Stage 3 Pericardial And Testicular Mesothelioma
Doctors and researchers do not clearly define stage 3 pericardial or testicular mesothelioma due to their rare nature.
Only 1% to 2% of mesothelioma cases are pericardial, which means cancer forms within the sac that protects the heart. Therefore, a diagnosis for this disease is unlikely until the late stages, after metastasis to the lungs or chest cavity.
Doctors evaluate testicular mesothelioma tumor characteristics by using staging guidelines for general testicular cancer. For example, doctors more commonly refer to stage 3 testicular mesothelioma as late-stage cancer. This description indicates that cancer has spread beyond the lining of the testicles to other tissues such as lymph nodes or bone.
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Understanding Prostate Cancers Progression
To determine the appropriate treatment, doctors need to know how far the cancer has progressed, or its stage. A pathologist, the doctor trained in analyzing cells taken during a prostate biopsy, will provide two starting pointsthe cancers grade and Gleason score.
- Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. The area of cancer cells in the prostate will also be graded. The higher the grade, the more abnormal the cells.
- Gleason score: The two grades will be added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.
After a biopsy confirms prostate cancer, the patient may undergo additional tests to see whether it has spread through the blood or lymph nodes to other parts of the body. These tests are usually imaging studies and may include a bone scan, positron emission tomography scan or computed tomography scan.
Treatment For Advanced Cancer
Stage IV prostate cancer is cancer that has spread or metastisized. Cancer metastases results from a primary prostate cancer tumor that has spread to other parts of the body such as the brain, lungs and liver via varying routes including circulatory, lymphatic system, or skeletal structure. Bone metastases causes severe pain and is characterized by a dull, constant ache with periodic spikes of pain. Prostate cancer frequently spreads to the bones. Watch our expert medical oncologist, Alicia Morgans, discuss treatment options for advanced prostate cancer.
Traditional treatment for metastatic prostate cancer has not included direct treatment of the primary tumor in the prostate. For men with new or recurrent metastatic prostate cancer, research from the CHAARTED trial found that men lived longer if they were treated with chemotherapy when they started hormone shots. Read more about the study here. Visit the ZERO newsroom for more prostate cancer news.
Watch as ZEROs CEO, Jamie Bearse, discusses new prostate cancer treatment news:
Treatments for patients with metastatic prostate cancer are very new, with most of all have been approved within the last five years. These drugs work to control the cancer and include:
- Zytiga
- A treatment used with steroids to shut the adrenal glands while avoiding the effects of the adrenal glands being shut down and prolongs life. This drug can be used in men before chemotherapy.
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Four Crucial Cancer Treatment Options Your Protocol May Be Missing
Your chemotherapy has stopped working.
These are the words no cancer patient wants to hear, yet this is an all-too-common phrase millions of people are forced to accept each year. But why does this happen for so many people? With nearly two decades of experience treating complex and late-stage cancers, Envita Medical Center has found four crucial factors which may be contributing to the failure of radiation and chemotherapy treatments in America. Envita is one of the world leaders in personalized, targeted cancer treatment and strives to help our patients overcome these common cancer treatment failures with the aim to improve outcomes and quality of life for our patients.
Envita Medical Centers doesn’t make any guarantee of outcomes. Results are not typical and will vary from person to person and should not be expected.
Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, its no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
- chemotherapy
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
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Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA-only or biochemical recurrence.
Seven Types Of Standard Treatment Are Used:
Watchful waiting or active surveillance
Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test.
Watchful waiting is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life.
Active surveillance is closely following a patient’s condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer.
Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management.
Surgery
Patients in good health whose tumor is in the prostategland only may be treated with surgery to remove the tumor. The following types of surgery are used:
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Treatment Of Late Stage Prostate Cancer
Late stage prostate cancer is cancer that has spread to the spine or to other tissues some distance from your pelvis. In late stage prostate cancer, the treatment objective is to delay further progression and to prevent or relieve any associated pain and suffering.
There are several basic categories of late stage prostate cancer: micrometastatic disease, metastatic disease, hormone-refractory disease, and terminal .
At present there is no possibility of curing late stage prostate cancer. The approach to treatment of late stage prostate cancer is therefore quite different from the approach to treatment of early stage prostate cancer and even locally advanced disease. Hormone therapies, chemotherapy, radiotherapy, and palliative care are usually needed as the disease progresses, but progression can now be slowed down and delayed for many years in appropriate patients. many patients with late stage disease prefer to get treatment from an appropriately qualified medical oncologist, and might want to read the article entitled, Finding the medical oncologist who is right for you: one specialists opinion.
How Is Prostate Cancer Staged
Prostate cancer is one of the most common types of cancer that develops in men and is the second leading cause of cancer deaths in American men, behind lung cancer and just ahead of colorectal cancer. The prognosis for prostate cancer, as with any cancer, depends on how advanced the cancer has become, according to established stage designations.
The prostate gland is a walnut-sized gland present only in men, found in the pelvis below the bladder. The prostate gland wraps around the urethra and lies in front of the rectum. The prostate gland secretes part of the liquid portion of the semen, or seminal fluid, which carries sperm made by the testes. The fluid is essential to reproduction.
The term to stage a cancer means to describe the evident extent of the cancer in the body at the time that the cancer is first diagnosed.
- Clinical staging of prostate cancer is based on the pathology results, physical examination, PSA, and if appropriate, radiologic studies.
- The stage of a cancer helps doctors understand the extent of the cancer and plan cancer treatment.
- Knowing the overall results of the different treatments of similarly staged prostate cancers can help the doctor and patient make important decisions about choices of treatment to recommend or to accept.
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What Happens Without Treatment
Physicians will sometimes talk about a particular diseases natural history or typical progression if it is left untreated indefinitely.
With regard to prostate cancer, most cases of the disease are discovered while the cancer is still confined to the prostate itself. This is called local disease or localized disease.
The disease is easiest to treat while it is confined to the prostate. At this stage, surgery and radiation are most likely to be curative and completely kill or remove whatever cancer cells are present.
If left untreated, however, prostate cancer can proceed on a number of different paths.
Recurrent Prostate Cancer Treatment
For most patients, initial prostate cancer treatment includes either radiation therapy or surgery. If a patients prostate cancer returns, the other treatment option may be used. In addition, doctors may recommend the use of systemic therapies , like hormone therapy and possibly chemotherapy.
In some cases, patients can have what is known as biochemical recurrence. These patients have elevated PSA levels that indicate the disease has returned, but imaging exams do not show any cancer. Patients with biochemical recurrence are given intermittent hormone therapy and are monitored closely for further changes.
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Treatments To Help Manage Symptoms
Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms there are treatments available to help manage them. The treatments above may help to delay or relieve some symptoms. There are also specific treatments to help manage symptoms you may hear these called palliative treatments. They include:
This is the team of health professionals involved in your care. It is likely to include:
- a specialist nurse
- a chemotherapy nurse
- a urologist
- an oncologist
- a diagnostic radiographer
- a therapeutic radiographer
- a radiologist
- other health professionals, such as a dietitian or physiotherapist.
Your MDT will meet to discuss your diagnosis and treatment options. You might not meet all the health professionals straight away.
Your main point of contact might be called your key worker. This is usually your clinical nurse specialist , but might be someone else. The key worker will co-ordinate your care and help you get information and support. You may also have close contact with your GP and the practice nurses at your GP surgery.
The Most Common Symptoms Of Stage 3 Mesothelioma Include:
- Shortness of breath
- Fluid buildup
- Weight loss
As the tumors continue to grow and spread throughout the chest, symptoms will become more problematic. Stage 3 symptoms vary from patient to patient depending on where the cancer is spreading and if the tumor mass damages vital organs. Some patients may experience referred pain felt in the neck, back or shoulders.
A tumor invading the chest wall may cause increased chest pain, while tumors forming around the lung may lead to increased breathing difficulties. Pleural mesothelioma tumors also cause increased pleural fluid, which puts pressure on the lungs. Symptoms and characteristics of stage 3 mesothelioma vary based primarily on cancer type.
Connect with a Top Mesothelioma Specialist
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Bone Protection In Patients Receiving Androgen Blockade
Two drugs, the bisphosphonate zoledronic acid and the RANKL inhibitor denosumab, have been approved to treat osteoporosis secondary to androgen deprivation. Zoledronic acid is administered as an intravenous infusion. Denosumab is administered subcutaneously. These drugs are given along with supplemental vitamin D and calcium. Patients should be monitored regularly for hypocalcemia. Both agents are associated with a low incidence of osteonecrosis of the jaw. Both drugs delay the risk of skeletally-related events by relieving bone pain, preventing fractures, decreasing the need for surgery and radiation to the bones, and lowering the risk of spinal cord compression.
A double-blind, placebo-controlled, multicenter study in men with primary or hypogonadism-associated osteoporosis found that over a 14-month period, treatment with zoledronic acid reduced the risk of vertebral fractures by 67%. New morphometric vertebral fracture occurred in 1.6% of men taking zoledronic acid and in 4.9% taking placebo. Patients receiving zoledronic acid had significantly higher bone mineral density and lower bone-turnover markers. However, the rate of myocardial infarction was higher in the treatment group .
What Is My Outlook
If youre diagnosed with advanced prostate cancer, you may want to know how well your treatment is likely to control your cancer and for how long it will control it. This is sometimes called your outlook or prognosis. But not all men will want to know this.
While it isnt possible to cure advanced prostate cancer, treatments can help keep it under control, often for several years. Treatments will also help manage any symptoms, such as pain.
No one can tell you exactly what your outlook will be, as it will depend on many things such as where the cancer has spread to, how quickly it has spread, and how well you respond to treatment. Some men may not respond well to one treatment, but may respond better to another. And when your first treatment stops working, there are other treatments available to help keep the cancer under control for longer. Speak to your doctor about your own situation and any questions or concerns you have.
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First Line Treatment For Advanced Prostate Cancer
The established first line approach is to control the progression of the disease by reducing levels of testosterone in the body. This is because testosterone increases the speed at which prostate cancer cells reproduce.
There are two different ways to lower testosterone levels. Hormone therapy lowers the levels of testosterone in the body by taking tablets or having injections. It is sometimes referred to as medical castration. The surgical option involves removing the testicles, known as surgical castration or orchidectomy, although this is now rarely used.
Another approach is called anti-androgen treatment. Androgens have to bind to a protein in the cell called an androgen receptor to work. Anti-androgens are drugs that bind to these receptors so the androgens cant, effectively blocking them. The main side-effects are gynaecomastia breast enlargement and breast pain, although a single radiotherapy dose to the breasts can help this side-effect.
Combining anti-androgens with testosterone reduction is known as Maximum Androgen Blockade and may be used if hormone treatment alone is not working sufficiently.
Treating with chemotherapy at the same time as the start of hormone deprivation was found to increase survival by 13 months in all patients and 17 months in men with high-volume disease.
Radiation Therapy Plus Androgen Ablation Therapy
Androgen ablation has been shown to improve survival in men with localized disease who are treated with external radiation. DAmico et al reported higher overall survival with the combination of radiation therapy and 6 months of ADT in men with intermediate-risk prostate cancer. Median follow-up was 7.6 years.
A study by Jones et al found that for patients with stage T1b, T1c, T2a, or T2b prostate cancer and a PSA level of 20 ng/mL or less, short-term ADT increased overall survival in intermediate-riskbut not low-riskmen. The 10-year rate of overall survival was 62% with combination therapy, versus 57% with radiation therapy alone 10-year disease-specific mortality was 4% and 8%, respectively. In this study, ADT was given for 4 months, starting 2 months before radiation therapy.
In a study by Pisansky et al of 1489 intermediate-risk prostate cancer patients, disease-specific survival was not significantly different whether total androgen suppression was given for 8 weeks or for 28 weeks prior to radiation therapy. Patients in the study were randomized to 8 or 28 weeks of TAS with LHRH agonist, along with a daily nonsteroidal antiandrogen, prior to radiation treatment. This was followed in both groups by an additional 8 weeks of androgen suppression, administered concurrently with radiotherapy.
Taken together, radiation therapy is generally given for 4-36 months, depending on the risk group of the patient.
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Advanced Cancer Treatment Success Stories
Patients at Personalized Hematology-Oncology have found great success through the work of Drs. Castillos and PHO. One 66-year-old woman was suffering from a poorly differentiated hepatocellular carcinoma. With guidance from the testing provided by the team at PHO, she entered a clinical trial with drugs Vorinostat and Sorafanib. This female patient, we are proud to say, is in remission and remains in the trial.
Another woman, 68-years-old, was battling recurring stage IV breast cancer that had metastasized to her lungs and brain. She now displays no signs of disease. The patient was prescribed Gemcitabine and Avastin, in conjunction with radiation a treatment suggested after gene testing was done to determine what would be most effective on her tumors.