Monday, July 29th, 2013
The number of children diagnosed with melanoma, the most serious form of skin cancer, is rising about 2 percent each year, and the disease is escaping the notice of many pediatricians who do not expect to see it in their young patients, according to a new study published in the journal Pediatrics. More from ABC News:
Melanoma makes up 5 percent of skin cancer diagnosis but a majority of skin cancer deaths.
In 2013, the American Cancer Society estimated, 76,690 new melanomas will be diagnosed and 9,480 people are expected to die from the disease.
Children make up a tiny fraction of these cases, but a study recently published in the journal Pediatrics found that cases of pediatric melanoma are increasing. Between 1973 and 2009, the study found, cases of pediatric skin cancer rose, on average, 2 percent each year.
Melanoma is also the second most common form of cancer for adolescents and young adults between 15 and 29 years old, according to a 2007 study from the National Cancer Foundation.
Unfortunately, pediatric melanoma can be very difficult to diagnose because the warning signs are often very different than those for adult melanoma. In addition, experts say, testing biopsies in a pathology lab can be inconclusive and occasionally these cancers are only definitively diagnosed after they’ve grown or spread.
A major factor in surviving a cancer diagnosis is early detection, but the early signs of pediatric melanoma often masquerade as inconsequential skin problems….
….Dr. Ashfaq Marghoob, director of Memorial Sloan-Kettering’s regional skin cancer clinic in Hauppauge, N.Y., and spokesman for the Skin Cancer Foundation, said melanoma presents very differently in children versus adults.
“You’re asking these doctors to look for zebras,” said Marghoob. “If you usually see horses you’re not looking for zebras. Their mind is not in tune with looking for these melanomas. The morphology of melanoma in kids is different from adults.”
A 2011 study presented at the Pediatric Dermatology Annual Meeting found that 60 percent of children between the ages of 0 and 10 in the study with melanoma did not meet the common melanoma-detection criteria. The criteria is broken down by the “ABCDE warning signs,” which stands for Asymmetry, Border irregularity, Color variation and Diameter over six millimeters, and Evolution of the lesion.
For children between the ages of 10 and 20, approximately 40 percent did not strictly meet the ABCDE criteria.
Instead, many children in the study had tumors that were symmetrical and amelanosis (lacking pigment). The differences were so significant that the study’s authors proposed creating alternative ABCD criteria for pediatric patients, where A is for amelanosis, B for bumps or bleeding, C for uniform Color, and D for various Diameters or de novo (or new) Development.
Image: Dermatologist examining child, via Shutterstock
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Wednesday, July 17th, 2013
Women who had cancer as girls are often concerned that they will experience diminished or lost fertility, but a new study conducted by researchers from the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center offers hopeful news–though it took female cancer survivors longer to get pregnant than sisters who had not had cancer, two-thirds of the cancer survivors did eventually become pregnant. More from Reuters:
“The main message counters what some people have thought, which is if you had cancer you won’t be able to get pregnant or have children,” said Dr. Lisa Diller, the study’s senior author, from the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center.
Historically, childhood cancer survivors have been counseled that they may be unable to get pregnant because cancer-fighting chemotherapy and radiation can damage their ovaries.
For the new study, Diller and her colleagues used data from questionnaires in an ongoing study of 3,531 cancer survivors and 1,366 of their sisters between the ages of 18 and 39 years old.
The survivors were all diagnosed before age 21 with cancer at one of 26 medical centers in the U.S. or Canada from 1970 through 1986. The women had all been cancer free for at least five years.
Compared to their sisters, cancer survivors were more likely to be clinically infertile, which means they had been trying unsuccessfully to get pregnant for more than a year.
Thirteen percent of survivors were clinically infertile, compared to 10 percent of their sisters.
Still, 64 percent of the 455 clinically infertile survivors eventually got pregnant.
That pregnancy rate is similar to what has been observed in clinically infertile women without a history of cancer, Richard Anderson, a professor of clinical reproductive science at the University of Edinburgh in the UK, writes in an editorial accompanying the new study in the journal Lancet Oncology….
….But Dr. Mitchell Rosen, director of the University of California, San Francisco Fertility Preservation Center, cautions that the new study cannot predict how childhood cancer survivors’ fertility will change as they get into their late 30s or their 40s.
Rosen, who wasn’t involved in the new study, told Reuters Health that getting pregnant gets harder about 10 years before women go through menopause and childhood cancer survivors tend to go through early menopause.
That means childhood cancer survivors’ fertility problems may be amplified in their late thirties and early forties, compared to women without a history of cancer.
Image: Pregnant woman, via Shutterstock
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Thursday, July 11th, 2013
The use of medical marijuana in children is becoming a hotly debated topic, with some parents expressing horror that the drug would be used on children, and others praising the possibilities that marijuana could help kids cope with disorders ranging from epilepsy to cancer and autism. More on the issue from NBC News:
Eighteen states, plus Washington, D.C., allow use of medical marijuana. A number of them provide prescriptions to children, with parental supervision, to treat a host of ills, ranging from autism to cancer to seizures.
Critics, including the American Academy of Pediatrics, argue that the remedy hasn’t been clinically tested in kids and might have some long-term ramifications.
[10-year-old] Zaki [Jackson's] parents were surprised at first and a bit taken aback. “We are Christians,” Jackson said. “We are conservative. And we’re using medical marijuana. That’s a kind of big hump for people to get over. Despite the stigma associated with cannabis, we owed it to Zaki to give it a try.”
Jackson said the results were immediate and stunning. “I probably stared at him for a good three hours after his first dose and then I fell asleep. I didn’t feel any seizures after his first dose,” his mother said.
In fact, it’s been eight months since Zaki’s last seizure and he’s finally starting to do normal kid activities, like ride a swing.
Zaki’s pot is provided specifically for him by a team of brothers who legally grow medical marijuana. It has been bred to have low levels of TCH, but higher levels of another cannabinoid called cannabidiol, or CBD.
While both cannabinoids impact pain, nausea and seizures, CBD isn’t psychoactive, said Dr. Margaret Gedde of the Clinicians’ Institute for Cannabis Medicine. That means that kids using this type of marijuana won’t get high.
Cannabinoids work by hijacking normal brain circuitry.
In other words, the cannabinoids in pot are very similar to substances our own brains naturally make, called endocannabinoids. These substances serve to quiet excessive activity, whether it’s in the immune system, in the gut or in the nervous system, Gedde explained to NBCNews.com.
When cells become overactive, a switch is thrown and endocannabinoids are released. Once they lock on to receptors in the brain, “a message is sent to tell the cells to calm down,” she said. “It’s a balancing system and it’s what keeps seizures from happening in healthy brains. In these kids the system is overwhelmed. It needs a little extra help.”
That’s where the pot comes in. For Zaki, it’s delivered in a syrup that he takes each day, which contains an extract of purified cannabis oil that is high in CBD, Gedde said.
While the drug seems to be working miracles for Zaki, some doctors believe its safety in children needs to be tested in clinical trials.
“I worry that we just don’t know enough about it,” said Dr. Sharon Levy, of the Boston Children’s Hospital/Harvard Medical School. “I think they’re putting their child at risk of long-term consequences of marijuana use that we don’t fully understand.”
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Tuesday, July 9th, 2013
Male factor infertility may be linked by a slightly elevated risk of certain types of cancer, including testicular cancer, according to a new study published online in the journal Fertility and Sterility. More from The New York Times:
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About one in six infertile men have azoospermia, or no viable sperm in their ejaculate, and these men may be at the highest cancer risk, a new study shows.
For the study, published online in the journal Fertility and Sterility, researchers evaluated 2,238 men, average age 36, at a fertility clinic in Texas; 451 had azoospermia. They found 29 cases of cancer during an average follow-up of almost seven years.
Over all, those in the infertile group were 1.7 times as likely as the general population in Texas to develop some form of cancer. But the risk more than tripled for those with azoospermia.
While the increase in relative risk is substantial, the authors write, the absolute risk of cancer in this population remains low.
“The main message here is to continue follow-up after a fertility workup,” said the lead author, Dr. Michael L. Eisenberg, an assistant professor of urology at Stanford.
Tuesday, July 2nd, 2013
The White family of Louisville, Kentucky, now has a full house. Shelly White’s 10-year-old daughter, Ryan Elizabeth, became intrigued about the plight of Haitian orphans after the 2012 earthquake. She begged her parents to adopt an orphan, even requesting donations instead of toys one Christmas. Her parents listened and the White’s welcomed a 1-year-old girl, Mya, in March. She has a cancerous tumor, but that doesn’t stop her new family from loving her. More from TODAY:
“I had a mother’s love for her right away,” says White, whose other children are 3, 6 and 9. “I can’t really explain it. I couldn’t stop thinking about her. I couldn’t get her off my heart.”
Kosair Children’s Hospital in Louisville committed to treating Mya at no cost to the Whites, which allowed the girl to receive a one-year medical visa and come to the United States before an adoption was complete. Mya arrived on May 7, with the Whites serving as her guardians as they go through the adoption process.
“We just had this love for her that was instant, and it wasn’t a hard decision because of our faith,” Shelly White says. “Peace and stage four cancer don’t go hand-in-hand, but we just have it with her.”
The Whites had called on a longtime friend and church elder, Scott Watkins, vice president of operations for Norton Healthcare. Watkins has raised $18,000 in pledges to help with the adoption, and Norton Healthcare owns the hospital providing Mya’s care.
Mya has rhabdomyosarcoma, cancer of the connective tissue, in her pelvis. After several rounds of chemotherapy, the tumor, which is protruding from her vagina, has shrunk significantly, said Dr. Stephen Wright, Kosair’s medical director.
“We think the prognosis at this point is pretty good,” he said. “We’re very pleased with how well the tumor is responding to chemotherapy.”
Mya was not getting the optimal doses of medication in China, and likely would not have survived, said Wright, who has seen Mya’s development improve in the short time she has been in Louisville.
“It’s a life-changing event that they would open their home and their hearts to somebody they did not know at all with a serious medical problem and provide her with the love that she wouldn’t get in an orphanage,” Wright said of the Whites.
Image: holding hands, via Shutterstock
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