Dr. Robert Morgan, MD

Hello, Pathology reports from prostate biopsies are difficult to interpret. In general a physician familiar with the treatment and diagnosis of prostate cancer needs to carefully read the report prior to making treatment recommendations.

My suggestion would be to consult the guidelines published by the National Comprehensive Cancer network (NCCN.org). These guidelines are updated at least annually and more often as needed.

My suspicion is that your physician was performing screening Prostate Specific Antigen (PSA) testing and that you had a prostate biopsy. The guidelines subdivide patients with prostate cancer into several groups and make treatment decisions based on tumor characteristics and the subgroup into which one falls. The pathology report is necessary to make these risk group determinations. Further molecular characterization can then be carried out if necessary.

It is recommended that your physician be consulted and questions about the pathology be asked of that person. Good luck.

Hello,

Your questions are those that all parents encounter at some point when raising children. The symptoms are very non-specific and can be from many abnormalities. These can include cancer, but this is an uncommon cause.

My recommendation is that the patient be taken to a good general pediatrician who will perform a general history and physical examination to figure out the source of the symptoms and examine the lump on his head that you have discovered. If you don’t have a good general pediatrician, my suggestion would be to identify a large regional children’s hospital and call them for an appointment. This would be the best route to take at present. Good luck with this.

Hello, your question is quite complicated. As you mention, this type of sarcoma is very rare. It usually arises in patients who are ages 10-20, and arises usually in bones or the soft tissue around bones. It requires a tissue diagnosis, and a biopsy is the diagnostic procedure that is indicated. Treatment depends on the stage of the cancer. The higher the stage (where the cancer has spread) the more severe is the prognosis. Treatment depends on the stage. You indicate that chemotherapy has been started, so it is presumed that the patient is under the care of an experienced cancer doctor (oncologist). The prognosis depends on the response of the tumor to chemotherapy.

Hello.

Your question is difficult to answer. There are many types of blood disorders. Most are not cancerous. In general it is necessary to have a bone marrow examination in order to assess the blood producing factory. Then the treatment and necessary diagnostic tests depend on these results. It is necessary to have a hematologists opinion. These are physicians who specialize in blood disorders.

Hello. You are asking an important question. Skin abnormalities are quite common. They are most likely non cancerous moles. However, if you are noticing a new lesion, it is important to have it investigated. Many skin abnormalities can be diagnosed by an experienced dermatologist who maybe able to identify the type of lesion. Many times the only way to know for sure is to do a biopsy.

Hello, you are asking a very difficult question. The specific cause of osteosarcoma is unknown in the pediatric age group. It is the third most common malignancy in children and young adults with only lymphomas and brain tumors more frequent.

The most common therapy is surgical excision. Most patients are recommended to receive chemotherapy post-operatively which has been shown to reduce the recurrence rate. Survival rates are variable and depend on whether the tumor is localized or has spread (metastasized) and can be surgically removed.

Hello,

You are asking a very interesting question. The question of the initial treatment of prostate cancer depends on several factors. The age of 38 is a very young age to develop prostate cancer. The patient should have a genetic evaluation to be certain that there are no familial concerns to further evaluate. This would also be important for any children to be aware of and if positive, one must make certain that children may not have inherited the propensity to develop prostate cancer. However, I am assuming that an examination was performed and a prostate specific antigen test was performed. I am also presuming that a prostate biopsy was performed to be certain of the diagnosis.

The treatment depends on several factors. The best place to look for information is in the guidelines panel of the National Comprehensive Cancer Network (www.nccn.org). This group is an organization consisting of many cancer center members in the USA which publishes guidelines for the treatment of about 97% of cancers. These are updated annually or more often as articles are published in order to stay current.

Several approaches are recommended. One is a radical prostatectomy and node dissection. Other treatment approaches, depending on the risk group for the individual patient include external beam radiation, endocrine therapy, or observation. The treatment approach to be followed depends on the physician recommendation and the patient"s desires. Surgery, in my
opinion, provides the best chance of curing the illness if the patient is in the proper risk group. These options need to be discussed with the patient's doctor and the risks and benefits of each treatment group need to be identified.

Hello.

You ask the question that has been the scope of research for the past century. In general the treatment approach for ovarian cancer is multi-factorial. It also depends on the stage of the cancer at the time of diagnosis. Most ovarian cancer is found at a time when the patient develops symptoms from the cancer spreading into the abdominal cavity. Often ascites (fluid) is excreted by the tumor causing abdominal distention and pain, sometimes bowel dysfunction. Other times the diagnosis is from the finding of an ovarian mass.

Most of the treatment approaches include surgical removal of the tumor with the goal of removing all visible tumor nodules. Microscopic disease is inevitably left behind and post-operatively chemotherapy is recommended. The options for chemotherapy depend on the microscopic diagnosis and the location of the tumor, and the results of the debulking surgery.

The best place to look for information is the website of the National Comprehensive Cancer Network. (Www.nccn.org). This is a group of cancer centers in the US that publish guidelines updated at least annually and more often if necessary as scientific reports are published.

It is important that the surgery be performed by a gynecologic oncologist who is familiar with the necessary steps for the surgery. Good luck to your friend.

Hello, you are asking an interesting question, but I don't have enough information to completely answer your question. Bones are one of the most common sites for cancer to spread. Additionally there are multiple pathologic types of primary bony cancers. These range from cartilage tumors to osteopenia sarcomas. In general a multi-disciplinary team is recommended to treat these tumors.

I will try to answer your query assuming that the tumor is an osteogenic sarcoma. The team that is necessary includes a medical oncologist, an orthopedic oncologist, a pathologist who is familiar with bony tumors, a radiation oncologist, and many times physical and/or occupational therapists.

If the tumor/tumors are resectable they should be surgically removed. Post-operatively radiation or chemotherapy may be recommended. If the tumors are not able to be respected, radiation or chemotherapy may be the primary treatment.

If no biopsy has been done it would be recommended to obtain a biopsy. Treatment would depend on the pathologic type of tumor. Every tumor, including other primary sites has recommended treatment approaches.

You are asking an interesting question. Surgery is a complicated process. Generally a primary care physician diagnoses a medical issue for which surgery is a possible treatment process. Breast cancer is one such illness. There are several approved surgical procedures that can be used for the treatment of this illness. Among these are mastectomy (removing the entire breast). Lumpectomy is also possibe in some situations. It is important for the surgeon to meet and examine the patient prior to starting any procedure. The surgeon and the patient need to discuss the possible treatment options and order the appropriate medical tests to be certain the the procedure is correct for any individual patient.

So the answer to your question is that hat a surgical consultation is the correct approach to meet the surgeon and allow the surgeon to discuss treatment approaches and possible side effects of the procedures with you.

For further information I suggest the guidelines published by the National Comprehensive Cancer Network (NCCN) www.nccn.org). These guidelines are available online and are updated at least annually and more often if necessary. A large group of established cancer centers in the United States develop these guidelines.

Good luck with your procedure.

Hello. You ask an interesting question. HPV (human papilloma virus) is a very frequent transmissible agent for humans. It is commonly present in asymptomatic individuals and frequently is eliminated with the passage of time. However it has been shown to be the causative agent in cervical cancers and frequently is present in head and neck cancers. I am assuming that your polyps were cervical polyps that were diagnosed by your gynecologist during routine examinations.

The polyps were removed surgically and have not recurred.

It is important that you continue to have routine examinations by your gynecologist. This person may also be performing tests to determine if the virus continues to be present in your body.

It is possible to be reinfected with HPV if the culture tests are currently negative.

My impression is that you do not currently have a viral infection or an uncontrolled cancer. You are, however, at a higher risk of an HPV cancer recurring. It is important that you continue regular evaluations with your physicians. For further information I would suggest consultation with the guidelines published by the National Comprehensive Cancer Network (www.nccn.org). This group publishes treatment guidelines for about 98% of cancers and are updated at least annually or more often as necessary.

Hello. You pose an interesting question. You are a 71year old lady with elevated vitamin b12 levels and elevated serum ferritin levels. Your WBC and RBC counts are normal as are your liver function tests. I am not sure what was imaged by the receptive ultrasound, but I presume that was an imaging of your liver. You feel well.

Vitamin B12 is important for blood cell maturation. There is no major knowledge of the effects of high blood levels although there is some evidence that supplementation may result in lowering incidences of depression. Are you taking over the counter B12 pills? Most of the time excessive intake of B12 is excreted by the normal kidneys.

Ferritin levels that are elevated may be due to multiple reasons. Many times they may be elevated due liver disease. I am not sure why your doctor ordered these levels since they are not usually routine in a CBC and must be ordered individually. If you have an elevated level it may be due to some condition that causes you to store large amounts of iron. These conditions may include hyperthyroidism, liver disease, other inflammatory conditions, or rheumatoid arthritis. All of these conditions have other associated symptoms. It is important to understand the reasons that your doctor ordered the tests. Other follow up tests will depend on your overall findings in the history and physical exam that your doctor is performing.

In general I would not be concerned about these test results. Excessive intake of iron pills or vitamin B12 pills can result in these findings. You should ask your doctor for the reasons that these tests were ordered.

Hello. I will try to summarize and answer the questions that appear in the query.

There are many types of lymphomas. They include follicular and diffuse lymphomas. Their growth pattern is different from person to person. The subtype of lymphomas is determined by the pathologist who analyzes the biopsy.

I agree with your doctor. Follicular lymphomas can be very slow growing. The recommended treatment depends on the stage of the tumor (whether or not it is localized or has spread). In general these tumors need to be treated based on the location and the symptoms that the tumor is causing or is likely to cause.

Treatment can be either chemotherapy, immunotherapy, or sometimes localized radiation therapy. It is important for your doctor to explain the treatment approach that is recommended. I think that observation would be an excellent treatment approach for you.

An excellent source of information is in the NCCN guidelines (National Comprehensive Cancer Network ( nccn.org)). This is a group of cancer hospitals in the United States that publish treatment guidelines for cancer which are continually updated. Check the guidelines for B cell lymphomas.

Good luck in your investigation and for your efforts to learn the best treatment approaches.

Lymphomas and leukemias are separate illnesses whose behavior depends on the cell of origin which has become malignant.

Hello.

Chemotherapy related fatigue is very common. However, there are many possible causes or factors that contribute to this irritating symptom. These include simultaneous radiation therapy, bone marrow transplant, and biological therapy. Other contributing factors which can be induced by chemotherapy include anemia, combination therapy in patients receiving more than one treatment at a time, a treatment induced “hyper metabolic state” which can result in weight loss, decreased appetite and fatigue, decreased nutrition which can result from side effects of chemotherapy including nausea and vomiting, hypothyroidism, pain, medications given along with chemotherapy, stress and/or depression.

To deal with these issues it is important to plan ahead and organize the workload. Schedule and take rest periods, pace oneself, limit overhead and isometric work, practice proper body mechanics to combat cancer fatigue including using carts or chairs with good support, bending at the knees or hips rather than the back, avoiding temperature extremes or smoke. It is important to prioritize nutrition and fluid intake. Getting good sleep, exercise and stress management are also important.

It is important to discuss the fatigue problem with the doctor who prescribes the chemotherapy. Other causes of fatigue must be considered and medications can be adjusted. Sometimes stimulants can be prescribed to counteract the fatigue.

Good luck to the patient. It is important for him to talk to his doctor about this. An excellent review of this syndrome can be found at chemocare.com, Care during chemotherapy and beyond. The heading is Fatigue and Cancer Fatigue.

Hello. I will try to summarize and answer the questions that appear in the query.

There are many types of lymphomas. They include follicular and diffuse lymphomas. Their growth pattern is different from person to person. The subtype of lymphomas is determined by the pathologist who analyzes the biopsy.

I agree with your doctor. Follicular lymphomas can be very slow growing. The recommended treatment depends on the stage of the tumor (whether or not it is localized or has spread). In general these tumors need to be treated based on the location and the symptoms that the tumor is causing or is likely to cause.

Treatment can be either chemotherapy, immunotherapy, or sometimes localized radiation therapy. It is important for your doctor to explain the treatment approach that is recommended. I think that observation would be an excellent treatment approach for you.

An excellent source of information is in the NCCN guidelines (National Comprehensive Cancer Network ( nccn.org)). This is a group of cancer hospitals in the United States that publish treatment guidelines for cancer which are continually updated. Check the guidelines for B cell lymphomas.

Good luck in your investigation and for your efforts to learn the best treatment approaches.

Lymphomas and leukemias are separate illnesses whose behavior depends on the cell of origin which has become malignant.

Hello. We don’t have enough information to answer this question accurately. I am presuming that you are referring to a primary bone lesion, ie osteosarcoma. However bones are one of the most common places to which cancers can spread. The treatment depends on the histology of the tumor and if the tumor has spread anywhere else.

I suggest that you consult the guidelines published by the National Comprehensive Cancer Network (www.nccn.org). On the website look under “bone cancer”. That will give a summary of treatment options for many types of bone cancers.

Osteosarcomas which are localized should have consideration of surgery as the initial treatment. For tumors which have spread, chemotherapy is recommended.

My advice to your friend is that a biopsy should be considered and treatment should depend on the results of the biopsy.

Hello. Your history is very common. DCIS (ductile carcinoma in situ) is a relatively uncommon way for invasive breast cancer to present. I would recommend the guidelines published by the NCCN (National Comprehensive Cancer Network, www.nccn.org) which is a cooperative group of cancer institutions in the US that publish and update guidelines for cancer treatment. Your wife needs surgery to treat this lesion. The guidelines have four surgical options. The primary option is lumpectomy followed by radiation. This is a category 1 option. Other possibilities include mastectomy (removal of the entire breast with or without radiation. Post operative treatment depends on the menopausal status of your wife. It also depends on the pathology of the tissue removed surgically. She should also be evaluated for familial types of breast cancer which are more uncommon. Her oncologist should be familiar with all of these options and it is reasonable to ask for their opinion and recommendations. Good luck to you and your wife.

Hello. I am not sure why you are asking this question. Our bodies have excellent systems to maintain oxygen levels in the blood. The levels depend on the usage of oxygen by our activity. It is usual that even with strenuous activity the oxygen level does not vary significantly. The lungs are excellent in replenishing oxygen content and disposing of waste gases such as carbon dioxide. Severe lung disease, though, can impede normal functioning of the lungs. Heart disease which can cause fluid buildup in the lungs can also cause a decreased functioning of the lungs which can cause low oxygen concentrations. Your body will react and a person can feel short of breath in these situations.

Hello. There are many paraneoplastic syndromes associated with lung cancers. The most common occur with squamous cell cancer or with small cell lung cancer. Often these syndromes can appear as the first manifestation of cancer recurrence. The syndrome of pulmonary osteoarthropathy can occur with adenocarcinomas. There is a good review of these syndromes authored by Kanoji Noruhiro, in World journal of Clinical Oncology, 8/10/2014 pages 197-223 entitled Paraneoplastic syndromes associated with lung cancer.

The majority of these syndromes are either endocrinological or neurological in origin. The above syndrome is also associated with adenocarcinomas.

I am presuming that your relative has been evaluated for tumor recurrence? My suggestion would be to discuss the findings related in the above article with his oncologist and obtain the appropriate testing.

Often a fine needle aspirate (closed biopsy) can provide adequate tissue for a diagnosis. However an excisional biopsy (open biopsy) will often provide a more accurate amount of tissue for a diagnosis. You need to ask this question of your doctor. That person is clearly of the opinion that an open biopsy is necessary to obtain an adequate tissue sample for an accurate diagnosis.