Question 1
I wanted to use ginseng to get added energy and was told it would interact with osimertinib. I currently only take osimertinib. What other natural vitamin or supplement can I take for energy?
This is uncharted territory. Question would be about the reason for God low energy level. Is it anemia? Or other organic reasons? Fact that you are in Osimertinib would mean you have advanced stage lung cancer. Is there any psychosomatic reason for low energy? I would not take any supplements unless some factor deficiency is proven on labs etc. just common sense. Upbeat attitude. Regular diet. Routine exercises etc n relaxation techniques
Patient Info
Initials : DS
Primary Cancer : Lung
State : Pennsylvania, United States
Question 1
Hi my wife have IDC breast cancer. Finished 4 cycles of AC and now doing her 12 weekly Taxol. She had 3/12 Taxol already but after her 3 Taxol, she is having a dry cough… Is it pissible to buy Over the counter medication for cough and what cough medication is best for her case? Thank you!
Hi, Cough isn’t a typical side effect of Taxol. Although it’s safe to use Over the counter cough medicine, it is advised to make sure there is no underlying infection or gastroesophageal reflux.
Patient Info
Initials : AR
Primary Cancer : Breast
State : New York, United States
Question 1
Good day I would like to find out, I have been having pain on the left side of my abodmen which makes my stomach warm the pain starts moderate to severe, it's all on the left side I'm scared because I only have to see A SOPD in January which is so long away blood test shows things are normal and ultra sound but I still sit wit this pain which moves up and down on my left abdominal side I really need help or what can i do something???
Hello. So first, I am a surgical oncologist, specializing in Foregut and pancreas and liver cancers. This left side pain you are having is a little non specific. I would want to know some things like how many months have you been having this pain? What causes the pain to come on? Any other associated symptoms like fever? Associated with food? Any difficulty eating? Weight loss? Does the pain radiate to any other parts of the body. How old are you? Etc. A good clinician should be able to get the right details. You will likely need a workup to investigate this pain which, depending on the answers to the questions above, might include an upper endoscopy, lower endoscopy, and a CT scan of the abdomen and pelvis with IV contrast. If the pain is severe, I would see somebody before January. If the pain is severe, I think it is even reasonable to go to your ER, where you would probably end up with a CT scan anyway. I hope this is helpful, however, without additional information the differential diagnosis for this pain is quite wide and difficult to say for sure what is going on. I don’t even think we can say for sure that you have a cancer at this point. Please feel free to follow up with more details if you have them. Kind regards,
Patient Info
Initials : GC
State : Adana,
Question 1
Hello I was diagnosed with breast cancer. Right breast. Just lump. No limph nodes. Had biopsy done, CT scan, mri everything. Had port put in and started red devil on 2nd July. All said and done. Finished the red devil and had to start the 12 week treatment. Don't know the name. First one went well. Second and third I had allergic reaction. Then tried new one it went okay but the second one again reaction. Now they stopped chemo completely. Am seeing plastic surgeon on Monday. They going to do mastectomy on 20th January. But nothing was explained further. Now it's waiting. I just feel that the chemo made me sick, my hair fell out, the meds made me sick and now everything is just stopped?? What must I think or feel now. What if it's growing back in two months time. What if it wasn't even cancer and I went through all this for nothing and all they do is make you sicker? They don't care as long as the medical aid pays the bills. I know I mustnt question scan results and mri results and biopsy results, but it makes me think now.
Thank you so much for reaching out, it sounds like you were managed with a strategy called Neoadjuvant chemotherapy. It is typical to use a medication called Adriamycin (red devil) followed by weekly Taxol. Taxanes are known to carry a risk of causing a hypersensitivity/allergic reactions. Your oncologist had to stop the treatment for your own safety. It is typical to wait a few weeks between the last chemotherapy and the surgery. It is important to allow your immune system and your blood counts to recover fully, which would lead to a successful surgical outcome and an easier recovery. I hope this gives you some reassurance and increases your confidence in The care you are receiving. Best Dr. T
Patient Info
Initials : MB
Primary Cancer : Breast
State : Western Cape, South Africa
Question 1
Good day, please could you advise me Doc. My 62 year old mum was diagnosed with colorectal cancer November 2021. She had surgery and started Folfox chemo in January 2020. She has just finished her 12th round of chemo. The delay in chemo was due to the cancer moving to the liver, surgery was supposed to occur however when a petscan was done it showed that it was just cysts. Docs then saw it spread to the peritoneum. So now that 12 chemo rounds have just finished, on the 11th chemo, the CEA marker was 34. It was higher at 80 something but i assumed by chemo round 11 it would be dowb to less than 5. What does this mean now, should more surgery be done or more Folfox be administered? Really stressed for my mum as the chemotherapy was very harsh on her. Its a miracle she got through it. Thanks Doc
Hi Samantha, Thank you for contacting me. If the colon cancer has already spread to the peritoneum, I would not recommend surgery right now. From what you said, it appears like she is having a good CEA response. However, CEA is still higher than normal. It would be good to check response using a CT scan or PET scan rather than using just the CEA. If she is not having any significant side effects, she can continue chemotherapy but one may have a higher risk of neuropathy with the use of more oxaliplatin. Adding targeted therapy is an option. I will need more information regarding sidedness of cancer and molecular testing results. 1. The sidedness of her colon cancer (left-sided colon or right-sided colon)? 2. Certain test results include KRAS status, BRAF, Her2, Microsatellite instability. Based on these results, targeted therapy options can be recommended. If she has Kras wild type, Panitumumab or Cetuximab-based regimen can be used down the line if she progresses. 3. If CT shows a good response, oxaliplatin may be stopped and Bevacizumab can be added as maintenance along with 5FU. Oral capecitabine ( if she can afford it) plus IV Bevacizumab maintenance is also an option. 4. If the CT or MRI shows no evidence of peritoneal deposits, one may consider surgical resection of primary cancer if that’s the only site of residual disease. All the best.
Patient Info
Initials : SR
Primary Cancer : Colon
State : KwaZulu-Natal, South Africa
Question 1
CAN YOU PLEASE HELP ME WITH AN ANSWER WHAT TO DO NEXT? WE DID THE SCANS GOT THE REPORT - WHERE TO NEXT? WHAT DOCTOR MUST WE SEE NEXT TO EXPLAIN THE RESULTS AND WHAT ACTION MUST WE TAKE? IS THE RESULT OF THE REPORT CANCEROUS,? I STILL HAVE CHEST PAINS, SHORTNESS OF BREATH BUT ANGIOGRAM SHOWS MY HART AND ARTIRIES ARE CLEAR NO PROBLEMS. NO DIAGNOSE HAS BEEN MADE YET. NO MEDICATION HAS BEEN GIVEN. I WAS TOLD TO WAIT 4 - 6 MONTHS AND DO A CT SCAN AGAIN SO THAT THEY CAN MEASURE THE MODULES TO SEE IT THEY GOT BIGGER OR SMALLER.
Hi. I would approach either an Interventional Pulmonologist for EBUS/EUS or a Thoracic Surgeon for mediastinoscopy for biopsy of those hilar and/or mediastinal lymph nodes for maximum diagnostic yield Those pulmonary nodules can be biopsies using Navigational Bronch, but the yield will be low
Patient Info
Initials : JA
Primary Cancer : Lung
State : Limpopo, South Africa
Question 1
I have had a steep decline in wellbeing since starting revlimid 2 months ago. I feel like I am deteriorating- my hearing, vision, voice, mobility have all taken a dive. I feel like I am dying from the medicine but my doc says its the multiple myeloma. I had pain before diagnosis but it has amplified considerably since starting treatment. Is this the type of cancer/treatment that just makes you feel worse until you feel better or should we consider a different medication? I also had syncope for 7 minutes last night and ended up in the hospital. I had stage 1 but fee like I am nearing the end. I am 87.
Hi Em, I understand that you are having a variety of effects following the initiation of treatment. Multiple myeloma itself can make you feel very fatigued, causes weight loss and bone pain. However, medications such as Revlimid do have side effects. It may cause fatigue. Some patients may have generalized body aches, throat irritation, joint pain, dizziness, and so on. However, syncope is concerning. Revlimid may cause irregular heart rhythm and also, increase the risk of having a blood clot. These factors may cause syncope. Also, it’s very much possible that the syncope is unrelated to Revlimid. Your physician may have already evaluated the cause of syncope. Your age and reduced kidney function may also make you more susceptible to experiencing the side effects with Revlimid. If it’s felt that Revlimid is causing side effects, a dose reduction may be explored or one could use other treatment options. I wish you all the best.
Patient Info
Initials : EW
Primary Cancer : Blood
State : New York, United States
Question 1
How do you determine if you have throat cancer? I have oral growths lining the bottom jaw under my tongue. I have a sore throat almost every morning when get up but once up it goes away. Does it mean that I need to get tested for cancer?
Hi Judy, It is hard to determine what type of growth it is without seeing it. Please schedule an appointment with your doctor and get it checked. If it looks suspicious, your doctor will refer you to Ear/Nose/Throat physician and a biopsy may be considered. Certain risk factors for oropharyngeal cancers include smoking and HPV.
Patient Info
Initials : JG
Primary Cancer : Head and neck
State : KwaZulu-Natal, South Africa
Question 1
Hello, I'm sorry I don't have any scans as the oncologist doesn't provide the scan images or blood work results to us. He only provides the scan report and just informs us that the blood work showed all organs are functioning well etc. The reason I am messaging is because I need a second opinion for my husband's case. He was diagnosed with stage 4 colon cancer in March 2020. He underwent emergency surgery to remove the mass in his sigmoid colon but there were 8 lesions on his liver, biggest being around 3cm and there were some small nodules on his lungs, smaller than a cm. There were also some in his lymph nodes. He received 5 rounds of XELOX and response was good. Only 2 liver lesions could be seen on the scan and they were about 1cm big. The spots on his lungs could no longer be seen as well as in the lymph nodes. He stopped chemotherapy in preparation for liver resection as instructed by the surgeon but surgery was pushed back (7 months) due to having to go get it in Canada instead since the surgery cost was too high locally. Anyway, his lesions on his liver doubled in size and 2 more grew back. The spots on his lungs and lymph nodes also returned. He then received 8 rounds of FOLFIRI and there was good response. No lesions could be seen on the liver but the nodules on his lungs remained as well as in his lymph nodes. His oncologist decided to stop FOLFIRI and instead give him Irinotecan alone,once every 2 weeks for 4 rounds. The next scan showed 5 lesions on his liver reappeared, the biggest being around 2cm. Also some new nodules appeared on his lungs. When the oncologist first suggested my husband try the Irinotecan alone, he said if it didn't work we'd go back to the FOLFIRI. However, when it didn't work, he said we're not going back to the FOLFIRI and he suggested Panitumumab instead as his last treatment option. He said if this doesn't work there is nothing else that can be done. What is your opinion? Also, is it possible that stopping the FOLFIRI was not the best thing to do and lead to progression? Any help would be greatly appreciated as my husband is only 30 years old.
Hi Chelly, Thank you for the detailed history. To summarize, your husband is a 30-year-old with metastatic KRAS wild-type metastatic colorectal cancer with liver, lung, and nodal metastases. Upfront XELOX was given with no targeted therapy and it appears that this regimen was able to convert unresectable disease to “resectable” liver mets. Unfortunately, surgery could not be performed sooner and there was a 7 month period with no chemotherapy. I definitely do not agree with stopping treatment for that long because your husband still had the residual liver metastatic disease as per the CT scans. When the treatment was restarted, FOLFIRI was chosen which was appropriate, however, targeted therapy was not used. A further aggressive approach with combined chemotherapy and anti-EGFR therapy ( cetuximab or panitumumab) would have been my preferred approach. Your husband has a left-sided KRAS wild-type cancer which is likely to have better outcomes with anti-EGFR targeted therapy. Our preferred choice would be to use these earlier in the disease course. Now that he is progressing on single-agent Irinotecan, it seems Panitumumab is being considered which is reasonable. However, I would suggest FOLFIRI plus Panitumumab if he is in good shape and is tolerating treatment well. Also, anti-VEGF targeted therapy had never been used which may be considered down the line should be progress on Panitumumab Should he progress beyond the above treatments, options include:- ✅ Check if Nex Gen sequencing and microsatellite instability ( MSI, MMR) were done. If not done yet, please ask to get them done because identifying a target may open up therapeutic options for him. If Her-2 is positive, he can use Her2 targeted therapies. If MSI-High or MMR-proficient, he will be an excellent candidate for immunotherapy. If BRAF positive, can her Encorafenib plus Cetuximab. ✅ Regorafenib ✅ Triflurudine plus Tipiracil ✅ Clinical trials Your husband is very young and if the performance status is good, every available aggressive option must be pursued. Genetic testing should be considered if not already performed. Please feel free to reach out anytime. Wish you all the best.
Patient Info
Initials : CR
Primary Cancer : Colon
State : Arizona,
Question 1
Whats food to help lessen cancer cells
I can’t think of any food that can decrease the cancer cells in the body of someone who’s already diagnosed with a cancer.
Patient Info
Initials : CS
Primary Cancer : Nasal cavity
State : Delaware,
Question 1
My nephew is 3 yrs old and is battling Leukemia since birth , he has TCell problem , he relapsed 4 times , did marrow transplant 3 times But still battling with the cancer cells that come back We wanted to try some alternative medicine since the hospital stopped all medications and chimio We were advised astragalus and reishi as a beginning We don't want to lose this poor baby ????
Are you in the US? If so where? Have you looked into CAR T cell therapy? Phase 1 studies? That’s what I would recommend
Patient Info
Initials : NS
Primary Cancer : Hematology
State : California, United States
Question 1
Jan. 2021 a 10cm cyst was found on left ovary. My CA 125 was 19. My gynecologist said, based on transvaginal ultrasound that it looked benign. I wanted to wait, because we were in the process of house hunting. March 2021 no change, although found out later My CA 125 was 21. March 21 cyst torqued. Had CT at ER, said it looked suspicious. Surgery next day by gynecological surgeon confirmed Staged 1A HGSOC. Began chemo in May. My CA 125 in July was 32. Earlier CT scan in June came back clear. August CA 125 was 17. PET scan was never performed because insurance would not approve one. Shouldn't My CA 125 be below 10, at least? Finished my 6th round of carbo/taxol. Oncologist says he's treating me with chemo as a precaution. Surgeon did extensive exploratory examination and took several biopsies, which all came back clear. However, he did not take any lymph nodes. I feel that something was missed. Complete hysterectomy, including ovaries, fallopian tubes, etc. Oncologist says catching ovarian cancer at Stage I is rare. Plans to do another scan in October's after all inflammation from chemo has subsided. Should I be worried. I've been told ovarian cancer is chronic and never goes away.
If your ovarian cancer is staged at 1A then while you're getting adjuvant chemotherapy, there is no benefits for checking or trending CA125 level, as you're assumed to be cancer-free and this treatment if adjuvant to prevent recurrence. CA125 should be checked for surveillance after completion of adjuvant chemotherapy course. Unfortunately the information you provided is not adequate to be able to comment about accuracy of your ovarian cancer staging.
Patient Info
Initials : KS
Primary Cancer : Ovarian
State : Tennessee, Cameroon
Question 1
hello guys , one month ago my brother's Pet scan Shows Deauvill 2 as response it was great news for us , he needs to finish the whole cycles i do have 2 questions if anyone can help me plz -he had 2 chemo beacopp then 3 ABVD the 4th one will be the next monday as long as we meet different doctors everytime we go we had 2 opinions the first one told us that : he needs to finish 2 beacopp + 4 ABVD then we go to the Radiotherapy the second one told us : he needs to finish 2 beacopp + 6 ABVD after that the Radiotherapy dont know who is correct or what should i do or is it an opinion and eveyone had its own protocol ? My second question is : after the last 2 chemos my brother's lymphocytes start droping it is 1.1 G/L while the normal values are situated between 1.5-4 what does that mean , what may be happening or is it a normal to happens during chemo ? sincerly ,
Q1. I believe 2 BEACOPP + 4 ABVD followed by radiation therapy is standard Q2. Lymphopenia is a known adverse effect from chemotherapy and will be normalized after completion of treatment.
Patient Info
Initials : GB
Primary Cancer : Blood
State : Biskrah, Oman
Question 1
Hi. Can you please advise if a lobular breast cancer due to cdh1 has a higher risk of recurrence compared to someone who does not have gene mutation? Can you also advise how much taking an AI for 5 years reduces the risk of recurrence also. Thank you.
Hello Wendy, Your first question: does CDH-1 mutation make you at a higher risk of breast cancer recurrence? There are two separate issues I want to help clarify: 1- The risk of recurrence that the cancer that already developed: this risk is the same as everyone else with or without CDH-1 mutation, Meaning it depends on the size of the tumor, the lymph node involvement and oncotype score. (6cm tumor with no LN involvement: I estimate anywhere between 15 and 30%, oncotype would be more precise) 2- having CDH one mutation increases the risk of of having NEW breast cancers in the remaining breast tissue or the contralateral breast that risk is up to 50% (depends on the penetrance of the gene as indicated by the family history) That is why it is recommended to have bilateral mastectomy‘s and women with CDH1 mutation: to prevent gnu breast cancer The cancer that has already developed should be treated the way we treat everyone else with or without the mutation. Your second question: The benefit of aromatase inhibitors for five years is very significant: 50 to 60% reduction in the risk of recurrence compared to a woman who have no Treatment. There are three aromatase inhibitors anastrozole, letrozole, exemestane. If there are any tolerability challenges I switch amongst those three in attempt to find the one that’s the most suitable for my patient. If none of them is tolerated well, tamoxifen is another option to fall back on, especially in the individuals who have had a hysterectomy. I hope this helps, thanks again for reaching out. Always here Dr. T
Patient Info
Initials : WB
Primary Cancer : Breast
State : Victoria, Australia
Question 1
Hi I was diagnosed with stage iv colon cancer in 2016 age 35, with mets to liver, lymph nodes, abdominal lining and liver. After surgery, I had Folfox and Avastin. I had a local recurrence 6 months after completing chemo. After second surgery I had Folfiri and Erbitux. About 8 months after completing this treatment plan, they found cancer nodules on both lungs. I had ablation and went onto maintenance treatment (Xeloda). My cancer was stable for about 18 months on Xeloda, although a small lung nodule was picked up. Routine scans in Dec 2020 found that the tumour on liver and the lung nodule doubled in size. Liver was resected, and my onc added Irinotecan to the Xeloda. I had 4 cycles and could not continue, as it was too toxic, with each cycle I could not eat or drink for 7 to 9 days due to nausea and vomitting. This leaves me sick, dehydrated and bedridden for at least 9 or 10 days each cycle. Onc feels I need to continue but I don't want to sacrifice quality :-(. I'm a mom of 4 kids who need a mom and not a vegetable. Please provide an opinion, Im not convinced that there will be significant or worthwhile benefit if I continue with the chemo, given all of the above. Thank you
Hi Leigh, Thank you for contacting me. It appears like you’ve received excellent treatment so far from your oncologist incorporating chemotherapy along with targeted therapy and resection of oligometastatic disease whenever possible. From your summary, I understand that cancer has progressed recently and you’re currently on Xeloda and Irinotecan. You seem to be having significant side effects and I agree with you that quality of life should take priority. There are some options you can consider to see if you can minimize side effects and bring back quality:- 1. Your side effects may be secondary to Irinotecan. Do you just have nausea and vomiting? Do you have diarrhea and low blood counts as well? If so, it’s worth checking for UGT1A1*28 polymorphism which makes you susceptible to excessive irinotecan toxicity. The dose may be adjusted without likely compromising the efficacy. Dose reductions may help you continue the treatment. This is if your oncologist strongly feels Irinotecan is significantly controlling your cancer. Also, more effective supportive care and side effects management can help. If you have delayed nausea and vomiting lasting that long and all the other agents ( aprepitant etc) have already been used, you may try Olanzapine as well which can help significantly in controlling nausea. 2. If your oncologist feels benefits vs. quality of life compromise with Xeliri is no longer worth pursuing, you may consider the following options. Since I don’t have full details regarding the molecular profile of your cancer, I will list all the recommended options based on molecular targets. Some of these may have already been tested and if your tumor does not have these specific attributes, such specific treatments won’t be effective. a. Check Guardant 360 or liquid biopsy to see if you developed any resistance mutations in the Kras gene. If no mutations are detected, you may consider retreatment with Cetuximab ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096178/ https://jamanetwork.com/journals/jamaoncology/fullarticle/2716075 ) b. Check your tumor for Her2 gene amplification and if positive, consider her2 targeted therapy. c. Check microsatellite instability/ MMR and Tumor mutation burden- if positive MSI/ MMR-d or if TMB greater than 10, pursue immunotherapy. d. Pursue other FDA approved options such as Regorafenib or Lonsurf e. Consider clinical trials - for example; Tepotinib with Cetuximab f. Do you have a family history of cancer? Have you had genetic testing ( such as CHEK2?) I wish you all the best.
Patient Info
Initials : GP
Primary Cancer : Colon
State : Gauteng, Costa Rica
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