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IASLC Textbook of Prevention and Early Detection of Lung Cancer




By Fred R. Hirsch, Jr., Paul A. Bunn, James L. Mulshine, Harubumi Kato

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With increasing emphasis being placed on screening and early prevention in cancer, this textbook examines the various methods and interventions used in screening in lung cancer, and presents a detailed review of the approaches to prevention and treatment of early disease. The book addresses topics such as epidemiology, spiral CT and the role of sputum examination for screening and early detection, and chemoprevention. The book also includes a chapter on international organization of screening programs. IASLC Textbook of Prevention and Early Detection of Lung Cancer will be of particular interest to lung cancer and respiratory medicine specialists.


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Advances in cancer research


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Volume 76 of Advances in Cancer Research continues the series' goal of publishing timely and authoritative reviews in the broad field of cancer research. Ruoslahti begins the volume with a review of fibronectin and its integrin receptors in cancer. Chapter 2 by Ganter and Lipsick discusses Myb and oncogenesis. Biscardi and colleagues present their research on c-Src, receptor tyrosine kinases, and human cancer in Chapter 3. Chapter 4 by Schulz covers epidemiology of Kaposi's sarcoma and associated herpesvirus/human herpesvirus 8.

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Breast Cancer: Prognosis, Treatment, and Prevention, Second Edition



By Jorge R. Pasqualini
* Publisher: Informa HealthCare
* Number Of Pages: 608
* Publication Date: 2008-04-11
* ISBN-10 / ASIN: 142005872X

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Pathology of Incipient Neoplasia


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Many malignant tumors have a morphologically recognizable precursor lesion. As screening and early detection have improved our ability to detect lesions at increasingly earlier stages of growth, an increased number of precancerous lesions are seen by pathologists. Unfortunately, a lack of uniform histologic criteria for precursors found in many organs can make diagnostic interpretation difficult. It is evident that physicians are seeking a better understanding of the genesis and progression of these lesions and their early biology, to provide optimal treatment and patient care.Pathology of Incipient Neoplasia 3E brings together all of the information available on the clinicopathologic features of precancerous lesions, defined to include atypical hyperplasias, in-situ changes, microinvasive or very small cancers in some sites, and other lesions recognized as potential precursors for invasive cancer. In some tissues, benign tumors may serve as precursors to malignant tumors, and therefore these also are considered.Organized by organ, each heavily-illustrated chapter is written by a well-recognized expert, to stress different facets of preneoplasia and minimally invasive tumors in that given tissue. Areas where strides have been made in research on molecular biologic aspects of neoplasia are discussed in conjunction with morphologic parameters. A chapter on salivary glands, and more than 350 color photos interspersed throughout the text, are new to this edition.
PDF 86.7 MB
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Methods of Cancer Diagnosis, Therapy and Prognosis: Breast Carcinoma (Methods of Cancer Diagnosis, Therapy and Prognosis)




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This is the first book that discusses subjects of diagnosis, therapy, therapy assessment, and prognosis of breast cancer in one single volume. Cancer killed 6.7 million people around the world in 2002 and this figure is expected to rise to 10.1 million in 2020. Approximately, 189,510 new cases of breast cancer were reported in 2007 in the United States, and 40,910 died in the same year. Focusing on Breast Carcinoma, this first volume in the series Methods of Cancer Diagnosis, Therapy and Prognosis brings together 56 leading scientists from around the world to deliver a comprehensive treatise on all aspects of breast cancer, including diagnosis, treatments and prognosis. Scientists and clinicians have contributed state of the art chapters on their respective areas of expertise providing the reader a whole field view of breast cancer management. This fully illustrated volume: * Presents a constructive evaluation of commonly used methods for elucidating primary and secondary cancer initiation, progression, relapse, and metastasis. * Highlights methods of breast cancer diagnosis and treatment assessment including various imaging modalities such as ultrasound, computed tomography, magnetic resonance imaging, immunohistochemistry and histochemistry. * Discusses detailed therapeutic protocols, including both their benefits and side-effects. * Discusses examples of breast cancer treatments includingchemotherapy, radiation, chemoradiation, surgery, hormonal - and immunotherapy * Details the molecular processes that lead to the development and proliferation of cancer cells * Includes recent major advances in cancer diagnosis and therapy assessment Professor Hayat has summarized the problems associated with the complexities of research publications and has been successful in editinga must-read volume for oncologists, cancer researchers, medical teachers and students of cancer biology.


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Bioinformatics in Cancer and Cancer Therapy (Cancer Drug Discovery and Development)

By Gavin J. Gordon

Publisher: Humana Press

Number Of Pages: 202 Publication

Date: 2008-11-21

ISBN-10 / ASIN: 1588297535 ISBN-13 / EAN: 9781588297532


Binding: Hardcover Product Description: Bioinformatics can be loosely defined as the collection, classification, storage, and analysis of biochemical and biological information using computers and mathematical algorithms. Although no single person or group started the field wholly on their own, Temple Smith, Ph.D., a professor at Boston University, is generally credited with coining the term. Bioinformatics represents a marriage of biology, medicine, computer science, physics, and mathematics, fields of study that have historically existed as mutually exclusive disciplines.Concurrently, bioinformatics has vaulted into the public’s eye in lay newspapers and magazines, most notably in the area of (personalized) DNA sequencing. The combined result is that bioinformatics is being heralded as a panacea to the current limitations in the clinical management of cancer. While certainly over optimistic in some regards, this designation is not without promise particularly in the area of cancer diagnosis and prognosis.The focus of this book is to: i) to provide a historical and technical perspective on the analytical techniques, methodologies, and platforms used in bioinformatics experiments, ii) to show how a bioinformatics approach has been used to characterize various cancer-related processes, and iii) to demonstrate how a bioinformatics approach is being used to bridge basic science and the clinical arena to positively impact patient care and manage







Cancer And Benign Tumors
(NELSON textbook of pediatrics 18th edition)

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Medicine - Holland-Frei Cancer Medicine 6th edition




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AJCC Cancer Staging Manual (6th Edition)



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Cancer: Principles and Practice of Oncology 6th edition




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Prostate Cancer: Signaling Networks, Genetics, and New Treatment Strategies

Award winning authors present a comprehensive review of new perspectives in prosate cancer research
and open up new directions in the clinical management of prostate cancer. In, Prostate Cancer: Signaling Networks, Genetics, and New Treatment Strategies, the authors focus on the biology, genetics, molecular signaling networks in the disease process, and recent advances in the treatment of prostate cancer. This state-of-the-art title provides key insights into cutting edge advances in prostate cancer research, such as laparoscopic radical prostatectomy, and offers a critical evaluation and discussion of opportunities for development of novel therapies for prostate cancer. Clinical trials that have not been covered or evaluated in any other books currently available are also discussed. Invaluable to physicians and researchers, Prostate Cancer: Signaling Networks, Genetics, and New Treatment Strategies provides a comprehensive translational resource as well as an important source of information for prostate cancer patients
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Julia A. Ericksen “Taking Charge of Breast Cancer”



University of California Press 2008-04-07 ISBN: 0520252926 336 pages PDF 1,14 MB
Vividly showcasing diverse voices and experiences, this book illuminates an all-too-common experience by exploring how women respond to a diagnosis of breast cancer. Drawing from interviews in which women describe their journeys from diagnosis through treatment and recovery, Julia A. Ericksen explores topics ranging from women’s trust in their doctors to their feelings about appearance and sexuality. She includes the experiences of women who do not put their faith in traditional medicine as well as those who do, and she takes a look at the long-term consequences of this disease. What emerges from her powerful and often moving account is a compelling picture of how cultural messages about breast cancer shape women’s ideas about their illness, how breast cancer affects their relationships with friends and family, why some of them become activists, and more. Ericksen, herself a breast cancer survivor, has written an accessible book that reveals much about the ways in which we narrate our illnesses and about how these narratives shape the paths we travel once diagnosed



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Molecular Pathology of Gynecologic Cancer (Current Clinical Oncology)

Molecular Pathology of Gynecologic Cancer focuses on putting successful molecular strategies into practice for the treatment of gynecologic cancer. The volume begins with an explication of the editors’ hypothesis that cancer is mainly a disease of the cell cycle, based on the deregulation of the physiological process of cell reproduction. The following eleven chapters focus on specific issues in gynecologic cancers, including: a proposed model of ovarian serous carcinogenesis, molecular markers for ovarian epithelial cancer, an overview of the pathology of endometrial cancer, molecular genetic aspects of endometrial carcinoma and cervical cancer, a natural history of Human Papilloma Virus (HPV) as it relates to cervical cancer, and hereditary issues in gynecologic cancers. The concluding chapter proposes and outlines a holistic approach to the treatment of female cancer patients. This new volume in Humana’s Current Clinical Oncology™ series will be necessary reading for clinicians and experimental researchers alike.

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Atlas of Gynecologic Oncology




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Pericardial Mesothelioma

Mesothelioma is a rare form of cancer that affects three main parts of the body – the lungs, the abdomen, and the heart. The development of mesothelioma only occurs after exposure to asbestos, a dangerous natural substance. Therefore, mesothelioma is preventable in most cases. Unfortunately, however, thousands of people have died from this deadly form of cancer and thousands more are diagnosed every year. Are you at risk? If you have been previously exposed to asbestos, you may develop mesothelioma, even if your exposure happened decades ago. By learning a bit about asbestos and mesothelioma, you can determine if you are at risk and what you should do to stay healthy.
Of all types of mesothelioma, pericardial mesothelioma is the one that doctors least understand. Pericardial mesothelioma is a cancer that affects the lining of the heart. It all starts by breathing in asbestos fibers. Asbestos was once used in a number of products because it is strong, durable, lightweight, flexible, and heat-resistant. In addition, when compared to the other options, asbestos was extremely cheap to mine, ship, and use in manufacturing. However, another of asbestos’ qualities is that it is very fibrous. Whenever asbestos rock or powder is disturbed, tiny fibers fill the air.
Although very small, asbestos fibers are extremely dangerous because they are jagged and pointy. These sharp fibers can tear tissue and become lodged in the body. This is how mesothelioma develops in the linings of the lungs and abdomen – asbestos is either breathed in or swallowed, and the fibers get stuck in the soft tissue linings of these organs. Please see “Peritoneal Mesothelioma” and “Pleural Mesothelioma” for information about these cancers.
How asbestos attacks the lining of the heart is still open for debate. The most popular theory is that some of the smaller asbestos fibers break through the lining of the lung and enter the blood stream going to the heart. When the heart pumps, the asbestos fibers get stuck in the very sensitive soft tissue lining of the heart – the pericardium. Because this is unlikely to happen, pericardial mesothelioma is extremely rare, with less than 200 new cases diagnosed every year. That also makes it hard to study and thus hard to treat. The life expectancy for a patient dealing with pericardial mesothelioma is lower than other mesothelioma patients.
Mesothelioma is a type of cancer that develops slowly over many years. In some cases, patients are not diagnosed with this cancer until 30 or more years after initial exposure to asbestos. Inhaling asbestos fibers just once is enough to cause cancer, but the risks greatly increase the longer you are exposed.
Because pericardial mesothelioma builds up slowly, some people miss the signs and symptoms that gradually worsen until they become a major problem. At this point, it is likely that the cancer is unable to be effectively treated, and it may have spread through the blood stream to other parts of the body. Some symptoms you should look for include the following: chest pains that worsen over time, irregular heartbeat, pressure on the chest, coughing, and shortness of breath.
If you are diagnosed with pericardial mesothelioma, there are a number of treatment options you should discuss with your doctor. The best path depends on the advancement of the cancer and your personal preferences. Surgery is sometimes a good option, especially if you catch the mesothelioma early. However, because the cancer is located near the heart, surgery is not always an option. Instead, you can opt to try radiation or chemotherapy. Both of these traditional cancer options work at destroying cancerous cells which, left untreated, grow very quickly. For information about treatment, please see “Mesothelioma Treatment Options.”
You can also choose not to treat the cancer, which is often a decision that patients with advanced pericardial mesothelioma consider. Instead, the medical treatments done are used to make you more comfortable. Fine needle aspiration is recommended to help the heart beat and subdue any pain – this technique uses a hollow needle to drain the fluid from your chest. Medications can also be effective, and new clinical trials are testing alternative drugs to see if they are effective against mesothelioma.
If you’ve developed pericardial mesothelioma, it's important to talk with both a medical professional and a lawyer. A mesothelioma attorney can discuss your case with you and talk about your legal rights. In most cases, mesothelioma is the fault of a past employee or of someone else who knowingly put you in harm’s way without your consent. Asbestos corporations chose profit over the health of consumers and employees and, as a result, thousands of people have died. You do have legal rights in this situation to help you get the compensation you deserve to pay for medical bills, lost wages, funeral expenses, and other fees associated with mesothelioma. Please see “Legal Issues and Mesothelioma” for more information

Peritoneal Mesothelioma

Every year, thousands of people are diagnosed with mesothelioma. Unfortunately, almost all cases of this rare and deadly form of cancer could have been prevented. Mesothelioma is caused by an environment substance – asbestos. Asbestos is found naturally in the ground, but poses little threat undisturbed in nature. However, during the industrial revolution, manufacturers began using asbestos in a number of products, especially those used for construction. Asbestos is a great product to use because it is fire-resistant, lightweight, flexible, durable, and cheap, but it also puts people at risk for very serious health problems. Today, the EPA regulates all use of asbestos, but this wasn’t always the case.
There are three kinds of mesothelioma, each attacking a different part of the body (the lungs, the heart, and the abdomen). While pleural mesothelioma (affecting the lungs) is the most common, peritoneal mesothelioma is the second most common form of mesothelioma. Please see “Pericardial Mesothelioma” and “Pleural Mesothelioma” for information about these cancers.
This type of mesothelioma affects the abdomen and is predominately caused by swallowing asbestos. Of course, no one eats asbestos, and it was never an ingredient in food products, but asbestos can be accidentally consumed in a number of ways:
Children who are teething may stick something containing asbestos in their mouths.
If you naturally breathe through your mouth, you could swallow asbestos.
Eating near an area contaminated with asbestos could cause asbestos fibers to settle on your food.
Asbestos could pollute a drinking water source you use.
Asbestos is so dangerous when it enters the body partly because of the shape of its fibers. These fibers are extremely sharp and jagged, which is why your throat might feel itchy if you’re around asbestos. When you swallow these fibers, they can get stuck in and tear the peritoneum.
The peritoneum is a soft tissue lining in the abdomen. It surrounds the liver, pancreas, stomach, colon, and small intestines for protection. This lining provides a fluid that allows them to glide against one another when moving. However, when asbestos enters the body, it creates a perfect condition for the development of abnormal cells – cancer.
When peritoneal mesothelioma develops, which can happen over the course of decades, the asbestos fibers irritate the peritoneum and cause cells to multiply quickly and overproduce the fluid normally used to keep the body healthy. Therefore, one of the main symptoms of peritoneal mesothelioma is the accumulation of fluid in the abdomen. Other symptoms include weight loss (even though your waist size may increase due to the fluid), stomach pains, bowel obstruction, and fever. Some peritoneal mesothelioma patients also develop anemia, a condition that reduces the red blood cells in the body. This strains the heart and can make you feel tired. It is also dangerous if you are injured, as bleeding becomes a problem.
Peritoneal mesothelioma makes up approximately one out of every five mesothelioma cases. While it can take years or even decades to develop, in most cases, it is discovered sooner than other forms of mesothelioma, which is in part due to the build-up of fluid.
There are two types of peritoneal mesothelioma. Dry peritoneal mesothelioma reveals a tumor in the abdomen in a single location. For this kind of cancer, many times the best option is surgery to remove the mass. Wet peritoneal mesothelioma is a bit harder to treat. In this type of mesothelioma, you’ll see a number of smaller tumors growing all over the peritoneum. Surgery is also an option, and patients can also consider chemotherapy, radiation, gene therapy, and other traditional cancer treatments. For information about treatment, please see “Mesothelioma Treatment Options.”
In addition to traditional forms of treatment, there are also alternative options as well. Not that not all of these alternative therapies are recommended by all doctors. Usually, a doctor will prescribe a traditional medical treatment, but if alternative medicine interests you, make sure you talk to a licensed professional about these options as well. For mesothelioma, some of the alternative therapies being studied include ukrain, iscador, vitamin C, ozone therapy, astragalus, and cat’s claw. Techniques like medical massage, acupuncture, and acupressure may help if you’re experiencing a lot of pain due to the mesothelioma.
Whatever course of treatment you choose, make sure that you talk to a lawyer in addition to talking to medical professionals. In the vast majority of mesothelioma cases, you are not at fault for developing this condition. Companies that produced asbestos products knew about the dangers involved with this substance since the 1940s. However, asbestos was still commonly used until the 1980s, at which time it became more regulated. Employees were put at risk without consent, as were their families, since asbestos is easily transferred home on clothing or in hair. You have legal rights against those who put you at risk. Please see “Legal Issues and Mesothelioma” for more information

Pleural Mesothelioma

Mesothelioma is a rare kind of cancer that attacks the body after exposure to asbestos. Once used commonly in the manufacturing of materials for homes, ships, and other structures, today, asbestos is highly regulated by the EPA. However, the cases of mesothelioma continue to rise. Mesothelioma also takes a long time to develop (typically 15-40 years), so patients today could have been exposed prior to the 1980s when asbestos was not highly regulated.
There are three kinds of mesothelioma, each attacking a different organ. The most common is called pleural mesothelioma. Pleural mesothelioma is cancer of the pleura, which is the lining of the lungs. Other kinds of mesothelioma affect the linings of the heart and abdomen. With all three types of mesothelioma, if the cancer goes untreated, it can easily spread to the surrounding organs or to other parts of the body via the blood stream. Please see “Pericardial Mesothelioma” and “Peritoneal Mesothelioma” for information about these cancers.
About ¾ of all mesothelioma cases are pleural mesothelioma. The average survival rate once diagnosed, according to one study, is less than a year.
When around airborne asbestos, it is easy to breath in small asbestos fibers. You may notice that your throat feels scratchy, but in most cases, you won’t notice any immediate reactions from breathing in asbestos fibers. Fibers fill the air whenever asbestos-contaminated products are disturbed (the same applies to naturally occurring asbestos). Asbestos fibers are microscopic, jagged particles. When you breathe them in, they travel into the lungs and can get stuck in the soft tissue lining – the pleural.
The lung actually has two parts to the pleura. The visceral pleura is the outside of the lungs themselves. This part of the lung is very soft, delicate tissue that protects the lung from abnormal particles. The parietal pleura is, essentially, a sack around the lung, lining the chest wall and diaphragm. This creates a pleural space. The lungs use this space to expand when you breathe.
When the jagged asbestos fibers enter the lung, they can get stuck in the pleura. The body tries to fix this problem, but the result is scar tissue that builds up in the pleural space, making it difficult to breathe since the lungs cannot expand properly. This environment with foreign objects and scar tissue creates the perfect environment for abnormal cell growth. The cells mutate, causing cancer, and these cancerous cells begin to grow quickly into tumors, further preventing you from breathing correctly.
Pleural mesothelioma builds up very slowly , as the scar tissue in the lungs is, at first, unnoticeable. Symptoms of pleural mesothelioma include shortness of breath, coughing, difficulty swallowing, fever, weight loss, and chest pain. That said, because these symptoms progress so slowly, more than 30 years or more in some cases, a patient might not notice them at all. In other words, the symptoms feel normal. Many patients do not catch mesothelioma until a late stage of development.
If diagnosed with pleural mesothelioma, there are a number of treatment options to try. If the cancer is contained in the pleura, one of the best options might be the removal of the cancerous area. Surgery isn’t the best option for everyone, however. You can also try radiation, chemotherapy, intraoperative photodynamic therapy, immunotherapy, and gene therapy. Only you and your doctor can decide on the best course of action for your body. For information about treatment, please see “Mesothelioma Treatment Options.”
You are at risk for developing pleural mesothelioma if you worked in an industry using this substance prior to 1980. Some of the main products manufactured with mesothelioma include the following: insulation, roofing, gaskets, piping, floor tiles, plaster, joint compound, shipbuilding products, and textiles. You’re also at risk if a family member worked in these industries, as asbestos readily sticks to clothing and hair (meaning it can be transferred home easily). In addition, you could be at risk if you live in a home built prior to 1980. You should have your home tested for asbestos to make sure that it is safe. Smokers are especially at risk, as smoking cigarettes weakens the lungs and complicates the chance of developing mesothelioma.
Another risk factor is level of exposure. If you’ve experienced exposure to asbestos for many years, you are more likely to develop mesothelioma and other asbestos-related health problems. The best way to protect yourself is to remove the asbestos from your environment. Exposure to asbestos does not automatically mean that you’ll contract mesothelioma, but the longer your exposure, the more likely you are to develop this condition.
Unfortunately, for many people, asbestos exposure occurred unknowingly at the workplace. Larger corporations conspired to keep the dangers of asbestos a secret and, as a result, many people were put at risk without consent. If you’ve developed pleural mesothelioma after exposure to asbestos that was not your fault, contact a lawyer today to learn about your rights. Please see “Legal Issues and Mesothelioma” for more information

Diagnosing Mesothelioma

Basic Diagnosis
Diagnosing mesothelioma often means ruling out many diseases with similar symptoms before completing the diagnostic process. The diagnosis of mesothelioma is often difficult and typically occurs in a late stage of development. The patient will give a medical history, which will include answering questions about their history of exposure to asbestos. Other diagnostic tests include x-rays, CT scans, or MRI scans. The purpose of these tests is to try to see any shadowing, or tumor growth. In the case of pleural mesothelioma, lung function tests are performed.
Lung function tests are an extensive battery of tests that show the physician how much air your lungs can hold and how well they transport oxygen through the body and release carbon dioxide. Once a physician makes a preliminary diagnosis, you will be referred to an oncologist.
After a Positive Diagnosis
Most doctors will have an idea about whether you are dealing with mesothelioma or not following tests, but a definitive diagnosis will not be made until after the oncologist completes a biopsy. A biopsy is a medical procedure that removes a small section of tissue from the affected area. This tissue is then sent to a pathologist who will examine the tissue and make the official diagnosis of mesothelioma.
Stages of Mesothelioma
Once a diagnosis of mesothelioma is made, the oncologist will want to determine what stage the cancer is in. Mesothelioma is considered localized if it is contained to the mesothelium. If it has spread to the lymph nodes, the chest or other organs, then it is considered to be in the advanced stages. Staging the tumor is important because it helps the oncologist determine the best course of treatment. When deciding on a treatment protocol, physicians use the acronym TNM to determine the progression of the cancer. The 'T' refers to the size of the tumor, 'N' signifies whether or not there is lymph node involvement, and 'M' stands for metastasis, or whether the tumor has spread to any other organs. The correct assessment as to the stage of the tumor gives the patient the best hope for a positive outcome.
Getting the Earliest Diagnosis
Because mesothelioma mimics so many other diseases, it is important to get an accurate and early diagnosis. If you feel that you may be at risk for developing mesothelioma and begin to suffer from any of the symptoms, you should consult a doctor who will aggressively work to diagnose you. While the "wait and see" approach is fine for many minor health concerns, mesothelioma requires an early diagnosis for any chance of curing the disease.
Mesothelioma is all too often in the advanced stage by the time a diagnosis is made. The tumors in the mesothelium are so thin that they will not show up on an x-ray during early stages. By the time tumors are visible, the mesothelioma may very well have invaded other organs.
While there is currently no screening tool that will allow doctors to test for mesothelioma in the earliest stages, if you are concerned about your odds of developing mesothelioma, there are some precautions you can take.
If you know that you have been exposed to asbestos, through occupational exposure, exposure in your home, or by some other means, you should find a physician that has experience diagnosing patients with mesothelioma and other lung diseases. The more cases of any disease a doctor sees, the more easily he can diagnose them. If you are at risk for developing any asbestos related disease, choose a doctor that has experience in this area and see him for regular check-ups.
Ask your doctor about baseline tests. These tests can be controversial. X-rays, CT scans, or MRIs are not always recommended, and many doctors feel that, in the absence of symptoms, they are a waste of time and money. Some doctors feel that having these baseline tests make it easier to spot subtle changes on follow up tests.
Monitor your health. Early symptoms of mesothelioma are subtle and in order to catch it early you must be attuned to your body. A cough that doesn't go away, heaviness in the chest or shortness of breath can all be signs of a cold or the flu, but with the absence of other symptoms such as a fever or chills, you should question whether it could be something more, such as plural mesothelioma.
If you smoke, stop. Smoking has not been shown to influence the development of mesothelioma, however, it is a risk factor. If you are a smoker when you develop mesothelioma, you will also be putting enormous additional stress on your lungs. When a patient develops plural mesothelioma, their lungs will be severely stressed by excess fluid and their body will be stressed by a decrease in oxygen, as their lungs are unable to work as hard.

Symptoms of Mesothelioma


Early Symptoms of Mesothelioma
The early symptoms of mesothelioma are very minor, and may be mistaken for symptoms of other, less serious, diseases. Pleural mesothelioma, the most common form of mesothelioma, is cancer in the mesothelium surrounding the lungs. The early symptoms of pleural mesothelioma are shortness of breath, chest pain, or a cough. One common misdiagnosis of pleural mesothelioma is pneumonia.
Peritoneal mesothelioma is cancer that is in the mesothelioma surrounding the abdominal organs. Mesothelioma in this area causes weight loss, nausea, and swelling in the lower extremities. Symptoms of both pleural and peritoneal mesothelioma include the development of an effusion.
An effusion, either in the pleural or peritoneal mesothelium, is a build-up of excessive fluid. The excessive fluid is a result of the imbalance in the mesothelium cells. Their job is to lubricate the organs that they surround. When the mesothelium cells are invaded by cancer they overproduce the protective cells, which in turn cause fluid build-up. The fluid build-up from an effusion can cause side effects such as shortness of breath and chest pain, or, in the case of a peritoneal effusion, bowel obstruction and swelling of the abdomen. For more information about each kind of cancer, please see “Pleural Mesothelioma,” “Pericardial Mesothelioma,” and “Peritoneal Mesothelioma.”
More Advanced Symptoms of Mesothelioma
By the time that a patient is diagnosed with mesothelioma, the cancer is often well advanced. The patient may cough up blood, have abnormal blood clotting, experience fatigue, and suffer with night sweats.
Diagnosis is normally made through x-ray, but CT scans or ultrasound can be used as well. About five percent of the patients that are diagnosed with pleural mesothelioma have it in both lungs at the time of the initial diagnoses. Often, by the time a diagnosis is made, the tumors have metastasized and moved to other areas of the body.
What to do if You Suspect You have Mesothelioma
Mesothelioma is a very serious disease, and diagnosis is complicated. The early symptoms of mesothelioma mimic many other more benign health problems, and many people have no early symptoms at all. The turning point in the progression of mesothelioma is in the development of effusions. At the point where the mesothelium starts to manufacture a surplus of cells, the cancer is often well advanced.
Of course, no one wants to live a life in fear. One can not run to the doctor every time one has a cough or chest pain. However, it is argued that the best prognosis for mesothelioma patients is tied to an early diagnosis. Here are some tips on how to balance concerns for your health with the desire for a normal life:
Assess your risk. Do you, or did you at any time, work in an occupation with a high incidence of exposure to asbestos? If so, it makes sense to be more vigilant about any health issue, particularly any problems associated with your lungs or breathing.
Have regular check-ups. By choosing a doctor that understands the dangers of asbestos exposure and has seen many cases of mesothelioma, you increase the odds that your doctor will recognize the early symptoms, should you develop them.
Have your level of exposure tested. Although there is no definitive amount of asbestos that presents an increased health risk, for your peace of mind you can have a lung wash, which will give your doctor an idea about your level of exposure.
Keep your lungs healthy. Mesothelioma is most common in the pleural cavity. While strong and healthy lungs are not immune to mesothelioma, if your respiratory system is in top shape, through regular exercise, you will be better prepared to undergo the stressful treatments surrounding mesothelioma.
Preventing Mesothelioma
The only sure way to prevent mesothelioma is to avoid exposure to asbestos. Unfortunately, this is easier said than done. Asbestos was widely used throughout the country for both domestic and industrial uses. Once the dangers of asbestos exposure became widely known, use was reduced. Unfortunately, it was too late for an ever-growing number of people. The health risks associated with asbestos exposure may not show up for 50 years. Given the long latency period, it is expected that there will be an increase in the cases of mesothelioma as generations of workers age.
Today, exposure to asbestos often occurs in remodeling and repair projects. While stringent guidelines are in place for the abatement of asbestos in schools and other public buildings, most areas give the homeowner the option of removing or repairing asbestos building materials themselves. However, a licensed professional should perform all forms of repair and abatement of asbestos-contaminated materials.
If you decide to undertake an asbestos abatement project, it is important to understand the importance of wearing protective clothing and breathing apparatus, as well as cleaning the areas thoroughly and preventing dust from the project area from contaminating the rest of the home. If done incorrectly, you run the risk of exposing not only yourself, but the rest of your family to asbestos.

Mesothelioma Information

Diagnosing Mesothelioma
Basic Diagnosis
Diagnosing mesothelioma often means ruling out many diseases with similar symptoms before completing the diagnostic process. The initial diagnosis of mesothelioma is often made through the family doctor. The patient will give a medical history, which will include answering questions about their history of exposure to asbestos. Other diagnostic tests include x-rays, CT scans or MRI scans. The purpose of these tests is to try to see any shadowing, or tumor growth. In the case of pleural mesothelioma, lung function tests are done.
Lung function tests are an extensive battery of tests that show the physician how much air your lungs can hold as well as how well they transport oxygen through the body and release carbon dioxide from the body. Once your general physician makes a preliminary diagnosis, you will be referred to an oncologist.
After a Positive Diagnosis
Most doctors will have an idea about whether you are dealing with mesothelioma or not following the battery of tests, but a definitive diagnosis will not be made until after the oncologist completes a biopsy. The biopsy is a medical procedure that removes a small section of tissue from the affected area. This tissue is then sent to a pathologist who will examine the tissue and make the official diagnosis of mesothelioma.
Levels of Mesothelioma
Once a diagnosis of mesothelioma is made, the oncologist will want to determine what stage the cancer is in. The mesothelioma is considered localized if it is contained to the mesothelium. If it has spread to the lymph nodes, the chest, abdomen or other organs, then it is considered to be in the advanced stages. Staging the tumor is important because it helps the oncologist determine the best course of treatment. When deciding on a treatment protocol, physicians use the acronym TNM to determine the progression of the cancer. Tumor refers to the size of the tumor, N for whether or not there is lymph node involvement, and M for metastasis, or whether the tumor has spread to any other organs. The correct assessment as to the stage of the tumor gives the patient the best hope for a positive outcome.
Getting the Earliest Diagnosis
Because mesothelioma mimics so many other diseases, it is important to get an accurate and early diagnosis. If you feel that you may be at risk of mesothelioma and begin to suffer from any of the symptoms, you should consult a doctor who will aggressively work to diagnose you. While the wait and see approach is fine for many minor health concerns, mesothelioma requires an early diagnosis.
Mesothelioma is too often in the advanced stage by the time that a diagnosis is made. The tumors in the mesothelium are so thin that they will not show up on an x-ray during the early stages. By the time the tumors are visible, the mesothelioma may very well have invaded other organs.
While there is currently no screening tool that will allow doctors to test for mesothelioma in the earliest stages, if you are concerned about your odds of developing mesothelioma, there are some precautions that you can take.
If you know that you have been exposed to asbestos, either through occupational exposure, or exposure in your home, you should find a physician that has experience diagnosing patients with mesothelioma and other lung diseases. The more cases of any disease a doctor sees, the more easily he can diagnose them. If you are at risk for developing any asbestos related disease, choose a doctor that has experience in this area and see him for regular check-ups.
Ask your doctor about the wisdom of baseline tests. These tests can be controversial. Unnecessary x-rays, CT scans or MRIs are not recommended, and many doctors feel that, in the absence of symptoms, they are a waste of time and money. Some doctors feel that having these baseline tests make it easier to spot subtle changes on follow up tests.
Monitor your health. Although no one likes a hypochondriac, early symptoms of mesothelioma are subtle, and, in order to catch it early you must be attuned to your body. A cough that doesn't go away, heaviness in the chest or shortness of breath can all be signs of a cold or the flu, but with the absence of other symptoms such as a fever or chills, you should question whether it could be something more.
If you smoke, stop. Smoking has not been shown to influence the development of
mesothelioma, however, it is thought to be a risk factor. If you are a smoker when you develop mesothelioma, you will also be putting enormous additional stress on your lungs. When a patient develops mesothelioma, their lungs will be severely stressed by excess fluid and their body by a decrease in oxygen as their lungs are unable to work as hard. Do you really want to further tax your lungs by damaging them with smoke?

Cancer Stem Cells Linked to Radiation Resistance

Information courtesy of Duke University Medical Center News Office

DURHAM, N.C. - Certain types of brain cancer cells, called cancer stem cells, help brain tumors to buffer themselves against radiation treatment by activating a "repair switch" that enables them to continue to grow unchecked, researchers at Duke University Medical Center have found. The researchers also identified a method that appears to block the cells' ability to activate the repair switch following radiation treatment. This finding may lead to the development of therapies for overcoming radiation resistance in brain cancer as well as other types of cancer, the researchers said. Working with animal and cell culture models, the researchers found that a specific cellular process called the "DNA damage checkpoint response" appears to enable cancer stem cells to survive exposure to radiation and to switch on a signal to automatically repair any damage caused to their DNA. "In recent years, people have hypothesized that cancer stem cells are responsible for the resistance of malignant tumors to radiation treatment," said Jeremy Rich, M.D., senior investigator of the study and an associate professor of neurology at Duke. "We have shown, for the first time, that this is indeed the case." The findings appear Oct. 18, 2006, in the advance online edition of the journal Nature. The research was supported by the National Institutes of Health and a number of philanthropic organizations [complete list below]. The type of cancer that the researchers studied, glioblastoma, is highly resistant to radiation and other forms of treatment and is the most deadly form of brain cancer worldwide. Although aggressive treatments can destroy the majority of the cancerous cells, a small fraction of them remain and often regenerate into even larger masses of tumor cells. Until recently, scientists knew little about what made these resistant cells different from those that succumb to radiation treatment. It was clear, however, that the cells shared characteristics similar to those of normally functioning nerve stem cells, Rich said. In the current study, the researchers used glioblastoma tissue removed from patients during neurosurgery and created two separate models. For one model, the researchers extracted cells from the tissue and grew them in cultures in the laboratory. For the second model, they transplanted the glioblastoma tissue into the frontal lobes of the brains of mice. The researchers first measured the number of glioma stem cells present in the original tissue and then administered set doses of ionizing radiation to the cell cultures and to the mice. In both cases, the researchers observed a roughly fourfold jump in the number of glioma stem cells present in the tumor tissue following radiation treatment. Because ionizing radiation works primarily by causing permanent damage to the key genetic material of cells, DNA, the researchers hypothesized that the glioma stem cells survive and multiply by somehow fixing radiation-induced DNA damage better than the other cancer cells. To test this, the researchers searched the tissue samples for specific proteins that are responsible for detecting DNA damage. Using cell samples taken from both study models, the team examined the DNA damage checkpoint response both before and after use of ionizing radiation treatments by testing for activation of the key proteins that detect DNA damage. The researchers wanted to know whether the cells, following exposure to radiation treatment, would repair the DNA damage by activating the checkpoint response or whether they would instead die. The team found that after ionizing radiation, the DNA damage checkpoint proteins in glioma stem cells were more highly activated than in other cancer cells. This heightened activation, the researchers said, leads cancer stem cells to more effectively repair DNA damage and thus render the cells less likely to die as a result of the treatment. In another set of experiments, the researchers treated both the test animals and the cell cultures with a drug, called debromohymenialdisine, which is known to inhibit the proteins involved in the activation process. They added the drug before and after radiation treatment and measured the number of surviving cancer stem cells. They found that administering the drug before radiation did little to change the number of cancer stem cells, but giving the drug in conjunction with radiation appeared to halt the resistance of cancer stem cells to radiation. This finding, the researchers said, suggests that use of a checkpoint inhibitor during radiation ruins the cells' potential to repair themselves and increases the likelihood that the cells will die. "Our findings show one pathway in cancer stem cells that promotes the radiation resistance of glioblastomas," said Rich. "Treatments that target DNA damage checkpoint response in cancer stem cells may overcome the radiation resistance and eventually allow us to help even greater numbers of cancer patients." Other researchers involved in the study were Shideng Bao, Qiulian Wu, Roger McLendon, Yueling Hao, Qing Shi, Anita Hjelmeland, Mark Dewhirst and Darell Bigner. The philanthropic organizations that supported the research include the Childhood Brain Tumor Foundation, the Pediatric Brain Tumor Foundation of the United States, the Damon Runyon Cancer Research Foundation, the Sidney Kimmel Foundation for Cancer Research, Accelerate Brain Cancer Cure, and the Duke Comprehensive Cancer Center Stem Cell Initiative.

Prostate Cancer: Rapidly Rising PSA Before Treatment Is Key Indicator of Cancer Spread

Rapidly Rising PSA Before Treatment Is Key Indicator of Cancer SpreadPHILADELPHIA-Results of a new Fox Chase Cancer Center study show that men with a rapidly rising PSA level before treatment have a high probability of metastatic disease and should receive hormone therapy in addition to radiation. The findings were presented today at the 48th Annual Meeting of the American Society for Therapeutic Radiology and Oncology in Philadelphia.The rate of a rise in PSA level, known as PSA velocity (PSAV), can be used to determine when prostate cancer spread may have already occurred, even in men with clinically localized disease. PSA, or prostate specific antigen, is measured by a blood test and used to determine if prostate cancer is present."We've known that men with a rapidly rising PSA are at greater risk of prostate cancer-related death and this study suggests that undetected distant metastasis present prior to radiation therapy may be the cause," explained Mark K. Buyyounouski, M.D, M.S.., an attending physician in the radiation oncology department at Fox Chase and lead author of the study. The study looked at data collected between 1989 and 1999 for 671 men with clinically localized prostate cancer who received 3-D conformal radiation therapy.Buyyounouski and others demonstrated that when the PSAV was greater than 2 ng/ml per year, the PSA was likely to continue rising at the same rate despite radiation therapy to the prostate. What's more, this group of men was found to have a greater likelihood of distant spread of prostate cancer and a greater risk of dying of the disease. This relationship was not seen for men with a slower PSAV of less than 2 ng/ml."This study suggests that an initially high PSAV often represents previously undetected metastatic disease exists at the time of diagnosis," said Buyyounouski. "This disease has the opportunity to progress if radiation therapy to the prostate and surrounding tissue is the only treatment," said Buyyounouski. "Therefore, it is recommended that the PSAV be used in addition to other high risk factors to determine if androgen deprivation therapy should be part of the treatment."Androgen deprivation therapy, or hormone therapy, has been shown to improve survival when used in conjunction with radiation therapy for men at high risk of undetected spread of prostate cancer.Buyyounouski concluded that requiring a PSAV of less than 2 ng/ml will be important for selecting patients who are most likely to benefit from radiation therapy alone. This has important implications for studies designed to compare various radiation regimens such as hypofractionation.

Lung Cancer: Key Immune Cells Predict Recurrence in Lung Cancer Patients

Patients treated surgically for early-stage lung cancer face an increased risk of recurrence if their tumors contain a large number of cells that act as "dimmer switches" on the immune system, according to a study at Duke University Medical Center. These immune-suppressing cells, called T-regulatory cells, effectively turn down the action of the immune system's T-cell lymphocytes that normally fight cancer. In the study, the researchers found that the more T-regulatory cells and the fewer T-cell lymphocytes present in the tumors of treated patients, the greater the likelihood the cancer would recur. "If further studies prove successful, it may be possible to measure the levels of T-regulatory cells in a lung cancer tumor as a marker to help predict which patients require additional chemotherapy following surgery to help prevent their cancer from recurring," said Ned Patz, M.D., senior investigator of the study and a professor of radiology, pharmacology and cancer biology. Patz said it is essential to develop biologic markers that can help stratify patients into high-risk and low-risk categories, because the overall survival rate for early stage lung cancer patients is only 50 percent. The findings appear online and will be published in the Dec. 15, 2006, issue of the journal Cancer. The study was funded by the National Cancer Institute. In current practice, patients with early-stage lung cancer undergo surgery to remove their tumors, but they rarely are prescribed follow-up chemotherapy because their tumors are considered at low risk of recurrence. Yet nearly half of early stage patients will experience a recurrence of their tumors, Patz said. There is no method of detecting which patients will recur after treatment, so physicians avoid prescribing toxic chemotherapy for the entire group of early-stage patients to prevent its harmful side effects. In the absence of biologic markers, physicians now rely on assessing a tumor's size and location, the type types of cells it contains and whether or not it has spread to nearby lymph nodes in order to determine its stage. Yet these physical traits do not disclose the tumor's genetic composition and thus its intended course of action, just as viewing one's face or body shape cannot disclose his intent or behavior. Thus, identifying the biologic differences between aggressive versus nonaggressive lung cancers would provide oncologists with a more accurate method of selecting the best treatments for a given patient, Patz said. In the study, Patz' team analyzed tumor samples taken from 64 patients with early-stage lung cancer who had their tumors removed. The scientists measured the levels of T-regulatory cells and T-cell lymphocytes in each tumor, and then compared the relative levels in each tumor to the patient's eventual health outcome. Among all the patients, the risk of recurrence increased as the number of T-regulatory cells in their tumors increased, Patz said. Patients whose tumors had the highest proportion of T-regulatory cells in relation to T-cell lymphocytes suffered a recurrence 50 percent of the time. Patients without any T-regulatory cells did not suffer recurrences. "This finding indicates that it is important to analyze the biology of the tumor cells as well as the tumor's relationship with the immune system," Patz said. "Testing newly diagnosed lung cancer patients for their levels of T-regulatory cells may serve as one important marker for their eventual risk of recurrence." Patz said the next step is to examine what factors cause certain tumors to carry more T-regulatory cells than others. The ultimate goal, he said, would be to devise therapies that can prevent tumors from having more T-regulatory cells than T-cell lymphocytes

Lung Cancer: Study Shows No Reduction in Lung Cancer Deaths after CT Screening

The first report of an international study looking at computed tomography (CT) to screen current or former smokers for lung cancer found that screening did not reduce deaths from lung cancer. Although CT screening found nearly three times as many lung cancers as predicted, the researchers found that early detection and treatment did not lead to a corresponding decrease in advanced lung cancers or a reduction in deaths from lung cancer. H. Lee Moffitt Cancer Center & Research Institute’s Dr. Melvyn Tockman co-authored the study led by researchers at Memorial Sloan-Kettering Cancer Center. The study found no advantage to using CT screening on current or former smokers -- the population at highest risk for developing lung cancer. The findings appear in the March 7 issue of the Journal of the American Medical Association.“Our data have not yet shown that helical CT screening for lung cancer is beneficial to patients,” said Tockman, a member of Moffitt’s thoracic oncology program. “Until there is beneficial evidence of lung cancer mortality reduction that outweighs the potential harm from additional surgery and radiation, helical CT screening should continue to be considered a research procedure.” Beginning in 1998, 3246 asymptomatic men and women with a median age of 60 who had smoked or still smoked for an average of 39 years were screened for lung cancer with state-of-the-art multi-detector CT at Moffitt, the Mayo Clinic in Minnesota, or the Instituto Tumori in Italy. Each study provided an initial CT scan and then at least three subsequent annual exams. The researchers followed the volunteers to see how many had cancers detected by screening and how many had surgery to remove them. They then used government death records to follow the study participants for five years to see if they died of lung cancer. The researchers compared what they saw to what statistical models predicted would happen without screening. Over the course of the studies, screening found more than three times as many lung cancers as the number that would have been diagnosed without screening, and there were ten times as many surgeries performed for lung cancer compared to what was expected. This meant that as a direct result of the test, an additional 99 people were diagnosed with lung cancer and an additional 98 had lung surgery. However, the early detection and treatment did not change the death rate. There were 38 deaths due to lung cancer, and 39 would have occurred without screening.CT screening is not without risk. The radiation can become significant when the scans are repeated every year. Because the test is not very specific, it is known to have false positive results, which can lead to additional CT scans at full radiation doses and invasive procedures like lung biopsies. This study also suggests CT screening can lead to additional major surgeries to remove very small growths that look like lung cancer but do not pose a meaningful threat to the patient’s health.The study was led by Dr. Peter B. Bach and co-authored by Dr. James R. Jett from Memorial Sloan-Kettering, Dr. Steven J. Swensen of the Mayo Clinic and Dr. Ugo Pastorino of the Instituto Tumori. It was supported by grants from the European Institute of Health, the Italian Ministry of Health, the National Cancer Institute, the Department of Defense, and funds from the four involved institutions.

Breast Cancer and Lymphedema: Risk Greatly Increased With Added Boost of Radiation to Axillary Nodes

Risk vs. Benefit; Lymphedema Risk Greatly Increased With Added Boost of Radiation to Axillary Nodes After LumpectomyPHILADELPHIA -The significant risk of developing lymphedema may outweigh the benefit of receiving an extra boost of radiation to lymph nodes possibly involved in early-stage breast cancer. That is the conclusion of a study presented today at the 48th Annual Meeting of the American Society for Therapeutic Radiology and Oncology in Philadelphia.Lymphedema is an uncomfortable swelling of a limb caused by a build-up of lymphatic fluid. This occurs when the lymph vessels are damaged and/or nodes are removed. The disruption of lymphatic flow prevents the proper drainage, causing a back-up of fluid. About 15-20% of women with breast cancer who have lymph nodes removed during surgery will develop lymphedema."We know radiation can increase one's risk of developing lymphedema, so it's important to determine whether the radiation technique or dose contributes," explained Shelly B. Hayes, M.D., a resident in the radiation oncology department at Fox Chase Cancer Center and lead author of the new study.Standard therapy for women with early-stage breast cancer calls for radiation following a lumpectomy. The radiation field includes the whole affected breast and some of the lymph nodes under the arm, called the axillary lymph nodes.Doctors may also irradiate the lymph nodes found in the upper axilla and above the clavicle (collar bone), depending on the number of nodes removed and the number that test positive for cancerous cells). Sometimes, an additional dose or "boost" of radiation is added to the axillary region."The reason we irradiate the lymph node regions is to prevent recurrence of disease in those locations," Hayes said. "When an aggressive lymph-node dissection is performed, the utility of additional radiation is questionable. This is the subject of some debate."Hayes' study consisted of 2,581 women with early-stage breast cancer treated at Fox Chase Cancer Center with lumpectomy, axillary-node dissection and radiation between 1970 and 2005. A total of 2,174 patients (84%) were treated with radiation to the breast alone, 221patients (8.6%) were treated to the breast and supraclavicular lymph nodes (those above the collar bone) while 184 patients (7.1%) received an additional boost of radiation to the axillary nodes. The median follow-up was 81 months."The most striking result we found involved women who had more than four positive lymph nodes," explained Hayes. "They were four times more likely to develop lymphedema when treated with a boost, despite similar risks of nodal recurrences."Given the increased risk of lymphedema and the lack of evidence supporting improvements in nodal recurrences from the boost, we should carefully consider these results before deliveringa boost to our patients," Hayes concluded

Aggressive Breast Cancer: Research finds link between body mass index and prognosis

Body Mass Index (BMI), the measure of a person's fat based on their height and weight, may be an effective prognostic tool for specific types of breast cancer, according to research from The University of Texas M. D. Anderson Cancer Center.The study, published in the March 15 issue of Clinical Cancer Research, reports that women with locally advanced breast cancer (LABC) and inflammatory breast cancer (IBC) with high BMIs had worse prognosis than women with the disease whose BMIs were in the healthy range.One's BMI is scored based on height and weight. A score less than 18.5 indicates that a person is underweight and a score of 18.5 -24.9 indicates that one is in a normal or healthy range. A person is overweight if their score is 25-29.9 and any score above 30 classifies that a person as obese. According to Massimo Cristofanilli, M.D., the study's senior author, LABC, or cancer that has spread to nearby tissue or lymph nodes, accounts for approximately five percent of newly diagnosed breast cancer cases each year in the United States. In underserved communities, LABC accounts for 50 percent of new cases. IBC is extremely aggressive, yet rare - representing just 1- 2 percent of all breast cancers diagnosed in this country. Before now, there were few epidemiological or retrospective studies suggesting a correlation between weight gain, obesity and risk of developing breast cancer; even fewer had address the prognostic value of obesity, said Cristofanilli, associate professor in M. D. Anderson's department of Breast Medical Oncology."This is the first study to highlight the value of BMI at the time of diagnosis as a prognostic indicator in women with aggressive disease and at a high risk of recurrence and at the time of diagnosis in locally advanced disease, including it's most aggressive form, inflammatory breast cancer," said Cristofanilli. "We embarked on this research because the vast majority of our newly-diagnosed inflammatory breast cancer patients were overweight or obese, and IBC is associated with a poor prognosis. The idea was to understand the etiological link between the most aggressive forms of breast cancers and, ultimately, with prognosis." For the retrospective study, researchers reviewed 606 patients - 495 (82 percent) with LABC and 111 (18 percent) with non-metastatic IBC. All were enrolled in clinical protocols at M. D. Anderson between 1974 and 2000. The median follow up was six years for all patients; for women still alive, the median follow-up was 9.9 years.In calculating BMI, 208 (34 percent) of the patients were normal or underweight, 194 (32 percent) were overweight and 204 (34 percent) were obese. Cristofanilli noted that obesity was more frequent in women with IBC, 45 percent vs. 31 percent in non-IBC cases.For the entire group, the median overall survival was 8.6 years and recurrence-free survival was 5.8 years. Both statistics were significantly worse for overweight and obese patients compared to those who were of normal weight or underweight.Specifically regarding overall survival, for overweight LABC patients, five-year survival was 58.3 percent and 10-year survival was 44.1 percent; 58.6 percent of obese LABC patients lived five years and 42.4 percent lived 10 years. In contrast, 69.3 percent of women with LABC who were normal or underweight lived five years and 57.3 percent lived 10 years.In women with IBC who were overweight, five-year survival was 45.3 percent and 10-year survival was 29.1 percent; 49.3 percent of obese IBC patients lived five years and 43.7 percent lived 10 years. In comparison, 55.1 percent of women with IBC who were normal or underweight lived five years and 50.9 percent lived 10 years.For the design of the study, it's important to note that all patients received similar anthracycline-based treatments and that doses were not adjusted based on a patient's weight, said Cristofanilli."Of course, it's important to explore interventions to prevent overall obesity. These outcomes may have a major impact not only on the incidence of future breast cancer patients, but on their long-term outcome," Cristofanilli said. "From a research standpoint, we really need to further look at the relationship between obesity and some endocrine factors that may explain why inflammatory breast cancer patients are more frequently obese, for example. Our next step is to go back to the lab and start looking into those specific factors related to obesity in breast cancer - insulin, estrogen levels and leptin are areas of immediate interest."Cristofanilli acknowledged that dietary intervention might be difficult for women undergoing chemotherapy; however, some change of lifestyle habits for overweight and obese patients after diagnosis are vital. Cristofanilli noted that before BMI is completely accepted as a prognostic tool for breast cancer, prospective trials and endocrinology studies must be conducted. However, to oncologists currently treating overweight and obese LABC and IBC patients, Cristofanilli recommends they be more aggressive in follow-up, including considering more frequent physical exams and imaging studies.

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