Treatment Options

The robotic system is generally recommended in the setting of early-stage cervical cancer to perform a radical hysterectomy or radical trachelectomy. It is also very commonly used to perform simple hysterectomy and lymph node removal in the setting of uterine cancer. It may also be used when performing prophylactic removal of the tubes and ovaries in patients with hereditary breast and ovarian cancer syndromes.

The robotics approach may also be used in very select cases of patients with isolated recurrent disease.
The robotic system is generally recommended in the setting of early-stage cervical cancer to perform a radical hysterectomy or radical trachelectomy. It is also very commonly used to perform simple hysterectomy and lymph node removal in the setting of uterine cancer. It may also be used when performing prophylactic removal of the tubes and ovaries in patients with hereditary breast and ovarian cancer syndromes.

The robotics approach may also be used in very select cases of patients with isolated recurrent disease.

Watchful waiting is most often utilized for indolent lymphomas such as follicular lymphoma. As such, patients may have enlarged lymph nodes that are not causing symptoms and patients may feel well without significant anemia or other signs of disease. Patients may be monitored monthly of every other month with blood testing, symptom survey and physical exams to determine the need for treatment. Watchful waiting is most often utilized for indolent lymphomas such as follicular lymphoma. As such, patients may have enlarged lymph nodes that are not causing symptoms and patients may feel well without significant anemia or other signs of disease. Patients may be monitored monthly of every other month with blood testing, symptom survey and physical exams to determine the need for treatment.

Similar to a previous answer (http://talkabouthealth.com/for-what-types-of-non-hodgkin-lymphoma-is-rituxan-a-typical-treatment-option), the B cell non-Hodgkin’s lymphomas are usually treated with Rituxan. This is because all but a few of these lymphomas express CD20, the target antigen that Rituxan binds to. Rituxan has been shown the be beneficial a single agent therapy in indolent lymphomas, when combined with chemotherapy (R-CHOP or R-CVP are two examples) and for maintenance after initial treatment in the case of indolent lymphomas. Similar to a previous answer (http://talkabouthealth.com/for-what-types-of-non-hodgkin-lymphoma-is-rituxan-a-typical-treatment-option), the B cell non-Hodgkin’s lymphomas are usually treated with Rituxan. This is because all but a few of these lymphomas express CD20, the target antigen that Rituxan binds to. Rituxan has been shown the be beneficial a single agent therapy in indolent lymphomas, when combined with chemotherapy (R-CHOP or R-CVP are two examples) and for maintenance after initial treatment in the case of indolent lymphomas.

R-CHOP (cycophosphamide, adriamycin, vincristine and prednisone, with rituximab) is the standard front-line therapy for diffuse large cell lymphoma and older patients with mantle cell lymphoma. Hyper-CVAD ( a more intensive regimen of cyclophophamide, vincristine, and doxorubicin, alternating with cytosine arabinoside and methotrexate) is often used for younger patients who have mantle cell lymphoma or Burkitts lymphomas. Patients with follicular lyphomas may receive CVP (a gentler form of cyclophosphamide, vincristine and prednisone) with rituximab or receive single agent rituximab. R-CHOP (cycophosphamide, adriamycin, vincristine and prednisone, with rituximab) is the standard front-line therapy for diffuse large cell lymphoma and older patients with mantle cell lymphoma. Hyper-CVAD ( a more intensive regimen of cyclophophamide, vincristine, and doxorubicin, alternating with cytosine arabinoside and methotrexate) is often used for younger patients who have mantle cell lymphoma or Burkitts lymphomas. Patients with follicular lyphomas may receive CVP (a gentler form of cyclophosphamide, vincristine and prednisone) with rituximab or receive single agent rituximab.

Stem cell transplants can be performed as part of the initial therapy, at the time of first relapse and later in the course of the disease. Following initial induction therapy, autologous transplants are being used in first remission for patients with mantle cell lymphoma and T cell lymphomas; although there is not uniform agreement on this practice. Patients with diffuse large cell lymphoma are generally offered autologous transplant when relapse occurs following a first remission. Patients with follicular lymphoma are not offered transplant until the have relapsed 2 or more times or when their disease has transformed to a more aggressive subtype. Stem cell transplants can be performed as part of the initial therapy, at the time of first relapse and later in the course of the disease. Following initial induction therapy, autologous transplants are being used in first remission for patients with mantle cell lymphoma and T cell lymphomas; although there is not uniform agreement on this practice. Patients with diffuse large cell lymphoma are generally offered autologous transplant when relapse occurs following a first remission. Patients with follicular lymphoma are not offered transplant until the have relapsed 2 or more times or when their disease has transformed to a more aggressive subtype.

Rituxan is a useful drug for B-cell lymphomas. Most B-cell lymphomas express the B-cell marker protein CD20. Rituxan is a monoclonal antibody with specificity for B cell lymphomas expressing CD20. These include follicular, diffuse large cell, mantle cell and several other types. Rituxan is a useful drug for B-cell lymphomas. Most B-cell lymphomas express the B-cell marker protein CD20. Rituxan is a monoclonal antibody with specificity for B cell lymphomas expressing CD20. These include follicular, diffuse large cell, mantle cell and several other types.

I require a very complete set of medical records for my new patients. I review these carefully. If I am unfamiliar with any aspect of their cancer or treatment, I research by reading my oncology text books, reading published studies and consulting with my naturopathic and oncologist colleagues. My first visits with new patients are typically 90 minutes so that I can learn as much as I can about each person as an individual (after all they are people with cancer, not just cancer diagnoses). I then several more hours developing my recommendations, which stem from my experience and additional research. I then provide my consultation note and my recommendations to the patient and to their other healthcare providers. I typically follow-up with patients in accordance with their treatment and disease experience on a repeated basis. I require a very complete set of medical records for my new patients. I review these carefully. If I am unfamiliar with any aspect of their cancer or treatment, I research by reading my oncology text books, reading published studies and consulting with my naturopathic and oncologist colleagues. My first visits with new patients are typically 90 minutes so that I can learn as much as I can about each person as an individual (after all they are people with cancer, not just cancer diagnoses). I then several more hours developing my recommendations, which stem from my experience and additional research. I then provide my consultation note and my recommendations to the patient and to their other healthcare providers. I typically follow-up with patients in accordance with their treatment and disease experience on a repeated basis.

In general, most chemotherapy medicines can be used to treat metastatic breast cancer until side effects become a problem or the medicine stops being effective. Breast cancer that has metastasized will often require continual treatment whereas treatment in the non-metastatic setting typically has a defined number or duration of treatments. For example, in the non-metastatic setting, a usual care plan includes surgery with or without radiation therapy, and some type of systemic (drug) therapy, with the drug therapy specified as a certain number of cycles (if chemotherapy) or a certain duration of treatment (for example, tamoxifen for 5 years). In metastatic breast cancer, the goal of medicines is to destroy or damage tumor cells and to shrink tumors or keep tumors stable and in order to do that we have to keep patients on treatment most of the time. Sometimes when the cancer is stable we can provide our patients with some time off or drug holiday but most of the time we have to consider some type of systemic therapy. In general, most chemotherapy medicines can be used to treat metastatic breast cancer until side effects become a problem or the medicine stops being effective. Breast cancer that has metastasized will often require continual treatment whereas treatment in the non-metastatic setting typically has a defined number or duration of treatments. For example, in the non-metastatic setting, a usual care plan includes surgery with or without radiation therapy, and some type of systemic (drug) therapy, with the drug therapy specified as a certain number of cycles (if chemotherapy) or a certain duration of treatment (for example, tamoxifen for 5 years). In metastatic breast cancer, the goal of medicines is to destroy or damage tumor cells and to shrink tumors or keep tumors stable and in order to do that we have to keep patients on treatment most of the time. Sometimes when the cancer is stable we can provide our patients with some time off or drug holiday but most of the time we have to consider some type of systemic therapy.

Genetic mutations play a key role in NSCLC. Identifying certain, key mutations can help select targeted therapy. The two most important mutations in lung cancer right now are the EGFR and EML-4ALK mutation and are found in the subtype of lung cancer called adenocarcinoma. These mutations are more commonly found in female, asian, non-smokers. However, they are also found in smokers and males, but to a lesser degree.

Patients with the EGFR mutation are generally treated with a drug (pill) called Tarceva as first line treatment, rather than chemotherapy. Similarly, patients with the EML-4 ALK mutation are treated with a recently approved drug (pill) called Xalqori (Crizotinib). Generally patients with these mutations who are treated with the appropriate drug do very well when compared to patients who don't have the mutation and are treated with chemotherapy

It is important to note, that while other mutations in lung cancer do exist and can be identified (KRAS mutation, PIK-3 mutation, MET to name a few), there are no approved drugs that target these mutations like Tarceva and Xalqori do for EGFR and EML-4ALK and thus patients with these mutations are treated with standard chemotherpay. That said, there are several clinical trials open looking a new drugs that target these mutations. Genetic mutations play a key role in NSCLC. Identifying certain, key mutations can help select targeted therapy. The two most important mutations in lung cancer right now are the EGFR and EML-4ALK mutation and are found in the subtype of lung cancer called adenocarcinoma. These mutations are more commonly found in female, asian, non-smokers. However, they are also found in smokers and males, but to a lesser degree.

Patients with the EGFR mutation are generally treated with a drug (pill) called Tarceva as first line treatment, rather than chemotherapy. Similarly, patients with the EML-4 ALK mutation are treated with a recently approved drug (pill) called Xalqori (Crizotinib). Generally patients with these mutations who are treated with the appropriate drug do very well when compared to patients who don't have the mutation and are treated with chemotherapy

It is important to note, that while other mutations in lung cancer do exist and can be identified (KRAS mutation, PIK-3 mutation, MET to name a few), there are no approved drugs that target these mutations like Tarceva and Xalqori do for EGFR and EML-4ALK and thus patients with these mutations are treated with standard chemotherpay. That said, there are several clinical trials open looking a new drugs that target these mutations.

Every patient must have a definitive determination of the tissue of origin. This is accomplished at the time of a careful review of the biopsy and provides a diagnosis. The second step is to determine where the disease has spread to at the time of diagnosis. This is done through x-rays, PET scans and MRIs, and is known as “staging”. At this point, most physicians begin treatment.
We add a third dimension to our workup. Knowing where it came from (diagnosis) and where it has gone to (stage), our laboratory then seeks to determine what to do about it (chemosensitivity). That is where our group is different from many. Every patient must have a definitive determination of the tissue of origin. This is accomplished at the time of a careful review of the biopsy and provides a diagnosis. The second step is to determine where the disease has spread to at the time of diagnosis. This is done through x-rays, PET scans and MRIs, and is known as “staging”. At this point, most physicians begin treatment.
We add a third dimension to our workup. Knowing where it came from (diagnosis) and where it has gone to (stage), our laboratory then seeks to determine what to do about it (chemosensitivity). That is where our group is different from many.

Honesty, I thought it was strange that the surgeon was calling the shots. After I was diagnosed, I was told that I might have to see an oncologist and possibly have chemo but only after the surgical biopsy revealed the extent of my disease. In my initial stages of fear, panic and conflict, I followed that trail, like a deer in headlights. I was scheduled to have surgery, a double mastectomy and double tram reconstruction; although I am a poor candidate for that procedure. I am relatively thin and very athletic. The plastic surgeon did not explain that my abdominal muscles would be part of the rerouting and that I would not be able to continue my active lifestyle. I would also drop from a 34A/B to ??. They don’t make bras for that…………………,but then, I guess I would not need one :o/ . Anyway, sore subject……. My mother, who lived in another state, broke her hip a few days prior to my scheduled surgery. Everything went on hold as I helped her and I also took it as a sign to have a plan B. I consulted with 2 highly recommended oncologists who essentially said the same thing, “The cancer in your breast is not going to kill you, it is the cells that get away that might.” SOLD! The core biopsy sample that was initially taken when I was diagnosed was submitted for oncotyping and the results showed that chemo was indicated. The beauty of having the chemo up front was that we would be able to actually see if it would work, by watching the tumor shrink, and if so, we knew it would be getting any cells that might have escaped, as opposed to hoping. This also gave me time to help my mother AND explore my surgical options. I had 4 rounds of Taxotere and Cytoxan followed by a nipple sparing mastectomy 4 weeks after my last blast. The original tumor, invasive ductal carcinoma, was 2.6 cm at the time of my diagnosis. When it was removed after chemo, it was a nonviable scar. It was GONE, totally disappeared :o) Fortunately, I did have a mastectomy because they found a totally different microscopic but invasive tumor when the tissue was biopsied, invasive lobular carcinoma. Fortunately, also, all of the 11 lymph nodes that were removed were clear :o). Having chemo up front was the best decision for me and according to my oncologist, the standard practice in Germany. When I was diagnosed that was the only option I was told about: have chemo before breast surery. My cancer was evolving quite fast and «I was put on a protocol with Avastin aimed at reducing the tumor prior to surgery. For me it was incredibly efficient. My 2.5-3 inches diameter tumor shrunk to almost nothing during the first chemo treatment allowing for a skin sparring double mastec. I was very pleased and it also gave me hope that I was taking care of any wayward cancerous cell anywhere else in my body, instead of waiting for surgery and the recoup time before going through chemo.

It certainly gave me peace of mind to know I was fighting ALL the cells not only those localised in a tumor in my breast from the get go.

Mary

It is important to note that phyllodes tumors are often categorized as benign and malignant. Benign phyllodes tumors are more common, and the treatment is surgical excision with a clear margin. They can become quite large, and rarely, mastectomy is needed; most can be removed with a lumpectomy. They do have the potential to recur in the breast, but do not have the potential to metastasize or spread to other areas of the body, and no other treatment besides removal is recommended.

Malignant phyllodes tumors are fortunately much less common. As mentioned by knutter1, chemotherapy has not been shown to be effective, and the data regarding radiation therapy is limited, but radiation therapy might be beneficial in some cases. Phyllodes tumors are a rare sarcoma type of cancer that occures within the connective tissues of the breast. It is technically a soft tissue sarcoma but originates within the breast so in some respects and fortunately we are now also catagorized as breast cancer as well. For US Phyllodes survivors this is fortunate as we can now have coverages previously not available from insurance and orgizations as well as making it easier to locate other Phyllode survivors. This is very helpful when dealing with a rare cancer as there is little or no information on treatment options and so forth. Phyllodes is reported to rarely metastisize though will often reoccur in or near the previous location. Surgery is the main treatment for Phyllodes or PT's until recently, but there was a study done in NH by Dr. Barth that has indicated that radiation has reduced the reoccurance rate. Thus far chemotherapy has proved to be useless in treatment of PT but when there is mets. often the treatment will include chemo but as far as I know there has been no success in it's use. It is unfortnate but if the mets are in a location where they cannot be surgically removed the prognosis is not good.

In some cases, it may be best to wait and see if a problem gets worse before deciding how to treat it. Doctors call this strategy “watchful waiting.” Watchful waiting also gives more time for patients and doctors to figure out what kind of treatment (if any) might be best.

For more information about watchful waiting, see: preparedpatientforum.org: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue5.cfm
In some cases, it may be best to wait and see if a problem gets worse before deciding how to treat it. Doctors call this strategy “watchful waiting.” Watchful waiting also gives more time for patients and doctors to figure out what kind of treatment (if any) might be best.

For more information about watchful waiting, see: preparedpatientforum.org: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue5.cfm

First of all, watchful waiting does not mean doing nothing. If you and your doctor agree that watchful waiting is a good choice for you, you may still need regular checkups. These checkups could include tests like blood tests, biopsies, or imaging scans. You may also be asked to track your symptoms and record any problems you experience.

For more information about watchful waiting, see: preparedpatientforum.org: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue5.cfm

First of all, watchful waiting does not mean doing nothing. If you and your doctor agree that watchful waiting is a good choice for you, you may still need regular checkups. These checkups could include tests like blood tests, biopsies, or imaging scans. You may also be asked to track your symptoms and record any problems you experience.

For more information about watchful waiting, see: preparedpatientforum.org: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue5.cfm

What usually happens when someone has this problem?

If I wait, will my condition be harder to treat later?

What kinds of tests or monitoring do you recommend while I am waiting?

Is there anything I can do to slow or stop the course of this health problem?

For more information about watchful waiting, see: preparedpatientforum.org: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue5.cfm
What usually happens when someone has this problem?

If I wait, will my condition be harder to treat later?

What kinds of tests or monitoring do you recommend while I am waiting?

Is there anything I can do to slow or stop the course of this health problem?

For more information about watchful waiting, see: preparedpatientforum.org: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue5.cfm

Watchful waiting is used for many kinds of health conditions. Watchful waiting is sometimes used with cancers that may grow slowly or with pre-cancerous conditions. It can also be used for minor illnesses like children’s ear infections, since many go away on their own. Back pain or pulled muscles are other common problems where watchful waiting may be suggested.

For more information about watchful waiting, see: preparedpatientforum.org: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue5.cfm
Watchful waiting is used for many kinds of health conditions. Watchful waiting is sometimes used with cancers that may grow slowly or with pre-cancerous conditions. It can also be used for minor illnesses like children’s ear infections, since many go away on their own. Back pain or pulled muscles are other common problems where watchful waiting may be suggested.

For more information about watchful waiting, see: preparedpatientforum.org: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue5.cfm

First, you need to slow down by using deep breathing techniques, buy some meditation tapes and get a journal to keep track of your feelings and what you are going through.
That being said, there are number if factors that will determine what your treatment options are, for example:
What stage _____ are you; What grade _____ are you? Have you had your biopsy yet and, if so, did you have clear margins, were any lymph nodes involved, etc. If you need a list of questions to ask your oncologist, please e-mail me and I will send you a list.
I am a two time cancer survivor and a Certified Professional Cancer Coach, just like Elyn. I also work with cancer patients with the goal to get them through this journey and come out the other side thriving and surviving.
Susan Mayer-McHugh
susan@helpyouhealcoaching.com


This is such a complex question, and there is no one answer. An excellent resource is http://ww5.komen.org/. The first link on the top of the page is "Understanding Breast Cancer." There are several choices in the drop-down menu, including Questions to Ask Your Doctor. That is divided into sections every step of the way.

Ask your doctor if there is a "Breast Cancer Navigator" or a "Peer Navigator Program" at your hospital, or call the local cancer center. You can also Google "Peer Navigator Program" to find one near you. There are women there who can help guide you through each step and provide resources to help you sift through the decisions you will face.

As you go to your upcoming medical and testing visits, it's helpful to take a list of questions, a notebook to write answers, as well as a supportive friend, spouse or family member with you as a second set of ears.

First it is important to understand the diagnosis. Some of the important factors to understand are:
- is the cancer invasive or non-invasive
- your mammogram
- your pathology report
- your margins of resection
- your medical history
- details of similar cases

After analyzing these factors, your medical team will determine the stage of the disease and treatment options. In many cases, surgery might be necessary to determine the stage of the cancer. In these cases the patient will have to make a decision for short-term treatment, as well as another treatment decision after the surgery.

An example of a common set of treatment options are the following:
- hormonal therapy
- breast conservation surgery - lumpectomy plus radiation
- mastectomy
- mastectomy plus radiation
- chemotherapy followed by surgery First it is important to understand the diagnosis. Some of the important factors to understand are:
- is the cancer invasive or non-invasive
- your mammogram
- your pathology report
- your margins of resection
- your medical history
- details of similar cases

After analyzing these factors, your medical team will determine the stage of the disease and treatment options. In many cases, surgery might be necessary to determine the stage of the cancer. In these cases the patient will have to make a decision for short-term treatment, as well as another treatment decision after the surgery.

An example of a common set of treatment options are the following:
- hormonal therapy
- breast conservation surgery - lumpectomy plus radiation
- mastectomy
- mastectomy plus radiation
- chemotherapy followed by surgery