Dr. Robert Morgan, MD

Hello,

You are asking a very important question which cannot be answered based on the information that you have provided. I am suspecting that you have had a biopsy of the mass to determine the most effective treatment regimen. Each type of cancer is treated in a unique fashion based on the histology of the tumor. Some cancers do better with pre-operative chemotherapy, but others receive chemotherapy following surgery. Some cancers are treated primarily with chemotherapy.

So in order to provide good information to you, more information is needed.

If you are unable to ask these questions of your doctor it would be a good idea to obtain a second opinion from an excellent source. These can be obtained from any academic cancer centers. Another place to obtain good second opinions is large medical centers such as the Mayo Clinic.

Good luck in your quest.

Hello,

It’s a good thing that you are doing a breast self examination because early lesions are most treatable when they are found in early stages. However, the possibilities are multiple. If this lump has been present for only two weeks.it is unlikely to be cancer. Most likely it is a cyst that is forming or a reaction to a bug bite. However, the only way to be certain is to perform a needle biopsy and send the tissue to a pathologist to examine. I would also recommend that any tissue obtained be sent for cultures. The results of this examination and biopsy will determine the correct treatment course to recommend.

You need to make an appointment with your doctor and let this person examine the lump that you have found.

Good luck.

Hello

You are asking a valid question that many worry about. However, radiation is delivered to limited fields. In general, except for skin irritation, there are generally no severe side effects associated with radiation. So the real answer is “No”.

Depending on the fields involved this is truly a question that should be asked of your radiation oncologist. The question should include asking about what side effects should be expected from the treatment and what would be recommended for treatment if they should occur.

Hello.

You are asking a very excellent question. However, in order to make a diagnosis more information is needed. I am not sure what you mean by “blood related issues” which have been ongoing for at least five years. I am also not sure about the evaluation at Mayo Clinic. Certainly they must have had some ideas about why the leukocytosis, thrombocytosis, and lymphocytosis are occurring, and why you need follow-up by an oncologist which implies that a cancer diagnosis has been made.

Your photo of a skin rash may be completely unrelated to the blood issues.

I would recommend a complete medical evaluation by a general internal medicine physician. An investment of money might be the solution for your questions. Treatment recommendations depend on the diagnoses.

Good luck.

Hello,

You are a 37 year old woman with a past history of heavy alcohol intake. Now you are having symptoms of RUQ pain for 11 months off and on. Many x-ray exams have been performed and your question is could a diagnosis of cirrhosis be missed.

You can learn much about cirrhosis from the online website “Wikipedia”. Search on cirrhosis and read the intensive discussion of cirrhosis. Basically this is a condition of an inflamed and damaged liver that results in fibrosis of the liver tissue as it tries to heal. There are multiple causes of this condition including alcohol intake. Generally it occurs in people who drink heavily for 10 years. There are also multiple symptoms of liver failure that occur. The diagnosis is based on a biopsy of the liver showing changes diagnostic of this condition. Other causes of liver inflammation including hepatitis can result in this illness.

In general, radiologic tests are quite reliable in identifying changes in the liver from cirrhosis. The treatment is avoiding alcohol or treating the underlying illness.

In general, my thought is that at your age and with your history, a diagnosis of cirrhosis is unlikely. It sounds to me that your doctor or doctors are ordering the appropriate tests to rule in or out liver disease. I am guessing that the results of the x-rays have resulted in the opinions that there is no underlying liver disease or cirrhosis explaining your symptoms.

It might be a good idea for you to obtain counseling to help you compensate for what I perceive is the possibility that you are harboring unresolved guilt feelings about your previous behavior and are not able to improve your quality of life based on your symptoms. I strongly advise you to ask your doctor for a consultation with a mental health professional to help you deal with your symptoms. Avoidance of alcohol is always recommended and I encourage you to continue with this behavior.

Good luck.

Hello

Your question is very appropriate. It is, however, difficult to answer your question without further information. Lung resections are performed for many reasons. The most common reason is to treat a person who develops a localized cancer in an area of the lung that can be safely removed along with the cancerous lesion for a possible cure.

The recovery time following this operation depends on several factors. One main factor is how much of the lungs must be removed to provide the best possibility of cure of the illness. Other possible reasons include non-malignant lesions that are interfering with life’s function. Hemangiomas are a possible diagnosis.

The recovery time is also dependent on pre-surgical functioning of the lungs. It is possible that the remaining lung tissue has been damaged and might be poorly functioning due to other lung disease such as emphysema. This might be due to a long history of cigarette smoking.

My advice to you is to consult with a physician who specializes in lung treatments. These physician specialists are called pulmonologist who can advise you on your chances for recovery and also advise you on post-operative treatments to improve or preserve lung function. It is likely that your surgeon works with such a physician and it might be beneficial to request a consultation pre-operatively.

Good luck.

Hello

I am presuming that “Golo” is referring to a patented all natural plant and mineral based dietary supplement that has been clinically tested and found to be effective in weight loss. Your question is if this supplement is safe to take when a person is receiving chemotherapy. I am presuming that the chemotherapy is being given as a treatment for cancer.

Chemotherapy is an administration of medications that is very intensive. There are side effects associated with these drugs. Each chemotherapy has specific side effects that effect both he cancer that is the target. The side effects also effect normal body tissues. Many times weight loss is associated with these agents.

It is not possible to state yes or no as an answer to your question. The concurrent administration of golo supplements depends on the chemotherapy that you are receiving and also on the type of cancer that is being treated. In general the best answer is to avoid taking supplements that might have side effects on your normal body tissues and concentrate on the chemotherapy that is being given to treat the cancer.

Many times this question needs to be asked of the oncologist who is prescribing and delivering the chemotherapy. The oncologist needs to be aware of any supplements that you are taking in order to assess any side effects that may be arising from the chemotherapy or the cancer. This should be discussed with the oncologist.

Thanks.

Hello

Your symptom complex is quite concerning. Your question implies that these symptoms have been increasing and/or becoming more frequent. Whatever the illness is that is causing your constellation of symptoms needs to be evaluated. My suggestion would be to see a neurologist for evaluation. It would be unusual for a hemangioma to cause a cascade of symptoms that are slowly progressing. Your history of a treated lymphoma is also concerning.

It might be best for you to obtain an opinion from a referral medical center. Experts at such a center will be the best physicians to see for an opinion. Mayo Clinic in Rochester, MN is one such place where people can obtain a second opinion and consultations with doctors of many specialties. All university hospitals may have similar services.

Thanks.

Hello,

Your question is filled with concern and worry. This is a natural reaction to the news that your child requires spinal cord surgery.

However, your question is very difficult to answer without more information. The information about toxicity of treatment depends on the age of the child. Toddlers and young children are much different than teenagers and young adults.

I think that it is necessary to talk this over with the neurosurgeon who will be performing the procedure. It is unclear if the surgery involves a malignant (cancer) process, or if it is due to a benign cause. Post-oerative treatment recommendations depend on the diagnosis and the procedure itself.

Hello,

You are asking an important question. Does radiation from a ct scan stay in your body? The short answer is no.

Radiographic exams are tests that a doctor needs to evaluate symptoms. These tests serve to visualize parts of the body that are otherwise not able to be seen. Low safe doses of radiation are used for this purpose. Some nuclear medicine tests may have some remaining radiation for a short time.

Hello

Your question about the staging of anal cancer is very pertinent. The most common plan for tumor staging applies to all cancers. This is the T (tumor size) N (lymph nodes) and M (presence or absence of metastasis) staging system. This system helps define the tumor presence and helps define the treatment approach recommendations.

Hello,

Peripheral neuropathies are unfortunately a common disorder that can be quite troubling to effected patients. Your history of treatment with chemotherapy for the lymphoma is certainly suggestive that a chemotherapeutic agent may be responsible for your symptoms. According to your history your chemotherapy included vincristine which is a common cause of chemotherapy induced peripheral neuropathies.

However, there are multiple other causes of peripheral neuropathies. It is uncommon that symptoms should occur several years following treatment. It usually occurs while on or shortly after completing chemotherapy. One main illness is diabetes which can cause chronic ongoing peripheral neuropathies. An excellent source of information regarding causes of peripheral neuropathies is found online at www.mayoclinic.org. Then one must search on peripheral neuropathy.

There have also been multiple drugs approved in the past years to help alleviate these symptoms which doesn’t necessarily depend on the specific cause. Your intake of neurontin is an excellent choice which should be continued. My suggestion would be to obtain a second opinion from a neurologist who is an expert in the field. Any academic institution or cancer hospital should be able to provide this service. Mayo Clinic is an excellent referral hospital to consider.

Good luck in further investigating the etiology of your neuropathy.

Hello.

Your mom has had a history of throat cancer which was apparently well treated two years ago. At this time she has a number of radiographic abnormalities which have not yet received a definite diagnosis. Your history does not specify what symptoms she is having that suggested the examinations.

It is unusual that her throat cancer is causing these findings. Truly the only way to know her diagnosis is to perform a needle biopsy of the most accessible of the lesions. These tests are not usually uncomfortable and are performed routinely by radiologists. The tissue is then sent to an experienced pathologist for evaluation. Treatment recommendations are then discussed with the patient and family with emphasis on effectiveness and side effects of the treatment courses.

I encourage you to accompany your mom to her next doctor appointment and ask these questions.

Good luck.

Hello. Your questions are very appropriate regarding cancer treatment.

However, you do not provide enough specific information regarding your partner. Your letter makes it clear that your partner is a woman since the same issues occur in men who develop breast cancer.

Triple negative breast cancer can be very aggressive. Presumably this clinical situation specifies ER (estrogen receptor) and PR (progesterone receptor) negative cancer and HER2 Neu negative cancer.

Breast cancer undergoes staging analysis (stages 1-4). Then the tissue undergoes pathologic analysis. For many years only Er and pr were available. Then Her2neu analysis was developed. At present there are multiple biochemical analyses that can be performed. Each of these analyses have specific predictive value describing the chances of recurrence of the cancer and how effective adjuvant treatment might be. Adjuvant treatment implies treatment given to decrease the possibility of recurrence. This can be either chemotherapy or radiation therapy.

Staging of breast cancer requires the size of the primary tumor and the presence or absence of involved lymph nodes.

It sounds like your partner received appropriate treatment for her breast cancer. Further information can be obtained from guidelines published by the NCCN (National Comprehensive Cancer Network). This is a group of well known academic cancer institutions in the United States. They are available at the website www.nccn.org and then you would need to search on treatment guidelines for breast cancer.

I am unsure why the doctor is prescribing further chemotherapy at this point. Usually this treatment is deferred until and if the cancer should recur systemically. I believe that it would be beneficial for your partner to obtain a second opinion from a major cancer center in her area.

Good luck

Hello,

A diagnosis of stage 4 lung cancer is serious. There are basically two types of lung cancer. I am presuming non-small cell lung cancer which is the most common type. The other type is small cell lung cancer (a neuroendocrine type). The second type is very aggressive but responds better to chemotherapy. The first type, non-small cell, is most common. The staging is 4A or 4B. 4A implies that it is only in the lungs, but 4B implies that it has already spread to other areas of the body.

The treatments include radiation, chemotherapy, targeted agents, or immunotherapy. There have been many newer agents approved in the last five years. The efficacy often depends on analysis of the cancer cells to determine the likelihood of response to an agent.

You, though, indicate that you have been receiving chemotherapy for the past 11 months. I am presuming that your doctor is doing the appropriate tests to determine if your cancer is responding to treatment. I am presuming that your cancer is among those that are responding to the chemotherapy. The best advice is to continue receiving this treatment that appears to be effective.

There is no cure for this lung cancer. It must be considered a chronic disease for which you will require treatment for the rest of your life. One place to obtain better information is online at www.healthline.com. They cover prognosis and refer to five year survivals of the various stages. However, these survival rates are dependent on whether the cancer is responding to treatment, what systemic effects a patient is experiencing due to the cancer or treatment, and what other health conditions you might have. Five-year survivals in all groups is less than 10%, but every patient is different.

If you have concerns about your treatment a second opinion should be considered. Sometimes enrollment in a clinical trial can be considered. Second opinions can be obtained from clinics in regional health care centers and universities. Mayo Clinic in Rochester, MN is an excellent institution where many patients obtain second opinions. However, in your situation, assuming that your cancer is responding to treatment and that the side effects are mild, my advice would be to continue your current course of treatment. Another place to obtain current information is the guidelines panels of the National Comprehensive. Cancer Network, www.nccn.org and look for the guidelines for non-small cell lung cancer.

Good luck with your treatment.

Hello,

You are asking questions that are normal for a patient who has been diagnosed with cancer. Your analysis of the situation is excellent.

Tumor staging is a mechanism to provide about three types of information. The first is to describe the extent of the cancer. This allows doctors to group patients into various categories for which treatment is recommended. Many groups have produced various staging parameters. One area to find more information would be the treatment guidelines produced by the National Comprehensive Cancer Network. (Www.nccn.org). Search on the guidelines for non-small cell lung cancer. Another group with information is the American Cancer Society. (Www.cancer.org). Search on this topic with a google search. Then look for staging of non-small cell lung cancer.

In general the risk of recurrence is generally larger with multiple tumors or larger primaries. The staging is dependent on the pathological findings following the surgery even if all of the tumor nodules are removed.

It is impossible to know if the second very small tumor is another primary or a metastasis. I think that your surgeon was very wise in removing both tumors.

Your largest tumor was greater than 4 cm, making it a T2 tumor. Your smaller tumor was 3 mm a T1 lesion. This is if one prefers to consider these individual primaries. The other alternative is to assume that the smaller one is a tumor nodule in the same lobe of the lung. This would be defined as a T3 lesion. All nodes are negative. For situation number 1, with two primaries, one would be stage 2B and the other stage 1A. For situation number 2 the staging would be 2B.

Now how does this effect the future treatment recommendations? One piece of information that would be helpful is to talk to the pathologist to see if either scenario is more likely.

Hello

You are asking a very excellent question. However, you do not provide enough information about the illness to allow me to fully answer your question. Embryonic tumors can also be referred to as embryonal tumors. In children, they are often a form of tumor that occurs in the brain or central nervous system. Most often, depending on the location of the tumor, they are treated with surgery followed by radiation. Sometimes chemotherapy is recommended.

If your daughter has a form of this tumor that involves her brain or central nervous system, you can obtain more information online. An excellent source of information is www.mayoclinic.org and search for “brain tumors.” Or you can do a google search looking for “embryonic tumors in children.” The results take you to several references including the Mayo Clinic reference. To summarize more fully, I would need to know her symptoms, overall condition, and potentially the results of any biopsy that has been done. I would recommend that she be evaluated by a pediatric neurologic oncologist at a center with specialists in this field.

Good luck.

Hello.

You are asking a very common question. “What is my risk of inheriting a trait that can cause an uncommon cancer?”

Small cell lung cancer is among the list of cancers that commonly occur starting in the lungs, but can also occur starting in other organs. This type of lung cancer is commonly associated with cigarette smoking (80% of the time). There are other risk factors that have been identified including exposure to second hand smoke, exposure to radiation sources such as radon, air pollution, or exposure to asbestos. There have been some inherited chromosomal changes that may be implicated, but these are in the investigational realm and haven’t been directly implicated as a cause. No routine testing is available at this time.

More information can be obtained from an article published online by the American Cancer Society at www.cancer.org. It is entitled “Small Cell Lung Cancer, Causes Risk Factors and Prevention.”

Prevention methods are documented in the above article. These include avoiding the use of tobacco, avoiding exposure to other chemicals that are thought to be a link to this form of cancer, avoid exposure to radon, and eat a healthy diet.

This type of cancer is rare, and rarer still in non-smokers. My advice to you is to obtain regular medical care and continue to be a non-smoker. Good luck in your future.

Hello

You are asking a question that occurs to every woman who finds a lump in her breast. You don’t give enough information about your situation, however, to be definitive about the etiology of the lump.

The most worrisome possibility is the presence of cancer in your breast. However, there are multiple other possibilities. If you have had routine mammograms in the past, it is possible that this abnormal finding may have been seen on one of these tests. Other possibilities include cysts which are completely benign and can appear later in life.

Hello,

You are asking a very pertinent question. I, however, prefer to interpret the question as what are the chances for late onset side effects from the radiation.

Stage 2 prostate subdivides into total risk factors for recurrence. It consists of cancer which is small at the time of diagnosis and has a low PSA (prostate specific antigen) score. More information about prostate cancer diagnosis and treatment can be obtained by looking at the prostate cancer guidelines published by the National Comprehensive Cancer Network (NCCN) or from the website published by the NCI (National Cancer Institute) (www.cancer.gov). In either website search on prostate cancer.

There are several publications dealing with long term side effects from radiation therapy. These are uncommon and usually appear early during treatment. Most commonly they involve the urinary or gastrointestinal systems. Their incidence also depends on the type of radiation that was administered. Standard radiation gives wide fields to the pelvic region and can cause inflammation to these organ systems. More recently methods to aim the radiation directly toward the prostate gland (stereotactic radiation) and have been shown to have lower side effects. I am unsure of the type of radiation that was administered to you. More information on radiation toxicity can be found in an article in the Canadian Journal of Urology: “Late toxicity rates following definitive radiation for prostate cancer” authored by Nitin Ohri et al. In (8/2012). 19(4):6373-6380. It is best to ask these questions of the radiation oncologist that treated you.

In summary, late side effects from radiation therapy are unusual. It is best, however, that you continue routine followup with your treating oncologist.

Good luck.