Month: November 2022

Breast Cancer

Posted on by Julie Scott, DNP

What is Breast Cancer?

Breast cancer is the most commonly diagnosed cancer in women in the United States. The average female will have about a 13% chance of getting breast cancer sometime in her life. That number may be higher for women who are at higher risk due to genetic factors. 

Risk Factors

The most common risk factors for getting breast cancer include:

  • Getting older
  • Family history of breast or ovarian cancer
  • Genetic mutations such as BRCA
  • Having dense breasts
  • Previously having radiation therapy to the chest
  • Obesity
  • Taking hormone replacement therapy for > 5 years
  • Heavy alcohol use

Diagnostic Imaging

Mammograms are x-rays of the breast. These x-rays can look for changes of the breast that may suggest the development of breast cancer. If something suspicious is seen on a mammogram, the next step is usually a breast ultrasound. 

A breast ultrasound can be done to get a better look at something a mammogram showed, or to get a better look at dense breasts. An ultrasound can also be done during a biopsy to help guide the radiologist on where to get the tissue. 

Breast MRI is another diagnostic tool that can be used to look at the breasts. Sometimes they are used as a screening tool for those at high risk of getting breast cancer. MRI can be used if the mammogram and ultrasound are inconclusive.

CT scans and PET scans can be done after someone has been diagnosed with breast cancer, to see if there has been any spread of cancer outside of the breasts. 

Diagnosis

If a mass in the breast is suspicious for cancer, a biopsy will be ordered. This is often done by a surgeon or radiologist, who will get a small sample of the tissue to check for the presence of cancer cells. 

Once a diagnosis is made, and any other additional imaging is done, the cancer team can diagnose the stage of the cancer. 

Staging

Breast cancer is staged from 0 to IV, with higher stages meaning the cancer is more advanced. Staging is based on the size of the tumor, the involvement of any nearby lymph nodes, and presence of metastases, or spread to other organs. 

 

Are you interested in learning more about Breast Cancer Characteristics? Check out our next article on this topic.

Colorectal cancer treatment (CRC)

Posted on by Julie Scott, DNP

Treatment is often classified into local therapy or systemic therapy. Local therapy means that it only treats the colon or rectum, and not any other parts of the body. Systemic therapy is treatment that goes around your entire body, treating cancer cells that may be present outside of the colon. A combination of local and systemic therapy may be given for CRC. 

This article will focus on the systemic therapy options for CRC- chemotherapy, targeted therapy, and immunotherapy.

Chemotherapy 

Chemotherapy is medication that is used to stop the division of cells, causing cell death. Because cancer cells are abnormal and usually grow out of control, they are killed by chemotherapy. Unfortunately, chemotherapy can cause side effects because healthy cells are affected as well.

Chemotherapy can be given before surgery (called neoadjuvant chemo) or after surgery (adjuvant chemo). 

To treat CRC, a combination of multiple chemotherapy medications are often given. These work against the cancer cells in different ways, so that the cancer is being killed more effectively. The chemotherapy medications used most often to treat CRC include:

  • 5-fluorouracil (5-FU)
  • Oxaliplatin
  • Capecitabine (Xeloda)

If cancer has spread to other areas of the body, different chemotherapy medications may be given. 

Targeted Therapy

These medications are usually only given if colon cancer is advanced and has spread into other areas of the body. If the cancer has specific genetic mutations, such as mutations in the KRAS or BRAF genes, there may be medications available that target those genes specifically. 

Immunotherapy

Immunotherapy medications are usually intravenous medications that work by helping the immune system see any CRC cells in the body. This allows the immune system to help fight against cancer. Immunotherapy medications are most often used for advanced CRC.

Colorectal Cancer Staging

Posted on by Julie Scott, DNP

Colorectal cancer staging

The stage of the cancer describes how advanced the cancer is, from stage 0 (where it has not grown outside one of the layers of the colon wall) to stage IV (cancer has spread to other areas of the body). The cancer stage can help your oncologist develop the best treatment plan for you. 

 

Treatment for colorectal cancer 

Treatment is often classified into local therapy or systemic therapy. Local therapy means that it only treats the colon or rectum, and not any other parts of the body. Systemic therapy is treatment that goes around your entire body, treating cancer cells that may be present outside of the colon. A combination of local and systemic therapy may be given for CRC.. 

 

This article will focus on the local therapy options for Colorectal cancer- surgery and radiation. 

Surgery

When CRC is at an early stage, surgery is often the choice for treatment. During surgery for CRC, a partial colectomy may be done. This surgery removes the affected part of the colon as well as some of the healthy colon around it. The other parts of the colon are then attached together. If the entire colon is removed, it is called a total colectomy.

When a colectomy is done, lymph nodes in the abdomen near the affected area of the colon are also removed to be tested for the presence of cancer cells. 

Depending upon the type of surgery that’s done, a temporary or permanent colostomy may be needed. This is a procedure that moves part of the colon out to the surface of the abdomen. As the contents of the intestines move through, instead of having a regular bowel movement, it leaves the body through the new abdominal opening, into a bag attached to the outside of the body. 

Radiation Therapy

Radiation therapy uses high energy beams of x-rays to kill cancer cells. This is a treatment most often used for rectal cancer, and not as often for colon cancer. Sometimes it’s done before surgery, to help shrink the tumor so the surgeon has an easier time removing it. Radiation may also be done after surgery if the surgeon finds that the cancer was really difficult to remove and they aren’t confident that it was all removed. 

When given for rectal cancer, it is often given in combination with chemotherapy. Radiation treatments are typically done Monday through Friday for about 6 weeks.

 

Are you interested in learning more about colorectal cancer treatments? Check out our next article on this topic.

Colorectal cancer

Posted on by Julie Scott, DNP

What is Colorectal cancer?

Colorectal cancer also referred to as CRC, is cancer that starts somewhere inside the colon or rectum of the digestive system. It is the third most common cancer in the United States for both men and women, and although rates of CRC overall have been decreasing, the rates have actually been going up for younger adults. 

CRC starts off by abnormal cells developing in the colon or rectum. These often start out by becoming polyps, small growths of tissue along the intestinal wall. Not all polyps will become cancer, and if they do, it can take many years for them to develop into cancer. 

Signs and Symptoms

Someone may have colon cancer and not have any signs or symptoms of it being there. This is what makes screening tests so important, so cancer can be caught before it becomes advanced. If someone does have symptoms, they may include:

  • Changes in bowel patterns (such as diarrhea or constipation)
  • Fatigue
  • Unintentional weight loss
  • Blood in the stool, or dark or tarry stool
  • Abdominal pain

Diagnostic Tests

If someone is having symptoms that may be concerning for CRC, a stool sample can be obtained to check for blood in the stool that might not be visible to the naked eye. If this test is positive, it’s likely a colonoscopy will be ordered. 

Not only are colonoscopies suggested if blood is present in the stool, but it may also be recommended to be done as a screening tool to detect colon cancer early.  During this procedure, a special camera is inserted into the rectum and moved up into the large intestine to evaluate the lining and look for any abnormalities. If a polyp or any area of abnormality is found, it can be biopsied and tested for cancer cells. A colonoscopy requires a day or so of preparation, where no solid foods are eaten, only clear liquids are to be consumed, and large amounts of laxatives are used to clean out the colon. This prep allows the gastroenterologist performing the procedure to get the best look possible at the intestinal wall. 

Once a diagnosis of CRC is made, the oncologist will likely order additional tests to learn the characteristics of the cancer. This can include molecular testing to see if there are any mutations present, such as BRAF, NRAS, or KRAS. Knowing if these mutations are present can help the oncologist come up with a treatment plan. 

Additional testing, such as CT scans or PET scans may also be done to determine if CRC has spread to any other areas of your body. Once all of the testing is complete, your oncologist can stage the cancer. 

 

Are you interested in learning more about colorectal cancer staging? Check out our next article on this topic.

 

Endometrial cancer treatments

Posted on by Julie Scott, DNP

Endometrial cancer treatment

The exact treatment prescribed for you will be based on the stage and characteristics of your endometrial cancer. It’s important to talk to your oncology team if you have any specific questions about your particular treatment. 

Treatment is often classified into local therapy or systemic therapy. Local therapy means that it only treats the uterus, and not any other parts of the body. Systemic therapy is treatment that goes around your entire body, treating cancer cells that may be present outside of the uterus. A combination of local and systemic therapy may be given for endometrial cancer. 

Surgery

During surgery for endometrial cancer, the uterus is removed. This is called a hysterectomy. Often the fallopian tubes and ovaries will be removed as well. Lymph nodes near the uterus may also be removed to evaluate for the presence of cancer cells. 

Radiation Therapy

Radiation therapy uses high energy beams of radiation to kill cancer cells. It is often used after surgery, to treat the area where the cancer was to make sure any cancer cells left behind don’t have the chance to grow. This is most often done with external beam radiation. 

However, brachytherapy, where seeds of radiation are placed directly into an area to be treated, may be done, especially in the upper part of the vagina, which is closest to the uterus. 

Chemotherapy

Chemotherapy is medication that is used to stop the division of cells, causing cell death. Because cancer cells are abnormal and usually grow out of control, they are killed by chemotherapy. Unfortunately, chemotherapy can cause side effects because healthy cells are affected as well. 

Chemotherapy is typically used for endometrial cancer when it’s at a later stage. A combination of chemotherapy medications may be used to treat endometrial cancer. Some examples include:

  • Cisplatin
  • Carboplatin
  • Adriamycin
  • Taxotere

Other Treatment Options

When endometrial cancer becomes metastatic and has gone into distant areas of the body, other treatments such as hormonal therapy, targeted therapy, or immunotherapy may be used to treat it. 

 

Why Black women are more likely to get endometrial cancer?

Posted on by Julie Scott, DNP

What is Endometrial cancer?

Endometrial cancer starts when cells in the lining of the uterus become abnormal. This type of cancer is most often seen in women who are post-menopausal, and is more common in Black women. 

Signs and Symptoms

The most common symptom of endometrial cancer is abnormal vaginal bleeding. Bleeding can range from light spotting to heavy bleeding. This can include bleeding between menstrual cycles, or bleeding after menopause, after menstrual cycles have stopped. Other symptoms of endometrial cancer include:

  • Pelvic pain
  • Unintentional weight loss
  • Pelvic mass

Diagnosis

If someone presents with symptoms concerning for endometrial cancer, testing will likely be done to evaluate the cause. This can start with a pelvic exam, where the practitioner examines the vagina and uterus, looking for signs of a tumor. 

An ultrasound is a commonly ordered test. This can be done externally as well as through the vagina, to fully evaluate the uterus. The ultrasound waves can evaluate the thickness of the uterine lining and measure the size of the uterus and any masses, if present. 

Ultimately a biopsy will need to be done of any abnormal tissue, to test for the presence of cancer cells. A biopsy can be done in a number of ways. One way can be done in the gynecologist office, where a sampling tool is placed into the uterus through the vagina and cervix. The tool then suctions some of the abnormal tissue out to be evaluated for cancer. 

Another way to biopsy the uterine lining is through dilation and curettage (D&C). During this procedure, often done with anesthesia, the cervix is dilated and more uterine lining is scraped away for testing. 

Once a diagnosis of endometrial cancer is made, the cells are further tested for genetic changes that may or may not be present, that can help the oncologist develop a treatment plan. 

Imaging tests such as x-rays, CT scans, or PET scans may be done to see if endometrial cancer has spread into lymph nodes or other areas of the body. 

CA-125 is a substance that can be released by endometrial cancers, and may be evaluated through a blood test. This may be part of the workup for endometrial cancer, and may be followed after treatment has been given. An elevated CA-125 is not diagnostic of endometrial cancer on its own, so it is used in combination with imaging studies to evaluate the presence of endometrial cancer. 

Are you interested in learning more about Endometrial cancer treatments? Check out our next article on this topic.

The different types of leukemia

Posted on by Julie Scott, DNP

What is Leukemia?

Leukemia is a type of cancer that affects the white blood cells in the body. There are multiple types of leukemia, classified as either acute (which can grow quickly) or chronic (slower growing). They are also further divided into the types of cells they start in. The main types of leukemia are:

  • Acute Lymphocytic Leukemia (ALL)
  • Acute Myeloid Leukemia (AML)
  • Chronic Lymphocytic Leukemia (CLL)
  • Chronic Myeloid Leukemia (CML)
  • Chronic Myelomonocytic Leukemia (CMML)

Signs and Symptoms

The exact signs and symptoms that are associated with leukemia can differ based on the type of leukemia someone has. People with acute, quickly-growing leukemia, they may develop symptoms quickly and severely. For those who have chronic leukemia, they may not have any symptoms, and if they do, they may be mild. Generalized symptoms of leukemia include:

  • Unexplained fevers
  • Chills
  • Unintentional weight loss
  • Being very tired or feeling weak
  • Bruising without any injury to the skin
  • Bleeding, such as nosebleeds or gum bleeding
  • Feeling dizzy or lightheaded
  • Night sweats
  • Pale skin
  • Enlarged lymph nodes

Diagnosis

When someone presents with the above symptoms, the healthcare team may order testing to help determine the cause of what they’re experiencing. One of the most commonly ordered blood tests is a complete blood count (CBC). This blood test evaluates the numbers of white blood cells, red blood cells, and platelets. These levels can be significantly abnormal (both higher and lower than normal) in someone with leukemia. 

Along with CBC, a blood smear may also be done. This test allows the pathologist to look at how the different blood cells look under the microscope, to check for the presence of early white blood cells, called blasts, which can signify leukemia. 

Additional blood tests, such as flow cytometry, can be done to evaluate the white blood cells in a specific way. This test looks to see if leukemia cells are present in the sample. 

A bone marrow biopsy is often done when leukemia is suspected. This test takes a sample of bone and bone marrow (where blood cells are made) from the hip bone to evaluate for the presence of leukemia cells in the bone marrow. 

Once a diagnosis of leukemia is made, further testing is often done evaluating chromosomes of the cells to help further clarify the diagnosis. Exactly what tests are done can be a bit different for each type of leukemia. 

Imaging Tests

A CT scan may be done to check out the organs of the body, such as the lungs, liver, and spleen, to see if they look normal. A PET scan may also be done to look for the presence of leukemia cells outside of the bone marrow or bloodstream. 

Treatment

How leukemia is treated depends upon the type of leukemia someone has. Treatments can vary from no treatment needed except observation to intensive chemotherapy and bone marrow transplant. 

 

Lymphoma staging and how they affect treatment options

Posted on by Julie Scott, DNP

Lymphoma Staging

Once the biopsy confirms lymphoma, and all of the imaging has been done, the oncologist can stage the cancer. Staging describes how advanced the lymphoma is, and helps the oncologist determine the best treatment. 

Lymphoma staging is different from the staging for solid tumors such as lung cancer or breast cancer. The lymphoma staging system is determined based on the number of areas of lymph nodes that are affected, whether they are on the same or on both sides of the diaphragm (the muscle separating the chest from the abdomen), and if lymphoma is present in any solid organs. 

Lymphoma Treatment

Once the staging is determined, and the type of lymphoma has been diagnosed, the oncologist can develop the treatment plan. Chemotherapy is often used for both Hodgkin and non-Hodgkin lymphomas. 

Chemotherapy is medication that is used to stop the division of cells, causing cell death. Because cancer cells are abnormal and usually grow out of control, they are killed by chemotherapy. Unfortunately, chemotherapy can cause side effects because healthy cells are affected as well. The exact chemotherapy regimen can change from person to person based on the type of lymphoma they have. Some examples of chemotherapy that may be used include:

  • Adriamycin
  • Bleomycin
  • Cytoxan
  • Vincristine
  • Etoposide
  • Bendamustine
  • Carboplatin
  • Methotrexate

 

Combinations of chemotherapy are most often used to treat lymphoma. 

Immunotherapy is often used to treat lymphoma as well. Immunotherapy medications work by alerting the immune system to attack certain proteins on the outside of the lymphoma cells. These medications work differently than chemotherapy, but are often used along with chemo. 

Examples of immunotherapy include:

  • Rituxan
  • Gazyva
  • Arzerra
  • Adcetris

Radiation Therapy

Some types of both Hodgkin and non-Hodgkin lymphoma respond well to radiation. Radiation therapy uses high energy beams of radiation to treat and kill lymphoma cells. The radiation is most often given Monday through Friday for a period of a few weeks. Each treatment takes only a few minutes. This type of radiation is called external beam radiation.

Stem Cell Transplant

For people with certain types of lymphoma, or lymphoma that comes back quickly after treatment, a stem cell transplant may be suggested. During this treatment, high doses of chemotherapy, and sometimes radiation, are needed to completely kill the cancer cells. These high doses can cause the bone marrow to stop working properly, leaving someone at high risk for infection, severe anemia, or severe bleeding, because their blood cells are low. 

A stem cell transplant can be done by removing the stem cells from a person’s own body in the weeks before the procedure, which are frozen until they are ready to be used. Once the high doses of chemo are given, the stem cells are then infused back in, to help the bone marrow start to make blood cells again. 

Stem cells can also be used from a donor, either someone in the family or unrelated. They have to be a close match to the person who needs them though, or there is a high risk that the cells will be rejected, leading to many complications.

Lymphoma

Posted on by Julie Scott, DNP

What is Lymphoma?

Lymphoma is a cancer of the lymphocytes, which have a role to play in your immune system. When the lymphocytes become abnormal, they no longer function normally and become cancerous. Lymphoma can start in either the B lymphocytes or T lymphocytes of the immune system. 

There are many types of lymphoma, which are separated into two general groups: Hodgkin lymphoma and non-Hodgkin lymphoma. To further subdivide non-Hodgkin lymphoma, there are over 50 subtypes. 

Signs and Symptoms

There can be many signs and symptoms associated with lymphoma. These can include:

  • Enlargement of lymph nodes in the neck, armpits, or groin
  • Unexplained fevers or chills
  • Drenching night sweats
  • Unintentional weight loss
  • Severe itching
  • Extreme fatigue
  • Pale skin
  • Persistent cough
  • Difficulty breathing

Diagnostic tests

If someone is suspected of having lymphoma, or is experiencing symptoms that are suspicious and need further evaluation, a variety of tests may be ordered. 

Tests can include x-rays, which can show abnormal masses in the lungs that may be causing cough or shortness of breath. 

Another test that may be done is a CT scan, which can see abnormal lymph nodes as well as the other organs in the body to check for abnormalities. 

If lymphoma is confirmed or strongly suspected after the above tests, a PET scan may also be done. This type of imaging test shows not only the location of any abnormality, but also if those areas are actively growing or not. A sugar is attached to a radioactive tracer and given through an IV before the PET scan is done. The tracer is given time to circulate through the body, and then the person is scanned. Any areas of the body that take up alot of sugar, and are seen to be active, will be seen as bright areas on the screen. These areas may be very suspicious for cancer involvement. 

Biopsy

Ultimately a diagnosis of lymphoma is made through a biopsy. During a biopsy, a tissue sample from the suspicious lymph node is removed and tested for cancer cells. A biopsy can be done through a few different ways. 

In an excisional biopsy, an entire lymph node is removed to be evaluated for cancer. This is preferred when lymphoma is suspected, as sometimes just taking a small sample of a lymph node can miss the cancer cells. 

A needle biopsy may be done of a lymph node. During this procedure, a needle is placed into the suspicious area, and tissue is removed from it. Because less tissue is removed, it may not be as accurate of a way to diagnose lymphoma. 

Sometimes a bone marrow biopsy is done as well. During this procedure, a sample of bone and the marrow inside of it is removed from the hip area. The bone marrow is where blood cells are made, and it can be important to know if lymphoma cells are present there. This procedure is often done with anesthesia for patient comfort. 

Additional testing for specific chromosome changes and other markers may be done on the lymphoma tissue. This can help the oncologist with their treatment planning.

Are you interested in learning more about Lymphoma Staging and Treatments? Check out our next article on this topic.

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