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December 10th, 2013 - by Dr. Jack West Why do we care about lymph nodes when staging lung cancer? The simple answer is that they give us prognostic information (insight into the likely future behavior, the “natural history”, of the cancer). When you think of a cancer’s growth, there are a few potential ways for it to progress. It might progress right where it started, staying local. It might travel through the lymphatic system, kind of like debris swept off a roof and into a home’s gutter, and it might spread distantly to other parts of the body. We’re interested in getting a sense of how aggressive a cancer is likely to be overall, the engine behind its growth, but also whether it’s more likely to stay local or travel distantly. The staging system for lung cancer and most others is called the TNM system, where T stands for Tumor stage (the primary cancer, where it started), N stands for Nodal stage (are lymph nodes involved, and if so, where?), and M stands for Metastasis stage (distant metastases, yes or no?). The M stage overrides the others — if a cancer has spread to distant parts of the body, it’s an advanced cancer, no matter how big or small the primary tumor or whether there are lymph nodes involved or not. But N stage is also quite important. Essentially, the distance from the primary cancer to any involved lymph nodes, along with the number of lymph nodes that have cancer within them, help predict the probability that the cancer is able to get out of the area in which it started and spread to distant parts of the body, where cure is generally not something we can expect to achieve. Lymph nodes within the same lung as the primary cancer are called N1, and those in the mid-chest (mediastinum) between the lungs are called N2 if on the same side as the primary tumor, or N3 if on the other side or above the collarbone (lymph nodes outside of the chest are unfortunately considered metastatic sites, because they almost always occur in the setting of more widespread progression). This numeric staging reflects the distance the cancer had to travel to get there, so higher number for N stage means greater distance and greater chance of spread to other parts of the body, and the stage is often dictated by the highest N stage seen, unless there is distant metastatic disease (which, as noted above, overrides other considerations and denotes metastatic/advanced cancer). Basically, nodal status assesses the probability of a cancer to travel further, even if you don’t see evidence it has metastasized yet. It’s kind of like when my youngest son had wandered out onto the driveway after figuring out how to unlock the front door, open it, and walk outside. He didn’t quite wander into the street, but he had clearly shown that he had the skills to escape. Imagine that N1 nodal involvement is like finding him having unlocked the door, N2 is like opening it and starting to look outside, and N3 is like him walking down the driveway toward the street. (He is now 7 and at far more risk of video-game induced brain rot.) While the number of lymph nodes involved is not formally part of the staging system, there are many studies over the years that have shown that prognosis is more favorable if one or a few lymph nodes are involved by cancer vs. many nodes involved. Lymph node involvement that is only microscopic has a more favorable prognosis than involvement that leads the nodes to become enlarged (as I think you would expect). And lymph node involvement by “direct extension” of a primary tumor just growing into an adjacent lymph node tends to be associated with a more favorable prognosis than having one or more lymph nodes involved by the usual method of traveling through the lymphatic system, so there is some space between the primary cancer and the involved nodes. How does this change our management? Aside from providing important information about the probability of cure, such as the probability of the cancer recurring after potentially curative surgery or chemo and radiation, it helps provide clues about the relative weight we might want to give to chemotherapy vs. “local” treatments like surgery and radiation. For example, a cancer that shows a pattern of a 4 cm primary tumor but no lymph node involvement has provided a clue that it’s going to stay local and not be at as high a risk for distant spread as a cancer that is 3 cm but has spread to mediastinal lymph nodes on the same side as the primary tumor. The latter might possibly be treated with surgery, but chemotherapy is going to be a strong recommendation for just about any patient with N2 or higher node involvement, and it’s standard to recommend chemotherapy to reduce the risk of recurrence after surgery for a resected cancer with N1 (within the lung) node involvement, but not as clearly needed for someone with the same cancer but no lymph nodes involved. For locally advanced (stage III) non-small cell lung cancer, lymph nodes are critical in selecting an optimal treatment. A single N2 node is in the realm that many experts would consider perfectly appropriate for surgery, but multiple N2 nodes or any N3 disease puts it in the range in which surgery is generally not favored. Instead, chemo and radiation are typically favored. This isn’t because we can’t find a surgeon to try to remove all visible disease, but rather that both multiple N2 nodes and N3 nodal disease represent a situation in which we need to concentrate on more than just the disease we can see. We need to be sure to cast a wide net to treat the disease we can see and the disease we can’t. Radiation treats a broader local area than surgery, as a general rule, and we can more reliably get in a meaningful amount of chemo when someone hasn’t just undergone a major lung surgery. This is a big topic, so I’d welcome your questions. There are always individual circumstances, but I wanted to provide a general sense of why nodal status matters and how we use this information to prioritize one treatment approach over another. I hope that helps

December 10th, 2013 - by Dr. Jack West Why do we care about lymph nodes when staging lung cancer? The simple answer is that they give us prognostic information (insight into the likely future behavior, the “natural history”, of the cancer). When you think of a cancer’s growth, there are a few potential ways for it to progress. It might progress right where it started, staying local. It might travel through the lymphatic system, kind of like debris swept off a roof and into a home’s gutter, and it might spread distantly to other parts of the body. We’re interested in getting a sense of how aggressive a cancer is likely to be overall, the engine behind its growth, but also whether it’s more likely to stay local or travel distantly. The staging system for lung cancer and most others is called the TNM system, where T stands for Tumor stage (the primary cancer, where it started), N stands for Nodal stage (are lymph nodes involved, and if so, where?), and M stands for Metastasis stage (distant metastases, yes or no?). The M stage overrides the others — if a cancer has spread to distant parts of the body, it’s an advanced cancer, no matter how big or small the primary tumor or whether there are lymph nodes involved or not. But N stage is also quite important. Essentially, the distance from the primary cancer to any involved lymph nodes, along with the number of lymph nodes that have cancer within them, help predict the probability that the cancer is able to get out of the area in which it started and spread to distant parts of the body, where cure is generally not something we can expect to achieve. Lymph nodes within the same lung as the primary cancer are called N1, and those in the mid-chest (mediastinum) between the lungs are called N2 if on the same side as the primary tumor, or N3 if on the other side or above the collarbone (lymph nodes outside of the chest are unfortunately considered metastatic sites, because they almost always occur in the setting of more widespread progression). This numeric staging reflects the distance the cancer had to travel to get there, so higher number for N stage means greater distance and greater chance of spread to other parts of the body, and the stage is often dictated by the highest N stage seen, unless there is distant metastatic disease (which, as noted above, overrides other considerations and denotes metastatic/advanced cancer). Basically, nodal status assesses the probability of a cancer to travel further, even if you don’t see evidence it has metastasized yet. It’s kind of like when my youngest son had wandered out onto the driveway after figuring out how to unlock the front door, open it, and walk outside. He didn’t quite wander into the street, but he had clearly shown that he had the skills to escape. Imagine that N1 nodal involvement is like finding him having unlocked the door, N2 is like opening it and starting to look outside, and N3 is like him walking down the driveway toward the street. (He is now 7 and at far more risk of video-game induced brain rot.) While the number of lymph nodes involved is not formally part of the staging system, there are many studies over the years that have shown that prognosis is more favorable if one or a few lymph nodes are involved by cancer vs. many nodes involved. Lymph node involvement that is only microscopic has a more favorable prognosis than involvement that leads the nodes to become enlarged (as I think you would expect). And lymph node involvement by “direct extension” of a primary tumor just growing into an adjacent lymph node tends to be associated with a more favorable prognosis than having one or more lymph nodes involved by the usual method of traveling through the lymphatic system, so there is some space between the primary cancer and the involved nodes. How does this change our management? Aside from providing important information about the probability of cure, such as the probability of the cancer recurring after potentially curative surgery or chemo and radiation, it helps provide clues about the relative weight we might want to give to chemotherapy vs. “local” treatments like surgery and radiation. For example, a cancer that shows a pattern of a 4 cm primary tumor but no lymph node involvement has provided a clue that it’s going to stay local and not be at as high a risk for distant spread as a cancer that is 3 cm but has spread to mediastinal lymph nodes on the same side as the primary tumor. The latter might possibly be treated with surgery, but chemotherapy is going to be a strong recommendation for just about any patient with N2 or higher node involvement, and it’s standard to recommend chemotherapy to reduce the risk of recurrence after surgery for a resected cancer with N1 (within the lung) node involvement, but not as clearly needed for someone with the same cancer but no lymph nodes involved. For locally advanced (stage III) non-small cell lung cancer, lymph nodes are critical in selecting an optimal treatment. A single N2 node is in the realm that many experts would consider perfectly appropriate for surgery, but multiple N2 nodes or any N3 disease puts it in the range in which surgery is generally not favored. Instead, chemo and radiation are typically favored. This isn’t because we can’t find a surgeon to try to remove all visible disease, but rather that both multiple N2 nodes and N3 nodal disease represent a situation in which we need to concentrate on more than just the disease we can see. We need to be sure to cast a wide net to treat the disease we can see and the disease we can’t. Radiation treats a broader local area than surgery, as a general rule, and we can more reliably get in a meaningful amount of chemo when someone hasn’t just undergone a major lung surgery. This is a big topic, so I’d welcome your questions. There are always individual circumstances, but I wanted to provide a general sense of why nodal status matters and how we use this information to prioritize one treatment approach over another. I hope that helps

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Mike Magerko was a five-year lung cancer survivor. Originally given just three weeks to live after his small cell lung cancer diagnosis, he was nicknamed “Miracle Mike” when he responded well to his treatment. Mike’s philosophy for himself and others living with lung cancer was that life is precious and to enjoy every minute.

Rules: If you respond to a question with your ONE WORD, then you are IT. You must follow up with a question. I'll go first. If you could talk to one person in the whole world (past or present). Who would it be? (So, now whoever answers my question with their ONE WORD has to post a question.) TAG - You're IT!

Hello everybody! It is HOLIDAY PARTY time. Are you excited? I think we all love to be invited even though we sometimes cringe when we are asked to bring a dish. Well stress no more! I found this easy idea for you. Shopping list: 2 - Fresh Broccoli bunches 1- container of cherry tomatoes 1 - bottle of ranch dressing Just make sure you wash the veggies well & dry them on paper towels.

Roll call! Who is in here? The weather in Texas has been wild this week. Tuesday it was 80 degrees (F) and last night we had hours of sleet, & rain. The temperatures dropped and everything has turned into a 1/2 inch or more of ice. Where I live the City has shut down, all of the schools are closed and the local markets were cleared out yesterday. It looks like we will all be indoors for the next few days. I'm typing this hoping that my power stays on. It's been an off & on type thing all day. What is it like in your neck of the woods?

4 Steps to Maintaining a Positive Health Status December 2nd, 2013 - by Jessica Iannotta Eating healthfully is of the utmost importance in maintaining overall positive health and in preventing some cancers; yet, there are other actions that can also maintain a good, positive health status. Some of these include ongoing self-education, physician-approved exercise, and socialization. Ongoing self- education Self-education represents an important self-directed action that can result in improved health. Self-education can help promote one’s confidence in achieving optimal health goals.[1] Ongoing education also increases knowledgeable about proper nutrition and health and clarifies the ways to optimally achieve these goals. By staying updated, one can stay abreast of new advances in cancer treatment and make more educated choices when it comes to decisions related to medical care and treatments. Physician-approved exercise It is important to perform physician-approved exercise. Physical activity strengthens the immune system, and enhances and supports digestive system activity. In addition, a number of studies have demonstrated reduced cancer risk and improved quality of life and survival rate in cancer patients who engage in regular exercise. [2,3] It is recommended to begin with 30 minutes of moderate activity each day. If fatigue or side effects of treatment inhibit the ability to include regular physical activity, it is encouraged to do so in small, manageable amounts. Even a brief slow walk can provide benefits. It is important to always consult with your doctor before doing any new exercise routine or vigorous activity. Socialization Socialization is a natural part of life and is often used as a measurement of quality of life. Activities such as exercise are found to be correlated with improved social functioning. Healthier lifestyle practices that include socialization can help improve overall quality of life and health status.[4] For example, participating in social events and being active in social environments can help support the adoption and maintenance of nutrition and physical activity behaviors to help people maintain health and well-being.[5] What you can do: Eat healthy, well-balanced meals rich in cancer-fighting plant foods rich in phytonutrients. Stay educated to help you keep abreast of new information that can help you to make better decisions regarding your health. Include regular physical activity, even in small amounts, to help improve overall health and prevent chronic disease. Remain involved in social activities with friends and family in order to promote healthier lifestyle practices and enhance well-being. http://blog.lungevity.org/2013/12/02/4- ... th-status/

Good morning everyone! As the temperatures get colder we all start to think of delicious comfort foods. Brownies are a common favorite for many of us. If you try this please let us know! I'm so excited about this healthy brownie recipe! Recipe provided by Cancer Treatment Centers of America - Brooke McIntyre, clinical oncology dietitian and Diabetes Program Coordinator at our hospital in Tulsa Gluten-free Black Bean Brownies 1 1/2 cups black beans (1 15-oz can, drained and rinsed very well) 2 tbsp cocoa powder -- Dutch or regular (add a little extra if desired) 1/2 cup gluten free quick oats 1/4 tsp salt 1/3 cup pure maple syrup or agave 2 NuNaturals stevia packs or 2 tbsp sugar (or omit and increase maple syrup to 1/2 cup) 1/4 cup coconut oil 2 tsp pure vanilla extract 1/2 tsp baking powder 1/2 cup to 2/3 cup chocolate chips Optional: more chips, for presentation Preheat oven to 350 F. Combine all ingredients except chips in a good food processor, and blend until completely smooth. Really blend well. (A blender can work, but the texture—and even the taste—will be much better in a food processor.) Stir in the chips, and then pour into a greased 8×8 pan. Optional: sprinkle extra chocolate chips over the top. Cook the black bean brownies 15-18 minutes, then let cool at least 10 minutes before trying to cut. Makes 9-12 brownies.

Hi Bruce! Thank you so much for starting today's air. It sounds unbelievably cold where you are. I am thinking you live in Canada or North of the US somewhere. Down here, in Texas it was 80F yesterday and today we are expecting 1/2 -1/4 inches of ice to blanket the area. Goodness, I didn't think my magical weather powers were so effective. I need to work on that. I hope Diane will heal quickly so we can read her sweet messages soon. I'm not sure why it is so quiet in here this week. I'm thinking people are just watching all of those lovely Hallmark movies I've been hearing so much about. Tonight on ABC is the Muppet's Christmas. Well, I just thought I'd drop in and say a quick hello. Hope to see meet you ALL at the Dallas Hope Summit!!

TONIGHT 6-8 PM at The Wellness Community - Arizona, learn about new advances in radiation treatment for lung cancer. Keep up to date on treatments and know your options! 360 East Palm Lane Phoenix, AZ 85004 Phone: (602) 712-1006 http://twccaz.org/programs-services/Education.aspx

Yes, your donation can help save lives. Yes, one person can make a difference. Please help us end lung cancer by participating in #GivingTuesday. We have many ways you can help us to fund research to find an end to lung cancer. There are so many ways to donate to LUNGevity. Which will you choose? http://events.lungevity.org/site/PageSe ... _DonateNow

Hi everybody! Happy December to you! I hope you had a great Thanksgiving weekend. My family and I traveled a bit and it was the most memorable, happiest Thanksgiving I have ever had. My sister and brother recreated a photo from around 10 years ago on our family fire place. We sat in the same place, posed the same way and then put the two photos together for our Dad & my step mom. Everyone loved it! It's a beautiful day here in Dallas. Sunny, partly sunny skies, with temps in the high 60's. Tuesday will be near 80. The weather is supposed to be pleasant like today for the next couple of days. Thursday however we are supposed to drop back down to freezing temps. It's Texas. What's going on in your neck of the woods? Riddle: What often falls at the North Pole but never gets hurt? Sending hugs, hope & healing thoughts your way.

Top down treatment: Why we prioritize treating brain mets over the chest/body disease in metastatic lung cancer This morning, I saw a lady who was just diagnosed with lung cancer after developing problems with speaking that led her to the ER. There, she was found to have several brain metastases, then a lung mass that was biopsied and proven to be a new lung cancer. In talking with her and her family about how to proceed, I outlined a plan of starting with treating the brain lesions with radiation, then following with chemotherapy (she doesn’t have a driver mutation like EGFR or ALK). Why do we prioritize treating the brain metastases? The simple answer is that they are a more pressing problem that set the pace if not treated quickly. Encased by a hard skull, the brain has limited real estate and is intolerant of being squeezed by metastases growing faster than the brain around it. If not treated quickly, problems like balance problems, vision changes, seizures, and eventually death can occur. While there is a lot more room in the chest or abdomen, making a delay in the start of treatment by a few weeks unlikely to make much of a difference, brain metastases need to be treated within days to a week or so. You might ask, “why not treat brain and body at the same time, with both brain radiation and chemo (or targeted oral therapy) together?”. Yes, that’s a possibility, but that involves combining the side effects of concurrent therapies when there isn’t a clear value in doing so. Certainly, if a patient has just one or a few brain lesions and can get focal radiation like Gamma Knife/Cyber Knife in a single session, that can be done with concurrent chemotherapy and likely no additive side effects. Some patients may be motivated enough and/or hardy enough to do whole brain radiation and chemo at the same time, but there isn’t a clear advantage to that overlap. Instead, it’s most important to tackle the most imminent threat first, and that’s the brain metastases. The cancer in the rest of the body is important, too, but it usually be safely deferred until the higher priority brain mets are treated. http://expertblog.lungevity.org/2013/11 ... ver-heart/

Top down treatment: Why we prioritize treating brain mets over the chest/body disease in metastatic lung cancer This morning, I saw a lady who was just diagnosed with lung cancer after developing problems with speaking that led her to the ER. There, she was found to have several brain metastases, then a lung mass that was biopsied and proven to be a new lung cancer. In talking with her and her family about how to proceed, I outlined a plan of starting with treating the brain lesions with radiation, then following with chemotherapy (she doesn’t have a driver mutation like EGFR or ALK). Why do we prioritize treating the brain metastases? The simple answer is that they are a more pressing problem that set the pace if not treated quickly. Encased by a hard skull, the brain has limited real estate and is intolerant of being squeezed by metastases growing faster than the brain around it. If not treated quickly, problems like balance problems, vision changes, seizures, and eventually death can occur. While there is a lot more room in the chest or abdomen, making a delay in the start of treatment by a few weeks unlikely to make much of a difference, brain metastases need to be treated within days to a week or so. You might ask, “why not treat brain and body at the same time, with both brain radiation and chemo (or targeted oral therapy) together?”. Yes, that’s a possibility, but that involves combining the side effects of concurrent therapies when there isn’t a clear value in doing so. Certainly, if a patient has just one or a few brain lesions and can get focal radiation like Gamma Knife/Cyber Knife in a single session, that can be done with concurrent chemotherapy and likely no additive side effects. Some patients may be motivated enough and/or hardy enough to do whole brain radiation and chemo at the same time, but there isn’t a clear advantage to that overlap. Instead, it’s most important to tackle the most imminent threat first, and that’s the brain metastases. The cancer in the rest of the body is important, too, but it usually be safely deferred until the higher priority brain mets are treated. http://expertblog.lungevity.org/2013/11 ... ver-heart/

CHICAGO — November was Lung Cancer Awareness Month, but you’d never know it. Consumers aren’t bombarded by products in blue, the color designated by some to raise the profile of the disease. No NFL players or coaches wore blue-ribboned apparel, despite donning pink just a month earlier for breast cancer. “It just doesn’t seem fair,” said Meghan O’Brien, 31, a nonsmoker diagnosed with stage 4 of the disease last year. There is no stage 5. Lung cancer is the leading cause of cancer death in the United States, claiming more lives than breast, prostate, colon and pancreatic cancers combined. The five-year survival rate is just 16 percent — a statistic that has barely budged since 1975, according to the American Cancer Society. But lung cancer is seen as a tobacco-related illness that patients somehow bring upon themselves. About 10 to 15 percent of the roughly 228,000 people diagnosed with the disease each year were never smokers, according to the LUNGevity Foundation, a Chicago-based support organization. However, nowhere is the disparity felt more acutely than in funding research. The National Cancer Institute estimates that $17,835 is spent per breast cancer death versus $1,378 for lung cancer, even though lung cancer accounts for almost 23,000 deaths annually among nonsmokers. “If we don’t start paying attention and changing attitudes, we will have a losing battle ahead of us,” said Dr. Ravi Salgia, O’Brien’s oncologist at University of Chicago Medicine. Not that it’s easy to build awareness. Forget the pink marketing blitz; just try to find a ribbon for lung cancer. There’s even dispute over the appropriate color, according to Andrea Ferris, president and chair of the LUNGevity Foundation, who says it’s blue. Others say it’s clear or pearl. “In every other disease, the first question people ask is, ‘How can I help?’ But with lung cancer, there’s no empathy. It’s always, ‘Did you smoke?’ After a while, it’s just easier not to say anything,” Ferris said. In O’Brien’s case, doctors pinpointed a rare genetic mutation, called ALK, created when two normal genes fuse together to form a new, cancer-causing one. The University of Chicago is one of the nation’s major treatment centers because of a clinical trial for crizotinib, part of a new arsenal of drugs designed to help patients by blocking ALK. This pharmaceutical “Hail Mary” helped contain O’Brien’s cancer for a while, but now it has come roaring back, invading her lungs and brain. Two months ago, a scan revealed a liver studded with tumors. The Huntley woman is now in another early stage clinical trial and channeling her waning energy into chipping away at the “blame and shame” that has impeded progress. “I try not to get too mad when people ask if I smoked,” she said. “Instead, I try to turn it into an opportunity to talk about it … to educate. I guess that’s the teacher in me.” Even so, O’Brien immediately recited her virtuous health habits: Physical education teacher. Avid tennis player. An “almost vegetarian” who hasn’t rolled through a fast-food window since age 13. No cigarettes, ever. At first she had experienced back pain, which she attributed to muscle strain, a logical explanation for someone so active. But in May 2012 it became excruciating. She went ahead with X-rays, paying the $600 tab herself because, as a teacher’s aide at New Trier High School, she didn’t have health insurance. The results were inconclusive. By the end of summer she had landed a full-time job teaching physical education at Kenwood Academy High School in Hyde Park, allowing her to move out of her parents’ home and into her own apartment in Bridgeport. However, just as her “grown-up life” was taking off, it splintered apart. On Sept. 1, the first day of her new job, she went to her neighborhood clinic. The physician took one look at her test results and sent her to University of Illinois at Chicago’s emergency room. Six hours later, a nurse told her to call her parents. Even after being admitted to the oncology floor, cancer didn’t enter her mind. But two weeks later, a doctor confirmed the worst: stage 4 non-small cell lung cancer, already assaulting other organs. O’Brien spent most of the next four months in the hospital. Before she could start therapy, she needed emergency spinal surgery to remove the malignant tumors wrapped tenaciously around her spinal cord. Surgeons removed several of her vertebrae, replacing them with titanium rods and screws. The ultimate indignity, she said, “is when people ask, ‘Are you sure you never smoked?’ As if I forgot.” Not that anyone deserves the deadly diagnosis. It wasn’t so long ago that the military dispensed cigarettes to soldiers, and many lung cancer patients kicked the smoking habit decades ago, she said. “But it doesn’t matter. … People still think it’s your fault.” http://www.wildcat.arizona.edu/article/ ... statistics

CHICAGO — November was Lung Cancer Awareness Month, but you’d never know it. Consumers aren’t bombarded by products in blue, the color designated by some to raise the profile of the disease. No NFL players or coaches wore blue-ribboned apparel, despite donning pink just a month earlier for breast cancer. “It just doesn’t seem fair,” said Meghan O’Brien, 31, a nonsmoker diagnosed with stage 4 of the disease last year. There is no stage 5. Lung cancer is the leading cause of cancer death in the United States, claiming more lives than breast, prostate, colon and pancreatic cancers combined. The five-year survival rate is just 16 percent — a statistic that has barely budged since 1975, according to the American Cancer Society. But lung cancer is seen as a tobacco-related illness that patients somehow bring upon themselves. About 10 to 15 percent of the roughly 228,000 people diagnosed with the disease each year were never smokers, according to the LUNGevity Foundation, a Chicago-based support organization. However, nowhere is the disparity felt more acutely than in funding research. The National Cancer Institute estimates that $17,835 is spent per breast cancer death versus $1,378 for lung cancer, even though lung cancer accounts for almost 23,000 deaths annually among nonsmokers. “If we don’t start paying attention and changing attitudes, we will have a losing battle ahead of us,” said Dr. Ravi Salgia, O’Brien’s oncologist at University of Chicago Medicine. Not that it’s easy to build awareness. Forget the pink marketing blitz; just try to find a ribbon for lung cancer. There’s even dispute over the appropriate color, according to Andrea Ferris, president and chair of the LUNGevity Foundation, who says it’s blue. Others say it’s clear or pearl. “In every other disease, the first question people ask is, ‘How can I help?’ But with lung cancer, there’s no empathy. It’s always, ‘Did you smoke?’ After a while, it’s just easier not to say anything,” Ferris said. In O’Brien’s case, doctors pinpointed a rare genetic mutation, called ALK, created when two normal genes fuse together to form a new, cancer-causing one. The University of Chicago is one of the nation’s major treatment centers because of a clinical trial for crizotinib, part of a new arsenal of drugs designed to help patients by blocking ALK. This pharmaceutical “Hail Mary” helped contain O’Brien’s cancer for a while, but now it has come roaring back, invading her lungs and brain. Two months ago, a scan revealed a liver studded with tumors. The Huntley woman is now in another early stage clinical trial and channeling her waning energy into chipping away at the “blame and shame” that has impeded progress. “I try not to get too mad when people ask if I smoked,” she said. “Instead, I try to turn it into an opportunity to talk about it … to educate. I guess that’s the teacher in me.” Even so, O’Brien immediately recited her virtuous health habits: Physical education teacher. Avid tennis player. An “almost vegetarian” who hasn’t rolled through a fast-food window since age 13. No cigarettes, ever. At first she had experienced back pain, which she attributed to muscle strain, a logical explanation for someone so active. But in May 2012 it became excruciating. She went ahead with X-rays, paying the $600 tab herself because, as a teacher’s aide at New Trier High School, she didn’t have health insurance. The results were inconclusive. By the end of summer she had landed a full-time job teaching physical education at Kenwood Academy High School in Hyde Park, allowing her to move out of her parents’ home and into her own apartment in Bridgeport. However, just as her “grown-up life” was taking off, it splintered apart. On Sept. 1, the first day of her new job, she went to her neighborhood clinic. The physician took one look at her test results and sent her to University of Illinois at Chicago’s emergency room. Six hours later, a nurse told her to call her parents. Even after being admitted to the oncology floor, cancer didn’t enter her mind. But two weeks later, a doctor confirmed the worst: stage 4 non-small cell lung cancer, already assaulting other organs. O’Brien spent most of the next four months in the hospital. Before she could start therapy, she needed emergency spinal surgery to remove the malignant tumors wrapped tenaciously around her spinal cord. Surgeons removed several of her vertebrae, replacing them with titanium rods and screws. The ultimate indignity, she said, “is when people ask, ‘Are you sure you never smoked?’ As if I forgot.” Not that anyone deserves the deadly diagnosis. It wasn’t so long ago that the military dispensed cigarettes to soldiers, and many lung cancer patients kicked the smoking habit decades ago, she said. “But it doesn’t matter. … People still think it’s your fault.” http://www.wildcat.arizona.edu/article/ ... statistics

Blood Test to Define Probability of Lung Nodule Being Cancer? Could Help, but Potential to Backfire November 25th, 2013 - by Dr. Jack West One of the challenges of the increased frequency of chest CT scans being done for screening of people at higher risk of lung cancer, or done more commonly for chest symptoms, is that lung nodules are very commonly found, but most the time they aren’t cancer. Most studies show that >90% of lung nodules are benign, but the majority lead to additional work-up, and in nearly 100% of cases, they cause anxiety for the patient. What if a blood test could help clarify the probability that someone doesn’t have a lung cancer? A recent paper from a highly respected group of researchers describes a new blood test called XPRESSYS that did a complex analysis of several hundred proteins to identity a 13-protein signature from a serum sample that assigns patients a favorable result associated with an extremely low probability of having lung cancer, so that a “negative” result was associated with a benign diagnosis 94% of the time. Importantly, a “positive”/”not negative” result was associated with only a 56% chance of the person having cancer, which is why the people developing the test that is now commercially available don’t consider a result other than negative helpful, and they don’t report it as a positive, but rather just negative or not. Will this help? I must confess that I’m not confident it will. It’s a great idea — being able to use a blood test to help clarify whether someone should be reassured about one or more lung nodules not being cancer is wonderful. The problem is that the company says that a result other than negative should be ignored, but that’s far easier said than done. In reality, people won’t ignore a result that isn’t negative, and I suspect that patients and doctors who see a result that isn’t negative will escalate their anxiety and the pace of their workup even though only 50-60% of the people on the study who tested this way ended up having cancer. In other words, while the concept is great, it seems to me that the results are helpful if the test is negative, but harmful if the test comes back as “not negative”, and you can’t just tell people to ignore results that make your test unhelpful. What do you think? Would you NOT feel more anxious and want to move ahead faster with a workup if your test came back with a result other than negative? http://expertblog.lungevity.org/

Older Lung Cancer Patients Desire Information on Complementary Therapies Once considered "alternative" treatments, many cancer centers are now using complementary therapies as a regular part of cancer treatment. This integrative approach - combining conventional treatments such as chemotherapy and surgery with complementary treatments such as acupuncture - is designed to treat the whole person; body, mind and spirit. But since this is a fairly new approach, researchers were wondering how older patients with lung cancer and colon cancer felt about the use of complementary therapies. Through interviewing patients at a hospital in Ireland, they learned several things: Older patients believe these services should be promoted more effectively Older patients felt these treatments should be more accessible While desiring more information these patients had a few concerns: That there is a lack of good written information about complementary treatments (and as such there is uncertainty about possible benefits leading to fewer people receiving them) Some patients were concerned that if they use complementary therapies and let their physician know, that it will harm their relationship This leads to some good instructions for doctors who treat cancer patients: provide better information to patients about complementary therapies and become educated themselves about these treatments. If you are a cancer patient, here are some articles that talk about complementary therapies and possible benefits they may have for people with cancer: Acupuncture for Cancer Patients Meditation for People with Cancer Yoga for Cancer Patients Qigong for Cancer Patients Healing Touch for Cancer Patients Art Therapy for People with Cancer Music Therapy Massage Therapy for Cancer Patients To view these link please copy and paste the following URL. http://lungcancer.about.com/b/2013/11/2 ... urlbuttons

Passion into Action ~ Sharing My Story November 25th, 2013 - by Jill Feldman “There is no greater agony than bearing an untold story inside of you.” ~Maya Angelou November is Lung Cancer Awareness Month. On the heels of a very pink October, it’s a tough act to follow, even though lung cancer kills more women each year than all female cancers combined! I used to be bitter and angry about it, but the way I felt wasn’t going to change anything. I could hear my mom’s voice in my head saying, “You have no right being upset about something you haven’t tried to change!” So that is exactly what I did. In 2001, shortly after we moved from the city to the suburbs, coincidence or fate, LUNGevity Foundation had just gotten off the ground and a friend suggested I attend a LUNGevity Fall Benefit meeting. With the loss of both my parents, two grandparents and my aunt to lung cancer, it didn’t take long to realize that LUNGevity was exactly what I needed. LUNGevity was the first organization in the country dedicated exclusively to lung cancer research. There is both a lot of excitement and a lot of pressure that comes with filling a badly needed niche. My role as a volunteer evolved pretty quickly. At first I helped with organizing and fundraising for the Fall Benefit, my cousin and I started a golf outing and in 2002, I joined the Board, and then I served as vice president, president and chair before I stepped down a few years ago. LUNGevity empowered me, gave me control and provided me with the opportunity to choose what role lung cancer was going to have in my life. No amount of therapy could have given me the power and control to work through all of my losses like my involvement with LUNGevity. And then ‘patient’ was added to my lung cancer resume. I continued to fundraise for various events. I was speaking at more LUNGevity events across the country and at medical conferences. I started to write blogs and talk to newly diagnosed patients and their loved ones. But, after a second surgery and then learning that lung cancer would be a lifelong roller coaster ride for me, I took a step back. I thought it would lessen the burden on my husband and kids. Boy was I wrong! I fell into a cancer depression, feeling helpless and hopeless. Once again I had no control over the disease, so lung cancer was solely my illness; all consuming, negative, depressing and scary! Right around that time I was gently forced (actually I couldn’t say no) to actively participate in a local event. Again, LUNGevity was exactly what I needed! I was reminded that nothing was going to happen, or change, unless I did my part to make it happen. I have a story to tell that has, and continues to, raise awareness, critical funds for research, give hope to others and make a difference! This past year my efforts reached outside of fundraising. Below are some of the ways LUNGevity helped me take action: * I spoke to over 1,400 people in my own community at Breathe Deep North Shore. * Pfizer used my story on their Lung Cancer Profiles website and I did an interview with WegoHealth to raise awareness. * My kid’s high school chose LUNGevity as the recipient of their annual fundraising drive (which resulted in $135,000 raised), and by sharing my story, 2,000 teenagers now know that lung cancer can happen to anyone and that funds are desperately needed to save lives. * I attended LUNGevity’s Hope Summit and was honored to share my story and experiences as both a caretaker and a patient with other lung cancer patients. * I attended National Women’s Survivor Conference in Nashville and shared my story with 1,000 women survivors of all cancers. * Just last week I spoke to Astellas’ Oncology group (the pharma company that makes Tarceva) and put a face to all the hard work they do to better the lives of cancer patients. * LUNGevity nominated me to be a consumer reviewer for the Department of Defense Lung Cancer research program. I just finished the online panel, and in December I will be going to Washington DC for the onsite panel. * I continue to support newly diagnosed patients through LUNGevity’s Lifeline online program of matching. I know the words volunteer and advocate can be overwhelming, but they don’t have to be. I always tell people who are hesitant to get their feet wet to first attend a meeting or an event in their area, go on LUNGevity’s website and snoop around, connect with another patient through lifeline, or I suggest caregivers visit the caregiver resource center. Get involved in a way and at a pace that feels good to you. Being an advocate is not always easy. Fighting lung cancer is an uphill battle and some days feel like two steps forward then one step back. But the reward has been knowing I have helped others in their journey and that I helped create a community of people who understand and don’t judge ~ and the community we built is a force to be reckoned with! And personally, I can look my kids in the eyes and know I did everything in my power to fight this disease for me and for them. I am honored that I have had the opportunity to play a critical role in the profound impact that LUNGevity has had over the past 12 years. Conversely, LUNGevity has played a critical role in my personal growth. Being an advocate has helped me make sense of all that I have been through and gives it meaning. http://blog.lungevity.org/2013/11/25/pa ... y-story-2/

What are the holidays like for you? Do you have any tips you could share with us that could help someone else? This article is from LungCancer.About.com Please read it here or visit the link listed below. http://lungcancer.about.com/od/caregive ... givers.htm Coping with holiday stress on top of being a cancer caregiver can seem overwhelming. Most of us get “stressed out” during the season just going about our normal routines. How can you cope with the stress of the holidays, and not only cope, but enjoy your time fully as a cancer caregiver? Put Yourself First I know it doesn’t sound right to put yourself first as a cancer caregiver. After all, if you are healthy it can feel wrong to put your needs before someone who is not so fortunate. But taking care of yourself is your number one responsibility. And – if you don’t take care of yourself – you won’t be able to provide the best care and support possible for your loved one with cancer. Plan Ahead and Prioritize Are you someone who used to bake 12 batches of cookies or decorate the entire house in a day? If so, the holidays can be daunting as you add on the role of caregiver. Making a list of what you need to do, and tackling a few items each day can be helpful. As a caregiver during the holidays, I made 3 lists of things to do to prepare. One was for very important preparations, one included less important, but meaningful items, and one was for optional but nice things I could do (including sending holiday cards). I threw away list number 3. Simplify Most of us do far too much to make the season bright, but what is the meaning of the season anyway? Practicing simplicity can bring your focus back to what is really meaningful – spending time with our loved ones – and be freeing in the process. Express Your Emotions Despite the festivities, many people experience moments of sadness during the holiday season. This can be accentuated if you care for a loved one with cancer. You may miss holidays in the past, when you and your loved ones weren’t burdened by illness and other concerns. If your loved one has advanced cancer, you may also be grieving the future, envisioning holidays to come without her present. We often try to be “strong” for someone living with cancer, and deny our feelings. Allow yourself to feel and express those emotions. Your loved one is likely experiencing similar emotions, and seeing you express yourself (of course tactfully and with sensitivity), may give her permission to share her own feelings as well. Practice Forgiveness If you are the primary family caregiver for someone with cancer, it is likely you are carrying more than your fair share of the work, not only in supporting your loved one, but in other areas of your life as well. The more caregivers I meet, the more convinced I am that the family members who do the most caregiving are the ones who are the busiest – not the ones who have time to spare. This can often lead to resentment. For the holidays, try letting go and practicing forgiveness. Hanging on to anger and resentment won’t encourage other family members to do more, but it will decrease your happiness and ability to enjoy the season as you deserve. Enjoy the Season Don’t wish away these precious moments as you focus on the details and all you need to do. Think back to holidays in your childhood. Do you remember every decoration and dish served? Probably what you remember the most was simply enjoying family and friends. Make Memories Take pictures, make a video, play a game that asks friends and family to share life experiences; happy moments, embarrassing moments, funny moments. Is there a new tradition you can start this year? The holidays, and all of the stress that accompanies the planning, pass all too quickly. Make memories that you can carry with you after the lights are taken down, and the last piece of fruitcake has been fed to the dog.

Songwriter Martha McCann Lesnick has been living with lung cancer since 2006, and is an ardent believer in the importance of making one’s voice heard through advocacy and music. Her attitude about lung cancer is to “hold on and take heart.” Here, Martha shares her inspirational song, “Breathe Hope.”

Hey Bruce! I hear you are trying to blame the cold on us Texas gals? Well, ever since I fanned that warm air from here, it's been cold, sleeting and grey. Haha. Stay warm up there. I'm with Diane, our electric bill has been so high these past few winters we try to do other things to help reduce the cost. I'm currently typing this with a twin sized heating blanked wrapped around me in my office. I'm sure I look silly, but I am very warm. That's what matters, right? Well it sounds like you all had a good weekend. This weekend was Thanksgiving at my Father in laws house. He is a great cook but it's starting to get more crowded every year. I'm ready for this week to be over with. Tuesday is Thanksgiving with my Mom, Wednesday, is when I will go to see some distant (5 hours away) relatives. We are supposed to go to my Dad's friends house this year for their Thanksgiving, it seems weird and awkward to me and my half brother. Neither one of us really want to go, but we are having another Thanksgiving Friday when my sister arrives at my Dad's house. Saturday we are going to go see "Frosty" at the children's theater, and afterwards we will take my mother in law out to eat for Thanksgiving. Ugh. Everyone always asks me, "Are you looking forward to the holidays?" Every year I reply with "Yes, like a Volkswagen pimple". Christmas, now that's a holiday I do enjoy. That's the day I stand up and refuse all invites for us to visit all over Texas. We spend it here at home together, just the 4 of us. Peacefully. No hustle and bustle, just glittery type of happy. I hope you all get to enjoy your week of feasts. If you have any tips on how you balance healthy eating and your health, please drop them off in the Healthy Living - Recipes board. Talk to you soon, Cindy

The holidays can be stressful especially when you loved ones encouraging you to eat one more serving of something. Here are some easy tips to remember during Thanksgiving and all of your holidays that include feasts. Stay clear of any canned goods. Fresh is best. Fresh vegetables,& fresh fruit. Makes sure all meats have been cooked well. To avoid dangerous bacterial growth, casseroles or similar type dishes should be cooked to a minimum of 165° in the center. Ground beef and eggs should be cooked to 160°, Poultry to 165° and fresh beef, pork or fish to 150° in the center or thickest portion. Try substituting at least half of white flour for whole grain flour in recipes (you may need to add applesauce for moisture) Remove visible fat from your holiday meats. This decreases the overall fat and cholesterol content of your meal, which is a good way to keep it heart-healthy! Clean all fruits and veggies well before consuming. If you don't want to buy produce washing product at the store, use a mixture 3 parts water and 1 part vinegar, soak 10 minutes, and rinse! Substitute evaporated milk or reduced fat milk in place of cream in pumpkin pie or white sauce dishes. Tips provided by Cancer Treatment Center of America

Hi everybody! Bruce, I DID fan warm air your way but I think you fanned it back because it is near freezing here in Dallas. 37F will be our high for today. Besides it being cold and rainy here, I'm glad I get to work from home where it is toasty roasty. Hey, how's that shopping going? I know it's online, but have yo uever checked out mancrates.com? My husband ships these to his clients. They are SO neat! Eric! A dating site? Very cool. I have a couple of friends who were introduced via a website and they are now happily married with a 6 year old and 1 on the way. I wish you happiness with this venture. I also erased the extra 2 posts that were submitted. Easy peasy. Please take a picture of your article when it is published in the Herald, we'd love to see it! Diane, we have a Great Wolf lodge here near town and I hear it is a great place to go. I've never been myself but I drive by it often. Let me know what you think of it. Don't forget to take your swim attire. They have heated pools from what I hear. I hope you have a good weekend too. Stay warm! Y'all have a great weekend!