Monday, April 20, 2009

Bone drugs may protect against radiation exposure

By Julie Steenhuysen – Sun Apr 19, 3:09 pm ET

CHICAGO (Reuters) – Drugs commonly used to strengthen bones to prevent osteoporosis may protect people exposed to radiation against developing leukemia, U.S. researchers said on Sunday.
They said two compounds in a class of drugs called bisphosphonates delayed and in some cases prevented mice exposed to high doses of radiation from developing leukemia, a common long-term side effect of radiation exposure.
Alexandra Miller, a scientist at the Armed Forces Radiobiology Research Institute in Bethesda, Maryland, has been studying ways to protect military personnel and astronauts from radiation exposure.
But she said the findings, which she presented at the American Association for Cancer Research in Denver, Colorado, could also help cancer patients treated with radiation who later develop leukemia as a side effect of their treatment.

The compounds Miller studied are bisphosphonates known as ethane-1-hydroxy-1, 1-bisphosphonate or EHBP, which Miller said is chemically similar to Procter & Gamble's osteoporosis drug Didronel or etidronate.
The other was an experimental drug called CAPBP, which Miller said is similar to Roche's Boniva or ibandronate.
She picked the drugs because of studies in humans that suggest bisphosphonates may help prevent cancer from spreading to the bone. They also have been shown to remove uranium from the body.
Miller exposed lab mice to radiation strong enough to cause leukemia. She injected some of the mice with one of the two compounds and waited.

Typically, mice exposed to radiation developed leukemia and died 92 to 110 days later.
"With the drug, the animals were developing leukemia too, but it took much longer, 150 to 170 days," Miller said in a telephone interview.

"The total number that actually developed leukemia was significantly lower with both of the drugs," she said.
She said all of the untreated animals developed leukemia after radiation exposure, but only about half did in the treated group.
"It was very significant. We didn't have any toxic effects with the drug treatment," she said.
Miller said many more studies would be needed before the drugs could be used in humans, but she thinks the compounds show promise as a way of addressing one of the most toxic side effects of radiation exposure.

Tuesday, April 14, 2009

Recovery from surgery on small intestine

It's now been 10 weeks since my surgery to remove 10 inches from my small intestine. As I look back on the recovery process a few things stand out:

1. I lost more weight than I expected (about 10 pounds total) and it took several weeks to steadily build up energy.
2. the worst part of the recovery was the first two weeks dealing with incision pain when I coughed ...
3. it took about 6 weeks before I could swing a golf club easily and attempt to play tennis.
4. it took about 8 weeks before I was able to play golf and tennis normally.
5. even in the past two weeks I still feel some incision discomfort but it's minor. The discomfort seems to move a bit and comes and goes although it's pretty mild at this point.
6. getting my full energy back has been a steady process. I was surprised how debilitating the surgery and 3 night stay in the hospital was on my energy level --- I remember walking 18 holes of golf after 3 weeks and was extremely tired afterward.
7. the digestive process and bowel movements from the first week on have been quite normal which has surprised me. I have been able to eat anything from the day I left the hospital. I did supplement my diet drinking Ensure "milk shakes" to take in more calories as I wanted to gain back the weight.

The incisions are still quite visible --- there are 3 small (1/2 inch) incisions that are still noticeably reddish, and about a 2 1/2 inch main incision above my belly button that is also reddish. I can feel a minor discomfort when pressing on them even now.

Saturday, February 14, 2009

Surgery to remove section of small intestine

On Feb 2nd I went in for surgery to remove an inflamed, infected section of my small intestine (about 10" was removed) -- the surgery was called a small bowel re-section. The problem had shown up a few days before in a Cat-scan indicating a perforation of the small intestine (jejunal loop area) had occurred leading to the body countering that with a mass of tissue accumulating. The source of the 5 stomach pains bouts was found.

So at 8:30 am, Monday Feb 2, surgery at the Stanford hospital was performed by Dr. Shelley Marks of PAMF. The surgery we were told went well and that led to 3 1/2 days of recovery at Stanford. The surgery was performed laprascopically, leaving three small incisions (about 1/2 inch each) and a larger (2 1/2 inch) incision above my belly button --- the larger incision was necessary in order to remove the mass of material and the small intestine intact.

My care was good, and the amount of pain was limited, only being acute if I coughed. As expected I was weak after the surgery and ended up losing about 10 pounds from the lighter eating prep period before and the surgery aftermath.

I was released Thursday afternoon, Feb 6, to continue recovery at home. The only pain I was feeling was from the incision and that was pretty mild, except when I coughed. Holding a pillow against my stomach helped a bit but it still would hurt. Gradually the incision pain has receded, all my bodily functions have returned to nearly normal until today, Feb 14, or 12 days after surgery.

Throughout this period of time I only took two vicadin (sp?) pills for pain and then a few days worth of Tylenol. No other pain meds since. In the hospital I only had morphine as low levels 3-4 times. I have felt fatigued which is normal throughout the time after the surgery. Hope to be back on the golf course within a couple of weeks and on the tennis court as well. Just need for the incision to be able to take the movements.

After a visit with Dr. Marks on Thursday, Feb 12, she said everything looked good and that full and final recovery would continue for a couple of months. Fully normal activities could be undertaken as I felt able to do so and the fatigue would go away soon. The best news was a call from PAMF indicating that there was no cancer. Hooray!

The official diagnosis is that I have diverticulitis of the small intestine (bowel). The removed section seemed to contain the only affected parts of my small intestine or colon (where it is quite common for people to have diverticula --- 50% of those over 60 have it). Turns out it is quite rare to have diverticulitis show up in the small bowel, or at least to have complications leading to a performation as I had. My surgeon thinks there may not be any reoccurrence as the tissue in both the small intestine around the removed section and in my colon looks quite good.

Wednesday, January 21, 2009

Prostate & stomach problem CT-Scan updates

Prostate PSA test -- My Jan 5, 2009 PSA test was .84 so that was a continuing decline from last time.

Recurring Stomach Problem -- Following a 5th episode of stomach pains that began around 9 pm Monday, Jan 19th, I had a CT Scan at PAMF on Tuesday, Jan 20, and it showed that there was a "focal area of marked abnormal appearance to the proximal jejunal loop in the left upper quadrant suspicious for possible mass ..." Dr. Matthews believes this is the cause of my recurring problems and I have a follow-up meeting with a general surgeon at PAMF, Dr. Marks on Friday, Jan 23 at 1:30.

Also, received an email response below from Dr. Hancock with his thoughts including referral to 3 Stanford GI surgeons:

Mr. Stevens,

Sorry to hear of the new problem. I have difficulty relating this to your radiation, given that the treatment fields were confined to the pelvis and well below the area where, I think, this is being described. Most radiation-induced tumors arise more than 15 years after exposure, and small bowel tumors have been extremely rare, even when radiation fields directly included the region. I looked back at the images from your MRI scan from December 2007 but could not identify any definite abnormality. Might be more useful to look with the new study side by side with the old to see precisely where the mass is located. It would be interesting to see how thearea with the current problem looked 13 months ago.

Jejunal problems are pretty rare. I usually think of tumors causing such masses. I would guess that the list of possibilities would include gastrointestinal stromal tumor, leiomyosarcoma of the jejunum, primary adenocarcinoma and lymphoma of the bowel. Abnormal masses in this area could also arise due to diverticulosis, lipoma (benign fatty tumor) and other benign or inflammatory causes.

There are some reports of jejunal masses being successfully removed by laparoscopy, which usually features less cutting and more rapid recovery than open surgery. I am not certain what the pros and cons of each approach might be--particularly if there is concern that there may be air outside of the bowel.

I don't know if Dr. Marks is a general surgeon or one who specializes in GI tumors. There are three GI oncologic surgeons here: Shelton, Welton, and Norton. Sounds like a law firm. I understand that Jeff Norton is usually the fellow who does most of the cases where GIST tumors are a possibility (GI stromal tumors). They, incidentally, are the rare tumors that put the drug Gleevec on the market because they have a unique genetic mutation (c-kit) that makes them quite responsive to Gleevec. Sometimes when tumors are a consideration, surgeons have evaluated the area first with an angiogram to determine the source of blood supply. This may not be necessary, since the area will be directly explored, anyway. It will be interesting to see what your surgeon(s) recommend.

First to figure out what this is, however. I would be happy to have a look at the CT if the PAMF folks want to ship it over on a CD.

Best, Steve

Steven L. Hancock, MD
Professor, Radiation Oncology
Stanford Cancer Center, CC-G-230
875 Blake Wilbur Drive
Stanford, CA 94305-5847

Sunday, December 28, 2008

Recurring Stomach Pain

Starting July 31, 2008, four months after radiation treatment ended, I had a first episode that started with stomach pain and bloating across the abdomen after playing a round of golf at SJ CC. The pain lasted across the abdomen for a number of hours, never leading to nausea but it was followed by feeling totally wiped out as if I had the flu.

The flu-like symptoms knocked me flat on my back in bed where I had a fever (up to 102), body ached and had no energy. This lasted for several days. The stomach pain gradually subsided until it became a localized pain under the belly button. On the day the symptoms began after playing golf I had eaten a whole wheat sandwich (probably turkey) and an energy bar I think.

These symptoms weren't a concern until they re-occurred about 7 weeks later following the same pattern with a slightly lower fever (probably 100). And about 6-8 weeks later they re-occurred for a third time. And then on Wednesday evening Dec 11, 2008 they re-occurred for a 4th time after playing golf at Stanford. This time I ate a dinner that started with about 5 pieces of bread from a restaurant (next to Kepler's).

After dinner the same stomach pain began. One difference in the following symptoms that occurred were that Saturday night the stomach pains for the first time intensified (always before they steadily got better). After eating almost nothing I did eat a piece of whole grain white toast which has a number of whole grains and gluten in it. The stomach pains afterwards increased, I believe as a result of being aggravated by digesting the piece of whole grain toast.

I saw Dr Scott Matthews at PAMF on Friday and he felt it was most likely a bowel obstruction and ordered a series of lab tests. All results including a gluten sensitivity test were negative (there was an elevated level of a diabetes related test for (?) with a reading of 130 versus a high normal of 90). He asked if I had had a colonoscopy exam and it turns out I had one in September that was clear.

At this point I plan to avoid all whole wheat and whole grain breads. Another problem would likely lead to a CT scan to see if something shows up in the bowel. I also will ask Dr. Hancock if the radiation could be a contributing factor. One additional factor is that I do have more gas in the system than before the radiation and that certainly could be leading to stomach pain and the boating. I'll discuss that as well.

Monday, November 3, 2008

New Study of Secondary Cancers

In the new study below, the increased cancer risk is a "relative" not absolute risk. Bottomline is that the lifetime risk of developing rectal cancer in men is about 2% and the risk of developing bladder cancer is about 3.4%. Using the new study data below, assuming there is an 80% increase in the relative risk of developing these cancers after external beam radiation, my risk of developing these cancers is about 3.6% for rectal cancer and 6% for bladder cancer. This increased risk would occur 15-20 years out, in other words there should be no increased risk before that. All in all, this increased risk, though significant, in absolute terms is not that much.

NEW STUDY -- see

A new study, in the Journal of Urology, evaluated the cancer treatment records of more than 240,000 men who had previously been treated for prostate cancer with prostatectomy, brachytherapy, external beam radiotherapy or a combination of brachytherapy and external beam radiotherapy between 1988 and 2003. The data for this study was collected from the massive Surveillance, Epidemiology and End Results (SEER) national cancer database, which is maintained by the National Cancer Institute. This study was conducted by researchers from Columbia University and the Mount Sinai Medical Center.

In this study, the authors compared the incidence of subsequent cases of cancers of the bladder and rectum occurring in these 243,082 men. The men who underwent prostatectomy alone, and who did not receive any radiation therapy, essentially served as the “control group” for this study.

An almost insignificant increase in the risk of bladder cancer was seen in the men who underwent brachytherapy alone. However, there was a more pronounced and statistically significant increase in the risk of both bladder cancer and rectal cancer observed among the men who received either external beam radiotherapy alone or combined brachytherapy and external beam radiotherapy. Compared to the men who underwent prostatectomy alone, external beam irradiation was associated with an 88 percent increase in the relative risk of developing bladder cancer, and a 26 percent increase in the relative risk of developing rectal cancer. Among those men who received both brachytherapy and external beam radiotherapy, the relative risk of developing bladder cancer was 85 percent higher than what was observed in the men who underwent prostatectomy alone, while the relative risk of developing rectal cancer was 21 percent higher. (It should be noted that “relative risk” is a measure of the difference in risk between two patient treatment populations, and is not the same as the “absolute risk” of developing a particular disease.)

The relative risk of bladder cancer developing after external beam radiotherapy, brachytherapy and external beam radiotherapy-brachytherapy compared to radical prostatectomy was 1.88, 1.52 and 1.85, respectively. This is compared to the general United States population the standardized incidence ratio for bladder cancer developing after radical prostatectomy, external beam radiotherapy, brachytherapy and external beam radiotherapy-brachytherapy was 0.99, 1.42, 1.10 and 1.39, respectively. The relative risk of rectal cancer developing after external beam radiotherapy, brachytherapy and external beam radiotherapy-brachytherapy compared to radical prostatectomy was 1.26, 1.08 and 1.21, respectively. The standardized incidence ratio for rectal cancer developing after radical prostatectomy, external beam radiotherapy, brachytherapy and external beam radiotherapy-brachytherapy was 0.91, 0.99, 0.68 and 0.86, respectively.

In this retrospective study, which involves a relatively short duration of clinical follow-up, external beam irradiation for prostate cancer (either administered alone or in combination with brachytherapy) was associated with a significant increase in the risk of developing subsequent cancers of the bladder and rectum.

Since most studies of radiation-induced secondary cancers have shown an average biological lag time of 15 to 20 years between radiation therapy and the diagnosis of secondary malignancies, the findings of this study may actually underestimate the long-term risks of secondary bladder and rectal cancers in men who have previously received external beam radiotherapy as treatment for their prostate cancers. At the same time, however, recent and continuing improvements in the accuracy of radiation therapy delivery have significantly reduced the “innocent bystander” effect, whereby clinically significant doses of radiation are absorbed by the organs that surround the prostate gland (namely, the bladder and the rectum). As a final note, all retrospective studies that are based upon prospectively collected data, such as this study, are subject to potential biases, including the “completeness” of the clinical data that is present within large databases such as the SEER database. However, based upon a large body of clinical literature on this topic, the findings of this particular study are not at all surprising, or unexpected.

The American Cancer Society estimates that about 108,070 new cases of colon cancer (53,760 in men and 54,310 in women) and 40,740 new cases of rectal cancer (23,490 in men and 17,250 in women) will be diagnosed in 2008. Overall, the lifetime risk for developing colorectal cancer is about 1 in 19 (5.4%). Thus the risk of rectal cancer alone should be about 2% (23,490/54,310 x 5.4%). This risk is slightly higher in men than in women. A number of other factors (described in "What are the risk factors for colorectal cancer?") may also affect a person's risk.

The American Cancer Society estimates that in 2008 there will be about 68,810 new cases of bladder cancer diagnosed in the United States (3.7%) about 51,230 men and 17,580 women). The chance of a man developing this cancer at any time during his life is about 1 in 27 (and for a woman, 1 in 85.

In 2008, there will also be about 14,100 deaths from bladder cancer in the United States (about 9,950 men and 4,150 women). In spite of the increased incidence, the rate of people dying of this cancer is decreasing. Over 500,000 people in the United States are survivors of this cancer.

Wednesday, October 1, 2008

6-month PSA Results

On Sept 29th my PSA result was 1.07. To take again in 3 months and likely have a follow-up visit with Dr. Hancock.