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Lung Cancer Lung cancer is
the leading cause of cancer deaths for both men and
women. Each year there will be about 178,000 new cases
of lung cancer in the United States. That is about 13%
of all new cancers. More than 160,000 people will die
of lung cancer. Smoking is by far the leading cause of
lung cancer. Up to 90% of lung cancer cases are caused
by smoking. At the beginning of this century lung
cancer among women was quite rare. With the increasing
use of cigarettes by women, the frequency of lung
cancer has increased among women until it is now the
leading cause of cancer deaths, even exceeding the
deaths caused by breast cancer. Clearly the best way
to prevent lung cancer is not to smoke. Young people
should not start smoking and those who already smoke
should quit. Everyone, especially babies and children,
should avoid breathing in other peoples smoke.
Symptoms In the earliest
stages, lung cancer causes little or no symptoms or
discomfort. As it enlarges, however, it may cause any
of the following symptoms: Persistent cough, repeated
or persistent bronchitis or pneumonia, hoarseness,
blood in the sputum, persistent chest and/or shoulder
pain, persistent and progressive shortness of
breath.
Diagnosis A physician may
suspect lung cancer based on the symptoms and findings
on physical examination and/or a chest x-ray. A CAT
scan of the chest may also be utilized. To make a
definite diagnosis, some type of biopsy is necessary.
This may require a procedure known as bronchoscopy in
which a flexible fiberoptic tube is inserted through
the nose or mouth into the windpipe to visualize the
bronchial structures and to obtain samples.
Alternatively, a needle can be inserted between the
ribs and directly into the tumor to obtain a sample
utilizing a CAT scan or sonogram to guide the needle.
Without a proper biopsy, appropriate treatment cannot
be started.
Types and Stages of Lung
Cancer There are two
broad categories of lung cancer as determined by
biopsy: Small cell and non-small cell carcinoma. They
are quite distinct in their behavior and their
treatment. Lung cancer generally goes through four
stages. Stage I refers to a relatively small cancer
that is completely restricted to the lung tissue. In
Stage II the cancer has spread to the lymph glands
that are located at the root of the lung (hilum).
Stage III refers to cancers that have spread into the
central part of the chest, an area sandwiched in
between the two lungs, known as the mediastinum. Stage
IV refers to cancers that have spread to other parts
of the body (metastasis). In order to accurately
determine the stage of the disease, it may be
necessary to proceed through an orderly sequence of
testing. Mediastinoscopy, in which tissue samples are
taken from the lymph nodes along the windpipe, may be
required. PET scans, which are still under
development, may ultimately replace this invasive
procedure as a staging tool. Small cell cancer, also
known as oat cell cancer, has only two stages: Limited
and extensive disease. Limited stage usually means
that the cancer is only in one lung and in the lymph
nodes on the same side of the chest.
Treatment of Non-Small Cell Lung
Cancer Treatment of
non-small cell lung cancer depends upon the stage of
the disease. In general, Stage I and II cancers can be
most successfully treated with surgery unless there
are contraindications, such as poor lung function.
Some Stage III cases are operable but most are treated
with a combination of radiation therapy and
chemotherapy. Stage IV cases require chemotherapy
which can be used either alone or in combination with
some radiation therapy. Radiation therapy uses high
energy x-rays to kill or shrink cancers. It may also
be used to relieve some of the symptoms related to the
cancer. These treatments are administered at a
radiation center, a facility specifically designed for
these treatments. The treatments are usually
administered once daily on Monday through Friday for a
number of weeks. Chemotherapy
involves the use of anticancer drugs to kill cancer
cells. These treatments are generally administered
intravenously on an intermittent schedule and,
usually, at least four sets of treatment are required.
There has been a lot of research in this field in
recent years. A number of new drugs have been
developed which are more effective than the older
agents. This includes drugs such as Taxol, Navelbine,
and gemcitabine. Even advanced cases of lung cancer
are showing favorable response and some improvement in
survival.
Current Treatment of Small Cell Lung
Cancer Because of the
rapid growth of this type of lung cancer, surgery is
not generally recommended. Instead these patients go
directly to chemotherapy. If the disease is still in
the “limited” stage, radiation treatments are given at
the same time. If there is extensive disease,
chemotherapy is used alone. The most commonly used
treatment program is a combination of etoposide and a
platinum compound (either Cisplatin or Carboplatin).
The majority of patients will respond favorably and
many will go into complete remission fortunately, only
a small percentage of patients with this disease are
cured at this time. A lot more research will be needed
to develop new drugs and new technologies to improve
the overall outlook for these patients.
Clinical Trials A clinical trial
studies the usefulness of a new treatment for cancer
patients. Many of the currently available treatments
yield unsatisfactory results and so new treatments
need to be developed. After going through extensive
evaluation in a laboratory setting and in laboratory
animals, the new drug or treatment is then used on
humans. Phase I clinical trials detetermine the safety
and toxicities that humans can expect with the use of
the new drug. Phase II trials are aimed at determining
the optimal dose and schedule for the use of the drug.
In Phase III trials the new drug is compared to the
standart treatments to determine whether it is
superior or not. Participation in clinical trial is
purely voluntary but is often encouraged since this is
the only way in which we can expect to make progress
in the treatment of lung cancer. There are advantages
and potential disadvantages to participating in these
trials. The physician and/or his research nurse will
provide a wealth of information and details prior to
including a patient in a study. For additional
information about lung cancer and clinical trials,
please click on the oncology banner on this
page.
James
Wilder, M.D.
PROSTATE CANCER
Introduction Prostate cancer
is the most frequently diagnosed cancer (excluding
skin cancer) and the second leading cause of cancer
death in American men. Only lung cancer results in
more male cancer deaths in this country. Each year,
roughly 180,000 men in the U.S. will be diagnosed with
prostate cancer, and about 37,000 will die of this
disease. These numbers are remarkably similar to those
for breast cancer. However, there seems to be less
awareness regarding prostate cancer, and breast cancer
receives more research funding. In recent years,
though, prostate cancer has been receiving more
attention, as a number of public figures have been
diagnosed and treated for it.
Risk Factors The cause of
prostate cancer is unknown, but several factors
associated with a higher risk for it have been
identified. Increasing age is one of the most closely
associated variables, with the average age at
diagnosis being 72. Fewer than 10 percent of cases are
diagnosed in men less than 60 years of age, and more
than 75 percent of cases are diagnosed in men older
than 65. The incidence of prostate cancer is low in
native Chinese and Japanese men but higher among men
from Scandinavian countries. African American men have
the highest incidence rate of prostate cancer in the
world, and they also present with more advanced stages
of disease and are more than twice as likely to die of
prostate cancer than are white American men. The
incidence of prostate cancer is higher in men with a
family history of prostate cancer, particularly in
those with two or more first-degree relatives having
the disease. Diets high in fat content may also
increase the risk of developing prostate cancer. Of
these risk factors, diet is the only one that, in
theory, can be modified.
Symptoms In most cases,
prostate cancer itself causes no specific symptoms,
especially in its early stages. It is sometimes
diagnosed in men who present with symptoms of urinary
obstruction related to benign enlargement of the
prostate (benign prostatic hypertrophy, or BPH). BPH
is a separate, unrelated process and does not appear
to cause prostate cancer. In rare instances, cancer
can become advanced within the prostate and cause
urinary obstructive symptoms, but these symptoms are
much more often due to BPH. Occasionally, prostate
cancer can spread to the bones and cause pain prior to
diagnosis.
Screening Since prostate
cancer typically causes no symptoms in its earliest,
most curable stages, individuals must be screened in
order to detect prostate cancer in its early stages of
development. Historically, this was accomplished with
a digital rectal examination (DRE), in which the
physician inserts a gloved finger into the rectum to
feel for nodules, hard areas, asymmetry, and other
abnormalities. However, many of the abnormalities
detected by DRE turn out not to represent prostate
cancer, and, conversely, DRE fails to detect some
prostate cancers. A blood test known as PSA (prostate
specific antigen) is more sensitive and frequently is
elevated in patients with prostate cancer who have a
normal DRE. However, the PSA is sometimes normal in
patients with prostate cancer, so both PSA and DRE
should be performed in screening for prostate cancer.
Whether widespread screening for prostate cancer
should be recommended is controversial. Men,
particularly those above age 50, should discuss with
their physician whether to undergo screening for
prostate cancer. Those at higher risk, such as African
Americans and those with a family history of prostate
cancer, may wish to consider screening at age
40-45.
Diagnosis A man with an
abnormal PSA or DRE should be evaluated to determine
the cause of the abnormality. PSA elevation may be due
to prostate enlargement, inflammation or infection of
the prostate, prostate cancer, or other causes. A
biopsy of the prostate gland is often necessary to
determine the cause and to rule out the possibility of
prostate cancer. This is usually performed under
transrectal ultrasound (TRUS) guidance, a procedure in
which a urologist views images of the prostate
obtained by inserting an ultrasound probe into the
rectum. Needles are inserted through the probe and
into the prostate to obtain tissue samples which are
analyzed for the presence of prostate cancer. This is
usually a simple outpatient procedure. If prostate
cancer is found in the biopsy specimens, additional
tests, such as a CT scan or bone scan, may be ordered
to determine whether the cancer has spread beyond the
prostate gland. In some cases, additional testing is
not necessary.
Prognostic Factors Several
variables can aid the physician in predicting the
aggressiveness of a particular case of prostate cancer
and, in turn, aid in deciding which form of treatment
is most appropriate for each individual. These
prognostic factors include: PSA, Gleason score, tumor
stage, and lymph node status. Higher PSA levels at
diagnosis predict a higher likelihood that the cancer
will spread or relapse after treatment. The Gleason
score is a system in which a grade is assigned to the
cancer, based on characteristics of the appearance of
the tumor under the microscope. A higher grade or
higher Gleason score also predicts a higher
probability that the tumor will spread or recur after
treatment. The stage of the tumor is a description of
the size or extent of the tumor, based of DRE, TRUS,
and other measures. Higher stage tumors are more
advanced and are less likely to be completely removed
by surgery or eradicated by radiation treatment.
Conversely, cancers associated with a low PSA level,
low Gleason score, and early stage are more likely to
behave in an indolent fashion and are more likely to
be controlled by surgery, radiation, or other
treatments.
Treatment Several options
exist for management of prostate cancer. These
include: surgery, radiation therapy, hormonal therapy,
and observation (watchful waiting). The decision
regarding which treatment is best for an individual
can be complex, and many factors influence this
decision. The optimal treatment in one case is often
not the best choice in another case. Each method of
treatment has advantages and disadvantages, and the
challenge for physicians and patients is to determine
the most appropriate course of action for each
patient.
Surgery Surgical
treatment of prostate cancer usually consists of a
radical prostatectomy – complete removal of the
prostate. This has the potential to cure cancers in
which the tumor is confined within the prostate gland.
Advantages of this procedure include its potential to
cure early stage cancers, avoidance of potential
problems associated with radiation, and accurate
determination of the tumor’s extent, based on careful
microscopic examination of the lymph nodes and
prostate gland by a pathologist. The pathologist’s
findings can refine knowledge of the patient’s
prognosis and may indicate the need for additional
treatment, such as radiation therapy or hormonal
therapy. Disadvantages of radical prostatectomy
include the fact that it is a major operation that
requires hospitalization and that it may result in
side effects such as impotence or incontinence.
Transurethral resection of the prostate (TURP) is a
procedure in which tissue is removed from the inside
of the prostate in order to relieve obstruction of
urinary flow from the bladder. Since it removes only
part of the prostate gland, this operation is not
designed to cure prostate cancer and is usually done
to relieve symptoms related to BPH. It may sometimes
be performed for symptom relief if prostate cancer is
locally advanced and the patient is not a candidate
for radical prostatectomy because of advanced age,
medical problems, or advanced stage prostate
cancer.
Radiation Therapy Radiation
therapy uses x-rays to kill prostate cancer cells.
Like radical prostatectomy, it is capable of curing
prostate cancer in its earlier stages. Radiation is
delivered by two general methods: external beam
radiation therapy and interstitial brachytherapy.
External beam irradiation is delivered by a machine
called a linear accelerator, which generates a
high-energy x-ray beam that is aimed at the prostate
gland from outside the body. The patient lies on a
table, and the linear accelerator rotates around the
table, typically delivering the beam from four or more
directions, converging on the prostate gland.
Treatments are administered once a day, five days a
week, for approximately eight weeds. Each treatment
lasts a few minutes, and the patient feels nothing
during treatment delivery. External beam radiation
therapy may also be given to the prostate bed in
patients in whom the cancer recurs there after
surgery. Radiation therapy may also be used to treat
pain and other problems in advanced cases in which the
cancer spreads to the bones or other areas.
Recent advances
in computer technology have given rise to more
accurate methods of targeting and delivering the
radiation beam – three-dimensional conformal radiation
therapy (3D conformal radiation) and intensity
modulated radiation therapy (IMRT). Proton beam
radiation therapy, available only in a few centers
nationwide, is another means of delivering radiation
more accurately. These newer techniques all facilitate
irradiation of the prostate gland while minimizing
radiation exposure to surrounding structures such as
the bladder and rectum. Advantages of external beam
radiation therapy include its potential to cure early
stage prostate cancer, avoidance of major surgery, and
a lower risk of incontinence and impotence than with
radical prostatectomy. Disadvantages include extensive
travel associated with the course of treatment and
potential complications such as bowel damage.
Interstitial
brachytherapy is a technique in which radioactive
sources are placed into the prostate gland, delivering
radiation from within the prostate. The most common
method of brachytherapy is known as the “seed
implant,” in which multiple radioactive seeds, usually
isotopes of iodine or palladium, are inserted into the
prostate by needles passing through the base of the
scrotum under ultrasound guidance. Other methods of
inserting the seeds have also been developed. The
seeds remain in the body permanently, although the
radioactivity diminishes over time. The seed implant
may be performed as the sole treatment modality in
very early stage prostate cancers of low
aggressiveness, or it may be combined with an
abbreviated (five-week) course of external beam
radiation therapy, particularly in cases in which the
PSA, Gleason score, or tumor stage would predict a
lower likelihood of controlling the cancer with the
seed implant alone. In some cases, radioactive
sources, typically an isotope of iridium, are inserted
into the prostate gland temporarily and than removed.
This is known in some situations as high-dose rate
(HDR) brachytherapy and is usually combined with an
abbreviated course of external beam irradiation. An
advantage of combining external beam radiotherapy with
the seed implant or HDR brachytherapy over external
beam irradiation alone is that the former approach
delivers a higher total radiation dose to the prostate
and may result in a higher probability of controlling
the cancer. For patients who are suitable candidates
for the seed implant alone, this approach is often
attractive, as it avoids both the lengthy course of
external beam radiotherapy and the major surgery
associated with radical prostatectomy. Disadvantages
of the seed implant include its relatively shorter
track record than radical prostatectomy or external
beam radiation therapy and the fact that it is a minor
surgical procedure, which may not be suitable for some
patients.
Hormonal Therapy Prostate
cancer’s development and growth is stimulated by
testosterone, the male sex hormone. Thus, prostate
cancer usually responds favorably to withdrawal of
testosterone. In some cases, all clinical evidence of
prostate cancer can disappear in response to hormonal
therapy. However, hormonal therapy alone is not
regarded capable of curing prostate cancer. Hormonal
therapy is usually recommended for patients who
initially present with the cancer having spread to
bones or lymph nodes, patients in whom the cancer
spreads to such areas after surgery or radiation
therapy, or patients in whom the cancer recurs after
radiation therapy. Hormonal therapy may also be
recommended for some patients with earlier stage
prostate cancer who are not suitable for definitive
surgery or radiotherapy. Historically, hormonal
therapy was usually accomplished by surgical removal
of the testicles (orchiectomy) or administration of
female hormones such as DES. DES is not commonly used
today, since it may cause heart and blood vessel
problems, breast enlargement, and other side effects.
Newer pharmaceutical agents are usually better
tolerated and do not require removal of the testicles,
which men may find objectionable. These agents include
injections known as LHRH agonists, such as Lupron or
Zoladex, and oral medications known as nonsteroidal
antiandrogens, such as Eulexin or Casodex. Orchiectomy
remains a simple, expedient option in some cases,
though.
Temporary courses of an LHRH agonist, sometimes
with an antiandrogen, are sometimes used in
combination with radiation therapy. Recent studies
have shown that this combination of therapies may
result in better cancer control in some cases than
radiation therapy alone. A temporary course of
hormonal therapy may also be used to shrink the
prostate gland if the prostate is initially too large
to permit interstitial brachytherapy.
Observation Also known as
watchful waiting, this is a choice not to undergo
definitive treatment for prostate cancer, involving an
assumption that an individual is likely to die of a
cause other than prostate cancer. Prostate cancer
sometimes progresses slowly, and the choice of no
active treatment may be reasonable, particularly in an
elderly patient or one with major medical problems.
For patients who are relatively young (less than
approximately 70 years old) and otherwise reasonably
healthy, physicians in this country are often hesitant
to endorse a policy of watchful waiting.
Follow Up/Salvage After definitive
treatment with surgery or radiation therapy, patients
are typically followed by their urologist and
sometimes by other physicians. The DRE and PSA are
repeated at fairly regular intervals, usually a few
times each year. Other tests may be ordered if
necessary. A progressive rise in the PSA is frequently
the earliest sign of relapse after surgery or
radiotherapy. Radiation therapy, sometimes in
combination with hormonal therapy, may be instituted
if the PSA rises after radical prostatectomy. Hormonal
therapy is usually initiated for a rising PSA after
radiation therapy. Patients on hormonal therapy for
advanced disease are followed by their urologist or
other physicians. If the disease progresses despite
hormonal therapy, palliative radiation therapy,
second-line hormonal therapy agents, chemotherapy, or
other treatments may be indicated.
Janice Tomberlin, M.D.
Breast Cancer Breast cancer is
the most common cancer in women, representing 183,000
newly diagnosed cases and 46,000 deaths per year in
the United States. This accounts for one third of
female cancer diagnoses. The risk of developing breast
before age 50 is 1 in 50 and increases with age.
Nearly 70% of breast cancers are diagnosed in women
age 55 and older. Over the course of a lifetime of 85
years, women have a 1 in 8 chance of developing breast
cancer. The good news is that deaths from breast
cancer are decreasing due to increased awareness and
earlier detection of the cancer through screening
mammograms.
The exact cause of breast cancer is unknown.
Researchers have different theories about what causes
breast cancer and most suspect that a combination of
lifestyle, environmental and genetic factors can
increase a woman’s risk of developing the disease.
There is also a pronounced variability in breast
cancer rates in different countries around the world.
There are roughly 100 cases of breast cancer per
100,000 women in western countries such as the United
States compared to 10-15 cases per 100,000 women in
Asian countries. This is thought to be in part due to
the differences in diet between these two regions.
Several studies have suggested that a diet high in fat
may increase the risk of breast cancer.
The genetics of breast cancer are also intriguing.
Any woman with a first-degree relative (mother, sister
or daughter) with breast cancer is at increased risk
of the disease herself. This familial tendency does
not necessarily imply a genetic transmission of the
disease. The BRCA1 and BRCA2 genes have been mapped
and are linked to the truly genetically transmitted
cases. Genetically linked cases are thought to
represent only 5-10% of all cases, however, and breast
cancers occurring in some families probably represent
common environmental risk factors. True BRCA1 cases
typically occur at earlier ages and are also linked to
ovarian cancer. Carriers of a BRCA1 mutation
apparently have roughly an 85% risk of developing
breast cancer by age 70, and a 45% risk of developing
ovarian cancer by the same age.
Several hormonal factors increase the risk of
developing breast cancer. Beginning menstruation
early, entering menopause late, or waiting until after
age thirty to have your first child or not having
children at all, increase a woman’s risk of developing
breast cancer. All of these factors are linked to the
female hormone, estrogen. Breast cancer has also been
associated with estrogen replacement therapy after
menopause. Most doctors strongly believe that this
therapy does not cause breast cancer, but may
accelerate the growth of a tumor that is already
present. Many women worry that the use of oral
contraceptives ("the pill") may increase the risk of
developing breast cancer. After reviewing 54 studies,
the conclusion of a panel of experts report that "the
pill" did not appear to cause breast cancer. In fact,
some doctors suspect that the use of "the pill" during
a woman’s reproductive years may actually protect her
from developing breast cancer after menopause.
Screening Mammography is a very
successful screening tool for breast cancer. There is
considerable controversy in the medical community,
however, over when mammographic screening should
begin. There is no doubt that annual mammographic
screening in women over the age of fifty is
beneficial. Some studies indicate that the routine use
of screening mammograms in women over fifty is
beneficial. Some studies indicate that the routine use
of screening mammograms in women over fifty can
decrease breast cancer deaths by one-third. The
American Cancer Society (ACS), the American College of
Radiology and the American College of Obstetricians
and Gynecologists all recommend annual mammograms for
women in their forties. In March 1997, based on their
review of scientific data, the National Cancer
Advisory Board recommended that women should have a
screening mammogram every one to two years beginning
at age forty. Another group of experts gathered by the
National Institutes of Health (NIH) in January of 1997
concluded that based on their review of the same
studies, mammograms should be optional until age
fifty. In view of this controversy, women should
discuss their particular risk factors with their
doctor and decide when they feel comfortable beginning
a screening program.
A monthly breast self-exam is another part of a
successful screening program. The best time for a
woman to examine her breasts is during the week after
her period when her breasts are the softest and the
least tender. The following is the three-step
technique for breast self-exam published by the Susan
G. Komen Breast Cancer Foundation:
In the shower: Raise one arm and place your hand on
the back of your head. Slowly and methodically, move
the pads of your fingertips over the breast in a
circular pattern. Don’t forget to feel in the armpit
area. Repeat on the other side.
Lying down: Lie down and put a pillow under your
right shoulder and your right arm behind your head.
Using the pads of your fingertips, make the same
circular pattern of your right breast as you did in
the shower. Don’t forget to feel the armpit and the
chest area from the collarbone to the area below the
breast. Repeat, using firmer pressure. Squeeze the
nipple gently to see if there’s any discharge. Repeat
the procedure on the left breast. Report any strange
findings or changes to your doctor immediately.
Detection Once an
abnormality is detected on mammogram or exam, a
physician should evaluate whether or not a biopsy is
indicated. While 90 percent of breast lumps are not
cancerous, any lumps should be examined immediately.
There are many ways of obtaining a piece of the tumor
to make an accurate diagnosis. Biopsies can be
obtained under ultrasound or stereotactic
localization. Sometimes the entire lump is removed at
the time of the biopsy. Lumps commonly occur in the
lobules or small sacs that produce milk or in the
ducts that carry milk to the nipple. Cancers beginning
in these structures represent the vast majority of
breast cancer and are called lobular and ductile
carcinomas. Each category has many subtypes.
Staging and Treatment Once a cancer is
detected, the next step is usually a surgical
procedure. The standard surgical procedure for breast
cancer was once the radical mastectomy – total removal
of the breast and the surrounding fat, muscle, and
lymph nodes. Many women whose cancer is detected early
now are offered a lumpectomy or partial mastectomy
where the tumor and lymph nodes under the arm are
removed, but the majority of the breast tissue is
spared. This has been shown in early cases to be as
effective as a mastectomy at curing the disease. Many
women will choose to have a modified radical
mastectomy – removal of the breast and lymph nodes,
which leaves most of the chest wall muscle intact.
This can be combined with reconstructive surgery
either immediately at the time of the mastectomy or at
a later date. Advances in surgical techniques,
reconstructive surgery, radiation therapy and
chemotherapy have led to many more options for
treatment for a newly diagnosed breast cancer patient.
Many patients want to research their decisions, seek
second opinions and become involved in the decision
making process. Generally, a brief delay between
diagnosis and treatment will not compromise the
effectiveness of treatment.
nbsp; Certain tests to
detect if the cancer has spread are often ordered and
these help doctors determine if chemotherapy or
hormone therapy will be recommended. These tests are
generally ordered by the Medical Oncologist – an
Internist with specialized training in treating
cancers. They will determine from the size of the
tumor as well whether the lymph nodes are involved or
not, whether chemotherapy or hormone therapy would be
beneficial. Certain tests done on the cancer cells
give an indication of how fast or aggressively it was
growing and determine if the female hormone estrogen
had influenced its growth. All of these factors help
the Medical Oncologist decide what treatment to
recommend. Radiation is almost always used to treat
the remainder of the breast when a lumpectomy is
performed, and is sometimes used after a mastectomy in
certain cases. These treatments are recommended and
prescribed by a Radiation Oncologist, a physician who
specializes in the treatment of cancer with radiation.
The overall treatment can involve a team of doctors
made up of the primary care physician, the diagnostic
radiologist, the surgeon, medical oncologist and
radiation oncologist.
nbsp; The good news is that
through the efforts of cancer researchers and
patients’ involvement in clinical trials, the overall
death rate from breast cancer has decreased by five
percent in the past decade. For information on ongoing
clinical trials relating to breast cancer, please
click on the Texas Oncology banner at the beginning or
end of this web page.
Sue
Graham, RN CCRA
RESEARCH STUDIES Research
studies, also called clinical trails, are conducted to
answer important medical and scientific questions to
find better ways to treat diseases such as cancer.
Clinical trials evaluate study or investigational
drugs, combinations of investigational and standard
drugs or different ways of giving drugs. Researchers
must believe that a study drug or method will be as
good as or better than what is currently being used or
they would not offer it to patients.
nbsp; Cancer research
studies are divided into several types. Studies that
are considered Phase One are generally the first time
a drug is given to cancer patients. In Phase One
studies, physicians want to know the best dose of drug
to give a patient. More importantly they want to know
how well a patient tolerates the drug and any side
effects the drug may cause. They also want to know
what dose of the drug is best at killing cancer cells
and what kind of cancers are best killed by a study
drug. In Phase Two, a small number of patients with a
particular type of cancer receive the study drug at
the dose that was found to be safe and most effective
in the Phase One studies. The purpose of Phase Two
studies is to better define the effectiveness and
safety of study agents in treating different types of
cancer.
nbsp; Only a small number of
patients participate in Phase One and Phase Two
studies. The next step, Phase Three studies have
greater numbers of patient participation. They are
designed to confirm the findings of the Phase One and
Phase Two studies in a larger group of patients. They
also compare the study treatment with drugs physicians
are currently using or what is considered the standard
treatment. Your physicians are involved in several of
these Phase One, Two and Three studies and offer
patients treatment as part of a clinical trial if your
physician feels it is the best treatment option.
nbsp; Even though your
physicians are involved in cancer research, the final
decision to participate in a research study is made by
you. Patients choose to take part in clinical trials
for many reasons. Some may hope for a cure, for a
longer time to live and for a way to feel better.
Others want to be among the first to received research
treatments and investigational drugs because standard
therapies are not optimal for their cancer. Most
people want to know that their efforts will make a
difference for future cancer patients.
nbsp; While you are being
treated as part of a clinical trial, your physician is
closely monitoring every aspect of your care. Your
physician fully understands the study treatment plan
and what important questions are being addressed. A
special research nurse who works directly with your
physician is also dedicated specifically to patients
who are on a clinical trial. At the same time, your
needs as a patient come first. If there is no
improvement in your condition, or if the treatment or
drug causes intolerable side effects, you and your
physician can decide to discontinue the study and
proceed with other treatments. Should you decide to
stop participating in the clinical trial, your wishes
are respected without any effect on future treatment
plans.
nbsp; For more information
on research trials, click on the banner at the
beginning or end of this web page.
Additional Information The American
Cancer Society is an excellent resource for
information and support for prostate cancer patients
and their families. They can be contacted locally or
on the web. Man to Man (sponsored by the American
Cancer Society) and Us Too, prostate cancer education
and discussion groups, are also excellent resources.
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