Research Check 15

53. AV Chemotherapy Cancer Treatments and Side Effects

Expert: Dr. David Cathcart

• Color of the skin can reflect the side effect
• It can include deep sores, color changes, red flushed skin
• Dr. Cathcart is an occupational medicine physician at the Heartland Regional in Missouri

53. AV Dr. Mejia discusses skin cancer treatments

• Mohs is a surgerical procredure that helps you remove all the cancer cells and do less damage to the skin around it
• Mohs is also a same day procedure
• Dr. Mejia is also trained in plastic surgery techniques
• Discussing other options other than surgery, such as radiation therapy or a combination of treatments
• Radiation therapy (hospital), Scrape it and burn it approach, cutting it out, liquid nitrogen (for pre-cancer)
• Mohs is the balance or the best approach
• It is named after Frederick Mohs.  It is the removal of the skin cancer, examining the margins to make sure all the cancer is out. 
• .Discusses the 3 types of skin cancer, noting what I already know which is melanoma is the most dangerous one

53.  AV Dr. Meija does a follow up with a patient

• Dr. Meija removed the basal skin cancer. It was basal. It was on his head and 3-4 inches wide. 
• Dr. Meija had to do a plastic surgery after removing the skin cancer, but he was able to repair the scar.
• Skin cancers can do some serious damage to the skin around it also.

53. AV Treating Melanom

• 60,000 new cases every year
• People identified early can be helped
• There are 4 stages of melanoma
• Stage 1 and 2 is it hasn’t spread yet
• Stage 3 is when it has spread to the tumor
• Stage 4 is when it has spread past the tumor to your brain or other significant parts
• Excision is always the first step, but Stage 3 and 4 is to follow up with additional therapies.  Immunotherapy or radiation therapy is used as follow up after excision.  Radiation therapy is only used for Stage 4 or people who can’t be helped by surgery.  Chemotherapy is also used after excision if follow up is needed. 

53. AV Photodynamic Therapy

• No needles, just cream for this treatment
• The cream creates a toxin to kill the skin cancer cells
• The device has a UVC light that activates the cream and converts the chemical in the cream into a toxin in about 3 hours
• It kills the cancer cell and does not damage the skin around it
• They are working on making the Photodynamic machine smaller so patients can take home the treatment

54. AV  Skin Cancer Surgery

• Cancer is located on his chest

• Inject a needle of something around the skin cancer, probably to numb the pain
• Cutting around the cancer, where the surgeon was injecting the pain killer
• Then cutting out the skin cancer cell
• An assistant immediately puts a cloth on the area to stop the bleeding
• The surgeon then continues to cut to make sure they got all the cancer cell out
• It looks like the final step is to stitch up the wounded area

Research Check 14

51. Berman, Russell. Skin Cancer: Surgical Management of Melanoma. NY Cancer Institute, 4 Aug. 2011. Web. <http://www.youtube.com/watch?v=j50ULW7vXa0>.

L: Three levels of treatment:

o   Local

o   Regional

o   Distant or systemic metastases

Get your pathology report

·      determines the surgical intervention

·      the stage of the tumors

·      deep, thickness

·      thickness of the melanoma is crucial to how it is treated

·      presence of ulceration (skin breaks down, such as bleeding)

·      mitotic rate tells you what to do also

I:  The pathology report is significant to understand so the oncologist team knows what is best for you.

Local (wide excision)

·      to remove the tumor cells, because melanoma does not go in a straight line

·      to reduce the cosmetic damage and muscle damage

·      Randomized trial done:  less than 1m thick, we take a 1 cm excision, 1-2 mm, we take a 1-2 cm, 2-4 mm, we take a 2 cm margin excision compared to 1906, they took the 2 in excision

·      Examples of how excision is closed

I:  Russell Berman shows significant gain over the last 100 years in the wide excision.  I am surprised how exact they can be to get the tumor. 

Regional (Lymph Node)

·      Surgery or removal hasn’t meant you will live longer, so much question regarding this process

·      If the node is negative, then the surgeon is done, if it is positive, then it is standard to look at again to see if it spread

·      The thicker the melanoma the more concerning it is

·      Offered to anybody with melanoma of 1mm or larger, but meant for larger mm

I:  Difficult to comprehend.  The thicker the melanoma, more likely it is called regional.   It seems like we have less success with this melanoma using surgery, almost sounded like hit and miss if we stop the spreading effectively the first time.

Systemic

·      Spreading to the brain, lungs, etc

·      Typically don’t think of surgery, but can go after each part using surgery

I: Didn’t speak much on it, because another speaker at the conference was going to speak on it. 

Multidisciplinary Treatment and follow up

·      Surgeons, Dermatologist, Medical Oncologist, Radiology Oncologist

I:  It is important to see there are many different roles in helping a patient.   This list does not include the assistants such as the radiologist. 

 52. US News. U.S.News & World Report, 21 July 2009. Web. 12 Apr. 2012. <http://health.usnews.com/health-conditions/cancer/skin-cancer/treatment>.

All skin cancers are treatable.  Surgery is the first option usually.

Sometimes the biopsy (the scraping of it to test it) removes it, “doctors use surgery, radiation therapy, topical chemotherapy, photodynamic therapy (treatment with drugs that become active when exposed to light), or a combination of methods to treat basal and squamous cell skin cancers.”

I:  There is no one thing a team can do.  It is whatever works.  Surgery is the first option usually though.

Moh’s surgery:  thin layer is removed

Cryosurgery:  freezes it

Laser surgery:  destroy the skin cancer

Electrodesiccation: scraping and burning

I: There are a number of additional treatments depending on the situation. 

Blog 21: Three-Column Chart

Three-Column Chart

Research Check #13

Etiological Factors in Skin Cancers:
Environmental and Biological
(Chapter 5)

Jacquelyn Huynh Vu
March 16, 2012

1. The cause of the vast majortity of basal cell cancer, squamous cell cancer and melanoma is exposure to UV.

Skin cancer has to do with multiple factors
Endogeneous (e.g. genes)
Exogenous (e.g. Ultraviolet Radiation)

The interaction between these factors is complex and they usually act synergistically in the multistage process of Carcinogenesis:
Tumor initiation
Promotion
Premalignant progression
Malignant conversion of normal skin cells into skin cancers

Research focuses on squamous cell carcinoma (SCC), since only that skin cancer can be reliably reproduced in animal models.


2.  Development of skin cancer

• Genes vs.  UV, ionizing, viruses, chemicals, dyes, arsenic and more (Endogenous vs. Exogenous)

3.  Stages of Carcinogensis

• Initation: damage is caused
• Promotion: expansion or copy of cells
• Premalignant conversion: more instability, some obvious skin damage seen
• Malignant progression: skin cancer

4. Ultraviolet radiation

What it is?
How does it effect the skin?
UVA, UVB, UVC, Visible and Infra-red
UVA is most important because most of the UV reaching your skin is UVA
People living closer to the equator are exposed more (2.4 fold higher incidents)
People immigrating from Australia (who live there at a young age) have had higher incidents of skin cancer

Blog 10: Self Reflection

(1) How do you think you are doing so far in your senior project and why?  AE, P, AP, CR, or NC

P+

I have done every assignment on time and met the proficient requirements.  I also have really worked at getting my service learning at El Monte Hospital started and taking my independent component college class three days a week.

(2) What one thing do you think you have done well on and why?

I started off wanting to do radiology therapy, but as I have learned more about it I realize I want to do radiology onocology.  I learned this because of my first, second interview, and a few informal interviews.   I think I have done this transition from one focus to another well including the interviews.

(3) What is one thing you would like to improve on and why? 

The weaker part of my project has been how many articles I am reading and the notes.  I need to finish more articles and take more notes.

Blog 8: What I've Learned So Far

1. What have you learned to do since you started working on your senior project?I've learned how to contact interviewees and interview them with appropriate questions effectively.

2. Post evidence.
Click here

3. What research helped you to do this and how?
Dennis Jarmin, MBA, RCP Assistant Administrator CEO

Mr. Jarmin was able to help me with volunteering in the radiation department and understanding his role in the hospital. He was helpful on giving advice as to how to work in a hospital environment.

Blog 1: Senior Project Topic

Topic: Radiation Therapy - a form of cancer treatment that uses radiation (strong beams of energy) to kill cancer cells or keep them from growing and dividing.

Why Radiation Therapy?
My reason is not because I have family members who has cancer, nor does any of my friends. I simply see the personal satisfaction of being able to help patients who may be going through the toughest battle of their life. Cancer specifically because the fight seems and feels more realistic and surreal (sort of like watching sports and seeing the players go through pain and sweat to reach the championship and the glory) when I see patients go through their treatments.


What do you hope to accomplish after studying this topic all year?
1. A satisfying yet sufficient career
2. Hopefully I can start opening doors for myself within this field (Radiation therapy)
3. To truly see if this is the career that I want to spend the rest of my life studying and working for
4. The best way to approach to becoming a radiation therapist
5. To see what else is out there that is similar to radiation therapy if I decided to change my path of career

I hope to have a better understanding about radiation therapy and the process of the treatment for patients with cancer. Hopefully, I can find foundations throughout senior year that helps the research of cancer to participate in/with as I continue to study radiation therapy. While I strive to not only obtain a good grade to my senior project, I can also prove to myself that I am very much capable of setting a goal and step-by-step reaching it.