New technique holds promise for melanoma patients: Know how to deal with this condition

New technique that improves on existing methods for assessing risk of melanoma recurrence after surgical removal developed. But you need to be alert too.

There is good news for patients of skin cancer. Thanks to a new study at Brigham and Women’s Hospital, there may soon be a new melanoma test that will be able to better predict recurrence and improve patient care. Researchers have developed this new technique that improves on the current method for assessing whether primary melanoma is likely to recur and spread, following surgical removal. Nature Cancer published this study.

Most people first suspect melanoma when they see changes in the appearance of a pigmented spot like a mole or freckle. Though a primary melanoma can be cured through surgical removal, in some cases the lesion recurs and spreads. Unfortunately, there has been no major changes in the field of lesion analysis in the last hundred years. This puts patients at risk of recurrence at a disadvantage. But now, the new developments will lead to better patient care.

A treatable condition

Early stage melanoma is a treatable condition. But the problem with this disease is detecting it early. Usually, a diagnosis is made only after the cancer has progressed. A cure is difficult once the diseases has progressed. Hence, an early detection is essential for a favourable outcome from treatment. Be alert to any changes in the size of a mole or any changes on your skin. Consult your doctor to rule out this condition. Early detection can lead to a cure.

What you can do

You can bring down your risk of melanoma significantly by taking a few precautions besides being alert to any changes on your skin surface. Avoid excessive sun exposure. If you spend a lot of time in the sun, wear protective clothing. Nowadays, you can buy sun-block shirts. You can try these out. Always use sunscreen and re-apply every 8 hours.

Know the ABCDE method of detecting skin cancer
You can use the ABCDE method to determine if a mole or freckle may be melanoma. This is what you need to look out for.

A: Asymmetrical: Healthy moles are symmetrical and cancerous ones are asymmetrical. Just draw a line through the middle of your mole to see if there is any asymmetry.

B: Border: If the border of your mole is ragged, raised or notched, it may be cancerous.

C: change in colour: All healthy freckle and mole have uniform colour. If there is any color variation, it may be because of cancer. Look out for different shades of tan, red, brown, blue, white and black.

D: diameter: If your mole is bigger than 6 millimeters, it may be cancerous.

E: evolving: Keep an eye out for any new moles and marks on your body. Also check to see if there are any changes in the colour or size of existing moles.

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New VR tool may help boost mental health, well-being:

Researchers are developing a personalised, therapeutic virtual reality (VR) tool which may enable new forms of self-reflection, and help improve and maintain positive mental health. The VR tool being developed by researchers can be used by people with common mental health problems to create an immersive version of their journey through life.

The tool allows people to capture life events, upload relevant digital content and reflect on their thoughts and feelings in great detail, researchers said.

As well as helping with better mental health, this approach could also be beneficial for people in the early stages of dementia, those receiving end-of-life care and those with addiction problems or long-term physical conditions.
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Are cooling caps the solution to prevent hair loss during chemotherapy?

Hair loss—one of the most-feared side effects of cancer treatment—may have met its match. Scientists have known since the 80s that cooling a person's scalp can prevent significant hair loss during chemotherapy. A cooling device called DigniCap was approved for women with breast cancer by the U.S. Food and Drug Administration in 2015. This cap was tested in a clinical trial at UCLA led by Dr. Sara Hurvitz, director of hematology and oncology breast cancer program at UCLA's Jonsson Comprehensive Cancer Center. 

Two studies  found that the cap was effective; results showed that women lost less than 50 percent of their hair. The trial Hurvitz participated in paved the way for physicians to help people with cancer overcome one of the most visible signs of treatment.

How did scientists come up with the idea of cooling the scalp to help save the hair of a woman who has cancer, and how long did the development process take?
The idea to cool the scalp during chemotherapy infusion to reduce hair loss is not a new one. It has been in place for over three decades and evaluated by several other companies. There are other devices in use clinically. This is the first one to be FDA approved.

How did your research play a role in the FDA approval of this cooling cap?
We participated in the clinical trial that led to the FDA approval of this device. We enrolled and treated multiple patients on this study who were undergoing standard chemotherapy for early stage breast cancer.

How does the cooling cap actually work?
Cooling the scalp slows down blood flow to the hair follicles during the infusion of chemotherapy, which in turn limits the delivery of chemotherapy to the scalp. This lessens the toxic effects of chemotherapy on the hair follicle, thus limiting hair loss. Several devices utilize ice caps that are cumbersome to store and to manage. The device we evaluated is a tight-fitting cap, much like a bathing cap, that is attached to a cooling machine and worn during chemotherapy and for an hour or two after chemotherapy. This machine avoids the need to use a freezer or change caps during treatment.


Why do you think this cooling cap is beneficial for women going through treatment?
Hair loss from chemotherapy causes a major impact on quality of life for many women with early stage breast cancer. The hope is that reduction in or prevention of hair loss will reduce the emotional stress associated with a cancer diagnosis.

Why is it that some women still lose their hair after using the cooling cap?
Hair loss is not completely prevented in the majority of patients with scalp cooling, but half of patients are able to keep more than 50 percent of their hair with cooling (whereas nearly all patients who take curative chemotherapy without cooling cap use will lose over 50 percent of their hair). This allows a woman to look more like herself during chemotherapy. Hair also tends to fill in and look normal more quickly after chemotherapy has completed, compared to women who did not use scalp cooling.

What is the future of the cooling cap and could it prevent hair loss in people with other cancer types as well as men who have cancer?
Different devices are being evaluated in clinical trials in a variety of cancer types. This could certainly be utilized by male cancer patients as well. 

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Here's how new radiotherapy may help treat liver cancer

A novel technique that delivers high doses of radiation to tumours while sparing the surrounding normal tissue may help treat patients with early-stage liver cancer, according to a study published today. Curative treatment options for early-stage hepatocellular carcinoma (HCC), the most common type of liver cancer, include surgery, liver transplantation and radiofrequency ablation, said researchers.

However, many patients are not candidates for these therapies due to the presence of other conditions.
Radiation segmentectomy (RS) is a minimally invasive option that uses the radioisotope yttrium-90 (Y90) to destroy tumours.

The isotope is embedded into tiny beads that are delivered through a catheter into a blood vessel in the liver.

They then travel to the site of a tumour, where they come to rest and deliver their radioactive effect while sparing much of the surrounding healthy tissue.

The procedure's name derives from the fact that surgeons divide the liver into a number of segments.
Using an imaging approach called cone beam CT, interventional radiologists gain a detailed view of the complex liver vasculature and can focus delivery of the Y90 to the relevant segment.

"Cone beam CT has revolutionised our ability to perform segmental injections isolated to very small tumours, sparing the majority of normal tissue," said a Dr.

"Before cone beam CT, we had the ability to focus radiation, but not with this level of accuracy," said Salem, senior author of the study.

The team studied long-term outcomes in 70 early-stage HCC patients who had undergone RS between 2003 and 2016.

They analysed the patients' responses to treatment based on two commonly used sets of criteria.

Based on one criteria, 90 per cent of patients showed positive response to the therapy, of which 59 per cent showed complete response.

Based on a second criteria, 71 per cent achieved positive response, of which 16 per cent achieved complete response.

RS controlled the target tumour, slowed the time to disease progression and improved survival outcomes at rates comparable to radiofrequency ablation, surgery and transplantation for early-stage HCC patients.

Almost three-quarters of patients had no progression of cancer in the target tumour five years after treatment, researchers said.

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Crucial to check for colorectal cancer

It's a leading cause of cancer death here and is highly treatable when caught at early stage.

 Three in 100 Singaporeans will develop colorectal cancer in their lifetime, according to experts.

This makes the disease - cancer of the colon and rectum (or large intestine) - the most commonly diagnosed cancer in Singapore and a leading cause of cancer death among both men and women.

A medical oncologist , told that a total of 9,807 cases of colorectal cancer were diagnosed between 2011 and 2015.

Singapore also ranked 16th globally in terms of incidence rates, according to a 2012 research, a database of cancer statistics worldwide.

In the US, a study from researchers last year found that more young people - those aged 20 to 54 - were dying of colorectal cancer than in previous decades.

Although studies have not confirmed it, Dr. suspects a similar trend.

 "The increased incidence of colorectal cancer in young and middle-aged adults may be related to diet and lifestyle," she said.

"An important message to learn from the study is that young people can and do get colon and rectal cancer, so they should pay attention to signs and symptoms, and so should their doctors."

RISK

Although it can occur at any age, people aged 50 and older have an increased risk of colorectal cancer, according to the oncologists.

The organisation believes that awareness of the disease is crucial as incidence rates soar.

March marks Colorectal Cancer Awareness month globally.

Despite the increase in cases abroad and here, Dr. said mortality rates have declined.

She attributed this to advancements in treatments such as chemotherapy and radiation therapy.

"It thus allows for earlier detection and more timely treatment of the cancer at an earlier stage where treatment success rates are high," she said.

Dr.  added that colorectal cancer death rates dropped in part because of screenings too.

She said: "It is a fact that colorectal cancer screenings help people stay well and save lives.

"In some cases, screenings find growths, called polyps, that can be removed before they become cancer."

Besides seeing blood in their stool, other symptoms include cramping or abdominal pain, fatigue, unexplained weight loss and a change in bowel habits.

But Dr. stressed that early stage cancer may have no symptoms, resulting in it being described as a "silent killer".

There are also many misconceptions about the cancer and its symptoms, such as how screening is unnecessary if you have regular bowel movements and feel fine.

"Usually there are no symptoms to rely on. When there are, the cancer may already be at an advanced stage," said the Dr..

"Colon cancer is preventable and highly treatable when caught at an early stage. People who are diagnosed at early stages have over a 90 per cent chance of a cure and surviving."

Aside from screenings, especially when you reach the big 50, there are dietary and lifestyle habits that may help prevent colorectal cancer. It is important to maintain a healthy weight, avoid excessive alcohol, not smoke, eat greens and fruits, exercise regularly and limit consumption of fatty food and red and processed meat.

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Ultrasound, blood test together may boost liver cancer detection

Earlier detection is important to improving survival of patients with liver cancer, and combining an ultrasound imaging with a blood test can help achieve that, say researchers.

Using ultrasound and a blood test for high alpha fetoprotein (AFP) levels together improves detection of early-stage liver cancer significantly, said the study published in a journal .

AFP is a plasma protein that is produced in abundance by the liver cells in the foetus. In adults, AFP levels are normally low, but liver cancer can cause AFP levels to rise.

"Liver cancer screening in patients with chronic liver disease has traditionally been performed using an abdominal ultrasound. While ultrasound is readily available and noninvasive, it misses many cancers when they are small," said an associate professor.

Risk factors for liver cancer -- also known as hepatocellular carcinoma (HCC) -- include hepatitis C infection, chronic heavy alcohol consumption, and nonalcoholic fatty liver disease related to diabetes and obesity.

Symptoms can include upper abdominal pain or swelling, loss of weight or appetite, white chalky stools, and general fatigue, the researchers said.

"Our study found that adding the blood biomarker alpha fetoprotein increased detection of early-stage hepatocellular carcinoma from 45 per cent with ultrasound alone to 63 per cent using the two tests in combination," a researcher. said. 

Liver cancer screening guidelines for patients with cirrhosis vary, with some guidelines calling for just imaging and other guidelines calling for both imaging and AFP measurement.

"Our results support a change in clinical practice and the routine use of ultrasound and biomarkers together for liver cancer screening," a researcher said. 

The results were based on a meta-analysis of 32 previous studies. Meta-analysis refers to a technique of combining the results of multiple scientific studies.

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