Cancer in Women

cervical cancer facts

cervical_cancerCervical cancer is the third most common cancer in women, with an estimated 529 828 new cases and 275 128 deaths reported worldwide in 2008. In developing countries, the age standardized mortality rate is 10/10 000—more than three times higher than in developed countries. However, cervical cancer still represents a major public health problem even in developed countries: 54 517 new cases of invasive cervical cancer are diagnosed in Europe every year and 24 874 women die of this disease.

It is common knowledge that the most important cause of cervicalcancer is persistent papillomavirus infection. The human papillomavirus (HPV) is detected in 99% of cervical tumors, in particular the oncogenic subtypes such as HPV 16 and 18. While PAP smears are used in the classical primary screening technique, HPV DNA testing, introduced in 2008, is well diffused in developed countries and is taking off in developing countries with a potentially significant reduction in the numbers of advanced cervical cancers and deaths.

diagnosis and pathology/molecular biology

Squamous cell carcinomas account for ∼70%–80% of cervical cancers and adenocarcinomas for 10%–15%. Early cervical cancer is often asymptomatic while locally advanced disease could cause symptoms including abnormal vaginal bleeding, also after coitus, discharge, pelvic pain, and dyspareunia. Some early cancers are not appreciable and even deeply invasive tumors may be somewhat deceptive on gross examination. If examination is difficult or there is uncertainty about vaginal/parametrial involvement, this should be done under anesthesia together with a radiotherapist. Papillary tumors are more commonly adenocarcinomas.

primary treatment

Depending on stage, primary treatment consists of surgery, radiotherapy, or a combination of radiotherapy and chemotherapy. Definitive radiation therapy should consist of pelvic external beam radiation with high-energy photons and intracavitary brachytherapy, and must be administered at high doses (>80–90 Gy) and in a short time (<55 days), with the best technological resources available.

stage IA1 to IA2

Stage IA1 cervical cancer can be managed conservatively to preserve fertility, with conization without lymphadenectomy, because the risk of nodes metastasis is <1%. The cone’s margins must be free of disease. If a nonfertility-preserving therapy hysterectomy is performed, ovaries need not be removed.

Stage IA2 with no LVSI can be treated by conization (if fertility is to be preserved) or extrafascial hysterectomy. In case of LVSI pelvic lymphadenectomy is indicated with radical trachelectomy or radical hysterectomy. In patients with surgical contraindication, brachytherapy may represent an alternative option.

stages IB1 to IIA1

Stages IB and IIA cervical carcinoma can be cured by radical surgery including pelvic lymphadenectomy or radiotherapy. The two procedures are equally effective, but differ in terms of morbidity and type of complications.

In the only randomized trial directly comparing radical hysterectomy and radiation therapy, the rate of severe morbidity was 28% in the surgery group and 12% in the radiotherapy group.  There is no published evidence that concurrent chemoradiation would be useful in patients with early cervical cancer (stages IB1 and IIA <4 cm). Fertility-preserving surgery consisting of radical trachelectomy or conization with/without chemotherapy can be offered to young patients with early-stage cervical cancer wishing to preserve their fertility (level of evidence IV).

stages IB2 to IVA

chemoradiation and adjuvant treatment

Historically, radiotherapy has been the mainstay in the treatment of locally advanced cervical cancer, with a local control rate ranging between 88% and 95% for stage IB, 70%–80% for stage IIB, and 30%–40% for stage III and 5-year survival >80% for stage IB, 65% for stage IIB, and 40% for stage III. Optimal radiation therapy, consisting of high doses (80–90 Gy to the target) administered over a short time (<50–55 days), significantly impacts on outcome.

One recent study seems to indicate a significant benefit for the use of adjuvant chemotherapy following chemoradiation with great improvement in progression-free survival and overall survival.

management of advanced/metastatic disease

Patients with metastatic or recurrent cervical cancer are commonly symptomatic. The role of chemotherapy in such patients is palliative, with the primary objective to relieve symptoms and improve quality of life.

No definitive agreement exists on the best post-treatment surveillance. A clinical visit with gynecological examination including PAP smear is usually performed every 3 months for the first 2 years, every 6 months for the next 3 years, and yearly thereafter. CT or PET/CT scan should be performed as clinically indicated.

The Lewis Law Firm has a history of representing women who are diagnosed with cervical cancer.  If you are in Philadelphia or New Jersey and you or a loved one have been diagnosed with cervical cancer contact the Lewis Law firm today for a FREE consultation.

Source: Annals of Oncology (Approved by the ESMO Guidelines Working Group: January 2008, last update July 2012.)

Cancer and Family History

cancer_family_treeResearchers in Milan, Italy have recently published their research in the Annals of Oncology. The study followed  some 12,000 patients with cancer at different sites in the body including bowel, pancreatic, liver, breast, ovarian, cervical and prostate cancer.

The patients were compared with approximately 11,000 people without the disease.

Researchers collected specific information on the family history of cancer, particularly in a first-degree relative -those who share about 50% of their genes (ie. a parent, sibling or child).

Among their findings were that men had a 3.4-fold increased risk of prostate cancer if a first-degree relative had bladder cancer and that woman had an increased risk of breast cancer if they also have a family history of bowel cancer.  They also confirmed the long-suspected associated risk of having the same type of disease as a near relative.

In some cases, the links may be due to shared environmental factors, such as family smoking and drinking habits, she said. But there was also evidence of genetic factors affecting multiple sites in the body.

Some easy take away’s from the study are that you can lower your risk, genetics notwithstanding by being a non-smoker, reducing alcohol consumption, remaining physically by being active and eating a more balanced diet.

This study was based on a network of Italian and Swiss case–control studies conducted between 1991 and 2009, and including more than 12 000 cases and 11 000 controls. They collected information on history of any cancer in first degree relatives, and age at diagnosis. Odds ratios (ORs) for Family History (FH) were calculated by multiple logistic regression models, adjusted for major confounding factors.  All sites showed an excess risk in relation to FH of cancer at the same site.

The Lewis Law Firm has a history of representing patients who are diagnosed with cancer.  If you are in Philadelphia or New Jersey and you or a loved one have been diagnosed with cancer contact the Lewis Law firm today for a FREE consultation.

Lung Cancer Research Continues

Source:  BBC Health News

Lung_Cancer_RibbonOne of the problems with lung cancer, other than its frequent late discovery, is that the cancer adapts and becomes resistant to chemotherapy treatments over time.  Once adaption occurs, there is no current treatment available and patients with the disease die.

Scientists across Britain are undertaking a mapping of the genes of the tumors of 850 lung cancer patients to understand more about the deadly disease.  The £14m research at six centres aims to find out how lung cancers become resistant to treatment; they are the most common cause of UK cancer death and one of the top 4 causes of cancer death in the US.

Scientific progress for lung cancer treatment has lagged behind that for other cancers – only 9% of patients survive beyond five years. Researchers in London, Leicester, Cardiff, Birmingham, Manchester and Aberdeen, will create a genetic profile of each patient’s tumour to study how the cancer changes and evades treatment. Patients with non-small-cell lung cancer patients, which make up about 78% of lung cancers diagnosed in England and Wales, will be recruited.

Lead researcher Prof Charlie Swanton, of Cancer Research UK’s London Research Institute and University College London, told BBC News: “The main hope will be a much better understanding of how non-small-cell lung cancer changes and adapts over time.” “And by understanding how it changes and adapts over time, I hope we’ll get a better insight into developing better therapeutics to stop those changes and adaptations from happening.” It is one of the largest studies of its kind.

Dr Harpal Kumar, Cancer Research UK’s chief executive, said research into lung cancer had been underfunded compared with other cancers, which was why the charity was now making it a research priority. “Typically we’re diagnosing lung cancer patients very, very late,” he said. “By which time their cancers are already very advanced, they’ve often already spread around the body and often that means that those patients are too ill to go onto a clinical study or for us to get access to a sample of their tumour on which we can then do research.

Dr Kumar said it was a myth that lung cancer was just a smoker’s disease as 2 out of every 10 lung cancers are unrelated to smoking.

“We mustn’t take our eyes off smoking,” he told BBC News. “We know that smoking causes a quarter of all cancer deaths not just lung cancer – of all cancer deaths. “So it is a problem that still needs to be tackled. But it is wrong to think that all lung cancer is caused by smoking.”

The Lewis Law Firm has a history of representing patients who are diagnosed with lung cancer.  If you are in Philadelphia or New Jersey and you or a loved one have been diagnosed with lung cancer contact the Lewis Law firm today for a FREE consultation.

Breast Cancer Surgery New Technology

Source: UC Irvine Health News, Making Breast Cancer Surgery More Precise;

breast-cancer-surgeryOne of the many problems facing breast cancer patients is weather their surgeon cut out all of the cancer in her breast during surgery. The goal in a lumpectomy is to completely remove the cancer while preserving as much normal breast tissue as possible. If a pathologist finds cancer cells on the edges of the tissue taken out, surgeons must assume the lumpectomy didn’t get the entire tumor. According to some statistics 30-60% of the time cancerous cells are found on the margins of the original cutting area, which require another surgery for the patient.

Using a sterile handheld probe and a portable console, surgeons at UC Irvine Medical Center are the first in the country to find a better way to get a definitive answer, the first time. When the probe tip touches an excised lumpectomy specimen, radio-frequency signals are transmitted into the tissue and reflected back to the console (think sonar), where they are analyzed using a specialized algorithm to determine tissue status. The MarginProbe System lets the surgeon immediately assess whether cancer cells remain on the margins of excised tissue. Currently, patients have to wait days for a pathologist to make the determination, assuming the pathologist gets it right.

“All of my patients know someone who has had to go back into surgery because their doctor didn’t get the entire tumor out,” said UC Irvine Health surgical oncologist Dr. Alice Police. “The ability to check tissue in the operating room is a game changer in surgery for early-stage breast cancer.” The US Food & Drug Administration (FDA) approved MarginProbe in December 2012, and UC Irvine Medical Center is the first hospital in the U.S. to employ the system, according to manufacturer Dune Medical Devices. Dr. Police, assistant professor of surgery at UC Irvine and medical director of Pacific Breast Care in Costa Mesa, and Dr. Karen Lane, associate professor of surgery and clinical director of the UC Irvine Health Breast Health Center in Orange, began operating with MarginProbe in early March.

They had participated in an FDA trial that included more than 660 women across the U.S. In the prospective, multicenter, randomized, double-arm study, surgeons applied the device to breast tissue removed during in-progress initial lumpectomies and, if indicated, shaved additional tissue on the spot. This was found to reduce by 56 percent the need for repeat surgeries.  “It will save you a lot of anxiety,” said Jane Madigan, a Costa Mesa resident who underwent the procedure with Police as part of the MarginProbe trial. “You will come out of that surgery knowing you are cancer-free.”

The Lewis Law Firm has a history of representing women who are diagnosed with breast cancer.  If you are in Philadelphia or New Jersey and you or a loved one have been diagnosed with breast cancer contact the Lewis Law firm today for a FREE consultation.

Breast Cancer Dense Breast Spread Risk

Sources: Nature Cell Biology, May 2013; Washington University School of Medicine, St. Louis

Promote Breast Cancer AwarenessBreast Cancer Spread (metastasis) risk is higher in women with dense breast tissue.  Researchers at Washington University School of Medicine in St. Louis have discovered why breast cancer patients with dense breasts are more likely than others to develop aggressive tumors that spread. This greater density is caused by an excess of a structural protein called collagen.

“We have shown how increased collagen in the breasts could increase the chances of breast tumors spreading and becoming more invasive,” says Gregory D. Longmore, MD, professor of medicine. “It doesn’t explain why women with dense breasts get cancer in the first place. But once they do, the pathway that we describe is relevant in causing their cancers to be more aggressive and more likely to spread.”

Working in mouse models of breast cancer and breast tumor samples from patients, Longmore and his colleagues showed that a protein that sits on the surface of tumor cells, called DDR2, binds to collagen and activates a multistep pathway that encourages tumor cells to spread. “We had no idea DDR2 would do this,” says Longmore. “The functions of DDR2 are not well understood, and it has not been implicated in cancer — and certainly not in breast cancer — until now.”

At the opposite end of the chain of events initiated by DDR2 is a protein with the unfortunate acronym of  “SNAIL1,” which has long been associated with breast cancer metastasis. Longmore and his colleagues found that DDR2 is one factor helping to maintain high levels of SNAIL1 inside a tumor cell’s nucleus, a necessary state for a tumor cell to spread. Though they found it is not the only protein keeping SNAIL1 levels high, Longmore says DDR2 is perhaps the one with the most potential to be inhibited with drugs. “It’s expressed only at the edge of the tumor,” says Longmore. “And it’s on the surface of the cells, which makes it very nice for developing drugs because it’s so much easier to target the outside of cells.”

The researchers emphasize that DDR2 does not initiate the high levels of SNAIL1. However, it is required to keep the level elevated. This mechanism that keeps tumor cells in a state that encourages metastasis requires constant signaling — meaning constant binding of DDR2 to collagen. If that signal is blocked, the cell remains cancerous, but it is no longer invasive. So a drug that blocks DDR2 from binding with collagen won’t destroy the tumor, but it could inhibit the invasion of these tumors into surrounding tissue and reduce metastasis. “This whole notion of fiber alignment and the tumor interface is a hot topic right now,” Longmore says. “Our co-authors at the University of Wisconsin have developed a scoring method for collagen alignment that correlates with prognosis. And the bad prognosis disappears when you take away DDR2.”

70% of invasive ductal breast cancers show DDR2. But in 95% of these tumors the genes in this pathway — from DDR2 to SNAIL1 — are entirely normal, without mutations. “Currently there are no DDR2 specific inhibitors,” Longmore says. “But there is great interest and work being done here and elsewhere to develop them.”

The Lewis Law Firm has a history of representing women who are diagnosed with breast cancer.  If you are in Philadelphia or New Jersey and you or a loved one have been diagnosed with breast cancer contact the Lewis Law firm today for a FREE consultation.

Breast Cancer -Early Detection Key

Sources: American Cancer Society; and 30+ years of medical malpractice experience

Prevent-Breast-CancerEARLY detection of breast cancer, before it causes symptoms, is the key to cure and long-term survival of this disease.  The goal of screening exams for early breast cancer detection is to find cancers before they start to cause symptoms.  Breast cancers that are found because they are causing symptoms tend to be larger and are more likely to have already spread (metastasized) beyond the breast.

Although not all will admit this when they are Defendants in a medical malpractice case, most doctors believe that early detection tests for breast cancer save thousands of lives each year and that the size of a breast cancer when it is found and how far it has spread, and genetics, are the most important factors in predicting the prognosis (outlook) of a woman with this disease.

What are the risk factors for breast cancer? Many women with breast cancer have no apparent risk factors.  There are breast cancer risk factors you cannot change.  Among these are: Gender, men can develop breast cancer, but this disease is about 100x more common in women; Aging, your risk of developing breast cancer increases as you get older; Genetics,  5% to 10% of breast cancer cases are caused directly from genes BRCA1 and BRCA2; Family history of breast cancer, having a first-degree relative (mother, sister, or daughter) with breast cancer almost doubles a woman’s risk. 85% women who get breast cancer do not have a family history for it; Personal history of breast cancer, a woman with cancer in one breast has a 3- to 4-fold increased risk of developing a new cancer in the other breast (contralateral) or in another part of the same breast; Race and Ethnicity, white women are slightly more likely to develop breast cancer than are African-American women, but African-American women are more likely to die of this cancer; Dense breast tissue, women with dense breasts have a higher risk of breast cancer; Menstrual periods, women who started menstruating early (before age 12) and/or went through menopause later (after age 55) have a slightly higher risk of breast cancer; Previous chest radiation, treatment for hodgkin’s disease or lymphoma increases the risk of breast cancer as does chemotherapy.

What are the Signs and symptoms of breast cancer? The most common symptom of breast cancer is a new lump (mass).  A mass that is painless, hard, and has irregular edges is more likely to be cancerous, but breast cancerscan be tender, soft, or rounded. They can even be painful. For this reason, it is important to have any new mass, lump, or breast change checked by your doctor and possibly by a breast surgeon.  Other signs are: Swelling of the breast; Skin irritation or dimpling of the breast; Nipple pain or retraction (turning inward); Redness or scaliness of the breast; and, discharge. The American Cancer Society recommends that women age 40 and older should have a mammogram every year.

The Lewis Law Firm has a history of representing women who are diagnosed late with breast cancer.  If you are in Philadelphia or New Jersey and you or a loved one have been diagnosed with breast cancer contact the Lewis Law firm today for a FREE consultation.

Skin Cancer Season

It’s almost Memorial Day weekend, the kick-off to Summer and with Summer comes much needed warnings to enjoy, but be safe and aware of the cancer facts, in the sun!

The Lewis Law Firm has a history of representing patients who are diagnosed with cancer.  If you are in Philadelphia or New Jersey and you or a loved one have been diagnosed with cancer contact the Lewis Law firm today for a FREE consultation.

Skin Cancer Infographic

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