Preventing a Recurrence of Cancer

Another guest blogger.  Enjoy

According to the National Cancer Institute, there are over 12 million cancer survivors in the US today.  And that number is expected to grow, as the population ages, treatments improve, and tests find the disease earlier.  

Cancer survivors face a myriad of health challenges, not to mention the daunting fear the cancer will return.  However, once a patient is deemed "in remission," they are typically disconnected from care -- as well as any attending support -- and told to come back in three to six months where diagnostic scans or blood tests will determine if the cancer has returned.

We suggest a far more pro-active, empowered approach: a remission maintenance plan that offers cancer survivors a personalized program to regain control of their health, restore vitality and protect against the cancer returning. At the Block Center, once a patient has completed their treatment, we personally tailor a comprehensive Remission Maintenance program for them that includes: therapeutic nutrition, exercise, mind-spirit care, and anti-tumor therapies.

Understandably, after hearing that they are "in remission," patients may want to retreat psychologically to a "cancer- free" zone and never think about the disease again.  But this is why they shouldn't:  Cancer is as much a microscopic and molecular disease as it is a visible one. Thus, a patient in remission may still harbor malignant cells (ones that were resistant to chemotherapy or radiation, and therefore survived the attack phase). These cells unfortunately have the ability to show up with a vengeance, even when one least suspects. Not placing far greater emphasis on containing and addressing these cells from the get-go is a significant omission of mainstream treatment. But while preemptive treatment strategies may only exist in integrative clinics, when it comes to the diagnostic side, a new technology has begun demonstrating the relevance of these virulent escape cells.

Enter CTCs (circulating tumor cells)! Over a decade ago, the Block Center was one of a few that were performing bone marrow biopsies to evaluate for malignant cells in both the marrow and in circulation. It took several years, but eventually this evolving diagnostic technology made it into conventional care. While easier to perform today and more reliable as well, we continue to use this in our clinic. This technology allows us and others the ability to measure in our patients the number of these detached cells circulating freely from the main cancer mass.  Though not yet approved for all cancer, research studies have shown that an increase of these cells is prognostic of a patient's survival.

For instance, a CTC count may be a better prognostic indicator for survival among prostate cancer patients than a PSA level -- the test used presently to determine and follow the course of prostate cancer growth.

By comparing the levels of CTC in 37 men with metastatic prostate cancer, researchers at Thomas Jefferson University found that for the men with 5 CTCs or more, the median overall survival was only 8.4 months. Whereas, if these men were found to have less than 5 CTCs, the median survival was 48 months! 

The relevance of CTCs is also relevant to other cancers. For instance, CTCs were measured in 151 women with metastatic breast cancer. The MD Anderson Cancer Center's researchers found that those patients with 5 or more CTCs had a median survival of only 13 months, whereas those with less 5 survived over 29 months!

Controlling, preventing or overcoming these detached and disseminating cells is possibly the biggest conundrum facing cancer scientists. While these cells are generally addressed during treatment, the first steps of recurrence prevention should start with strategies to counter the survival of these residual cells and inhibiting their potential proliferation. In fact, CTCs that have gone through the onslaught of treatment and have nonetheless survived have the potential to evolve into more aggressive clones encouraging a more virulent malignancy. So what to do?

Aggressive Monitoring

We recommend regular monitoring of patients' status with lab tests and imaging to detect early signs of disrupted biochemistry or a recurrence of disease, especially in the year or two after remission.

Being "diagnostically aggressive" may allow us to be less invasive therapeutically. In the first years after remission, therefore, we recommend:

• Clinical visits with your oncologist, at least every three to four months in the first and second year and every six months for the next several years
• Scans and blood tests of tumor markers every three months.
• Complete blood count and chemistry test every three months.
• Nutrition status, including weight changes, body composition, and albumin levels, every three months.
• Internal terrain monitoring, every three to six months for the terrain factors that are most problematic.

While monitoring, there is no reason to wait anxiously for the other shoe to drop.  So immediately implement a full integrative program.

• Make sound dietary changes toward adherence of a whole foods diet.  Reduction in dietary fat has already been shown to cut recurrences in different cancers. Controlling refined flour, sugar and junk food is a necessary step to avoid the recurrence risk of elevated blood glucose and spiking insulin levels.
• Introduce aerobics, strength and flexibility training into your daily schedule. Yoga, pilates, chi gong or any number of fitness approaches is an essential step towards recurrence prevention. Considerable research supports that risk, response, recurrence and outcomes are tied to physical care.
• Mitigate stress through progressive relaxation, meditation, or simply easing the load on an excessive work schedule. Elevated cortisol levels are associated with poorer outcomes in breast cancer patients. So do what it takes to transform less healthy patterns.
• Get rest and adequate sleep. The more active you are in the daytime, the better you'll sleep at night. Few of us get enough sleep and the adverse consequences to an otherwise health promoting, cancer inhibitory environment can be devastating.

© 2010 Keith I. Block, M.D., author of Life Over Cancer: The Block Center Program for Integrative Cancer Treatment
Author Bio
Keith I. Block, M.D. is Director of Integrative Medical Education at the University of Illinois College of Medicine; Medical Director of the Block Center for Integrative Cancer Treatment in Evanston, Illinois; and founder and Scientific Director of the nonprofit Institute for Integrative Cancer Research and Education. He is also editor in chief of the peer-reviewed professional journal Integrative Cancer Therapies and a member of the National Cancer Institute's Physician Data Query Complementary and Alternative Medicine (CAM) Editorial Board.

For more information, please visit www.lifeovercancer.com and www.blockmd.com. Become a fan of Life Over Cancer and the Block Center for Integrative Cancer Treatment on Facebook.

Sun Safety, Sunscreens & Cancer

By Keith I. Block, M.D.,
Author of Life Over Cancer: The Block Center Program for Integrative Cancer Treatment

As we reach the peak season of the summer sun, wisdom suggests that we pay greater attention to protecting our skin. Yet, there are questions about the best way to do this. Should we avoid the sun? Is all sun exposure bad for us? Are all sunscreens created equal? Does clothing afford any protection?

On one hand, we've all been warned of the dangers that lurk behind those healthy-looking tans; most notably, an increased risk of skin cancer and premature wrinkles. On the other hand, there is also reasonable evidence that sun exposure does not induce melanoma, the deadliest form of skin cancer. In fact, there are several studies that demonstrate sun exposure can actually protect us from cancer! To be specific, the exposure to UVB sun radiation has been shown to reduce the risk of 19 major types of cancer through the production of vitamin D!

So what's a bikini to do?!

I think it's important we all try to get 20 minutes of unprotected sun-to-skin exposure every day. This is essential for meeting our most basic needs for Vitamin D. Once this is taken care of, I recommend both physical protection; i.e., hats, clothing and umbrellas, as well as chemical protection, sunscreens. However, it must be mentioned that many sunscreens on the market today have come under fire not only due to inaccurate labeling -- a product states it has an SPF (Sun Protection Factor) of 50 and it's actually a 4 -- but many have been found to contain a host of controversial chemicals that include potential carcinogens, cancer promoters, free radical generators, and hormone disruptors. In addition, the use of sunscreen is known to reduce the production of Vitamin D in the body.

Tip: Try and get 20 minutes of unprotected sun exposure daily. 

Recently, The Environmental Working Group (www.ewg.org), a non-profit organization with the mission of using the power of public information to protect public health and the environment, came out with a fairly disconcerting report about sunscreens. EWG researchers recommended only 39 of 500 (that's only 8 percent!) beach and sport sunscreens for this season. The reason? As the word got out that the higher the SPF the better, there was a surge among manufacturers misrepresenting that their products contained an SPF over 50. Additionally, there have been new disclosures addressing potentially hazardous ingredients. In particular, recent government data has linked the common sunscreen ingredient vitamin A to accelerated development of skin tumors and lesions.

According to EWG, the best sunscreen is a hat and a shirt. No worries about chemicals that will be absorbed through the skin, and no question about their effectiveness. But if you choose to wear a "teenie weenie yellow polka dotted bikini," or any clothing that provides only partial skin coverage, EWG suggests using sunscreens that provide broad-spectrum (UVA and UVB-sunburn) protection, as well as those that contain fewer hazardous chemicals.  For a list of their recommendations, go to: http://www.ewg.org/2010sunscreen/best-beach-sport-sunscreens/.

Tip: Make every effort to avoid burning your skin.  There is sufficient data to know that sun burns cause serious, long-term damage.

In an effort to make a wise decision regarding which sunscreen to purchase, many consumers look for The Skin Cancer Foundation's "seal of approval."  However, this shouldn't be the sole criteria you use to make a purchasing decision. According to the EWG, The Skin Cancer Foundation (SCF) lends its logo to hundreds of sun protection products that have not necessarily been thoroughly scrutinized.

My Advice:

Get 20 minutes of unprotected sun exposure daily. Even on cloudy days, you can still get up to 80% UV rays and boost your production of vitamin D.

Make every effort to avoid sunburns. Be particularly cautious during mid-day sun exposure or near water where reflections can increase exposure and risk of burns. This can lead to skin damage and injury. Extensive research demonstrates that sunburns -- and particularly repeated burns -- cause serious, long-term damage.

Cover up! The use of hats, shirts and umbrellas offer safe and effective protection from the sun.

Buyer beware.  Before purchasing a sunscreen, consult with a website such as www.ewg.org to ensure you are purchasing a product that is both safe and effective.
© 2010 Keith I. Block, M.D., author of Life Over Cancer: The Block Center Program for Integrative Cancer Treatment

Author Bio:

Keith I. Block, M.D. is Director of Integrative Medical Education at the University of Illinois College of Medicine; Medical Director of the Block Center for Integrative Cancer Treatment in Evanston, Illinois; and founder and Scientific Director of the nonprofit Institute for Integrative Cancer Research and Education. He is also editor in chief of the peer-reviewed professional journal Integrative Cancer Therapies and a member of the National Cancer Institute's Physician Data Query Complementary and Alternative Medicine (CAM) Editorial Board.

For more information, please visit www.lifeovercancer.com and www.blockmd.com. Become a fan of Life Over Cancer and the Block Center for Integrative Cancer Treatment on Facebook.