Dr. Robert Morgan, MD

Hello. Polyphenols have been included in nutritional supplements as unregulated substances. They are present in many foods some of which are either inedible or poorly edible such as soy. There is very little known about their overall effects on the body. An interesting article appeared in the American Journal of Clinical Nutrition published on January 1, 2005. The first author is Louise Mennonite. Title is Risks and Safety of Polyphenol Consumption.

It appears that there are reports of interactions with the thyroid gland and with hematologic functioning. There are reports of cancers developing in patients taking these supplements. Cause and effect, though, is not known and more studies should be done for further investigation.

Hello. Your friend’s daughter is in the pediatric age group. My suggestion would be to refer to the website sponsored by the children’s hospital of Los Angeles (choc.org). They have a breakdown of the various types of leukemia that are treated in the pediatric age grouping.

Basically the side effects of chemotherapy are generalizable. Depending on the regimen most chemotherapeutic regimens cause temporary hair loss which recovers when chemotherapy is completed. Chemotherapy also causes temporary decreases in white cells which fight infections and platelets which help with blood clotting. These counts recover after chemotherapy is completed. Nausea and vomiting are common and medicines need to be prescribed to decrease these side effects. Other systemic effects such as mouth soreness or numbness and tingling are less common.

Children usually tolerate chemotherapy well. It would be good to ask this question of the pediatric hematologist who is prescribing the medications.

Hello. The bones are one of the most common sites to which cancers can move (metastasize). So it is important to do a biopsy to be certain of the location of the primary tumor. I will assume that a biopsy has already been done and that your friend has a diagnosis of a primary bone tumor. I would recommend that you consult the guidelines of the National Comprehensive Cancer Network (NCCN.org). The group is a multi-institutional group that publishes and updates guidelines for cancer treatment at least annually.

Bone cancer is one of the most responsive of tumors. The treatment always depends on the primary site of the tumor. Many times combined modality treatment (surgery, chemotherapy and/or radiation) is recommended. Your friend needs to ask questions of the treating oncologist to be certain that the primary site has been identified.

Breast cancer is a very common illness. Approximately one in every eight women will develop it sometime in her life. Genetic inheritance is also very important.

The treatment of breast cancer depends on several characteristics. One is the age and underlying health of the patient. The second is the location of the cancer. Local disease is treated much differently than metastatic disease. The third is the molecular characterization of the tumor. Localized disease in a young woman is usually treated with surgery followed by hormonal blockers, chemotherapy and/or radiation. The schedule and treatment recommendations depend on specifics of the cancer. Metastatic disease treatment depends on where the metastasis occurs and what the symptoms might be.

An excellent reference is the guidelines prepared by the National Comprehensive Cancer Network (nccn.org). This is a national group of cancer centers that meet annually or more often and publish guidelines which are continually updated. The guidelines are available to the general public online.

I recommend that your cousin see her oncologist with a list of questions and have a discussion with her oncologist for recommendations regarding the best treatment for her.

Hello. Your question is quite complicated. “Bone cancer” is usually diagnosed following symptoms appearing that are able to be referred to a bony area. An X-ray can then be done. Usually pain is one major symptom. X-rays will show an abnormality in the area with symptoms.

The X-rays and the doctor can usually interpret the reason for the symptoms.

Bone cancer, though, can be a symptom of a primary tumor that arises in a bone. Very commonly, though, it can be a manifestation of a metastatic spread of another tumor. The treatment depends on the type of tumor which usually needs a biopsy to determine. The doctor needs to give an opinion on the next step to take.

I’m sorry to hear that your daughter is having persistent nausea. Many chemotherapy regimens have nausea and vomiting as side effects. The symptoms generally only last a short time, mostly a few days at most. There are anti-nausea drugs that can be taken to make this symptom subside. It is important to ask her doctor to prescribe medications to take care of this symptom. It is also important to be certain that she can take in orally enough fluids and solid food to maintain her overall health. Good luck in dealing with this.

Hello. The cause of cancer in general is unknown. Much research has been done to try to figure out what are the factors that cause cancer. These factors give percentages of the possibility of developing cancer over a set number of years. A family history of cancer often causes an increased chance of the development of that type of cancer. It remains unclear if this increased risk is due to environmental factors or otherwise. There is increasing information about genetic changes increasing the formation of cancers. This is particularly true in breast ovarian and colon cancers and other less common types of cancer.

The types of familial cancers can be inherited. There are guidelines published that recommend screening and or genetic analysis. One group is the NCCN (nccn.org) (National Comprehensive Cancer Network) which publishes guidelines for about 95% of cancers which are updated at least annually.

Each of these pieces of information provides only an estimate of the possibility of cancer development. It is important to follow guidelines recommending standard eating and or genetic testing that should be performed. Environmental factors also play a role in cancer development.

Hello,

Sometimes chemotherapy is administered to improve the response of the tumor to radiation. Each chemotherapy has an effect on the skin or other organs. It can improve the anti-cancer effect of the radiation. Sometimes the chemotherapy can have immediate effects on the cancer for which it is given. Generally, the effects of chemotherapy and radiation are known through observation of patients enrolled in clinical trials. I would suggest that you discuss these concerns with the doctor who is administering the chemotherapy regarding how to minimize the skin toxicity of the treatment. There are creams and other topical medicines that can be used to minimize effects of the treatments.

Hello, I am presuming that your question refers to hepatocellular cancer. The liver is one of the most common organs to develop metastases and therefore it is important that a biopsy be done to confirm the diagnosis. The treatment possibilities for hepatocellular cancer are varied. The guidelines published by the National Comprehensive Cancer Network (nccn.org) suggest that the possibility of resection (surgical removal of the tumor) is preferable. Other options include ablation (instillation of chemotherapy by intra-arterial or intravenous administration), or external beam radiation are possible. It is important that a specialist in this type of cancer be consulted for an opinion. Good luck. If the biopsy reveals another type of cancer the recommendations are likely to change.

Hello. I am not sure about the symptoms that you were having prior to the discovery of this tumor. However it is necessary to know what this tissue is. Your doctor needs to help you decide how to obtain a small amount of tissue (a biopsy) so that a pathologist can look at it and make a diagnosis. Where this tumor is located defines the options. Sometimes a colonoscopy can be performed. Sometimes a needle biopsy by a skilled radiologist can be performed. These procedures are not usually procedures that have a large number of side effects. But it is necessary to know what the tissue is in order to figure out what treatment should be done. Many of these tumors are curable. Treatment options, though, are dependent on what the tissue is. Sometimes medications can be prescribed for patients who are nervous about going through the recommended procedure. I urge you to have it done. Please discuss your concerns with your doctor. Good luck!

Hello. Hair loss is a side effect of chemotherapy administration that is disturbing to all patients. Each chemotherapy drug has a different effect on hair loss. Some cause only a mild thinning of hair, but others cause complete hair loss. This can occur suddenly a few days after the first dose of chemotherapy. But if this happens to you, don’t worry about it. The good news is that everyone’s hair grows back after completion of the chemotherapy. You should ask your doctor about the chance of hair loss with the prescribed chemotherapy. Many women get a hairpiece to get them through the chemotherapy with less distress. Good luck with your treatment.

Hello. Many medications for chemotherapy side effects are prescribed and are safe during chemotherapy. Tylenol is one of the safe medications. But it is important to take the medication following the instructions that come with the Tylenol.

Hello

Chemotherapy can be rigorous. Every chemotherapeutic drug has a set of side effects that effect everyone in different ways. Fatigue and loss of appetite are common side effects of chemotherapy, but side effects of the anti nausea drugs that I presume that you are taking can also result in side effects that include fatigue and loss of appetite. My suggestion is that you listen to what your body tells you. If you are fatigued, you need to rest. Please try to eat well as you are able. Discuss these side effects with your doctor as some medication doses may need to be adjusted. The doctors and nurse practitioners can suggest a good diet for you.

Hello,

I have read your history. You seem to have a stable lymph node enlargement and are likely responding to antibiotics. Your questions seem to be primarily that your concern is with the possibility of cancer that might have spread from the area where it arose and is growing in a lymph node.

With your concerns the best way to settle this is to do a biopsy. I believe that the possibility of cancer is very low. Lymph nodes can swell for a large number of reasons including inflammations from infections, cancerous growths, or lymphomas. It sounds like your doctors are feeling that your lymph node is due to non-malignant causes, but the best way to know is to do a biopsy which is usually a very benign procedure. Answers to your questions are as follows:

1. A malignant enlarged lymph node should be increasing in size. Your node is small. The chance of a malignancy is also very small. But a biopsy is the best way to know for sure.
2. The exact location of the node does not define how it should be evaluated. Whether it is supraclavicular or cervical does not matter as the nodal groups overlap in this part of the body. The enlarged description leads me to recommend a biopsy.
3. The nodes should decrease in size with time if swollen for non-malignant causes.

Ask your doctor if you can see a surgeon for a biopsy.

Hello. Anemia is a common side effect of chemotherapy administration. However it is important to have a diagnosis as to why the anemia exists. It is important to ask your doctor about the reason for the anemia to be present. Your doctor needs to do the correct testing. It could be one of the other medications you’re taking along with the chemotherapy that could be a factor. If your doctor is convinced that the reason for the anemia is the chemotherapy a drug called erythropoietin or Avastin can be used to stimulate the red blood cell production from the bone marrow. But it is important to know the exact reason for the anemia to exist.

Hello. The major issue in adults with anemia is the cause of the anemia. Anemia is one way of stating that a persons red blood cell concentration is lower than normal. This can be due to bleeding or abnormal destruction of red cells or inadequate production of red blood cells by the bone marrow. Whole books cover all of these problems. Treatment depends on the cause.
Basically a person can experience abnormal tiredness as a result of anemia. If bleeding is the cause stool can be either red due to the bleeding or tarry black due to digestion of the blood.
It is important for the doctor to recommend and do appropriate testing to determine the cause of the abnormality.

Hello. Your email states that the bone growth was removed. But you don’t mention the pathology on the removed tissue. The answer to your question depends on the pathology from the already removed tissue. This tissue might serve as a biopsy specimen.

Hello. I am sorry to hear about the vomiting experienced by your father. Nausea and vomiting are common side effects from chemotherapy. Each chemotherapy has an individual chance of causing this side effect. For this reason it is common (standard) to administer anti-nausea drugs to try to prevent this. It will be important to tell your fathers oncologist about this side effect as his premedication May need to be adjusted or the instructions for post chemotherapy drugs may need to be changed.

Hello. I am sorry to hear about your situation. I don’t know, though, the exact diagnosis. The treatment of cancer depends on the tumor type and the overall condition of the patient. It sounds like your cancer has progressed to the point where you are being affected by the cancer and possibly the failure of your liver to function. I would suggest that you should have a consult from a palliative care physician who is well educated to treat your symptoms. Pain, which can be severe but treatable, is a usual symptom of advanced cancer. Please ask your oncologist for a consult with a palliative care physician.

Thrombophilia in children is an extremely rare condition. Generally it is diagnosed after a child develops a blood clot. There are multiple genetic syndromes associated with this illness and one must be aware that siblings or other relatives can also be affected. The treatment recommendations depend on the diagnosis and are not universal across all illnesses. My suggestion to a parent or relative of a child affected by thrombophilia is that the patient be evaluated by a physician who is a pediatric hematologist, so appropriate testing can be done and appropriate diagnosis can be made. My suggestion would be to take the advice of the expert pediatric hematologist regarding treatment.