Sunday, November 8, 2020

CANCER RECURRENCE: Viewpoints and Strategies




INTRODUCTION:
WHY CANCER COMES BACK
(Source: NIH- National Cancer Institute)

When cancer comes back after treatment, doctors call it a recurrence-  or recurrent cancer. Finding out that cancer has come back can cause feelings of shock, anger, sadness, and fear. But you have something now that you didn’t have before—experience. You’ve lived through cancer already and you know what to expect. Also, remember that treatments may have improved since you were first diagnosed. New drugs or methods may help with your treatment or in managing side effects. In some cases, improved treatments have helped turn cancer into a chronic disease that people can manage for many years.

Recurrent cancer starts with cancer cells that the first treatment didn’t fully remove or destroy. This doesn’t mean that the treatment you received was wrong. It just means that a small number of cancer cells survived the treatment and were too small to show up in follow-up tests. Over time, these cells grew into tumors or cancer that your doctor can now detect. [1]


RECURRENCE & METASTASIS- THE MOVING TARGET   By: Dr. Ben Ho Park

There are two flavors of recurrence- one being LOCAL recurrence and the other is METASTATIC. Local recurrence means that should for whatever reason some cancer tissue or cells get left behind, cancer can come back (a curable situation). In the case of breast cancer (per se), recurrence can also mean METASTATIC- where it can re-appear outside the breast area and outside of the lymph nodes in the armpit.  Now it doesn't mean it's not treatable, but it essentially means that the cancer now has traversed from the local area to a distant site, set up shop and grown to a point where it's now detectable in higher numbers.

Recurrence is really a math game. The numbers would tell you that by the time that happens, there's so many cells and so many cell divisions that the heterogeneity of cancer (the main treatment challenge) prevents us from being able to cure metastatic disease, because we don't currently have enough drugs that can get rid of all of those different cancer cells. A patient's breast cancer, as an example, is not uniform. It's a dynamic process. Every time a cancer cell grows and divides those two daughter cells (if you will) are slightly different from one another.  Whereas normal cells are exactly the same when they grow and divide-- they have to be (they're identical twins), this is the problem with cancer; it is a disease of DNA gone bad, but it's also underlying of what we call genetic instability that leads to heterogeneity making cancer cells resistant to many drugs.

As far as heterogeneity, by the time you can see a cancer tumor at one centimeter, that's a billion cancer cells, and they're all a little bit different from one another. And so if that cancer cell recurs in the bone, the liver, the brain, the lungs it's left a trail of breadcrumbs. So we know it's more than just a cubic centimeter. That's already a billion plus cancer cells. So even if you cut it out, there's all these breadcrumbs that are already seeded everywhere that we can't see.  There's going to be at least one cancer cell resistant to a given therapy, because of all the changes in DNA as cancer cells divide, meaning the cancer cell from one to the next is a little bit different. And that's what makes cancer so tough to beat because we're not dealing with a static target. We're dealing with a moving target. And even though we can get 99.9% of the cells with a drug or series of drugs, that 0.1% of cells left behind is eventually going to come back.

And that point when it comes back, cancer cells gets even more heterogeneity and more changes and more, again, evolution of different subclones as we call it. That's the fundamental crux and problem with cancer and why it's so tough to beat. And this is not different when you think about some infectious diseases like tuberculosis, right? I mean, that's why we need four drugs to cure patients with tuberculosis because it evolves and changes. HIV is the same way. So, I also use those examples to point out we've controlled those diseases. In some cases, we cured those diseases and we can do the same for cancer.


OUTSMARTING CANCER WITH SELF-AWARENESS   Dr. Robert L. Bard

Once you do enough Google-searching-especially for key terms like "CANCER PREVENTION" and "STAY IN REMISSION", you'll learn how to come up with a simple plan to keep cancer away- or increase the likelihood of beating cancer with the comprehensive Early Detection & Prevention plan. In each case, much can be done to prevent the current stage. The first step is to GET MORE FAMILIAR WITH YOURSELF.

• Be aware of your genetic lineage: risk of cancer increases upon heredity. The first place to look is within your own dna or family history. Many cancers tend to travel down generations. It can also have the tendency to skip one generation and appear in the next one.

• Periodic Checking of your body for any anomalies like lumps, bumps, discolored bruises or growths. Self-checking is the first base. Also stay on top of unusual feelings like frequent headaches, unique pains and strains- anything that feels out of the ordinary. Take nothing for granted when it comes to your body.

• Know your environment: Many health issues are known to be caused by environmental toxins. Where you sleep, eat and work could be affecting how you feel later. Some health hazards are fairly visible and apparent while others may need some historical research in your area where there may have been potential chemical wastes or spills in the past. If you know of such issues, further research, demographic studies, protective measures and targeted checkups may be your next step.



METASTASIS: RECURRENCE WITH A VENGEANCE
By: Kirby Lewis

 In 2012, I was diagnosed with stage two (male) breast cancer.  Standard operating procedure was having me undergo a mastectomy to my left breast.  It came with all the physical impact of treatments and surgery but I wasn't too worried about the outcome. I was sure that it wasn't going to kill me because I found that most people don't die from stage one, two or three.

 Then, by 2016, I had recurrence. As a lot of people know, recurrence is about 30% of early stagers.  I sensed the first time that it was going to come back-- and that when it did, it was going to be metastatic.   Metastasis is when those rogue cancer cells that are in the area of the breast tissue decide to venture out into another neighborhood of the body. When that happens, they tend to go to the liver or the pancreas or, the kidneys or the bones or even the brain. I had metastases in both lungs and in my spine so it was quite alarming.  

Through a battery of testing, it was unnerving to find out how fast it went from being non-present in my body to being everywhere-- in my lungs and in my spine. Basically, I was looking at a six week period where I went from clear lungs, clear scans and within six weeks, my, my lungs lit up like Christmas trees.

I think that what people can learn from this is that you should never take the changes in your body lightly. Do self exams. And if you find something that is unusual, go have it checked out. It's $50 for a doctor visit and that's $50 well spent rather than buying a coffin. If your body has propensity to turn on those cancer cells, flip that switch, then (my thinking is that) it's likely that it is going to come back in some other form. And I hope that it doesn't. When someone is designated cancer free, I would love for them to think that that's it. But they do need to be diligent. And they do need to be cognizant and aware of the fact that the possibility will always exist.

References:

1) https://www.cancer.gov/types/recurrent-cancer




The New York Cancer Resource Alliance is committed to seeking out SMART SCIENCE from the top sources of current and most helpful solutionists. Because there is no SILVER BULLET to cancer, a recent article from our generous friends at Boehringer-Ingelheim shed some light into some of their greatest cancer findings from recent research work about "undruggable" targets and their views on how to approach them.

Despite significant progress over recent decades, many key molecular drivers for a wide range of cancers remain undruggable. Only 10-15% of cancer patients currently benefit from drug treatment targeting the genomic aberrations driving their cancer. Our mission is to change this. We’re taking cancer on by working on pioneering approaches to identify key cancer cell dependencies that drive the growth and proliferation of cancer cells. Our scientists are developing novel therapies to turn these drivers off, and combining them with specially selected partners to switch off multiple drivers, as well as with immunotherapy to harness the patient’s immune system to fight cancer cells.

FINDING SMART COMBINATIONS TO TACKLE ‘UNDRUGGABLE’ TARGETS
 
We’re digging deep into the science and taking a precision approach to develop smart combinations to bring the greatest benefit to patients. The first step is to find cancer-cell directed therapies that induce rapid tumor shrinkage. But we know that the long-term efficacy of current targeted therapies has been limited by the development of resistance, leading to relapse and disease progression. Cancer cells quickly find ways to circumvent the effects of targeted drugs by mutating or re-routing along alternative pathways. So we’re using a smart science approach to understand molecular pathways at a deep level to identify the ‘Achilles heels’ where we can potentially outwit the cancer cells at the same time as finding innovative ways to increase and prolong anti-cancer effects with combination partners.

Immune therapies often take longer to act than cancer cell-directed therapies but can achieve much more long-lasting responses. So part of our smart combination strategy is exploring how to transform ‘cold’ tumors, which have no, or limited, immune system activity, making them unresponsive to immuno-therapy, into ‘hot’ tumors so that the patient’s immune system can be recruited to fight cancer with immuno-oncology therapies. By combining both approaches, patients gain the immediate benefit and high responses of cancer-cell targeted therapies and the longer-term survival benefit of immunotherapy. (See complete article: A Smart Science Approach to Cancer Combinations- by Norbert Kraut, Ph.D., Global Head of Cancer Research, Boehringer Ingelheim)

Thursday, November 5, 2020

INHERITING CANCER

CANCER HEREDITY
Cancer is a genetic disease—that is, cancer is caused by certain changes to genes that control the way our cells function, especially how they grow and divide. Genes carry the instructions to make proteins, which do much of the work in our cells. Certain gene changes can cause cells to evade normal growth controls and become cancer. For example, some cancer-causing gene changes increase production of a protein that makes cells grow. Others result in the production of a misshapen, and therefore nonfunctional, form of a protein that normally repairs cellular damage.  

Inherited genetic mutations play a major role in about 5 to 10 percent of all cancers. Researchers have associated mutations in specific genes with more than 50 hereditary cancer syndromes, which are disorders that may predispose individuals to developing certain cancers. Genetic tests for hereditary cancer syndromes can tell whether a person from a family that shows signs of such a syndrome has one of these mutations. These tests can also show whether family members without obvious disease have inherited the same mutation as a family member who carries a cancer-associated mutation. [1]


Everyone has two copies of each set of genes from both parents. If a person inherits a mutation in a Lynch syndrome gene, they still have the normal copy of the gene from the other parent. Cancer occurs when a second mutation affects the normal working copy of the gene, so that the person no longer has a copy of the gene that works properly. Unlike the inherited Lynch syndrome mutation, the second mutation would not be present throughout the person’s body, but would only be present in the cancer tissue. However, not everyone with Lynch syndrome will get cancer. You and your family members are more likely to have Lynch syndrome if your family has a strong history of colorectal cancer. Family members who inherit Lynch syndrome usually share the same mutation. If one of your family members has a known Lynch syndrome gene mutation, other family members who get genetic testing should be checked for that mutation. (source: CDC.gov)

GENETICS VS. GENOMICS

Excerpted from www.genomicmedicineworks.com

Genetics and genomics sound alike and are often used interchangeably, yet important scientific and clinical distinctions exist between these two scientific fields of study. The classical definition of genetics is the study of heredity, how characteristics and traits (phenotypes) of a living organism are transmitted from one generation to the next. This occurs via deoxyribonucleic acid (DNA), a double helix molecule in the cell’s nucleus that comprises genes—the basic unit of heredity. Many of the early principles and rules of heredity were discovered by an Augustinian monk and scientist, Gregor Mendel. His seminal research with pea plants in the mid-1800’s laid the foundation for modern-day genetics.

Genomics is the next evolution of classical genetics, and became possible only in recent decades due significant advances in DNA sequencing and computational biology. In 1976, Belgian scientists succeeded in fully sequencing the genome of bacteriophage MS2, a bacteria-infecting virus. They identified all 3,569 DNA base pairs, and the 4 nucleotides (Adenosine, Cytosine, Guanine and Tyrosine) that make up the DNA code. The first animal genome was completely sequenced in 1998. Five years later, with more than 1,000 researchers from six countries collaborating on the Human Genome Project, all 3.2 billion DNA base pairs in the human genome were identified.  Genomics is the study of the entirety of an organism’s genes—the genome. Genomic researchers analyze enormous amounts of DNA-sequence data to find variations that affect health, disease or drug response. In humans, that means searching through about 3.2 billion units of DNA across 23,000 genes.


In a clinical sense, genetics is the study of single genes or parts of genes and their effects on a person’s development, disease risk or response to drugs. This is generally referred to as a “monogenic” approach, since the focus is on a single gene. In contrast, genomics is the study of the function and interactions of all the genes in the genome.

While genetics and genomics are still quite distinct in how they impact health and disease, scientists are starting to view genetics and genomics as part of a continuum. On one end of the spectrum are single gene disorders with high penetrance – meaning if you have the mutation, you get the disease. On other end are genomic SNPs, which are common, low penetrance gene variants from multiple locations interacting with environmental factors, leading to complex diseases. Unlike genetic mutations, SNPs don’t automatically cause disease.

Genomic Medicine: It is now possible to use results from clinically-based genomic testing to evaluate a person’s disease susceptibility, and develop evidence-based, personalized intervention strategies to reduce those risks. These strategies include DNA-directed lifestyle modifications, dietary recommendations, nutritional supplements and/or exercise, all of which influence how these genes function to create health or disease. Biomarker testing can then be used to evaluate whether the intervention is efficacious. With this approach, the guess-work and inefficiencies of trial-and-error strategies are greatly reduced, leading to better health more quickly and cost-effectively.

Our comprehensive Ultimate Wellness genomic test provides gender-specific reports to create personalized programs for many health conditions, including:

  • Prevent ER+ breast cancer or its recurrence in women diagnosed with the condition
  • Reverse osteopenia and osteoporosis
  • Prevent or treat Type II diabetes, heart disease, stroke, metabolic syndrome and obesity.
  • Optimize athletic performance
  • Customize nutrient requirements and resolve nutritional paradoxes
  • Prevent, treat and manage depression and anxiety
  • Plus many more health and wellness issues
  • Genomic Medicine is personalizing healthcare with precision. 

To see complete article, visit: https://genomicmedicineworks.com/genetics-genomics/


About the Author

ROBERTA KLINE MD
Co-Founder & CEO of Genomic Medicine Works. Board-certified Ob-Gyn physician, author, educator, genomics expert and entrepreneur, Dr. Kline is passionate about helping others harness the power of personalized, DNA-directed healthcare. Dr. Kline graduated magna cum laude and Phi Beta Kappa from the University of Connecticut. She received her medical degree from the University of Connecticut School of Medicine under an Air Force Health Professions scholarship, and completed her Obstetrics and Gynecology residency at Wright Patterson AFB earning multiple honors. Today, she brings her expertise in healthcare, practice development, genomic science and education, clinical and genomic medicine along with Human Design to Genomic Medicine Works.



Directory of Inherited Cancer Syndromes source: NIH LINK
• BRCA1 / BRCA2 - breast & ovarian cancer
• Cowden Syndrome
• Diaphyseal medullary stenosis
• Duodenal carcinoid syndrome
• Endolymphatic sac tumor
• Familial adenomatous polyposis
• Familial isolated pituitary adenoma
• Gardner syndrome
• Hereditary diffuse gastric cancer
• Hirschsprung disease ganglioneuroblastoma
• Langerhans cell histiocytosis
• Li-Fraumeni syndrome
• Lynch syndrome
• Multiple endocrine neoplasia:
- (type 1
 | type 2A | type 2B)
• MYH-associated polyposis
• Oslam syndrome
• Paraneoplastic Neurologic Disorders
• Perlman syndrome
• Pheochromocytoma | islet cell tumor synd.
• Premature aging Okamoto type
• Stewart Treves syndrome
• Von Hippel-Lindau disease
• WAGR syndrome

 LYNCH SYNDROME is a hereditary cancer condition in which a mismatched repair gene, which ordinarily repairs errors in DNA duplication, is defective. As a result, individuals are predisposed at a very high lifetime risk of cancer, including an up to 85% risk for colorectal cancer, 65% risk for uterine cancer, 19% risk for gastric cancer, 13% risk for ovarian cancer and a higher than average risk for other cancer including cancers of the liver, gallbladder, kidney, bladder, prostate, pancreas, skin, brain and breasts. With genetic testing, there is hope...once diagnosed, annual cancer screenings take place and cancers can be treated or removed before becoming life threatening. By knowing our family history and having a great medical team, we live longer than ever before...as long as anyone else!




An Introduction to Lynch Syndrome
By: Lindy Bruzzone

I was diagnosed in 2007 with colorectal cancer which was tied to my having Lynch Syndrome.  There are tens of thousands of people now diagnosed with this genetic disorder which means this is NOT a RARE disorder like most might think.  It came from a defective mismatch repair gene, where instead of repairing errors in DNA replication, it puts in different proteins and create more errors than it tries to keep doing. 

I produced this video 10 years after I lost lost my father. It was just so difficult for me to lose him that way. The day before he died, he said to me, "the doctors think it's hereditary, go get checked and tell your brother and sister, to get checked."  After his funeral, my brother and I started looking for the right cancer center to get help. Knowing my father's reports, my surgeon and other doctors jumped in to get me tested, and sure enough--- it was positive. 

That's why Lynch Syndrome International was developed because nobody was getting diagnosed. NOW they are! And then when Color Genomics was developed (a Steve Jobs startup offering for FREE genetic testing), suddenly everybody started getting tested because they could finally afford it. They didn't want insurance companies involved. It took care of every barrier that we have to testing for hereditary cancers. 

tbc


References

1) Cancer Heredity / NIH: https://www.cancer.gov/about-cancer/causes-prevention/genetics

Wednesday, November 4, 2020

Reduce Your Exposure to Harmful Chemicals - by Dr. Aly Cohen


Dr. Aly Cohen, founder of The Smart Human®, discusses many of the everyday chemicals in our food, drinking water, cookware, cleaning products, personal care products, and even in the air we breathe are not tested for safety that can cause both short and long-term health issues. 

Here are five things you can do right now to reduce exposure from harmful chemicals.

1) DECREASE CANNED FOOD AND DRINKS. Canned food and drinks, yes soda too, all have a lining of plastic material made from BPA or bisphenol-A, a compound that was found to mimic estrogen and other hormones in the body. Resulting in a variety of hormone related health issues like thyroid disease, developmental issues in children, insulin resistance in diabetes, high blood pressure, obesity, and some cancers. Try buying fresh foods or frozen produce and prepared meals, and heat them up in glass containers and not the steam bag that they came in.

2) AVOID COOKING IN NON-STICK PANS. The chemicals used on these pans break down and get into the foods that you're cooking. These non-stick chemicals, also called perfluoralkyls have been shown to cause cancer in laboratory animals, and are made using fluorine, an element which takes decades to breakdown in our bodies and in our environment. You may have to use a bit more elbow grease to clean your pans, but stick with cast iron or stainless steel and look for 18/8 on the bottom that let's you know it's food grade steel. Use real olive or coconut oil instead of synthetic non-stick sprays.

3) NO MORE PLASTIC for storage and microwave use. Ever wonder why clear plastic containers turn cloudy after running through the dishwasher a few times? Plastic breaks down over time, from high heat from dishwashers and microwaves and even from scratches. This breakdown can release harmful chemicals into your food in the container, especially food that has high fat content because many of the plastic chemicals are lipophilic or fat loving. It's well worth your time to take a few extra seconds to transfer prepared foods into a glass container before heating it up in the microwave, and store foods in glass or stainless steel too.

4) CREATE A WATER SYSTEM no matter if your water comes from an in-ground well or city water from a water treatment plant. Always filter your water at the point of use, which is your faucet. This allows you the greatest control of what you and your family drink. Now there are simple carbon filters that are used in pitchers, on refrigerator doors, as well as those you can actually install onto your sink faucet. Then there are more complicated filters such as reverse osmotic, ion exchange, and distillers. Choosing the right filter for you and your family is very important, and the best resource for this is ewg.org guide to buying a water filter. Whichever type of filter drinking water system you choose, remember to change your filters regularly and carry your water in glass or stainless steel.

5) DUST, MOP & VACUUM WEEKLY. In many studies household dust has been found to contain hundreds of chemicals that come from products we use in our homes every day. Children and household pets have been shown to have the highest levels of many harmful chemicals such as flame retardants, plasticizers, smoking chemicals, cleaning product chemicals in their bodies because they're on the floor where dust collects and sticks to toys, fingers, and paws.

Of course making all of these changes doesn't happen overnight. Try making one healthy change per month. Taking the time to think about the products we use everyday can help minimize chemical exposures and create a safer and healthier home and human body.

I share these prevention tips and more on TheSmartHuman.com website and on Facebook, Twitter, and Instagram. Thanks for joining me, I'm Dr. Aly Cohen and remember, when it comes to our environment and our health, you too can be the smart human.

The Smart Human LLC. seeks to educate, coach, and empower everyday people to make safer, smarter choices for human health. Our goal is to help hospitals, schools, and manufacturers, make changes to reduce unsafe chemical exposure of  the children and adults that they serve. It’s a lofty goal, but it has to start somewhere! I hope you will join us on this mission.


Additional videos are available with topics including: Chemicals in Personal Care Products, Improving Poor Air Quality and Making our Drinking Water Safer. Check out the complete set of episodes of THE SMART HUMAN Video Channel.






IMMUNOLOGY AND THE SCIENCE OF SELF-HEALING  By: Dr. Jesse A. Stoff
To help restore our health and to help restore harmony, it's a matter of rebuilding the immune response. A functional immune system is based upon an intact biochemistry, which means our biochemistry, the system of biochemical substances, hormones, enzymes and the like in our body has to be intact, functional and in balance, one to the other, in order to support the immune system as efficiently as is possible. Together, they work together to protect us from all sorts of illnesses and keep us above ground on the shiny side of the grass that much longer. When we're looking at the immune system, it's actually a bridge. A bridge where? A bridge between our biochemistry and a bridge in the sort of metaphysical sense to our higher self... -go to full article


RESPIRATOR vs. SURGICAL MASK - What's the Difference?  
By: Dr. Robert L. Bard
Fact: ANY PPE is better than NO PPE!  The science of prevention states that measures toward a reduction in risk can greatly support life-saving others - and yourself.  Meanwhile, discerning the difference between face coverings, specifically MASKS vs RESPIRATORS can be useful in identifying which situation to use which type of mask. There is a significant difference between the two, and wearing one vs. the other provides differing results. The FDA defines a surgical mask as a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment... -go to full article






This newsletter series is produced by: The New York Cancer Resource Alliance (NYCRA) -- a self-funded union of volunteers comprised of caregivers, accredited medical professionals, cancer educators, publishers and published experts, patient support clinicians and non-profit foundation partners whose united mission is to bring public education and supportive resource information to the community of patients, survivors and any individual(s) seeking answers about cancer. NYCRA is an exclusive, non-commercial private network originally established on the LINKEDIN digital society and is supported in part by the AngioFoundation whose mission is to share informative materials to the community. For more information, visit: www.NYCRAlliance.org


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Friday, October 30, 2020

FDA APPROVED BLOOD TESTS TO DETECT CANCER

"FDA Approves Blood Tests That Can Help Guide Cancer Treatment" was originally published by the National Cancer Institute. |  October 15, 2020, by NCI Staff

Two blood tests recently approved by FDA for use in some people with cancer, known as liquid biopsies, identify genetic changes by scanning DNA that tumors have shed into the blood.  (image credit: ref: #1)

The Food and Drug Administration (FDA) has approved two blood tests, known as liquid biopsies, that can help guide treatment decisions for people with cancer. The tests, Guardant360 CDx and FoundationOne Liquid CDx, are made by different companies and were approved separately.

Doctors have traditionally based treatment decisions on features like the organ in which the cancer started growing, whether the cancer has spread, and whether the patient has other health conditions. Now they often use another feature to guide treatment: genetic changes in the tumor. 

Certain therapies, called targeted therapies and immunotherapies, work best against tumors that have specific genetic changes. The newly approved tests identify genetic changes, including mutations, by scanning DNA that tumors have shed into the blood. 

Doctors can then use that information to determine if there is a targeted therapy or immunotherapy that is likely to work for the patient. Analyzing genetic changes in a patient’s cancer is called tumor profiling, genomic profiling, or tumor sequencing.

Both Guardant360 CDx and FoundationOne Liquid CDx are approved for people with any solid cancer (e.g., lung, prostate), but not for those with blood cancers. While FDA has approved other blood tests that check for the presence a single gene mutation in tumor DNA, these are the first approved blood tests that check for multiple cancer-related genetic changes.

Liquid biopsies can sometimes be an alternative to a traditional biopsy, in which a sample of a tumor is removed with a needle or during surgery. They are considered less invasive and quicker than a traditional tissue biopsy. 

“Even though the tests have been around for a while, we don’t know how useful they’re really going to be in the clinical setting,” said Ben Ho Park, M.D., Ph.D., of Vanderbilt-Ingram Cancer Center. Many details about how the blood tests may be incorporated into everyday care for people with cancer, including who should get them and whether the cost is covered by private insurance companies, are still being ironed out.  What the FDA’s stamp of approval provides, Dr. Park explained, is validation that the results of a blood-based tumor profiling test can be used to guide the selection of a targeted therapy. 

“It’s great that we’ve crossed that hurdle now. It’s great for patients [because] it’s easier to get,” he said.

See complete article @ NIH (https://www.cancer.gov/news-events/cancer-currents-blog/2020/fda-guardant-360-foundation-one-cancer-liquid-biopsy)


GENETICS VS. GENOMICS
By: Dr. Roberta Kline, MD 

Genetics and genomics sound alike and are often used interchangeably, yet important scientific and clinical distinctions exist between these two scientific fields of study. The classical definition of genetics is the study of heredity, how characteristics and traits (phenotypes) of a living organism are transmitted from one generation to the next. This occurs via deoxyribonucleic acid (DNA), a double helix molecule in the cell’s nucleus that comprises genes—the basic unit of heredity. Many of the early principles and rules of heredity were discovered by an Augustinian monk and scientist, Gregor Mendel. His seminal research with pea plants in the mid-1800’s laid the foundation for modern-day genetics.

Genomics is the next evolution of classical genetics, and became possible only in recent decades due significant advances in DNA sequencing and computational biology. In 1976, Belgian scientists succeeded in fully sequencing the genome of bacteriophage MS2, a bacteria-infecting virus. They identified all 3,569 DNA base pairs, and the 4 nucleotides (Adenosine, Cytosine, Guanine and Tyrosine) that make up the DNA code. The first animal genome was completely sequenced in 1998. Five years later, with more than 1,000 researchers from six countries collaborating on the Human Genome Project, all 3.2 billion DNA base pairs in the human genome were identified.  Genomics is the study of the entirety of an organism’s genes—the genome. Genomic researchers analyze enormous amounts of DNA-sequence data to find variations that affect health, disease or drug response. In humans, that means searching through about 3.2 billion units of DNA across 23,000 genes.

See complete article: INHERITING CANCER- 12/5/2020


By: Dr. Robert L. Bard

The strategy of relying on a (PSA) blood test as the precursor to a biopsy required significant reassessment.  Though approved by the FDA in 1986 as the gold standard for monitoring cancer relapses, increasing reports continue to indicate that elevated PSA levels in over 70% of men show a false positive reading- and does not conclude a malignant cancer. (NIH ref). Because of the inaccuracies of the PSA test and the risk of side effects, many centers are now using imaging solutions like ultrasound 3-D Doppler and MRI before considering a biopsy.

Patient-Specific Anxiety: "My PSA was 22. I had a biopsy; it was benign...GOOD! The biopsy showed inflammation, so I had a (surgical) biopsy I didn’t need... BAD!  There has to be a better way!” 

CANCER IMAGING:
The GenX Diagnostic Solution
Medical imaging (and screening) especially of cancer tumors has advanced since the establishment of the x-ray in 1895.  Imaging earned the acceptance in the medical community as a low-risk, reliable and non-invasive (no-cutting) alternative.  It is widely employed today as a routine and standardized diagnostic protocol in almost every area of healthcare.  Treatment specialists and research scientists alike rely (solely) on medical imaging technology as the go-to protocol to investigate a patient's physiological condition in pathology studies. 

The DIGITAL MOVEMENT and the "end of FILM in radiology" was part of the global tech evolution- driven by the "Economics of Scale theory of Faster-Better-Cheaper". The digital imaging revolution harvested and processed images from an electronic photo conductor, managed bio-information into electronic pixels for more efficient management of diagnostic studies.  The Digital state allowed for computerized intervention to optimize and expand the data acquiring process to new heights of study including 3D modeling- offering a 3D visualization of anatomical studies.  This also paved the way for the induction of AI (artificial intelligence) which was developed to automate analytical paradigms (algorithms) for quicker analysis, advanced workflow, optimized visual dissection, extrapolation and 'prediction' of any biological information with remarkable performance. (see complete article


References

1)  Image #1: (Credit: Adapted from World J Gastroenterol. October 2016. doi:10.3748/wjg.v22.i38.8480. CC BY-NC 4.0)

2) Complete article: NIH (https://www.cancer.gov/news-events/cancer-currents-blog/2020/fda-guardant-360-foundation-one-cancer-liquid-biopsy)

3) Circulating tumor DNA as a liquid biopsy target for detection of pancreatic cancer https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5064029/



Thursday, October 8, 2020

VERIFYING SIGNS OF COVID-19 STROKE THROUGH IMAGING

 By: Robert L. Bard, MD  and Dr. Pierre Kory, MD

ABSTRACT 
Early detection and prevention of arterial and venous disease is key to minimizing the effects of arterial obstruction & hemorrhage,  brain aneurysms, and strokes from venous thrombosis.  The association of trauma to PTSD is now followed by advanced Doppler ultrasound and functional MRI. This abnormal physiology may also manifest as arterial dissection, collagen disease, inflammatory arthritis, dermatitis, ocular disorders, GI disturbances, limb pain, aneurysms of the brain and aorta. Devastating strokes in the Covid-19 era occur in the younger age group and the Latin population is at higher risk.


INTRODUCTION 
Interest in arteritis was elevated with the study of Tayakasu’s disease in the 1970s when advances in contrast arteriography diagnosed diffuse vascular involvement causing strokes and aneurysms in multiple sites. While this arterial inflammation is more common in Asians, in the US, blacks are nearly three times more likely to have a stroke at age 45 than whites. The pediatric population seems to be at higher risk for this arteritis as evidenced by their unusual rate of Covid-19 affliction affecting the vasculature and called “MULTIPLE ACUTE INFLAMMATORY SYNDROME“. Birth control pills is a distinct cause of such disease in younger women while cancer, alcoholism and obesity raise the incidence at all ages.


We have learned over the last century that blockages of coronary arteries to the heart and carotid arteries to the brain are precipitated by inflammation of the inner walls of the vessel, called the “intima”

While thickening of the interior wall of vessels gradually occurs over time and is aggravated by diet, stress and hypertension (high blood pressure), the acutely disabling event is when there is an abrupt tear of the overlying plaque which ruptures debris which then forms a blood clot which blocks blood flow or the clot travels deeper into the brain and blocks blood flow. Similarly, abnormal heart rhythms such as “atrial fibrillation”, causes the pooling of blood in the heart which predisposes to clot formation and the clots can then travel into the brain causing a stroke. In Covid-19, the virus causing severe inflammation in the blood which then promotes clot formation which can travel through the vascular system and affect  almost every organ system in the human body, with the brain and lungs being the most affected.. An article in September NEUROLOGY reported by Medscape documented the incidence of large artery stroke as the presenting symptom of  COVId-19 was highest in men under the age of 50 years. 

HISTORY
A medical research team at Metropolitan Hospital in New York first noticed unusual neurologic symptoms in young and middle aged patients in the late 1960s. As a division of the NY Medical College system, they were fortunate to have an active interventional radiology department specializing in neuroimaging and arteriography. The observation of distortion and occlusion of arteries supplying the brain, kidneys, GI tract and lower limbs to various degrees from single to multiple locations was closely linked to the Japanese disorder known as Tayakasu’s arteritis at the time and recently renamed “arteritis.” A clinical finding of this arterial inflammation in the abdominal aorta was pain in the upper abdomen by the great vessels by palpation. Astute physicians were successfully treating this with commonly available “aspirin.”

However, the chronic and diffuse nature of arteritis often weakened the vessel wall producing aneurysmal dilation and rupture. Today we find sophisticated non-invasive or minimally invasive modalities to be the first line of interrogation of vasculitis.

COVID AND STROKE
COVID-19 was rapidly understood as a disease caused by severe and widespread inflammation and “hypercoagulability” (a tendency to spontaneously form clots in the blood vessels. Autopsies have revealed extensive small vessel strokes, with such strokes often occurring despite aggressive blood thinner treatment and regardless of the timing of the disease course, suggesting that it plays a role very early in the disease process. In one autopsy series, there was a widespread presence of small clots with acute stroke observed in over 25%. In a recent review of the incidence of stroke in COVID-19, almost 2% of all hospital patients suffered a stroke, which is 8x higher than in patients with influenza. More worrisome is that this is almost definitely a gross underestimate given the many likely missed strokes in patients who died on ventilators who were too ill to obtain imaging, the general restrictions on and lack of autopsies, and the well-recognized decrease in the number of patients with acute stroke symptoms seeking medical attention in the COVID-19 era.  Another worrisome finding from a recent study of COVID-19 cases found that 45.5% of patients reported neurologic symptoms [4]. This under-recognized epidemic of neurological symptoms and strokes in COVId-19 highlights the need for more intensive imaging and investigation to achieve not only earlier recognition and improved treatment of patients but in furthering understanding of COVID-19 effects on brain function.

DIAGNOSIS BY IMAGING
Blood flow abnormalities in the arterial system are best study by Doppler imaging like the weather Doppler showing tornadoes. Multiple options exist for blood flow analysis including:

- CAROTID SONOGRAM
- CAROTID DOPPLER
- EYE SONOGRAPHY
- TRANSORBITAL DOPPLER
- CONTRAST ENHANCED ULTRASOUND
- TRANSCRANIAL DOPPLER
- HYBRID IMAGING

- 3D/4D VESSEL DENSITY HISTOGRAM
- ENDOARTERIAL 3D DOPPLER
- RETINAL OCT
- SOFT TISSUE OCT
- REFLECTANCE CONFOCAL MICROSCOPY
- SMALL COIL MRI
- 7 TESLA MRI


CAROTID SONOGRAM:
While cerebrovascular disease is often diagnosed ex post facto after a catastrophic episode with MRI and CT, the non invasive Doppler analysis of the vascularity is generally checked with ultrasound for plaque and obstruction. A useful measure of the risk of coronary and cerebrovascular disorder is the carotid intimal thickness (CIMT). Standard depth of the inner wall thickness is a measure best obtained by high resolution sonograms since a reading over 0.9mm indicates increased risk. The newer sonogram units have depth resolution of 0.02mm making this a preferred non invasive option.

CAROTID DOPPLER: Flow abnormalities of turbulence and absence are commonly evaluated with this modality. Plaque forms more readily in aberrant flow patterns and high velocity regions accompanying narrowing.

EYE SONOGRAPHY: Sonofluoroscopy of the orbital soft tissues and eyes is performed in multiple scan planes with varying transducer configurations and frequencies. Power and color Doppler use angle 0 and PRF at 0.9 at optic nerve head. 3D imaging of optic nerve and carotid, central retinal arteries and superficial posterior ciliary arteries performed in erect position before and after verbal communication. Retinal arterial flow is measured. Optic nerve head bulging is checked as increased intracranial pressure may be demonstrable.

TRANSORBITAL DOPPLER: R/L ciliary arteries have normal Doppler flows of 10cm/s which is symmetric.

CONTRAST ENHANCED ULTRASOUND: Widely used European nonionic contrast injection allows imaging capillary size vessels and perfusion characteristics

TRANSCRANIAL DOPPLER: This measures the flow in the anterior, middle and posterior cerebral arteries as well as Circle of Willis.

3D/4D VESSEL DENSITY HISTOGRAM: Multiple image restoration and reconstruction shows retinal vessel density of 25% at the optic nerve head and adjacent region with quantitative accuracy.

ENDOARTERIAL 3D DOPPLER: Microcatheters inserted into the arterial or venous system provide measurement of wall thickness and presence of inflammatory vessels inside the intima.

RETINAL OCT: Subtraction techniques done with OCT optical coherence tomography may show changes in the caliber of the retinal vessels with verbal ideation.

SOFT TISSUE OCT: The depth of penetration may be extended to 2-3mm allowing for analysis of vascular changes in erythematous or erythropoor dermal areas. Thrombosis may be observed.

REFLECTANCE CONFOCAL MICROSCOPY: This microscopic analysis of the cells also quantifies microvascular pathology and is a potential modality for studying vasculitis.

SMALL COIL MRI: High resolution systems used for animal study and superficial organs can image the intra-arterial anatomy including dynamic contrast imaging on standard 1.5T and 3T units.

7 TESLA MRI: High field systems analyse signal abnormalites rapidly with high resolutions.

HYBRID IMAGING: Hybrid imaging refers to combining diagnostic modalities to assess disease and monitor therapy. 


TREATMENT OPTIONS
CEUS and nanoparticle delivery of dexamethasone may be used to reduce plaque inflammation and stroke occurrence. Intraarterial unstable plaque, most commonly found in the carotid artery, readily ruptures (acutely blocking flow) or dislodges causing distal embolism and arterial occlusion often in the brain, extremities and GI tract. While the composure of this plaque is mostly fibrin and lipid, it is the ulceration, bleeding and active inflammation that produces catastrophic outcomes. Neovascularization plays a central role in plaque initiation, progression and rupture. Quantifying these inflammatory microvessels is a surrogate marker of plaque instability and stroke risk. Histopathologic evidence shows plaque with high vessel density is more likely to rupture. [5]

SUMMARY
Covid-19 affliction of the arterial and venous systems with clot formation and vessel inflammation affect every organ system in the body. Arteritis of the small vessels involves the lungs, heart, brain, kidneys and liver predominantly which increases stroke risk in the absence of other contributing factors. Advanced ultrasound imaging offers early detection alerts and image guided therapeutics are now available. Anti inflammatory treatments, such as the MATH+ protocol used to treat Covid-19 pulmonary disease, might be useful in reducing intra-arterial inflammation and preventing plaque rupture.


REFERENCE

1. Hassani SN, Bard RL: Ultrasonic Diagnosis of Abdominal Aortic Aneurysms.

 J. Natl. Med. Assoc. 66:298-299, July 1974

2. Lande A, Bard RL: Arteriography of Pedunculated Splenic Cysts. Angiology 25:617-621, October 1974

3. Lande A, Bard RL, Rossi P: Takayasu's Arteritis: A World Entity. N.Y. State J. Med. 76:1477-1482, Sep 1976

4. Helbick Eur Radiol 30:5536-5538, 2020

5. Mao l  JAMA Neurol 2020 77:683-690

 

CONTRIBUTORS

ROBERT L. BARD, MD, PC, DABR, FASLMS
Advanced Imaging & Diagnostic Specialist
Dr. Bard received the 2020 nationally acclaimed Ellis Island Award for his lifetime achievement in advanced cancer diagnostic imaging. He co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital imaging technology and has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered sonograms, Power Doppler Histogram, sonofluoroscopy, 3D/4D image reconstruction and the Power Doppler Histogram  are safe, noninvasive, and do not use ionizing radiation. 



PIERRE KORY, M.D., M.P.A.
Dr. Kory is Board Certified in Internal Medicine, Critical Care, and Pulmonary Medicine. He served as the Medical Director of the Trauma and Life Support Center at the University of Wisconsin where he was an Associate Professor and the Chief of the Critical Care Service. He is considered a pioneer and national/international expert in the field of Critical Care Ultrasound and is the senior editor of the widely read textbook “Point-of-Care Ultrasound” (winner of the President’s Choice Award for Medical Textbooks from the British Medical Association in 2015).  Most recently, Dr. Kory joined the emergency volunteer team during the early COVID-19 pandemic in NYC at Mount Sinai Beth Israel Medical Center. He is also a founding member of the Front Line COVID-19 Critical Working Group (flccc.net) composed of 5 critical care experts that devised the COVID-19 treatment protocol called MATH+. (www.covid19criticalcare.com/)

Thursday, October 1, 2020

What is HIFU? High Intensity Ultrasound for the Treatment of Cancer

INTRODUCTION TO HIFU

By: Dr. Robert L. Bard  |   Graciella Davi | Editorial Staff @ NY Cancer Resource Alliance

Medical science has taken significant leaps in the past three decades with the advent of a non-invasive approach to surgical investigation and treatment modalities.  This movement was greatly prompted by the need to reduce or eliminate the many significant risks and hidden dangers of cutting through the skin and vital organs.  Technologies such as the ULTRASOUND offers the medical community life-saving alternatives that ensures quantifiable results without the  potential dangers to the patient. (also see "No More Scalpel" and "Bye Bye Biopsies")

Pursuing the concept of safe, non-surgical alternatives, the principle of HIFU is based on controllable high energy sound waves, which leads to coagulation necrosis at the focal point. It can be applied for different indications: complete ablation of prostatic tissue is attempted in whole gland HIFU in the primary treatment of localized prostate cancer. [1] The first therapeutic trial of high intensity ultrasound beams was carried out in 1942. The Fry brothers are credited with the first application of HIFU for neurologic disorders in humans. Early attempts to generate HIFU lesions in the brain through the intact skull bone were unsuccessful. Jan 10, 2011 [2]



HIFU: THE NEXT WAVE OF NON-INVASIVE CANCER TREATMENT By: Dr. Robert L. Bard 

Prostate cancer, certainly the most common cancer among men, might be considered a two-headed hydra. On the one hand, some of these tumors, especially among African-Americans are aggressive, resulting in premature death. On the other hand, many of these tumors are slow growing and for a significant subset of patients, watchful waiting is recommended. But it is difficult to watch and wait when you believe that a cancer is growing within.

The quest for minimally invasive treatments of prostate tumors has been ongoing since the 1990’s. There have been advocates of focal freezing as well as heating of prostate tissue that results in the destruction of prostate cancers. Focal cancers may be targeted by high intensity focused ultrasound beams (High Intensity Focused Ultrasound or HIFU) and have been in clinical practice for 25 years. Developed simultaneously in the US (Sonoablate 500) and France (Ablatherm) the technique is favored by men wishing to avoid possible complications or side effects of surgery or radiation therapy. 

Treatment is usually performed under anesthesia. Energy is delivered to malignant tissue using in this instance, high frequency ultrasound waves that heats the tissue above 40 degrees Centigrade destroying the tissue.  Tissue temperature is closely monitored by sophisticated electronics to minimize adjacent tissue damage which can result in narrowing of the urethrae and obstruction of the flow of urine. Additionally, nerves involved in sexual performance may be inadvertently heated resulting in some degree of sexual dysfunction. 

A recent study reported in the Journal of Urology looked at 52 patients treated with this technique. The results are mixed. Patients included all had localized biopsy proven prostate cancers. The study defined treatment failure as recurrence on follow up biopsy at 20 months showing recurrent or higher grade tumor, metastatic spread systemic therapy or cancer specific mortality. 

  • There were 13 minor complications of which urinary retention was the most common.  There were no deaths and no cases of rectal injury.
  • Of the 60% of individuals undergoing repeat biopsy, 83% had no residual tumor

This study was limited in two significant ways. First, nearly a quarter of the patients underwent simultaneous “debulking” of prostate tissue by conventional surgical means in order to treat pre-existing difficulties with urination. Second, if biopsy is to be considered the outcome of importance, then 40% of the patients did not complete the study. It did not recognize that microscopic analysis of biopsies is limited by the posttreatment effect on the gland and the gold standard for pathology has been whole gland analysis after radical prostatectomy.


UCLA Health is among the world’s most comprehensive academic health systems, with a mission to provide state-of-the-art patient care, train top medical professionals and support pioneering research and discovery. It includes four hospitals on two campuses — Ronald Reagan UCLA Medical CenterUCLA Mattel Children’s Hospital and the Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA in the Westwood area of Los Angeles, and UCLA Health - Santa Monica Medical Center – and more than 200 medical practices throughout Southern California. UCLA Health also includes the David Geffen School of Medicine at UCLA.


VIEWPOINTS:

Treatment will be more effective on smaller volume glands and low grade cancer. As an imaging specialist, the problem with biopsies is that the cells under the microscope may look malignant but the tumor is clinically indolent or inactive. Biopsies are random and the area presumed to be a cancer may have active malignancy in one area, scarring in another, benign tissue adjacent or immune cells attacking the injured tissue.  Most post treatment biopsies are guided by blood vessel flow study with contrast MRI or 3D Doppler in the cancer site since PSA is not very reliable. The targeted area is the region of greatest arterial tumor arterial concentration.  [J Urol 2016]

Worldwide the aggression of a tumor is determined by the activity of the feeding blood vessels. Generally ablative treatments are deemed successful when there are no more arterial suppliers demonstrable by the various blood flow perfusion imaging technologies (Doppler ultrasound, CT dye, MRI contrast)  It is well known that there is a PSA rise in the presence of inflammation as well as recurrence which is non diagnostic. Over many years the cancer statistics observed that the re-occurrence of malignancy in 5 years falls between 10-30% regardless of the treatment delivered.


OTHER NON-INVASIVE CANCER SOLUTIONS

ADVANCEMENTS IN PROTON THERAPY
It is commonly observed that surgeons are increasingly using minimally invasive procedures. Whether it's robotic or video assisted surgeries, we can identify the pattern of new treatment protocols to result in higher quality of life and a reduction in toxicity. In doing so, it allows us, in some cases, to actually improve survival through those same methods of reducing toxicities for patients. According to Dr. Charles B. Simone II, Chief Medical Officer of the New York Proton Center, “We’re going to see more and more customized treatment; it's not a one size fits all approach to cancer. We are going to have individualized ways to deliver radiation therapy, individualized drugs or immune agents—and then, potentially more synergy between modalities such as radiation with systemic therapies.” (See article link)


CYBERKNIFE® AND THE ERA OF ETHICS IN ENGINEERING
Today's engineering and medical technology (from the late 1980s) show significant evidence of ethical standards and major consideration for patient response. Ethics in treatment engineering covers all angles considered about the innovation including: the way it is built, the materials applied, the engagement of the operator and the aftermath of the patient.. “Historically, radiation CAUSED cancer, but that's because you didn't have precision then. You were basically irradiating healthy tissue. That's what you want to avoid at all costs. So the more precise you can be, the better - and we (Accuray) pride ourselves on exquisite and unparalleled precision,” says Ms. Fleurent. (See article link)





About the Author:

DR. ROBERT L. BARDMD, PC, DABR, FASLMS 
For over 40 years, Dr. Bard is recognized internationally for his advanced clinical work in non-invasive cancer diagnostic imaging. His wide body of work is catalogued in countless medical texts and journal articles about the continued advancements in quantitative 3-D Ultrasound Doppler Imaging. In addition, he has been a major advocate for early detection in many high-risk professionals such as first responders, law enforcement and military personnel. Today,  Dr. Bard continues to respond to major health crises like the Coronavirus pandemic with his collaborative research work in chest ultrasound scanning of covid-related issues and the launch of his Medical Virtualization campaign -supporting "borderless medicine" and improved technical response to emergency medical calls.


GRACIELLA DAVI is a public health and safety advocate, an environmental researcher and a publisher for Prevention101, ImmunologyFirst.org, Awareness for a Cure and (fmr) EcoSmart News.  As an educator and writer, her career is dedicated to providing FACT-CHECKED NEWS in assignments concerning health, safety, science and environmental news.  This includes a wide list of studies in Cancer causing agents and pathogenic response and medical innovations.  



REFERENCES

1) High intensity focused ultrasound (HIFU) : Importance in the treatment of prostate cancer https://pubmed.ncbi.nlm.nih.gov/28439616/#:~:text=Results%3A%20The%20principle%20of%20HIFU,treatment%20of%20localized%20prostate%20cancer.

2) High intensity focused ultrasound in clinical tumor ablation - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3095464/#:~:text=HIFU%20BACKGROUND-,History,unsuccessful%5B8%2C10%5D.

Sources: Prospective Evaluation of Focal High Intensity Focused Ultrasound for Localized Prostate Cancer Journal of Urology DOI: 10.1097/JU.0000000000001015



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