, responds: HPV infection leads to development of head and neck cancer, usually decades after the initial HPV infection. Your body clears the HPV infection, but HPV leaves a
Cancer Remission Question My doctor told me there is a chance that my cancer could come back. Will I have to get radiation and chemotherapy again? Answer Patricia Dooley, Associate Director of the Division of Speech Language Pathology at Penn Medicine, responds: If cancer returns in a previously radiated area, the best treatment, ideally, would be surgery. If
Mucus after Radiation Treatment Question Can you give any tips to dealing with the thick mucus I have after radiation for oral cancer? It has been 6 weeks and the mucous does not seem to be getting any better. Answer Valaree Williams MS RD LDN, Clinical Dietitian Specialist, Department of Radiation Oncology at Penn Medicine, responds: Adequate hydration using decaffeinated
IMRT vs Traditional Radiation Question Is there a benefit with IMRT versus traditional radiation therapy for head and neck cancer patients? I have met with 2 radiation oncologists with different approaches and wondering how to know which one is better for me? Answer Alexander Lin, MD, Radiation Oncologist at Penn Medicine, responds: It depends on the area that needs to be
Communicating after Surgery Question I am so self-conscious about talking to people because of how I look after my surgery. I even feel like I can't communicate right in terms of my facial expressions. Can you help me deal with this? Answer Tracy Lautenbach MSW, LCSW, Oncology Social Worker at Penn Medicine, responds: Your "new normal" since your surgery may take some
Mouth Sores after treatment Question How can I prevent mouth sores or treat it before it gets too bad? Answer Alexander Lin, MD, Radiation Oncologist at Penn Medicine, responds: The development of mouths sores may be inevitable, especially if areas in the mouth need to be irradiated due to cancer involvement. Strategies to minimize mouth sores include minimizing the
Eating after Treatment Question Will I ever be able to eat normal food again and not have to worry about it getting stuck? Answer Valaree Williams MS RD LDN, Clinical Dietitian Specialist, Department of Radiation Oncology at Penn Medicine, responds: Your tolerance and ability to eat a variety of foods will likely improve over time after treatment. You may find a
Pain Management during Treatment Question I am getting chemo & radiation. Should I tough it out with the pain during treatment? I'm afraid to start taking pain killers. Answer Alexander Lin, MD, Radiation Oncologist at Penn Medicine, responds: You should not "tough it out." There are many forms of therapy we can employ during therapy to minimize pain. By minimizing pain,
Stopping Neurontin and Oxycontin Question My pain is improving. I am on neurontin and oxycontin. How do I stop them- slowly, one at a time, etc? Answer Erin McMenamin MSN, CRNP, Oncology Nurse Practitioner on the Head & Neck Cancer Team at Penn Medicine, responds: If your pain is decreasing, you should talk to the doctor/nurse about decreasing the opioid (oxycodone)
Housing Resources during Treatment Question I live 100 miles from the radiation facility where I am going to be treated. Are there resources to help me with cost or housing or something? Answer Tracy Lautenbach MSW, LCSW, Oncology Social Worker at Penn Medicine, responds: Check with the American Cancer Society at www.cancer .org or 1-800-ACS-2354 to inquire about a Hope Lodge
Appetite during Treatment Question Do you have any tips for helping my husband improve his appetite while on treatment? Answer Tracy Lautenbach MSW, LCSW, Oncology Social Worker at Penn Medicine, responds: To promote appetite it is important to create and follow a meal schedule with small, frequent meals/snacks every 2-3 hours. Treat your food like medicine and do not
Ringing in the Ears after Treatment Question Since getting treatment for my cancer, I have ringing in the ears. Is there anything that will make this go away? Answer Alexander Lin, MD, Radiation Oncologist at Penn Medicine, responds: Platinum-based chemotherapy can cause ringing in the ears. If you are receiving this type of chemotherapy currently, you may want to discuss your
Dangers of extended radiation treatment Question My sister is getting radiation every day- well, supposed to be- but at least once a week or more she takes a day off. Is this harmful? Answer Alexander Lin, MD, Radiation Oncologist at Penn Medicine, responds: Yes. All efforts should be made to avoid treatment delays or interruptions. For each day that radiation is extended due to
Removal of Voice Box after Laryngeal Cancer Surgery Question If I have surgery for laryngeal cancer and my voice box is taken out, how can I talk again? Is it true that my voice will be different? Answer Patricia Dooley,Associate Director of the Division of Speech Language Pathology at Penn Medicine, responds: If the entire voice box is removed, called a total laryngectomy surgery, you will
Which Patients With Neuroendocrine Tumors Should Have Genetic Testing? Question What are the criteria for referral to a genetic counselor for genetic testing in the presence of NETs? Who should be tested? Answer Shana Merrill, CGC, Genetic Counselor at Penn Medicine responds. First, I would like to note that sometimes people see a genetic counselor for evaluation and do not have genetic testing if it's not
Family Genetic Testing in the Presence of MEN Syndrome Question If a family member has a known MEN-1 syndrome, what is the recommended testing and screening for other family members? And what constitutes "family"- first degree, second, etc? Answer Shana Merrill, CGC, Genetic Counselor at Penn Medicine responds. If a person or family member has known, clear MEN-1 then they should seek genetic
Interventional Radiology Procedures for Bone Metastases Question Can interventional radiology do anything for bone mets in NETs? Answer Ginna Deitrick, CRNP, MSN, Nurse Practitioner for Interventional Radiology at Penn Medicine responds. IR can sometimes treat bone metastases. It depends on the location and nature of the bony lesion. For example, if there is an isolated right rib lesion that is
Alcohol Use and Carcinoid Question Can a person with carcinoid drink alcohol? Answer Nevena Damjanov, MD, Medical Oncologist at Penn Medicine responds. Alcohol is not recommended for people who have underlying liver disease, or people who are receiving active treatment of their carcinoid. In people who had all of their disease removed, an occasional drink may be well
Chemoembolization for Liver Metastases Question How does chemoembolization work for liver disease? What are the requirements to be eligible for this? Answer Ginna Deitrick, CRNP, MSN, Nurse Practitioner for Interventional Radiology at Penn Medicine responds. Chemoembolization (TACE) works by directly treating the tumors within the liver via the hepatic artery with an infusion of
Preparation for 5-HIAA Testing Question What are the "rules" to prepare for a 5-HIAA urine test? Foods you can't eat, etc. And do these also apply to the blood test? Answer Ginna Deitrick, CRNP, MSN, Nurse Practitioner for Interventional Radiology at Penn Medicine responds. For 24 hour 5-HIAA we tell patients to avoid the following foods 5 days before completing the test:
Do All Carcinoid Tumors Cause Symptoms Question If you don't have symptoms like flushing, diarrhea or rapid heartbeat does that mean you likely do not have a carcinoid tumor? Answer Ginna Deitrick, CRNP, MSN, Nurse Practitioner for Interventional Radiology at Penn Medicine responds. No, not all carcinoid tumors secrete the hormones that cause the "classic" neuroendocrine symptoms.
Use of Octreoscan in Neuroendocrine Tumor Diagnose and Treatment Question How is octreoscan used in the diagnosis of NETs? Is it also used to monitor response during treatment? Answer Nevena Damjanov, MD, Medical Oncologist at Penn Medicine responds. The OcteroScan is used to evaluate the full extent of spread of a tumor that is likely to have octreotide receptors on its surface. Some people have NE tumors
Online Resources for Neuroendocrine and Carcinoid Information Question What are some online resources for patients? Answer Gloria DiLullo, Nurse Practitioner at Penn Medicine responds. Carcinoid Cancer Foundation: www.carcinoid.org Caring for Carcinoid Foundation: www.caringforcarcinoid.org NET Alliance: www.thenetalliance.com Carcinod Link: www.carcinoid.com North American
Safety After Octreotide Scan Question After octreoscan, are there safety precautions because of the radiation used? Answer Katie Fanslau, RN, MSN, Nurse in Nuclear Medicine at Penn Medicine responds. After an Octreotide scan there are no radiation safety precautions to follow. There is only enough radiation given to perform imaging. This question and answer was part of
Are Carcinoid & Neuroendocrine the Same? Question Can carcinoid and neuroendocrine tumor be used interchangeably? Or is one not always the other or something? Answer Katie Fanslau, RN, MSN, Nurse in Nuclear Medicine at Penn Medicine responds. There are a several different types of NETs (Neuroendocrine Tumors). So Carcinoid is a type of NET, but not all NETs are carcinoid. Other types
Neuroendocrine Tumors and Niacin Supplements Question What are your recommendations regarding niacin supplements? Should you take them if you have NETs, if so, how much? Answer Nevena Damjanov, MD, Medical Oncologist at Penn Medicine responds. Niacin supplements are used to treat pellagra, a disease caused by severe niacin deficiency. Some people with carcinoid develop niacin deficiency
Radioactivity After Nuclear Medicine Tests Question For procedures in nuclear medicine or Interventional radiology where radioactive dyes or beads are used/injected, does that make a person radioactive? What precautions should be taken and for how long? Answer Katie Fanslau, RN, MSN, Nurse in Nuclear Medicine at Penn Medicine responds. Yes, the injections in nuclear medicine make you
Is Pregnancy Safe for Women with Carcinoid on Somatostatin (Octreotide) Question Can a woman with carcinoid ever become pregnant? Is somatostatin safe during pregnancy? Answer Carolyn Vachani, RN, MSN, AOCN OncoLink Nurse Educator responds. Octreotide is not thought to be harmful to an unborn baby. However, you should talk to your doctor if you are pregnant or plan to become pregnant during treatment. Using
Finding Expert Care Question Are their specialists that can see patients or take a look at previous scans? My mom was told there isn't any because it was so rare so they continue with CT scans and urine analysis every 3 months. Answer Katie Fanslau, RN, MSN, Nurse in Nuclear Medicine at Penn Medicine responds. At Penn, our radiologists review outside films and
Does Chemoembolization Work? Question Is there usually a good response from having a chemoembolization? How long should you wait to get a scan after having it done? Answer Ginna Deitrick, CRNP, MSN, Nurse Practitioner for Interventional Radiology at Penn Medicine responds. Both chemoembolization (TACE) and SIRSpheres embolization are equally effective in treating carcinoid
Chromagranin A Blood Test Question When is chromagranin A used? Is there any preparation for this test? Answer Nevena Damjanov, MD, Medical Oncologist at Penn Medicine responds. The chromogranin A blood test is used to monitor neuroendocrine tumors that secrete chromogranin A. It is used in combination with imaging modalities as part of the physician's attempt to assess
Work Up of Suspected Carcinoid Tumor Question What tests are done to work up a suspected carcinoid tumor? Answer Bonnie Bennett, RN, Nurse in Gastroenterology at Penn Medicine responds. Lab tests ordered to look for carcinoid tumor are 24 hr urine 5HIAA and Chromogranin A. It depends upon the location of the suspected tumor as to what other tests and studies are ordered.
What is an MIBG Scan Question What is MIBG and how is it different than an OctreoScan? Answer Katie Fanslau, RN, MSN, Nurse in Nuclear Medicine at Penn Medicine responds. MIBG scans are also done in nuclear medicine and take 2 days to complete. MIBG is a different targeting agent attached to radiation to locate and assess neuroendocrine tumors. MIBG scans are done
Typical Carcinoid Versus Atypical Carcinoid Question What is typical versus atypical carcinoid- what is the difference and are they treated differently? Answer Nevena Damjanov, MD, Medical Oncologist at Penn Medicine responds. Typical carcinoid has a "typical" appearance when the pathologist looks at it under the microscope. Clinically, the person with typical carcinoid is likely to