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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

Question 1

Hi, I got diagnosed with Adenocarcinoma stage 4 lung cancer metastasized to the brain about a month ago. My lung mass was about 3.7cm and the brain lesion was about 2.2cm. I will be going for the stereotactic brain radiation (5 sessions) next Thursday and will be exactly the 4th week since taking osimertinib. Do you recommend taking osimertinib during those 5 days of brain radiation therapy? Thank you.

Yes. There are no issues with continuing Targeted therapy during the stereaotactic radiation

Patient Info

Initials : JK

Primary Cancer : Lung

State : California, United States

Question 1

Hi I wrote to you on 8th August regarding the benefit of getting an oncotype test. You offered to review my pathology report and give your opinion. I would value your thoughts on this. Thank you.

Your had a stage II invasive lobular carcinoma (T3, N0), completely removed with negative margins Your prognosis is good because the Lymoh nodes were negative. Oncotype would be an important piece of information to help decide if Estrogen blockers (with or without abrmaciclib) are sufficient. I am only remotely considering the possibility of chemo because Ki67 was high: 72% (the percentage of cells in proliferation) Oncotype would be more precise in estimating the benefit of chemo. Thank you Tlemcani

Patient Info

Initials : WB

Primary Cancer : Breast

State : Victoria, Australia

Question 1

Good morning, I'm Vanessa. I'm diagnosed with Stage 3 Triple positive breast cancer back in may. I have 3 lumps in my left breast. one at 12 o'clock (primary), one at 1 o'clock in th milk duct, and one in th armpit, (lymph node). I also have 2 small spots on my lungs which showed up on my pet scan also and my doctor said they can't do biopsy on th lungs cos they are way too small to take samples. so they are just seeing if th lung nodules react to th chemo n if they do, I'll be a stage 4. my next pet scan is after my next chemo(20th Aug). I was told triple positive is not hereditary. is that true? I believe that I got my cancer from th contraceptive pill for hormone replacement as they took my ovaries. I had endiometriosis bad which I was taking for th last 7 yrs due to a hysterectomyback in 2014. my doctor told me to stop taking it as th cancer feeds off oestrogen. I said, so that pill couldve gave me th cancer? she said, it's a possibility but we can't prove it... im 45 yrs old.

Hi Vanessa, thank you for contacting me. Yes, ER/PR/Her2 positive breast cancers do have excellent treatment options. Your oncologist is doing the right thing by giving you aggressive treatment upfront. If cancer responds very well to the treatment, surgery to remove the primary tumor should be considered unless the lung nodules are convincingly felt to be metastases. Initial treatment may include chemotherapy with her2 targeted therapy ( Docetaxel, Carboplatin, Herceptin, and Pertuzumab) followed by surgery. If no residual disease, you could continue her2 targeted therapy postoperatively to complete one year plus endocrine manipulation therapy. If residual disease, switch to Ado-Trastuzumab. You are relatively young for breast cancer diagnosis. Your oncologist is correct in saying Her-2 positive breast cancers are typically not inherited. However, consideration for genetic testing in your case should also depend on your family history. Concerning your question about the association between hormone replacement therapy (HRT) and ER-positive breast cancer, studies have shown increased risk with combination HRT and long duration of treatment. Recent data from the Women’s health initiative study shows a reduction in breast cancer risk with short-term unopposed estrogen therapy whereas a slight increase in risk with “combination HRT”. This topic continues to be debated and needs further evidence. In your case, you should not take any type of estrogen or HRT since you are already diagnosed with breast cancer. Wish you all the best.

Patient Info

Initials : VB

Primary Cancer : Breast

State : Queensland, Australia

Question 1

My wife had parotid glade tumer, we oprated it in October 2020,after 6 month we took chemotherapy until firstl july we took 4 chemotherapy after this we test CT now I attechment my reports, we want to remove all virus from it Now petiont have pain in oprated place

The scan doesn’t suggest any concerns about cancer recurrence. Has a doctor examined her? There could be other reasons for pain.

Patient Info

Initials : SK

Primary Cancer : Soft tissue

State : Rajasthan, India

Question 1

Hello, I have stage IV NSCLC, metastases in the brain. Currently on Tagrisso. My question is based on an article (link belo). I understand that the collagen play a role in the cancer. I’m taking collagen supplements and was wondering: 1) does increase risk of metastases or progression?; 2) does increase the risk of scar tissue on my Gamma knife treated brain metastases? Reference: https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-019-2058-1#Tab2 Thank you, Maria

Hi Maria, I assume it’s a Stage 4 AdenoCa Lung with EGFR mutation, in which case you are on the right/best treatment today with Tagrisso About your questions about collagen, I’m not sure there’s enough evidence or knowledge (right now) to make a recommendation one way of the other So, cannot take you off your collagen intake increases the risk of progression or developing further metastasis, or development of scar tissue Sorry

Patient Info

Initials : MN

Primary Cancer : Lung

State : Washington, United States

Question 1

Hi Doctor, My dad is diagnosed with stage 3, anaplastic oligodendroglioma. He got operated and he is undergoing radiotherapy. Could you please suggest me how can I save him from this cancer. Please help me.

For this diagnosis I would recommend going to an academic center that includes a team that includes a neurosurgeon, radiation oncologists and neuroncologist. I can’t give more advice based on what you have given me. He will need imaging of his brain every 3-6 months with MRIs to monitor. Best of luck. Dr S

Patient Info

Initials : SB

State : Indiana,

Question 1

Hello Dr. Shah, I was diagnosed with breast cancer in my left breast and told it was stage 2 about an year back. I had a CAT scan and was told they found 2 lymph nodes in my chest between my lungs that have cancer cells. So it was considered 2A breast cancer. I underwent lumpectomy, radiation therapy and have been on Herceptin since then. When I went in last week my oncologist spoke with me and said that cancer has spread to more than 5 lymph nodes and diagnosed me with stage 3B breast cancer but not it is not an Inflammatory breast cancer (IBC). He said I would never be cured and will have to have treatments for the rest of my life. He compared it to diabetes saying that there’s no cure for it but can survive with medication. He hasn’t told me yet whether I need to undergo additional surgery or what is treatment plan. Is stage IIIB an inoperable cancer? What is the typical treatment plan?

1. I would get a PET scan 2. I would get a biopsy of one of the lymph nodes 3. Stage, prognosis and treatment plan would be determined by those tests If it looks to be stage IV I would recommend genetic next generation sequencing on the tumor and also do a liquid biopsy. Depending on age and family you may also need BRCA testing 4. Find a doctor you trust. I hope that helps. Dr S

Patient Info

Initials : JA

Primary Cancer : Breast

State : Indiana,

Question 1

Given that I have had have a 6cm lobular cancerbdue to CDH1 should I consider getting a oncotype test done. I have had right breast masectomyband when I do reconstruction next year I will do a prophylactic masectomy and reconstruction of left breast.

Hello Wendy, Oncotype DX studies 17 genes the of the cancer cells and provides 2 pieces of information: 1-prognosis : 9 year disease free survival with estrogen blockers alone 2- predicts the potential benefit from chemotherapy Is is broadly studied in women with ER+ HERS 2- breast cancer with up to 3 Positive Lymph nodes and is drives the dicision of adjuvant (post surgery) chemotherapy. In post menopausal women with oncotype score less than 25, the benefit of chemo is negligible and therefore is omitted and in those with a score > 25 the benefit of chemo is >15% and is considered worth discussing. Now you: Lobular cancer is typically strongly ER + HER2 Negative with a low oncotype score and no benefit from chemo. Also your surgery was in April and if chemo is considered it should be given within 4-12 weeks of surgery. Your oncotype would most likely be low and validate the decision of omitting chemotherapy. No harm in getting one. The results need to be interpreted by your oncologist in the context of other features of the cancer. My practice: I get Oncotype on every ER+ HER2 negative surgical specimen regardless of the stage, if the oncotype is low but there are other high risk features ( large tumor or positive LN), I consider adding Abemaciclib to the aromatase inhibitor first 2 years per the “PALLAS” clinical trial. I add Zometa every 6 months. Please feel free to send details of your pathology report if you wish Or any follow up questions Regards Tlemcani

Patient Info

Initials : WB

Primary Cancer : Breast

State : Victoria, Australia

Question 1

My doctor told me I have early stage of precancerous ampullary tumor at the beginning of this year. I just turned 54, they said it's a rare cancer and it's more rare because I'm a female. Usually men gets it in later age. Per doctors only whipple surgery can be performed for that type of cancer. The survival rate of this type of cancer is not good either. I'm in a shock mode right now. I'm never been scared in my life til now. I don't know what other people do when they have the same diagnosis. Is there other alternative surgery for this?

So your doctors are correct. The standard treatment for this type of cancer is the whipple operation. Having said that, if the mass does not have “high grade dysplasia” and if the anatomy of the mass cooperates, you can have just the mass resected endoscopically or surgically. This is called a local resection. Now, if you do a local resection, it can recur. The higher the grade of dysplasia then the more likely it is to recur as a cancer. If what you have is high grade dysplasia, then the management is a little more controversial. Most people would recommend whipple, but there are studies suggesting a local resection can be done with good local control. Here is a review article that describes most of what I just said. Particularly, see figure 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3244941/#!po=0.961538

Patient Info

Initials : AQ

Primary Cancer : Pancreas

State : California, United States

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