Dr. Robert Morgan, MD

Hello. Breast cancer is a serious illness in women. There has been much research on potential causes of breast cancer. The illness can be caused by familial genetic factors. It can also occur spontaneously in women without predisposing factors. It is important that all women be followed and obtain testing to be certain that no cancers arise. Early diagnosis is important to be able to cure this illness. Many answers to questions and recommended follow up and testing can be found in documents published by the National Comprehensive Cancer Network (NCCN) (nccn.org). There are also papers about the risks of abortion on the development of breast cancer. One important paper is by Y. Deng md published in Medicine in 2018. “Induced abortion and breast cancer an updated meta-analysis”. The data is not clear but there is a possible linkage but the analysis states that there is no clear causative linkage. It is important, though, that you obtain follow up with your doctor and obtain recommended examinations on a regular basis.

Hello. I am sorry to hear about your situation. I am not sure, though, about the diagnosis. Has a biopsy been done? Possible treatments depend on the tissue type of the tumor. I understand that your doctor is considering your overall health and ability to tolerate treatment without having severe side effects from the treatment.

Melanoma is a skin cancer which arises in melanocytes which are present in the skin. Sun exposure is a predisposing factor. When a melanoma or a mole is discovered it is important that it be surgically removed. At times some lymph node biopsies are recommended. Excellent guidelines are available in the guidelines published and annually updated by the National Comprehensive Cancer Network (NCCN.org). The chance of a recurrence depends on the depth of the original lesion and whether or not lymph nodes were involved. One major issue is whether a new lesion is a recurrence or the appearance of a new melanoma. It is important to be examined routinely by a dermatologist.

This is a question that requires more information to be answered. Usually hepatitis implies an inflammation of liver tissue with elevation of enzymes from the liver cells. This is detectable in blood tests. The prognosis depends on why the inflammation is occurring. If it is due to chemotherapy effects on the liver it should improve and subside with the passage of time. However it is possible that a viral infection is the cause of the inflammation. So it is important to make a diagnosis of the cause and treat the inflammation as indicated by the exact diagnosis. You should ask his oncologist for an explanation.

Hello. It is normal to have worries about chemotherapy. Chemotherapy drugs can have side effects some of which can be uncomfortable but others that cause no side effects. The most common side effect which is very common to many drugs is nausea and vomiting. This, however, is likely controlled by drugs given to decrease or prevent these symptoms. Anti-emetics have become very effective in the past few years. A second side effect common to a few drugs is neurotoxicity which are symptoms of numbness and tingling most common in the hands and feet. Many drugs have been tested and approved to prevent or decrease the intensity of these symptoms.
I encourage your father to try chemotherapy. You and he should discuss your individual fears with the oncologist who is treating him. Asking about expected symptoms do to treatment is expected by the oncologist and should not be considered threatening. The oncologist should be able to help you and your father go through the treatment. More questions will likely arise during treatment and these should be written down as it is easy to forget to ask them in the future.

The short answer is no. When a person or their physician identifies an abnormal lesion it is important to know what it is. This is done by sampling the lesion in a number of ways and looking at the tissue under a microscope. Then decisions can be made regarding treatment and prognosis.

This is a very difficult question to answer. There are several types of pediatric leukemias. The best place to look is in the website of the National Comprehensive Cancer Network (www.nccn.org) which publishes guidelines for the treatment of multiple cancers and is updated at least annually. More than 30 major cancer centers in the USA participate in writing these guidelines.

The word “cancer” is by definition an uncontrolled growth of cells in some part of the body. These cells can effect the organ in which they arose or can metastasize and grow in other organs than those from which they arose.

Symptoms of each particular cancer depend on the organ from which the cancerous cells arose and if they have already spread. The treatments of each cancer include either surgery, radiation, chemotherapy or more recently immunotherapy. Each cancer responds differently to each form of treatment. Every cancer must be treated individually with a specific plan. Chemotherapy may be part of the treatment plan in combination with surgery and or radiation. The behavior of each cancer can be predicted based on the organ where the cancer arose and if it has already spread at the time it was diagnosed. So predictably slowly growing tumors may safely be observed. Addition of chemotherapy or radiation depends on data obtained from treating with combinations and comparing how people do with some alternative. So clinical trials are mandatory and necessary to give an opinion on cancer treatment.

It is important to have good nutrition during chemotherapy. It is also important to drink adequate fluids to protect your kidneys. If you are unable to eat or drink well it is an important fact to discuss with your doctor. Make sure that you drink nutritious liquids that contain calories and protein.

This is an important question. One problem is that all cancers are different. One facet of vaccine development is the discovery of genetic abnormalities that are identical in all or the majority of cases. This would allow scientists to stimulate the immune system to eliminate abnormalities as they appear in microscopic quantities of cells. This unfortunately is not the situation with cancer. Cells in this situation develop different mutations that cause uncontrolled growth. Each type of cancer is unique. Hopefully some day there will be a genetic analysis developed that will allow us to develop drugs or immune cells specific for the cancer in question.

Cognitive problems can be a result of toxicities due to medications given to prevent side effects of the chemotherapy. Incoordination can be an effect on nerves caused by the chemotherapy drugs. It may be that the dosages or the agents need to be adjusted. It is important to ask these questions of the prescribing doctor so that these symptoms can be considered.

Chemotherapy implies drugs that cause cancer cells to die. When this happens our body starts biological actions that result in clean up of the dead tissue. The same thing happens if normal tissue is injured and dies. Chemotherapy effects are usually measured several weeks after administration of the drugs. It takes about eight weeks to be able to see the effects of the chemotherapy. I know that it is hard to have patience particularly when the drugs cause side effects. There are a number of additional drugs that can be prescribed to decrease the side effects and this should all be discussed with her doctor.

I would encourage you to have patience during treatment and try to get your mom through the chemotherapy. Good luck.

Hello, advances in breast cancer management occur through clinical trial results which are usually multi-institutional and are published in literature which is peer-reviewed. These have resulted in recommendations for chemotherapy, radiation therapy and hormonal therapy. These recommendations are summarized in multiple published guidelines. The National Comprehensive Cancer Network, NCCN.org is composed of representatives from multiple cancer centers and updates their guidelines at least annually. They are open to be read by patients.

CBD and it’s derivatives have been used for centuries to treat multiple illnesses. It has been approved to treat nausea and vomiting due to chemotherapy. It has many anecdotal reports of efficacy in treating cancer, but the current clinical trial evidence is insufficient to result in recommendations for its routine use. It is unknown if single-agent use or combination use is superior. It is not approved in the USA for routine use in breast cancer. Nonetheless there are multiple marijuana clinics in the USA that prescribe this agent. Preclinical laboratory data is available which reports an effect on cancer cells with administration of this drug.

My advice is to be very cautious when using this drug due to our inability to demonstrate effectiveness in the treatment of breast cancer. Certainly, it’s effects on the side effects of cancer treatment have been demonstrated. It is wise to ask your physician about their experience and reasoning regarding the prescription of this agent.

Hello. Fever cold and cough are not normal during cancer treatment. It is important to make sure that these are not side effects of treatment or another illness that is developing during the cancer treatment. Cancer treatment can cause decreases in the white cells or infection fighting cells. It is important to tell your doctor about these symptoms do that other causes can be eliminated.

Hello. It is possible that your mother is having side effects from the anti nausea medications. It is possible for the doctor to adjust the medications to decrease the effects of these drugs. I suggest mentioning this to the doctor the next time she is seen and the chemotherapy is ordered. Otherwise it might be possible for the doctor to prescribe a drug to counteract these symptoms.

Hello,

The reasons for fluctuation are usually due to hydration. It could be that the radiation was causing side effects on your intestines or that you didn’t feel like drinking enough liquids. It is important that your doctor try to figure out why your creatinine has fluctuated. A small change is usually inconsequential, but a large change might indicate that your kidneys are malfunctioning. You need to question your doctor who will at least order a recheck of your creatinine and electrolyte levels.

Hello

Your mother had breast cancer treated with surgery about 18 years ago. She should be cured for the primary for which she was treated. It is important, though, to continue to obtain annual check ups from her physician. The chance of a recurrence at this time is small, but depends on her stage of disease and her molecular markers. Every patient is different and the chances of a new primary and/or recurrence depends on her overall characteristics and the stage of the cancer at the time of first diagnosis.

This is a difficult question to answer because the term “leukemia” is very general. There are several types of leukemia and each illness has different effects on a patient and requires different treatment approaches. My suggestion would be to see a hematologist for an opinion. Records need to be provided including a pathology and lab reports. The hematologist must see this information in order to determine treatment recommendations.
Good luck in your endeavors.

Cancer has characteristics that are present in the particular type and different depending on the patient involved. So the prediction in your case is that future cancers will behave similarly and that specific behaviors are mostly unpredictable. Getting tested for BRCA is a predictive test for future cancers to develop and does not effect the behavior of the cancer. If positive it might influence you to accept surgery that would decrease your likelihood of developing new cancers, or taking some medications that have been shown to decrease the chances of the development of new malignancies.

My suggestion would be to find a good general internist and get a good comprehensive history and physical exam. The finding in your axilla may either be benign or could be serious, but an expert should examine you and make a recommendation.