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No Benefit with Addition of Platinol® to Treatment for Anal Cancer Addition of the drug Platinol® (cisplatin) to 5-FU (5-flourouracil), mitomycin, and radiation may not improve outcomes for patients with anal cancer. These findings were recently published by the Journal of the American Medical Association. Anal cancer is a rare form of cancer that develops in the tissues of the anus. Although treatment for anal cancer if often very effective, with most patients experiencing a cure, anal cancer can be a serious condition. The American Cancer Society estimates that 680 people will die of anal cancer in 2008. Current treatment options include surgery, radiation, and chemotherapy. Current standards for treating anal cancer include chemotherapy and radiation. The five-year survival rate, however, following treatment with 5-FU, mitomycin, and radiation is only about 65%. Researchers in the current study sought to determine if the addition to standard therapy of Platinol, an alkylating agents that kills cancer cells by damaging their DNA, could improve outcomes of patients with anal cancer. Study participants included 682 patients diagnosed with anal cancer between 1998 and 2005. Patients were further categorized according to their gender and tumor features. Participants received either 5-FU, mitomycin, and radiation (341 patients) or Platinol, 5-FU, mitomycin, and radiation. The goal of the study was to measure five-year survival rates, as well as overall survival and time to relapse. Results were evaluated from 644 patients. The average patient age was 55 years; 69% were women; 27% had tumors that were greater than 5cm; and 26% had positive lymph node involvement.® Five-year survival rates were 60% among the patients treated with 5-FU and mitomycin compared with 54% among the patient treated with Platinol. Among the patients treated with 5-FU/mitomycin, the five-year local recurrence rate was 25%, and the distant metastasis rate was 15%. Among the patients treated with Platinol as well as 5-FU/mitomycin, these recurrence rates were higher at 33% and 19%. Fewer patients needed a colostomy among the 5-FU/mitomycin group than the Platinol group (10% versus 19%). Patients in the 5-FU/mitomycin treatment group, however, reported more frequent severe hematologic side effects, such as low blood counts. Researchers concluded that the addition of cisplatin to traditional treatment with 5-FU and mitomycin did not improve disease-free survival and contributed to significantly worse colostomy rates. These findings do not support the use of Platinol in addition to 5-FU and mitomycin in the treatment of anal cancer. Reference: Ajani, J., Winter, K., Gunderson, L., et al. Fluorouracil, Mitomycin and radiotherapy vs. fluorouracil, cisplatin and radiotherapy for carcinoma of the anal canal. Journal of the American Medical Association . 2008; 299(16) 1914-1921. Related News:® 5-FU/Mitomycin Remains Standard of Care for Anal Cancer (07/26/2006)
Women with CIN at Higher Risk for Anal Cancer and Other Cancers According to an early online publication in Lancet Oncology , women diagnosed with cervical intraepithelial neoplasia (CIN) grade 3 are at an increased risk of developing vaginal, vulvar, and anal cancers. Further research into the impact of the human papillomaviruses on these risks is underway. Cervical intraepithelial neoplasia refers to pre-cancerous or abnormal cells on the surface of the cervix cell layer. The different grades of CIN refer to the severity of the cells? abnormality as viewed by a microscope as well as the depth of the abnormal cell layer. CIN3 refers to the highest grade of cellular abnormality, which is often treated in order to avoid progression to cervical cancer. Because the human papillomavirus (HPV) is thought to play an extensive role in the development of CIN3, researchers continue to evaluate HPV?s link to CIN along with the potential preventive effects of the vaccine now available against HPV. Researchers from Sweden recently conducted a clinical study to evaluate potential associations between CIN3 and increased risks of other cancers potentially caused by HPV. This study included women from Sweden between the ages of 18 and 50 years. Participants were evaluated between 1968 and 2004. Compared with women who had not been diagnosed with CIN3, women with a history of CIN3 had nearly a sevenfold increased risk of developing cancer of the vagina, more than a 4.5-fold increased risk of developing cancer of the anus, and a greater than twofold increased risk of developing cancer of the vulva. There was no increased risk for rectal cancer among women diagnosed with CIN3. The researchers concluded that women diagnosed with CIN 3 have a significantly increased risk of developing cancers of the vagina, vulva, and anus compared with the general population. The authors state, ?Further studies are needed to clarify the type of HPV associated with this increase in risk to determine the clinical applicability of the new HPV vaccines.? Women diagnosed with CIN3 may wish to speak with their physician regarding their individual risks and benefits of screening for cancers of the vagina, vulva, and anus. Reference: Edgren G, Sparen P. Risk of anogential cancer after diagnosis of cervical intraepithelial neoplasia: a prospective population-based study. Lancet Oncology [early online publication]. February 27, 2007. DOI:10.1016/S1470-2045(07)70043-8. Related News: ? American Cancer Society Develops Recommendations for HPV Vaccination (3/5/2007) HPV Test Identifies a Majority of Women with High-Grade CIN (4/13/2006)
5-FU/Mitomycin Remains Standard of Care for Anal Cancer According to results recently reported at the 2006 semi-annual meeting of the Radiation Therapy Oncology Group (RTOG), treatment including the chemotherapy agents 5-fluorouracil?and?mitomycin-C (Mutomycin?) plus?radiation therapy remains the standard of care for patients with anal cancer. Anal cancer is a fairly uncommon cancer and refers to cancer originating at the end of the rectum. Depending on the stage of disease (extent of disease at diagnosis) and other factors, cancer of the anus may be treated with surgery, chemotherapy, and/or radiation therapy. Treatment is aimed at a cure or improving the duration of survival, as well as maintaining the ability to control bowel function (fecal continence). A colostomy is sometimes required for patients with anal cancer if bowel function is lost; a colostomy is an opening created from the skin to the bowel to help dispose of waste. Treatment for anal cancer typically consists of surgery, chemotherapy, and/or radiation therapy. The standard chemotherapy combination for the treatment of anal cancer has been mitomycin plus 5-FU. Researchers affiliated with RTOG recently conducted a clinical trial to directly compare mitomycin plus 5-FU to Platinol? (cisplatin) plus 5-FU in the hopes of improving outcomes among patients with anal cancer. This trial, referred to as the RTOG 98-11 study, was a phase III trial that included 632 patients who underwent surgery and radiation therapy with either 5-FU/mitomycin or 5-FU/Platinol. At five years, cancer-free survival was 59% for patients treated with 5-FU/mitomycin, compared with 53% for those treated with 5-FU/Platinol. At five years, overall survival was improved by nearly 30% for patients treated with 5-FU/mitomycin compared to those treated with 5-FU/Platinol. At five years, 90% of surviving patients treated with 5-FU/mitomycin did not require a colostomy, compared with 81% for those treated with 5-FU/Platinol. The researchers concluded that 5-FU/mitomycin remains the standard of care in terms of chemotherapy for treatment of anal cancer. The authors stressed that the addition of targeted agents in combination with this regimen are the next step in improving outcomes for patients with anal cancer. Patients with anal cancer may wish to speak with their physician regarding their individual risks and benefits of participating in a clinical trial evaluating new therapeutic regimens for the treatment of anal cancer. Reference: Radiation Therapy Oncology Group. A Phase III Randomized Study of 5-Fluorouracil, Mitomycin-C, and Radiotherapy versus 5-Fluorouracil, Cisplatin and Radiotherapy in Carcinoma of the Anal Canal. Proceedings from the 2006 semi-annual meeting of the Radiation Therapy Oncology Group. June? 2006. Ontario, Canada. ? ?
Radiation to the Pelvis Increases Risk of Pelvic Fractures According to a recent article published in the Journal of the American Medical Association (JAMA), women who undergo radiation to the pelvis for cancers of the cervix, rectum, or anus are at an increased risk for pelvic fractures compared to women with these types of cancer who do not undergo pelvic radiation as part of their treatment regimen. Radiation to the pelvis is a rather common treatment for patients with cancers involving the cervix, rectum, or anus. Unfortunately, older women are at an increased risk for bone fractures than their younger counterparts, particularly hip fractures. These bone fractures result in a significant decline in quality of life, often necessitating surgery, hospital stays, and rehabilitation. Researchers from the University of Minnesota and the University of North Carolina School of Medicine reviewed extensive data to determine if radiation to the pelvis may be associated with the risk of pelvic fractures. This study included 6,428 women diagnosed with cancers of the cervix, rectum, or anus between 1986 and 1999. The women were aged 65 or older; approximately half had received radiation to the pelvis as part of their treatment regimen, while the other half had not received pelvic radiation. Pelvic radiation was associated with an increased risk of pelvic fractures among these women: Among women with cervical cancer, 8.2% who underwent radiation to the pelvis had a pelvic fracture, compared to 5.9% of those who did not undergo pelvic radiation. Among women with rectal cancer, 11.2% who underwent radiation to the pelvis had a pelvic fracture, compared with 8.7% of those who did not undergo pelvic radiation. Among women with anal cancer, 14% who underwent radiation to the pelvis had a pelvic fracture, compared with 7.5% of those who did not undergo pelvic radiation. The majority of fractures (90%) were hip fractures. Women with anal cancer who were treated with pelvic radiation had the highest risk of developing a pelvic fracture. The researchers concluded that elderly women diagnosed with cervical, rectal, or anal cancer who undergo radiation to the pelvis as part of their treatment regimen have a significantly higher risk of developing a pelvic fracture than those who do not undergo pelvic radiation. Elderly women who are to receive pelvic radiation for treatment of cancer may wish to speak with their physician regarding possible ways to reduce the risk of developing a pelvic fracture. Reference: Baxter N, Habermann E, Tepper J, Durham S, Virnig B. Risk of Pelvic Fractures in Older Women Following Pelvic Irradiation. Journal of the American Medical Association. 2005; 294:2587-2593. ?
New Colorectal Cancer Test Offers Hope for Early Detection According to a report in the November issue of the journal Gastroenterology , early detection of colorectal cancer and precancerous tumors may be possible with a new screening test that involves looking for abnormal DNA in stool samples. When detected early, colorectal cancer is a highly curable disease. Colorectal cancer begins with the development of an adenomatous polyp, which is a small benign tumor that grows in the colon. These polyps take 10 to 15 years to transform into cancer. Since this development phase is so long, screening and early detection can play a crucial role in the prevention of colorectal cancer, as detection and removal of the polyps can prevent the development of the disease. As the polyp develops, there are changes in the tumor’s DNA. By examining tumors that have been removed from patients, researchers have identified some of these altered DNA molecules. The tumors shed cells into the intestine, which makes it possible to detect the abnormal DNA cells in stool samples. In a recent study at the Mayo Clinic, researchers examined the stool samples of three different groups: 22 people who had been diagnosed with colorectal cancer, 11 people who had polyps, and 28 people without any colorectal tumors. They found abnormal DNA in 91% of the stool samples from cancer patients and 73% of the stool samples from the patients with polyps. None of the stool samples from tumor-free people had abnormal DNA. The results of this study show that DNA stool testing has the potential to become an efficient screening test for colorectal cancer. This could be an accurate and non-invasive test that people might be more willing to undergo than other more intrusive and uncomfortable tests. A 3-year clinical trial funded by the National Cancer Institute is scheduled to begin in January in order to further evaluate this procedure. In the meantime, it is still important for people to utilize the existing methods of screening for colorectal cancer, which include the fecal occult blood test (FOBT), sigmoidoscopy, colonoscopy and the double-contrast barium enema. People concerned with screening for this disease can consult with their physicians for more information. Future clinical trials will help to establish the feasibility of using DNA stool testing as a standard screening procedure. People who are at a high-risk for developing colorectal cancer may wish to speak with their physicians about the risks and benefits of participating in a clinical trial in which DNA stool testing and other promising new screening techniques are being evaluated. Two sources of information about ongoing clinical trials include clinical trials listing services provided by the National Cancer Institute ( cancer.gov ) and eCancerTrials.com . eCancerTrials.com also performs personalized clinical trial searches on behalf of patients.
Selenium May Reduce Risk of Developing Lung, Colorectal, and Prostate Cancers The essential dietary nutrient, selenium, may help reduce the risk of developing cancers of the lung, colon, rectum, and prostate, as well as reduce the number of deaths in persons who have certain types of cancer, according to preliminary research findings. It is believed that cancer is caused by a number of factors, making prevention of the disease a challenge. Few cases of cancer have a causative association as clear as the one between smoking and lung cancer. However, ongoing research continues to elucidate characteristics or exposures that may increase the chance of developing different types of cancers ( risk factors ) as well as characteristics or exposures that may reduce the chance of developing those cancers ( protective factors ). Recently, much attention has been given to the potential protective effects of various dietary supplements and nutrients, including selenium. Selenium is a nutrient that is essential to the human body. A component of a number of the body’s enzymes, selenium is found predominantly in foods but also in water and air. Several scientific reports have shown an increased risk of developing certain cancers when the diet does not contain enough selenium. Similarly, some clinical studies have shown that selenium supplements in the diet may reduce the risk of developing some cancers. The side effects of most forms of selenium are low; however, certain forms (such as selenious acid) can be fatal if ingested. Excessive exposure to selenium, often characterized by a garlic odor on the breath, can result in chronic selenium poisoning. Further investigation of the potential protective effect of selenium from some types of cancer is ongoing. Researchers from several centers in the United States conducted a study to determine whether the use of selenium supplements would result in a reduced risk of developing cancer or a recurrence (return) of cancer in 1312 persons who had a history of basal cell or squamous cell cancer of the skin. The researchers assigned the patients to receive either 200 micrograms of selenium per day or a placebo. The findings showed that the selenium did not have any impact on whether the patients developed the skin cancer again. However, the selenium was associated with fewer cancer-related deaths. Of the group receiving placebo, 57 persons died of cancer; of the group receiving selenium, 29 persons died of cancer. Of the cancers that were diagnosed, 119 were in the placebo group and 77 were in the selenium group. Cancers that were shown to be reduced in the selenium group included lung, colorectal, and prostate cancers. Because of these favorable results showing reductions in the incidence of lung, colorectal, and prostate cancers and the reduction in deaths from cancer, this study was stopped early. The researchers concluded that the protective effects of selenium shown here appear promising; however, further studies are needed to confirm these findings. ( Journal of the American Medical Society , Vol 276, No 24, pp 1957-1963)