'Microbeads' May Boost Survival in Advanced Colon Cancer Patients

Jan. 19 (HealthDay News) -For advanced colon cancer patients who have developed liver tumors, so-called "radioactive beads" implanted near these tumors may extend survival nearly a year longer than among patients on chemotherapy alone, a small new study finds.

The same study, however, found that a drug commonly taken in the months before the procedure does not increase this survival benefit.

The research, from Beaumont Hospitals in Michigan, helps advance the understanding of how various treatment combinations for colorectal cancer -- the third most common cancer in American men and women -- affect how well each individual treatment works, experts said.

"I definitely think there's a lot of room for studying the associations between different types of treatments," said study author Dr. Dmitry Goldin, a radiology resident at Beaumont. "There are constantly new treatments, but they come out so fast that we don't always know the consequences or complications of the associations. We need to study the sequence, or order, of treatments."

The study is scheduled to be presented Saturday at the International Symposium on Endovascular Therapy in Miami Beach, Fla. Research presented at scientific conferences has not been peer-reviewed or published and should be considered preliminary.

Goldin and his colleagues reviewed medical records from 39 patients with advanced colon cancer who underwent a procedure known as yttrium-90 microsphere radioembolization. This nonsurgical treatment, approved by the U.S. Food and Drug Administration, implants tiny radioactive beads near inoperable liver tumors.

Thirty of the patients were pretreated with the drug Avastin (bevacizumab) in periods ranging from less than three months to more than nine months before the radioactive beads were placed.

The liver is a common site for the spread of colorectal cancer, which, according to the U.S. Centers for Disease Control and Prevention, is diagnosed in about 137,000 Americans and kills about 52,000 each year. Many of the liver tumors are inoperable, leaving doctors fewer choices to help prolong patients' lives.

Avastin is commonly prescribed for colon cancer that has spread ("metastatic" cancer) because the drug hinders the growth of new blood vessels that feed tumors.

With the yttrium-90 procedure, which has been in use at major U.S. medical centers for more than a decade, a catheter is inserted into a small incision near the groin and threaded through arteries until it reaches the hepatic artery in the liver, where millions of microbeads are released near tumor sites. These beads emit high-dose radiation directly to cancerous cells, sparing damage to healthy cells.

Goldin's team found that 40 percent of the 17 patients with shorter intervals -- less than three months -- since their last Avastin dose before receiving the microbeads needed their microbead infusion stopped early due to slow blood flow near the tumors, a much higher number than patients whose last Avastin dose was further in the past. This was expected, Goldin said, because the main effect of Avastin is to cut tumors' blood supply.

Additionally, treatment with Avastin didn't increase the survival benefit of the microbeads, which added 10 to 12 months to patients' life spans compared to chemotherapy alone, Goldin said -- a survival of 34.5 months after the diagnosis of metastatic colon cancer, compared with 24 months.

"If you look at those [survival] numbers, there's a promising benefit" to using microbead radiation, he said. But the cost of both treatments is high -- in the tens of thousands of dollars per patient, he noted.

Dr. Felice Schnoll-Sussman, a gastroenterologist and director of research at the Jay Monahan Center for Gastrointestinal Health at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City, said the study won't change her clinical approach to treating metastatic colon cancer. But "it's important for us to try to tease through the different treatment recommendations and understand how one treatment affects another," she said.

"Maybe it helps you understand timing, which is never a terrible thing," she added. "This is the art of treatment of metastatic colorectal cancer -- it's in the tweaking of the treatments."

The U.S. National Cancer Institute has more about metastatic cancer.

'Microbeads' May Boost Survival in Advanced Colon Cancer Patients

Smartphone Apps Can Fall Short in Detecting Skin Cancer, Study Finds

Relying on health-care smartphone apps to detect skin cancer can postpone diagnosis and cause harm, a new study has found.

When researchers at the University of Pittsburgh Medical Center tested four popular apps for detecting melanoma -- the most serious form of skin cancer -- they found that on average three of them incorrectly classified 30 percent or more melanomas. The findings were published Wednesday in the Journal of the American Medical Association-Dermatology.

Of the 188 moles the researchers studied, 60 of them had already been diagnosed as melanoma by a board-certified dermatologist. The study found that the accuracy of the apps varied drastically -- the best-performing apps diagnosed cancerous moles correctly 98.1 percent of the time, while the worst-performing detected melanoma only 6.8 percent of the time.

Typically, in employing these apps, users photograph the skin lesions they would like analyzed, and the app generates a response.

"Patients do bring these in and ask about them," Dr. Darrell Rigel, clinical professor of dermatology at NYU Langone Medical Center, told ABC News. "I tell them that the difference between these and 'real' in-office melanoma diagnostic devices is the difference of a toy car versus a real car. One you play with, and the other works."
The app with the highest sensitivity for melanoma detection, the study found, did not use automated algorithms to analyze the images. Instead, the images were sent to board-certified dermatologists, and users received a diagnosis within 24 hours.

None of these apps, though, are not subject to regulatory oversight, and although disclaimers state they are for educational purposes only -- to help users track their lesions, for example -- dermatologists worry that people, particularly those who are lower-income and uninsured, might substitute the apps' findings for medical advice.

"It is very concerning that these apps are used for diagnosis by patients, as it could lead to delay in diagnosis of melanoma, the cancer which is perhaps the most critical in early diagnosis being important for survival," said Rigel.

The U.S. Food and Drug Administration has responded to the explosion of health-related smartphone apps and announced in July 2011 plans to regulate smartphone apps that paired with medical devices the agency already regulates, such as cardiac monitors and radiologic imaging devices. In 2012, Congress passed the FDA Safety and Innovation Act, allowing the FDA to regulate some medical apps on smartphones. But which apps will come under this regulation and which will not remains unclear.

Given their accessibility, these apps could hold tremendous potential once they have been evaluated, said Dr. Meg R. Gerstenblith, an assistant professor in the department of dermatology at Case Western Reserve University.

"If a patient were insistent on using one of these apps," said Gerstenblith, "I would inform him/her that the current study suggests that those apps that involve a board-certified dermatologist evaluating images of lesions may be superior to those that do not employ a board-certified dermatologist to evaluate the lesions."

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Segregation tied to more lung cancer deaths: study

Black lung cancer patients seem more likely to die of the disease than white cancer patients in the U.S., especially those living in segregated counties, according to a new study.

Researchers, who published their findings in JAMA Surgery on Wednesday, found blacks patients living in segregated counties had a lung cancer mortality rate about 10 percentage points higher than those living in diverse neighborhoods during the mid-2000s.

That compared to white lung cancer patients whose lung cancer mortality rate did not seem to change between segregated and diverse areas.

"We first thought it was a mistake. We ran it five times through the program," said the study's lead author Dr. Awori Hayanga, a lung transplant fellow at the University of Pittsburgh Medical Center.

"If you are one color living in one type of neighborhood versus another, 10 percent is huge," he said.

According to the American Cancer Society, lung cancer is the leading cause of cancer deaths for both men and women. It kills more people than colon, breast and prostate cancer combined.

In 2013, the Society projects over 228,000 Americans will be diagnosed with lung cancer, and about 159,500 will die from it.

For the new study, Hayanga and his colleagues used national databases to collect information on lung cancer deaths in U.S. counties between 2003 and 2007. They also classified those counties as low, moderate and high segregated areas based on their concentration of one race versus another.

Nationally, black lung cancer patients had about a 59 percent mortality rate when the researchers accounted for smoking and income, compared to about a 52 percent mortality rate in white patients.

When looking at specific counties, the researchers found white lung cancer patients' mortality rate remained steady between diverse and predominantly white counties - between about 50 percent and 53 percent.

For black lung cancer patients, however, there were larger differences.

Black patients living in diverse counties had a mortality rate of about 52 percent, which was comparable to white patients.

But black patients living in highly segregated counties had a mortality rate of about 63 percent. Black patients living in moderately segregated areas had a mortality rate of 57 percent.

While the study cannot prove living in a segregated community caused the worse mortality rates in black patients, Hayanga said there is probably something different in predominantly black communities.

ENVIRONMENTAL VS. PATIENT FACTORS

"The point I'm trying to make is that neighborhood segregation is not just a proxy for socioeconomic status. We accounted for that," said Hayanga. "That's where we ask ourselves, do we know about the different fabric of different neighborhoods?"

He told Reuters Health that by comparing different counties, a person would find one has resources the other does not, such as hospitals and doctors.

The new study shows there are some health problems that can't be explained by genetics and treated with drugs, said David Chang, who wrote a commentary accompanying the work.

Disparities are "probably one of the issues that it's not the patients that matter but the systems," Chang, from the University of California, San Diego, told Reuters Health.

"Location matters, and one has to be critical about where they live and where they pay taxes," said Hayanga, who worked with Chang on previous research.

Dr. Karen Reckamp, a lung cancer specialist at City of Hope in Duarte, California, said there should be a focus on getting cancer care where it's needed.

"There is more technology in our healthcare and it's becoming more complex. People living in more remote areas wouldn't have the knowledge or access to seek out that care," said Reckamp, who was not involved with the new study.

She added that the new research doesn't answer what needs to change in those communities, but may shine a light on where the disparities are coming from.

"What we're seeing is that we can't uproot half of the American population and move them to other counties. What we have to do is take responsibility for those neighborhoods," said Hayanga.

Tiny Tim, Houston's Beloved Fat Cat, Has Cancer

Tiny Tim, the hefty Houston feline that gained national attention for his overweight figure and subsequent strict diet and exercise plan, has been diagnosed with cancer in his leg that could prove fatal.

Dr. Alice Frei, who has been monitoring the 30-pound cat's progress at the Southside Place Animal Hospital, today announced Tiny's "aggressive tumor" on his Facebook fan page, "Tiny Tim at Spah."

"Tiny Tim has cancer," Frei wrote. "There is no radiation or chemotherapy for such an aggressive tumor."

Frei said Tiny was rushed to Texas A&M University School of Veterinary Medicine for treatment on Wednesday after SPAH staff noticed his elbow was swollen and pathology results showed cancer. A&M veterinarians confirmed the pathologist's findings, and "said the cancer was so rapidly growing that they could not define the cell of origin," Frei wrote.

Tiny is scheduled to have a CAT scan on Friday to see how far the tumor has spread. The SPAH staff will then assess a treatment plan, but options for the beloved cat seemed dire.

"If Tiny Tim's CAT scan does not show [the] tumor has invaded his chest, we have decided that the only course of treatment is to have the leg amputated," Frei wrote. "If the tumor has spread to his chest his treatment options are basically zero."

The staff is now waiting to see if Tiny will need surgery, but even that will be a difficult decision.


"Surgery for Tiny Tim is a huge risk because of his size, and if he makes it through the surgery he has a long road back," Frei wrote. "It will be rough. With it he may die. Without it he will die."

Tiny, who's about 9 years old, weighed in at a hefty 35.2 pounds when he arrived at the animal hospital around Christmas 2011, but testing showed that Tiny was otherwise healthy. When a search for his owner proved unsuccessful, the hospital took him in as a permanent resident -- provided he'd lose weight.

By New Year's, the "super sweet cat" had been placed on a strict diet for the year.

"He has been on a very, very regimented diet -- measured meal plans, the whole works, and he is at 28.6 pounds," SPAH manager Debbie Green told ABCNews.com in a recent interview. "He weighs in twice a week, and he gets meals measured in little bags throughout the whole week, so we know exactly what he's eating."

Tiny is fed a precise 307 calories per day, and his team of doctors would be "really, really excited if he got closer to 20 pounds," Green said.

Earlier this year, Tiny seemed to plateau at 30 pounds. The cat, somewhat ironically, lives in a food pantry in the animal hospital because he is too big for the normal cat cages at Southside. A staff member figured out Tiny had clawed a small hole into a bag of food and had been having midnight snacks.

Tiny's doctors make sure Tiny exercises by making him work for his bed and board. He is carried to the front of the clinic at least three times a day, and he has to walk the 50 feet back to his room for meals.

"He doesn't voluntarily walk around the office," Green said. "He used to move 10 steps and then sit down. Now he can get from the front to the back, which is about 50 feet, without much trouble at all."

Tiny's cancer hasn't been the only health concern for the SPAH staff. He is also at risk for feline diabetes or thyroid problems in the future because of his weight, Green said. They believe arthritis could become a problem for him too.

Regardless, the popular feline is usually pretty quiet and prefers the peace of his pantry to the business of the hospital's waiting room, but he enjoys the attention and brushing he receives from friends and fans who often stop by to visit him.

Tonight, he remained at the A&M veterinary hospital, where "he is doing fine, has the entire cat ward to himself and is getting lots of attention," according to his Facebook fan page.

http://abcnews.go.com/US/tiny-tim-houstons-beloved-fat-cat-cancer/story?id=18243559

NI hospital offers new procedure for diagnosing lung cancer

A new technique for detecting lung cancer without the need for surgery is helping patients in Enniskillen, County Fermanagh.

A thin flexible telescope, called an endobronchial ultrasound, is inserted through the patient's mouth and provides camera pictures and ultrasound images.

Samples can also be taken which can lead to faster diagnosis.

Dr Terence McManus uses the device in the South West Acute Hospital.

The 30-minute procedure is carried out under local anaesthetic and patients can normally return home the same day.

Dr McManus, a respiratory consultant, said: "It's a new technique that allows us to biopsy and diagnose conditions at an earlier stage.

"It can, in some cases, avoid the need for more invasive surgery techniques.

"Using this technique we can diagnose conditions such as cancer, inflammatory conditions, and sometimes infections as well."Lung disease

He said it allowed doctors to "establish a diagnosis and then determine what is the most appropriate treatment for a patient as quickly as possible".

Approximately 900 people in Northern Ireland are diagnosed with lung cancer each year.

It is the second most common cancer among men and the third most common among women.

Stephen Hogan from Florencecourt, County Fermanagh, has lung disease and has undergone the procedure.

He described it as very simple and added it had no unpleasant side effects.

"The big difference for me is knowing where I'm at with the diagnosis and the referral on to the oncologist and then I know what my treatment options are. So, it actually gives you a sense of relief and it saves a lot of time.

"I'm dependent on some degree of oxygen so travelling between A and B is a bit of an issue and we're very lucky to have this brand new facility, so it's brilliant."

The South West Acute Hospital, which opened its doors six months ago, is the first in Northern Ireland to offer this service.

Joe Lusby, deputy chief executive of the Western Health Trust, said it demonstrated how the latest technology is benefiting patients in the new state-of-the-art hospital.

"Anything that provides a faster and more accurate diagnosis of lung disease is bound to be good for the patient," he said.

"This hospital is built for the next 60 years at least so what we were doing is not just transferring services across from the former Erne Hospital.

"We were determined to add services that were appropriate to provide locally so that people don't have to travel great distances to access these services."

About 90% of lung cancer cases are caused by smoking cigarettes and Dr McManus has also seen patients getting the disease at a younger age.

He said: "It can affect any age. Smoking is certainly the biggest risk factor so we would always emphasise the importance of stopping smoking as soon as possible, it's never too late to stop smoking."

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treatment of lung cancer (Adenocarcinoma Lung )

In the treatment of lung cancer. Depends on the stage of the cancer and the patient's condition. As well as the lungs. And other factors.

If cancer is detected. Has not spread anywhere.the ideal treatment is surgery to remove skin cancer from fresh.the three options are as follows.

Wedge resection is surgery to remove part of the lung.lobectomy was cut out of one lung lobe (lobe).pneumonectomy is cut out all the lung.

Surgery is required to remove the lymph nodes.
Check the spread of cancer cells to the lymph nodes as well.

Some doctors may use. video-assisted thoracoscopy (VATS) surgery.
The tumor is small. The initial phase. Especially in the border area.
The output of the lungs, called VATS has been used for the diagnosis.
Of lung cancer as well.

The surgery to remove the lung. Can cause respiratory problems in the second.
Especially in patients with severe emphysema. Before surgery, your doctor should monitor their lung function before and.Expect. After surgery, the result would be?
In some cases, surgery may be impossible.

If the cancer has spread. Treatment may include "chemical treatment".
And "radiotherapy", which may be earlier. Or after the surgery.

In cases where the tumor has already spread. The way in which chemotherapy.
Select to slow the growth of cancer. 

Do not expect to be cured.
Treatment with chemical treatment. Can cause the symptoms of the disease can do better.The lives of patients with lung cancer live longer than I have.

And radiation. Enable to reduce the symptoms of lung cancer.
It will be used in cases where the cancer has spread to the bone and cause.
Bone pain. It can be used in combination with a chemical treatment.
Tumor confined to the breast.

Patients who can not tolerate surgery because of this.
Patients may receive radiation. With chemical treatment. O alone.
For the tumor reduced.

As the treatment of cancer has evolved very ...
Some cancer treatment centers. Check for any abnormalities.
Specific genes (mutations) and treatment of cancer.
The process is called "targeted therapy".

Directing therapy to inhibit the growth of tumor cells in the wave.
By chemical reaction. Focusing on the transformation of the Alliance.
For example, gene therapy can targetedterapy something.
Prevent cancer has been a growing wave of orders ...

Knowledge. Genetic variation (specific genetic mutation).We can provide that. Patients should be treated every battle.For example, women with adenocarcinoma. Those who have never smoked before

Prognosis (prognosis).
Appearance of lung cancer. adenocarcinoma. Report directly to global health.
The patients themselves. In general, cancer has a poor prognosis.In particular, the cancer has spread outside the breast or.The cancer spread to lymph nodes. That is in both lungs.


Possibility of treating lung cancer is cured. There was only one case is cut.
Cancer out. Or kill cancer cells outside.Of lung cancer, but a doctor. Has spread to the waste.Likely to be cured, it can be difficult.Only one out of five patients only. This can survive up to five years.

After completion of the procedure then.
Patients should be monitored periodically.Although the results of treatment in the early stages, it seems. Cancer is already lost.However, cancer is seen once again during the month or year

Immune Cells, Cytokines Predict Recurrence in Stage I Lung Adenocarcinoma

Expression of certain immune markers in tumor and surrounding cells can help predict probabilities of recurrence in patients with stage I lung adenocarcinoma, according to new work by researchers at Memorial Sloan-Kettering Cancer Center in New York.

According to senior author Prasad S. Adusumilli, MD, the presence of a “good” immune response can apparently help prevent the cancer’s recurrence. In the new study, Adusumilli and colleagues looked for eight tumor-infiltrating immune cells as well as five cytokines in 956 patients with stage I lung adenocarcinoma; the first 478 patients were considered a training cohort, and the second group of 478 was a validation cohort. The results were published online ahead of print on December 26 in the Journal of Clinical Oncology.

Among the immune cells, a high density of FoxP3-positive cells in the tumor-associated stroma was significantly associated with recurrence (P = 0.43 vs low density). The ratio of FoxP3 to CD3 cells was an even stronger predictor, however; the 5-year recurrence-free probability was 85% for those with a high ratio and 77% for those with a low ratio (P = 0.004). This result was replicated from the training cohort to the validation cohort.

High magnification micrograph of a primary lung adenocarcinoma showing nuclear staining with a TTF-1 immunostain; source: Nephron, Wikimedia Commons

Of the cytokines tested, several were found to have prognostic value. Higher expression levels of interleukin-12 receptor beta-2 (IL-12RB2) was associated with better recurrence rates than lower expression, with a 5-year recurrence-free probability of 90% for the former and 80% for the latter (P = 0.026). In contrast, high expression of tumor IL-7R yielded a poorer 5-year recurrence-free probability of 76% vs 86% for those with lower expression of the cytokine (P = 0.001). These results were also replicated in the validation cohort after first appearing in the training cohort. The other three cytokines tested—CCR7, CXCL12, and CXCR4—showed no significant associations with recurrence.

Multivariate analysis showed that these three immune markers—stromal FoxP3-CD3 ratio, IL-12RB2, and IL-7R—are independently associated with recurrence. The FoxP3-CD3 ratio had a hazard ratio (HR) for recurrence of 2.00 (95% CI, 1.22–3.27; P = 0.006). The two cytokines had HRs of 2.24 (95% CI, 1.02–4.95; P = 0.045) and 1.65 (95% CI, 1.02–2.68; P = 0.45), respectively.

The authors wrote that the current system for evaluating of stage I disease relies only on anatomic factors. “In fact, for stage I lung adenocarcinoma, tumor size is the only standard prognosticator available,” they wrote. “In our study, we have demonstrated the prognostic power of immunologic parameters for stage I lung adenocarcinoma.”

Notably, when overall survival was used as an endpoint rather than recurrence, only IL-7R remained a significant prognosticator (P = 0.007). “The ability of IL-7R to prognosticate both recurrence-free and overall survival merits further investigation of its biologic role,” the authors wrote.

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