Month: July 2017

When we think of cancer, we think of smoking, alcohol, genetics and other things. Does anyone think of viruses? What if I were to tell you that there are viruses that cause cancer? Would you believe it?  A virus is a very small organism that can’t be seen with a light microscope. It takes what is known as an electron microscope to see a virus. These viruses enter our cells and replicate by using our machinery. Viruses then insert their DNA or RNA into our cells and this is what can lead to cancer.

The Human Papilloma Virus (HPV) is the most commonly sexually transmitted disease in the world.  In fact, most people who have had sex have been infected with HPV. For most, our immune system clears the virus, however, in those where immune surveillance fails cancer can develop. There are many types of this virus but certain ones are more apt to cause cancer. The HPV is what can contribute to  genital warts, cervical cancer, anal, vaginal, vulva and even oropharyngeal head and neck carcinoma. Did you know that we are in an epidemic of head and neck cancers caused by the human papilloma virus? We are seeing more and more patients who are younger, non-drinkers and non-smokers (which typically contribute to the disease.)

Of importance is the fact that there are vaccines available against the human papilloma virus for those between the ages of 9 through 26. Vaccines, as you know help prevent disease. Could you imagine preventing a cancer simply by giving a vaccine? The problem is that there is too much misinformation out there along with too many scare tactics. We have an opportunity to protect the ones we love most, however, quite a few people fail to act on it. I know as a parent I will do everything to protect my children, so why not vaccinate? Our vaccination rates in all reality are dismal in my opinion.

Another virus implicated in cancer is the Epstein-Barr Virus (EBV.) This virus can cause nasopharyngeal carcinoma which is a head and neck cancer along with lymphoma.  This is the same virus that causes mononucleosis. This is an extremely common virus and almost all people are infected with it by their teen years. That being said, it is not common to get a cancer from it. Infection by no means is a guarantee that one of the aforementioned cancers will be diagnosed. It is rather the exception.

There are yet other viruses that can lead to cancer. Hepatitis B and hepatitis C are viruses passed through unprotected sex, sharing of needles, childbirth and very rarely blood. Our blood is screened very well today. Per the National Heart, Lung and Blood Institute the odds of getting hepatitis B from a blood transfusion is 1 in 205,000. The odds of getting hepatitis C is 1 in 2,00,000. These viruses can lead to liver cancer. They contribute to cancer by the chronic infection/inflammation and eventually the cirrhosis that develops. It is important to know that there are millions infected with hepatitis in this Country but less than 5% will develop cancer. In those who develop cirrhosis about 1 in 5 will develop liver cancer.

There is a vaccine to prevent hepatitis B, however, not hepatitis C. As a health care worker I have had the hepatitis B vaccine which is a series of shots. Hepatitis B is less likely to contribute to cancer because it does not lead to chronic infection as frequently as hepatitis C, however, it is still possible.

There are other viruses that can cause cancer, however, these are much less common and therefore won’t be discussed in this blog. Should there be interest please contact me and I will be more than happy to discuss at a later date and time.

Walking into an oncology clinic has to be one of the most terrifying moments of one’s life. Not knowing what to expect instills fear into the hearts of all. So, what is cancer?  Simply put, it is a cell that continues to divide without limitation.  You see, normally our body, which is made up of trillions of cells that are constantly turning over. What I mean is, cells are made and then eventually die in something known as programmed cell death (apoptosis.)  However, when cancer arises signals are lost which usually lead to programmed cell death. Instead of the cells dying in a controlled fashion, they grow uncontrollably.

Patients who enter my clinic ask me all of the time, “why me?” Unfortunately, I don’t have the answer. Why can someone who has smoked their entire life not develop cancer and instead die of natural causes at the age of 90? Why does a young child not old enough to know what tobacco or alcohol is suffer from such a terrible disease such as cancer? I wish I knew.  In fact,  I wish people much smarter than am could get down to the bottom of this so that we can continue to move forward and cure this terrible disease (which is not one disease but a collection of diseases characterized under one name….cancer.) You see, if cancer were the same in every person and acted the same in every person it would be much easier to cure. This is not the case.  I would like to refer you to the following address. Please just copy and paste into a new browser to learn about the bad luck of random mutations

http://www.hopkinsmedicine.org/news/media/releases/bad_luck_of_random_mutations_plays_predominant_role_in_cancer_study_shows

This article and research shows that sometimes it is just bad luck that cancer develops. That is not to say we can’t control certain factors and help with what’s called primary prevention. For example, not smoking would be an example of primary prevention. Another example would be keeping one’s weight under control. Did you know it is estimated that approximately 50% of endometrial (uterine) cancers are caused by obesity?

We must keep moving forward with further research, determination and education to continue to improve on the survival rates of cancer. Contrary to the belief of many people, cancer can be cured. Of course, it is always better to live a life which helps to prevent cancer in the first place. Onward we must march, like soldiers ready to fight and conquer the enemy!

Next up: viruses and cancer

Each and every discussion I have with a patient is different when it comes to end of life and I never know which direction we are going to go.

Looking someone in the eyes and telling them they are going to die soon is no small feat. It is one that eats me up just a little each and every time. I must say, I learn with each and every conversation I have. Some surprisingly go very easy and others are extremely difficult.

I still remember my very first patient in fellowship. A 19 year-old with sarcoma of the leg which had spread to distant areas of his body. Once out of the hospital I treated him with chemotherapy and he did well for quite some time. As a matter of fact, as time passed we each got to know each other well. We had many discussion about death and what the future held. Near the end I learned that he had built out of wood his own casket knowing that he would die soon. Could this have been easy? What was he thinking?  I learned from the very beginning he knew his death was close and he took control of his life. He never let cancer control it. He never wanted to give up the fight and he did so to the very end.

A day which would become the last day we would see each other he presented to my clinic at the end of the day in a frail yet somewhat energetic state. Thankful that he was my last patient of the day not because I was tired but rather because I could spend extra time with him. You see, he knew this was our last meeting and he came bearing a gift. Two very small crown royal shots. My favorite drink and his. That day we toasted to our friendship and his life. He died shortly thereafter. He left me with memories and lessons learned.

As the years have gone by I realize that without death one can not live a life as intended. Could you imagine what life would be like without death? I would like everyone to think about this for a moment. Glorious things would become less glorious. Those precious moments we spend making memories would mean less and less. Death is a must because life without death is a life without meaning.