Wednesday, July 22, 2009
Other than that, things are pretty typical for 2 weeks into the drug cycle. I'm a little more anemic than usual, but not enough to be concerned. Hands, feet, mouth, etc. are about as usual. The worst part is finding a vein for the blood siphoning as I've got scar tissue in them and that hurts!
Wednesday, July 15, 2009
I go into my oncologist's office next week. I think I'll tell them about this then, unless it repeats. If it does, I'll call them right away.
You Might be a United Methodist if...
.. you don't take Rolaids when your heart is strangely warmed
... you know that a circuit rider is not an electrical device
... The Upper Room is as essential to your bathroom as the toilet paper
... you felt that the NCAA penalties against SMU football were too harsh
... you've ever owned a pair of cross and flame boxer shorts
... you sit while singing "Stand up, stand up for Jesus"
... you've ever sung a gender-inclusive hymn
... tithing is encouraged but widely ignored
... half the people sitting in your pew lip-sync the words to the hymns
... the word apportionment sends a chill down your spine
... you realize pluralism isn't a communicable disease
... your pastor has a hyphenated last name
... names like Aldersgate, Asbury, and Epworth are vaguely familiar
... you consider the monthly potluck a sacrament
... the only church camp song you know by heart is "Kum ba yah"
... you've ever attended an Annual Conference and actually enjoyed it
... you have an unexplained yearning to visit Wesley's Chapel in London
... your church is named for a geographical location rather than for a saint
... you've never heard a sermon on Hell and don't feel you're missing out
... you realize that VBS isn't a sexually transmitted disease
... your pastor moves every four or five years and you like it that way
... there's at least one person in every church meeting who says, "But we've never done it that way before"
... your congregation's Christmas pageant includes both boy and girl wise men
... you accept the fact that the hymn "O, for a thousand tongues to sing" has almost as many stanzas as tongues
... you know that the Wesleyan Quadrilateral isn't a trick football play involving four lateral passes
... you realize that the Book of Discipline is not a guide to getting your child to behave
... you understand that an "appointment" has nothing to do with keeping a lunch date
... you think "UMW" stands for United Methodist Women rather than the United Mine Workers
... you know the difference between a "diagonal" minister and a "Diaconal" minister
... "Good morning" has the status of a liturgical greeting in the worship service
... you say "trespasses" instead of "debts" in the Lord's Prayer and have no idea why
... your annual conference spends most of its time debating resolutions that nobody reads
... you'd rather be branded with a hot iron than serve on the Nominating Committee
... you've ever sipped Welch's grape juice out of a plastic shot glass during Communion
... you're asked to donate money to a "special offering" every other Sunday
... you pore over the Conference Journal with the same intensity you would read a John Grisham novel
... you have to fight through a cadre of greeters to get into the sanctuary
... when the worship service lasts for more than one hour, the beeping of watch alarms drowns out the final hymn
Hand-foot syndrome is a side effect of some chemotherapy drugs that results when a small amount of drug leaks out of the blood vessels, damaging tissues. This tends to happen in the hands and the feet because of the increased friction and heat that your extremities are exposed to through daily activities. Symptoms can be prevented by avoiding friction and heat. Treatment consists of reducing or stopping treatment with the drug that caused the syndrome. You may be able to prevent symptoms by avoiding friction or heat.
Hand-foot syndrome is a side effect of some chemotherapy drugs that results when a small amount of drug leaks out of the smallest blood vessels in the palms of the hands and soles of the feet. The amount of drug in the capillaries of the hands and feet increases due to the friction and subsequent heat that is generated in those extremities. As a result, more drug may leak out of capillaries in these areas. Once out of the blood vessels, the chemotherapy drug damages surrounding tissues.
The chemotherapy drugs that have been reported to cause hand-foot syndrome in some patients include:
- Capecitabine (Xeloda®)
- Cytarabine (Cytosar-U®)
- Floxuridine (FUDR®)
- Fluorouracil (5-FU)
- Idarubicin (Idamycin®)
- Liposomal doxorubicin (Doxil®)
Symptoms of hand-foot syndrome include:
- Tingling or burning
- Small blisters
- Small sores on the palms of the hands or soles of the feet
Changes to your normal, daily activities after receiving intravenous (through a vein) chemotherapy or during treatment with oral chemotherapy can reduce your chances of developing hand-foot syndrome.
Reduce exposure of hands and feet to friction and heat by avoiding the following:
- Hot water (washing dishes, long showers, hot baths)
- Impact on your feet (jogging, aerobics, walking, jumping)
- Using tools that require you to squeeze your hand on a hard surface (garden tools, household tools, kitchen knives)
- Rubbing (applying lotion, massaging)
Hand-foot syndrome is first treated by reducing the dose or stopping treatment with the chemotherapy drug that is causing it. Other approaches to managing hand-foot syndrome include:
Corticosteroids: Steroids work by reducing inflammation. Your doctor may recommend a systemic corticosteroid (administered in a pill) to help relieve the symptoms of hand-foot syndrome.
Dimethyl-sulfoxide (DMSO): Topical treatment with DMSO has shown activity in treating leakage of chemotherapy drugs into tissues.
Vitamin B6 (pyridoxine): A small clinical trial has shown that treatment with vitamin B6 can reduce the symptoms of hand-foot syndrome.
For relief of symptoms associated with hand-foot syndrome, try the following:
- Cool with ice packs for 15-20 minutes at a time
- Elevate hands and feet
- Apply antibiotic ointment on open sores
- Apply moisturizers sparingly
- Avoid constrictive clothing
 Nagore E, Insa A, Sanmartin O. Antineoplastic therapy-induced palmar plantar erythrodysesthesia ('hand-foot') syndrome. Incidence, recognition and management. Am J Clin Dermatol. 2000 Jul-Aug; 1(4): 225-34.
Lopez AM, Wallace L, Dorr RT, Koff M, et al. Topical DMSO treatment for pegylated liposomal doxorubicin-induced palmar-plantar erythrodysesthesia. Cancer Chemother Pharmacol. 1999; 44(4): 303-6.
 Fabian CJ, Molina R, Slavik M, Dahlberg S, et al. Pyridoxine therapy for palmar-plantar erythrodysesthesia associated with continuous 5-fluorouracil infusion. Invest New Drugs. 1990 Feb; 8(1): 57-63.
Important research into thyroid cancer is under way right now in many university hospitals, medical centers, and other institutions around the country. Each year, scientists find out more about what causes the disease, how to prevent it, and how to improve treatment. In past years, for example, evidence has grown showing the benefits of combining surgery with radioactive iodine therapy and thyroid hormone therapy. The results include higher cure rates, lower recurrence rates, and longer survival.
Recent identification of the genetic causes of familial (inherited) medullary thyroid cancer now makes it possible to identify family members carrying the abnormal gene and to prevent cancer from developing. Researchers are optimistic that progress in understanding the abnormal genes that cause sporadic (not inherited) thyroid cancer, especially papillary cancer, will eventually lead to better treatments.
New treatments for thyroid cancer are being tested in several types of clinical trials.
Research to better define who needs RAI therapy after surgery is ongoing. A promising approach was described in a presentation recently using blood tests for thyroglobulin after thyroid surgery. If the thyroglobulin was very low after 3 months, RAI was not given to some of these patients and after 3.2 years none of them have had a recurrence. However, these results are preliminary and more research is needed.
Some studies are testing the value of newer chemotherapy drugs such as paclitaxel (Taxol) and other drugs, as well as combined chemotherapy and radiation in treating anaplastic thyroid cancer.
In general, thyroid cancers have not been found to respond well to chemotherapy. But exciting data are emerging about some newer targeted drugs. Unlike standard chemotherapy drugs, which work by attacking rapidly growing cells in general (which includes cancer cells), these drugs attack specific targets on cancer cells. The targets they attack can be present on normal cells as well, but the goal is to find targets that help cancer cells grow and survive.
Tyrosine kinase inhibitors: A class of targeted drugs known as tyrosine kinase inhibitors has already been used successfully in some other forms of cancer. These drugs may help reverse the abnormal growth of thyroid cancer cells that results from mutations of certain genes, such as BRAFand RET/PTC. Many of them also have anti-angiogenic properties (see below) Some of the tyrosine kinase inhibitors being tested against thyroid cancer in clinical trials include sorafenib (Nexavar), sunitinib (Sutent), motesanib (AMG 706), axitinib (AG-013736), and vandetanib (Zactima). Several studies have been recently reported showing that these drugs can shrink many thyroid cancers. None will likely be a cure, but will cause some shrinkage in many thyroid cancers. These studies are promising, but they are not yet routine treatments for thyroid cancer. Studies combining these agents with other agents like chemotherapy will be done to try to increase the benefits.
Anti-angiogenesis drugs: As tumors grow, they need a larger blood supply to get enough nutrients. They do this by causing new blood vessels to form (a process called angiogenesis). Anti-angiogenesis drugs work by disrupting these new blood vessels. Some of the tyrosine kinase inhibitors listed above have anti-angiogenic properties. Another drug with these properties is combretastatin A-4 phosphate (CA4P), which has shown some promising early results and is now being tested in larger studies. Lenalidomide, a drug with anti-angiogenic effects used in some blood cancers, has shown some promising results in a recent, small study.
Monoclonal antibodies: Monoclonal antibodies are man-made versions of immune system proteins designed to attack a very specific target. Studies are testing radiolabeled monoclonal antibodies (antibodies with radioactive material attached) for treating medullary thyroid cancer (MTC). The antibodies help deliver the radiation to the cancer cell. Carcinoembryonic antigen (CEA) is a protein that is not normally found in adult tissues. But many MTCs make CEA. Since radioiodine treatment is not useful in MTC because MTC does not take up iodine, the ability to deliver radiation (and other treatments) to MTC cells by bonding radioactive material to anti-CEA antibodies appears promising. Studies of this technique are in progress.
Last Medical Review: 04/28/2009
Last Revised: 05/14/2009
July 15, 2009 on 2:00 am
Intensified screening doesnt entirely explain the jump in thyroid cancers noted in the United States since 1980, and scientists now believe that other as-yet-unknown factors are to blame.
“You cannot simply explain this by increased screening, theres a real increased incidence,” said Dr. Amy Chen, lead author of a study published online July 13 in the journal Cancer.
A new study finds that thyroid tumors of all sizes are being picked up, not just the smaller ones that more aggressive screening would be expected to detect.
The findings surprised one expert.
Although, “some of this increased incidence is due to increased screening finding smaller tumors,” she added.
An estimated 37,200 new cases of thyroid cancer will be diagnosed this year, according to the U.S. National Cancer Institute. Fortunately, the cancer is considered highly curable, but the researchers said survival rates have not improved with better detection.
“I wrote a chapter about this for a textbook about a year ago and I came away thinking this [rise in cancers] is a reflection of enhanced diagnostics,” said Dr. Bruce J. Davidson, professor and chairman of otolaryngology-head and neck surgery at Georgetown University Hospital in Washington, D.C. But, “it is more disturbing that its not just small tumors; it seems to be all tumors,” he said.
Looking at thyroid cancer cases from 1988 to 2005 reported in a large cancer database, Chen and her team found a higher incidence not just in small tumors, but across all sizes.
Until now, an uptick in cases seen over the past three decades was attributed to increased use of ultrasound and image-guided biopsy to detect tumors. Some researchers had found that thyroid cancer was diagnosed more often in areas with higher incomes and less in uninsured populations, adding further credence to this theory.
But the authors also saw a 3.7 percent annual increase in tumors exceeding 4 centimeters in men and a 5.7 percent yearly rise in these tumors in women.
The most pronounced increase was seen in primary tumors under 1.0 centimeters — small ones for which many experts consider it safe to take a wait-and-see approach. The rate for these tumors rose almost 10 percent per year in men (1997 to 2005) and 8.6 percent per year in women (1988 to 2005).
Thyroid cancer can be caused by exposure to radiation but there has been no evidence of increased exposure to radiation among Americans.
Cancers that had spread also increased in men by 3.7 percent annually and in women by 2.3 percent.
Chen proposed in the study that environmental, dietary and genetic issues be explored.
“People have looked at background radiation and nothing really has come of that thats very useful. And certainly not useful to us in why there would be a bump in incidence in the last 15 years,” Davidson said.
Theres more on thyroid cancer at the American Cancer Society.
Wednesday, July 8, 2009
With any luck, the new cycle will be easier.