Men and their physicians need not hesitate to use a drug proven effective in preventing prostate cancer out of concern that it is likely to cause sexual dysfunction, say authors of a study conducted by the Southwest Oncology Group.
The authors, who surveyed more than 17,000 men 55 and older for seven years, reported their results in the Journal of the National Cancer Institute. The study found that men given finasteride reported on average more dysfunction than did men given a placebo. That small effect diminished over the seven years.
The results allay concerns about a negative side effect associated with finasteride up till now. Physicians usually warn that sexual dysfunction is a possibility when they discuss the drug with patients. Finasteride is an FDA-approved drug for the treatment of benign prostatic hyperplasia, but it is not yet FDA-approved for the prevention or reduction in risk for prostate cancer.
The study’s large sample and long follow-up period allowed researchers to examine whether or not finasteride negatively affected sexual function and, if so, whether this effect was lasting, said Carol Moinpour, Ph.D., of the Fred Hutchison Cancer Research Center in Seattle, the study’s lead author. She coordinates quality-of-life studies for the Southwest Oncology Group, the nation’s largest National Cancer Institute-funded clinical trials network.
The study grew out of the Prostate Cancer Prevention Trial, a large double-blind National Cancer Institute-funded study which found that finasteride, a drug which curbs the proliferation of prostate gland cells, is effective at preventing prostate cancer in men age 55 and older. The 2003 results of that trial, conducted by the Southwest Oncology Group in more than 18,000 men, showed that finasteride could reduce a man’s chances of getting prostate cancer by almost 25 percent.
The authors of the newly published sexual function results wanted to assess how many men in the Prostate Cancer Prevention Trial reported experiencing sexual dysfunction, and whether the problems decreased or increased over time. In earlier studies, some men taking finasteride reported decreased libido, impotence and other signs of diminished sexual function. But these studies were short-term and didn’t try to assess the effects of age and other health factors, as well as individual variation.
The study authors used two surveys, a widely used Sexual Problems Scale and another questionnaire which they created, the Sexual Activity Scale. They also gathered other data to take into account other health factors that affect sexual function, such as age, medical conditions and smoking status. They surveyed the subjects three times in the first year and then annually for seven years.
“Was this average decrease (in sexual function) an important difference” We concluded it was not,” Moinpour said, adding that there were much larger differences due simply to individual variation among men in the trial.
The study suggests that finasteride will cause little or no sexual dysfunction for most men who decide to take it, conclude the authors.
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Article adapted by Medical News Today from original press release.
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Citation: Journal of the National Cancer Institute, DOI: 10.1093/jnci/djm023
In addition to Moinpour, the other authors include: Amy K . Darke , Gary W . Donaldson , Ian M . Thompson, Jr. , Connie Langley , Donna Pauler Ankerst , Donald L . Patrick , John E . Ware, Jr. , Patricia A . Ganz , Sally A . Shumaker , Scott M . Lippman , and Charles A . Coltman, Jr.
Affiliations of authors: Southwest Oncology Group Statistical Center (CMM, AKD) and Division of Public Health Sciences (DLP), Fred Hutchinson Cancer Research Center, Seattle, Wash.; Pain Research Center, Department of Anesthesiology, University of Utah, Salt Lake City (GWD); Department of Urology, University of Texas Health Sciences Center at San Antonio, (IMT); Department of Urology, Wilford Hall Medical Center, Lackland Air Force Base, Tex. (CL); Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany (DPA); Department of Health Services, University of Washington, Seattle (DLP); QualityMetric Incorporated, Lincoln, R.I. (JEW); Health Assessment Lab, Waltham, Mass. (JEW); Schools of Medicine and Public Health and Jonsson Comprehensive Cancer Center, University of California at Los Angeles, (PAG); Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, N.C. (SAS); Departments of Clinical Cancer Prevention and Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, (SML); Cancer Control and Prevention, Southwest Oncology Group, Operations Office, San Antonio, (CAC) .
The study was funded by the National Cancer Institute.
The Southwest Oncology Group (http://www.swog.org/) is the largest cancer clinical trials cooperative group in the United States. Funded by research grants from the National Cancer Institute, part of the National Institutes of Health, the group conducts clinical trials to prevent and treat cancer in adults, and to improve the quality of life for cancer survivors. The group’s network of more than 5,000 physician-researchers practice at nearly 550 institutions, including 16 National Cancer Institute-designated cancer centers. Headquartered in Ann Arbor, Mich. (734-998-7130), the group has an operations office in San Antonio, Tex. and a statistical center in Seattle, Wash.
Source: Anne Rueter
University of Michigan Health System
Tuesday, October 2, 2007
Action Of Cancer Cells Holds Potential For Cancer Treatment
An enzyme that cancer cells eliminate, apparently so they can keep proliferating, may hold clues to more targeted, effective cancer treatment, scientists say.
In a high-stakes tit for tat, protein kinase G enables healthy cells to stay on task to proliferate, differentiate then provide a useful function. Cancer somehow reduces or eliminates PKG and cells get stuck proliferating.
“The bottom line is, in normal tissue, you can see PKG being expressed; but tumors or cell lines that correlate with those tissues don’t have nearly as much,” says Dr. Darren Browning, cancer researcher at the Medical College of Georgia.
Cell lines used for all types of research appear to support his hypothesis. Many are actually cancer cells because of their proclivity to keep producing; Dr. Browning and others have shown PKG is lost in these cells. “You split them once or twice and they kind of lose their character,” he says.
The same appears true for tumors in people, says Dr. Browning, whose lab has found dramatic differences in PKG levels in tumors compared to even nearby, healthy tissue removed in surgery to ensure a cancer-free margin.
The findings made him wonder if the change in PKG level was just an artifact or was critical to cancer survival. “A lot of proteins are lost by cancer cells, so we asked, ‘What happens if we put PKG back into the cancer cells”‘”
He took metastatic colon cancer cells, created a system for reintroducing PKG, then put the cells into mice without an immune system. He admits he was disappointed that the PKG-enhanced cells grew but became very interested in how they grew.
Cancer cells without PKG created hard, solid tumors that spread. PKG-enhanced cells created a soft, non-invasive tumor that literally fell apart on contact and seemed to grow in little islands. After consultation with pathologists and others, he realized the PKG-enhanced cells were congregating around the few blood vessels. “We know that cancer cells, particularly colon cancer cells, are very aggressive at bringing blood vessels into the tumor,” he says. Cells poor at recruiting blood vessels don’t grow well, which seems to be the case for PKG-enhanced colon cancer cells.
Now he wants to know how PKG nullifies aggressive metastatic cancer cells. “We think PKG inhibits cancer by getting rid of a cancer-promoting gene called beta-catenin, which slows growth and blocks the tumor’s ability to recruit blood vessels that are needed to grow bigger,” says Dr. Browning, who recently received a $720,000 American Cancer Society grant to pursue his hypothesis. His proposal was ranked number one by the ACS Cell Structure and Metastasis Study Section.
He’s already shown that PKG can reduce vascular endothelial growth factor, or VEGF; anti-VEGF drugs are the focus of numerous anti-cancer trials underway in the country because of VEGF’s critical role in development of new blood vessels. “Maybe by activating PKG or increasing PKG expression in tumors, we are going to reduce the amount of VEGF they produce,” he says. “We don’t know whether PKG has a role in going from normal tissue to the initiation of a tumor, but we think it’s important to the tumor both in terms of angiogenesis and blocking metastasis.” He points to one of his studies in which colon cancer’s spread to the lungs — a common path for metastatic colon cancer — was completely blocked by PKG expression.
A big part of the magic of PKG may be its impact on a gene called beta-catenin, which enables many stem cells, including those in the skin, bone marrow and colon, to proliferate throughout life. Little pits called crypts in the wall of the colon contain Wnt hormone which stimulate nearby stem cells, causing an increase in beta-catenin. The net effect is the colon makes new cells to replace cells lost to the ongoing grind of absorbing water and minerals from food and forming and eliminating waste.
As cells start moving out of the crypt, away from the Wnt hormone, beta-catenin levels go down so cells should stop dividing and start maturing. Essentially all colon cancers have an aberration in this beta-catenin system that prevents normal degradation and allows cell to keep proliferating.
“In the normal cells that line the colon, you don’t see very much beta-catenin. We think PKG in these cells keeps it that way to keep the cells from continuing to proliferate and spread,” says Dr. Browning, who has already shown that in the test tube at least, adding PKG lowers beta-catenin levels. Interestingly, beta-catenin also is known to regulate VEGF expression in colon cancer.
“In a nutshell, the first and most important genetic lesions leading to colon cancer cause increased beta-catenin levels,” says Dr. Browning. “We found PKG can knock down beta-catenin levels by up to 80 percent in some colon cancer cells and we think that is part of the mechanism by which PKG is able to block tumor angiogenesis and metastasis.”
He’s excited by the implications and is involved in extensive collaborations to understand how PKG regulates beta-catenin and how it might be used in cancer therapies.
Evidence of PKG’s effectiveness in fighting colon cancer in humans may already be available. Colon and rectal cancer is the third most common cancer in men and women in the United States but it’s rare in developing countries where residents eat less processed food and ingest more bacteria. Some of these bacteria make a protein, STa, which appears to prevent and even kill colon cancer cells. Dr. Browning believes that PKG is responsible for STa’s anti-cancer effects.
In a high-stakes tit for tat, protein kinase G enables healthy cells to stay on task to proliferate, differentiate then provide a useful function. Cancer somehow reduces or eliminates PKG and cells get stuck proliferating.
“The bottom line is, in normal tissue, you can see PKG being expressed; but tumors or cell lines that correlate with those tissues don’t have nearly as much,” says Dr. Darren Browning, cancer researcher at the Medical College of Georgia.
Cell lines used for all types of research appear to support his hypothesis. Many are actually cancer cells because of their proclivity to keep producing; Dr. Browning and others have shown PKG is lost in these cells. “You split them once or twice and they kind of lose their character,” he says.
The same appears true for tumors in people, says Dr. Browning, whose lab has found dramatic differences in PKG levels in tumors compared to even nearby, healthy tissue removed in surgery to ensure a cancer-free margin.
The findings made him wonder if the change in PKG level was just an artifact or was critical to cancer survival. “A lot of proteins are lost by cancer cells, so we asked, ‘What happens if we put PKG back into the cancer cells”‘”
He took metastatic colon cancer cells, created a system for reintroducing PKG, then put the cells into mice without an immune system. He admits he was disappointed that the PKG-enhanced cells grew but became very interested in how they grew.
Cancer cells without PKG created hard, solid tumors that spread. PKG-enhanced cells created a soft, non-invasive tumor that literally fell apart on contact and seemed to grow in little islands. After consultation with pathologists and others, he realized the PKG-enhanced cells were congregating around the few blood vessels. “We know that cancer cells, particularly colon cancer cells, are very aggressive at bringing blood vessels into the tumor,” he says. Cells poor at recruiting blood vessels don’t grow well, which seems to be the case for PKG-enhanced colon cancer cells.
Now he wants to know how PKG nullifies aggressive metastatic cancer cells. “We think PKG inhibits cancer by getting rid of a cancer-promoting gene called beta-catenin, which slows growth and blocks the tumor’s ability to recruit blood vessels that are needed to grow bigger,” says Dr. Browning, who recently received a $720,000 American Cancer Society grant to pursue his hypothesis. His proposal was ranked number one by the ACS Cell Structure and Metastasis Study Section.
He’s already shown that PKG can reduce vascular endothelial growth factor, or VEGF; anti-VEGF drugs are the focus of numerous anti-cancer trials underway in the country because of VEGF’s critical role in development of new blood vessels. “Maybe by activating PKG or increasing PKG expression in tumors, we are going to reduce the amount of VEGF they produce,” he says. “We don’t know whether PKG has a role in going from normal tissue to the initiation of a tumor, but we think it’s important to the tumor both in terms of angiogenesis and blocking metastasis.” He points to one of his studies in which colon cancer’s spread to the lungs — a common path for metastatic colon cancer — was completely blocked by PKG expression.
A big part of the magic of PKG may be its impact on a gene called beta-catenin, which enables many stem cells, including those in the skin, bone marrow and colon, to proliferate throughout life. Little pits called crypts in the wall of the colon contain Wnt hormone which stimulate nearby stem cells, causing an increase in beta-catenin. The net effect is the colon makes new cells to replace cells lost to the ongoing grind of absorbing water and minerals from food and forming and eliminating waste.
As cells start moving out of the crypt, away from the Wnt hormone, beta-catenin levels go down so cells should stop dividing and start maturing. Essentially all colon cancers have an aberration in this beta-catenin system that prevents normal degradation and allows cell to keep proliferating.
“In the normal cells that line the colon, you don’t see very much beta-catenin. We think PKG in these cells keeps it that way to keep the cells from continuing to proliferate and spread,” says Dr. Browning, who has already shown that in the test tube at least, adding PKG lowers beta-catenin levels. Interestingly, beta-catenin also is known to regulate VEGF expression in colon cancer.
“In a nutshell, the first and most important genetic lesions leading to colon cancer cause increased beta-catenin levels,” says Dr. Browning. “We found PKG can knock down beta-catenin levels by up to 80 percent in some colon cancer cells and we think that is part of the mechanism by which PKG is able to block tumor angiogenesis and metastasis.”
He’s excited by the implications and is involved in extensive collaborations to understand how PKG regulates beta-catenin and how it might be used in cancer therapies.
Evidence of PKG’s effectiveness in fighting colon cancer in humans may already be available. Colon and rectal cancer is the third most common cancer in men and women in the United States but it’s rare in developing countries where residents eat less processed food and ingest more bacteria. Some of these bacteria make a protein, STa, which appears to prevent and even kill colon cancer cells. Dr. Browning believes that PKG is responsible for STa’s anti-cancer effects.
Computer Dosage Calculation Of Blood Thinning Drugs Found To Be Safe
The largest ever study into the administration of blood thinning drugs like Warfarin has concluded that dosages calculated by computer are at least as safe and reliable as those provided by trained medical professionals.
Increasing evidence of the value of these anticoagulant drugs in a wide range of clinical disorders such as abnormal heart rhythm, or atrial fibrillation, has led to a rapid rise in their use around the world.
However, prescribing the right oral dose of anticoagulant to patients, even for experienced medical staff, can be problematic as individuals differ greatly in response to a given dose: too high a dose for an individual and the blood becomes too thin and can lead to internal bleeding, too low and the blood clots too readily.
Previous studies supporting the use of computer-assisted dosage have depended solely on laboratory results and have not been sufficiently large to determine whether observed improvements in normal blood clotting time — known as the ‘international normalised ratio’ or INR — resulted in clinical benefit and improved safety.
But now results from a four-year clinical trial organised from The University of Manchester have shown that computer-assisted dosage is as good, if not better, at prescribing the correct dosage to normalise and maintain the correct INR in patients as dosages given by medical professionals.
“The need for computer assistance arises from the massive demand for oral anticoagulants following their success at treating an increasing number of thrombotic and embolic conditions,” said Professor Leon Poller, who headed the research in Manchester’s Faculty of Life Sciences.
“This increased demand has been overwhelming and stretched medical facilities worldwide to their limits. Computer dosage was introduced as a way to meet this demand but its safety and effectiveness had never been established.”
The study, carried out in 32 medical centres across the European Union and involving more than 13,000 patients, analysed nearly 400,000 INR tests, divided evenly between manual and computer-assisted dosage.
The percentage of manual tests to give the correct INR was 64.7%, compared to 65.9% for computer-assisted dosage, confirming the effectiveness of the two programs tested by the team.
In terms of safety, the number of INR tests that resulted in clinical complications was 7.6% lower in all clinical groups with computer-assisted dosage, dispelling any safety concerns.
Indeed, while this overall figure may not be deemed significant, in the 3,208 patients with deep vain thrombosis or pulmonary embolism, the number of clinical events following treatment were significantly lower for computer dosage — 9.1 per 100 patient-years with medical staff dosage was reduced to 6.1 in the computer arm.
“The results are even more impressive when you consider that the comparisons were made against medical professionals based at centres that specialised in prescribing oral anticoagulants,” said Professor Poller.
“At the very least, our study confirms the clinical safety and effectiveness of computer-assisted dosage using the two systems we tested and should help to bring relief to overstretched medical professionals while providing reassurance to patients.”
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Article adapted by Medical News Today from original press release.
—————————-
The 32 centres with a special interest in oral anticoagulation recruited 13,219 patients, providing 18,617 patient-years.
INR tests numbered 193,890 with manual dosage and 193,424 with computer-assistance, giving ‘time-in-range’ of 64.7% and 65.9% respectively.
The two computer programs tested were PARMA 5 and DAWN AC.
The results of the study have just been presented to the International Society on Thrombosis and Haemostasis conference in Geneva, Switzerland.
Increasing evidence of the value of these anticoagulant drugs in a wide range of clinical disorders such as abnormal heart rhythm, or atrial fibrillation, has led to a rapid rise in their use around the world.
However, prescribing the right oral dose of anticoagulant to patients, even for experienced medical staff, can be problematic as individuals differ greatly in response to a given dose: too high a dose for an individual and the blood becomes too thin and can lead to internal bleeding, too low and the blood clots too readily.
Previous studies supporting the use of computer-assisted dosage have depended solely on laboratory results and have not been sufficiently large to determine whether observed improvements in normal blood clotting time — known as the ‘international normalised ratio’ or INR — resulted in clinical benefit and improved safety.
But now results from a four-year clinical trial organised from The University of Manchester have shown that computer-assisted dosage is as good, if not better, at prescribing the correct dosage to normalise and maintain the correct INR in patients as dosages given by medical professionals.
“The need for computer assistance arises from the massive demand for oral anticoagulants following their success at treating an increasing number of thrombotic and embolic conditions,” said Professor Leon Poller, who headed the research in Manchester’s Faculty of Life Sciences.
“This increased demand has been overwhelming and stretched medical facilities worldwide to their limits. Computer dosage was introduced as a way to meet this demand but its safety and effectiveness had never been established.”
The study, carried out in 32 medical centres across the European Union and involving more than 13,000 patients, analysed nearly 400,000 INR tests, divided evenly between manual and computer-assisted dosage.
The percentage of manual tests to give the correct INR was 64.7%, compared to 65.9% for computer-assisted dosage, confirming the effectiveness of the two programs tested by the team.
In terms of safety, the number of INR tests that resulted in clinical complications was 7.6% lower in all clinical groups with computer-assisted dosage, dispelling any safety concerns.
Indeed, while this overall figure may not be deemed significant, in the 3,208 patients with deep vain thrombosis or pulmonary embolism, the number of clinical events following treatment were significantly lower for computer dosage — 9.1 per 100 patient-years with medical staff dosage was reduced to 6.1 in the computer arm.
“The results are even more impressive when you consider that the comparisons were made against medical professionals based at centres that specialised in prescribing oral anticoagulants,” said Professor Poller.
“At the very least, our study confirms the clinical safety and effectiveness of computer-assisted dosage using the two systems we tested and should help to bring relief to overstretched medical professionals while providing reassurance to patients.”
—————————-
Article adapted by Medical News Today from original press release.
—————————-
The 32 centres with a special interest in oral anticoagulation recruited 13,219 patients, providing 18,617 patient-years.
INR tests numbered 193,890 with manual dosage and 193,424 with computer-assistance, giving ‘time-in-range’ of 64.7% and 65.9% respectively.
The two computer programs tested were PARMA 5 and DAWN AC.
The results of the study have just been presented to the International Society on Thrombosis and Haemostasis conference in Geneva, Switzerland.
Cancer Vaccines: Training the Immune System to Fight Cancer
By Michelle Meadows
Vaccines traditionally have been used to prevent infectious diseases such as measles and the flu. But with cancer vaccines, the emphasis is on treatment, at least for now. The idea is to inject a preparation of inactivated cancer cells or proteins that are unique to cancer cells into a person who has cancer. The goal: to train the person's immune system to recognize the living cancer cells and attack them. (See "The Immune System and How It Works.")
"The best settings are for treating people who have minimal disease or a high risk of recurrence," says Jeffrey Schlom, Ph.D., chief of the Laboratory of Tumor Immunology and Biology at the National Cancer Institute (NCI). "But at this time, most therapeutic cancer vaccines are being studied in people who have failed other therapies."
Cancer vaccines are experimental; none have been licensed by the Food and Drug Administration. But there are about a dozen cancer vaccines in advanced clinical trials, says Steven Hirschfeld, M.D., a medical officer in the FDA's Center for Biologics Evaluation and Research. "Research has shown us that the fundamental approach to cancer vaccines is right; we are moving in the right direction," he says.
The three standard cancer therapies are surgery to remove tumors; chemotherapy, which modifies or destroys cancer cells with drugs; and radiation, which destroys cancer cells with high-energy X-rays. Immunotherapy, which includes cancer vaccines, is considered a fourth, and still investigational, type of therapy. Cancer vaccines are sometimes used alone, but are often combined with a standard therapy.
While standard treatments alone have proven effective, they also have limitations. Radiation and chemotherapy can wipe out a person's cancer cells, but they also damage normal cells. "We want to find treatment that is more targeted and less toxic," says Hirschfeld. "Cancer vaccines are designed to be specific, targeting only the cancer cells without harming the healthy ones."
The approach has made cancer vaccines generally well tolerated, allowing them to be used in outpatient settings. And they can be added to standard therapy with a low likelihood of causing further serious side effects.
How Cancer Vaccines Work
Cancer is a term for more than 100 diseases characterized by the uncontrolled, abnormal growth of cells. To the immune system--the body's natural defense system against disease--cancer cells and normal cells look the same. The immune system tends to tolerate the cancer cells, just as it tolerates the normal cells. That's because the immune system doesn't recognize cancer cells as something foreign, Hirschfeld says. Rather, cancer cells are once-normal cells that have gone awry. Cancer vaccines try to get the immune system to overcome its tolerance of cancer cells so that it can recognize them and attack them.
All cells have unique proteins or bits of proteins on their surface called antigens. Many cancer cells make cancer-specific antigens. The goal of using cancer antigens as a vaccine is to teach the immune system to recognize the cancer-specific antigens and to reject any cells with those antigens. The antigens activate white blood cells called B lymphocytes (B cells) and T lymphocytes (T cells). B cells produce antibodies that recognize a particular antigen and bind to it to help destroy the cancer cells. T cells that recognize a particular antigen can attack and kill cancer cells. In 1991, the first human cancer antigen was found in cells of a person with melanoma, a discovery that encouraged researchers to search for antigens on other types of cancer, according to the NCI.
The two main approaches for cancer vaccines are whole-cell vaccines and antigen vaccines. Whole-cell vaccines may take whole cancer cells from a patient or sometimes several patients, or use human tumor cell lines derived in a laboratory. "Some cell-based vaccines use tumor cells from the patient, some contain something that looks like a tumor cell but was created in a lab, and others are personalized vaccines that use some cells from the patient and some from the lab," Hirschfeld says. Cells that are taken from people with cancer are altered in a lab to inactivate them so that they are safe to re-inject.
Regardless of the exact source of the cells, whole cell vaccines potentially use all the antigens found on the tumor cells. Antigen vaccines try to trigger an immune response by using only certain antigens from cancer cells. Hirschfeld says antigens may be particular to an individual, to a certain type of cancer, or to several types of cancers.
Boosting the Immune Response
In the early 1990s, Steven Rosenberg, M.D., one of the pioneers of immunotherapy and chief of surgery at the NCI, wrote that trying to use the immune system to fight cancer is so difficult that it made him feel "like a dog trying to bite a basketball." Among Rosenberg's contributions was identifying the antigens that trigger an immune response, and cloning genes that look for, or "code for," those antigens.
Researchers have been working to develop cancer vaccines for more than 100 years in one form or another, and the main mission has always been to make the immune system's response to the cancer antigens as strong as possible.
One major strategy involves combining vaccines with additional substances called adjuvants, which act as chemical messengers that help T cells work better. An example of one type of adjuvant, called a cytokine, is interleukin-2. This protein is made by the body's immune system and can also be made in a lab.
There have also been improvements in vaccine delivery. For example, Schlom developed a vaccine in which genes for tumor antigens are put into a weakened virus called a "vector" that delivers genetic materials to cells. This makes the tumor antigen more visible to the immune system. The CEA-TRICOM vaccine was developed at the NCI through a cooperative research and development agreement with Therion Biologics in Cambridge, Mass. Researchers use the vaccinia virus, the same virus in the smallpox vaccine, as the vector. The carcinoembryonic antigen (CEA), which is found on most breast, lung, colon, and pancreatic tumors, is added to the virus. Researchers also add three molecules, called "costimulatory molecules," which serve as signals that make the vaccine more potent than it would be if the antigen were used alone. A similar vaccine developed under the NCI agreement with Therion is the PANVAC vaccine, which has now entered advanced study as a treatment for pancreatic cancer.
In addition to studying this type of virus-based technique, researchers at Duke University's Cancer Center in Durham, N.C., have been studying vaccines that mix white blood cells called dendritic cells with genetic material from a person's tumor.
Dendritic cells, which can activate T cells, work by looking around, finding antigens, and showing them to the fighter T cells. Researchers have found ways to increase the number of dendritic cells in a vaccine. "Employing millions of 'pumped up' dendritic cells can help elicit a strong immune response," says H. Kim Lyerly, M.D., director of the Duke cancer center.
Recent work by Lyerly and Duke investigators Michael Morse, M.D., and Timothy Clay, Ph.D., has focused on modifying dendritic cells with viruses so that they activate even stronger T cell responses against cancer antigens.
"This is an evolving area, and it's exciting to be able to make progress," says Lyerly. "For decades, people thought it wasn't even fundamentally possible to develop cancer vaccines, and here we are. The science behind cancer vaccines is leading us to believe that we will find the answers."
Promising, But Still Early
As with any new treatment, cancer vaccines must be first studied in lab animals and then tested for safety and effectiveness in three phases of human studies, called "clinical trials," before they can be approved by the FDA. In Phase 1 clinical trials, cancer vaccines are used alone and studied for safety and to determine the proper dose. In Phase 2 trials, they are tested for effectiveness and may be used alone or in combination with another therapy. Phase 3 trials are large-scale studies testing effectiveness and usually comparing a vaccine with some standard therapy. Researchers are testing vaccines using various adjuvants, delivery methods, and types of antigens.
Cancer vaccines have shown promise in clinical trials with many types of cancer. According to Howard Streicher, M.D., a senior investigator with the NCI's Cancer Therapy Evaluation Program, it's too soon to say which cancers will be treated with vaccine therapy. The types of tumors that have proven most susceptible to vaccines so far, he says, are: skin cancer (melanoma); kidney cancer (renal cell); a group of cancers that affect the lymphatic system (lymphoma); a malignant tumor of the bone marrow (myeloma); and solid tumors, such as lung cancer. The most work has been done in the area of melanoma, a type of skin cancer in which treatment options are limited when the disease is in advanced stages.
"After having a tumor removed, about half of patients with stage III melanoma may have a recurrence, and we want to prevent that," Streicher says. "Chemotherapy doesn't work in this area, so our hope is that this could be just the right place for a vaccine."
James Mulé, M.D., Ph.D., associate director of the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Fla., says, though some early studies have shown that some people's tumors shrank or even disappeared in response to a cancer vaccine, it's still early. Mulé was an investigator on the first study that tested dendritic cells in children. In the Phase 1 study, one 16-year-old with cancer that had spread to her lungs and spine showed significant shrinkage of tumors.
"There is promise in the sense that some of these vaccines can illicit a powerful immune response in some patients, but I think we have to be careful about getting too excited over early studies that can't be reproduced," Mulé says.
Jeffrey Weber, M.D., Ph.D., director of the Norris Melanoma Center at the University of Southern California, says there is also still a lot of work to be done in discovering new antigens and adjuvants and more sophisticated strategies to overcome the immune system's tolerance of cancer cells. "We are still discovering molecules that regulate the immune system such as CTLA-4, so we're still in the dark in some areas," Weber says. Recent research has found that inhibiting CTLA-4 can help the immune system attack some tumors.
Experts say that no therapeutic cancer vaccine has been licensed yet because few Phase 3 studies have been completed, and those that have been completed did not meet their goals of demonstrating safety and effectiveness of the vaccine. "We are still working with industry to define the characteristics, including potency," says the FDA's Hirschfeld. "So a trial may look promising early on, but our job is to make sure it can be reproduced. We have to ask: 'Will this treatment work in the larger population?'"
One of the challenges is that cancer vaccines may produce different effects than those caused by cancer drugs. With cancer drugs, experts ask whether there is an objective, measurable response, such as tumor shrinkage. A cancer drug may cause tumors to shrink, but a person still may not live longer. With a cancer vaccine, there may be fewer signs of tumor shrinkage, but a person might live longer.
There aren't the same landmarks that you would see with traditional therapies, says Natalie Sacks, M.D., medical director in the clinical research division at San Francisco-based Cell Genesys, which is studying its vaccines, called GVAX, in people with prostate cancer, pancreatic cancer, leukemia, and myeloma. These whole-cell vaccines all use a hormone that stimulates immune response, called granulocyte macrophage colony stimulating factor (GM-CSF).
"As sponsors, we want to develop treatments and get them out to the market and help patients," Sacks says. "In the case of cytotoxic chemotherapies, the traditional endpoints used in drug development are shorter-term outcomes, such as tumor response and progression-free survival. Where I expect immunotherapy to be successful is in longer-term outcomes and increased survival. Because of the mechanism of action, the patient may not show an immediate response as is generally observed with standard chemotherapies, and the trial may take longer."
Finding a Clinical Trial
Cancer researchers say their work won't mean much if more people don't enroll in clinical trials. According to the NCI, less than 3 percent of U.S. adults with cancer participate in clinical trials.
If there is a standard treatment available for a type of cancer, the NCI recommends choosing it over an experimental therapy. Cancer vaccines show the most promise at preventing a recurrence of cancer after surgery, radiation, or chemotherapy because the immune system will need to recognize and attack a smaller number of cancer cells. Cancer vaccines are also being tested as a treatment for advanced cancer.
Gary Montgomery, 66, of Redmond, Wash., enrolled in a cancer vaccine trial in 2002 to treat a rare form of abdominal cancer called pseudomyxoma peritonei. According to the National Organization for Rare Disorders, the disease is characterized by the accumulation of mucus-secreting tumor cells in the abdomen and pelvis. As the mass of tumor cells grows, the abdomen swells and digestive function becomes impaired.
Montgomery first had the standard therapy of surgery to remove the tumors in 2000. "They opened me up like a sardine can--from the sternum to the abdomen--and took out as many tumors as possible," Montgomery says. Then they inserted a tube into the abdomen, which delivered chemotherapy for six months. He experienced no tumor growth for about a year, but then the tumors came back. "It's known as a relentless form of cancer that wears you down," he says. "The doctor said that with the exception of another surgery, there was really nothing else they could do."
So Montgomery started with the Internet and found one NCI study that involved surgery and chemotherapy with an agent different from the one he had before. But the trial was closed. Taking advice from a friend, he checked at the Lombardi Cancer Center at Georgetown University in Washington, D.C. "I was feeling pretty low at this point," he says. He found out the one vaccine study he was interested in had just ended. But a nurse told him that another trial with newer versions of cancer vaccines developed at the NCI was about to start. "There were two slots left," he says. "Luckily, I met the criteria."
Montgomery received a "prime-boost regimen" of Therion Biologics' TRICOM vaccine. He first received an injection in the upper leg of a modified version of the smallpox vaccine to prime the immune system. Then he received monthly boosters of a vaccine called fowlpox CEA (carcinoembryonic antigen), an antigen found on most colorectal and pancreatic cancers. He also received a shot of the hormone GM-CSF, which helps stimulate the cells of the immune system. He had to give some of the injections to himself when he arrived back home in Washington state.
He says he experienced minimal side effects, such as soreness at the site of injection and mild flu-like symptoms. Though most cancer vaccines have been well-tolerated, in other trials some people have experienced autoimmune problems such as inflammation of the thyroid gland, skin disorders, and colitis. Autoimmune conditions are those in which the immune system mistakenly attacks the body's tissues and organs. Before he began the trial, Montgomery signed an informed consent form acknowledging that he was aware of all the risks.
Montgomery continues to participate in the trial and flies to the nation's capital every month to receive treatment because it's been working. "It hasn't cured the cancer," Montgomery says, "but it seems to be keeping it in check. And that's good enough for me."
For Successful Healing, Cancer Must Be Treated as a Multi-System Disease
You have just been diagnosed with cancer. Your oncologist is pushing you to begin chemotherapy immediately. You know that chemotherapy will make you sick, your hair fall out and leave you completely debilitated and dependent on someone to care for you. You will suffer severe side-effects that may leave your nervous system damaged, weaken your bones or damage your heart. You also realize that chances are your cancer will return after months of grueling treatments. You think maybe you would like to try alternative medicine but your oncologist is against it and you know of others who tried that route and died. What you may not know is this: Cancer can be healed naturally, and is done so every day, but it takes more than a multivitamin, a few supplements and a daily bowl of blueberries to accomplish complete healing.
As an herbalist who has spent many years helping cancer patients heal themselves I have come to the conclusion, like many herbalists before me, that cancer is a result of what I call ‘poor blood’ – by poor I mean the blood is not in optimal condition. Since the blood circulates through every organ in the body and through every cell, it only makes sense that toxins in the blood contaminate the entire body. Blood becomes less than optimal when it is not nourished properly. Without proper nourishment to the blood the body will not survive. It may survive for awhile, even years, but ultimately, the body will suffer from starvation to organs which ultimately causes illness with cancer often resulting as the eventual killer. Therefore, the fundamental goal in curing cancer is not only to restore the blood but to also treat the lymph glands, kidneys, liver, bowel, and bones by nourishment found in herbs. Herbs are effective in healing the body because they are modulators and understand the intricacy of the body’s innate healing capabilities. Their role is to enhance and direct the body’s various systems to function optimally thereby restoring health without doing harm.
Begin with an herbal blood/lymph tonic that includes herbs to build the blood, cleanse the blood, inhibit bacteria, and boost the white blood cells, the red blood cells, and the immune system. An example of a combination of herbs for a tonic that would fit the above criteria is: anise seed (anti-spasmodic, anti-microbial and appetite stimulant), astragalus (helps trigger immune cells), blue violet/sweet violets (has a good reputation for it’s anti-cancer properties through its blood purifying ability), burdock (has been shown to have anti-cancer properties; removes uric acid from body), chaparral (anti-bacterial, anti-viral, anti-tumor), fennel (excellent for digestion; supports spleen and gallbladder) dandelion root (a rich source of vitamins and minerals), licorice root (shows a broad range of anticancer activity in vitro; antibody production is enhanced; inhibits growth of several DNA and RNA viruses), oregon grape (stimulates white blood cells known as macrophages; excellent for the blood), red clover (clinical evidence has shown there is basis for its long-standing reputation as an anti-cancer herb though purifying the blood), yellow dock (excellent for purifying blood supplied to the glands; improves function of the intestines, kidneys, liver and lymph glands; eliminates pollutants including lead and arsenic).
The kidneys need to be supported because they are the organs that filter the blood. They are responsible for separating urea, mineral salts, toxins and other waste products from the blood to be discarded in the urine while it sends clean blood back into the body. They also conserve water, salts, and electrolytes. Prescription medicine is the biggest cause of kidney toxicity with heavy metals from pollution a close second. When the kidneys are weak due to congestion they are unable to completely filter waste products from the blood, which is why an herbal kidney formula needs to be incorporated in all cancer treatments. A good kidney formula might contain cilantro (removes heavy metals), cleavers (clears obstructions, reduces swelling, and is also excellent for the lymphatic system making it a wise choice for any kidney tonic when the body has cancer; it will keep the lymph clear), horsetail (clears uric acid), hydrangea root (reduces backache due to kidney pain and dissolves obstructions) gravel root (dissolves kidney stones), uva ursi (antibiotic properties), sandalwood (antiseptic), marshmallow root (high Vitamin A content; it is also good to clear mucus buildup in the kidneys and anywhere else in the body), sarsaparilla (blood purifier; kidney circulation), saw palmetto (urinary & prostate support).
The liver is part of the digestive system. It stores carbohydrates, fats, and proteins until it can break them down. The main purpose of the liver is to clean out fluids and to clear toxins from the blood. The liver is a highly vascular tissue so it is important that the body’s circulation is in good condition otherwise the liver may become congested. If the body is sick with cancer the liver needs help. It needs to be cleansed while at the same time built up. Some of the herbs you might choose for a liver tonic to both cleanse and heal the liver are: agrimony (not only helps the liver but also supports the intestines) barberry (aids in the secretion of bile and helps regulate digestive problems), bupleurum (liver specific but it also works for inflammation and pain), dandelion (helps bile duct inflammation and gives gastric balance while supporting the gall bladder and pancreas) horehound (for chronic liver illness), parsley (supports blood vessels and capillaries), pau d’ arco (clears out liver poisons and fungus), licorice (provides energy and works to heal hepatitis and liver lesions), milk thistle (liver diseases and gallbladder support), oregon grape (a hepatic which means it is specific for treating the liver while at the same time a powerful blood cleanser), wild yam (for bilious colic, indigestion and spasms).
Now we look to the colon. The purpose of the colon as an eliminative organ is to remove waste material by mass muscular contraction called peristalsis. In my experience I have found that nearly 75% of cancer patients have suffered from some form of chronic constipation during their lives. I consider constipation when the bowels do not move at least once a day. When the bowels do not move daily poisons can accumulate in the colon. Depending on where the poison accumulates in the colon will depend on where cancer develops for there is a point on the colon for every organ and system in the body. Any of these points, if clogged, toxic, or full of old fecal matter, will eventually bring illness to that part of the body the colon signifies. The bowel must be swept clean of all debris. Some people will need a gentle nudge while others require a greater nudge. Herbs that can be used in combination for healing the colon are: aloe vera (has anti-cancer properties; has a long reputation for bowel health; rich in over 200 nutrients), barberry (for bacteria, not only in the bowel, but anywhere in the body), black walnut hull (for parasites), cascara sagrada (anti-biotic effects on harmful bacteria in the colon; restores nerve tone to the colon; cleanses the intestines, builds the bowel, treats a sluggish gallbladder, kills intestinal parasites), cinnamon (kills parasite eggs), cramp bark (eases cramping), fenugreek seed (clears out hardened mucus), gentian (for digestive function including production of stomach acid to break down foods) marshmallow root (helps heal gastritis; is smooth moving; fibrous so it also sweeps and cleans), plantain (clears toxic waste from the body), red raspberry leaf (has anti-cancer properties including ellagic acid), rhubarb (anti-bacterial; eases stomach pain; mild laxative), and yucca (reduces toxins in the alimentary canal; aids digestion; relieves pain; reduces inflammation; breaks up mineral deposits).
Bones also need to be protected so that cancer does not invade to them. Calcium-rich herbs along with red blood cell building herbs will protect the bones as well as give a boost to bone marrow: codonopsis (it stimulates the growth of red blood cells, enhances T-Cell transformation; enhances the spleen and lung), gota kola (strengthens the connective tissue), ho-shou-wo (lumbago, weak bone, sinew and cartilage), horsetail (bones, skin and nails; high in silica), nettles (anemia; red blood cells), oatstraw (heart, nerves, nutritive; calcium; used for general debility), red clover (calcium, chromium, magnesium, niacin, phosphorus, potassium, copper, iron, thiamine, and vitamin C), red raspberry (acts as a nutritive; rich in calcium), rose hips (source of vitamin K), suma (powerful immune stimulator).
It only takes 4 or 5 tonics to heal the blood, lymphatic system, urinary system, digestive system, circulatory system and skeletal system depending on the herbal combinations chosen. The reason is because most herbal combinations will include herbs that treat other organs and conditions as well. Horehound, licorice and blue violet along with marshmallow are excellent for the lungs. Licorice root also supports the adrenal glands. Many of the kidney herbs treat the prostrate. The lymphatic herbs will treat the breast. Herbs in the colon/bowel tonic will treat fungus and Candida. Plantain will eliminate poisons in the body and yucca can help with inflammation while black walnut kills parasites. Bupleurum will help with pain and inflammation.
Every cancer patient should be given one form or another of the above tonics made specifically to fit their special needs for their liver, kidneys, bowel, and bones, along with a blood tonic. The blood tonic should be chosen and made specifically for the type of cancer the client has; just as each person is unique, cancer’s are different as well. I believe all herbal tonics should be in liquid form. Liquid is easy on the digestive organs and it goes straight to the problem. The results are faster and the patient is not overwhelmed with having to swallow 40 or more supplements a day. It is advantageous when the patient is under a great deal of fatigue. Concentrate herbal tonics along with diet changes, essential fatty acids, probiotics, alpha-lipoic-acid for brain protection and at least 9 hour of sleep a night will put you on your way to healing your cancer and restoring your health.
Locate a local herbalist who can prepare concentrated herbal liquid tonics, or teas, for you that are tailored to your special needs.
As an herbalist who has spent many years helping cancer patients heal themselves I have come to the conclusion, like many herbalists before me, that cancer is a result of what I call ‘poor blood’ – by poor I mean the blood is not in optimal condition. Since the blood circulates through every organ in the body and through every cell, it only makes sense that toxins in the blood contaminate the entire body. Blood becomes less than optimal when it is not nourished properly. Without proper nourishment to the blood the body will not survive. It may survive for awhile, even years, but ultimately, the body will suffer from starvation to organs which ultimately causes illness with cancer often resulting as the eventual killer. Therefore, the fundamental goal in curing cancer is not only to restore the blood but to also treat the lymph glands, kidneys, liver, bowel, and bones by nourishment found in herbs. Herbs are effective in healing the body because they are modulators and understand the intricacy of the body’s innate healing capabilities. Their role is to enhance and direct the body’s various systems to function optimally thereby restoring health without doing harm.
Begin with an herbal blood/lymph tonic that includes herbs to build the blood, cleanse the blood, inhibit bacteria, and boost the white blood cells, the red blood cells, and the immune system. An example of a combination of herbs for a tonic that would fit the above criteria is: anise seed (anti-spasmodic, anti-microbial and appetite stimulant), astragalus (helps trigger immune cells), blue violet/sweet violets (has a good reputation for it’s anti-cancer properties through its blood purifying ability), burdock (has been shown to have anti-cancer properties; removes uric acid from body), chaparral (anti-bacterial, anti-viral, anti-tumor), fennel (excellent for digestion; supports spleen and gallbladder) dandelion root (a rich source of vitamins and minerals), licorice root (shows a broad range of anticancer activity in vitro; antibody production is enhanced; inhibits growth of several DNA and RNA viruses), oregon grape (stimulates white blood cells known as macrophages; excellent for the blood), red clover (clinical evidence has shown there is basis for its long-standing reputation as an anti-cancer herb though purifying the blood), yellow dock (excellent for purifying blood supplied to the glands; improves function of the intestines, kidneys, liver and lymph glands; eliminates pollutants including lead and arsenic).
The kidneys need to be supported because they are the organs that filter the blood. They are responsible for separating urea, mineral salts, toxins and other waste products from the blood to be discarded in the urine while it sends clean blood back into the body. They also conserve water, salts, and electrolytes. Prescription medicine is the biggest cause of kidney toxicity with heavy metals from pollution a close second. When the kidneys are weak due to congestion they are unable to completely filter waste products from the blood, which is why an herbal kidney formula needs to be incorporated in all cancer treatments. A good kidney formula might contain cilantro (removes heavy metals), cleavers (clears obstructions, reduces swelling, and is also excellent for the lymphatic system making it a wise choice for any kidney tonic when the body has cancer; it will keep the lymph clear), horsetail (clears uric acid), hydrangea root (reduces backache due to kidney pain and dissolves obstructions) gravel root (dissolves kidney stones), uva ursi (antibiotic properties), sandalwood (antiseptic), marshmallow root (high Vitamin A content; it is also good to clear mucus buildup in the kidneys and anywhere else in the body), sarsaparilla (blood purifier; kidney circulation), saw palmetto (urinary & prostate support).
The liver is part of the digestive system. It stores carbohydrates, fats, and proteins until it can break them down. The main purpose of the liver is to clean out fluids and to clear toxins from the blood. The liver is a highly vascular tissue so it is important that the body’s circulation is in good condition otherwise the liver may become congested. If the body is sick with cancer the liver needs help. It needs to be cleansed while at the same time built up. Some of the herbs you might choose for a liver tonic to both cleanse and heal the liver are: agrimony (not only helps the liver but also supports the intestines) barberry (aids in the secretion of bile and helps regulate digestive problems), bupleurum (liver specific but it also works for inflammation and pain), dandelion (helps bile duct inflammation and gives gastric balance while supporting the gall bladder and pancreas) horehound (for chronic liver illness), parsley (supports blood vessels and capillaries), pau d’ arco (clears out liver poisons and fungus), licorice (provides energy and works to heal hepatitis and liver lesions), milk thistle (liver diseases and gallbladder support), oregon grape (a hepatic which means it is specific for treating the liver while at the same time a powerful blood cleanser), wild yam (for bilious colic, indigestion and spasms).
Now we look to the colon. The purpose of the colon as an eliminative organ is to remove waste material by mass muscular contraction called peristalsis. In my experience I have found that nearly 75% of cancer patients have suffered from some form of chronic constipation during their lives. I consider constipation when the bowels do not move at least once a day. When the bowels do not move daily poisons can accumulate in the colon. Depending on where the poison accumulates in the colon will depend on where cancer develops for there is a point on the colon for every organ and system in the body. Any of these points, if clogged, toxic, or full of old fecal matter, will eventually bring illness to that part of the body the colon signifies. The bowel must be swept clean of all debris. Some people will need a gentle nudge while others require a greater nudge. Herbs that can be used in combination for healing the colon are: aloe vera (has anti-cancer properties; has a long reputation for bowel health; rich in over 200 nutrients), barberry (for bacteria, not only in the bowel, but anywhere in the body), black walnut hull (for parasites), cascara sagrada (anti-biotic effects on harmful bacteria in the colon; restores nerve tone to the colon; cleanses the intestines, builds the bowel, treats a sluggish gallbladder, kills intestinal parasites), cinnamon (kills parasite eggs), cramp bark (eases cramping), fenugreek seed (clears out hardened mucus), gentian (for digestive function including production of stomach acid to break down foods) marshmallow root (helps heal gastritis; is smooth moving; fibrous so it also sweeps and cleans), plantain (clears toxic waste from the body), red raspberry leaf (has anti-cancer properties including ellagic acid), rhubarb (anti-bacterial; eases stomach pain; mild laxative), and yucca (reduces toxins in the alimentary canal; aids digestion; relieves pain; reduces inflammation; breaks up mineral deposits).
Bones also need to be protected so that cancer does not invade to them. Calcium-rich herbs along with red blood cell building herbs will protect the bones as well as give a boost to bone marrow: codonopsis (it stimulates the growth of red blood cells, enhances T-Cell transformation; enhances the spleen and lung), gota kola (strengthens the connective tissue), ho-shou-wo (lumbago, weak bone, sinew and cartilage), horsetail (bones, skin and nails; high in silica), nettles (anemia; red blood cells), oatstraw (heart, nerves, nutritive; calcium; used for general debility), red clover (calcium, chromium, magnesium, niacin, phosphorus, potassium, copper, iron, thiamine, and vitamin C), red raspberry (acts as a nutritive; rich in calcium), rose hips (source of vitamin K), suma (powerful immune stimulator).
It only takes 4 or 5 tonics to heal the blood, lymphatic system, urinary system, digestive system, circulatory system and skeletal system depending on the herbal combinations chosen. The reason is because most herbal combinations will include herbs that treat other organs and conditions as well. Horehound, licorice and blue violet along with marshmallow are excellent for the lungs. Licorice root also supports the adrenal glands. Many of the kidney herbs treat the prostrate. The lymphatic herbs will treat the breast. Herbs in the colon/bowel tonic will treat fungus and Candida. Plantain will eliminate poisons in the body and yucca can help with inflammation while black walnut kills parasites. Bupleurum will help with pain and inflammation.
Every cancer patient should be given one form or another of the above tonics made specifically to fit their special needs for their liver, kidneys, bowel, and bones, along with a blood tonic. The blood tonic should be chosen and made specifically for the type of cancer the client has; just as each person is unique, cancer’s are different as well. I believe all herbal tonics should be in liquid form. Liquid is easy on the digestive organs and it goes straight to the problem. The results are faster and the patient is not overwhelmed with having to swallow 40 or more supplements a day. It is advantageous when the patient is under a great deal of fatigue. Concentrate herbal tonics along with diet changes, essential fatty acids, probiotics, alpha-lipoic-acid for brain protection and at least 9 hour of sleep a night will put you on your way to healing your cancer and restoring your health.
Locate a local herbalist who can prepare concentrated herbal liquid tonics, or teas, for you that are tailored to your special needs.
Adrenal Cancer: The Basics
What are the adrenal glands?
The adrenal glands are small glands that are located just above each of your kidneys (they are sometimes called the suprarenal glands for that reason). They are triangular in shape and consist of several distinct parts.
The central part of the gland is called the adrenal medulla and produces the chemicals epinephrine (also called adrenaline) and norepinephrine. Both of these chemicals play an important role in the regulation of the nervous system. Epinephrine controls the short-term stress response (aka fight-or-flight response). While norepinephrine also plays a role in short-term stress response, it functions in regulating mood and attention, as well.
The outside part of the gland surrounding the medulla is the adrenal cortex . This part of the adrenal gland is largely responsible for producing steroid hormones in the body. There are several types of steroids hormones that are produced by the adrenal glands. Mineralocorticoids (such as aldosterone ) are hormones that help regulate the salt levels in the body by controlling the absorption and excretion of salt and water in the kidneys, which in turn helps to regulate blood pressure. Glucocorticoids (such as cortisol ) are hormones that play a critical role in the regulation of sugar within the body. These hormones also help to regulate the fat stores within the body, act as a strong anti-inflammatory force, and play an important role in fetal development, particularly in lung maturation. The adrenal cortex also produces several sex hormones, including androgens (critical for male sexual development) and precursors to estrogen (critical for female sexual development).
What are adrenal tumors, and what types of adrenal tumors are there?
Normally, cells in the body will grow and divide to replace old or damaged cells. This growth is highly regulated, and once enough cells are produced to replace the old ones, normal cells will stop dividing. Tumors occur when there is an error in this process, and cells continue to grow in an uncontrolled manner. Tumors can either be benign or malignant. Although benign tumors can grow uncontrolled, they do not break off and spread beyond where they start, nor do they invade into surrounding tissues. Malignant tumors (also known as cancers) will grow uncontrolled in such a way that they invade and damage other tissues around them. They also gain the ability to break off from where they start and spread to other parts of the body, usually through the blood stream or through the lymphatic system where the lymph nodes are located (a process known as metastasis ).
The most common tumor of the adrenal gland is actually a benign tumor called an adrenal adenoma . In most patients, these benign tumors never cause a patient to have any symptoms and do not need to be treated. The most common malignant tumors found in the adrenal gland are tumors that come from cancer cells that have metastasized (or spread) from other parts of the body to the adrenal gland through the blood stream. This can occur in a number of different types of cancers, but most commonly occur with melanomas, lung cancers, and breast cancers. The adrenal glands are the fourth most common site in the body for cancer cells to metastasize to, after the lungs, liver, and bone.
Cancers can arise directly within the adrenal glands themselves; however, these are relatively rare. Cancers can arise directly from the adrenal cortex. These cancers can either be functioning (meaning they secrete excess steroid hormones) or non-functioning (meaning they do not secrete steroids). Functioning adrenal cortical cancers are more common than non-functioning cancers. Cancers can also arise within the adrenal medulla, the most common of which are pheochromocytomas . These cancers are discussed in more detail in the section entitled "Pheochromocytomas" and are not discussed further in this review.
Other types of adrenal cancers can occur, such as lymphoma; however, these cases are rare.
What are the signs of adrenal cortical tumors?
Both adrenal adenomas and adrenal cortical cancers can be produce excess steroid hormones. Symptoms vary depending on the steroid that is produced. If too much aldosterone is produced, Conn 's syndrome (also known as primary hyperaldosteronism ) can develop. Conn 's syndrome most commonly occurs with pituitary adenomas, but it can also occur in the setting of adrenal hyperplasia (an overgrowth of normal adrenal cortical tissue) and adrenal cortical cancers. Patients who have Conn's syndrome have elevated blood pressure, decreased levels of potassium in the blood, and decreased levels of a chemical produced by the kidneys called renin in the blood. In most cases of Conn 's syndrome, elevations in blood pressure are mild to moderate. Other symptoms include weakness, muscle cramps, increased thirst, and increased frequency of urination.
If too much cortisol is produced, Cushing's syndrome (also known as hypercortisolism ) can develop. This syndrome is seen not only with adrenal tumors, but can also be the result of excessive levels of adrenal cortical stimulating hormone (also known as ACTH, a hormone that is responsible for stimulating the adrenal glands to produce cortisol) produced by the pituitary gland or another tumor in the body or though the use of corticosteroids as treatment for another disease. The symptoms of Cushing's syndrome can vary greatly from patient to patient and involve a number of different parts of the body. Symptoms include weight gain and water retention resulting in a round face and collection of fat on the back of the shoulders and neck. Red streaks can appear on the skin. Excessive hair growth (called hirsutism) can be seen. Excessive cortisol levels can interfere with the body's immune system predisposing a patient to unusual infections. Patients with Cushing's syndrome can develop diabetes. They can also have mental changes, including mood swings, irritability, and in the worst case, psychotic episodes. Virilization can occur, particularly in women, resulting in deepened voice, loss of hair, and increase in the size of the clitoris. Women can have irregular menstrual periods or stop menstruating altogether, and men can experience sexual impotence. In children, excessive cortisol can lead to premature sexual development and maturation (also called precocious puberty ).
Adrenal tumors can also cause symptoms if they grow large enough. Patients with large adrenal tumors may experience feelings of abdominal fullness or localized pain. Patients may feel as though they are quickly full when eating and may experience weight loss. In some cases of large adrenal tumors, patients may actually feel a mass in their abdomen.
What causes adrenal cortical cancers and am I at risk?
Each year, there are approximately 500 cases of adrenal cortical cancers in the United States. These most commonly occur in patients between the ages of 30 and 50; however, children under the age of 5 develop adrenal cortical cancers at a higher rate than the rest of the population. Males are more likely to develop non-functioning adrenal carcinomas, while females are more likely to develop functioning adrenal carcinomas. In general, it is not known what causes adrenal cortical cancers. It is not associated with smoking and does not run in families. Despite this, certain genetic mutations have been associated with its formation, and research is ongoing in trying to identify the causes of these cancers.
How can I prevent adrenal cortical cancers?
Given that the causes of adrenal cortical cancers are unclear, there are no known interventions that can reduce the risk of developing them.
How are adrenal cortical cancers diagnosed, and how do you tell them apart from adrenal adenomas?
Functioning adrenal cortical cancers and adenomas are frequently diagnosed because of the symptoms caused by the steroids. Patients with Cushing's syndrome need to be evaluated to see if the syndrome is caused by a problem in the adrenal glands or by production of ACTH from the pituitary gland or another tumor somewhere else in the body. The first step is measuring the amount of cortisol in the urine (called a 24-hour urinary free cortisol test ). This test is sometimes performed while giving the patient an extra dose of steroids to see how the body responds. After this is done, most patients undergo a dexamethasone suppression test where patients are given a high dose of the steroid dexamethasone. In normal patients and in patients with Cushing's syndrome due to a problem in the pituitary gland, a high dose of dexamethasone will cause the levels of cortisol in the blood and urine to decrease. In patients with adrenal tumors or another tumor in the body that produces ACTH, cortisol levels remain high even after a patient receives a high dose of dexamethasone.
In patients with excess levels of aldosterone, patients should be tested for blood levels of the chemical renin. In cases of hyperaldosteronism due to a tumor in the adrenal gland, renin levels should be low. In patients who have elevated aldosterone levels due to a problem with the blood vessels of the kidney (a condition called renal artery stenosis), renin levels in the blood are high.
In addition to tests for increased steroid production, radiographic imaging is an important part of the diagnosis of adrenal tumors. Computed Tomography (CT or CAT) scans are commonly used. CT scans use x-rays to form a three-dimensional picture of the inside of the body. If the adrenal tumor is larger than 6 centimeters (cm) on CT scan, it is much more likely to be an adrenal cancer than an adrenal adenoma. In most cases, CT scans can also tell the difference between a normal adrenal gland and adrenal hyperplasia.
Ultrasound is sometimes used in the diagnosis of adrenal tumors. Ultrasounds use sound waves to form a picture of the inside of the body. At times, it can be difficult to tell if an adrenal tumor is an adenoma or a cancer. For tumors that are larger than 3 cm, ultrasound is a good method of telling the difference between the two.
Another type of imaging that is used when it is unclear if an adrenal tumor is an adenoma or cancer is Magnetic Resonance Imaging (MRI). MRI uses magnets to produce a very sharp picture of the inside of the body. Certain types of changes on MRI are more commonly seen in adrenal cancers than adenomas and can be used to tell the two apart.
Positron Emission Tomography (PET) scans use radioactively labeled sugar to find rapidly growing cells within the body. When cells are dividing quickly, they require a lot of energy, and the main source of energy in the body is sugar. Areas of actively dividing tissue will require more sugar than slowly dividing tissue. Because cancer cells are rapidly dividing and growing, they take up more the radioactively sugar than the surrounding tissue and this can be detected by the PET scanner. PET scans have been very useful in detect a number of different types of cancers. Its use in adrenal cancers is still being studied.
Ultimately, the only way to tell for sure if an adrenal tumor is an adrenal adenoma or cancer, part of the tumor must be examined underneath a microscope. In most cases of tumors or cancers in other parts of the body, this is done by obtaining a biopsy of the tumor. A small piece of the tumor is taken, usually through a needle, and examined underneath a microscope. In the case of adrenal tumors, this procedure is usually performed while the patient is undergoing a CT scan, so that the radiologist can see where the needle is going in the body. In some cases, this can also be done using an ultrasound to guide the biopsy.
How are adrenal cortical cancers staged?
In addition to diagnosing adrenal cortical cancers, the radiographic imaging performed also helps to determine the stage of the patient. In general, patients with adrenal cortical cancer are divided into one of four stages.
Stage I: The cancer is smaller than 5 cm and has not spread outside of the adrenal gland.
Stage II: The cancer is larger than 5 cm and has not spread outside of the adrenal gland.
Stage III: The cancer has spread into the fat surrounding the adrenal gland or has spread to lymph nodes near the adrenal gland.
Stage IV: The cancer has spread to other parts of the body, has spread into other organs near the adrenal gland, or has spread into both the fat around the adrenal gland and the lymph nodes near the adrenal gland.
Although this system of cancer staging is quite complicated, it is designed to help physicians describe the extent of the cancer, and therefore, helps to direct what type of treatment is given.
How are adrenal adenomas treated?
Most adrenal adenomas are detected on a CT scan or MRI scan that is performed for an unrelated reason. It is only necessary to treat them if they are causing symptoms. Otherwise, they can be followed with repeated scans periodically. In the event that an adenoma does need to be treated, surgical removal is the most frequent treatment used. In many cases, this can be performed using a laparoscopic procedure. A laparoscope is a small fiberoptic camera that can be inserted into the abdomen through small incisions. Other small instruments can also be inserted through these incisions. The adrenal adenoma can be resected while inside the body, without making a large incision in the abdomen, and removed through the small holes through which the camera and other instruments are inserted. Occasionally, because of the size or location of the adenoma, a laparoscopic procedure cannot be performed, and a large incision will need to be made in the abdomen in order to remove the tumor.
In the majority of cases of hyperaldosteronism, symptoms resolve with surgical removal of the adenoma; however, 30% of patients will have repeat episodes of high blood pressure even after the adenoma is removed. If the adrenal adenoma produces cortisol, the patient should take steroids by mouth before and for some time after the surgery until the body is able to produce these steroids on its own again.
How are adrenal cortical cancers treated?
Surgery
Currently, the only known curative treatment for adrenal cortical cancers is complete resection of the tumor. Unfortunately, this is only possible in a limited number of patients with this disease. At least half of patients with adrenal cortical cancers have metastases or cancer invading into other organs, such that a complete resection of the cancer is not possible. The best results with surgical resection have been with an en bloc resection, meaning that the entire tumor is removed in one piece. This also includes removing the entire kidney on the same side as the adrenal cancer. Because of this, it is unusual for adrenal cancers to be removed using a laparoscopic procedure, although as techniques of laparoscopic resection improve, more patients are being treated with this method. Occasionally, adrenal cancers will grow into the large blood vessel that carries blood back from the lower body to the heart (the vena cava ). Even in these cases, complete resections of the cancer can sometimes be performed. If this is the case, a very large surgery is required involving both a general surgeon or urologist and a vascular surgeon.
Even in cases where the tumor cannot be removed in its entirety, surgical removal of as much tumor as possible can improve symptoms, particularly if they are due to excessive steroid secretion.
Chemotherapy
Chemotherapy is a medication that is usually given intravenously or orally as a pill. It goes to the bloodstream and throughout the body to kill cancer cells. This is one of the big advantages of chemotherapy. If cancer cells have broken off from the tumor and are somewhere else inside the body, chemotherapy has the chance of finding those cells and killing them. A number of different chemotherapeutic agents exist, each with its own side effects. You should discuss the potential side effects of any chemotherapy you may receive with your medical oncologist.
Although chemotherapy is used in some cancers as neoadjuvant or adjuvant treatment (meaning it is given routinely before or after surgery to improve the chances that the cancer stays away), chemotherapy has not been shown to be beneficial in adrenal cancers that have been completely resected. However, chemotherapy is often used in cases where the adrenal cortical cancer has metastasized or where the adrenal gland can not be completely resected. The most commonly used agents for adrenal cortical cancers are mitotane and cisplatin . Mitotane acts to block the hormones produced by the cancer and can also kill adrenal cancer cells. It has been found to cause shrinkage of the tumor in over one-third of patients tested, and in some cases causes complete disappearance of the cancer on radiographic imaging. Despite these good responses, the adrenal cancer usually comes back at some point down the road.
There are a number of other types of chemotherapy used for adrenal cancers. Exactly which chemotherapeutic agents are given varies according to the physician giving them. Based on your own health status and the risks of side effects that you are willing to accept, the choice of chemotherapy can vary.
Radiation Therapy
Radiation therapy is used in a number of cancers as both the main method of killing cancer cells or in combination with surgery (either before or after). The radiation comes in the form of high-energy x-rays that are delivered to the patient only in the areas at highest risk for cancer. These x-rays are similar to those used for diagnostic x-rays, only of a much higher energy. The high-energy of x-rays in radiation therapy results in damage to the DNA of cells, causing tumor cells to die.
Radiation therapy is not part of the routine management of adrenal cancers, particularly in cases where the cancer is completely removed by surgery. Radiation has been tried in cases where surgical removal of the cancer is incomplete or in cases where the cancer comes back after surgery. In these cases, the radiation is usually delivered daily, Monday through Friday, 5 days a week, for a total of 5 to 7 weeks. In general, the side effects associated with this treatment include fatigue, skin redness and irritation, nausea, and diarrhea.
The adrenal glands are small glands that are located just above each of your kidneys (they are sometimes called the suprarenal glands for that reason). They are triangular in shape and consist of several distinct parts.
The central part of the gland is called the adrenal medulla and produces the chemicals epinephrine (also called adrenaline) and norepinephrine. Both of these chemicals play an important role in the regulation of the nervous system. Epinephrine controls the short-term stress response (aka fight-or-flight response). While norepinephrine also plays a role in short-term stress response, it functions in regulating mood and attention, as well.
The outside part of the gland surrounding the medulla is the adrenal cortex . This part of the adrenal gland is largely responsible for producing steroid hormones in the body. There are several types of steroids hormones that are produced by the adrenal glands. Mineralocorticoids (such as aldosterone ) are hormones that help regulate the salt levels in the body by controlling the absorption and excretion of salt and water in the kidneys, which in turn helps to regulate blood pressure. Glucocorticoids (such as cortisol ) are hormones that play a critical role in the regulation of sugar within the body. These hormones also help to regulate the fat stores within the body, act as a strong anti-inflammatory force, and play an important role in fetal development, particularly in lung maturation. The adrenal cortex also produces several sex hormones, including androgens (critical for male sexual development) and precursors to estrogen (critical for female sexual development).
What are adrenal tumors, and what types of adrenal tumors are there?
Normally, cells in the body will grow and divide to replace old or damaged cells. This growth is highly regulated, and once enough cells are produced to replace the old ones, normal cells will stop dividing. Tumors occur when there is an error in this process, and cells continue to grow in an uncontrolled manner. Tumors can either be benign or malignant. Although benign tumors can grow uncontrolled, they do not break off and spread beyond where they start, nor do they invade into surrounding tissues. Malignant tumors (also known as cancers) will grow uncontrolled in such a way that they invade and damage other tissues around them. They also gain the ability to break off from where they start and spread to other parts of the body, usually through the blood stream or through the lymphatic system where the lymph nodes are located (a process known as metastasis ).
The most common tumor of the adrenal gland is actually a benign tumor called an adrenal adenoma . In most patients, these benign tumors never cause a patient to have any symptoms and do not need to be treated. The most common malignant tumors found in the adrenal gland are tumors that come from cancer cells that have metastasized (or spread) from other parts of the body to the adrenal gland through the blood stream. This can occur in a number of different types of cancers, but most commonly occur with melanomas, lung cancers, and breast cancers. The adrenal glands are the fourth most common site in the body for cancer cells to metastasize to, after the lungs, liver, and bone.
Cancers can arise directly within the adrenal glands themselves; however, these are relatively rare. Cancers can arise directly from the adrenal cortex. These cancers can either be functioning (meaning they secrete excess steroid hormones) or non-functioning (meaning they do not secrete steroids). Functioning adrenal cortical cancers are more common than non-functioning cancers. Cancers can also arise within the adrenal medulla, the most common of which are pheochromocytomas . These cancers are discussed in more detail in the section entitled "Pheochromocytomas" and are not discussed further in this review.
Other types of adrenal cancers can occur, such as lymphoma; however, these cases are rare.
What are the signs of adrenal cortical tumors?
Both adrenal adenomas and adrenal cortical cancers can be produce excess steroid hormones. Symptoms vary depending on the steroid that is produced. If too much aldosterone is produced, Conn 's syndrome (also known as primary hyperaldosteronism ) can develop. Conn 's syndrome most commonly occurs with pituitary adenomas, but it can also occur in the setting of adrenal hyperplasia (an overgrowth of normal adrenal cortical tissue) and adrenal cortical cancers. Patients who have Conn's syndrome have elevated blood pressure, decreased levels of potassium in the blood, and decreased levels of a chemical produced by the kidneys called renin in the blood. In most cases of Conn 's syndrome, elevations in blood pressure are mild to moderate. Other symptoms include weakness, muscle cramps, increased thirst, and increased frequency of urination.
If too much cortisol is produced, Cushing's syndrome (also known as hypercortisolism ) can develop. This syndrome is seen not only with adrenal tumors, but can also be the result of excessive levels of adrenal cortical stimulating hormone (also known as ACTH, a hormone that is responsible for stimulating the adrenal glands to produce cortisol) produced by the pituitary gland or another tumor in the body or though the use of corticosteroids as treatment for another disease. The symptoms of Cushing's syndrome can vary greatly from patient to patient and involve a number of different parts of the body. Symptoms include weight gain and water retention resulting in a round face and collection of fat on the back of the shoulders and neck. Red streaks can appear on the skin. Excessive hair growth (called hirsutism) can be seen. Excessive cortisol levels can interfere with the body's immune system predisposing a patient to unusual infections. Patients with Cushing's syndrome can develop diabetes. They can also have mental changes, including mood swings, irritability, and in the worst case, psychotic episodes. Virilization can occur, particularly in women, resulting in deepened voice, loss of hair, and increase in the size of the clitoris. Women can have irregular menstrual periods or stop menstruating altogether, and men can experience sexual impotence. In children, excessive cortisol can lead to premature sexual development and maturation (also called precocious puberty ).
Adrenal tumors can also cause symptoms if they grow large enough. Patients with large adrenal tumors may experience feelings of abdominal fullness or localized pain. Patients may feel as though they are quickly full when eating and may experience weight loss. In some cases of large adrenal tumors, patients may actually feel a mass in their abdomen.
What causes adrenal cortical cancers and am I at risk?
Each year, there are approximately 500 cases of adrenal cortical cancers in the United States. These most commonly occur in patients between the ages of 30 and 50; however, children under the age of 5 develop adrenal cortical cancers at a higher rate than the rest of the population. Males are more likely to develop non-functioning adrenal carcinomas, while females are more likely to develop functioning adrenal carcinomas. In general, it is not known what causes adrenal cortical cancers. It is not associated with smoking and does not run in families. Despite this, certain genetic mutations have been associated with its formation, and research is ongoing in trying to identify the causes of these cancers.
How can I prevent adrenal cortical cancers?
Given that the causes of adrenal cortical cancers are unclear, there are no known interventions that can reduce the risk of developing them.
How are adrenal cortical cancers diagnosed, and how do you tell them apart from adrenal adenomas?
Functioning adrenal cortical cancers and adenomas are frequently diagnosed because of the symptoms caused by the steroids. Patients with Cushing's syndrome need to be evaluated to see if the syndrome is caused by a problem in the adrenal glands or by production of ACTH from the pituitary gland or another tumor somewhere else in the body. The first step is measuring the amount of cortisol in the urine (called a 24-hour urinary free cortisol test ). This test is sometimes performed while giving the patient an extra dose of steroids to see how the body responds. After this is done, most patients undergo a dexamethasone suppression test where patients are given a high dose of the steroid dexamethasone. In normal patients and in patients with Cushing's syndrome due to a problem in the pituitary gland, a high dose of dexamethasone will cause the levels of cortisol in the blood and urine to decrease. In patients with adrenal tumors or another tumor in the body that produces ACTH, cortisol levels remain high even after a patient receives a high dose of dexamethasone.
In patients with excess levels of aldosterone, patients should be tested for blood levels of the chemical renin. In cases of hyperaldosteronism due to a tumor in the adrenal gland, renin levels should be low. In patients who have elevated aldosterone levels due to a problem with the blood vessels of the kidney (a condition called renal artery stenosis), renin levels in the blood are high.
In addition to tests for increased steroid production, radiographic imaging is an important part of the diagnosis of adrenal tumors. Computed Tomography (CT or CAT) scans are commonly used. CT scans use x-rays to form a three-dimensional picture of the inside of the body. If the adrenal tumor is larger than 6 centimeters (cm) on CT scan, it is much more likely to be an adrenal cancer than an adrenal adenoma. In most cases, CT scans can also tell the difference between a normal adrenal gland and adrenal hyperplasia.
Ultrasound is sometimes used in the diagnosis of adrenal tumors. Ultrasounds use sound waves to form a picture of the inside of the body. At times, it can be difficult to tell if an adrenal tumor is an adenoma or a cancer. For tumors that are larger than 3 cm, ultrasound is a good method of telling the difference between the two.
Another type of imaging that is used when it is unclear if an adrenal tumor is an adenoma or cancer is Magnetic Resonance Imaging (MRI). MRI uses magnets to produce a very sharp picture of the inside of the body. Certain types of changes on MRI are more commonly seen in adrenal cancers than adenomas and can be used to tell the two apart.
Positron Emission Tomography (PET) scans use radioactively labeled sugar to find rapidly growing cells within the body. When cells are dividing quickly, they require a lot of energy, and the main source of energy in the body is sugar. Areas of actively dividing tissue will require more sugar than slowly dividing tissue. Because cancer cells are rapidly dividing and growing, they take up more the radioactively sugar than the surrounding tissue and this can be detected by the PET scanner. PET scans have been very useful in detect a number of different types of cancers. Its use in adrenal cancers is still being studied.
Ultimately, the only way to tell for sure if an adrenal tumor is an adrenal adenoma or cancer, part of the tumor must be examined underneath a microscope. In most cases of tumors or cancers in other parts of the body, this is done by obtaining a biopsy of the tumor. A small piece of the tumor is taken, usually through a needle, and examined underneath a microscope. In the case of adrenal tumors, this procedure is usually performed while the patient is undergoing a CT scan, so that the radiologist can see where the needle is going in the body. In some cases, this can also be done using an ultrasound to guide the biopsy.
How are adrenal cortical cancers staged?
In addition to diagnosing adrenal cortical cancers, the radiographic imaging performed also helps to determine the stage of the patient. In general, patients with adrenal cortical cancer are divided into one of four stages.
Stage I: The cancer is smaller than 5 cm and has not spread outside of the adrenal gland.
Stage II: The cancer is larger than 5 cm and has not spread outside of the adrenal gland.
Stage III: The cancer has spread into the fat surrounding the adrenal gland or has spread to lymph nodes near the adrenal gland.
Stage IV: The cancer has spread to other parts of the body, has spread into other organs near the adrenal gland, or has spread into both the fat around the adrenal gland and the lymph nodes near the adrenal gland.
Although this system of cancer staging is quite complicated, it is designed to help physicians describe the extent of the cancer, and therefore, helps to direct what type of treatment is given.
How are adrenal adenomas treated?
Most adrenal adenomas are detected on a CT scan or MRI scan that is performed for an unrelated reason. It is only necessary to treat them if they are causing symptoms. Otherwise, they can be followed with repeated scans periodically. In the event that an adenoma does need to be treated, surgical removal is the most frequent treatment used. In many cases, this can be performed using a laparoscopic procedure. A laparoscope is a small fiberoptic camera that can be inserted into the abdomen through small incisions. Other small instruments can also be inserted through these incisions. The adrenal adenoma can be resected while inside the body, without making a large incision in the abdomen, and removed through the small holes through which the camera and other instruments are inserted. Occasionally, because of the size or location of the adenoma, a laparoscopic procedure cannot be performed, and a large incision will need to be made in the abdomen in order to remove the tumor.
In the majority of cases of hyperaldosteronism, symptoms resolve with surgical removal of the adenoma; however, 30% of patients will have repeat episodes of high blood pressure even after the adenoma is removed. If the adrenal adenoma produces cortisol, the patient should take steroids by mouth before and for some time after the surgery until the body is able to produce these steroids on its own again.
How are adrenal cortical cancers treated?
Surgery
Currently, the only known curative treatment for adrenal cortical cancers is complete resection of the tumor. Unfortunately, this is only possible in a limited number of patients with this disease. At least half of patients with adrenal cortical cancers have metastases or cancer invading into other organs, such that a complete resection of the cancer is not possible. The best results with surgical resection have been with an en bloc resection, meaning that the entire tumor is removed in one piece. This also includes removing the entire kidney on the same side as the adrenal cancer. Because of this, it is unusual for adrenal cancers to be removed using a laparoscopic procedure, although as techniques of laparoscopic resection improve, more patients are being treated with this method. Occasionally, adrenal cancers will grow into the large blood vessel that carries blood back from the lower body to the heart (the vena cava ). Even in these cases, complete resections of the cancer can sometimes be performed. If this is the case, a very large surgery is required involving both a general surgeon or urologist and a vascular surgeon.
Even in cases where the tumor cannot be removed in its entirety, surgical removal of as much tumor as possible can improve symptoms, particularly if they are due to excessive steroid secretion.
Chemotherapy
Chemotherapy is a medication that is usually given intravenously or orally as a pill. It goes to the bloodstream and throughout the body to kill cancer cells. This is one of the big advantages of chemotherapy. If cancer cells have broken off from the tumor and are somewhere else inside the body, chemotherapy has the chance of finding those cells and killing them. A number of different chemotherapeutic agents exist, each with its own side effects. You should discuss the potential side effects of any chemotherapy you may receive with your medical oncologist.
Although chemotherapy is used in some cancers as neoadjuvant or adjuvant treatment (meaning it is given routinely before or after surgery to improve the chances that the cancer stays away), chemotherapy has not been shown to be beneficial in adrenal cancers that have been completely resected. However, chemotherapy is often used in cases where the adrenal cortical cancer has metastasized or where the adrenal gland can not be completely resected. The most commonly used agents for adrenal cortical cancers are mitotane and cisplatin . Mitotane acts to block the hormones produced by the cancer and can also kill adrenal cancer cells. It has been found to cause shrinkage of the tumor in over one-third of patients tested, and in some cases causes complete disappearance of the cancer on radiographic imaging. Despite these good responses, the adrenal cancer usually comes back at some point down the road.
There are a number of other types of chemotherapy used for adrenal cancers. Exactly which chemotherapeutic agents are given varies according to the physician giving them. Based on your own health status and the risks of side effects that you are willing to accept, the choice of chemotherapy can vary.
Radiation Therapy
Radiation therapy is used in a number of cancers as both the main method of killing cancer cells or in combination with surgery (either before or after). The radiation comes in the form of high-energy x-rays that are delivered to the patient only in the areas at highest risk for cancer. These x-rays are similar to those used for diagnostic x-rays, only of a much higher energy. The high-energy of x-rays in radiation therapy results in damage to the DNA of cells, causing tumor cells to die.
Radiation therapy is not part of the routine management of adrenal cancers, particularly in cases where the cancer is completely removed by surgery. Radiation has been tried in cases where surgical removal of the cancer is incomplete or in cases where the cancer comes back after surgery. In these cases, the radiation is usually delivered daily, Monday through Friday, 5 days a week, for a total of 5 to 7 weeks. In general, the side effects associated with this treatment include fatigue, skin redness and irritation, nausea, and diarrhea.
What is cancer of the lung?
Cancer of the lung, like all cancers, results from an abnormality in the body’s basic unit of life, the cell. Normally, the body maintains a system of checks and balances on cell growth so that cells divide to produce new cells only when needed. Disruption of this system of checks and balances on cell growth results in an uncontrolled division and proliferation of cells that eventually forms a mass known as a tumor.
Tumors can be benign or malignant; when we speak of "cancer" we refer to those tumors that are considered malignant. Benign tumors can usually be removed and do not spread to other parts of the body. Malignant tumors, on the other hand, grow aggressively and invade other tissues of the body, allowing entry of tumor cells into the bloodstream or lymphatic system which spread the tumor to other sites in the body. This process of spread is termed metastasis; the areas of tumor growth at these distant sites are called metastases. Since lung cancer tends to spread, or metastasize, very early in its course, it is a very life-threatening cancer and one of the most difficult cancers to treat. While lung cancer can spread to any organ in the body, certain organs – particularly the adrenal glands, liver, brain, and bone - are the most common sites for lung cancer metastasis.
The lung is also a very common site for metastasis from tumors in other parts of the body. Tumor metastases are made up of the same type of cells as the original, or primary, tumor. For example, if prostate cancer spreads via the bloodstream to the lungs, it is metastatic prostate cancer in the lung and is not lung cancer.
Lung Cancer Picture
Picture of lung cancer
The principal function of the lungs is the exchange of gases between the air we breathe and the blood. Through the lung, carbon dioxide is removed from the body and oxygen from inspired air enters the bloodstream. The right lung has three lobes while the left lung is divided into two lobes and a small structure called the lingula that is the equivalent of the middle lobe. The major airways entering the lungs are the bronchi, which arise from the trachea. The bronchi branch into progressively smaller airways called bronchioles that end in tiny sacs known as alveoli, where gas exchange occurs. The lungs and chest wall are covered with a thin layer of tissue called the pleura.
Lung cancers can arise in any part of the lung. Ninety to 95% of cancers of the lung are thought to arise from the epithelial, or lining cells of the larger and smaller airways (bronchi and bronchioles); for this reason lung cancers are sometimes called bronchogenic carcinomas. Cancers can also arise from the pleura (the thin layer of tissue that surrounds the lungs), called mesotheliomas, or rarely from supporting tissues within the lungs, for example, blood vessels.
Tumors can be benign or malignant; when we speak of "cancer" we refer to those tumors that are considered malignant. Benign tumors can usually be removed and do not spread to other parts of the body. Malignant tumors, on the other hand, grow aggressively and invade other tissues of the body, allowing entry of tumor cells into the bloodstream or lymphatic system which spread the tumor to other sites in the body. This process of spread is termed metastasis; the areas of tumor growth at these distant sites are called metastases. Since lung cancer tends to spread, or metastasize, very early in its course, it is a very life-threatening cancer and one of the most difficult cancers to treat. While lung cancer can spread to any organ in the body, certain organs – particularly the adrenal glands, liver, brain, and bone - are the most common sites for lung cancer metastasis.
The lung is also a very common site for metastasis from tumors in other parts of the body. Tumor metastases are made up of the same type of cells as the original, or primary, tumor. For example, if prostate cancer spreads via the bloodstream to the lungs, it is metastatic prostate cancer in the lung and is not lung cancer.
Lung Cancer Picture
Picture of lung cancer
The principal function of the lungs is the exchange of gases between the air we breathe and the blood. Through the lung, carbon dioxide is removed from the body and oxygen from inspired air enters the bloodstream. The right lung has three lobes while the left lung is divided into two lobes and a small structure called the lingula that is the equivalent of the middle lobe. The major airways entering the lungs are the bronchi, which arise from the trachea. The bronchi branch into progressively smaller airways called bronchioles that end in tiny sacs known as alveoli, where gas exchange occurs. The lungs and chest wall are covered with a thin layer of tissue called the pleura.
Lung cancers can arise in any part of the lung. Ninety to 95% of cancers of the lung are thought to arise from the epithelial, or lining cells of the larger and smaller airways (bronchi and bronchioles); for this reason lung cancers are sometimes called bronchogenic carcinomas. Cancers can also arise from the pleura (the thin layer of tissue that surrounds the lungs), called mesotheliomas, or rarely from supporting tissues within the lungs, for example, blood vessels.
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