Colon Cancer Surgery: Robotic or Laparoscopic?

robotic surgery

Researchers performed a literature search of 13 papers published between 2000 and 2012 that compared the performance of robotic and laparoscopic techniques for colorectal cancer. The investigators examined the number of nodes resected, lengths of postoperative stay, and conversions to an open procedure.

Results: There were more conversions among evaluated laparoscopic procedures (mean 6.3% versus 2.7%). There were no significant differences in blood lows, number of nodes resected (16 for robotic versus 19 for laparoscopic), or procedure length.

My take: While there was initial hesitation about using a robot for resection of patients with colorectal cancer, the results suggest its equivalence to laparoscopic approaches. More long-term follow-up is needed to assess patient outcomes, however.

Reference: Wilder FG. Abstract #Su1601. Presented at Digestive Disease Week; May 18-21, 2013; Orlando, Florida (USA).

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Pregnancy-related Breast Cancer: Prognosis

A pregnant woman
A pregnant woman (Photo credit: Wikipedia)

Bottom Line: Survival is similar whether breast cancer is diagnosed in pregnant or non-pregnant women.

Background: Nearly 3% of breast cancers are diagnosed during pregnancy. Pregnant women are often understandably concerned about whether their prognosis is worse because of the pregnancy.

The study: Belgian investigators identified women from 7 European countries who received diagnoses of invasive breast cancer during pregnancy between 2000 and 2011. Outcomes were then compared to those of women 45 years old or younger who received the same diagnosis while not pregnant.

Results: After adjusting for age at diagnosis,stage, grade, tumor type, receptor status, and chemotherapy, the average disease-free survival chance was 65% for pregnant women, and  71% for the nonpregnant women. The probablities of overall survival were 78% and 81%, respectively. These differences were not statistically significant.

My take: These findings allowus to counsel women that their survival will not be shortened because their cancer was diagnosed during pregnancy. We also know that selected chemotherapy may be safely and effectively given during pregnancy, without compromise to the fetus. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Lancet Oncol 2012;13:887

Glioblastoma: Bevacizumab (Avastin) Does Not Improve Survival

brain tumor glioma coronal

What You Need to Know: The addition of bevacizumab (Avastin) to first-line chemotherapy and radiation therapy did not improve overall survival length for patients with newly diagnosed glioblastoma multiforme (GBM).

The Study: Gilbert and colleagues randomly assigned 637 patients with GBM to the standard – radiation therapy (RT) + temozolamide + placebo versus RT + temozolamide + bevacizumab; that is, RT/temozolamide +/- bevacizumab. At progression, those on placebo could switch over to bevacizumab.

Results: Median overall survival times for both groups were around 16 months. Progression free survival was 10.7 months in the bevacizumab group versus 7.3 months in the standard. Side effects were more common in the bevacizumab group, including blood clots, low platelet counts, and high blood pressure.

My take: This study highlights are frustrations with GBM. In spite of improvement in progression-free survival, no gain in overall survival. Clearly, this study does not support the upfront use of bevacizumab for patients with GBM, but may play a role for recurrent disease. The discovery of molecular subgroups of GBM should open the door to a new understanding of the underlying genetic mutations that drive GBM, offering hope for the future. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Gilbert MR. Abstract #1. ASCO Annual Meeting 2013 (Chicago, IL, USA).

Lung Cancer: Combination of Asbestos & Smoking Amplifies Risk

Asbestosis
Asbestosis (Photo credit: Pulmonary Pathology)

Smoking remains the leading cause of lung cancer. It is followed by radon exposure, and asbestos exposure. Now we have more data showing a stunning increase in the risk of lung cancer when smoking is combined with asbestosis exposure. Still, quitting smoking can significantly reduce the risk for developing lung cancer after long-term asbestosis exposure.

The study: Researchers examined long-term North American insulators (N=2,377) and compared them with male blue-collar workers with no history of exposure to asbestosis (N-54,243( who participated in Cancer Prevention Study II. The authors looked at age, duration of work and duration from onset of work as an insulator, smoking history, asbestosis, asbestosis-related pleural (lining of organs such as the lungs) scarring (fibrosis), and poor lung function (FEV1/FVC less than 65%).

Findings: Each individual risk factor was associated with an increased risk of developing lung cancer, while the combination of two factors further increased risk. The combination of 3 factors increased the risk of lung cancer by almost 37-fold!

My take: If you don’t smoke, don’t start. If you do, quit: Insulator lung mortality was reduced by half within 10 years of smoking cessation. Insulators who stopped smoking more than 30 years earlier had similar lung cancer rates as insulators who never smoked. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Markowitz SB. Am J Respir Crit Care Med. 2013; Published online ahead of print April 13, 2013.

Aggressive Breast Cancer: A New Gene Marker

Summary: A new marker that identifies a more aggressive form of breast cancer has been identified. Tumors in which breast cancer stem and progenitor (first) cells have abnormalities in the PI3/Akt signaling pathway are more likely to have spread to regional lymph nodes. This was independent of size, grade, and hormone receptor status of the breast cancer.

My take: Previous studies have reported inconsistent results regarding this signalling pathway. Because stem/progenitor cells make only a small proportion of the breast cancer cells, they probably needed to be tested independently of the primary tumor. Whole tumor testing may miss these important stem cells. Perhaps in the future, we will have one more prognostic tool for patients with breast cancer.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: JAMA Surgery, 24 July 2013 (online publication)

Prostate Cancer Active Surveillance: Risky for African-Americans?

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As I recall, African-American men are at the highest risk of prostate cancer in the world. Are African-American men with very low risk prostate cancer more likely (as compared to their white American counterparts) to have more aggressive disease that goes undetected with current diagnostic approaches? The answer appears to be yes, at least according to a retrospective analysis conducted at Johns Hopkins University in Baltimore (USA).

Results: African-American men had significantly higher rates of upgrading at surgery (compared to whites): 27% versus 14%, and more aggressive pathology (high-risk disease): 14% versus 8%.

My take: This is the largest cohort to date of black men who qualify for active surveillance. While active surveillance is an effective management strategy for many, men thought to be at low risk aren’t necessarily so. The authors feel that race-specific criteria for entry into active surveillance are needed. For every 100 African-American men with a very low risk profile in the study, 25 had higher-risk disease. For every 100 such white men, 15 had higher risk disease. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Journal of Clinical Oncology, online edition (17 June 2013).