Thermography to Assess Breast Inflammation in breast cancer survivors

Thermography to Assess Breast Inflammation in breast cancer survivors

Breast thermography provides one of the best visual clues of the presence of inflammation in breast tissue. Since inflammation often accompanies precancerous changes to the breast and since it always produces heat, measuring the temperature of the breasts can provide us with vital information.

Temperature measurement as a means of assessing health has its roots in ancient Greece, when Hippocrates covered his patients’ bodies with a thin slurry of mud and, as it dried, observed temperature differences around diseased organs. With the advent of military infrared heat detection technology, specialized cameras were developed that could produce a detailed picture showing how the heat is distributed over the body. This picture could then be analyzed with computer software to
determine regions of abnormal heat, suggesting injury or disease.

When it comes to breast health, here’s how it works, according to Robert Kane (pers. comm.), a board-certified clinical thermologist who maintains a busy thermal-imaging interpretation practice in Redwood City, California: “Heat is produced in the breast by normal tissue metabolism and is carried to the surface by the blood supply. Our bodies naturally release heat to the environment in the form of infrared energy to maintain a normal body temperature of 98.6 degrees Fahrenheit. This energy can be captured and visualized by a special infrared detector inside the thermography camera.”

Normal breast tissue produces a characteristic temperature pattern when visualized with thermography. On the other hand, fast-growing, abnormal breast tissue (cancerous or precancerous) will produce heat through its faster metabolism.

This heat travels through the circulatory system to the surface of the skin, where it can be detected using a thermographic camera (Yahara et al. 2003). What’s more, as mentioned earlier, cancerous tissue can create its own blood supply via the process of angiogenesis, or new blood vessel formation (Anbar 1994). Both of these occurrences can translate into temperature changes at the surface of the breast and provide a means of detection with the thermographic camera.

Thermography findings are less dependent on the size of the abnormal tissue and are more directly related to the degree of inflammation, growth rate of the tissue, and metabolic activity (Gautherie et al. 1982). The more inflamed, aggressive, and metabolically active the tissue, the more likely that a trained interpreter will see it on a thermogram. Since highly inflamed, precancerous growth represents the highest likelihood that cancer will develop, we consider thermography to be an excellent addition to standard breast imaging (mammography, MRI, or ultrasound) to help identify smaller lesions that are growing quickly and may appear between annual examinations.

Perhaps even more important, thermography provides invaluable feedback if you’re attempting to lower your risk of recurrence through lifestyle and nutrition, allowing you to see if your actions are effective. In short, just as thermography can be used to identify physiological signs that precede cancer and signal future risk, you can also use it to track the success of your anti-inflammatory strategies, adding a great deal to your peace of mind between conventional screenings.

Diagram of Bladder Cancer Treatment Guide

bladder means =

ˈbladər/

noun

noun: bladder; plural noun: bladders

    1.     a membranous sac in humans and other animals, in which urine is collected for excretion.

    2.     anything inflated and hollow. 

    "an air bladder in the arch and collar of the shoe"

Case Study Anatomy of an Oncologist - Susan

The Importance of Axillary Node Involvement

The number of ipsilateral axillary nodes involved with breast cancer has become an increasingly important consideration in planning an attack on a patient’s primary disease. However, the use of the sentinel node technique1 for purposes of staging the extent of the primary breast disease is sometimes problematic. A clinical example will explain the dilemma that can be caused by a misreading of the axillary node situation. If N0 (absence of identified lymph nodes with cancer) is really N1 (cancer metastases found in one or more axillary lymph nodes), inappropriate therapy will be chosen.

1The sentinel note technique is one in which patients are injected in the area of the tumor with a saline solution of technetium-labeled colloid 2 16 h before surgery and with isosulfan blue dye at the time of surgery. Sentinel lymph nodes, identified by their presence of radioactivity and blue staining, are removed for microscopic evaluation of metastatic tumor.

Susan Cole, a widow at age 38, owned and operated a chain of pharmacies in the Chicago suburbs. There was no prior history of cancer in her family. She was healthy and fit and enjoyed an active social life. Her current love interest was a young surgeon who had been recently divorced. After a fun evening at the Art Institute of Chicago, he escorted her home. In the ensuing course of events, he palpated a mass in the upper outer quadrant of her left breast and was forced to assume the role of physician. She could tell he was concerned, and the evening ended after he explained what she must do immediately.

The following morning she called her gynecologist and asked his advice. He referred her to Dr. Gerald Powell, a general surgeon in practice at Northwestern Memorial Hospital and he ordered a mammogram.

She had a lesion in the described location and underwent an ultrasoundguided core biopsy. There was no doubt about the diagnosis, and she and Dr. Powell had a lengthy discussion as to how to proceed. He favored a standard mastectomy, principally to assure adequate staging. But Susan, being single and not wanting to lose her breast, convinced the surgeon to remove the lump and any nearby suspicious nodes followed by whole breast irradiation.

The surgery was uneventful. The cancer measured 2.3 cm in diameter. There was perilymphatic invasion in the area of the cancer. One of five left axillary (sentinel) lymph nodes was histologically positive for metastatic spread. The cancer was estrogen and progesterone receptor negative (ER2, PR2). At this point, Susan mentioned that, “by the way”, she would like a referral to Dr. Blumenschein in Arlington, TX.

Blumenschein did not like the tumor’s perilymphatic invasion and convinced Susan that Dr. Powell was correct. He felt that the limited nodal evaluation may have incorrectly downstaged Susan to stage II with less than three positive nodes with an expected 80% chance of cure. This would have permitted her to qualify for less therapy than she actually needed if she had been classified as stage II with more than three positive nodes. In that case, there would be concern that starting with radiation therapy would delay the time to chemotherapy by about 10 12 weeks and give any microscopic foci of metastases outside the radiation field time to grow and exceed a size that chemotherapy could eliminate,
i.e., ,1 million cells. Unfortunately, this level of sophistication was not common when therapeutic planning for Susan took place 23 years ago.

For some reasons, Susan decided to remain in Arlington for the mastectomy and lymph node evaluation that Blumenschein recommended. Dr. Bohn Allen was very accommodating, saw Susan immediately, and made arrangements for surgery to be done on the following day. The results were not what her referring physician had expected. Dr. Allen found 17 additional lymph nodes containing cancer. So Susan’s prognosis changed dramatically to less than a 20% chance of 5-year survival. The recommended treatment changed to induction with 6 courses of FAC (abbreviated as FAC36) to be followed by a combination of methotrexate, cisplatin, Cytoxan (trade name for cyclophosphamide), and 5FU with leucovorin for methotrexate rescue (MCCFUD)33. Chest wall and peripheral lymphatic irradiation was begun 4 weeks after MCCFUD.

For the 5 years following January 1988, Susan was seen by Blumenschein every 3 months. Visits to Texas then gradually diminished to every 4 months, then every 6 months. January 1995 could be considered a close call when symptoms of a headache led to the discovery of a dural mass. Fortunately, this proved to be a meningioma that was successfully resected 2 months later.

Today, Susan is continuing to enjoy life in Chicago and is sharing it with the surgeon who had been her date on that Art Institute evening. Blumenschein considers that Susan has been cured and that FAC was
the modality that successfully eradicated her microscopic metastatic disease. Although regional radiation therapy may have contributed somewhat to her cure, it is not clear in retrospect that MCCFUD was necessary.

Case Study Sara - Milestones Along the Road to the Cure

Liver Metastases

Sara Dayton was an attractive 43-year-old high school teacher from Houston. In June 1980, she was diagnosed as having a stage I breast cancer in the lower inner quadrant of her left breast. She was diagnosed, staged, and treated at one of the fine medical centers in Houston. Her cancer was small, nodes were negative, and she elected breast conservation surgery followed by radiation therapy. The malignancy was well differentiated and was both estrogen receptor and progesterone receptor positive (ER1 and PR1).

On completing radiation therapy, she began tamoxifen and rapidly resumed her normal active life. She was seen by her medical oncologist every 3 4 months. Her chest X-ray, bone scan, and the carcinoembryonic antigen (CEA) and cancer antigen 15-3 (CA 15-3) serum tumor biomarkers
were evaluated annually.

Twelve years after Sara had been diagnosed with breast cancer, the tumor markers started to climb. Shortly thereafter, liver metastases were noted on a computerized tomography (CT) scan. Sara’s oncologist advised her that her situation was hopeless and this grim prognosis was seconded by his oncology partner. Neither of these oncologists had observed a meaningful remission with significant extension of life in these circumstances and were attempting to spare Sara the side effects of multiple
courses of chemotherapy. But to what advantage?

When the liver lesion was removed, it measured 1.7 cm, so contained far in excess of the 1 billion cells required for visualization. The likelihood was at least 98% that microscopic metastases existed elsewhere in the liver and possibly the bone. But because they were so small, it was not possible to either remove them or to follow their response to radiation or chemotherapy. So the only way Sara could be followed to determine the success of therapy was to observe an absence of recurrence.

The best estimate of the number of cancer cells that could be eliminated by chemotherapy was 1 million cells. Therefore, if a metastasis of 10 million cells were present in the bone marrow when the liver imaging was done, as many as 9 million cells could remain and the bone site would not be cured even though “good” induction adjunct therapy was given. Furthermore, there was no way even to find tumor metastasis in the range between 1 million and 1 billion cells. This was the reason why Blumenschein routinely prescribed radiation to be given to the whole liver and why he was looking for further benefit to be provided by giving a course of consolidation adjuvant chemotherapy after completing the initial induction adjuvant drug therapy. Hopefully, this program would be adequate to tackle the suspected residual tumor burden.

During the 1980s, patients were becoming increasingly assertive in their search for knowledge about available treatment options for their medical problems. Sara, confronted by a situation which seemed hopeless, with the word “cure” never mentioned, asked for her films and records.

She planned to scour the country for a physician who could offer at least a modicum of hope and was willing to pursue a yet-to-be-widely-accepted course of action, if it seemed reasonable.

Fortunately, the Susan G. Komen Foundation had been started by Nancy Brinker, a dedicated, highly motivated young woman whose sister, Susan Komen, had died as a result of breast cancer. Nancy, herself, was 2 years postmastectomy and chemotherapy. The Foundation was in its start-up phase in Dallas and its primary goal at that time was to raise funds to support clinical research that would provide a cure of this disease which annually was responsible for the death of more than 40,000
US women during their most productive years. Sara had friends in Dallas who knew Nancy Brinker and Nancy was pleased to meet with her and share her insight about the various breast cancer treatment programs operating in the United States and Europe. She, however, was not aware of a program designed to effect cure as an outcome for patients with metastatic breast cancer, other than the many that were conducting adjuvant trials for stage II disease and were fiercely competing for patients.

At that time, only Blumenschein was attempting to find a cure for stage IV breast cancer. In March 1977, he reported on the treatment of patients who had limited sites of metastatic disease with regional therapy prior to chemoimmunotherapy with FAC and BCG (bacille Calmette Guerin), a vaccine against tuberculosis that was used as an immunostimulant. These patients, who were in complete remission because of surgery or radiation therapy when they started chemotherapy, became known as stage IV NED. In the initial reports, there were no patients with limited and resectable liver metastases, but these were soon included and some had positive outcomes. Nancy was aware of these encouraging results and advised Sara to return to Houston to see Dr. Blumenschein or one of his associates as soon as possible.

This was done. Blumenschein recommended that Sara had the liver lesion completely excised and that surgery should be followed by six courses of the current Adriamycin induction chemotherapy combination:
Cytoxan, Adriamycin, and VP-16 (generic name etoposide), abbreviated as CAVe.1 The most difficult task that confronted Blumenschein was to find a surgeon willing to perform what would be considered unconventional surgery. Most physicians would expect to find a showering of very small, almost grossly undetectable metastases throughout the liver when the abdomen was opened and the liver visualized. If this were the situation, the surgery would have been futile and inappropriate. Fortunately,
percutaneous biopsy of an area of the liver that was away from the site of metastases seen on CT scan was normal, and Dr. Robert Steckler in Dallas agreed to do the surgery. He had recently moved to the “Big D” after completing his surgical oncology training at MDA and was well known and highly respected by the MDA staff.

1Etoposide had been substituted for 5-FU at that time because there was a hint that etoposide produced a higher percentage of complete remissions in patients with malignant breast disease than did FAC, but subsequent trials failed to confirm this observation and FAC remained the primary choice for induction adjuvant chemotherapy. This was particularly true for the ACC’91 study of patients with inflammatory breast cancer. Blumenschein regrets that he got locked into CAVe longer than he desired, once he had observed that there was no difference in relapse-free survival and overall survival in FAC-treated patients versus CAVe-treated patients.

The resection was clean and the margins were clear of cancer. CAVe was started 10 days after surgery and Sara completed the six 21-day courses over 18 weeks, receiving a total of 300 mg/m2 of Adriamycin by continuous infusion. Following CAVe, she received three 28-day courses of consolidation adjuvant MCCFUD (methotrexate, cisplatin, 5-FU, and cyclophosphamide with leucovorin rescue). One month following completion of adjuvant chemotherapy, the decision was made to add low-dose late consolidation irradiation to the liver and she received slightly less than 3000 rads. Sara was in complete remission and there was no clinical evidence of cardiac muscle injury. The liver metastases had tested negative for both ER and PR, so tamoxifen was discontinued.

This unexpectedly positive outcome warranted an aggressive followup schedule that consisted of a clinical review, physical exam, chest and liver CT, isotope bone scan, and serum tumor markers every 3 months, as well as routine laboratory tests. To everyone’s surprise, she remained disease-free at her 24-month visit and these extensive reviews were changed to a 6-month interval. At 5 years when everything was normal, someone switched Sara to an annual follow-up visit, convinced that she
was cured.

They were wrong.

In June 2002, 120 months since she began dealing with her first hepatic metastases, her liver CT and her serum CEA level were found to be abnormal. Needle biopsy of the liver lesion again showed metastatic breast cancer. As with many things, however, “time is your friend.”

When dealing with cancer, this is doubly so. In this case, time was very kind to Sara as it allowed her physicians the opportunity to evaluate a host of compounds and protocols active in other cancers, but never given a critical trial against breast cancer.

After Adriamycin was introduced, there began a search for other chemotherapeutic drugs active against breast cancer and, hopefully, noncross resistant to Adriamycin. In an effort to expand the number of effective therapeutic options, some 2 dozen new chemotherapeutic agents were tested for their activity against breast cancer cells. This, as with many other tasks at MDA, was a joint project between Developmental Therapeutics and the Medical Breast Service. Dr. Gerald Bodey from Developmental Therapeutics directed the program. Dr. Hwee-Yong Yap from the Medical Breast Service was prodigiously productive in designing and conducting clinical trials of numerous candidate agents.

This massive effort expanded Sara’s therapeutic options and Blumenschein could now treat Sara’s second liver recurrence with nine courses of a combination of cyclophosphamide, Adriamycin, and taxol (CAT), giving her a cumulative Adriamycin dose of 750 mg/m2. When the area of liver recurrence was explored surgically after this regimen, multiple biopsies showed no evidence of cancer. So she received a final course of 5-FU, mitomycin C, etoposide, and cisplatin (FUMEP). As of this writing, Sara is doing well without evidence of disease (NED). Accordingly, Blumenschein counts Sara as cured!

Case Study The Evolving Goal of Cure and Inflammatory Breast Cancer - Martha

The Texas Challenge

Martha, age 26, was an attractive and busy mother of three preschool children. Her husband Michael, a successful banker, was active in community and church affairs. While not directly involved in politics, they did live in Austin and, as alumni of the University of Texas, kept current in knowing what was significant in their great state of Texas. In April 1974, that would have included the cognizance that if a person had to deal with the dreaded diagnosis of cancer, there was no greater institution than MDA for diagnosis, staging, and treatment of cancer in Texas, the United States, and, indeed, the world. At the time, MDA was one of two comprehensive cancer centers in the United States and it was part of the University of Texas. One could with confidence receive state-of-the-art care for any of the multiple expressions of cancer.

Unfortunately, in April 1974, Martha found a mass in her left breast. The following morning, Michael canceled his meetings, bundled their three children off to his in-laws, and took Martha to a general surgeon, Dr. Parker, who had insisted he see her immediately when Michael phoned. Dr. Parker confirmed the presence of a 4-cm mass in the upper outer quadrant of Martha’s left breast and palpated enlarged lymph nodes in her left axilla. Within 72 h, a mammogram and ultrasound confirmed
the physical examination, and a core needle biopsy was scheduled. The biopsy was read as a poorly differentiated ductal adenocarcinoma of the breast. Dr. Parker recommended that Martha undergo a modified radical mastectomy as her initial therapy.

Martha and Michael had a host of questions. They asked for details about the surgery. Were there complications to be expected? Was this the only surgical approach that would be considered? What were the chances this therapeutic approach would result in a cure? Here the surgeon paused, and in a careful and measured tone responded, “The answer to that question will depend on your stage of cancer. Your stage, to a great degree, will be determined by the number of axillary lymph nodes found
to contain metastatic cancer. Currently, I consider you to have stage II breast cancer. I would prefer to reserve further discussion of this question until I have more details.”

In 1974, it was uncommon for a physician to enter into a lengthy and detailed discussion of the probable outcome of the treatment of a serious illness, especially when it was considered to be negative. This information was transmitted to the patient gradually by contacts and discussions with her physician, other physicians, nurses, other patients, periodicals, and newspapers. Dr. Parker was pressed for time. He had worked Martha into his busy schedule as a favor to an associate and felt further discourse was unnecessary. His impression of the situation was that Martha had multiple nodes involved with metastatic cancer and a poor prognosis. Before Parker could leave, however, Michael had one additional question: Would Parker refer Martha to MDA for a second opinion?

This is the most delicate question a patient can ask a physician. It contains the implication that there may be another, more knowledgeable and experienced doctor who might better serve the patient, resulting in the transfer of care to the consultant with the location of this care at a different site. The concern about loss of cancer patients to MDA by physicians in the Houston area was such that the average distance from MDA to its patients was 150 miles. Fortunately, Dr. Parker had no ego problems and, in fact, looked forward to the recommendation he would receive. He phoned his good friend, Dr. Richard Martin, Chief of Surgery at MDA, and asked him to see Martha as soon as possible. Upon her arrival at the MDA registration office, Martha was met by Doris, a VIP patient care representative, whose job was to smooth any potential rough spots before they became an issue. After discussion with Dr. Parker, Dr. Martin scheduled a bone scan and an isotope liver scan in order to complete her preoperative staging prior to her initial visit with him.

In 1974, the standard approach in treating patients with advanced primary breast cancer was to perform a modified radical mastectomy which removed the cancer, the breast, and the axillary lymph nodes draining the involved breast. When nodes were involved, radiation therapy was begun about 3 weeks after surgery to allow the surgical wound to heal. At this time, there was a great deal of clinical research being conducted to establish the place for chemotherapy in the treatment spectrum of patients
with advanced primary breast cancer. Clinically, Martha was stage IIB and would be a candidate for chemotherapy after completing radiation therapy. The issue was going to be what type of chemotherapy. However, the direction that Martha’s postoperative therapy was going to take was
suddenly dictated by events. As Doris took her to radiology for the radioisotope injection prior to the bone scan, Martha had a grand mal seizure. Dr. Martin was notified, and he asked Dr. Blumenschein,
recently appointed Head of the Medical Breast Service, to assume her management.

There was no history of seizure in Martha’s past and her brain scan was unremarkable. She was admitted to the hospital for observation, a spinal tap, and an electroencephalogram (EEG). While no evidence for a brain metastasis could be found, it was assumed that was the cause of her seizure. Because there was no detectable brain lesion on which surgery or radiation therapy could focus, it was decided that chemotherapy might offer some benefit, if it crossed the blood brain barrier. However, for
purposes of tumor debulking and staging, she first needed to undergo a left modified radical mastectomy, to include an axillary dissection on the left. Technically, she would remain in stage IIB unless regional spread of cancer or under-measurement of tumor size was discovered at surgery
and/or measurable brain metastases appeared.

Understandably, Martha and Michael had been quite shaken by the rapid turn of events, but realized that the best course was to push on as aggressively as possible. They were informed that, because of the concern about her seizure, radiation therapy was not to follow surgery, as was usual. Rather, chemotherapy consisting of at least six courses of FAC would be started 2 weeks after her mastectomy.

The surgery and pathology examination established that Martha had a 4 cm tumor and 18 axillary lymph nodes involved with metastatic breast cancer. Her stage remained the same, IIB, but her prognosis grew worse as a result of the 18 positive lymph nodes. Without effective adjuvant chemotherapy,
Martha had less than a 50% chance of remaining disease free beyond 2 years from diagnosis and a 12% chance for survival after 10 years. This meant that at diagnosis she had a .88% probability of harboring lethal microscopic metastatic breast cancer. This gave Martha a prognosis approaching that of patients with stage IV breast cancer and raised a question about the clinical wisdom of treating her with anything less than the most aggressive drug program then available for patients with metastatic breast cancer.

Fortunately, Dr. Buzdar had initiated MDA’s adjuvant chemotherapy program for postmastectomy stage II patients with positive nodes and stage III breast cancer in January 1974. So in April, Martha began FAC 2 weeks after her mastectomy. At this same time, competing investigator teams around the world were beginning to address this issue with less aggressive combination chemotherapy programs, such as CMF (Dr. Bonadonna in Milan), L-PAM—5-FU (Dr. Bernard Fisher, NSABP, in Pittsburgh), and AC (Drs. Stephen E. Jones and Sydney E. Salmon in Arizona).

Toxicity was never a significant factor for Martha during her program of FAC administration. That is to say, toxicity never was severe enough to cause a lowering of a drug dose or a prolongation of a treatment interval (dose rate). She experienced nausea, occasional vomiting, mucositis, and 100% hair loss, but there were no EKG changes. One episode of temperature elevation also occurred during a time when her white blood cells were depleted and caused her to be hospitalized to receive IV antibiotic therapy. Martha’s experience was typical of most patients who received FAC in that adjustments and minor modifications in the toxicity protocols were able to solve most issues. Those that remained eventually fell to the magic of outpatient pump technology that permitted continuousinfusion Adriamycin administration, which minimized myocardial toxicity, and Neupogen (granulocyte colony stimulating factor), which bolstered production of white blood cells.

When the FAC protocol was initially designed, concerns about the persistence of a reduced but still viable microscopic tumor burden led to prolonged maintenance chemotherapy of patients who had completed 6 months of FAC induction chemotherapy. In the MDA FAC program, this consisted of CMF cycles that were given on a monthly schedule for 18 months after induction adjuvant therapy. The CMF regimen was given intramuscularly and by mouth, as a patient’s veins were thoroughly trashed after 6 months of FAC. The dose and schedule of each of the drugs was as follows: cyclophosphamide 500 mg/m2 orally in four divided doses on day 2 of each 28-day cycle, methotrexate 30 mg/m2 intramuscularly on days 1 and 8, and 5-FU 500 mg/m2 orally in 4 divided doses on days 1 and 8.

To further complicate the situation, it was decided that patients should not be denied the possible benefits of immunotherapy, so BCG was added to the program (63108 viable units of the Connaught
strain given by scarification on days 9, 16, and 23 of each cycle). Immunotherapy was part of a rigid belief system and BCG was its trinity. Emotions ran high every time it was discussed. To his discredit,
Blumenschein supported its inclusion in the MDA adjuvant breast protocol.  However, he began to worry about his judgment when one of the proponents of BCG was heard to challenge an opponent by asking, “Would you deny your mother BCG?”

The scarifications, aptly named, were visible and permanent. In a notable episode, an attractive young breast cancer patient on the BCG protocol was taking a stroll on a Florida beach. It wasn’t very long
before she acquired an ardent male admirer. He became overly persistent in asking too many questions. She put an end to things when she answered his query as to the reason for the multiple scars on her upper arms, thighs, and shoulders. “Don’t be concerned,” she said, “it’s a new treatment for syphilis.”
Martha made it through the first 12 months without missing a beat, but her enthusiasm began to wane as she contemplated a second 12 months of CMF and BCG. Her oncologists also began to realize that
the CMF maintenance dose, schedule, and route of administration were inferior. Even the concept was inferior if the goal of the chemotherapy, indeed, was cure. With the BCG component, patients began to suffer from “scarification burn out.” Suffice it to say, all of the patients continued to receive full doses of FAC. The other elements of the program were given and received with less enthusiasm and diligence.

For a comparative evaluation of the FAC protocol, a group of stage II and III breast cancer patients with at least one involved axillary node, who were treated at MDA with surgery and/or radiation therapy with curative intent, were selected for close follow-up in a study that utilized historical controls. After examining the records of patients treated between January 1972 and December 1973, 152 patients were found who were similar enough to the FAC-treated patients to qualify for the historical control group. The only subset of patients that was not evenly matched between the groups was the group with .10 positive lymph nodes. Because 40% of the patients in the FAC-treated group had .10 positive nodes while only 25% of controls were so staged, the control group was expected to have a slight survival advantage. However, an initial analysis at 1-year postmastectomy showed that 94% of the FAC BCG patients remained relapse free whereas only 75% of the control patients had been disease free. At 2 years, the relapse-free outcomes were 93 and 55%, respectively. Thus, the study showed conclusively that the FAC adjuvant program benefited pre- and postmenopausal, stage II and III breast cancer patients. Although Martha had .10 positive nodes, she was indeed fortunate to have developed her breast cancer at a time when she could be placed in the FAC treatment group!

Irradiation is an effective killer of breast cancer cells and plays an important role in eliminating microscopic metastases from the chest wall and peripheral lymphatics on the side of the mastectomy. It is an established therapeutic modality for the adjuvant treatment of node-positive disease. However, there are some limitations in its use. The time required to deliver a therapeutic dose of ionizing irradiation is usually 5 6 weeks, which is delivered daily Monday through Friday. During this time, concomitant Adriamycin chemotherapy should be avoided and there should always be a 3-week interval between radiation and Adriamycin therapy. Because of the daily schedule required for radiation therapy, Martha chose to receive her radiation therapy in Austin. It began 4 weeks after her sixth and final course of FAC.

Martha had no further problem with seizures but she was fatigued and worn down from the 6 months of therapy. Fortunately, there was no sign of heart muscle damage even though she had received a total of 240 mg/m2 of Adriamycin, still given at that time by IV bolus. While she did begin the maintenance program after the radiation therapy and continued to receive CMF and BCG for the first 12 months period following diagnosis, mutual enthusiasm to continue beyond 15 months was lacking and her adjuvant therapy was discontinued. This seemed reasonable because it had been noted in other programs by this time that the results after 12 months of adjuvant treatment were no different than those achieved after 24 months. In fact, BCG as adjuvant and CMF as maintenance therapy have never been shown in a clinical trial to influence patient outcome.

Martha was seen by Blumenschein at 3-month intervals for the first 10 years after diagnosis, at which time she graduated to an annual visit. Currently, she continues to remain free of breast cancer 36 years following regional therapy with a modified radical mastectomy, radiation therapy, and systemic therapy with FAC induction followed by BCG and CMF maintenance.

This more than likely qualifies as a cure!

Case Study Adjuvant Therapy Advances - Carol

Metastasis to Cervical Vertebra

Carol Rock was an informed and highly educated computer expert who was on assignment to the air force in Abilene, Texas. In the summer of 1988, at the age of 44, she developed a tender node in her right axilla. She saw her gynecologist, who confirmed the finding, gave her a prescription for an antibiotic, and told her to return in 3 days if there was no improvement. The node disappeared, but rapidly recurred within a week. She was referred for a mammogram on which a 2.5 cm mass was found in the tail of her right breast. She had an ultrasound-guided needle biopsy and the mass was diagnosed cancer.

Carol elected to have a quadrantectomy of the right breast with an axillary dissection. On August 10, 1988, the mass was removed. It measured 1.5 cm30.8 cm and eight axillary nodes were involved with metastases.  She was staged as having stage 2, T1N1 breast cancer, strongly positive for both ER and PR. Her surgeon was well trained, having recently completed a surgical oncology fellowship at Memorial Sloan Kettering in New York City. He had firsthand experience with what the finding of eight positive axillary nodes implied and, to his credit, guided her to the MDA program. At MDA, Carol received six courses of CAVe, underwent bilateral oophorectomy, completed 6 weeks of radiation therapy, and finished the therapeutic program with three courses of MCCFUD. When her assignment in Abilene was completed, Carol returned to her home base in El Paso. She did well, continued her computer work, and had follow-up examinations every 3 months. However, in June 1993, Carol was found to have a small stage 1, T1N0 cancer in her left breast. Again, she elected to have breast sparing surgery and was treated with lumpectomy and radiation therapy but received no adjuvant chemotherapy. This cancer was negative for both ER and PR.

In March 1996, Carol began to notice neck pain while driving her car. By June, this progressed to the point that it incapacitated her and she was referred to Dr. Howard Chang, a neurosurgeon in El Paso. Films showed almost complete destruction of the third cervical vertebra to the degree that her head was unstable. Dr. Chang felt that the only chance he had to prevent Carol from becoming severely paralyzed, or worse, was to remove the damaged bone and replace it with transplanted bone, which, hopefully, would regrow and give her cervical spine some structural integrity. In the interim, she would have to wear a cage-like device which rested on her shoulders and was attached to her skull with screws. She was told, “Life will be Hell for the next 6 months.” Carol had no other option. So she went for it, thus living up to her pseudonym of Rock. The surgery was a technical success but the bone in her third cervical vertebra was found to be infiltrated with breast cancer. Fortunately, staging failed to show any other sites that were suspicious for metastases.

Radiation therapy could not be given to the area of healing bone. However, chemotherapy could be justified. So 2 weeks postoperative, he took the precaution of treating her with a little-used adjuvant drug combination: Adriamycin/vinblastine by continuous infusion every 21 days X 8, followed by FUMEP 32.

Although, Carol has received a cumulative dose of Adriamycin that is more than 540 mg/m2, she has had no clinical evidence of myocardial injury. She remains in good health, teaching computer science at the University of Texas, Austin, 20 years after being treated for breast cancer that had metastasized to her third cervical vertebra. We’ll never know if this metastasis was from the original cancer or the second primary. But Blumenschein believes that she has passed the criteria necessary to be considered cured.

Case Study Adjuvant Therapy Advances - Amy

Academia versus Efficacy

An exchange between Blumenschein and an “Ivy League” academician demonstrates the principles that each saw as unbreakable. They were consulting on a 28-year-old woman who 4 months postpartum was diagnosed with a T1N0 breast cancer 2 months after a mass was detected in her right breast. The cancer was triple negative (HER2-, ER-, and PR-). The patient chose preoperative chemotherapy and in August 2003 was started by her primary oncologist on AC 34 followed by Taxol 34 without the effect of this chemotherapy on her fertility having been discussed.

There was a measurable preoperative response to both AC and Taxol. However, a 0.7 cm focus of cancer remained in the breast after surgery and one node was positive on review of pathology. At this point, she selfreferred to Blumenschein for a second opinion. With the advantage of the pathology report, Blumenschein pointed out that the axillary nodes seen on a mammogram obtained in August 2003 suggested that quite possibly the patient was T3N1 on starting adjuvant therapy and that this change in diagnosis would have made a different therapy program more appropriate for her. The prolonged interval from detection to starting 5 months of chemotherapy and the delay to late consolidation treatment were additional concerns. Yes, the patient was a candidate for breast radiation
therapy but, before she began, Blumenschein suggested the way to insure the best possible outcome would be to repeat induction therapy with TAC 34, giving the Adriamycin by continuous infusion, followed by consolidation with 2 or 3 courses of FUMEP. Further action was then deferred until the patient could consider this recommendation.

The next day, the patient’s father entered the fray. He asked to see a peer-reviewed paper supporting the need to return to chemotherapy after she had just completed a similar regimen. The need for literature support is a frequent weak point in the real world of clinical decision making. So Blumenschein knew his recommendation was sunk when he needed a publication to back it up. Real-world clinical decisions taken for a particular patient often cannot be defended by citing academic publications in which a randomized controlled clinical trial has been conducted in a group of patients who are exactly similar to the individual patient being considered.

The patient’s Ivy League physician also vetoed Blumenschein’s recommendation. At the time, it was considered unlikely that breast cancer recurrences would remain sensitive to Adriamycin, and there was a growing concern within the oncology community about limiting the cumulative Adriamycin dose in order to minimize cardiac toxicity. Furthermore, she had not heard of using complex chemotherapy combinations such as MCCFUD and FUMEP as consolidation regimens in the adjuvant therapy of breast cancer patients and would not consider their use unless there was a creditable randomized trial which demonstrated them to be safe and effective. She expressed very strong feelings about the need for physicians to practice “evidence-based medicine,” and even questioned the need to give Adriamycin by continuous infusion.

Unfortunately, the patient’s decision to stop systemic chemotherapy at this point probably lowered her chance of tumor eradication to less than 20%, whereas plunging ahead might have allowed a 50% chance of tumor eradication. A final blow was the rejection of Blumenschein’s recommendation to give the patient Lupron1 with each course of chemotherapy in an attempt to preserve ovarian function in a fertile 28-year-old woman who was receiving aggressive chemotherapy. In this case, Dr. Ivy League was aware of the concept and, in fact, her study group was evaluating its use in this situation in a randomized trial. However, Amy was not eligible to be included in the study, so she did not raise the issue with her or discuss the matter in any way.

Amy never regained her menstrual cycle, her cancer reappeared, and she was never cured. When Dr. Alfred DiStefano, who was one of Dr. Blumenschein’s colleagues at both MDA and ACC, reviewed this case he made the following comment. “It is a shame to see someone so obviously intelligent and concerned for the welfare of her patients paralyzed into inaction and confined to the ‘standard of care’ by lack of the statistical anomaly of randomization. In my opinion this standard represents the ‘average’ at best and ‘mediocre’ at worst. Randomized trials are not needed to guide most of the things that we do every day. Experience and observation are still the prime tools of the art of medicine. Otherwise
we could be replaced by assembly line robots!”

Quest for the Cure Breast Cancer Treatment - Case Study Beatta

Second-Guessing the System

In December 1999, Beatta Campos, a 37-year-old mother with three daughters, noted a mass in her right breast and consulted her physician. He reassured her that the mass was benign. However, the following May, the mass began to burn and she then sought the advice of Dr. Sanchez Basurto, a respected surgical oncologist in Mexico City. He advised her to have an immediate biopsy.

The needle biopsy showed a carcinoma. So on May 27, 2000, she had a modified right radical mastectomy. The breast contained a 4 cm33 cm32.5 cm, moderately well-differentiated infiltrating lobular carcinoma. Unfortunately, lymphatic permeation was present and 4 of 26 nodes from the right axilla contained tumor. The cancer was ER1, PR1, and HER22. At this point, Dr. Basurto referred her to Blumenschein.

Beatta seemed to present a straightforward situation. Blumenschein proposed CAT 36 induction adjuvant therapy, followed by irradiation and long-term tamoxifen. He reassured her that she should have a 90% chance of surviving at least 10 years with this program. He explained the need for an indwelling central venous catheter to be inserted during the CAT portion of her treatment so that she could be given Adriamycin by continuous infusion. He also mentioned that, at age 37, most women
given these drugs have a high probability of entering menopause. If this did not occur spontaneously, it would be well to consider an oophorectomy soon after beginning tamoxifen.

Beatta had a great deal of concern about entering menopause because she had seen her grandmother suffer from severe depression when she entered menopause. In an effort to get her started on adjuvant chemotherapy, while keeping options open on ovarian function, Blumenschein added 7.5 mg of Lupron to the program with each course of CAT. She did well on this regimen. Although menstrual cycles ceased when she was given Lupron during her CAT program, they resumed when CAT was completed and Lupron could be discontinued. Her periods were regular and it was decided to follow her with more frequent observation. For some reasons, tamoxifen was never started.

Subsequently, Beatta remained under the care of a very competent medical oncologist, Dr. Raquel Gerson in Mexico and Blumenschein saw her infrequently. Almost 10 years to the date of her cancer diagnosis, he realized that she had never stopped her menstrual cycles and had not taken tamoxifen. The absence of recurrence after 10 years in a patient whose breast cancer was ER1, PR1 strongly suggests the CAT adjuvant therapy had successfully eliminated any residual tumor burden soon after
it was started.

Beatta appears to have second-guessed the system and won. It was quite possibly time for Blumenschein to rethink his 10-year rule for designating complete remissions as cures.

Quest for the Cure Breast Cancer Treatment - Case Study Lisa

The Patient of the Future

In August 2000, Lisa Bridges, age 43, was diagnosed with cancer in her left breast. The tumor was small and was located in the lower inner quadrant. She was treated with a modified radical mastectomy because three nodes from the left axilla contained metastases and there was extranodal extension into the perinodal fat with focal intravascular invasion. The tumor was ER2, PR2, and HER21 with a 31 score.

The following month, she consulted a medical oncologist in Evansville, IN who recommended that she receive adjuvant chemotherapy to be followed by radiation therapy to the peripheral lymphatics and the chest wall. An adjuvant therapy program was begun that month that consisted of the undeservedly popular AC 34, followed by consolidation with Taxol as a single agent 34. Fortunately, Adriamycin was administered by continuous infusion and the adjuvant program was completed without incident.

On a routine a follow-up examination in August 2002, a mass was discovered in Lisa’s left upper lung. Lung tissue obtained by needle biopsy showed a poorly differentiated adenocarcinoma consistent with metastatic high-grade breast cancer. Several other sites were suspicious for metastases, including the hilum of the right lung and the 11th and 12th thoracic and 5th lumbar vertebrae. Lisa was started on weekly Herceptin (trastuzumab), a monoclonal antibody that blocks the HER2 receptor. Meanwhile, she visited MDA, Memorial Sloan-Kettering, Vanderbilt, and the University of Indiana. Each facility turned her down because they did not have an ongoing treatment protocol for which she was eligible.

In January 2003, Navelbine (vinoralbine), a vinca alkaloid that blocks dividing cells was added to her therapeutic regimen and Lisa first consulted Blumenschein later that month. His initial move was to refer her to Dr. Dan Meyer, a thoracic surgeon in Dallas, who was willing to attempt surgical removal of her lung metastasis. One week later, he operated and got her lung into a complete remission.

However, a major question was, how would resection of the lung lesion benefit a patient who had other sites of cancer spread? So Blumenschein used TAC 36 for induction and FUMEP 32 for consolidation adjuvant chemotherapy. Herceptin, which had been discontinued preoperatively, was restarted weekly with Navelbine, but had to be stopped after four doses because of declining cardiac function. Testing in the summer of 2003 showed blastic healing of the thoracic vertebrae and radiation oncologists proceeded with radiation therapy consolidation.

By September 2003, Lisa’s hilar lymph nodes were becoming a problem and radiation therapy was called into action once again.  Unfortunately, this resulted in radiation pneumonitis for which she had to receive steroid therapy. In July 2004, Lisa’s pleura-based lesion returned. By November 2004, it had increased by 70% and a pleural nodule was surgically removed. Although this nodule showed no evidence of cancer, the surgery was repeated in January 2005 and cancer was present.

In November 2005, the lung lesion was again growing and Herceptin therapy was resumed. This time it was given with Abraxane, a formulation of paclitaxel bound to albumin. Seven months later, Lisa’s chest scans had cleared and Abraxane was discontinued. Herceptin was continued every week until October 2006, when it again had to be stopped because of decreasing cardiac function. At that time, she was considered to be in complete remission. Herceptin was restarted when Lisa’s cardiac function improved but had to be discontinued again in November 2007 when her cardiac function deteriorated again. At this time, restaging studies showed NED. Herceptin was resumed from January 2008 through July 2008 at which time the staging studies continued to show NED.

Lisa is going to require aggressive follow-up. By my dated criteria she may not be cured, but could be classified as in Herceptin-maintained complete remission in Abraxane complete remission or in Abraxane complete remission maintained by Herceptin. In this sense, Lisa Bridges is the patient of the future who never completely eradicates cancer clones but may control them with intermittent or continuous therapy. There is the possibility that the pattern of behavior demonstrated by Lisa’s cancer will direct us toward a new strategy of maintenance therapy built around drugs like Herceptin that have specific targets.

What is Chemotherapy?

What is Chemotherapy?

Chemotherapy bottles

When we hear the word chemotherapy, will crosses our minds about the diseases that require chemotherapy as cancer, tumor or other carcinogenic types. Chemotherapy is an attempt to kill the cancer cells by interfering with the function of cell reproduction. Chemotherapy is a cancer treatment method by way of giving substance / drug that kills cancer cells have properties.

Chemotherapy is useful to reduce the size of the cancer prior to surgery, destroy all cancer cells left behind after surgery, and treating certain kinds of blood cancer

However, chemotherapy also have side effects, namely:

•     nausea
•     gag
•     kidney damage
•     irritate the oral cavity
•     hair loss
•     decrease sexual desire
•     sprue
•     diarrhea

how to deal with side effects:

•     provision of anti-nausea and vomiting
•     when you feel queasy sitting up fresh
•     eat foods high in protein and carbohydrates (puddings, cereals, meatballs, pudding, milk, toast, soup, yoghurt, cheese, condensed milk, dates, nuts, etc.)
•     do oral care by brushing your teeth before bed and after eating. If it can not brush his teeth because of gum bleeding, apply the cleaner mouth
•     give lip moisturizer as needed
•     avoid smoking, spicy food and water ice.

In some studies chemotherapy can reduce the number of deaths early stage cancer patients, but for patients with late stage cancer / metastasis, chemotherapy is only able to delay death or prolong the lifespan of the patient for a while. However man can only hope that while recent events only God disposes.

Urine Therapy and 6 glasses of water for cancer survivors and and other diseases

Urine Therapy and 6 glasses of water for cancer survivors and and other diseases

The following article is sourced from Mr. Hadi Suyitko that use urine therapy for health :

"I am a man aged 36 years. Back when I was aged less than 10 years, often experience fever, and even had to step (body heat is too high).

It was the children who often experience fever or step having grown very weak body resistance, easy pain, fatigue, colds (probably this is caused when attacked first heat, the organs of the body are also affected by heat). This will result in the future. For that to parents who have children are often attacked by hot, please quickly treated and handled, until later as adults, have the condition of the body is weak / vulnerable.

As I used to get sick (colds, easy cape, and does not fit). In conditions that are often sick, I am looking for information about health, either through books, magazines, and articles. In the end I found the road to health, that is, from the article. I like to collect articles, I make writings and clippings. It has been running for many-years.

As for how healthy I found was therapy urine / urine and 6 glasses of water. At first I was hesitant to drink urine. Due to the health and strong desire to be free from decreasing body condition and easily hurt, eventually determined to have a drink with plus 6 glasses of water.

In the instructions in the article I read, when we urinate when I wake up in the morning, the first urine dumped out a little, and take approximately one glass. Then drink immediately, no salty taste but it was only a short time in the mouth. Hose hour later I drink 6 glasses of water (for that is not used to drinking water 1 or 2 glasses just enough) gradually. After that light exercise / move the joints of the body and one hour later breakfast.

Cultivated lag time between urine and drinking 6 glasses of water and breakfast is 1 hour, in order to react in the body. Once done with the routine, I felt the condition of the body become more fit and stamina increase.

Through this therapy experience, I think it is evident what is written in the articles. With this therapy can cure a variety of diseases, including increases stamina and endurance. For those who are less passionate husband and wife can not be happy, because was tired of working, fatigue, a factor that age increases, the body's lack of passion, with this therapy will feel the difference.

Cure diabetes and chronic diseases. According to research and articles of urine therapy and 6 glasses of water can cure diabetes, cancer, high blood pressure / stroke, a weak heart, arthritis, migraine, asthma, bronchitis, kidney, hemorrhoids and more.

Toothache / gums (teething). Simply we gargle urine 2-3 times in 3 days surely recover. Sore eye irritation / tired of long trips. With the pan with the urine of a few moments later certainly cured. Bruises bruising hit a blunt object by eating along with 6 glasses of water a definite bruise will fade away.

Defecate difficult , with this therapy is guaranteed no longer need medication, but do not be surprised because the dirt is soft discharge. Indeed, one of the functions of urine is destroying substances that are not needed in the body. Skin diseases, water fleas, do not worry. Simply wash the body affected by the disease with urine and allowed to stand for a moment, then rinse with warm water must have a speedy recovery. 

Accelerate hair growth. With urine therapy and 6 glasses of water it every day, who has thinning hair, loss, or even go bald, guaranteed to have hair that is okay. For those who are in treatment, while efforts are made to stop using, or not consumption of foods such as banana, jengkol or cabbage to avoid strong odors.

Entropy-based feature extraction and decision tree induction for breast cancer diagnosis with standardized thermograph images

Entropy-based feature extraction and decision tree induction for breast cancer diagnosis with standardized thermograph images

by
Ming-Yih Leea,
Chang Gung University, Graduate Institute of Medical Mechatronics

and

Chi-Shih Yanga,
Lee-Ming Institute of Technology, Department of Mechanical Engineering

a b s t r a c t

In this study, a computer-assisted entropy-based feature extraction and decision tree induction
protocol for breast cancer diagnosis using thermograph images was proposed. First,
Beier–Neely field morphing and linear affine transformationwere applied in geometric standardization
for whole body and partial region respectively. Gray levels of pixel population
at the same anatomical position were statistically analyzed for abnormal region classification.
Morphological closing and opening operations were used to identify unified abnormal
regions. Three types of 25 feature parameters (i.e. 10 geometric, 7 topological and 8 thermal)
were extracted for parametric factor analysis. Positive and negative abnormal regions
were further reclassified by decision trees to induce the case-based diagnostic rules. Finally,
anatomical organ matching was utilized to identify the corresponding organ with the positive
abnormal regions. To verify the validity of the proposed cased-based diagnostic protocol,
71 and 131 female patients with and without breast cancer were analyzed. Experimental
results indicated that 1750 abnormal regions (703 positive and 1047 negative) were detected
and 822 branches were broken down into the decision space. Fourteen branches were found
to have more than 4 positive abnormal regions. These critical diagnostic paths with less
than 10% of positive abnormal regions (61/703 = 8.6%) can effectively classify more than half
of the cancer patients (42/71 = 59.2%) in the abovementioned 14 branches.

1. Introduction

Thermographs were designed to capture the infrared ray from
objects if its temperature were higher than the absolute zero
degree. This special characteristic was utilized to display the
metabolic heat that was dissipated from the skin surface
of human body, especially for the medical thermographs of
breast cancer. The pathological mechanisms of breast cancer
are that cancer cells produce nitric oxide (NO) at proliferative
stage [1]. This chemical material will interfere with the
neuronal control of blood vessel flow and lead up to regional
vasodilatation in the early stage of cancerous cell growth. This
angiogenesis facilitates a local temperature rise about several
years earlier than the tumor forming. And even deep
breast lesions seem to have the ability to induce changes
in skin temperature [2]. The abovementioned characteristics
of breast cancer tissue specifically imply some meaningful
graphic patterns (i.e., geometric size and location, topological
shape or thermal features) in thermograph images. Hence
thermographs are better suited than mammography for early
breast cancer prediction even when the tumor is taking shape.

Medical thermographs become a suitable tool for early warning.
This key point of this paper emphasizes the usage of
thermal image to diagnose breast cancer. The algorithm with
high concentration rate of cancer patients in a few rule paths
was proposed. The effect of early diagnosiswas not in the field
of discussion.

Besides, there exists highly false positive prediction due
to the little difference of thermographs between the normal
subject (negative case) and cancer patient (positive case) as
shown in Fig. 1. Due to the lack of effective image processing
methods to support the use of thermographs, the credibility
and sensitivity of thermographs are still in question in
medical applications. Medical thermograph has been quiescent
for a long time due to the limitation of hardware and
software. The hardware limitation was broken recently by the
advancement of the uncooled focal plane array (UFPA) photo
detector and personal computer, and the software limitation
was also overcame by the progress of analyzing algorithms. All
the signs indicate that the infrared thermal images will be successful
in medical usage [3]. Recently, large scale of case-based
studies showed that thermographs had an average sensitivity
and specificity of 90% as the significant biological risk marker
for the existence of breast tumor [4]. But all these analytical
techniques still come to a standstill with the traditional statistics
and manual evaluation. The parametric analysis on ROI
(region of interest) of hot spots and cold spots in the abnormal
regions still remain unsolved.

Different medical applications with thermographs were
received attention from various research groups. To name a
few, female breast cancer [4,5], pain management [6] or diabetic
foot [7]. Also various digitally analytical methods for
image processing algorithms were proposed, such as abnormal
statistics method [8], the thermal asymmetric method
[9,10] and the image standardization and anatomical matching
methods [11], etc. Although these image processing
techniques are important in medical thermograph analysis,
lots of these methods still lack delicate algorithms or cannot
totally be a part of the computer-assisted diagnosis solution.

The aim of this paper is to establish a computer-aided
cased-based diagnostic tool to automatically interpret the
thermal pattern by a bio-statistical technique [4] for investigating
the parametric connection between female breast
cancer and thermal physiology quantitatively. The proposed
algorithm consists of five steps, i.e. geometric lofting
standardization, abnormal region statistics, parametric factors
analysis, decision tree induction and anatomical organ
matching. This methodology is not intended to replace the
traditionally golden method on mammography and also not
to compare the minimal tumor diameter missed by these two
instruments. This paper is intended to explore the potential
benefits of thermograph for early detection of breast
cancer without comparing its sensitivities or specificities
with that of mammography. In addition, a parametric analytical
algorithm was proposed to extract the governing
rules from large scale dataset by decision tree induction
for breast cancer. Finally, the clinical applicability of
the proposed computer-assisted diagnosis tools was analyzed
by 71 and 131 cases with and without breast cancer
respectively.

COMPLEMENTARY THERAPY for Cancer

JANINE KIRBY, INTEGRATIVE PRACTITIONER

‘It’s about being a person, it’s about being compassionate, it’s about being a healer.’

There are many different facets to healing besides traditional western forms of
treatment like chemotherapy and radiation. Based on your own personal
experiences and feelings on the matter, you may want to explore the various
complementary therapies available to find a holistic way forward with your
cancer or even your health in general.

Integrative practitioner73 and trained medical doctor Janine Kirby
explains that patients often look to other forms of healing during cancer
treatment because of the limitations of western medicine. ‘Essentially, in
western medicine what we are doing is suppressing symptoms. In
complementary therapies, we are promoting balance and healing.’

It is very much a personal journey and one in which the cancer patient’s
personal decision is crucial. Kirby says that often cancer patients have a socalled
C-type personality. C-type or cancer-prone individuals have three main
attributes. Firstly, they tend to suppress their own needs in favour of the needs
of others, and easily comply with the wishes of others. Secondly, they have
difficulty expressing their own emotions, tending to suppress strong painful
emotions especially. Thirdly, they often feel helpless and powerless.

‘Something has happened in their life that has been very painful and thus
strong feelings of sorrow, grief, anger and pain have been incarcerated in their
bodies.’

This sadness or pain, Kirby believes, may be the catalyst for cancer. In
order for these patients to heal, they need to make their own decisions about
treatment and not simply comply with what doctors tell them, as this is what
got them here in the first place. ‘It’s actually about making a very important
and positive decision for themselves and their own healing and their own
path, which can be very spiritual,’ says Kirby.

Choosing a type of treatment, whether chemotherapy or homeopathy, or
a combination of the two, comes down to how the patient feels about the
treatment. Kirby says that if, for example, a patient is under the impression
that chemotherapy is a drug that will only further damage him or her, it is not
a good treatment option for them. However, if the patient feels it is a drug
that will heal, then it is a good treatment option. ‘It is critical that patients feel
empowered when making choices for treatment, making healing decisions
that resonate with their world views; decisions that reflect self-compassion.’
It is therefore important to explore all of the available options and to make
the decision yourself. What follows is an overview of some of the more
popular complementary therapies available in South Africa.

ACUPUNCTURE

Acupuncture involves pricking the skin or tissues with needles to alleviate
pain and to treat various physical, mental and emotional conditions. While it
originated in China, it is practised widely in South Africa.

‘Acupuncture is at least two centuries old, with research dating back even
further in the Chinese civilisation,’ explains Dr Natascha Wolf, an
acupuncturist based in Roodepoort. ‘The oldest acupuncture needle was a
stone in a needle-type shape.’ Wolf got into acupuncture after studying
homeopathy for six years and receiving her master’s degree. She has been
practising for twelve years, dealing with health issues like infertility,
musculoskeletal disease and mental illness.

For cancer patients, Wolf says that acupuncture is beneficial because it
helps to stimulate the body’s natural healing ability. ‘I personally use it pre-,
during and post-chemo for side effects and to increase energy and healing. It
is a great adjunct to medicinal treatment for cancer. I think it is also
important for post-chemo to try to re-establish balance in the body.’

In terms of general health, acupuncture can also be beneficial. It is noninvasive,
safe and has positive side effects that include deep relaxation and a
feeling of well-being. It can also be used alongside any kind of medication.

AYURVEDA

This traditional-healing system dates back over 5 000 years. While it
originated in India, it is gaining popularity in countries like South Africa.
According to the Allied Health Professions Council of South Africa
(AHPCSA), ayurveda ‘is a complete system of medicine which advocates that
all beings come from nature and are an integral part of the whole creation’.74

It is ideal for those who believe that the body, mind and spirit should be in
harmony. While ayurveda is a complex belief system, built on the
understanding that the universe is made up of space, air, fire, water and
earth, its focus is that when everything is in harmony or balance, you will be
at optimum health.

The AHPCSA and the National Ayurveda Medical Association of South
Africa offer advice, resources and information for those interested in pursuing
this route.

MACROBIOTICS

Macrobiotics, meaning great or big (macro) life (bios), is the study of
energetics. Mandy Hoffeldt, a macrobiotic and whole-foods teacher at the
LiveMacro Wellness Centre in Johannesburg, explains that ‘if you apply
macrobiotic principles of balance, then you will be strong and healthy and
able to live a great life’.

Underlying macrobiotics is the belief that there are two energy forces
governing all things: yin – expansive energy, also known as earth’s force – and
yang – contracting energy, also known as the heavens’ force. ‘These energies
influence and are present in everything, including the foods we eat. If we eat
extreme foods, which are foods that are either too yin or too yang, we
eventually become ill,’ Hoffeldt explains.

Using water as an example of yin and yang, she explains that in its
extremely expanded state (yin) water becomes steam and in its most
contracted state (yang) it turns to ice. Thus, nothing is ever completely yin or
yang; rather there are varying degrees of both in all things.

‘These energetic changes happen in our own bodies whenever we eat or
drink something, either causing some degree of expansion or contraction. By
eating balanced foods, like whole grains, legumes, vegetables and sea
vegetables, and by avoiding foods that are classified as extremely expansive or
contracting such as meat, dairy, refined food, alcohol and other stimulants,
we can achieve health,’ Hoffeldt says.

By taking diet into account, macrobiotics is also based on the theory that
eating local and seasonal foods is more balanced than eating foods that are
out of season or are grown in a region that is very different from the one in
which you live.

In terms of cancer, Hoffeldt says that because macrobiotics is a return to a
more natural way of eating and living, it can aid healing. ‘Macrobiotic foods
help to eliminate excess in the body, which is often a cause of many cancers.

The foods can help to strengthen and fortify people with cancer, and because
it is a completely natural approach, there are no ill effects. Many people begin
to “discharge” or “detox” when starting on macrobiotics, so they may feel
worse before they start to feel better.’

Treatment is simple, based on the principles of yin and yang. Hoffeldt
explains that if you have what is considered a more contracted cancer, like a
tumour, you would apply macrobiotic principles and various remedies to
address the particular condition by following a more yin-balanced diet. If you
are suffering from a more yin cancer, the opposite would apply. Macrobiotics
can also be used alongside other natural treatments like homeopathy and
reflexology or medical treatments like chemotherapy and radiation.

In all cases, the individual is key. ‘Macrobiotics is different for each
person, depending on that person’s condition and other factors like
environment and geographical position,’ says Hoffeldt. ‘Other
recommendations made to people who are ill include living more naturally,
avoiding electromagnetic-radiation exposure from electronic equipment or
cellphones, getting regular exercise, and engaging in practices like yoga,
shiatsu and meditation to help restore balance.’

In terms of living a healthy lifestyle, according to the principles of
macrobiotics everything eventually changes to its opposite. Just as night
becomes day and summer gives way to winter, our bodies are always
changing. ‘We need to continually change and adapt our way of eating to our
current circumstances, our current health and other factors that influence our
daily lives. This way we can truly experience health throughout our lives.’

As there are so many principles that guide macrobiotic teachings, Hoffeldt
recommends learning as much as you can and keeping a spirit of curiosity by
always questioning what is being taught. She was once even advised by a
macrobiotic counsellor to ‘practice moderation in all things, even
moderation. I like to remember this when I see people getting too stressed or
worked up about following any kind of dietary regimen too strictly and
causing themselves unnecessary angst.’

For those wanting to know more, Hoffeldt recommends books like The
Macrobiotic Way by Michio Kushi, The Hip Chick’s Guide to Macrobiotics by
Jessica Porter, Macrobiotics for Dummies by Verne Varona and The Great Life
Diet by Denny Waxman.

HOMEOPATHY

Homeopathy is one of the most popular forms of alternative medicine and is
based on the law of similiars. Developed by Dr Samuel Hahnemann, the
concept of homeopathy is that anything that can produce symptoms can also
be used to cure symptoms. For example, an onion causes symptoms like
watery eyes and a burning nose. In homeopathy, a remedy that utilises onion
will be used to treat something like hay fever, which causes watery eyes and a
burning nose.75 Kirby, who has studied homeopathy as well as mindful-based
stress reduction, explains that homeopathy involves treatments that promote
balance and healing.

One of the most crucial aspects of homeopathy is an understanding of the
mental and emotional state of the patient. One of the greatest clues is the
words patients use to describe their symptoms; words like ‘heavy’ or ‘eating
away at me’. ‘One thing that I have learnt over the years … is to really listen
very carefully to what people say and the words that they use to describe their
illness and their experience of it. You can’t say what is happening in the body
is separated from the mind and the emotions,’ Kirby asserts.

Before they look at remedying a patient, homeopaths and integrative
practitioners first ask the patient to describe his or her exact experience of the
physical symptoms, as well as associated emotions and thoughts, so that they
can get an essence of the person. ‘It depends a lot on why someone has come
to see me and what types of questions they are asking,’ explains Kirby. ‘The
diagnosis of cancer is a diagnosis [that will] stop you in your tracks. You have
to re-evaluate everything very carefully in your life.’

It is because of this that she believes healing is much broader than just
what you eat. It is a decision that the patient makes to look after him or
herself, rather than a list of what he or she can and cannot eat, drink or do.
Along with homeopathic remedies, Kirby prescribes mindfulness and
meditation.

The benefits of homeopathy and mindful-based stress reduction extend
further than traditional medicine in that they can be kinder and gentler and
help people to become more whole, Kirby believes. Letting go of emotional
baggage in order to heal can, however, be a challenge. ‘It’s hard for all of us to
forgive. It’s hard for all of us to let go. My role is helping people connect the
dots and come to a deeper understanding of themselves, and the truth is that
they want to do that.’

NATUROPATHY (HERBALISM)

Naturopathy or herbalism offers a more natural, herbal alternative (or
supplement) to the chemicals and treatments prescribed by modern medicine.
A South African but American-based naturopathic physician, medical
herbalist and doctor of integrative medicine, Dr Kathia Roberts, is always
amazed at the human body’s design and how it is able to rebalance and heal
itself when we provide it with what it needs. ‘Working with the individual
and assessing their health needs in order to determine which combined
naturopathic and botanical medicine approach would be best for that
individual at that time is the most exciting part of being a practitioner,’ she
says.

Roberts’s approach is to educate patients so that they can be their own
naturopath/herbalist by utilising everyday natural kitchen remedies and
lifestyle practices to prevent disease and optimise health. ‘It empowers the
individual and provides them with the tools and inner mind-body wisdom so
that they are able to heal themselves. They start listening to symptoms instead
of suppressing them. The symptoms provide them with valuable information
regarding the imbalance and disharmony that needs to be addressed.’

When it comes to cancer patients, Roberts says this type of treatment is
beneficial on many different levels, as it addresses psychoneuroimmunology,
the study of the interaction between psychological processes and the nervous
and immune systems of the body. ‘Many studies have been done on the link
between stress and cancer. With stress we look at the part that depression, selfinternalisation,
grief, anger, resentment, behaviour and self-blame plays in
creating the cancer personality.’

Because the innate immune system and neurotransmitter are found in the
gut, naturopaths have found that the restoration of health starts with
addressing the body’s fundamentals, such as a healthy gut through good
nutrition and lifestyle practices. It is because of this that diet plays a large role
in this form of treatment.

‘This is the most important part, as our modern diets can contribute to
why we have cancer in the first place,’ Roberts explains. ‘Food sensitivity
testing [blood tests] will identify what foods cause inflammation and physical
stress in that individual, as well as what environmental and food chemicals
will act as carcinogens.’

Roberts’s natural treatments for cancer patients include:

• An antioxidant-rich, liver-cleansing, mostly vegan, 40 per cent raw, 20 per cent juice diet low in sugar, and seasonal and constitutional specific.

• No caffeine and no alcohol.

• Cleansing practices, if applicable, such as hydrotherapy, sauna, colonic irrigations, coffee/chlorophyll enemas, etc.

• A herbal protocol that may consist of essiac tea, adaptogenic tinctures, antioxidant-rich supplements, lymphatic and liver support, and whatever else is needed to balance the individual’s system and improve organ function.

• Homotoxicology with complex homeopathic formulations to help with cellular detoxification.

• Interleukin therapy with homeopathic cell regulation to address pain and pro-inflammatory cytokines.

• Neurotransmitter therapy to help balance the sympathetic nervous system to address anxiety, depression, fatigue, etc.

• Chlorophyll treatment, Bach flower essences, tissue salts and ginger syrup if receiving chemotherapy.

• Meditation, hypnosis, visualisation, affirmation, and colour, sound and energy healing to balance the energy field.

• Acupuncture and massage therapy where applicable.

What is most important, Roberts explains, is that where integrative protocols
need to be applied, cancer should be approached on an individual basis. ‘We
are complex beings and cancer is a complex disease.’

PLANTS

One area in South Africa that has been extensively examined when it comes to
more natural remedies is the use of plants in healing. Dr Gerda Fouché and
her team in the bioprospecting research division of the Council for Scientific
and Industrial Research (CSIR) are investigating the possibility of a plantbased
drug for the treatment of cancer.

Fouché, who joined the CSIR in 1998, is involved in scientifically
investigating 24 000 South African plant species in collaboration with
traditional health practitioners, as they have found that many people consult
one or more of the 200 000 traditional healers in South Africa for treatment
with natural remedies based on indigenous knowledge.

‘For the past decade, our group, with collaboration from the National
Cancer Institute in the United States of America, has focused on – among
cures for other diseases – mining possible anticancer leads from plants
reportedly containing medicinal properties, even validating remedies and
testimonies from traditional healers who claim to have cured cancer with
specific plants,’ says Fouché.

This is not a new concept. In fact, a large percentage of drugs on the
market for the treatment of cancer are isolated or derived from natural
products, especially plants. It is a tedious process, however, and one that
Fouché says takes between ten and fifteen years of research and development
before the drug can be put on the market. With the focus shifting to cancer
prevention in recent years, they are also investigating the use of herbal
remedies for this application.

The CSIR’s research into this field stems from the need for a more
effective cancer drug. Fouché explains: ‘The drugs on the market for certain
types of cancer are not very effective and have numerous side effects mainly
because of non-selectivity towards normal cell lines. These drugs are also very
costly and the success rate very low.’

While diet does not play a role in their research, Fouché, who lost her
mom a few years ago to sarcoma cancer, says that she feels it is very
important to consider. She adds that the public need to be more informed
about major diseases and their causes.

In the meantime, Fouché and her team continue to search for a plantbased
drug that could aid with healing and treating cancer.

REIKI

Reiki, the ancient art of ‘laying on of hands’ in order to heal, addresses the
connection between emotions and health. According to reiki master Karen
Lange, when it comes to cancer patients, ‘Reiki restores balance to the body's
energy systems and helps with the effects of chemotherapy, as well as creating
a perfect environment for boosting immunity and the body's ability to self
heal.’

Rei – the spiritual power or universal transcendental spirit – and ki – the
essence of vital life-force energy – uses touch to convey feelings like warmth,
serenity, love and healing through the channelling of energy. This energy is
said to enhance a person’s life force. While not considered a religion, Western
Reiki techniques are based on ancient Tibetan healing methodologies that
enable one to tap into the infinite and limitless source of life-force energy to
heal.

Those who practise Western Reiki believe that there are many different
vibrations of ki within the human aura, as well as chakras that help to sustain
the physical body, thoughts, feelings and spirituality. When ki is out of
balance, negative energy forms around the physical body and within the auras
and chakras. This energy cannot flow freely and results in illness in the body.

By removing this negative energy, healthy ki can flow freely once again and
heal the body. Eastern Reiki is more about living by the reiki principles
(compassion, gratitude, duty and peace), understanding and working with the
body’s energy wave and stimulating the lymphatic system to release toxicity.

Lange says, ‘Reiki healers channel positive ki to the area of the body,
chakra or aura where negative energy is harboured, allowing it to be released
from the person’s energy field and replaced by healthy ki, resulting in the
natural flow of positive ki. In short, reiki healers channel through pure
universal love.’

While not advocated as a replacement for modern medicine, reiki can
assist individuals in that it allows them to take responsibility for their own
health and happiness. The benefits of reiki include physical improvements like
easing aches and pains, relaxing muscles and tension, relieving fatigue,
clearing toxins, supporting the immune system, reducing blood pressure and
helping with better sleep, as well as emotional and mental improvements like
relaxing the body and mind, promoting feelings of calmness and well-being,
relieving stress, encouraging emotional release and unlocking suppressed
feelings.

You can approach the Reiki Association of Southern Africa to find out
more.