Q&A with Dr. Jame Abraham
Dr. Jame Abraham is the director of the Breast Oncology Program at the Taussig Cancer Institute, co-director of the Comprehensive Breast Cancer Program at Cleveland Clinic and a professor of medicine at the Lerner College of Medicine at Case Western Reserve University.
What pain control is available for patients with severe headaches caused by glioblastoma multiforme?
Mr. Ravi, pain is important consequence of cancer. It could be due to the tumor, or as a side effect from the treatment. Surgery, radiation or some of the medications may have some residual side effect as pain. If the pain is as a result of tumor, palliation with radiation may help. Otherwise, pain control can be achieved by various types of pain medicines, starting from non narcotics to narcotics. The pain medicines can be titrated as needed under the guidance of a cancer doctor or a palliative care doctor. Management of pain is an important goal. So the dose of pain medicine is the dose which controls the pain. We are very careful in using the right dose of narcotics as needed to control pain in a patient with cancer.
How does a gynecologic cancer impact sexuality after treatment?
Rekha, sexual side effect from cancer treatment is significant. Cancer survivorship issues are not given proper attention, especially sexual side effects. GYN cancer and breast cancer treatment can cause various side effects, which can be related surgery, chemotherapy, radiation or hormonal therapy. This can lead to psychological changes or physiological changes. This can cause vaginal dryness, hot flashes, painful intercourse, bleeding or burning. It is important for patients to discuss these side effects with the treating physicians.
What is the difference between stage II and stage IV breast cancer?
Stage II breast cancer means, either the tumour is more than 2cm with or without lymph node involvement or tumour of any size (less than 5cm) with lymph node involvement. But in stage II, the cancer has not spread beyond the breast and lymph nodes. In stage IV the cancer has spread to distant organs such as skin, lung, liver, bones. The prognosis and treatment of stage II (which is early stage) and stage IV are totally different.
What should I avoid during treatment? Should I change my diet or lifestyle?
Chiba, diet during cancer treatment is one of the most common questions we get. This is part of patient's strong interest in taking charge or controlling what they can control. Usually we recommend, low fat diet with plenty of fruits and vegetables. I know that some doctors in India recommend avoiding any meat or fat at all. That has no scientific basis. It is okay to eat meat. Protein is important part of our usual diet. But increasing fruits and vegetables can be helpful. Hope this helps.
I am diagnosed with neurological cancer. What questions should I ask my doctor?
Narayan, sorry to hear about your diagnosis. The first question you need to make sure if you have a benign tumor or malignant tumor. If it is malignant tumor (cancer) ask them the grade, type and exact diagnosis. Ask about the size and location of the tumor. Once that is done, ask about surgery, radiation and medical treatment. Ask them if you are eligible for any clinical trials. Ask them if you have a team, which specializes in brain tumor, if not try to get a second opinion from the nearest brain tumor center.
Am I more likely to be diagnosed with breast cancer if i have a family history of the disease?
Ms. Rekha, family history is an important risk factor for breast cancer. When we look at risk factor for breast cancer, I think about it in two groups. 90% of breast cancer is sporadic and not due to an abnormal gene. So in that group having a first degree relative (means sister or mother) increases the risk for breast cancer. About 5-10% of breast cancers are due to an abnormal gene. So if you have a strong family history (multiple family members with breast cancer under the age of 50 - from either maternal side or paternal side, increases your risk of breast cancer due to an abnormal gene. The most common genes which cause breast cancer are BRCA 1 and BRCA 2 genes. So obtaining a good family history of breast cancer, ovarian cancer, pancreatic cancer or other cancers is important to establish or rule out the presence of BRCA genes or other genes. So family history can increase your risk for breast cancer.
Is it true that stress can cause cancer?
Hello Sujith, stress plays a major role with immune system. Immunosuppressive conditions can lead to cancer. But direct evidence to stress and cancer is limited. But it makes sense, constant stress, leading to high cortisol levels or other hormones can be harmful for our immune system. We have clear evidence of stress and other illnesses such as heart disease. But direct link with cancer is not completely established.
I'd like to organize a support group for cancer survivors and people facing a cancer diagnosis. What do I need to do to get one started?
Sunder Raj, that is a wonderful thing you are trying to do. Usually cancer support groups are tied to major cancer centers. So work with a nearby cancer center and engage the social workers or nurses working at that center. They can spread the word about your interest. Start with few patients 5-10 patients and they will recruit more patients. Patients do not want sympathy or tears. They are looking for sharing of the information, courage and support. All the best. I hope you will be able to start one soon. Keep me posted.
What screening options are available for cervical cancer?
Development and widespread use of pap smear is one of the most important success stories in cancer detection and prevention.
Are there any precautions to take to minimize the risk of developing breast cancer?
Breast cancer prevention (minimizing the risk) can be approached in two different ways. 90% of the breast cancers are due to multiple factors, Our hormonal factors, which is influenced by life style (diet, exercise and environment) plays a major role. So low fat diet, and exercise can clearly cutdown the risk of breast cancer. The change in life style is one of the major contribution of rise in incidence of breast cancer in India. About 10% of breast cancers are due to abnormal genes. This is due to two genes (about 85%)- BRCA 1 and BRCA 2. If some one has the genes, they can take many steps including removal of the breasts, removal of the ovaries, intense screening (using breast MRI), depending upon her preference, age and family status.