For mesothelioma, many ways of treatment were performed by combining various methods. The most successful of these ways is “triple therapy” combination of surgical, chemotherapy and radiotherapy. In this way of treatment, the most significant element is to diagnose the disease in its early stage. Particularly, the method combination of high dose radiotherapy and chemotherapy with surgical has been most successful way of treatment for recovering patients.
An operation called as extrapleural pneumonectomy is performed in order to completely remove the tumor. Lining of the lung and entire lung affected in chest cavity (or thoracic cavity) and with diaphragm muscle and lung of the heart which touched with the lining of the lung are removed. In the last decade, reliability of operation has increased and risk of death (or mortality) after operation has dropped below 4% from about 10%. Considering that risk of death after open-heart surgery is 1-2%, the rate above-mentioned is quite high. By the end of the treatment, life expectancy of patients treated in USA increased above 2 years and it was seen a long lifetime period in a certain part of patients. In a study carried out in collaboration with Marmara University and Osmangazi University in Turkey, 4 year disease-free survival was observed in patients treated by the following protocol.
Triple therapy takes a total of six months. At first the operation is performed and after a month radiotherapy begins, which will take 2 months. After the radiotherapy, the patient rest for a month and chemotherapy is performed for 2 months. Completing all three treatment periods is essential to ensure adequate achievement against the disease.
Friday, August 20, 2010
Thursday, August 19, 2010
Selective targeting of neuroblastoma tumour-initiating cells
Selective targeting of neuroblastoma tumour-initiating cells by compounds identified in stem cell-based small molecule screens by Kristen M Smith and 16 co-authors, including David R Kaplan, EMBO Mol Med 2010(Aug 18) [Epub ahead of print][Full text]. Abstract:
Neuroblastoma (NB) is the most deadly extra-cranial solid tumour in children necessitating an urgent need for effective and less toxic treatments. One reason for the lack of efficacious treatments may be the inability of existing drugs to target the tumour-initiating or cancer stem cell population responsible for sustaining tumour growth, metastases and relapse. Here, we describe a strategy to identify compounds that selectively target patient-derived cancer stem cell-like tumour-initiating cells (TICs) while sparing normal paediatric stem cells (skin-derived precursors, SKPs) and characterize two therapeutic candidates. DECA-14 and rapamycin were identified as NB TIC-selective agents. Both compounds induced TIC death at nanomolar concentrations in vitro, significantly reduced NB xenograft tumour weight in vivo, and dramatically decreased self-renewal or tumour-initiation capacity in treated tumours. These results demonstrate that differential drug sensitivities between TICs and normal paediatric stem cells can be exploited to identify novel, patient-specific and potentially less toxic therapies.See also: New Twist on Drug Screening to Treat Common Childhood Cancer, ScienceDaily, August 18, 2010. Excerpt:
A study led by scientists at The Hospital for Sick Children (SickKids) reveals a new method of identifying drugs to treat children suffering from fatal cancers for which an effective treatment has not been found. Rather than developing a new drug from scratch, which is a complicated and time-consuming process, they tried a different approach: in the lab, they tested existing drugs on cancer stem cells from young patients with neuroblastoma, one of the common cancers of infants and children.A related blog post is: High-throughput cancer stem cell-based screening assay for therapeutic compounds by Alexey Bersenev, Stem Cell Assays, August 19, 2010 [FriendFeed entry].
Bone scan saga
Bone scans have been a regular part of my cancer experience since the day I broke my leg in 2002. I don't remember that one (I was sedated) but usually they go something like this:
1) Have port accessed by specially trained nurses at Swedish Cherry Hill Ambulatory Infusion Center
2) Go to bone scan location in hospital basement and receive injection of radioactive dye
3) Head back upstairs to have port de-accessed
4) Drink lots of water, get a snack and amuse myself for a couple of hours
5) Return to bone scan location
6) Use the toilet and
7) Lie on scanner bed, get strapped in and covered with warm blankie for bone scan (duration about 60 minutes)
Luckily, they always let me listen to music during the bone scan. Before the days of iPods I brought CDs; now I just set the iPod to "shuffle" and enjoy random music for the duration.
Yesterday's bone scan was at Seattle Nuclear Medicine, not at Swedish's Cherry Hill location. SNM has some fancy, new machine that can read your bone scan after less than an hour's wait.
People who don't have ports must have an intravenous line started by a technician. I wanted to use my port but never heard back from the doctor's office to see if they had arranged for the Swedish Cancer Institute (in the building next door) to access it. As I sat down in the chair for the tech to start a line, my cell phone rang: yes, I could get my port accessed.
Well, I was already at the bone scan building, and I will let anyone try to start an IV line once, so I asked to lie down for the experience. Sure enough, my vein collapsed as the tech was trying to start the IV. That was it, I told him to stop and that I wanted to have my port accessed. He was a good technician; he listened to me. I walked over to the Cancer Institute.
After a 30 minute wait, a nurse was available to access my port. She did, I headed back to SNM, and received my radioactive contrast injection. Come back in 45 minutes.
I walked back to the Cancer Institute, which was extremely busy. I suggested to the receptionist that I could return after my bone scan. I went out on the street, found a new crepe place that had been open only three days, and had a freshly-made crepe with bananas, strawberries, Nutella and (sadly) fake whipped cream. I drank a huge glass of water.
Back to SNM. I went straight back to the bone scan room, used the toilet, took off my glasses and shoes and tried to get comfy on the narrow scanner bed. I wear an eye mask for these scans, so I can't see how close my nose is to the scanner ceiling. This scanner was in the shape of a CT machine, like a donut with a hole in the center, so less claustrophobic than others.
I put in my earphones and set my iPod to shuffle. The tech strapped my arms to my sides, covered me with a warm blanket and started the scan.
I actually fell asleep for the first 20 minutes. But after what felt like an hour, I really had to pee again, my back hurt from lying on the scanner bed and I was beginning to get really uncomfortable. I called out "How much longer?" and was told three more minutes.
Those last three minutes felt like another thirty. I had to pee. I wanted to move, or at least wiggle. My back ached. I had to pee! I asked again, how much longer, and heard back "only a minute and 30 seconds." Believe me, I sweated out those last 30 seconds.
The tech released me and I ran into the bathroom. I got dressed and headed back to the Cancer Institute, where all was quiet and a nurse de-accessed my port immediately.
Of course, I got stuck in rush hour traffic on the way home. Total elapsed time, door to door? Four and a half hours. Total aggravation? Extreme. From my doctor's office not calling to tell me he had written orders to get my port accessed, to the collapsed vein, the walking back and forth between buildings and the hour-plus scan duration, this was an afternoon from hell. I was so exhausted I fell asleep for an hour on the sofa.
This is one day in my life in Cancer Land.
1) Have port accessed by specially trained nurses at Swedish Cherry Hill Ambulatory Infusion Center
2) Go to bone scan location in hospital basement and receive injection of radioactive dye
3) Head back upstairs to have port de-accessed
4) Drink lots of water, get a snack and amuse myself for a couple of hours
5) Return to bone scan location
6) Use the toilet and
7) Lie on scanner bed, get strapped in and covered with warm blankie for bone scan (duration about 60 minutes)
Luckily, they always let me listen to music during the bone scan. Before the days of iPods I brought CDs; now I just set the iPod to "shuffle" and enjoy random music for the duration.
Yesterday's bone scan was at Seattle Nuclear Medicine, not at Swedish's Cherry Hill location. SNM has some fancy, new machine that can read your bone scan after less than an hour's wait.
People who don't have ports must have an intravenous line started by a technician. I wanted to use my port but never heard back from the doctor's office to see if they had arranged for the Swedish Cancer Institute (in the building next door) to access it. As I sat down in the chair for the tech to start a line, my cell phone rang: yes, I could get my port accessed.
Well, I was already at the bone scan building, and I will let anyone try to start an IV line once, so I asked to lie down for the experience. Sure enough, my vein collapsed as the tech was trying to start the IV. That was it, I told him to stop and that I wanted to have my port accessed. He was a good technician; he listened to me. I walked over to the Cancer Institute.
After a 30 minute wait, a nurse was available to access my port. She did, I headed back to SNM, and received my radioactive contrast injection. Come back in 45 minutes.
I walked back to the Cancer Institute, which was extremely busy. I suggested to the receptionist that I could return after my bone scan. I went out on the street, found a new crepe place that had been open only three days, and had a freshly-made crepe with bananas, strawberries, Nutella and (sadly) fake whipped cream. I drank a huge glass of water.
Back to SNM. I went straight back to the bone scan room, used the toilet, took off my glasses and shoes and tried to get comfy on the narrow scanner bed. I wear an eye mask for these scans, so I can't see how close my nose is to the scanner ceiling. This scanner was in the shape of a CT machine, like a donut with a hole in the center, so less claustrophobic than others.
I put in my earphones and set my iPod to shuffle. The tech strapped my arms to my sides, covered me with a warm blanket and started the scan.
I actually fell asleep for the first 20 minutes. But after what felt like an hour, I really had to pee again, my back hurt from lying on the scanner bed and I was beginning to get really uncomfortable. I called out "How much longer?" and was told three more minutes.
Those last three minutes felt like another thirty. I had to pee. I wanted to move, or at least wiggle. My back ached. I had to pee! I asked again, how much longer, and heard back "only a minute and 30 seconds." Believe me, I sweated out those last 30 seconds.
The tech released me and I ran into the bathroom. I got dressed and headed back to the Cancer Institute, where all was quiet and a nurse de-accessed my port immediately.
Of course, I got stuck in rush hour traffic on the way home. Total elapsed time, door to door? Four and a half hours. Total aggravation? Extreme. From my doctor's office not calling to tell me he had written orders to get my port accessed, to the collapsed vein, the walking back and forth between buildings and the hour-plus scan duration, this was an afternoon from hell. I was so exhausted I fell asleep for an hour on the sofa.
This is one day in my life in Cancer Land.
more soup
Starring (in order of appearance): olive oil, onions, garlic, garam masala, chipotle powder, water, vegetable stock, brown lentils, tomatoes, yu choy sum (Chinese greens), lemon juice, ground coriander. Served with a dollop of yogurt.
Loosely based on a Lebanese lentil soup recipe from the Toronto Star. I was out of cumin so substituted the garam masala. Ditto on the chipotle powder instead of cayenne. Soup is spicy but very, very good (if I do say so myself).
Annual Coffee Group Picnic
Yesterday the breast cancer gals got together for our annual summer picnic. Instead of meeting at a dept store coffee shop, we entertained ourselves outside in J’s back yard. It was our 9th picnic in a row and we sure enjoyed it.
Each of the gals brought a little something to eat which made for a yummy combination. Spring rolls, dumplings, wraps, potato salad, pasta salad and yes once again we were honored with one of Erm’s amazing desserts. This time it was a three-layer cake filled with peaches and whipped cream. She said she worked on it till midnight … wow, thanks so much Erm. Once again it was most delicious.
J has a beautiful blooming back yard. Occasionally a squirrel or chipmunk or blue jay would make a visit to sneak one of the peanuts. There were the sounds of squirrels chirping and birds singing too. It was real pleasure to be there surrounded by nature right in middle of the city.
Ari, our mascot was feeling a bit left out, so we gave him an opportunity to romp around a bit too. He was a bit rambunctious but we loved every minute of it.
After dessert, we sat around sipping fresh perked coffee. We talked a bit about when we first met and narrowed it down to the fall of 2000. Officially, our coffee group didn’t start till January of 2001 when our support group at the clinic ended. Wow, that’s almost 10 years now. Just then J’s daughter came home. She was kind enough to take some group pictures of us and then she gave each of us a gift … a beautiful bag of seven healing stones. With these came a handmade card to describe the healing properties of each polished stone. What a thoughtful gift.
TRAM Flap vs DIEP Flap: What's the Difference?
Up until a few years ago, the TRAM flap was the gold standard in breast reconstruction after mastectomy. The TRAM has now been surpassed by the DIEP flap for that honor. For patient's researching their reconstructive options after mastectomy, it is important to understand the concept of TRAM surgery and how it has evolved into today's cutting edge DIEP procedure.
1) The Pedicled TRAM flap: this was the first operation to describe use of one of the rectus abdominus muscles (sit-up muscle) for breast reconstruction. The surgery begins with an incision from hip to hip. Then, the lower abdominal tissue below the belly button (skin, fat and one of the abdominal muscles) is tunneled under the upper abdominal skin to the chest to create a new breast.
Recovery from the surgery can be difficult and painful. Long-term, the patient has to adapt to the loss of some abdominal strength (up to 20%). As with any surgical procedure there is the possibility of complications. These include delayed healing, fat necrosis (part of the tissue turns hard due to poor blood supply), abdominal complications such as bulging and/or hernia, and loss of the reconstruction altogether (rare).
2) The Free TRAM flap: this procedure uses the same abdominal tissue as the pedicled TRAM except that the tissue ("flap") is disconnected from the patient's body, transplanted to the chest, and reconnected to the body using microsurgery. Advantages over the pedicled TRAM include: improved blood supply (and therefore less risk of healing problems and fat necrosis), and less muscle sacrifice (so the abdominal recovery is a little easier, potentially more strength is maintained long-term, and the risk of bulging and hernia formation is lower).
Since the tissue is disconnected and transplanted to the chest, there is also no tunneling under the skin as there is with the pedicled procedure and no subsequent upper abdominal bulge around the ribcage area (which is typically seen with tunneling).
3) The Muscle-Sparing Free TRAM flap: this operation is associated with all the benefits of the free TRAM but has significantly fewer abdominal complications and side-effects (pain, bulging, hernia, strength loss) because the vast majority of the abdominal muscle is spared and left behind. The amount of muscle taken is typically very small (postage-stamp size). We will opt for this version of the TRAM only in the rare event that the patient's anatomy does not allow for a DIEP or SIEA flap.
4) The DIEP flap: This is the most advanced form of breast reconstruction surgery available today. Like the muscle-sparing free TRAM, the DIEP uses the patient's own abdominal skin and fat to reconstruct a natural, soft breast after mastectomy. Unlike the TRAM however, all the abdominal muscle is preserved. Only abdominal skin and fat are removed similar to a "tummy tuck". Patients therefore experience less pain after surgery, enjoy a faster recovery and maintain their abdominal strength long-term. Since the abdominal muscles are saved, the risk of complications like abdominal bulging and hernia are also significantly lower. Please visit our gallery to view DIEP flap before and after photos.
*****
Dr Chrysopoulo is a board certified plastic surgeon specializing in the latest breast reconstruction techniques including DIEP flap surgery. He and his partners perform over 500 DIEP flap procedures per year and are In-Network for most US insurance plans. Learn more about your breast reconstruction options and connect with other breast reconstruction patients here. You can also follow Dr C on Twitter!
*****
Dr Chrysopoulo is a board certified plastic surgeon specializing in the latest breast reconstruction techniques including DIEP flap surgery. He and his partners perform over 500 DIEP flap procedures per year and are In-Network for most US insurance plans. Learn more about your breast reconstruction options and connect with other breast reconstruction patients here. You can also follow Dr C on Twitter!
*****
Wednesday, August 18, 2010
Therapeutic implications of colon CSCs
Therapeutic implications of colon cancer stem cells by Eros Fabrizi and 3 co-authors, including Lucia Ricci-Vitiani, World J Gastroenterol 2010(Aug 21); 16(31): 3871-7. OA review. [FriendFeed entry][PubMed citation]. Abstract:
Colorectal cancer is the second most common cause of cancer-related death in many industrialized countries and is characterized by a heterogenic pool of cells with distinct differentiation patterns. Recently, the concept that cancer might arise from a rare population of cells with stem cell-like properties has received support with regard to several solid tumors, including colorectal cancer. According to the cancer stem cell hypothesis, cancer can be considered a disease in which mutations either convert normal stem cells into aberrant counterparts or cause a more differentiated cell to revert toward a stem cell-like behaviour; either way these cells are thought to be responsible for tumor generation and propagation. The statement that only a subset of cells drives tumor formation has major implications for the development of new targeted therapeutic strategies aimed at eradicating the tumor stem cell population. This review will focus on the biology of normal and malignant colonic stem cells, which might contribute to our understanding of the mechanisms responsible for tumor development and resistance to therapy.
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