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    March is Kidney Cancer Awareness Month. 


    We have 2 kidneys. They filter our blood to remove impurities, excessive amounts of salt and other minerals and water. Our kidneys are amazing workhorses in our body — continuously filtering our blood (equivalent to about 200 quarts of blood daily) and producing 2 quarts of urine (waste products). Our kidneys also produce hormones that help regulate our blood pressure and red blood cell production.
    Fortunately, our kidneys work independently of each other. We can live normal lives with just one kidney.
    How common is Kidney Cancer?
    Almost 74,000 people in the U.S. develop kidney cancer every year. About 44,000 are men, and 30,000 are women. Kidney cancer is the 6th most common cancer in men and the 8th most common cancer in women.
    About 15,000 people in the U.S. die each year from kidney cancer. Death rates have been declining by about one percent a year since 2007. Fortunately, two-thirds of kidney cancer is diagnosed when it only affects one kidney. The 5-year survival rate for these patients is 93 percent.
    What are the Risk Factors for Kidney Cancer?
    Risk factors are varied. You may have some of these risk factors and not develop kidney cancer. Some people may develop kidney cancer but have none of these risk factors.
    • Smoking • Gender – men are more likely to develop kidney cancer • Race – African-Americans are more likely to develop this cancer • Age – most people are over 50 when they are diagnosed • Obesity • High blood pressure • Excessive use of aspirin, acetaminophen and ibuprofen • Exposure to cadmium • Chronic kidney disease • Long-term dialysis • Family history

    What are the Symptoms of Kidney Cancer?
    Early kidney cancer
    does not produce any symptoms. It’s sometimes found when a person has an X-ray or CT scan for another condition. As the tumor grows, it begins to cause symptoms.


    • Blood in the urine • Low back pain on one side • A mass on the side or lower back • Fatigue • Lack of appetite • Weight loss • Fever • Anemia

    Men may also notice enlarged veins around a testicle, particularly the right testicle. This could indicate a large tumor in a kidney.
    How is Kidney Cancer Diagnosed?
    Physicians use many tests to determine if you have kidney cancer.

    • Blood and urine tests. These tests determine if you are anemic and/or have blood in your urine. • Biopsy. If your blood and urine tests suggest that you may have kidney cancer, a biopsy is done to confirm if you have cancer. A small sample of tissue is removed by an interventional radiologist for a pathologist to examine. A biopsy is an out-patient procedure. • Imaging tests. X-rays, CT scans and MRIs are used to measure the size of the tumor and its exact location. PET scans are not utilized in the diagnosis of kidney cancer.

    The imaging tests help determine the extent of your cancer and if it has spread. This process is known as staging. The biopsy determines the type and grade of the cancer cells — this information helps determine your specific treatment.

    The Kidney Cancer Association

    Treatments for Kidney Cancer
    Urologists treat kidney cancer. They specialize in diseases of the genitourinary tract, which includes the kidneys, bladder, and genitals. You will probably also have an oncologist who helps decide if targeted therapy or immunotherapy will work for you.
    • Surgery. Surgery varies with the size and location of the tumor. It may be just the removal of the tumor or removal of the kidney and surrounding tissue. Sometimes, the location of the tumor or the overall health of the patient may preclude surgery. In these circumstances, either radiofrequency ablation (RFA) or cryoablation (freezing of the cancer cells) can be used. • Medication therapy. This is also known as systemic therapy because it is given via an IV and helps prevent the cancer from spreading. These therapies include targeted therapy, immunotherapy or chemotherapy.



    Radiation is seldom used for kidney cancer because it has not proven effective.
    The Bottom Line …

    Always be proactive with your health. If you have any of these symptoms, be sure to see your doctor for blood work and a urinalysis. Kidney cancer
    , when caught early, is treatable with excellent outcomes.

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    Anal Cancer Awareness Day is March 21st

    March 21st is Anal Cancer Awareness Day. The anal passage is the lower end of our gastrointestinal system. The anus is located below the rectum and is about 1 to 1 ½ inches long. Two strong muscles, called the anal sphincter muscles, open and close to allow stool to pass from our bodies.


    Anal cancer is relatively uncommon, affecting about 8,300 (2,770 men and 5,530 women) people in the U.S every year. Almost 1,300 deaths occur annually from anal cancer
    .
    Risk Factors
    HPV virus. HPV causes about 90 percent of anal cancers. Almost every sexually active person has been exposed to HPV at some point in their lives. Most people don’t know that they have HPV because it doesn’t always cause symptoms. It can also stay dormant for years.
    Age. Most patients are between 50 and 80. Anal cancer seldom occurs in people under 35.
    Frequent anal irritation. You may be more likely to develop anal cancer if you have a history of irritation, redness, swelling or soreness in your anal canal.
    Anal fistula. If you’ve had an anal fistula (abnormal tunnel between the anal canal and the outer skin of the anus), you are at increased risk for anal cancer.
    Smoking. Smokers are eight times more likely to develop anal cancer.
    Lowered immunity. Immunocompromised people are more likely to develop anal cancer. This includes people who have had organ transplants or have HIV.
    Symptoms
    Not all of these symptoms are present. Be sure to talk to your doctor if you experience any of these symptoms.
    Bleeding, pus or discharge. Pain or pressure in the anal area. Anal itching. Stools that become narrow. Change in bowel habits. Lump or swelling near the anus. Swollen lymph nodes in the groin, pelvis or anal area.
    Anal cancer is sometimes misdiagnosed as hemorrhoids. If bleeding continues after you finish treatment for hemorrhoids, ask to be referred to a specialist.


    How is Anal Cancer Diagnosed?
    As with most other cancers, there are some tests and exams utilized to pinpoint a patient’s specific diagnosis.
    Digital rectal exam. After a thorough case history, your doctor will do a digital rectal exam (DRE) to determine if you have any lumps or other abnormalities.
    Anoscopy. An anoscope is a thin, lighted, flexible tube that is inserted into the anus so that the physician can visually look at any lump or abnormality that they felt. A patient may be sedated for this exam.
    Biopsy. A small amount of tissue from the suspicious area is removed and examined under a high-powered microscope by a pathologist (a person trained in the identification of disease in cells, tissues, and organs).
    Ultrasound. An ultrasound uses sound waves to create a “picture.” In the case of suspected anal cancer, a wand is inserted into the anus to create a detailed picture of the anal canal.
    Imaging. X-rays, CT scans, PET scans and MRIs show details of your tumor and whether it has spread into your pelvic region or to distant parts of your body.
    The diagnosis process provides your physician with the stage of your cancer and the grade. Your treatment is based on this information.
    How is Anal Cancer Treated?
    Treatment depends on the type, stage, the grade, your overall health and takes into account the side effects and your preferences (whenever feasible). Your medical team will consider your overall health and stamina, risk of side effects and if you want or need to continue working during treatment.
    Surgery. Early-state or carcinoma in situ patients are good candidates for surgery. A colorectal surgeon or surgical oncologist will remove all abnormal cells and some healthy tissue surrounding the area (called a margin). You will be monitored and checked as a follow-up. Recurrent anal cancer may require a major surgery called abdominoperineal resection (known as APR surgery), the removal of the anus, rectum and lower colon resulting in the patient having a permanent colostomy. The surgeon will also remove adjacent lymph nodes.
    Radiation. Recent studies have shown similar cure rates with radiation and chemotherapy instead of surgery. External-beam radiation is the treatment of choice for anal cancer. Treatment usually consists of radiation treatment on weekdays for 5 or 6 weeks — patients have weekend breaks from treatments.
    Chemotherapy. Chemotherapy is very effective when combined with radiation. When combined with chemo, lower doses of radiation can be given. Fluorouracil (5-FU) or the oral equivalent, Xeloda, is combined with either mitomycin C or cisplatin. The chemotherapy is given on the same days as the radiation with breaks on the weekends.
    Side effects include fatigue, skin irritation, upset stomach, anal irritation, loose bowel movements and discomfort during bowel movements. Most of these are temporary and resolve after treatment. Female patients who receive radiation may experience vaginal stenosis (narrowing and shortening of the vagina).
    Can Anal Cancer Be Prevented?
    Anal cancer can now be prevented by vaccination with the HPV vaccine Gardasil. Experts recommend that both boys and girls receive Gardasil between the ages of 11 and 13 before they become sexually active. HPV can cause cervical, vaginal, vulvar cancers, anal cancer, penile and head and neck cancer along with genital warts. Adults up to age 26 may also be vaccinated if their parents didn’t have them vaccinated when they were pre-teens.
    Anal cytology is similar to a Pap smear and can detect abnormal cells in the anus before they turn into cancer or at the earliest stage of anal cancer when it is easiest to treat. Experts recommend that high-risk individuals be screened for anal cancer.


    Straight Talk about HPV
    What is HPV? HPV is a family of over 150 viruses. They are the cause of genital warts and some cancers, including anal cancer. There is no need for shame or embarrassment if you are diagnosed with anal cancer. Yet, many patients are embarrassed, just as women used to be embarrassed to tell people they had breast cancer and men were embarrassed by their prostate cancer diagnosis. Cancer strikes virtually every organ of our body.
    HPV is a common virus, so common, in fact, that most men and women will contract HPV at some time in their life. HPV virus
    may not cause any symptoms. It can lay dormant for years so that you don’t even know when you contracted it.
    According to the Cleveland Clinic, about 14 million people every year contract the HPV virus. About 79 million people in the U.S. currently have the HPV virus — most of them don’t know it. 80 percent of people in the U.S. will have the HPV virus at some time in their life. HPV is spread through close intimate contact. Yet, 10 percent of virginal girls test positive for the HPV virus.
    Think about it — 80 percent of all people in the U.S. will have HPV at one time or another in their life. We don’t routinely screen for HPV. There is no treatment for it. There is only screening for the diseases that it causes. Take control of your health. Women should ask their OB/GYN about the combined PAP/HPV test. Currently, there is no HPV test for men.


    Other Informative, Inspirational, and Motivational Articles

    HPV Vaccine - Yes or NO?


    Living With Colorectal (colon) Cancer 


    Medical Marijuana and CBD Oils for Cancer - Pros and Cons


    11 Cancer Myths - And Truths 

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    Amazing Things: Sandy Kyrkostas - Victory Over Stage IV Colon Cancer

    When this TV and film producer was diagnosed at 47 with aggressive colon cancer, doctors gave him little hope – until he met Dr. Manish Shah.

    Sandy Kyrkostas isn’t the kind of guy who lets life’s little challenges get in his way.
    So in late 2013, when he noticed he was having diarrhea, coughing a bit, and occasionally feeling dizzy, he went to the drugstore to get some meds. He also made an appointment to see his doctor in a few weeks and went on with his busy, bicoastal life as a film and TV producer and father of two avid hockey players, a son and daughter, then ages 12 and 11.
    But he could no longer ignore his symptoms as he sat in an ice rink in Massachusetts that December, watching his son play in a tournament.
    “I couldn’t stop shaking, even when I went back to the hotel and got under the covers. I thought I was getting the flu,” says Sandy, now 53.
    He called his doctor, who advised him to go to a local emergency room. But Sandy preferred to be closer to home and that day headed back to Long Island. When he got to the local ER, an emergency colonoscopy revealed that he had two large tumors in his colon, which necessitated surgery to remove part of his colon.

    “When I woke up, the only thing I wanted to know is if I’d need a colostomy bag,” Sandy recalls.
    The doctors told him he didn’t — which was the last bit of good news he received for a long while. He had colon cancer, and it had metastasized, or spread, to his liver.
    “They told me it was stage 4. I didn’t even know what that meant,” Sandy recalls. “When you hear the word cancer, you just think, ‘I’m dead.’”

    A Dire Diagnosis
    Sandy’s prognosis wasn’t promising. His first oncologist told him that the remaining cancer in his liver was inoperable and that, at best, chemotherapy might keep him alive for six months to a year.
    Not willing to give up, Sandy and his wife, Michelle, saw an oncologist at another cancer center, where doctors told him to get his affairs in order.
    “It’s hard to explain what it feels like to be told you’re dying,” Sandy says. “I felt numb. I felt hopeless.”

    But in January 2014, a determined Sandy and Michelle made the journey to Manhattan to meet Dr. Manish Shah, chief of the solid tumor oncology service at NewYork-Presbyterian/Weill Cornell Medical Center and director of the gastrointestinal oncology program at Weill Cornell Medicine.
    Suddenly, there was a reason to have hope again.
    At that very first meeting, Dr. Shah sprang into action, telling Sandy that he wanted him to get more scans and that he should get ready to have a port put in for chemotherapy, starting the following week.
    “I told him I lived 50 miles away and asked if we could do everything that day,” Sandy recalls. “Dr. Shah started making phone calls and he got me in for a brain scan, a liver scan — he got me in everywhere. He stayed until 7 p.m. that night.”
    It turns out Sandy’s desire to tackle his tests that day may have averted a tragedy.
    While reviewing his scans that evening, Dr. Shah noticed blood clots next to Sandy’s portal vein and wrote a prescription for self-injecting blood thinners. On his ride home, Sandy received a call from Dr. Shah’s office, telling him to start the medication ASAP.
    “They were on it,” says Sandy. “Dr. Shah was amazing from the very beginning.”
    Getting a New Chance at Life
    In addition to the blood clots, Sandy’s scans showed his colon cancer had spread to multiple parts of his liver. Dr. Shah’s approach was to treat the cancer aggressively, knowing that if the remaining disease was limited to Sandy’s liver, there was a chance to eradicate it. Dr. Shah’s next step was to take his case to the hospital’s tumor board, where doctors from a variety of disciplines meet weekly to review difficult cases.
    In tumor board meetings, we push each other to see what the best options are to help patients,” says Dr. Shah, who was determined to do everything he could to help Sandy.
    Dr. Shah shared Sandy’s scan with the board, and together, the team decided to take a multipronged approach to try to eradicate Sandy’s cancer — starting with chemotherapy followed by directed treatment of the liver metastases, which would include surgery and interventional radiology.
    “I told Sandy, ‘Before we talk about getting your affairs in order, let’s focus on the treatment,’” Dr. Shah recalls. “We work in an environment where people have the expertise to do liver resections, to give state-of-the-art chemotherapy, and to do really novel interventional radiology treatments. We use our entire arsenal against the cancer. My approach, and that of many of the doctors here, is that it’s hard to know what’s going to happen until you start the best treatment possible.”
    “We are in this together,” Dr. Shah told Sandy.
    Once Sandy heard the plan, his spirits were immediately lifted.
    “Dr. Shah was the quarterback — he got the surgeons, he got the radiologists,” Sandy says. “At that moment, instead of feeling defeated, I felt hope.”

    A Collaborative Approach
    Sandy had 12 courses of chemotherapy — first in the hospital, then taking the rest of the infusion home in a fanny pack. And while he couldn’t yet go back to work, he was active as ever.
    “Sometimes, my wife and I would cry at night, but during the day, I was still running around with the kids and picking them up at school. I wanted to make things normal for them,” he says. “I had my chemo bag, but we were moving and shaking and going to hockey games. People asked me what I was doing, and I told them, ‘I’m living.’”

    “We tried to keep everything as normal as we could,” adds Sandy’s wife, Michelle. “I was hopeful but still nervous.”
    Within the first few months of Sandy’s treatment, the chemotherapy shrank his tumors by one-third to one-half their original size. Importantly, cancer wasn’t found anywhere other than the liver, making treatment to Sandy’s liver a reasonable option.
    Then, in April 2014, Sandy had his first surgery at NewYork-Presbyterian/Weill Cornell, a resection to remove part of his liver that had multiple tumors.
    Since many of Sandy’s lesions couldn’t be safely removed — they were too close to a major vein — an interventional radiologist additionally performed microwave ablation, which used heat generated by microwave energy to destroy the remaining lesions in the liver. Dr. Shah then administered another course of chemotherapy, and by the end of 2014, Sandy was — for the foreseeable future — finished with treatment. Based on scans, he was rendered free of cancer, something he could not have imagined a year earlier.
    “I had my chemo bag, but we were moving and shaking and going to hockey games. People asked me what I was doing, and I told them, ‘I’m living.'” — Sandy Kyrkostas

    But the cancer came back in the spring of the following year. Once again, Dr. Shah didn’t give up — and nor did Sandy and Michelle. Instead, Sandy went in for another ablation, and another when the lesions returned several months afterward.
    Then, in 2016, when Sandy had yet another recurrence, Dr. Shah began working with Dr. Karim J. Halazun, a liver transplant and hepatobiliary surgeon with the Liver Transplantation and Hepatobiliary Surgery program at NewYork-Presbyterian/Weill Cornell Medical Center, who had recently joined the staff.
    Colorectal cancer is the fourth most common cancer diagnosed among adults in the U.S., and “about half of patients with colon cancer end up having metastases to the liver,” Dr. Halazun says. “And though chemotherapy is getting better, surgery is the only curative option.”
    “We push the limits and take on cases that others might not take on,” Dr. Halazun adds. “Sometimes their cancers are just simply not operable. But when we can, we try our best to remove them.”

    Sandy’s case proved to be difficult. The doctors had told him that his surgery would take five or six hours. It ended up taking several more, in part because scar tissue from Sandy’s previous surgeries made it more complicated to lift out his liver.
    “His liver was very, very stuck to his diaphragm,” says Dr. Halazun. “It took two to three hours to free it up.”
    Once Dr. Halazun had isolated the liver and could see it clearly, he realized that the entire right lobe needed to be removed.
    “He had four large tumors on that side, many around the major veins, and an additional tumor on the left side that also needed to be removed,” Dr. Halazun says. He ended up removing 60 percent of the organ.
    “Depending on the patient, it’s possible to remove 65 to 70 percent of a person’s liver and still have it regenerate,” explains Dr. Halazun. “Within six weeks, in a normal liver, the volume of the remaining liver doubles.”

    With the right lobe removed, another surgeon came in and reconstructed Sandy’s abdominal wall to repair a gigantic hernia.
    “It was an amazing feat,” Dr. Shah says of the daylong surgery. “For many, a liver resection can be completed within a few hours. When Dr. Halazun operated on Sandy, it took him several hours just to get to the liver. Then, he performed intra-operative imaging to figure out how much disease remained. At that point, Dr. Halazun began operating on Sandy’s liver. Sandy has an incredible will to fight.”

    Michelle grew anxious when the surgery took longer than expected, but “when they came out, the surgical team was really optimistic,” she says. “Just knowing that the cancer was out of his body made me feel good.
    Sandy spent 12 days recovering in the hospital. All told, he had undergone a dozen major procedures, surgeries, and ablations. Once he returned home he was so weak that he had to learn to walk again.
    Getting Screened Early
    For two years after his major surgery, Sandy lived in remission, tending to his new garden of beets, spinach, and kale that he juices, and traveling all over the country for his kids’ hockey games. “I really felt I had beat it,” he says.
    But in October 2018, when blood appeared in his urine, tests showed that the colon cancer was back; this time, it had spread to his bladder. “I was in a dark place,” Sandy says. He then took on his new challenge with gusto. “I will get past this,” he said at the time. “Just add this to my résumé.”
    Sandy underwent surgery again. Dr. Douglas Scherr, an attending urologist at NewYork-Presbyterian/Weill Cornell Medical Center and professor of urology and clinical director of urologic oncology at Weill Cornell Medicine, removed the tumor from Sandy’s bladder wall using a robotic procedure.
    Since then, Sandy has been disease-free. “His risk of recurrence still remains high,” Dr. Shah says, “so we’ll continue to monitor him, but he’s doing quite well.”

    These days, Sandy is happy to go in for his screenings, and he has become an advocate for people getting screened for colon cancer at age 45. The American Cancer Society last year lowered the age recommendation from 50 to 45 for people at average risk.
    “People are scared of a colonoscopy, but I tell them it’s the best 30-minute sleep of my life,” he says with a laugh.
    Colorectal cancer rates in young adults have been rising sharply, Dr. Shah explains. One recent study found that adults born in 1990 have double the risk of colon cancer and four times the risk of rectal cancer, compared to people born around 1950.
    “If Sandy had gotten screened at 45, the cancer might have been found before it spread to his liver,” he says.
    “I told Sandy, ‘Before we talk about getting your affairs in order, let’s focus on the treatment.’ We use our entire arsenal against the cancer.” — Dr. Manish Shah



    Living With Purpose
    Sandy’s life, meanwhile, has taken on a greater purpose. “I want to talk to patients and give them hope,” he says.
    Indeed, the day after his bladder surgery, Sandy sat propped up in his hospital bed, speaking on the phone with a man diagnosed with colon cancer. Since then, Sandy has spoken to dozens of colon cancer patients on the phone and in hospitals, many through an organization that connects patients with survivors, and he has launched a “Cancer with Sandy” Facebook support group.
    “I’ve been living with this disease for five years,” Sandy says. “I’m probably going to live with it for the rest of my life, so it’s part o“It feels so good to tell my story,” he adds, “because Dr. Shah gave me hope that day when he told me that surgery was possible.”

    Sandy is grateful to be able to see his son and daughter being recruited to play hockey when they go off to college. “I wake up every day and thank God that I’m alive.”
    And he is thankful to Drs. Shah, Halazun, and Scherr and the rest of his healthcare providers for not giving up on him.
    The way the doctors cared for Sandy, he says, “I felt like they loved me.”

    “The whole team was awesome,” he adds. “I was so lucky to have found them. These days, even when things are stressful, I don’t let it bother me. I have a beautiful wife and two healthy children … it seems impossible that I’m still living, but I feel like a damn lucky guy.”

    Originally Posted on Health Matters, Stories of Science, Care, and Wellness by New York Presbyterian

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    Coping With Pain During and After Cancer

    All of us look forward to our treatments ending. We think that that we will have an uneventful return to normal life. But for some cancer patients, they suffer from pain after treatment as a late side-effect of their cancer treatment.


    The causes of chronic pain are as varied as are the diagnoses. These are the leading causes of pain in cancer survivors. Chemotherapy-induced peripheral neuropathy Pain after head and neck cancers Post-mastectomy pain
    Oncologists estimate that about one-third of their patients suffer from chronic pain after treatment. More patients are surviving cancer for longer times. Many survivors are well past the 10-year mark. Improving the quality of life through more effective pain management has become a higher priority now. Some of the long-term side effects, including pain, appear long after treatment ends.
    Where do cancer survivors fit in the opioid epidemic?
    A recent study by Duke University shows that cancer patients are ten times less likely to die of an opioid overdose than the general population. The researchers studied anonymous death certificates from the National Center for Health Statistics. Death certificates contain a single cause of death and up to 20 contributing factors along with demographic information. They looked at death certificates from 2006 to 2016.
    The results were definitive. Cancer patients are much less likely to die from an opioid overdose. 895 opioid-related deaths in cancer patients versus 193,000 in the general population. .66 per 100,000 people in the cancer populations versus 8.97 per 100,000 in the general population.
    Almost half of the opioid-related cancer deaths occurred in just two kinds of cancer — lung and gastrointestinal cancer. The other cancer diagnoses linked to opioid-related deaths were head and neck (12 percent), blood cancers (11 percent) and genitourinary (10 percent).
    Access to opioids has been reduced over the last few years as the opioid deaths continue to rise. Reduced access to pain medication affects cancer patients today. Walmart’s new opioid policy is just one example of how cancer patients and cancer survivors are adversely impacted. Walmart and other pharmacy chains now fill enough opioid for 7 days. Yet cancer patients undergo complex surgeries that the general population will never face. Most cancer patients need pain medication after surgery for several weeks.
    What’s Being Done to Help Pain in Cancer Survivors?
    Oncologists, surgeons and radiology oncologists are all exploring ways to effectively treat patients’ cancers while reducing the possibility of long-term pain.
    Newer surgical techniques help many patients. For example, more lumpectomies and less aggressive mastectomies reduce the risk of post-mastectomy pain syndrome (PMPS). PMPS may cause nerve endings to misfire for no reason, causing mild to severe pain.
    Use of other medications (instead of pain medications) for chemo-induced peripheral neuropathy. These medications include anti-epileptic drugs, anti-seizure medications and antidepressants.
    More effective use of pain medication, upfront, can reduce the need for extended physical therapy. Breast cancer surgery may cause adhesive capsulitis, a condition known as frozen shoulder. Frozen shoulder can be completely cured with physical therapy — but patients can’t effectively do the physical therapy without adequate pain relief. 


    What problems do we need to address specifically for cancer patients?
    Unfortunately, laws are a “one-size fits all” band-aid solution. Cancer patients may not get the pain relief that they desperately need to heal. Poorer patients (both in urban and rural areas) are especially at risk. The new laws create barriers for writing and filling prescriptions. Patients who lack transportation may be unable to travel back to a surgeon’s office to obtain another prescription for pain medication after colorectal, lung or other major surgery.
    Lung cancer patients are particularly at risk of suffering shortness of breath because access to morphine and other opioids is so tightly controlled. These substances help relieve the “breathlessness” caused by the removal of a lung or a lobe of a lung.
    Alternatives aren’t always well understood by oncologists and other physicians, insurance companies or our elected and government officials. Many alternative methods of pain relief like acupuncture, yoga and medical marijuana face prejudice and lack of acceptance. Lack of insurance coverage for these alternative methods of pain control limit which patients even have access to alternative pain-relief methods. Even milligram dosages are limited — methadone used to be available in 40 mg. tablets — now it is only available in 5 and 10 mg. tablets.
    Complementary Treatments That May Help
    Many complementary treatments exist. Some alternative treatments work for some people but not for others. Many patients find that adding complementary treatments to conventional medicine provides the best pain relief.
    Acupuncture. Acupuncture is an ancient Chinese method of inserting needles into precise locations. Modern science believes “needling” these points stimulates the nervous system to release chemicals into our muscles, spinal cord and brain.
    Biofeedback. This technique helps teach a patient to gain voluntary control over a normally automatic bodily function, like our heart rate. Biofeedback can help chronic pain, headaches, high blood pressure and even urinary incontinence.
    Massage. Massage comes in many forms. It can help relieve spasms, cramping and nerve pain. Massage enhances sleep, relieves anxiety and reduces fatigue. 


    Mind + Body. Meditation, hypnosis, and mindfulness are forms of mind + body where we learn to channel negative thoughts into more positive feelings. Mind + body is often combined with other complementary practices.
    Tai Chi . This ancient Chinese martial arts technique is gaining a following among older adults as a low-to-moderate exercise to increase balance and flexibility. Cancer survivors with chemo-induced peripheral neuropathy (CIPN) learn to use their entire body when exercising. They regain their confidence by reducing the risk of falls.
    The use of repurposed drugs helps peripheral neuropathy too. Older antidepressant drugs called tricyclics may provide excellent pain relief for nerve pain. These drugs include amitriptyline, imipramine, clomipramine, desipramine, and nortriptyline. They are inexpensive and are usually well tolerated. Anti-seizure medications sometimes work. Finding the one that works for you may take some trial-and-error, but many cancer survivors find relief using repurposed drugs.
    Don’t forget about over-the-counter pain relievers. Many of these provide powerful pain relief when used for specific types of pain. Nonsteroidal anti-inflammatory drugs (NSAIDs). Ibuprofen and Naproxen are good for inflammation, joint pain and bone pain. Frozen joints and general stiffness respond well to NSAIDs. Just remember to take with food to avoid stomach upset.
    Acetaminophen. This is a powerful pain reliever that is sometimes unappreciated. Be sure to follow dosing directions to avoid liver damage. Topical and local analgesics. Lidocaine patches and creams, peppermint oil and OTC gels get high marks from some patients. They work on nerve pain and joint pain.
    Don’t give up if your chronic pain robs you of quality of life. Schedule an appointment with your oncologist or primary care physician specifically to discuss pain management.


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    24 Tips to Better Handle Pain From Chemo and Radiation

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    The Value of Faith and Spirituality For People With Cancer

    A study by the U.S. Centers for Disease Control and Prevention (CDC) shows that 69 percent of cancer patients pray for their health. A 2015 study of over 32,000 cancer patients found that patients with a religious or spiritual belief system reported feeling better. The study was published in 2015 in Cancer, a peer-reviewed journal of the American Cancer Society.


    Details of this report
    Researchers and colleagues from Moffitt Cancer Center examined several published studies of cancer patients (totaling over 32,000 people with cancer) and found a link between patients having a higher sense of spirituality and reporting better physical health. In other words, patients who report an enhanced sense of spiritual well-being also report feeling better physically.
    The study organizers defined religious as belonging to a religious organization and attending services. They defined spirituality as feeling a connection to a force larger than oneself — that feeling might come from being part of a religion or finding spirituality outside of organized religion.
    Moffitt researchers studied age, sex and cancer-related variables, like type of cancer and stage. The association was consistent across all patient characteristics. Patients who were religious or felt spirituality consistently report better health.
    The type of belief that a particular patient had did not seem to affect the way they felt. Whether one attended church, prayed or meditated, the outcome was the same. Having a purpose in life or believing that one is part of something bigger than themselves appears to be the reasons these patients reported feeling better.
    Conversely, patients who were isolated or alone described worse physical health, decreased mental health and little social support.
    Sources for a Stronger Spiritual Life
    Even the National Comprehensive Cancer Network (NCCN) acknowledges that spirituality and religion can be important parts of a cancer patient’s ability to handle their disease.
    Regular attendance (health permitting, of course) at the church where you are a member. The diagnosis of cancer may be a “wake-up” call to attend their church more regularly. Being surrounded by friends you already know often provides comfort and support to someone newly diagnosed with cancer. Being on your church’s prayer list brings solace to many people. Cancer patients may welcome visits from their minister, priest or rabbi.
    Return to the church of your childhood. Some of us may have strayed from our upbringing in the church as our lives got busier and busier. Work, raising children, household duties or caring for aged parents may prompt us to stop attending church. However, many people begin attending church again after a cancer diagnosis. We may find ourselves attending the denomination of our parents — it’s a way of going back home to the traditions we learned in childhood.


    Non-denominational church. Some people with cancer find spirituality as they realize that they are part of a larger group of people all battling the same disease. They may feel more comfortable attending a non-denominational church. These churches are usually founded on Christian Protestant principles. They tend to be larger (mega-churches), use technology in their services and celebrate with contemporary music. First-time churchgoers might feel more comfortable in this setting as they learn about their new spirituality.
    Spiritual but not religious. This concept even has an acronym — SBNR. Almost every person has a spiritual side. They may disguise it by acting tough. They may have had a bad experience as a child in the church of their parents. We may never know why some people identify themselves as SBNR. Most people in this category love people, practice forgiveness and trust humanity. You see them volunteering at soup kitchens and homeless shelters. They are often passionate about helping others and/or helping animals. Although the SBNR don’t attend church or believe in organized religion, they find peace of mind in their lifestyle.
    Religion and spirituality are individual choices that we, as humans, are free to make. We, as cancer patients, realize how our spiritual life and how our particular religious affiliation can help us. However, not everyone finds comfort during a health crisis in the same way.
    Benefits of Religious and Spiritual Beliefs for People with Cancer
    The diagnosis of cancer is difficult for every person. No matter where we are in our cancer experience from early diagnosis to treatment or if we experience progression or face end-of-life, our religious or spiritual beliefs help us.
    “Why me?” Many patients ask this question. From the beginnings of history, people have wondered why misfortune struck them. The Book of Psalms is filled with writers who felt abandoned by God. Humankind is not different today. We wonder why we got cancer. We never smoked, but we got cancer. We led a healthy lifestyle, but we got cancer. We already had cancer, but we got another kind of cancer. People wonder why bad things happen to good people. People of faith may find it easier to accept the diagnosis of cancer because of our knowledge that misfortune is part of human history.


    Enhanced quality of life. Cancer patients experience an improved quality of life. Our spirituality gives up hope and positive feelings about our future. Spirituality helps relieve guilt and regrets and helps us find inner peace. Spirituality appears to help patients be more compliant with dosing instructions and with engaging in more healthy lifestyles. These patients feel less lonely, less angry or hostile and have better control of pain and nausea. They even have lower blood pressure.
    Our medical teams. Put yourself in the shoes of anyone in your medical team. Every day, a newly diagnosed patient arrives for their first visit. Chemo nurses calm new patients’ fears about chemo infusions. Oncologists have to be the bearer of bad news that a patient’s cancer has spread. Surgeons have to tell a patient that they can’t operate. Radiologists have to share that a patient has too many lung nodules. And they all have to deal with the death of patients. Did you know that some doctors pray over their patients? At some hospitals, nurses and doctors visit the chapel during shift change. At Dana-Farber Cancer Institute, patients may request a special blessing in the room of a patient about to have a stem cell infusion.
    As the lead author for this study, Heather S. L. Jim, Ph.D., points out — Cancer is a multifaceted disease. Many factors are interconnected. She observes that a patient’s faith may be as important as behavior factors and emotional health. Many of these factors are beyond human understanding.
    We simply don’t know. On a personal note, my surgeon, who delivered the news that I had Stage IV rectal cancer, told me that he was a “man of faith.” On the morning of my potentially curative surgery, he came into the pre-op holding area, took my hands and prayed over me. You have no idea how powerful that was for me. Then he asked me if I was ready, and I said, “Yes. Let’s get this done.” Prayer, faith and spirituality are important considerations for the majority of cancer patients.
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    KarenG_WN posted a blog post

    March is Colorectal Cancer Awareness Month

    Colorectal cancer is the third most diagnosed cancer, after lung and breast cancer (excluding skin cancer). Approximately 140,000 people were diagnosed with colorectal cancer in the past year — 97,220 new cases of colon cancer (49,690 men and 47,530 women) and 43,030 new cases of rectal cancer (25,920 men and 17,110 women). Ninety percent (90%) of all colorectal cancer occurs in people over 50. Colorectal cancer accounts for just over 50,000 deaths annually in the U.S.
    Risk Factors
    Age. For colon cancer, the average age at diagnosis is 68 for men and 72 for women. For rectal cancer, it is 63 for both men and women. An alarming trend is developing. Rates in people under 50 are rising at about 2 percent a year, especially for rectal cancer. Experts don’t know why.
    Gender. Men are slightly more likely to develop colorectal cancer than women.
    Family history. Colorectal cancer can run in families, especially if first-degree relatives (parents, brothers, sisters, and children) or several family members (grandparents, aunts, uncles, nieces, nephews, grandchildren, and cousins) have had colorectal cancer. This is especially true if the relatives were diagnosed at younger ages.
    Inflammatory bowel disease (IBD). People who have ulcerative colitis or Crohn’s disease are at increased risk of developing colorectal cancer.
    History of adenomatous polyps. This kind of polyp can develop into colorectal cancer. Unfortunately, if you’ve had a polyp, you’re more likely to develop more.
    Personal history of certain kinds of cancer. Women who have had ovarian or uterine cancer are more likely to develop colorectal cancer.
    Race. Colorectal cancer is the leading cancer-related cause of death in African-Americans. African-Americans are more likely to be diagnosed at a younger age. The American College of Gastroenterology recommends that black people begin screening with colonoscopies at age 45.
    Physical inactivity and obesity. Being inactive and overweight increases risk of developing colorectal cancer.
    Nutrition. Eating large amounts of red meat and processed meat increases your risk of developing colorectal cancer.
    Smoking. Smokers are more likely to die from colorectal cancer than non-smokers. To help lower your risk, eat more fruits and vegetables and lose weight. Exercise — a daily walk will do. Follow your doctor’s recommendations about a colonoscopy and other screening methods.

    Symptoms
    The symptoms are varied and may be vague. Be your own advocate. Press for more testing if symptoms persist. A change in bathroom habits Diarrhea or constipation or a feeling that your bowel hasn’t completely emptied Narrow or thin stools Anemia Feeling bloated Losing weight, without trying to lose Fatigue Blood (either red or dark) in your stools

    Related Article - Living With Colorectal Cancer

    No, it wasn’t “probably hemorrhoids” as my primary care physician speculated when I told him about my rectal bleeding. It was Stage IV rectal cancer. Although he knew that my medical history included a benign rectal polyp, he did not recommend that I consult with a gastroenterologist. All that he wanted to do was write me a prescription for steroid suppositories. I asked for a referral to a colorectal surgeon for further evaluation.
    Don’t take a chance. Ask for a referral to a gastroenterologist if you have lingering symptoms that don’t go away. If you have had a polyp in the past, ask for a referral to a colorectal surgeon or other specialist who is skilled in working with patients who are at higher risk for colorectal cancer.
    Treatments for Colorectal Cancer
    Depending on the stage and location of your tumor, treatment options include surgery, chemotherapy and radiation. Metastatic colorectal cancer have a variety of specialized treatments for brain, liver and lung tumors — including ablations, SBRT and the CyberKnife radiation, radioactive beads and VATS lung surgery.
    Latest Research

    There are still many challenges in the diagnosis and treatment of colon and rectal cancer. Rectal cancer is sometimes more challenging to treat — treatment usually includes radiation, chemotherapy and surgery, sometimes resulting in a permanent colostomy.
    Better diagnostic and screening methods. While the colonoscopy is the gold standard of finding polyps and removing them before they become cancerous, too many people avoid this potentially life-saving procedure. A stool sample test to detect genetic changes consistent with colorectal cancer is being developed. Then a colonoscopy could be used to remove polyps earlier when there is a better chance of cure.
    Tests to predict the chance of recurrence. Some genetic markers are associated with an increased risk of recurrence. This helps doctors and patients decide whether chemotherapy after surgery would be beneficial.
    Immunotherapy. Research continues to identify checkpoint inhibitors that will be effective for colorectal cancer patients who are microsatellite high (MSI-H).
    BRAF mutations. About 10 percent of colorectal cancer patients have the BRAF mutation. Clinical trials and more research is being conducted to help this subset of patients.
    Colon and Rectal Cancer Is Rising in Younger Adults

    Studies show that since 1974, colorectal cancer rates have been rising in younger adults, ages 20-39 and 40-54. For colon cancer, rates are increasing by about 1 percent a year.
    However, rectal cancer rates in younger adults are rising at twice the rate of colon cancer, roughly 2 percent annually since the early 1990s. Three in ten rectal cancer diagnoses are now in patients under 55. Experts don’t know why.
    Rectal cancer rates have been declining in people over 55 for the past 40 years. Educational efforts aimed at young adults are underway along with discussions of methods to increase screening efforts toward younger adults.
    The sad news is that many of these younger adults are diagnosed with advanced stage disease because physicians thought that they were too young for this diagnosis. Educational efforts are also targeted toward the medical community to ensure that a diagnosis of colorectal cancer should be considered in younger adults who have the classic symptoms of colon and rectal cancer.


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