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What are the options when lung cancer is inoperable?

November is Lung Cancer Awareness Month and for those who have been diagnosed with lung cancer, one dreaded word is inoperable. Many feel defeated when they hear they are not candidates for surgery, but promising non-surgical treatments are available. CyberKnife, a form of stereotactic body radiation therapy (SBRT), is one of these options.

Radiation treatment to a moving target adds a level of complexity. However, CyberKnife tracks a tumor and directs targeted radiation via a state of the art robotic arm. Most patients complete their treatment in 3 to 5 days.

Highly focused radiation has become the standard of care for treating medically inoperable early stage non-small cell lung cancer with excellent results.

This video demonstrates the robotic real-time tracking of the CyberKnife.

What should I do about a thyroid nodule?

Thyroid nodules are extremely common and studies have shown that about half of us have at least one!

Fortunately, most of these nodules do not pose any health risks. Not all thyroid nodules are benign, however, and in a minority of cases (about 5-15%) may contain a cancer.  The challenge, of course, is figuring out which nodules are cause for concern and which ones are not.

With increased use of high-resolution imaging, more nodules are being identified today than ever before.  It is also not uncommon for someone to learn they have a nodule “incidentally” after a CT scan, MRI or ultrasound that was performed for some other medical reason.

If you think you may have a thyroid nodule, or if one has been found incidentally by medical imaging, you should make an appointment to see your doctor. Your doctor will likely take several steps, including:

Breast cancer awareness is about information, not a color

In recent years, the colors of October seem to have changed from red, orange, and gold to pink, pink and more pink. I have always loved pink, well before becoming a breast cancer surgeon, but like many of us, I find the pink of October overwhelming, especially at this point in the month.

I appreciate and endorse the continued focus on breast cancer, but often the important information is drowned out by the rah-rah-rah of the awareness campaigns. Many women (and men) are “aware” of breast cancer, but never truly become aware of what it really is, what it really means, until they find themselves dealing with the cold terror of a palpable mass or a call-back after mammogram. They need information, not just pink blenders. 

Breast cancer is ...

Cancer control and survivorship

I recently attended the Southwest Oncology Group (SWOG) meeting, a consortium of research institutions doing clinical trials on cancer. The conference highlighted how new research will remarkably affect cancer survivorship, quality of life (QOL), integrative care and our ability to predict and provide needed services more accurately and with greater cost effectiveness for cancer survivors. The tools for implementing cancer control are evolving quickly.

Here are some highlights from the meeting:

  • Biomarkers, which are any human characteristics that are measurable including everything from gene expression (or over-expression) to pain surveys, can potentially predict long term survival as well as the specific services that will most benefit patients.
  • Symptoms that are increasingly predictable by biomarker assays include fatigue, insomnia, pain, anorexia, nausea, depression and others. This means that we will soon be able to better predict the patients who will be affected by these problems and deliver interventions much earlier and more effectively.
  • Patient satisfaction is frequently not related to treatment outcome. Factors such as QOL and survivorship are important.
  • Lung cancer patients suffer inordinately high, long-term QOL deficits. Many of these respond well to interventions but interventions are frequently not provided to patients with lung cancer.
  • Symptom clusters ...

Breast cancer awareness: What's good for our breasts is good for the rest

October is Breast Cancer Awareness month. Sports teams are wearing pink, survivors are telling their stories, and pink ribbons are everywhere. Women battling the disease and people who care for them are educating others about the importance of early detection. People who may never have been personally touched by breast cancer are showing their support by volunteering, raising funds for research and getting involved in other ways. It is a world of PINK! And that’s a good thing.

But……sometimes it feels like we spend so much time talking about breast cancer we forget to talk about our general health. Breasts are important, but so is the rest! There are things you can do to both decrease your risk of breast cancer and improve your health overall:

  • Get moving! You don’t have to run marathons. Even moderate walking 30 min, 4-5 days a week is beneficial. Adding resistance or weight training is ideal. Life is busy, but if you look you will find ways to fit exercise into your daily routine. You’ll be decreasing cancer risk and preventing osteoporosis. Plus, inactive women have more heart disease, stroke, type 2 diabetes, and depression than active woman.

  • Maintain a healthy weight. It can make a big difference - especially avoiding weight gain after menopause. Keeping your body mass index (BMI) <25 is ideal. (Click here for a tool to help calculate your BMI). Gaining even 20lbs during the course of adulthood has been shown to increase risk of breast cancer for some women.

  • Eat a healthy diet that is high in:

Quality of Life Following CyberKnife Treatment for Prostate Cancer

The Swedish Radiosurgery Center is the lead site in a national multi-institutional study evaluating CyberKnife for treating men with intermediate-risk prostate cancer (clinical stage 2). As the principal investigator of this study, I reported on the quality of life outcomes at the annual meeting of American Society of Radiation Oncology.

We now know that in low-risk prostate cancer patients (stage 1), active surveillance is a safe option. But men with intermediate-risk cancer have a significant risk of dying of their disease, so intervention is necessary. Conventional treatments (surgery, radioactive seed implants and external beam radiotherapy) can adversely affect patients’ quality of life.  We sought to determine if the unprecedented accuracy of CyberKnife treatment would translate into improvement in these patients’ quality of life.

We treated ..

Tips for reducing hot flashes for women with breast cancer

Hot flashes are the most common complaint from women going through menopause. And for women who are breast cancer patients, the problem is often more acute. Surgery, chemotherapy and estrogen blocking medications can bring on hot flashes or make them worse if you already have them. And for women who must discontinue hormone replacement therapy, the instant onset of hot flashes and night sweats can severely impact quality of life.

Fortunately, there are several strategies you can easily and safely employ to decrease the severity and frequency of hot flashes and night sweats. Everything I recommend here is non-estrogenic so while it is generally safe for breast cancer patients and survivors, you should always check with your oncologist before trying any new supplement.

First, a few notes on diet. I recently had a patient who stopped eating refined sugars for general health reasons, and her hot flashes nearly disappeared. Your mileage may vary on this one but there are clear health benefits from lowering sugar intake, so it may be worth a try. You might also try ...

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