New study finds a high blood platelet count is ‘strong predictor’ of cancer

LONDON, May 24 — A new UK study has revealed the first new strong indicator of cancer in 30 years, finding that having a high blood platelet count can predict who will go on to be diagnosed with cancer, and the researchers urge that it should be used by doctors in order to try to catch the disease early.

Known as thrombocytosis, up to half a million people (two per cent) of those over the age of 40 in the UK have a raised blood platelet count, with around 1 per cent of the general population developing cancer each year.

Led by the University of Exeter Medical School, the large-scale study is the first to thoroughly investigate the association between thrombocytosis and cancer, looking at 40,000 patient records in the UK.

The team found that 11per cent of men and 6per cent of women over the age of 40 with thrombocytosis went on to be diagnosed with cancer within a year.

This number rose to 18per cent of men and 10per cent of women being diagnosed with cancer if a second raised platelet count was found within six months.

The most commonly diagnosed cancers after a thrombocytosis diagnosis were lung and colourectal cancer, and one third of these patients had no other symptoms that would indicate to their GP that they had cancer — except for thrombocytosis.

The team are now urging GPs to consider that those with unexpected thrombocytosis may go on to also be diagnosed with cancer, in order to try to catch the disease early on.

“We know that early diagnosis is absolutely key in whether people survive cancer. Our research suggests that substantial numbers of people could have their cancer diagnosed up to three months earlier if thrombocytosis prompted investigation for cancer.

This time could make a vital difference in achieving earlier diagnosis,” commented lead author Dr Sarah Bailey, of the University of Exeter Medical School.

Professor Willie Hamilton, of the University of Exeter Medical School, also added that, “The UK lags well behind other developed countries on early cancer diagnosis. In 2014, 163,000 people died of cancer in this country.

“Our findings on thrombocytosis show a strong association with cancer, particularly in men — far stronger than that of a breast lump for breast cancer in women. It is now crucial that we roll out cancer investigation of thrombocytosis. It could save hundreds of lives each year.”

The paper can be found online published in the British Journal of General Practice— AFP-Relaxnews

 Note: At CA Care we have been using your Platelets Count as a monitor for cancer since the past twenty years!

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Exercise more effective than meds at relieving fatigue for cancer patients

Psychological interventions, such as therapy to help change personal behavior and the way a person thinks about his or her circumstances, also had a similar, beneficial effect.

Exercise could be a more effective way of reducing cancer-related fatigue than medications suggests new research published this week in JAMA Oncology.

Led by the Wilmot Cancer Institute at the University of Rochester in the state of New York, the study analyzed more than 11,000 patients across 113 unique studies that tested various treatments for cancer-related fatigue.

All were randomized clinical trials, the highest standard for evaluating effective treatments.

Nearly half of the studies’ participants were women with breast cancer, with ten studies focusing on other types of cancer and including only men.

All of the participants suffered cancer-related fatigue, the most common side effect during and after cancer treatment.

This type of fatigue is different from being chronically tired, explains lead author Karen Mustian, and is a “crushing” sensation that’s not relieved by rest or sleep and that can persist for months or even years.

Even more concerning, Mustian explained, is that this fatigue can decrease a patient’s chances of survival because sufferers are less likely to complete medical treatments, with the National Cancer Institute putting cancer-related fatigue as a top research priority.

After analyzing the data, Mustian and her team found that exercise alone — including both aerobic or anaerobic — had the most significant effect on reducing cancer-related fatigue.

Psychological interventions, such as therapy to help change personal behavior and the way a person thinks about his or her circumstances, also had a similar, beneficial effect.

However, perhaps surprisingly, studies which looked at a combination of exercise and psychological therapy had mixed results, with the researchers unable to say for sure what is the best combination of both to make them effective.

With exercise and/or psychological therapy working better than medications used for treating cancer-related fatigue, the team now believe that these methods should be recommended first to patients.

“The literature bears out that these drugs don’t work very well although they are continually prescribed,” commented Mustian, “Cancer patients already take a lot of medications and they all come with risks and side effects. So any time you can subtract a pharmaceutical from the picture it usually benefits patients.”

“If a cancer patient is having trouble with fatigue, rather than looking for extra cups of coffee, a nap, or a pharmaceutical solution, consider a 15-minute walk,” she suggested.

Mustian has been studying exercise and cancer alongside Wilmot colleagues for almost 15 years. Much or her work looks at gentle yoga, walking, resistance bands, and other forms of movement to help ease side effects.


1 in 4 males, and 1 in 5 females are likely to get cancer by 75 years old

From a Straits Times article by Ms Salma Khalik1, the National Registry of Diseases Office reported 13,241 cancer cases in 2014, with lung cancer being the deadliest type of cancer. Over a period of 5 years, from 2010 to 2014, out of 6,899 people diagnosed with lung cancer 5,732 died of it.

The incidence rate can be rather high for some types of cancer as shown in the table below, data from Singapore Cancer Society2.

Top 3 cancer by gender:

Men % Women %
Colorectal 17.2% Breast 29.2%
Lung 115.0% Colorectal 13.3%
Prostate 12.2% Lung 7.6%

A general word of advice, if you find anything unusual with your body, seek proper medical advice. The earlier the diagnosis and treatment of cancer (or any critical illness for that matter), the better your chances of making a good recovery.

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Cancer doctor Ang Peng Tiam appeals against misconduct conviction

Dr Ang was fined $25,000 last year after a disciplinary tribunal found him guilty of two charges.

When a 55-year-old woman with lung cancer saw him in April 2010, prominent oncologist Ang Peng Tiam told her there was a “70 per cent chance” of the disease responding to treatment and achieving control with chemotherapy and targeted therapy.

Dr Ang, who is the medical director of Parkway Cancer Centre, did not offer her the option of surgery, which he felt was not viable in this case due to, among other things, the location of the fist-sized tumour.

The patient died six months later, after the cancer spread to other parts of her body, including her brain, liver and pancreas.

Her family complained about Dr Ang to the profession’s watchdog – the Singapore Medical Council (SMC) – which brought four charges against him for professional misconduct.

Last year, Dr Ang was fined $25,000 after a disciplinary tribunal found him guilty of two charges – for falsely representing to the patient her chances of a favourable response to his prescribed therapy and for failing to offer her the option of surgery. He was cleared of the other two charges.

Yesterday, Dr Ang, who is also chief executive of medical oncology firm TalkMed, appealed against his conviction before a Court of Three Judges.

The SMC cross-appealed, arguing that he should be suspended for at least six months per charge.

Dr Ang, represented by Senior Counsel Edwin Tong, argued that it was reasonable for him to cite a 70 per cent disease-control rate just based on chemotherapy alone.

He cited medical literature to support his assertion that the patient’s chances would be optimised by combining chemotherapy with anti-cancer drugs called tyrosine kinase inhibitors. This was because the patient had four characteristics – including having never smoked – and such patients have been shown to be highly responsive to the therapy, he argued.

As for surgery, Dr Ang argued that he had made a judgment call that it was not a viable treatment option. Surgery cannot guarantee the complete removal of the tumour, given its size and location, he said.

But the SMC’s lawyer Melanie Ho charged that Dr Ang’s statement on the 70 per cent chance was false as it is achievable only for patients who test positive for epidermal growth factor receptor mutation.

As he did not carry out the test, Dr Ang had no basis to promise a 70 per cent chance of shrinkage and control of the tumour, she said.

She noted that Dr Ang had not produced literature to support his contention of a 70 per cent chance based on chemotherapy alone.

Ms Ho argued that it was not for Dr Ang to decide on the treatment but to offer options. “It is the patient’s right to choose,” she said.

After nearly five hours of arguments, the court reserved judgment. A decision will be given at a later date.

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Chemotherapy killed 50 percent of patients

No matter how much doctors push the treatment, chemotherapy might not be the best option in the fight against cancer, as a new study shows up to 50 percent of patients are killed by the drugs — not the disease, itself.

Researchers from Public Health England and Cancer Research UK performed a groundbreaking study examining for the first time the numbers of cancer patients who died within 30 days of beginning chemotherapy — indicating the treatment, not the cancer, was the cause of death.

Looking at those death rates in hospitals across the U.K., researchers found an alarming mortality rate associated with chemotherapy.

Across “England around 8.4 per cent of patients with lung cancer, and 2.4 per cent of breast cancer patients died within a month,” the Telegraph reported.

“But in some hospitals the figure was far higher. In Milton Keynes the death rate for lung cancer treatment was 50.9 per cent, although it was based on a very small number of patients.”

Alarmingly, the one-month mortality rate at Lancashire Teaching Hospitals for those undergoing palliative, rather than curative, chemotherapy for lung cancer was a full 28 percent.

One in five breast cancer patients receiving palliative care at Cambridge University Hospitals died from treatment.

In certain areas — Blackpool, Coventry, Derby, South Tyneside, and Surrey and Sussex — deaths of lung cancer patients by chemotherapy were ‘far higher’ than the national average.

Dr. Jem Rashbass, Cancer Lead for Public Health England — the national health care service, which requested the study — said, as quoted by the Telegraph:

“Chemotherapy is a vital part of cancer treatment and is a large reason behind the improved survival rates over the last four decades.

“However, it is powerful medication with significant side effects and often getting the balance right on which patients to treat aggressively can be hard.

“Those hospitals whose death rates are outside the expected range have had the findings shared with them and we have asked them to review their practice and data.”

Long the mainstay for treating various cancers, chemotherapy has finally drawn criticism in recent years, as the medicine does not differentiate between healthy and cancerous cells. Now, this study — published in the Lancet — shows how that powerful cell-destroying property can mean the demise for patients as well.

Researchers have advised physicians to exercise more caution in vetting which patients should ideally receive chemotherapy. Older and more infirm patients, in particular, might be better off without receiving palliative care, which is designed to offer relief instead of curing the disease.

Noted Professor David Dodwell of the Institute of Oncology at St. James Hospital in Leeds.

“I think it’s important to make patients aware that there are potentially life threatening downsides to chemotherapy. And doctors should be more careful about who they treat with chemotherapy.”


Colorectal cancer numbers far too high, say experts

Every day, five people here are diagnosed with colorectal cancer and two die of it. These numbers are far too high, say experts, since this is one of the most preventable cancers.

But not enough people here are using the available screening tools to detect the cancer in the early stages, or better yet, catch the problem before it becomes cancer.

Generally, colorectal cancer develops from polyps that grow on the inside walls of the large intestines and the rectum. If the polyps are discovered early and removed, they are not allowed to become cancerous.

It usually takes more than a decade for a polyp to become a tumour, so there is a large window of time for it to be dealt with.

In the US, where 60 per cent of people aged 50 and older have colonoscopy screening, the incidence of this cancer has fallen by 30 per cent over the past decade. It is now the fourth most common cancer there.

In Singapore, it remains the top cancer, although the rise in cases appears to have plateaued since 2000.

Singapore is ranked 16th by the World Cancer Research Fund in terms of the incidence of this cancer. It is higher in countries like South Korea and Australia, but lower in Japan and the United States.

Doctors advise a test every year to detect any blood in stools that could signal the cancer and a colonoscopy every decade from the age of 50, when the incidence of this cancer starts to climb.

The procedure, in which a tiny camera is inserted through the anus into the intestines to check for polyps and cancerous cells, costs about $1,200 to $2,000. Subsidised patients pay about $300 to $500. Depending on the complexity, between $1,250 and $1,850 for this test can be paid for with Medisave.

Overall, however, the rates of surviving colorectal cancer have improved vastly over the years.

The prognosis is especially good for those whose tumours are discovered in the early stages, before they have broken through the walls of the intestines.

Dr Ho Kok Sun, a colorectal surgeon at Mount Elizabeth Medical Centre, said the standard treatment is surgery if the cancer is still within the colon.

This is classified as stages one and two. Patients at this stage have a very high chance of surviving beyond five years, the holy grail for cancer survival.

But once it has spread through the four layers of the colon wall, the odds of survival plummet. Said Dr Ho: “Once it’s spread through the wall, as the intestines move, the cancer cells are like rice grains dropping off the surface. That’s one of the worst types of spread.”

When that happens, the loosened cancer cells can attach themselves to a host of organs and tissues nearby.

The cancer can also spread from the lymph nodes into the blood stream and the rest of the body, with the liver typically being the first target.

Dr Chee Cheng Ean, a consultant in haematology-oncology at the National University Hospital, said the actual stage of the cancer sometimes cannot be determined until after surgery, when the nearby lymph nodes are removed and checked. At least 12 nearby nodes need to be removed to check if they have the cancer.

At stages three to four, the cancer has spread to the lymph nodes or broken through the intestinal wall. Patients in those stages would need chemotherapy to reduce the risk of recurrence – 50 per cent in stage three without chemotherapy – to 40 per cent.

“The actual benefit is 10 percentage points, which is enough to justify chemotherapy,” she said, since it means that out of 10 patients doing chemotherapy, the cancer would not recur in one additional patient.

As a result, deaths have fallen, even though more people are getting the cancer. Between the five-year periods of 2005-2009 and 2010-2014, the five-year survival rate went up from 46 per cent to 51 per cent for men, and from 51 per cent to 53 per cent for women.

Even patients with stage four cancer, in which it has spread to other parts of the body, are living longer than they did before.

Said Dr Ho: “For stage four cancer 20 years ago, when people asked how long they had, the answer would be six weeks to six months. “Now, we have patients on long-term chemotherapy. We can control, but not cure, it.”

The effect of this treatment varies, he said. For some, quality of life is “lousy” for a few days after treatment, then fine for the next few weeks, and the whole cycle then repeats with the next treatment. This can go on for years. Others say it is so bad, they would rather die.


Childhood cancer survivors continue to have lasting health problems

NEW YORK, Nov 8 ― Despite advances that have made treatments safer and more effective, childhood cancer survivors don’t appear to have experienced gains in long-term health outcomes, a new study suggests.

Their survival odds are better, but as adults they may have chronic medical problems linked to cancer and tumour treatments, the study found.

Up to one in four childhood cancer survivors report health problems in their 20s and 30s, researchers report in the Annals of Internal Medicine.

“They have chronic conditions at higher rates than siblings and the general population and they perceive their health as worse,” said lead study author Kirsten Ness of St Jude Children’s Research Hospital in Memphis, Tennessee.

Childhood cancer survivors’ “adverse health outcomes increase with age ― like the rest of the population ― but several decades sooner,” Ness added by email.

Ness and her colleagues compared 14,566 adult survivors of childhood cancer treated in the 1970s, 80s and 90s to their siblings without a history of malignancies.

Over the past generation, there has been an overall reduction in radiation exposure and chemotherapy doses. Because the study includes survivors treated in a more recent era of more targeted and less toxic medicines, researchers expected survivors who were treated more recently to report better outcomes.

“We expected their perceived health to be better ― but it was not,” Ness said.

The proportion of survivors with severe, disabling or life-threatening conditions did go down, from about 33 per cent in the 1970s to about 21 per cent among those treated in the 90s.

But compared to people treated in the 70s, survivors from the 90s were more likely to report poor general health and cancer-related anxiety, the study found.

By the 90s, survivors of leukaemia, a blood cancer, were more likely to report poor general health and survivors of osteosarcoma, a bone cancer, were more likely to report persistent pain.

Changes in radiation or drug doses over time weren’t associated with changes in the proportions of cancer survivors reporting health problems, the study also found.

No matter when they were treated, survivors were also more likely to report poor health when they smoked, didn’t exercise enough or were unusually underweight or obese.

Certainly, changes in treatment and survival outcomes over time may have allowed people who would have died from cancer in the 70s to live long enough to complain of other health issues in the 90s, the authors note.

It’s also possible that some personal risk factors patients had for certain health problems might have preceded cancer, rather than being an outcome of tumours or treatment.

“While the quantity of survival has improved, it remains to be seen whether the quality of survival has improved,” said Dr Saro Armenian, director of the Childhood Cancer Survivorship Clinic at City of Hope Comprehensive Cancer Centre in Duarte, California.

“Research on childhood cancer survivorship issues during the past two decades has highlighted the high burden of chronic health conditions in this aging population,” Armenian, who wasn’t involved in the study, added by email.

While it can be difficult for patients and families to focus on other health issues when their main concern is cancer, leading a healthy lifestyle with good diet and exercise habits may help minimise the risk of additional medical problems, said Dr Joann Ater, of the childhood cancer survivor program at the University of Texas M.D. Anderson Children’s Cancer Hospital in Houston.

Avoiding obesity, high cholesterol, and high blood pressure can decrease risk of cardiac side-effects and possibly second cancers, Ater, who wasn’t involved in the study, said by email. She added, “Children should also participate in all preventive health measure such as not smoking or using tobacco, HPV vaccine, wearing sun screen to prevent skin cancer, and following recommended adult cancer screening, such as Pap smears for young women.” ― Reuters Health

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