LIVER CANCER

Cancer that starts in the liver is called hepatocellular carcinoma (HCC), or hepatoma. HCC is the 5th most common cancer in the world and the 3rd leading cause of cancer death. Most cases of HCC occur in Asia and Africa, but the number of people with HCC is rising rapidly in the U.S. and other western countries.

Liver cancer (HCC) is a tumor that starts in the liver cells (hepatocytes).

500,000 new cases of HCC worldwide every year.

HCC occurs more often in men than women, usually in people 50 to 60 years old.

HCC is one of the most common cancers in the world: it is the 4th most common cancer and 3rd leading cause of cancer death worldwide

80% of people diagnosed with HCC are in Asia and sub-Saharan Africa due to widespread hepatitis B virus (HBV) in these regions.

All HCC are due to liver damage (cirrhosis) from several causes: HBV, hepatitis C (HCV) infection, excess alcohol consumption, and certain genetic liver disorders.

A growing cause if HCC in the U.S. and other western countries, is fatty liver. Fatty liver can occur in people with diabetes, obesity, or combination of high blood pressure, high cholesterol, diabetes, overweight).

The U.S. incidence and death rate from HCC have been rising steadily since 1975 and there are 22,000 predicted new cases in 2012.

HCC incidence in the U.S. is predicted to increase 4-fold over the next decade or so, due to HCV and fatty liver.

Liver transplantation can offer a small percentage of patients (<10%) survival for several years, but >75% patients had advanced disease and are not eligible for transplantation, surgery or liver-directed therapies.

There is only 1 FDA-approved chemotherapy drug, sorafenib, available for HCC patients.

WHAT ARE THE MAIN CAUSES OF LIVER CANCER?

On average, smoker have a 50-60% higher risk of liver cancer than non-smokers. Heavy drinkers have around five times the risk of liver cancer of light or non-drinkers.

Chronic heavy alcohol consumption or infection with the hepatitis B or C viruses can cause cirrhosis, which greatly increases the risk of liver cancer.

People with diabetes have an increased risk of liver cancer.

Occupational exposure to vinyl chloride has been linked to liver cancer.

Aflatoxin – a toxin produced by fungi - can contaminate foodstuffs stored in hot, humid conditions and is a cause of liver cancer in many developing countries.

HOW MANY PEOPLE SURVIVE LIVER CANCER?

Liver cancer is often diagnosed late and so survival rates are poor. Around 5% of patients diagnosed with liver cancer survive their disease for five years or more or more.

One year survival rates for liver cancer have improved since the 1970s. Around 20% of patients survive their disease for at least one year, compared to less than 5% forty years ago.

MYTHS ABOUT CANCER III

Myth: Positive thinking will cure cancer?

Although a positive attitude can improve your quality of life during cancer treatment, there is no scientific evidence that it can cure cancer. Placing such importance on attitude can lead to unnecessary guilt and disappointment if–€”for reasons beyond your control–€”your health does not improve.

Source: cancer.net

 Myth: The medical establishment is hiding a cure for cancer.

The medical community is not withholding a miracle treatment. There is no one single cure for cancer. More than 100 types of cancer exist, and they respond differently to various methods of treatment. Those who work in the medical field have the same likelihood of developing cancer as the general population, and they are eager for new and better treatments to emerge.

Source: cancer.net

WORLD CANCER DAY

Cancer is a leading cause of death worldwide and accounted for 7.6 million deaths (around 13% of all deaths) in 2008.

World Cancer Day is marked on February 4 to raise awareness of cancer and to encourage its prevention, detection, and treatment. World Cancer Day was founded by the Union for International Cancer Control (UICC) to support the goals of the World Cancer Declaration, written in 2008. The primary goal of the World Cancer Day is to significantly reduce death and illness caused by cancer by 2020

RACE AND BREAST CANCER

The relationship between race, ethnicity, and breast cancer is complex. Many studies have shown that women of different racial and ethnic backgrounds have different rates of developing and surviving breast cancer, but the reasons for this difference aren't always clear.

According to the National Cancer Institute, white women are the ethnic group most likely to develop breast cancer, while Korean American women are the least likely. However, black women have a greater chance of being diagnosed with more aggressive, advanced-stage breast cancer. They are also more likely to be diagnosed at a younger age and tend to have a worse prognosis (chance of recovering).

Risk factors and race

Researchers have found that some of the differences in cancer diagnosis and survival may be linked to the fact that many black women have less access to regular medical care, such as having a primary care doctor. Having a primary care doctor increases the chance that a person will have regular check-ups and screening tests that may find breast cancer at an earlier stage before it has the chance to spread.

Various lifestyle factors that are more common in some ethnic groups, such as unhealthy eating habits and weight issues, as well as other health concerns, such as diabetes and high blood pressure, may also influence prognosis. Research has shown that obesity is a major risk factor for developing breast cancer, as well as decreasing recovery and survival following treatment, no matter what race you are.

Genetic factors

There are also genetic (inherited) factors associated with a person’s racial and ethnic ancestry that influence breast cancer development and survival. For example, Ashkenazi (Eastern European) Jewish women have a higher risk of carrying specific mutations (changes) in theBRCA breast cancer susceptibility genes that make them more likely to develop breast and/or ovarian cancer than women who do not have a BRCA mutation.

African ancestry has been linked with an increased risk of developing a particular type of breast cancer known as triple-negative breast cancer. This type of cancer is called ”triple-negative” because the tumors do not have receptors for estrogen and/or progesterone, like normal breast tissue does, and they do not have a protein called human epidermal growth factor receptor two (HER2). As a result, triple-negative breast cancers do not respond to medications that block estrogen production or receptors, like tamoxifen (Nolvadex, Soltamox) or aromatase inhibitors, or to HER2-blockers like trastuzumab (Herceptin) and lapatinib (Tykerb).  As a result, chemotherapy is often the treatment of choice, but when it does not work, triple-negative cancers may be difficult to treat. 

Interestingly, male breast cancer is also more common among African as well as African American men. Learn more about the genetics of breast cancer.

Steps you can take

Although you can't change your race or ethnicity, there are still a number of things you can do to lower your risk of breast cancer. First, it is important to talk with your doctor about getting a mammogram and decide on an appropriate screening schedule.  The U.S. Preventive Services Task Force recommends that women between the ages of 50 and 74 have a mammogram every two years and that mammography be considered in women aged 40 to 49 after evaluating the risks and benefits of this test with a doctor. The American Cancer Society recommends yearly mammography beginning at age 40. If you are worried about the cost of these tests, there are programs, such as the Centers for Disease Control and Prevention’s  National Breast and Cervical Cancer Early Detection Program, that provide free or low-cost mammograms to women who qualify. Find other financial resources that can help you manage the cost of cancer care.

If you have been diagnosed with breast cancer, it is important to talk with your doctor about the most effective treatment plan for your type and stage of cancer. Researchers have found that black women are less likely to get high-quality treatment if they have cancer, often due to a lack of social and economic resources. It is also important to consider participating in a clinical trial. Black women and women of other ethnic groups do not participate in clinical trials as frequently as white women and, therefore, have less access to new and promising therapies. A lack of participation in clinical trials also means that less is learned about cancer in women who are members of minority groups.

In addition, you can make healthy lifestyle choices that can keep your risk of developing cancer as low as possible and improve your health after a cancer diagnosis. This includes:

• Maintaining a healthy weight
• Exercising regularly
• Limiting the amount of alcohol you drink
• Eating nutritious food
• Stopping tobacco use

Learn more about risk factors and prevention.

Understanding risk and statistics

Cancer risk and survival statistics should be interpreted with caution. Although these numbers may be a good way to learn about how race may influence breast cancer risk and survival, they can't predict if someone will develop breast cancer or how well a treatment will work for a specific person. Your doctor can help you understand how these statistics relate to your chances of developing breast cancer or chances of being successfully treated. Learn more about cancer statistics.

Source: cancernet.com

MYTHS ABOUT CANCER II

Myth: Antiperspirants or deodorants can cause breast cancer?

Fact: There's no conclusive evidence linking the use of underarm antiperspirants or deodorants with breast cancer, according to the National Cancer Institute. 

Some reports have suggested that these products contain harmful substances such as aluminum compounds and parabens that can be absorbed through the skin or enter the body through nicks caused by shaving. No clinical studies have yet given a definitive answer to the question of whether these products cause breast cancer. But the evidence to date suggests these products don't cause cancer.

Source: mayoclinic.com

PAGET DISEASE OF THE BREAST

Paget disease of the breast is an uncommon disease, accounting for about 1% to 4% of all breast malignancies. It occurs most commonly in postmenopausal females, with a mean age of onset at 57 years. The disease presents as a solitary erythematous, slightly infiltrated patch on the breast; specifically, the lesion most often begins on the nipple, and then extends sequentially to the areola and finally to surrounding skin. As evidenced by this case, the nipple does not have to be involved. Serous drainage, crust, and scab formation and complaints of pain or itching are all frequent. Advanced lesions present as deeper red, polycyclic plaques. In short, Paget disease of the breast closely mimics eczema. In long-standing lesions, erosion or ulceration, and/or retraction of the nipple may occur. Paget disease of the breast is nearly always unilateral. Mammary Paget disease is associated with CANCER (either an in situ or an invasive ductal carcinoma) in some 92% to 100% of cases.

Source: Cancernetwork.com

MYTHS ABOUT CANCER I

Myth: Hair dye causes brain cancer?

There has been a lot of speculation about hair dye and cancer. It has been thought that hair dye caused several different types of cancers like bladder and breast cancer, but there is no evidence of it causing brain tumors. According to a study published in the Journal of the American Medical Association, hair dye does not increase the risk of developing cancer.

Source: about.cancer.com

WEIGHT CONTROL, PART II

Weight gain after a cancer diagnosis

In cancer survivors, weight gain may cause the development of other diseases and lower cancer-related survival and overall survival. What's more, cancer survivors are at greater risk for developing second cancers and other diseases, such as heart disease and diabetes, conditions that are clearly linked to weight gain.

Another problem related to weight gain and cancer is a change in body composition from some treatments. Studies show that people with breast cancer, prostate cancer, non-small cell lung cancer, and acute lymphoblastic leukemia (ALL) who receive chemotherapy, hormone therapy, or radiation therapy to the head lose lean body mass (muscle) as they gain weight. Although actual changes in total body weight are small, patients often report that they are outgrowing their clothes.

Although eating too much can cause weight gain, recent reports suggest that a decrease in physical activity and a lower metabolic rate (the rate at which the body converts food into energy) may be more important factors for weight gain in people with cancer. To avoid weight gain, patients should reduce their normal calorie intake and/or increase exercise, such as resistance training, that helps build muscle. Talk with your doctor or other health care team member about an appropriate plan before you begin. Learn more about physical activity and cancer.

Recommendations for weight management

Reaching and maintaining a healthy weight is important for everyone, including patients undergoing cancer treatment and cancer survivors. Avoiding excess weight is associated with cancer prevention, more effective cancer treatment, the prevention of diseases in addition to cancer, and improved overall health and survival.

To avoid weight gain, it is important to be aware of your diet and make healthy choices about food and beverages. This can be challenging because eating a high-calorie diet is typical in the United States today. The reasons for this include a plentiful, relatively low-cost food supply, large portions, and an abundance of foods that are high in sugar and fat. Here are some tips to help:

• Choose foods with lower calorie content, such as vegetables, fruits, whole grains, and soups. Some of these foods also help a person feel "full" faster.
• Limit foods and beverages that are high in sugar and fat.
• Balance the calories from foods and beverages with the amount of calories burned through physical activity.
• Increase levels of physical activity. Most people should aim for 30 to 60 minutes per day of moderate-to-intense exercise on most days. However, even a small increase in physical activity has benefits.
• People currently overweight or obese should take steps to lose weight through nutrition and exercise. Aim to lose 5% to 10% of your body weight as your first goal.

Some people with cancer have the opposite problem€” they need to gain weight. A typical cause is loss of appetite, which may be worsened by nausea, vomiting, mouth sores, difficulty swallowing, and loss of taste. Your doctor and a dietitian can make recommendations for adding calories and improving nutrition. Learn more about how to manage weight loss.

Weight management tips for cancer survivors

People being treated for cancer or those with a history of cancer should follow the same guidelines set for weight management for the general population. Individualized counseling provided by a dietitian can help patients and survivors who have completed treatment lose weight. Weight loss plans that include exercise have also helped people with cancer avoid weight gain during chemotherapy. Weight loss in people with cancer or cancer survivors should be closely followed by a doctor. People should aim to lose no more than 2 pounds each week.

Weight loss approaches

The National Institutes of Health approach to obesity treatment includes:

A change in lifestyle behaviors. Behaviors that both reduce the amount of food eaten and increase the level of physical activity should be changed before other weight loss treatments are considered. A registered dietitian, exercise physiologist, clinical psychologist, or doctor who specializes in weight loss can help.

Pharmacotherapy. The use of drugs can help a person lose weight when changing diet and increasing exercise fail.

Surgery. This may be an option for patients with severe obesity who haven't lost weight with other approaches.

Questions to ask a medical professional about weight loss:

• Am I at an unhealthy weight?
• How is my excess weight harming my health?
• How will losing weight improve my health?
• How much weight do I need to lose?
• How much weight should I lose each week?
• What programs and treatments are available to help me lose weight?
• Can you recommend professionals that can help me develop a weight loss program?
• Where can I find information on healthy eating?
• Where can I find information on exercise?

Most hospitals and health-care organizations have professionals on staff that can provide weight management treatment.

More Information

Managing Side Effects: Weight Gain

Risk Factors and Prevention

Additional Resources

American Dietetic Association

Centers for Disease Control and Prevention: Overweight and Obesity

National Heart, Lung, and Blood Institute: Obesity and Physical Activity

Source: cancer.net

WEIGHT CONTROL, PART I

This section has been reviewed and approved by the Cancer.Net Editorial Board, 6/2011

Key Messages:

• Being overweight or obese increases a person's risk of several types of cancer.
• People with cancer may gain or lose weight during their treatment, causing health problems that may affect their chance of survival.
• Many resources are available to help a person with cancer maintain a healthy weight, including doctors and dietitians. Talk with your doctor about an appropriate plan for you.

Being overweight or obese (extremely overweight) raises the risk of many health conditions, including cancer. In the United States, it is estimated that overweight and obesity cause 14% to 20% of all cancer-related deaths each year.

Although more studies are needed to better understand how being overweight or obese affects cancer risk, evidence suggests that maintaining a healthy weight is important for cancer prevention and recovery from cancer.

Understanding weight gain

It is estimated that more than two-thirds of American adults are overweight or obese. People who are overweight or obese are at greater risk for type II diabetes, high blood pressure, and heart disease. Many factors cause people to become overweight or obese, including genetic, biochemical, environmental, psychosocial, and cultural factors.

When a person is overweight or obese, it means that they have too much body fat in relation to lean body tissue, such as muscle. Obesity is often measured with body mass index (BMI), the ratio of a person's weight and height, and waist measurements. A normal BMI is between 18.5 and 24.9, and a BMI of 30 or higher is considered obese. A normal waist measurement is under 40 inches for men and under 35 inches for women. People with larger waist measurements are at a higher risk for various diseases, such as heart disease.

Common terms used in discussions about weight include:

Energy balance. The relationship between how many calories people eat and their energy needs.

Energy imbalance. Taking in more calories than the body uses, which results in weight gain.

Weight maintenance. When the calories eaten equals the calories used for energy. As a result, no weight gain or loss occurs.

Types of cancer linked to overweight or obesity

Some types of cancer appear to be closely linked to weight, although this association has not been proven for all cancers. Strong evidence suggests that being overweight or obese increases the risk of the following cancers:

• Breast (in postmenopausal women)
• Colon
• Uterine
• Kidney
• Esophageal

Although more evidence is needed, being overweight or obese may also increase the risk for the following cancers:

• Gallbladder
• Thyroid
• Ovarian
• Pancreatic
• Cervical
• Liver
• Non-Hodgkin lymphoma
• Multiple myeloma
• Prostate

Why obesity increases cancer risk

Several studies have explored why being overweight or obese may increase cancer risk and growth. People who are obese have more fat tissue, which can produce hormones, such as insulin or estrogen, and may cause cancer cells to grow.

How much a person weighs throughout various points in his or her life may also affect the risk for cancer. Although more research is needed, studies have shown:

• High birth weight is modestly associated with cancer risk.
• Weight gain during adulthood is consistently linked with increased cancer risk.
• Weight cycling (losing and regaining weight repeatedly) may slightly influence cancer risk.

CANCER SOCIETY SUGGEST CT LUNG SCREENING FOR HEAVY SMOKERS

New recommendations from the American Cancer Society say that older current or former heavy smokers may want to consider low-dose CT scans to help screen for lung cancer.

Specifically, that includes those aged 55 to 74 with a 30 pack-year smoking history who still smoke or who had quit within the past 15 years. Pack-years are a calculation made by multiplying the number of packs of cigarettes smoked a day by the number of years of smoking.

"Even with screening, lung cancer would remain the most lethal cancer," said Dr. Norman Edelman, chief medical officer at the American Lung Association. He noted the cancer society guidelines are similar to the ones from the lung association.

The new recommendation follows on the results of a major U.S. National Cancer Institute study, published in 2010 inRadiology, that found that annual CT screening for lung cancer for older current or former smokers cut their death rate by 20 percent.

Edelman stressed that the study does nothing to change the fact that smoking prevention and cessation remain the most important public health challenge there is.

"Screening is not a way to make smoking safe from cancer deaths, and certainly does nothing to prevent smoking-related deaths from chronic obstructive pulmonary disease and heart disease," he added.

The cancer society recommendations also emphasize smoking cessation counseling as a high priority and stress that CT screening is not an alternative to quitting smoking.

CT screening should only be done after a discussion between patients and their doctors so people fully understand the benefits, limitations and risks of screening. In addition, screening should only be done by someone experienced in low-dose CT lung cancer screening, the cancer society stressed.

These new guidelines were published in the Jan. 11 online edition of CA: A Cancer Journal for Clinicians.

Results from the 2010 trial indicated that deaths from lung cancer in specific high-risk groups could be reduced by annual CT screening. "These findings indicate that the adoption of lung cancer screening could save many lives," the cancer society concluded.

As with any guidelines, however, recommendations may change over time as more people are screened and new data are analyzed.

Despite the lifesaving benefits of screening, there are still some harms and limitations. Among these are missed cancers, anxiety caused by abnormal results, the need for additional tests and biopsies, investigation of other findings not related to lung cancer and exposure to radiation from repeated testing, the cancer society noted.

The cancer society hopes these guidelines will help inform people at high risk for lung cancer about finding lung cancer early, when it has the best chance of being treated.

Many questions remain, Edelman noted.

"The most prominent is which groups who have lower risks of lung cancer than the group studied will benefit from screening. That is, at what point, in terms of risk factors, will the risks of radiation and biopsy of benign tumors outweigh the risk of cancer," he said.

There are not only important medical questions, but also economic ones since issues of increased costs and insurance coverage are yet to be addressed, Edelman said.

Another expert, Dr. Michael Unger, a doctor with Allied Healthcare Associates in Northbrook, Ill., said that "it has been proven repeatedly that mere chest X-ray screening is insufficient to provide any benefit to survival."

That said, there have been several studies showing a survival benefit by screening high-risk individuals with low dose CT scans, he added.

"Whether or not such screening recommendations are accepted by Medicare and private insurance companies will eventually determine how broadly these recommendations are implemented," Unger said. "I believe only a small number would pay for such a scan out of their own pocket."

More information

For more on lung cancer, visit the American Cancer Society.

SOURCES: Norman Edelman, M.D., chief medical officer, American Lung Association; Michael Unger, M.D., Allied Healthcare Associates, Northbrook, Ill.; Jan. 11, 2013, CA: A Cancer Journal for Clinicians, online

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