Posts Tagged ‘ cancer ’

Fertility Concerns Becoming Less Common Among Childhood Cancer Survivors

Wednesday, September 25th, 2013

A new body of research is revealing how survivors of childhood cancer may struggle less with infertility than they may have expected.  Earlier assessment of fertility hormones is key to success, researchers say, because radiation and chemotherapy often ages the reproductive organs, including the ovaries, more quickly than normal aging would.  But fertility is within reach for many who have been through cancer treatment as children. The New York Times has more:

Last month, a large study in The Lancet Oncology found that about two thirds of female survivors who sought out fertility treatments as adults ultimately became pregnant — a rate of success that mirrored the rate among other infertile women. Other recent studies have found that many men who experience low sperm counts after pediatric cancer, a side effect in two thirds of boys who receive chemotherapy, can undergo procedures that harvest viable sperm, allowing them to father their own children. Doctors say that while there is no doubt that childhood cancer increases the likelihood of infertility, the ovaries and testes of young cancer patients may be more resilient than they had previously thought.

“When we see cancer survivors as adults, depending on how late they are in their reproductive years, radiation and chemotherapy tends to have a pretty suppressive effect on their future fertility,” said Dr. Hal C. Danzer, a reproductive endocrinologist at the Southern California Reproductive Center. “But this speaks to the fact that the ovaries and sperm production are more resilient in young individuals. It’s very encouraging.”

But if fertility treatment is to be successful, time is of the essence. Normally, for example, women under 35 are encouraged to attempt getting pregnant for at least a year before seeing a fertility specialist. For those with a history of cancer, however, the new message should be, “Don’t wait,” said Dr. Lisa R. Diller, the chief medical officer of the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center.

“The ovaries after childhood cancer have taken a hit, and they are almost aging more quickly than someone of the same chronological age without cancer,” said Dr. Diller, the lead author of the Lancet study. “In the setting of having had childhood cancer, if a woman is 25 and has been trying to conceive for six months, then I would say see a specialist.”

Typically, childhood survivors tend not to address fertility issues until they are in a relationship and their treatment is many years behind them, said Dr. Aarati D. Didwania, the director of the STAR survivorship program at the Robert H. Lurie Comprehensive Cancer Center at Northwestern University.

“A lot of young women will come in and say, ‘I’m married, we’ve been trying for six months, is this related to my treatment?’ ” she said.

Traditionally, the fertility discussion has involved finding out which cancer therapies patients received and what their hormonal status is like, so doctors can estimate their likelihood of being infertile. Then they can talk about their options, Dr. Didwania said, and whether they need to resort to things like surrogacy, using donor eggs and sperm, or adoption.

But the new goal in the field of cancer fertility, or oncofertility, is to be as proactive as possible, said Dr. Teresa K. Woodruff, chief of the division of fertility preservation at the Northwestern University Feinberg School of Medicine.

Oncologists are increasingly making a point of bringing up the subject of fertility at the time of diagnosis, discussing options like freezing eggs, sperm and embryos before treatment. In younger patients who have not gone through puberty, some fertility clinics offer the option of freezing ovarian and testicular tissue, which can be reimplanted when patients get older.

Studies show that up to two thirds of young patients are now counseled about fertility before starting their cancer treatment.

“Today 80 percent of kids will survive,” Dr. Woodruff said. “Now that patients are thriving and have decades of life ahead of them, fertility is a high priority for them.”

Image: Pregnant couple, via Shutterstock

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Half of New Moms Breastfeed, CDC Says

Monday, August 5th, 2013

Half of American new mothers now breastfeed their newborns for the recommended period of at least six months, according to data analyzed by the Centers for Disease Control and Prevention.  More from Today.com:

It’s a big increase from just 35 percent in 2000 and is good news for babies and moms alike, as breastfeeding boosts the immune system, may lower the risk of obesity and is even linked with higher intelligence.

“This is great news for the health of our nation because babies who are breastfed have lower risks of ear and gastrointestinal infections, diabetes and obesity, and mothers who breastfeed have lower risks of breast and ovarian cancers,” said Centers for Disease Control and Prevention director Dr. Tom Frieden.

The American Academy of Pediatrics recommends that newborns get nothing but breastmilk until they are six months old. The AAP recommends that mothers continue to breastfeed, along with giving other food, after six months for at least a year or even longer “as mutually desired by mother and infant.”

Studies show that babies given nothing but breastmilk for the first four months of life have a 72 percent lower risk of severe pneumonia and other lower respiratory tract infections for their first year. If moms stop breastfeeding between four and six months, their babies have four times the risk of pneumonia compared to moms who breastfeed for a year or longer.

Breastmilk contains the nutrients that a newborn baby needs and also transfers disease-fighting antibodies from mother to baby – something that’s very important for the first few months before an infant can be vaccinated. There’s also a growing body of evidence that beneficial bacteria, and perhaps also viruses and fungi, from a mother’s milk and skin can affect her baby’s health.

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Pediatric Melanoma Cases Rising, Difficult to Diagnose

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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Pregnancy Possible for Many Childhood Cancer Survivors

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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Medical Marijuana for Kids Prompts Debate

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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