Infections with certain viruses, bacteria, and parasites have been identified as strong risk factors for specific cancers. To examine the link between infections and cancer, researchers performed a systematic analysis of the proportion of cancer cases attributable to infection in 2008. They used data on cancer incidence from the GLOBOCAN project along with epidemiological data regarding the causal effects of infection on cancer. The data included information on 27 types of cancer from 182 countries.

They found that of the 12.7 million new cancer cases that occurred worldwide in 2008, 16 percent—or roughly two million—were attributable to infections. The rate of infection-related cancer was about three times higher in developing countries. For example, 3.3 percent of cancers in Australia and New Zealand were infection related, whereas 32.7 percent of cancers in sub-Saharan Africa were attributable to infections. The four main infections associated with cancer were human papillomavirus, hepatitis C, hepatitis B, and Helicobacter pylori. These infections were responsible for approximately 1.9 million cancer cases in 2008, mainly gastric, liver, and cervical cancers.

Cervical cancer accounted for about half of the infection-related cancers in women. Liver and gastric cancers accounted for more than 80 percent of the infection-related cancers in men.  About 30 percent of infection-related cancers occurred in people younger than 50 years. It’s important to note that it takes decades of chronic infection before an infection progresses to cancer.

Based on the statistics, the researchers noted that approximately two million cancer cases each year might be preventable with better public health methods for preventing infection. In an accompanying editorial, Dr. Goodarz Danaei, an assistant professor of global health at Harvard School of Public Medicine in Boston, noted that vaccines for HPV and hepatitis B are effective and that increasing their availability should be a priority for higher risk countries.[2] He suggests that increasing vaccine coverage could reduce the global burden of cancer.

References:

How does cancer treatment affect fertility in men?

Chemotherapy: Chemotherapy can temporarily—and in some cases, permanently—stop sperm production by the testes.[1] The extent to which chemotherapy affects sperm production depends on several factors, including the type and dose of chemotherapy.

Radiation: Radiation to the abdomen or pelvis can also reduce or eliminate sperm production by the testes.

Surgery: Surgery that involves the removal of both testicles (an option for some men with prostate cancer) eliminates sperm production, but other types of surgery can also affect a man’s fertility. Some types of pelvic surgery, for example, can change or eliminate ejaculation.

Options for preserving fertility in men

Although many men are able to conceive naturally after cancer treatment, others are not.

If possible, men should talk with their doctor about their future fertility before beginning cancer treatment. Some options for preserving fertility require that steps be taken before cancer treatment begins.

Sperm banking is the most well-established method of preserving fertility in men.[2] It involves the collection and storage of sperm, ideally before cancer treatment begins. The samples are kept frozen at a lab or sperm bank until they are needed. Sperm can be stored in this way for many years. After being thawed, the sperm can be used for intrauterine insemination (IUI) or in vitro fertilization (IVF). During IUI, sperm are placed directly into a woman’s uterus. During IVF, mature eggs are removed from a woman’s ovary and mixed with the sperm in the lab. Embryos that result from IVF can then be placed in a woman’s uterus or frozen for later use.

If a sample contains very few viable sperm (or if a man has already undergone cancer treatment and has a low sperm count), another approach may be used to fertilize an egg. Intracytoplasmic sperm injection (ICSI) requires only a small number of healthy sperm, along with mature eggs that have been collected from a woman’s ovary. A single sperm is injected directly into each egg. The embryos that develop can then be placed in a woman’s uterus or frozen for later use.

If it is not possible to collect sperm from ejaculate, it may in some cases be possible to collect sperm directly from the testicles. This approach is still investigational.

Finally, it may also be possible to modify some cancer treatments to minimize their effects on subsequent fertility. During radiation therapy, for example, it may be possible to shield the testes in order to preserve sperm production.

Pregnancy after cancer

In the event that your fertility is not affected by cancer treatment (or recovers quickly or unexpectedly), you and your partner should use birth control if you do not wish to have a child. If you are trying to conceive a child naturally, your doctor may advise you to wait for several months after treatment; this allows for the elimination of sperm that may have been damaged during treatment.

In general, the risk of birth defects in children born to cancer survivors appears to be similar to the risk in the general population.[3] If your cancer was due to a hereditary cancer syndrome, such as Lynch syndrome (hereditary nonpolyposis colorectal cancer), your children may inherit the gene mutation responsible for your family’s increased risk of cancer. Talking with a genetic counselor may be helpful.

Other options for parenthood

Not all men have the luxury of being able to explore their reproductive options before beginning cancer treatment, and not all men will find a fertility preservation option that meets their needs. But there are still ways to become a parent. Discussion of other routes to parenthood may be a painful topic for men who want to father a child but cannot. But as cancer survivors consider how best to build their families, methods such as adoption are important options.

Adoption: Couples and individuals who wish to adopt have a range of options, including different types of domestic and international adoptions. You may wish to start by learning about the adoption laws in your state and by talking with other adoptive parents about the professionals and agencies they worked with. Before selecting an adoption agency, you may wish to talk with them about their attitudes toward placing a child with a cancer survivor. Many agencies will be receptive toward this, but it’s important to know before making a final decision.

Donor Sperm: Donor sperm is readily available from sperm banks and can be used for either intrauterine insemination or in vitro fertilization.

Individual decisions within a larger community

The decisions that you make about building a family (or about coming to terms with not building a family) will be intensely personal, but know that you are part of a larger community of patients and healthcare providers who are grappling with these issues.  To think about future parenthood is to think about life after cancer. For many people with cancer, planning for the future may provide the motivation needed to get through treatment.

More information?

Discuss with others…. http://cancerconnect.com/groups/young-adults/topics/fertility-after-cancer-treatment

Fertile Hope (www.fertilehope.org) provides a range of fertility resources for people with cancer.

References:

How does cancer treatment affect fertility in women?

Chemotherapy: Many chemotherapy drugs are toxic to the egg cells (oocytes) in the ovaries. If the number of remaining oocytes in the ovaries reaches a critically low point during treatment, women experience “acute ovarian failure.” This means that the ovaries stop functioning during or shortly after cancer treatment. If oocytes are lost during treatment but do not reach this critically low point, women are at risk for early menopause but may still be able to get pregnant for some time after treatment.

Radiation: Radiation to the pelvis can also destroy oocytes. Radiation to the pelvis can also affect uterine growth and blood flow, particularly if received before puberty.[1] A poorly developed uterus may make a woman more likely to have a miscarriage, or more likely to have a preterm or low-birthweight infant.

Surgery: Some cancers require surgical removal of the uterus, the ovaries, or both.

The effects of cancer treatment on fertility can vary substantially by age. Younger women, who have a larger pool of oocytes when they start cancer treatment, are more likely than older women to be able to get pregnant after treatment.[2]

Options for preserving fertility in women

If possible, women should talk with their doctor about their future fertility before beginning cancer treatment. Some options for preserving fertility require that steps be taken before cancer treatment begins.

One of the most established approaches for preserving fertility among female cancer patients is embryo freezing.[3] Before starting cancer treatment, a woman would be given hormones to stimulate the development of eggs in her ovaries. Mature eggs would be removed and fertilized with the sperm of her husband, partner or a sperm donor. The embryos that result from these fertilized eggs would be frozen for later use.

Although embryo freezing is an established approach to helping women become pregnant after cancer, there are downsides. A woman may not currently have a male partner and may be unwilling to use an anonymous sperm donor. It’s also important to be aware that embryo freezing takes approximately two weeks after the start of a woman’s period. If a woman needs to begin cancer treatment immediately, she may not be able to go through this process. Finally, this approach is only an option for women of childbearing age; stimulating the ovaries to produce mature eggs is not an option for girls who develop cancer during childhood.

Several other options are still in the experimental phase. One approach being explored is the freezing of unfertilized eggs.3 Once again, the ovaries would be stimulated to produce mature eggs before cancer treatment begins. The eggs would then be frozen without being fertilized by sperm. Currently, freezing unfertilized eggs is less likely to result in pregnancy than freezing embryos, largely because unfertilized eggs are less likely than embryos to survive the process of freezing and thawing. Nevertheless, it may be an option for women who do not have a male partner at the time of their cancer diagnosis, and it avoids the difficult issue of what to do with unused embryos.

Another promising but still experimental approach is to freeze all or a part of an ovary before cancer treatment.[4] After treatment, the ovarian tissue is implanted either back in the woman’s pelvis or in another location (such as under her skin). If this process is successful, the ovarian tissue will begin producing eggs. A safety concern with this approach is the possibility of reintroducing cancer cells along with the ovarian tissue, and the tissue will need to be carefully screened for cancer before it is transplanted.4

Finally, it may also be possible to modify some cancer treatments to minimize their effects on subsequent fertility. For example, shielding the ovaries during radiation, or moving the ovaries out of the radiation field, may protect them from the effects of radiation. Scientists are also exploring whether using drugs to suppress the activity of the ovaries during chemotherapy will make the ovaries less susceptible to damage by chemotherapy.[5] For women with certain types of cervical or ovarian cancer, fertility-preserving surgery may also be an option.[6] It’s important to understand that only specific subsets of patients will be candidates for these approaches, and that some of the methods are still in the early stages of evaluation.

Pregnancy after cancer

In addition to having concerns about their ability to get pregnant, women may have concerns about whether pregnancy after cancer treatment will be safe for themselves and their children. While there is a limited amount of information about these topics, the news is generally good.

The risk of cancer recurrence during or after pregnancy has been most studied in women with breast cancer, and these studies generally have reported that pregnancy does not increase the risk of breast cancer recurrence. [7] Many doctors, however, suggest waiting for a period of time after treatment before becoming pregnant. [8]

If chemotherapy or radiation therapy has damaged her heart or lungs, a woman may also have concerns about the strain that pregnancy will put on her body. Studies of breast cancer survivors suggest that long-term heart problems are uncommon after chemotherapy or radiation therapy, [9] but a woman may wish to talk with her doctor about her current health status and the likely effects of pregnancy.

Children born after their mother’s cancer treatment do not appear to be more likely than other children to have birth defects or cancer.[10] If a woman’s cancer was due to a hereditary cancer syndrome, such as Lynch syndrome (hereditary nonpolyposis colorectal cancer), her child may inherit the gene mutation responsible for her family’s increased risk of cancer. Talking with a genetic counselor may help clarify the child’s risk.

When planning for pregnancy, be aware that some cancer treatments may cause you to have an early menopause even if your periods resume after treatment. Also be aware that you may be capable of conceiving even if your periods do not resume; continue to use birth control if you do not wish to become pregnant.

Other Options for Parenthood

Not all women have the luxury of being able to explore their reproductive options before beginning cancer treatment, and not all women will find a fertility preservation option that meets their needs. But there are still ways to become a parent. Discussion of other routes to parenthood may be a painful topic for women who want to become pregnant and cannot. But as cancer survivors consider how best to build their families, methods such as adoption are important options.

Adoption: Couples and individuals who wish to adopt have a range of options, including different types of domestic and international adoptions. You may wish to start by learning about the adoption laws in your state and by talking with other adoptive parents about the professionals and agencies they worked with. Before selecting an adoption agency, women may wish to talk with them about their attitudes toward placing a child with a cancer survivor. Many agencies will be receptive toward this, but it’s important to know before making a final decision.

Egg Donation: Women who still have a uterus may be able to become pregnant using an egg donated by another woman. Through in vitro fertilization, the donated egg would be fertilized by the cancer survivor’s male partner or a sperm donor, and implanted in her uterus. Alternatively, another couple may donate a frozen embryo that could be implanted in her uterus.

Gestational Carrier or Surrogate: Women who do not have a uterus, or who are otherwise unable to sustain a pregnancy, may be able to have another woman carry a pregnancy for them. If the cancer survivor has functioning ovaries, her own egg can be fertilized by her male partner’s sperm and transferred to the uterus of another woman. In this case, the woman who carries the pregnancy is known as a gestational carrier. If the cancer survivor does not have functioning ovaries, another woman can both donate an egg and carry the pregnancy. This is the arrangement traditionally known as surrogacy.

Individual Decisions Within a Larger Community

The decisions that you make about building a family (or about coming to terms with not building a family) will be intensely personal, but know that you are part of a larger community of patients and healthcare providers who are grappling with these issues.

To think about future parenthood is to think about life after cancer. For many people with cancer, planning for the future may provide the motivation needed to get through treatment.

More Information?

Discuss with others….. http://cancerconnect.com/groups/young-adults/topics/fertility-after-cancer-treatment

Fertile Hope (www.fertilehope.org) provides a range of fertility resources for people with cancer.

References:

Nearly 65,000 people are diagnosed with kidney cancer in the United States each year. For patients with early stage kidney cancer, partial nephrectomy (removal of only the cancerous part of the kidney) is the standard treatment; however, depending on the size of the cancer and the function of the second kidney, some surgeons may recommend radical nephrectomy (removal of the entire kidney). Although partial nephrectomy is not always possible, it offers the important advantage of preserving kidney function.

To compare long-term survival rates after partial versus radical nephrectomy, researchers from the University of Michigan Comprehensive Cancer Center evaluated data from 7,138 Medicare beneficiaries with clinical stage T1a kidney cancer treated from 1992 through 2007.
After a median follow-up of 62 months, 25.3% of patients treated with partial nephrectomy had died, compared with 41.5% of patients treated with radical nephrectomy. Patients treated with partial nephrectomy had a 46% lower risk of death.

Regardless of the type of surgery, patients had an equal chance of dying from kidney cancer, suggesting that each type of surgery was likely to cure the cancer. Kidney cancer was the cause of death for 1.9% of partial nephrectomy patients and 4.3% of radical nephrectomy patients. The survival discrepancy was found in death from any cause.

With the increased use of x-rays and CT scans (for unrelated reasons), the identification of early stage kidney cancer has become more common—making it important to weigh the risks and benefits of partial versus radical nephrectomy. Partial nephrectomy is a more technically challenging procedure and is associated with more short-term complications. Radical nephrectomy, on the other hand, can increase the risk of chronic kidney disease and is associated with more long-term complications.

Partial nephrectomy may not be the best choice for all patients, but the results of this study indicate that it should be an important consideration in order to optimize long-term survival.

Reference:

More than 58,000 people are diagnosed with kidney cancer in the United States each year. The most common type of kidney cancer is renal cell carcinoma (RCC). For people with metastatic RCC (cancer that has spread to other parts of the body), targeted therapies such as tivozanib can play an important role in treatment.

Tivozanib is an oral tyrosine kinase inhibitor that targets proteins responsible for stimulating cancer cell growth. Tivozanib blocks all three vascular endothelial growth factor (VEGF) receptors. VEGF plays a key role in the development of new blood vessels. By blocking VEGF, tivozanib deprives the cancer of nutrients and oxygen and inhibits its growth.

This phase II, randomized trial included 272 patients who received tivozanib for 16 weeks. After the initial 16 weeks, 78 patients who demonstrated tumor shrinkage greater than 25% continued to take tivozanib, while 118 patients with tumor shrinkage less than 25% were randomized to receive tivozanib or placebo. Patients who experienced tumor growth of 25% or more were discontinued from the study.

After 16 weeks of treatment, the objective response rate (ORR) for tivozanib was 18%. Of the 118 randomized patients, significantly more patients who were randomly assigned to receive double-blind tivozanib remained progression free after 12 weeks versus patients who received the placebo. PFS was 49% for patients who received tivozanib compared to 21% for those who received placebo. The most common grade 3 and 4 treatment-related adverse event was hypertension.

The researchers concluded that tivozanib is active against advanced RCC. The drug was well tolerated with minimal toxicities.

Reference:

A growing body of evidence suggests that aspirin may reduce the risk of several types of cancer, with particularly strong evidence for colorectal cancer. Not all studies have found a benefit, however, and any potential benefits of aspirin must be weighed against risks such as bleeding.

To further explore the relationships between daily aspirin and cancer, researchers conducted a combined analysis of 51 previous randomized trials.[1] The trials were originally designed to evaluate the effect of daily aspirin on outcomes such as heart disease, but information about cancer was also available.

• Daily aspirin reduced cancer deaths. After five years, aspirin users had a 37 percent reduction in risk of cancer death.
• Aspirin also reduced the likelihood of developing cancer. From three years onward, aspirin users had a 24 percent reduction in the risk of being diagnosed with cancer.
• As expected, aspirin carried a risk of major bleeding, but this risk appeared to diminish over time.

Another study published in the same issue of The Lancet evaluated the effect of daily aspirin on cancer metastasis (the spread of cancer from its original site to other parts of the body). The study focused on 987 people who were diagnosed with cancer while participating in one of five trials of aspirin use. Those who were taking aspirin were less likely to have metastatic cancer than those who were not taking aspirin.[2]

These results suggest that regular aspirin use may reduce cancer incidence and mortality, but concerns remain about the risks of regular aspirin use in healthy individuals. People who are considering using aspirin on a regular basis are advised to discuss the risks and benefits with their physician.

References:

Each year in theUnited States, more than 58,000 people are diagnosed with kidney cancer. Renal cell cancer is the most common type of kidney cancer.

For people with metastatic renal cell cancer (cancer that has spread to other parts of the body), targeted therapies such as Sutent and Nexavar can play an important role in treatment. When people respond to these treatments, the response is usually partial (a reduction in detectable cancer). Complete responses are less common, but have been reported.

To explore the predictors and outcome of complete responses, researchers inFranceandSwitzerlandevaluated 64 patients with metastatic kidney cancer. All had had a complete response to treatment with Sutent or Nexavar. In some cases, the drug was administered alone, and in other cases the drug was given in combination with local treatments such as surgery or radiation therapy.

At the main study center, complete responses occurred in less than two percent of all patients treated with Sutent or Nexavar.

• The researchers were not able to identify clinical or biological characteristics that were linked with a complete response to treatment. It’s still not possible to predict, therefore, which patients with metastatic kidney cancer are most likely to have a complete response to Sutent or Nexavar.
• After achieving a complete response, some patients continued treatment with Sutent or Nexavar and some did not. Relapses occurred in both groups (those who continued treatment and those who did not). Because of the small number of study subjects, it was not possible to determine whether continuing treatment reduces the likelihood of relapse.
• Among the patients who discontinued treatment, slightly more than half (55 percent) were still relapse-free after eight months of follow-up.

These results describe the experiences of patients who have a complete response to Sutent or Nexavar. Some patients relapse after achieving a complete response, but it remains uncertain whether continuing Sutent or Nexavar after a complete response reduces the risk of relapse.
Reference: Albiges L, Oudard S, Negrier S et al. Complete remission with tyrosine kinase inhibitors in renal cell carcinoma. Journal of Clinical Oncology. 2012;30:482-287.

Lynch Syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), results from inherited mutations in genes involved in DNA mismatch repair. These mutations greatly increase the risk of developing colorectal cancer. In individuals with Lynch Syndrome, the average age at diagnosis of colorectal cancer is about 44 years, compared with 64 years in the general population. Overall, roughly 3% to 5% of all colorectal cancers are thought to result from Lynch Syndrome. Several other types of cancer are also known to be more common in people with Lynch Syndrome, including cancers of the endometrium (the lining of the uterus), ovary, small intestine, ureter, and renal pelvis.

To further explore cancer risk in families with Lynch Syndrome, researchers conducted a study among 446 people with a Lynch Syndrome gene mutation, and 1,029 family members who did not carry a gene mutation.

Study subjects were followed for a median of five years.

• Compared with the general population, people with a Lynch Syndrome gene mutation were 20 times more likely to develop colorectal cancer, 31 times more likely to develop endometrial cancer, 19 times more likely to develop ovarian cancer, 11 times more likely to develop kidney cancer, 11 times more likely to develop pancreatic cancer, 10 times more likely to develop stomach cancer, 10 times more likely to develop bladder cancer, and 4 times more likely to develop female breast cancer.
• Family members without the gene mutation did not have an increased risk of cancer (cancer risk was similar to that of the general population).

This study confirms that people with Lynch Syndrome have an increased risk of several types of cancer, including some (breast and pancreatic cancer) that were not previously known to be linked with Lynch Syndrome.

People who come from a family with Lynch Syndrome but who do not carry the gene mutation themselves do not appear to be at increased risk of cancer.

Reference: Win AK, Young JP, LindorNMet al.Colorectal and other cancer risks for carriers and noncarriers from families with a DNA mismatch repair gene mutation: a prospective cohort study. Journal of Clinical Oncology. Early online publication February 13, 2012.

Inlyta is a drug that is taken orally, as a pill. It works by blocking certain proteins that play a role in cancer growth.

A study that contributed to the approval of Inlyta for kidney cancer involved 723 patients with metastatic, clear-cell, renal cell cancer.  All patients had experienced cancer progression after initial treatment that included Sutent® (sunitinib), Avastin® (bevacizumab), Torisel® (temsirolimus), or cytokine therapy.  Study participants were assigned to treatment with either Inlyta or Nexavar® (sorafenib).

Inlyta delayed the worsening of the cancer: progression-free survival was 6.7 months among patients treated with Inlyta and 4.7 months among patients treated with Nexavar.

The most common side effects among patients treated with Inlyta were diarrhea, high blood pressure, fatigue, decreased appetite, nausea, loss of voice, hand-foot syndrome, weight loss, vomiting, weakness, and constipation.

The approval of Inlyta specifies that it is for advanced renal cell carcinoma after failure of one prior systemic therapy.

Inlyta is the seventh new drug to be approved for advanced kidney cancer since 2005.

Reference: FDA News Release. FDA approves Inlyta to treat patients with a type of advanced kidney cancer. January 27, 2012.