cancer diagnosis « Medical Lessons

Considering 10 Newly-Defined Molecular Subtypes of Breast Cancer in Nature, and a Dream

By Elaine Schattner, MD, on April 30th, 2012

The 10 molecular BC categories bear prognostic (survival) information and, based on their distinct mutations and gene expression patterns, potential targets for novel drugs.…I wonder if, in a few years, some breast cancers might be treated without surgery.

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Cervical Cancer Screening Update: on Pap Smears, Liquid-based Cytology and HPV

By Elaine Schattner, MD, on November 29th, 2011

high-grade cervical cell dysplasia (Dr. Ed Uthman, Wikimedia Commons)

The latest issue of the Annals of Internal Medicine contains 2 noteworthy papers on cervical cancer screening. The first, a systematic review of studies commissioned by the USPSTF, looked at 3 methods for evaluating abnormalities in women over 30 years:

high-grade cervical cell dysplasia (Dr. E. Uthman, Wikimedia Commons)

1. Conventional cytology (as in a Pap smear; the cervix is scraped and cells splayed onto a microscope slide for examination);

2. Liquid-based cytology (for LBC, the NHS explains: the sample is taken as for a Pap test, but the tip of the collection spatula is inserted into fluid rather than applied to slides. The fluid is sent to the path lab for analysis);

3. Testing for high-risk HPV (human papillomavirus). Currently 3 tests have been approved by the FDA in women with atypical cervical cells or for cervical cancer risk assessment in women over the age of 30: Digene Hybrid Capture 2 (manufactured by Quiagen), Cobas

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cancer diagnosis | language | Oncology (cancer) | Tuesday Term

What is a Cancer Metastasis?

By Elaine Schattner, MD, on October 11th, 2011

A metastasis refers to a lump of cancer cells that’s physically separated from the original tumor. A metastasis can be local, like when colon cancer spreads to a nearby lymph node in the gut, or distant, as when lung cancer cells generate tumors in the adrenal gland, liver, bone or brain.

Sometimes metastases cause serious damage in the organs where they’ve settled. For instance, brain “mets” can result in impaired thinking, personality changes, blindness or seizures. Liver metastases, if large enough, can result in hepatic (liver) failure. Bone mets can lead to anemia and other blood cell deficiencies if the marrow becomes filled with malignant cells instead of normal ones.

A common source of confusion is that when cancer moves from one body part to another, it’s still referred to by its site of origin. For example, if breast cancer spreads to the liver or bone, it is still called breast cancer and

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Breast Cancer | cancer diagnosis | Magazine | Oncology (cancer) | Pathology

'More' on DCIS

By Elaine Schattner, MD, on October 10th, 2011

More, a magazine “for women of style & substance,” has an unusually thorough, now-available article by Nancy F. Smith in its September issue on A Breast Cancer You May Not Need to Treat.

Ductal Carcinoma in Situ (DCIS) in the breast, histopathology w/ hematoxylin & eosin stain, Wiki-Commons image

The article’s subject is DCIS (Ductal Carcinoma in Situ). This non-invasive, “Stage O” malignancy of the breast has shot up in reported incidence over the past two decades. It’s one of the so-called slow-growing tumors detected by mammography; a woman can have DCIS without a mass or invasive breast cancer.

While some people with this diagnosis choose to have surgery, radiation or hormonal treatments, others opt for a watchful waiting strategy. The article quotes several physicians, including oncologists, who consider the surveillance approach favorably and otherwise.

In 2009 the NCI sponsored a conference on diagnosis and management of DCIS. The participants issued a helpful, albeit technical, consensus statement.

The

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A Call for Clarity in Cancer Screening Discussions

By Elaine Schattner, MD, on October 7th, 2011

Today’s cancer news is about screening for prostate cancer. The U.S. Preventive Services Task Force will advise that men should not be screened by a PSA (prostate specific antigen) blood test. The new recommendations will apply to asymptomatic men in all age groups.

I happen to agree with the task force’s position on this, but the point I’d like to make is obvious but too-often missed by the press and others who consider cancer screening:

Prostate cancer is not the same as breast cancer. Rather, each is a distinct set of related diseases with varied prognoses and treatment options.

For any screening method, the potential benefit of detecting cancer early depends on the specific tumor type, the accuracy of the test, and the likelihood that treatment will be effective and confer a net benefit over risks. A key to understanding the screening debate(s) is not to conflate data for distinct cancer forms in

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cancer diagnosis | cancer treatment | Oncology (cancer) | Public Illness

Two Faces of Pancreatic Cancer

By Elaine Schattner, MD, on October 6th, 2011

Early this week I was saddened to hear of a former colleague’s death from pancreatic cancer. Dr. Ralph Steinman, a physician-researcher at the Rockefeller University, received a Nobel Prize for his work on the innate immune system. For many, news of Ralph’s death at 68 years arrived synchronously with word of his award.

Yesterday we learned that Steve Jobs, Apple creator and leader, died at 56 years from a neuroendocrine tumor of the pancreas. The tech-based, Twitter-type tributes reveal the breadth of this man’s influence on our world.

These two men faced completely different forms of cancer in the pancreas. This news underscores the importance of pathology in cancer diagnosis and treatment. For a patient to make an informed treatment decision, which might be to decline treatment, a patient needs to know what kind of cancer they have, what is the prognosis, and how might therapy change the course of the particular illness.

Jobs had a neuroendocrine tumor. According to the

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