Items in AFP with MESH term: Neoplasms
ABSTRACT: Targeted therapies, which include monoclonal antibodies and small molecule inhibitors, have significantly changed the treatment of cancer over the past 10 years. These drugs are now a component of therapy for many common malignancies, including breast, colorectal, lung, and pancreatic cancers, as well as lymphoma, leukemia, and multiple myeloma. The mechanisms of action and toxicities of targeted therapies differ from those of traditional cytotoxic chemotherapy. Targeted therapies are generally better tolerated than traditional chemotherapy, but they are associated with several adverse effects, such as acneiform rash, cardiac dysfunction, thrombosis, hypertension, and proteinuria. Small molecule inhibitors are metabolized by cytochrome P450 enzymes and are subject to multiple drug interactions. Targeted therapy has raised new questions about the tailoring of cancer treatment to an individual patient's tumor, the assessment of drug effectiveness and toxicity, and the economics of cancer care. As more persons are diagnosed with cancer and as these patients live longer, primary care physicians will increasingly provide care for patients who have received targeted cancer therapy.
The Era of Targeted Therapies - Editorials
ABSTRACT: There are more than one half million cancer deaths in the United States each year, and one third of these deaths are attributed to suboptimal diet and physical activity practices. Maintaining a healthy weight, staying physically active throughout life, and consuming a healthy diet can substantially reduce the lifetime risk of developing cancer, as well as influence overall health and survival after a cancer diagnosis. The American Cancer Society's Nutrition and Physical Activity Guidelines serve as a source document for communication, policy, and community strategies to improve dietary and physical activity patterns among Americans. In 2006, they published updated guidelines for the primary prevention of cancer and guidelines for improving outcomes among cancer survivors through tertiary prevention. These two sets of guidelines have similar recommendations, including: achievement and maintenance of a healthy weight; regular physical activity of at least 30 minutes per day and at least five days per week; a plant-based diet high in fruits, vegetables, and whole grains and low in saturated fats and red meats; and moderate alcohol consumption, if at all. Physicians are encouraged to find teachable moments to impart appropriate nutrition, physical activity, and weight management guidance to their patients, and to support policies and programs that can improve these factors in the community to reduce cancer risk and improve outcomes after cancer.
Recent Advances in Radiation Therapy - Article
ABSTRACT: Recent advances have improved the effectiveness, decreased the complications, and expanded the implications of radiation therapy. These advances include three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, stereotactic radiotherapy, brachytherapy, and radioimmunotherapy. Each of these modalities has improved radiation targeting, thereby limiting radiation exposure of healthy tissues. The way radiation therapy is administered has also changed. Although traditional external beam radiation therapy is administered daily over several weeks, stereotactic radiotherapy may be administered as a one-time treatment. Radioimmunotherapy is administered intravenously. Contemporary radiation techniques also have distinct toxicity profiles. The high radiation doses employed during stereotactic radiotherapy have been associated with obliteration or obstruction of tubular structures, such as bronchi and bile ducts, limiting its use near these tissues. Radioimmunotherapy may be complicated by anaphylactic reactions during and following infusions. As more patients are diagnosed with cancer and as these patients live longer, primary care physicians will increasingly care for those who have received radiation therapy.
Cancer Screening in the Older Patient - Article
ABSTRACT: Although there are clear guidelines that advise at what age to begin screening for various cancers, there is less guidance concerning when it may be appropriate to stop screening. The decision to stop screening must take into account patients' age; overall health and life expectancy; the natural history of the disease; and the risks, expense, and convenience of the screening test, and any subsequent testing and treatment. The U.S. Preventive Services Task Force and the American Academy of Family Physicians suggest that Papanicolaou smears can be discontinued in women at 65 years of age, provided they have had adequate recent normal screenings. Evidence suggests that cessation of breast cancer screening at approximately 75 to 80 years of age is appropriate, although American Geriatric Society guidelines recommend cessation at a more advanced age. Studies support continuing colon cancer screening until approximately 75 years of age in men and 80 years of age in women for patients without significant comorbidities. Prostate cancer screening, if conducted at all, may be discontinued at approximately 75 years of age in otherwise healthy men. Ultimately, the decision to screen or to discontinue screening must be made after careful discussion with each patient, using evidence-based guidelines and individual patient preferences.
Soy: A Complete Source of Protein - Article
ABSTRACT: Soybeans contain all of the essential amino acids necessary for human nutrition and have been grown and harvested for thousands of years. Populations with diets high in soy protein and low in animal protein have lower risks of prostate and breast cancers than other populations. Increasing dietary whole soy protein lowers levels of total cholesterol, low-density lipoproteins, and triglycerides; may improve menopausal hot flashes; and may help maintain bone density and decrease fractures in postmenopausal women. There are not enough data to make recommendations concerning soy intake in women with a history of breast cancer. The refined soy isoflavone components, when given as supplements, have not yielded the same results as increasing dietary whole soy protein. Overall, soy is well tolerated, and because it is a complete source of protein shown to lower cholesterol, it is recommended as a dietary substitution for higher-fat animal products.
Green Tea: Potential Health Benefits - Article
ABSTRACT: Green tea has been used widely and in high doses for centuries as a health tonic in many societies. Evidence suggests that green tea is effective for treating genital warts. There is some supportive evidence for the use of green tea in cancer prevention. Drinking green tea is associated with a decrease in all-cause mortality, but not in cancer-related mortality. Small clinical studies have found that green tea may also be helpful in losing and managing weight, and lowering cholesterol. Epidemiologic evidence suggests that green tea may prevent stroke and cardiovascular disease. Green tea appears to be safe, although there have been case reports of hepatotoxicity possibly related to a specific extract in pill or beverage form. Green tea seems to be a low-risk complementary therapy for a number of conditions, but more studies are needed.
Long-Term Benefits of a Vegetarian Diet - Editorials
So How Are You Doing? - The Last Word