Complementary/ alternative medicine and cancer therapy

Complementary medicine is usually defined as treatment outside the common medical treatment (chemo, radiation, surgery, etc) and not a standard therapy. An example would be  using acupuncture to reduce chemo related nausea.   Alternative medicine is commonly understood as a different treatment than the standard chemotherapy.  an example would be using alkaline diet instead of radiation in treating cervical cancer.

Some of these alternative and complementary treatments are recommended as a more natural treatment than the standard cancer medication.  However, being natural does not mean safe.  A herb called Kava Kava which has been used for stress relief may cause liver damage.    Even vitamin C, taken in a high dose, may adversely affect the effectiveness of chemotherapy.

Thus, it is very important that you share all your medication and alternative treatments with you oncologists.

A good resource of non-standard medicine is in NCI.gov

talc and ovarian cancer

In the last a few years, we heard more litigation cases brought by patients with ovarian cancer against the maker of talk/ baby powder.

Talc powder has been studied in the past 20-25 years in its association with ovarian cancer.   When these studies were combined, there seems to be a slight increase in relative risk 1.3 (95 percent confidence intervals 1.2–1.5).  Relative risk of 1 means no association.  RR above one suggests an association.   However, an association is not necessarily a causation.

Talc is a silicate material which is chemically classified similarly to asbestos but talc is not asbestos.   Asbestos has been clearly associated with certain types of cancer.   However, talc powder used in the genital or perineal areas have conflicting information.    Although the combination studies mentioned showed a slight increase in risks, one would question on why it is ovarian cancer, rather than cervical or vaginal cancer which anatomically more exposed to the talc powder.  Furthermore, the reduction of usage and production of talc powder (from 40,000 to around 5,000 metric tons) has not been associated with the similar degree of reduction in ovarian cancer.   Finally, we have been using talc to glue the lining of the lung (pleurodesis) in the treatment of air in lung (pneumothorax).  some of these studies have followed these patients of more than 40 years but showed no increased in lung cancer from talc powder.

My recommendation is if you are using talc powder, you may not want to use it until we get more data.  you definitely do not want to use talc powder that may be contaminated with asbestos (this is pre 1970 era).  I hope you do not keep a 40 year old baby powder and still using it.  Our current understanding of the collective data do not support causal effect of talc in inducing ovarian cancer.

duration of postmenopausal hot flushes

Average American women become menopausal around age 51 years old.   Some women experience hot flushes younger when they have their ovaries removed surgically for various reasons.   In the Study of Women Across the Nation (SWAN), the median duration of hot flash symptoms was 7.4 years.  This duration is longer than the currently recommended duration for treatment of symptoms (maximum 4 to 5 years to minimize excess breast cancer risk).

We postulate that the increase risk of breast cancer is due to the progestin part of hormone replacement therapy.  When women still have uterus and experience menopause, they are usually prescribe both estrogen and progestin.  The progestin seems to reduce risks of uterine cancer but with prolonged usage may incrase risk of breast cancer.

Thus, do discuss with your physicians and health care providers of risks and benefits of hormone replacement therapy.

Reference:

Avis NE, Crawford SL, Greendale G, Bromberger JT, Everson-Rose SA, Gold EB, Hess R, Joffe H, Kravitz HM, Tepper PG, Thurston RC, Study of Women’s Health Across the Nation (SWAN).  Duration of menopausal vasomotor symptoms.  JAMA Intern Med. 2015;175(4):531

Removing your fallopian tubes may decrease your risk for ovarian cancer

Research has shown that the majority of ovarian cancer arise from fallopian tubes, not ovary.  You may happen planning to have your uterus removed (hysterectomy) for non-cancerous reasons (fibroid, pain, excessive bleeding, etc).   And if you are a young woman, most of your surgeon would recommend preservation of your ovary/ovaries while removing your uterus.  A 2015 paper from Obstetrics and Gynecology journal showed that concurrent prophylactic removal of your fallopian tubes could reduce your ovarian cancer by 50%.

The removal of your fallopian tubes usually take only a few extra minutes.  Most surgeons do not even charge extra to do this.  There is a small risk of compromising blood perfusion to the ovary.   Please discuss with your surgeon if you plan to have hysterectomy for benign (non cancer) reasons.

Reference:
Kwon JS, et a.  Costs and Benefits of opportunistic salpingectomy.   Obstet Gynecol 2015
Falconer H, et al. Ovarian cancer risk after salpingectomy.  JNCI 2015

New HPV vaccines to prevent genital dysplasia and cancer (available start Feb 2015)

Human papilloma viruses (HVP) are known to cause cancers.  In the genital areas, HPV cause the majority of cervical cancer (>90%) and some vulvar, vaginal, anal and penile cancers.   In 2015, there is a new HPV vaccine called 9valent HPV vaccine (from Merck).   In the past, there were 2 HPV vacciness covering HPV 16,18 and HPV 16,18,6,11.  This new vaccine covers 9 different HPV types thus further protect patients from potential genital cancers.

This new vaccine, similar to the previous HPV vaccines, are administered at 0, 1-2 months, and then 6th month (3 doses).  Vaccination can be started as early as 9 years old to age 26 (females) and 21 (males).  Men who have sex with men and immunocompromised men (HIV) can be vaccinated up to age 26.

You could find out more information from CDC.gov or your physicians and other health care providers.

Morcellator (tissue grinder) and uterine fibroid and risk of spreading cancer

With wide spread surgical practice using robot or laparascopy hysterectomy, many surgeons have to work with large uterine mass.  Most of these uterine mass are fibroid (benign smooth muscle tumor).   Thus, the surgeons would use a morcellator (like a grinder) to make the uterine mass smaller so they could be removed laparascopically (without making large surgical skin incision).

Unfortunately, not all uterine masses are fibroid and it is difficult to tell before surgery which one actually has uterine cancer.   If you use the morcellator on uterine cancer, then you may have the cancer spreads on your pelvis and abdomen.   Because of some rare cases that have occurred, many surgeons are becoming more cautious about using morcellators.   Please discuss with your surgeon if you have large uterine mass and you are about to undergo hysterectomy.  You may want to choose open abdominal approach than laparascopic or robotic hysterectomy.

Chemotherapy before surgery in patient with ovarian cancer

In some patients with ovarian cancer, unfortunately,  the cancer spreads widely that surgery cannot remove most of the tumor.   A randomized trial reported of using neoadjuvant chemo (chemo before surgery) first for 3 months to shrink tumor to smaller size, then surgery.   In my experience, this approach works especially well on patients with a lots of tumor and ascites (fluid in abdomen) which put patient at high risk for surgical complications.   Some patients, due to extensive tumor, may need longer than 3 months of neoadjuvant chemo.  Although chemotherapy itself has its own side effects, some patients seem to better tolerate surgery after, rather than before chemo.

If you have widespread ovarian cancer with ascites, you may want to discuss this neoadjuvant chemotherapy approach with your doctor.

Reference:
Vergote I. et, al.  New England Journal of Medicine. September 2010