A Behind-the-Scenes Look at Immunotherapy

Cancer can cause a fight-or-flight response. Fear is normal. After all, who isn’t afraid when they hear the diagnosis?

Even so you can still bring the fight to it.

Your Body’s Unique Ability to Fight Cancer

Immunotherapy is in your corner. Basically, the treatment stands alongside your immune system to help your body fight cancer.

It functions the same way as your immunity does helping your body fight infections and other diseases. Its special forces include your white blood cells, your organs, and the tissues that make up your lymph system.

Biological therapy is another way to describe immunotherapy. Think of it as treating and defeating cancer with living organisms.

Attack Strategy

Cancer’s strategy is to hide from your immune system. Specific immune strategies call-out cancer cells and mark them as a target for destruction.

Immunotherapy is a counter-attack that can be used in a variety of ways. Each have a specific impact on cancer.

Checkpoint inhibitors
These drugs join your immune system for the strong assault on a tumor. They release the brakes that hold white blood cells back from killing cancer cells. The drugs run interference on cancer cells to prevent them from avoiding the attack of your immune system.

Cell transfer
This treatment strategy brings-out-the-fight in your T-cells natural ability to battle cancer. Cells are directly removed from your tumor. The active ones are ultimately used in the fight against the cancer.

Treatment vaccines
These battle cancer as they energize your immune system’s response to cancer cells. Its a different brand of vaccine than is used to help prevent disease.

Collateral Impact

Immunotherapy is effective. But side-effects are also common.

  • Skin reactions at injection site can include some pain, swelling, soreness, or a rash that’s red or itches.
  • Flu-like symptoms might occur such as fever, chills, weakness, dizziness, nausea/vomiting, muscle aches, fatigue, and headache.
  • Other side-effects are low or high blood pressure, weight gain from fluid retention, sinus congestion, some allergic reactions (though rare), and heart palpitations.

Your initial health, the stage of cancer, and type of therapy are factors in the side-effects you experience.

Keep in mind that routine doctor visits will monitor your progress with immunotherapy. Medical tests (including blood tests) and a variety of scans will measure the tumor’s size and any changes in blood work.

Contact us about immunotherapy and get answers to your questions about cancer treatment.

When It Comes To Cancer Treatment, Know Your Options

18 Jun 2018 Cancer

Learning that you’ve been diagnosed with cancer can be one of the most traumatizing and life-altering experiences you can go through. Individuals enduring this experience are often shocked, distressed and extremely overwhelmed. Upon diagnosis, they must quickly determine how to tell their friends and family, learn a whole new vocabulary regarding their illness, sort out how they’re going to balance treatment and the rest of their lives, and decide which cancer treatment options are best. Because of this, it can be difficult to take the time to fully understand which treatment is the best course of action. Read on to learn how to make this process a little easier.

Ask Questions: One overwhelming aspect of a cancer diagnosis is having a learn a whole new vocabulary. Many patients have to quickly understand how treatments like ablation and immunotherapy work, among other options. Don’t be afraid to ask your doctor as many questions as you need.

Look Into Alternative Treatment Options: Many alternative cancer treatments are based on pseudoscience, but there are some that may ease your symptoms. Popular alternative cancer treatments are acupuncture, meditation and aromatherapy.

Understand Side Effects: Side effects arising from a treatment on cancer that is caught early are going to be very different than the side effects that come from advanced cancer treatments. Talk with your doctor to get the full scope of which effects you might experience.

For more in-depth information about alternative cancer treatments and which treatment options may be best for you, it’s best to consult with your treatment center.

Thermal Ablation Therapy

18 Jun 2018 Cancer

Thermal Ablation Therapy and Other Ablative Therapies

Ablation treatment is an emerging treatment option for cancer patients. Ablation uses extreme temperatures to destroy tumors or alleviate blockages and other symptoms. It is a minimally invasive procedure that has become common since the advent of modern imaging in the 1990s. Ablative therapies include radiofrequency (RF) ablation, microwave ablation and cryotherapy.

Thermal ablation therapy procedures involve a thin, needle-like probe that is inserted through the skin into the tumor. The probe must be able to reach and access the tumor directly, therefore doctors use ultrasound, CAT scans or an MRI to guide the probe into the tumor. Once in place, the probe emits various energy sources through the tip such as RF electrical current, microwaves, laser light and ultrasonic waves until temperatures rise to cytotoxic levels (50-60 °C). This will heat and kill the tumor. Of these various energy sources, RF and microwave ablation are most commonly used worldwide for the last 20 years.

During RF ablation, alternating electrical current (~500 kHz) produces resistive heating around the interstitial electrode. Skin surface electrodes (ground pads) are used to complete the electrical circuit. Studies suggest it may be the first-line treatment option for small hepatocellular carcinoma (liver cancer) and renal-cell carcinoma (kidney cancer).

Even though RF heating produces good results, it is hampered by local blood flow and high electrical impedance tissues such as lung, bone, desiccated or charred tissue. Microwaves may lessen some of these problems by producing faster, volumetric heating. To create larger or conformal ablations, multiple microwave antennas can be used simultaneously while RF electrodes require sequential operation, which limits their efficiency. Studies found that early experiences with microwave systems suggest efficacy and safety like, or better than RF devices.

Non-thermal procedures such as cryoablation can freeze cancerous tumors. This is a result of cold gases including liquid nitrogen or argon flowing through a probe to form a ball of ice crystals at its tip to surround and freeze the mass. NanoKnife® is another type of ablation which uses electrical current instead of heat or cold to destroy tumors. Ablation therapy may be a treatment option for patients who have tumors that are three centimeters or smaller, this includes kidney tumors and tumors in the lungs, liver, and bones as well as soft-tissue tumors of the breast, adrenal glands, and head and neck.

Ablation therapy is often chosen when other therapies would be harmful or not be beneficial to the patient. For example, the liver is the site of cancers that originate from both liver cells and from tumors arising from distant sites, such as the colon. The most effective treatment of tumors originating in or spreading to the liver is surgery. Unfortunately, many patients are not candidates for surgery because of the number or location of the disease, or because their health does not permit extensive surgery; therefore, ablation therapy for liver cancer is appropriate for patients with four or fewer small tumors limited to that organ. Ablation of the liver may not be the best choice for patients with a greater number of tumors, or tumors involving multiple organs, and instead chemotherapy and other forms of therapy are recommended. This is also true for lung cancer. RF ablation is the technique most commonly used when lung cancer ablation is the chosen therapy to treat tumors in the lung.

Some of the benefits of ablation therapy, whether it is thermal or non-thermal, may include:

  1. Can be performed without open surgery.
  2. It has a reduced cost.
  3. Can be used to treat tumors when surgery is not an option.
  4. Can relieve pain and blockages.
  5. Requires a shorter hospital stay and recovery time.
  6. Can be used with other cancer treatments.
  7. If new tumors develop, it can be repeated.
  8. Requires a shorter hospitalization stay.
  9. Can increase preservation of surrounding tissues.

Immunotherapy Treatment For Cancer

What is immunotherapy? Immunotherapy, also called biologic therapy or biotherapy, is an immune system therapy for cancer that uses certain parts of a person’s immune system to fight the diseases. It uses substances made by the body or in a laboratory (also known as natural cancer fighters) to improve or restore these immune system functions.

This can be done in a couple of ways:

  • Stimulating your own immune system to work harder or smarter to attack cancer cells.
  • Giving you immune system components, such as man-made immune system proteins.

Immunotherapy may accomplish the following things in a patient:

  • Stop or slow the growth of cancer cells
  • Stop the cancer from spreading to other parts of the body
  • Help the immune system work better at destroying the cancer cells
  • Boosting the immune system for cancer patients

There are several types of immunotherapy treatments:

  • Monoclonal antibodies
  • Therapeutic Antibodies
  • Oncolytic virus therapy
  • T-cell therapy
  • Cancer vaccines

Monoclonal antibodies

Antibodies are proteins that fight infection, and when the body’s immune system detects something harmful, it produces these antibodies.

Monoclonal antibodies are a laboratory made specific type of therapy. They may be used in a variety of ways such as a targeted therapy to block an abnormal protein in a cancer cell. The immune system has a difficult time targeting cancer cells already. This is because cancer starts when cells become altered and start to grow out of control. The immune system doesn’t always recognize cancer cells as foreign so when monoclonal antibodies are used as an immunotherapy, some of these attach to specific proteins on cancer cells. This will flag the cells so the immune system can find and destroy them.

Therapeutic Antibodies

Therapeutic antibodies are antibodies made in the laboratory that are designed to cause the destruction of cancer cells. One class of therapeutic antibodies, called antibody drug conjugates (ADCs), has proven to be very effective. Several have been approved by the Food and Drug Administration (FDA) for the treatment of different cancers.

ADCs are created by chemically connecting antibodies, or fragments of antibodies, to a toxic substance. The antibody portion of the ADC allows it to connect to a target molecule that is on the surface of cancer cells. The toxic substance can be a bacterial toxin, a small-molecule drug or a radioactive compound. Once an ADC binds to a cancer cell, it is taken up by the cell and the toxic substance kills it.

Several FDA approved ADC drugs have been used to treat various cancerous diseases. The ADC drug known as Kadcyla® has been used to fight breast cancer while others such as Adcetris® has been used in the treatment of Hodgkin lymphoma and a type of non-Hodgkin T-cell lymphoma. Zevalin®, another FDA approved ADC, has been used for the treatment of non-Hodgkin B-cell lymphoma.

Oncolytic virus therapy

Oncolytic virus therapy uses genetically modified viruses to kill cancer cells. A medical professional will inject a virus into the tumor which will then enter the cancer cells and makes copies of itself. As a result, the cells burst and die. Specific substances called antigens are then released as the cells die. This triggers the patient’s immune system to target all the cancer cells in the body that have those same antigens.
T-cell therapy

T-cells are immune cells that fight infection. In T-cell therapy, some T-cells are removed from a patient’s blood then the cells are changed in a laboratory so they have specific proteins called receptors. The receptors allow those T-cells to recognize the cancer cells. The changed T-cells are grown in large numbers in a lab and returned to the patient’s body. Once in the body, they seek out and destroy cancer cells.

Cancer vaccines

A vaccine is another method used to help the body fight cancer. The vaccine works by exposing the immune system to an antigen which triggers the immune system to recognize and destroy that antigen. The two types of cancer vaccines are prevention vaccines and treatment vaccines. Doctors will give prevention vaccines to healthy children and adults to protect the body from viruses that can lead to cancer or other diseases, but the patient must receive it before the virus is contracted. The two types of cancer prevention vaccines approved by the FDA are the HPV vaccine and Hepatitis B vaccine. Many health articles on cancer try to stress the importance of getting vaccinated for these viruses that can lead to cancer.

The hepatitis B vaccine prevents the hepatitis B virus (HBV) infection which can cause liver cancer after a long lasting-infection. The HPV vaccine protects against human papillomavirus (HPV). If the virus is long-lasting, it can cause several different types of cancer such as anal cancer, genital warts and cervical, vaginal, and vulvar cancers. It is important to remember that immunotherapy treatments for cancer work better for some than it does for others.

Treatment vaccines are different from the vaccines that work against viruses. These vaccines try to get the immune system to fight against cancer cells in the body. Instead of preventing disease, they are meant to get the immune system to attack a disease that already exists. Some cancer treatment vaccines are made up of cancer cells, parts of cells, or pure antigens. The treatment vaccine Sipuleucel-T (Provenge®) is used to treat prostate cancer. It is the only vaccine approved in the United States to treat cancer so far.

For additional help on understanding immunotherapy as a treatment for cancer, please visit williamscancerinstitute.com

Radiofrequency Ablation

18 Jun 2018 Cancer

Radiofrequency Ablation is a medical procedure used in cancer treatment to eliminate tumors and metastases. It is also used for arthritis pain, and the pain relief in these cases can last anywhere from 6 months to a year. The percentage of people actually experiencing pain relief is estimated at over 70%. Sometimes, the pain relief lasts for years.

Medical doctors have used the radiofrequency ablation procedure for the past 28 years. Amongst the list of other conditions that it’s been used for are enlarged prostate, heart arrhythmias, and a type of benign bone tumor called osteoid osteoma.

Who Can’t Have RFA Ablation

The only people that should not have radiofrequency ablation are the following:

  • Those who have bleeding disorders
  • Those currently suffering from infections
  • Those who will need deep sedation (for the percutaneous approach)
  • Those whose tumor doesn’t have a normal margin of cells (it’s 100% cancer cells)

How RFA Ablation is Performed

The procedure for ablation therapy is pretty straightforward:

  1. Your body is prepared for an IV line to go into a vein close to the area of the problem.
  2. A type of anesthetic or sedative is administered and the doctor will watch you to make sure the anesthetic is activated in your body.
  3. A 1-2 mm wide 18-gauge to 14-gauge needle (probe) will be inserted into the area of treatment via the aid of x-ray. If the tumor is large, multiple probes will be used. One needle takes care of about 1.6 centimeters of cancerous tissue. However, with advanced technology, this distance can now be extended up to 7 centimeters, which is 2.75 inches. A treatment lasting 30 minutes has very few complications and cells other than the cancer cells don’t die off.The x-ray helps your doctor locate the actual target area to treat it. Once found, an electrode is next inserted into the area so that the stimulation of the cells in the area begins via radio waves. The purpose of this stimulation is to allow the doctor to verify that the placement is exactly correct.Advanced methods of using the technique include slow or pulsed heating, using multiple probes, internal electrode cooling and infusing saline into the area.
  4. Next an RF (radiofrequency) current is dispelled into the area. The stimulation may last anywhere from 30 minutes to 120 minutes. The tissue heats up and then cells susceptible to the heat die. The cells heat up to 50-52 degrees Celsius (122 degrees Fahrenheit to 125.6 degrees Fahrenheit), and after 4 to 6 minutes, the targeted cancer cells die.It is more difficult to use the ablation procedure for a tumor that lies next to arteries or veins larger than 3 mm in diameter. That’s because the transfer of heat could affect the blood vessels negatively. Thus, the doctors may have to clamp off the blood vessels, cause a temporary clot (called an occlusion balloon) in the blood vessels for a few minutes, or create an embolism with chemicals in the blood vessels.After the procedure anywhere from two to six weeks later, new imaging studies such as MRI are taken. They are repeated every 90 days for a little over a year. Doctors want to repeat the ablation if the tumor starts growing. The fear on the part of the doctors is that the new growth will be pretty erratic in its geometry, which would make further treatment quite difficult.

What Type of Precautions Should the Patient Take?

The procedure doesn’t restrict what you eat or drink but it is not a good idea to do any of the following after the ablation therapy:

  • Driving, especially farm equipment
  • Exercising strenuously at the gym or elsewhere

How Effective is Radiofrequency Ablation When Guided By Imagery?

Radiofrequency ablation doesn’t have to be a blind procedure. It can be guided by imagery. This isn’t referring to the psychological technique where someone imagines the immune system cells being attacked by one’s own body and the cancer killed. Instead, it means that the doctor has cameras hooked up to the inside of the body so he can see exactly where he is in the tissue, avoid damaging tissues that are healthy, and go right after the cancer cells alone.

The Mayo Clinic has the answer of whether or not radiofrequency ablation is effective when guided by medical imagery systems. The doctors at this prestigious institution just recently published a medical study on the results in July 2017 in the Journal of Vascular Intervention & Radiology. This powerful study tracked 16 patients with prostate cancer who were between the ages of 50 and 86 years old, and had cancer that had metastasized (spread) to other areas of the body.

The doctors found that 27 months after the patients received radiofrequency ablation with the assistance of imagery to see what parts of the body were being ablated, 15 of 18 of the tumor metastases were controlled. The tumor recurrence rate only occurred in 16.6% of the tumors. That’s a very low rate, compared to some failed procedures.

In this study, tumors did not recur until 3.5 months later on average so the patients had about 105 days where they were declared tumor free. The local ablation worked. (Local ablation means only the tumor that is in one location is addressed.)

The doctors at Mayo Clinic concluded that the radiofrequency ablation was feasible and well tolerated and achieved acceptable local tumor control rates and the method may be useful to patients with prostate cancer who aren’t ready or want to delay androgen-deprivation therapy (ADT).

Freezing Cancer Tumors Works

The type of ablation treatment done at the Mayo Clinic in this study is called Percutaneous Imaging-Guided Cryoablation or PICA. It’s one that closely views tumors as they are being destroying with extreme cold temperatures instead of heat from radio waves. Doctors and patients both like using it because it’s minimally invasive, safe, repeatable, and can be used with other cancer therapies.

When Cryotherapy and Radiofrequency Ablation are used together, according to researchers in France and Italy, PICA has been used in a wide range of patients and tumors with great success.

For example, the following conditions have resulted in reports of curative therapy:

Small primary/secondary lung tumors where RFA ablation is unsuitable (and lung ablation with cryotherapy is used).

In India, doctors reviewed 14 cases where RFA ablation was used for lung metastasis between January 2007 and December 2013. The size of the metastases ranged from 0.5 to 5.0 centimeters. The primary cancer associated with these metastases was liver cancer, colorectal cancer and prostate gland cancer. The average patient age was 50 years old. The medical reports showed complete ablations without local tumor recurrence in 81% of the nodules. The Indian doctors concluded that radiofrequency ablation for lung metastasis can be considered as a relatively safe, effective alternative treatment for lung metastasis.

Bone growths and the relief of pain of bone metastases

Radiofrequency ablation can be performed on both benign bone growths and ones that are cancerous. In bone, the procedure varies a little. The probe is placed in a bone-penetration cannula into the tumor and then activated at 90 degrees Fahrenheit for 4-6 minutes. Success rates for doing the procedure only once are as high as 91-94%. Most reoccurrences can be ablated when the procedure is repeated.

When cancer metastasizes to the bone, the patient suffers from a lot of pain. One study of 43 patients with a bone metastasis that was very painful and resistant to chemotherapy and radiation proved pain relief was possible. The patients had so much pain relief that they used significantly less analgesics to control pain.

Small T1a kidney tumor (where kidney ablation with cryotherapy is used)

These tumors should be ones that occur in the renal cortex. Kidney tumors that are in the interior of the kidney are a potential problem because of the blood vessels that run through this area. The tumors treated should also be less than 3 centimeters in diameter.

RFA ablation therapy may be a great choice of techniques to use for small renal masses, according to the National Institutes of Health and the National Cancer Institute. It’s especially good for patients with a genetic predisposition to have multiple metachronous kidney cancers, such as what happens in von-Hippel Lindau or hereditary papillary renal cancer. So far, results of studies in this area of renal tumors and radiofrequency ablation have shown a 70-90% success rate for the first ablation procedure. When the second procedure is done, the success rates will be higher.

The very best tumor type to respond to RFA is an exophytic tumor of the kidney. This is a tumor that grows outside the surface of the epithelial cells from where it starts. In other words, it’s similar to how a mushroom grows, and how a mushroom can be plucked off the area from where it originates. Complications are rare when ablation is used in the kidneys.

Liver tumors (called liver ablation)

Doctors at Memorial Sloan Kettering Cancer Center in New York reviewed 110 patients that received ablation of colorectal liver metastases between November 2009 and April 2015. Six weeks after the procedure, the margins of the metastases were measured. If the margins had increased in size, this would indicate that the metastases had grown. If the margins had decreased in size, this would indicate that the metastases had shrunk. Ideally, the metastases would be totally gone.

The doctors compared different types of radiofrequency ablation thermal ablation (ablation with microwave), and ablation of colorectal liver metastases. First of all, you should know that the technique of complete ablation was 93% successful and 97% successful for the microwave version of it. The tumors were completely gone in these cases.

The doctors determined that predictors of success included metastases that had 5 mm margins or less, and perivascular tumors. A perivascular tumor is a rare type of tumor that can occur anywhere in the body. Where this tumor originates from is not known at this time. Most commonly, they are found in the lungs or in the kidneys.

In the study, even the largest tumors (over 10mm) did not metastasize when the RFA ablation was done. They concluded that Regardless of the thermal ablation modality used, margins greater than 5 mm are critical for local tumor control, with no local tumor progression noted for margins over 10 mm. Unlike RF ablation, the efficiency of microwave ablation was not affected for perivascular tumors.

If patients have liver cirrhosis along with a liver tumor, they aren’t a candidate for radiofrequency ablation.

Ablation Therapy is Not Available At Every Clinic Yet

Not all doctors will use radiofrequency ablation (local ablation or cryoablation). In one national doctor survey, only 16% of doctors had access to local tumor ablation methods at their place of work. These doctors were primarily ones that were associated with universities.

Yet, not all doctors at universities used ablation therapy because of a lack of radiologists that could assist with and/or perform the procedure, and lack of expertise with the procedure. The doctors that did use ablation therapy used local tumor ablation, percutaneous radiofrequency and cryoablation. We use it here at Williams Cancer Institute because it works well as seen in our hundreds of patient cases. For more information, give us a call.

Sources

Erie, A.J., et al. Retrospective review of percutaneous image-guided ablation of oligometastatic prostate cancer: a single-institution experiment. J Vasc Interv Radiol 2017 Jul; 28(7):987-92. https://www.ncbi.nlm.nih.gov/pubmed/28434661

Cazzato, R.L., et al. Percutaneous image-guided cryoablation: current applications in the oncologic field. Med Oncol 2016 Dec;33(12):140. https://www.ncbi.nlm.nih.gov/pubmed/27837451

Trudeau, V., et al. Local tumour ablation for localized kidney cancer: practice patterns in Canada. Can Urol Assoc J 2015 Nov-Dec;9(11-12):420-3. https://www.ncbi.nlm.nih.gov/pubmed/26788232

Tongdee, T., Tantigate, P. and Tongdee, R. Radiofrequency ablation of lung metastasis not suitable for surgery: experience in Siriraj Hospital. J Med Assoc Thai 2015 Oct; 98(10):1019-27.

Shady, W., etal. Percutaneous microwave versus radiofrequency ablation of colorectal liver metastases: ablation with clear margins (AO) provides the best local tumor control. J Vasc Interv Radiol 2017 Dec 2. https://www.ncbi.nlm.nih.gov/pubmed/29203394

Friedman, M., et al. Radiofrequency ablation of cancer. Cardiovasc Intervent Radiol 2004; 27(5); 427-434. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2408956/
Callstrom MR, Charboneau JW, Goetz MP. Percutaneous CT/US-guided radiofrequency ablation of painful metastases involving bone: a multicenter international study. Radiol Soc North Am Annual Meeting. 2002.

Early Signs Of Prostate Cancer

18 Jun 2018 Cancer

Prostate Cancer Symptoms May Be Nonexistent. You might be surprised to find out that early signs of prostate cancer may not occur at all. You might feel as healthy as you did ten years ago and be having one of the best times in your life and then the diagnosis shows up. In fact, only when the cancer has progressed do the urinary symptoms begin to show up.

Because the prostate cancer symptoms could be so unobtrusive on your life, how would you know if you have cancer of the prostate? The prostate cancer signs include:

  • It’s difficult to start urinating, even though you know you have to go
  • When you urinate, it comes out in an interrupted fashion, not like a fire hose type of flow
  • While urinating, it’s painful or you feel a burning sensation. This is often referred to as prostate pain.
  • There’s blood in your urine or semen.
  • Ejaculation is painful.
  • You have pain in your pelvis, back or hips and it’s always there.
  • When finished urinating, it feels as if there’s still more urine that needs to come out.

Symptoms of Cancer in Men

These primarily urinary tract symptoms of prostate cancer symptoms make up the category of urinary changes that belong to a bigger picture of early symptoms of cancer in men. The rest of the categories that indicate cancer is a distinct possibility include:

  • Changes in bowel function
  • Bleeding of the rectum
  • Coughing that won’t go away
  • Lumps found in the testicles or breast
  • Fatigue that won’t go away
  • Weight loss that occurs for no reason

How A Diagnosis of Prostate Cancer is Made

About 13 million new cases of prostate cancer are diagnosed worldwide annually. Most of them a good 60% occur in men over the age of 65. The way to find out whether or not you have prostate cancer is not to go by the symptoms, but rather by the test results.

There are three primary tests that can be utilized in this decision making process:

  1. A PSA (prostate specific antigen) test this is a blood test that measures a specific protein produced by tissues of the prostate and by cancerous tissues.
  2. A digital exam of the prostate In this case, the word digital means done with the aide of the fingers. It doesn’t mean an electronic or computerized type of test. The doctor is actually feeling the prostate gland itself. If there are areas of the gland that feel hardened or bumps are on it, this could mean that there is a cancerous growth. The exam is done via a gloved rectal exam.
  3. A biopsy This is a test where a small amount of tissue of the prostate gland is excised and then examined underneath the microscope.

What the highly-trained pathologist is looking for is the appearance of the prostate cells and their alignment. In the worst possible case of aggressive prostate cancer, the cells of the prostate may look mostly undetectable because of all the mutations in the cells. They may also be misaligned, with cancer cells infiltrating into the surrounding tissues.

Once abnormal cells are found in the biopsy, the pathologist rates his findings on a scale of 2 to 10 called the Gleason score. The higher the number, the more invasive and serious the cancer is. A diagnosis of prostate cancer is made from this biopsy and Gleason score. The cancer cells may also be tested for genetic abnormalities. Imaging studies such as transrectal ultrasound and transrectal magnetic resonance imaging may also be used to make a diagnosis.

Prostate Cancer Causes

Researchers have found that genetics contributes to prostate cancer. Specifically, there are three factors that can indicate to the doctor that genetics are playing a role. In some cases, any or all of these three factors could be listed as prostate cancer causes:

  1. When the individual has relatives with prostate cancer (including the disease showing up in three successive generations on the mother or father’s side)
  2. When the prostate cancer happens in someone who’s 55 years old or younger
  3. When the prostate cancer history in the family also shows up with other cancers (pancreatic, breast, ovarian)

The genes associated with the highest to moderately highest lifetime risk of prostate cancer are the BRCA1, BRCA2, the mismatch repair genes, and the HOXB13 genes.

In addition, more than 100 single nucleotide polymorphisms, called SNPs, are related to prostate cancer. A SNP is a type of mutation in DNA sequences that doesn’t always have a negative effect. However, the accumulation of many of the same types of SNPs together along with the right environment to turn on a disease can be enough for a disease to appear. This right environment is usually a psychologically stressful environment; one that includes multiple chemical, radiological, or high electromagnetic field stressors; or even simply vitamin and mineral deficiencies.

The Risk Of Prostate Cancer Increases From Certain Factors

Risk factors are characteristics, attributes, or exposures that increase the likelihood of developing either an injury or a disease. Numerous medical studies have been done worldwide, attempting to find these risk factors.

To date, this is what has been found:

  • A high fat diet predisposes men to develop prostate cancer.
  • A high fruit and vegetable diet is associated with lower risks of developing prostate cancer. A diet low in fruits and vegetables is associated with higher risks.
  • Low levels of certain micronutrients in the diet are protective against prostate cancer, such as lycopene, green tea epigallocatechin gallate, and soy phytoestrogens. These medicinal components act as antioxidants and inhibit cancer cell proliferation. Soy phytoestrogens also can modulate the epigenetic modifications found in prostate cancer, reports scientists from France and Turkey.
  • The consumption of well done meats is associated with a high risk for advanced prostate cancer.
  • Men with a known family history of prostate cancer had a higher risk for developing prostate cancer if they were obese.
  • Men older than the age of 65 have a higher rate of prostate cancer than younger men.
  • African American men are more often diagnosed with prostate cancer than men of other races.
  • Men who have other health issues of the prostate such as prostatitis, and benign prostatic hyperplasia (BPH) have a higher risk of developing prostate cancer.

Knowing the risk factors is sometimes helpful to discover what might have contributed to the development of cancer, and it does give you a clue as to what you might be able to do to slow down the progression of the cancer on your own.

Treating Prostate Cancer at Williams Cancer Institute

Williams Cancer Institute regularly treats prostate cancer patients with two of the most advanced techniques: Cryoablation and immunotherapy.

Cryoablation is a minimally invasive treatment that uses very low temperatures to kill the cancer in the prostate gland. Specifically, needles are inserted into the tumor and cold temperatures then destroy the tumor. Cryoablation is considered highly effective by medical researchers. Doctors reported in May 2014 in the journal called BJU International (the official British Association of Urological Surgeons medical journal) that the disease-free survival rates were 65.3% at 36 months and 51.9% at 60 months. In an October 2017 case analysis of patients who developed prostate cancer after resection surgery on their abdomen and perineal area, cryoablation treatments, all four patients showed PSA levels below 0.1 ng/ml at the one-year mark.

Three of the four patients PSA levels stayed there below 0.1 ng/ml at the 33-month mark as well, and without any urinary incontinence or evidence of reoccurrence. The cryoablation was done to the whole gland. The doctors concluded, MRI-guided cryoablation appears to be a promising treatment option in patients who are poor surgical candidates due to prior pelvic surgery and/or radiation.

Fighting Cancer Cells With Their Own Weapons

At Williams Cancer Institute, immunotherapy is combined with cryoablation in patients with prostate cancer. Immunotherapy is the creation of a vaccine that is capable of stimulating an anti-cancer immune system response. This response is often what the body needs to kickstart its own immune system, something that is sorely needed in cancer patients.

Tumors have been known to send out chemical signals that block a normal immune system response in the patient. When this happens, the cancer is gaining ground and winning. However, with immunotherapy, the result is often a systemic response in the body where all cancer cells are wiped out.

The technology of immunotherapy allows the doctor to identify all the receptors the cancer cells are using to turn off the immune system and the ability to create substances that will block those receptors. Once the receptors are blocked, the cancer can no longer suppress the patient’s immune system. The cancer itself ends up being suppressed, and the cancer’s weapons have been turned on itself.

In a small case review study done by Jason Williams, M.D., Patrick E. Sewell, M.D. and Mark A. Rosenberg, M.D., the doctors found that by combining cryoablation with immunotherapy, the treatments complemented each other, leaving the patients free from cancer. Their results prove that prostate cancer doesn’t have to be a death sentence, even for older men. If you have been diagnosed with prostate cancer, consider obtaining a second opinion from the doctors at Williams Cancer Institute. It may be exactly what you are looking for.

Sources:

Genetics of Prostate Cancer (PDQ®)-Health Professional Version. Executive Summary. NIH. National Cancer Institute. Accessed online Dec. 4, 2017. https://www.cancer.gov/types/prostate/hp/prostate-genetics-pdq

How is Prostate Cancer Diagnosed? Prostate Cancer. Centers for Disease Control. Accessed online Dec. 4, 2017. https://www.cdc.gov/cancer/prostate/basic_info/diagnosis.htm

Adjakly, M., Nigollo, M., Dagdemir, A., et al. Prostate cancer: The main risk and protective factors Epigenetic modifications. Ann Endocrinol (Paris) 2015 Feb; 76(1):25-41. https://www.ncbi.nlm.nih.gov/pubmed/25592466

Chen, H., Ewing, C.M., Zheng, S., et al. Genetic factors influencing prostate cancer risk in Norwegian men. Prostate 2017 Nov 27. https://www.ncbi.nlm.nih.gov/pubmed/29181843

Gathirua-Mwangi, W.G. and Zhang, J. Dietary factors and risk for advanced prostate cancer. Eur J Cancer Prev 2014 Mar; 23(2):96-109. https://www.ncbi.nlm.nih.gov/pubmed/23872953

Liang, Y., Ketchum, N.S., Goodman, P.J., Klein, E.A., Thompson, I.M., Jr. Is there a role for body mass index in the assessment of prostate cancer risk on biopsy? J Urol 2014 Oct; 192(4):1094-9. https://www.ncbi.nlm.nih.gov/pubmed/24747090

Govorov, A.V., Vasil ev, A.O., Ivanov, Vlu, et al. Treatment of prostate cancer using cryoablation. Urologia 2014 Nov-Dec (6):69-72, 74. https://www.ncbi.nlm.nih.gov/pubmed/25799731

Ward, J.F., DiBlasio, C.J., Williams, C., Given, R., and Jones, J.S. Cryoablation for locally advanced clinical stage T3 prostate cancer: a report from the Cryo-On-Line database (COLD) Registry. BJU Int 2014 May, 113(5):714-8. https://www.ncbi.nlm.nih.gov/pubmed/24112776

Kinsman, K.A., White, M.L., Mynderse, L.A., et al. Whole-gland prostate cancer cryoablation with magnetic resonance imaging guidance: one-year follow-up. Cardiovasc Intervent Radiol 2017 Oct 17. https://www.ncbi.nlm.nih.gov/pubmed/29043385

Foods That Fight Cancer

18 Jun 2018 Cancer

Foods that Fight Cancer & Understanding Your Prognosis

It’s not an uncommon thought to be deeply afraid of getting cancer. More than 1.25 million new cases of invasive cancer are diagnosed each year while an additional of 1.5 million cases of noninvasive cancers will be diagnosed. Heartbreakingly, more than 500,000 people will die from cancer each year.

To fully understand how to support the body and prevent cancer, we’ll begin by looking at the connection between cells and cancer. Your body contains trillions of cells and within each cell is a central core called the nucleus. Inside the nucleus lies the key to life, deoxyribonucleic acid, better known as DNA. Our DNA contains the instructions that each cell needs to make its vital proteins and replicate itself.

Any abnormal changes are called mutations which generally recognize they are mutations and simply die off, the process called apoptosis. However, the mutations sometimes continue to divide at a rapid, uncontrolled rate and form clumps of cells that grow into a mass tissue we call a tumor. Now, there are two types of tumors: benign and malignant. Benign tumors are not cancerous because the cells are not cancerous. They can be surgically removed or removed with cancer ablation, which essentially burn or freezes it with special probes. They also don’t spread to other parts of the body. Malignant tumors are cancerous. The mutated cells divide without control or sympathy and can invade nearby tissues and organs. The cancer cells can also break away from a malignant tumor and enter the bloodstream or lymphatic system to form tumors in other organs.

The good news? There are nutritional and lifestyle changes each of us can take to aid in the prevention or to support the body while fighting cancer. There are also alternatives to chemotherapy and radiation that one may choose or simultaneously use with conventional medicine such as immunotherapy. Immunotherapy is a type of treatment that boosts the body’s natural defenses to fight cancer which may stop or slow the growth of cancer cells, stop the cancer cells from spreading to other parts of the body and support the immune system to work efficiently at destroying the cells.

Lifestyle and Health Factors That May Cause Cancer

Toxins and Free Radicals | It’s no shock that continual exposure to toxins and free radicals can cause extreme damage to the cells and DNA. However, it is shocking how many of our daily products and lifestyle choices generate free radicals and contain harmful chemicals. To combat free radical damage, ensure you’re consuming plenty of antioxidants and anti-inflammatory phytonutrients.

These include:

  • Exposure to radiation
  • Exposure to environmental pollutants
  • Consumption of alcohol, tobacco, and drugs
  • High use of antibiotics and certain medications
  • Too much exercise
  • Emotional or physical stress
  • A Standard American Diet (SAD)

A Weakened Immune System | This can be caused by dysbiosis, chronic inflammation, poor nutrition, exposure to toxins and high levels of emotional or physical stress. To boost the immune system ensure you’re consuming whole foods, exercise often and maintain a healthy weight. 70% of our immunity is located in the gut so consume plenty of fiber, fermented foods and prebiotic foods that will work together to create a healthy microbiome.

Ongoing Subclinical Malnutrition | Malnutrition affects every aspect your body and health. It’s essential to consume foods that dense in nutrients, digestion is working optimally and you’re absorbing all of the essential nutrients.

Less than Optimal Liver Function | Consuming processed fatty foods, excess alcohol and toxins can lead to an under-functioning liver. Liver detoxification, consuming whole foods and lessening the amount of chemical-filled products can greatly support and being the liver back into balance.

Mental-Emotional Trauma | Psychological aspects that have been identified by researchers include excessive fear, guilt, the inability to cope with change, denial and self-hate. Speaking with friends, family, a counselor can be incredibly helpful in this aspect. Meditating, yoga, journaling, and reading have also shown to be therapeutic.

Cancer-Causing Foods

Pesticides and Herbicides | I know, pesticides and herbicides aren’t a food, but they are heavily sprayed on our food supply. Industrial farms load our air, water, animals, produce and soil with chemicals. To avoid consuming pesticides choose organic and locally grown foods. Choosing locally grown food also supports local farms and ensures the highest nutrients. To put it into perspective, farmers will pick their produce before it’s ripe to guarantee it’ll arrive at its destination before molding or going bad. This means that the produce isn’t as nutrient dense as locally grown. Have you ever wondered why home-grown strawberries are so incredibly juicy, vibrant and sweet? It’s also more important to consume many vegetables and fruit than only choosing organic, which can get expensive, so, don’t sweat it!

Processed Meat | A study on more than 500,000 Americans has provided incredibly strong evidence that women and men were more likely to die quicker from cancer or heart disease from consuming red and processed meat. These processed meats include hot dogs, bacon, deli meats and pepperoni. However, scientists don’t know the specific type of fat, protein or if it’s the nitrates that are causing cancer or whether the meat signifies low vegetable intake or high intake of processed carbohydrates and sugars.

Fried & Over-Cooked Foods | Acrylamide is found in over-cooked foods like potato chips, fries, grains and sometimes even coffee. The chemical releases when starchy foods are cooked above 248 °F, causing the sugars and the amino acid, asparagine, to create acrylamide which is a carcinogen. The best option when consuming grains or potatoes is to steam, boil simmer or sprout them instead. And avoid processed chips, crackers, and cereals.

Conventional Dairy | Dairy is pushed on the market as a great source of calcium, but many are unaware that conventional milk is actually carcinogenic. Dairy is also high in potent estrogens because it’s produced from pregnant, lactating cows and will add to the estrogen laud in our body and can affect an estrogen-sensitive breast tumor. Lastly, agriculture toxins are known to accumulate in the fat of cows and are found in their milk.

Nutrients and Foods That Fight Cancer

Many foods that fight cancer are considered as they are high in antioxidants, support the immune system and even target cancer. The bioflavonoids, carotenoids, phytochemicals, indoles, and phytoestrogens are all nutrients that play a key role in cancer-fighting foods that many people are deficient in.

Omega-3 Fatty Acids | Essential fatty acids increase tumor necrosis factor and increase the removal of fat-soluble toxins such as pesticides from the body. Omega-3 fatty acids also produce anti-inflammatory effects and studies have connected them to cancer prevention and enhancement of antitumor therapies. The omega-3 fatty acids found in fatty fish, flaxseed and fish oil also increases the number of cell membranes which will ensure the biochemical functioning of the cells. Ensure you’re choosing wild-caught fish and grind up your flax seeds prior to consuming. This will promote the highest amount of nutrients and optimal absorption.

Carotenoids & Antioxidants | Carotenoids are the pigments that give fruits and vegetables their bright orange, vibrant yellow and green colors. Brightly colored fruit and vegetables such as carrots, kale, cantaloupe, mango, kale, broccoli, sweet potato, etc act as antioxidants that have strong cancer-fighting properties. These antioxidants protect the cells from free radical and other dangers that thrive on destroying cell membranes and DNA. Furthermore, some carotenoids (carrots, especially) are also converted to vitamin A which is necessary for cell growth and good eyesight. These foods are more effective when cooked, but be careful not to overcook them. A simple steam or roasted in the oven with a little olive oil and pink Himalayan salt should be sufficient enough.

Cruciferous Vegetables | Cruciferous vegetables contain indoles which are incredibly protective against cancer. Indoles support estrogen turnover and can protect against breast and ovarian cancer. They also increase the production of glutathione peroxide antioxidant enzymes. Furthermore, broccoli contains sulforaphane which will activate enzymes that remove cell carcinogens.

Curcumin | Is found in turmeric and causes cancer cell apoptosis or death. It’s also only toxic to cancer cells and not normal cells. To increase curcumins bioavailability, combine it with coconut oil and/or black pepper.

Onion & Garlic | These stimulate the natural protection against tumors. Onions and garlic contain allyl-sulfurs which aid in liver detoxification and prevent oxidative damage.

Mushrooms | Reishi, shiitake and maitake mushrooms contain polysaccharide beta-glucan which stimulates the immune system. This is important for cell communication and for normal T-cell function. This substance is also found in vine-ripened fruit and vegetables but is particularly high in Chinese mushroom sand astragalus which is an adaptogenic herb.

Cultured Dairy Products | These contain lactobacilli, a probiotic that increases the production of interferon that raises the level of natural killer cells and block production of carcinogenic substances in the colon. Purchasing or making your own cultured milk, yogurt or butter is a healthier and beneficial option. Pasteurized milk is heated to a high heat to kill any bad bacteria, but it also kills all the good bacteria too that is beneficial for the intestines microflora. If dairy doesn’t agree with your digestive system, you could make your own coconut yogurt or choose lactobacilli probiotic supplement.

Homemade Juice | Short, repeated and intermittent cleanse are sometimes advised for those with cancer, and can be beneficial for other areas of the body too. A good choice is freshly juiced red beet, carrot, green leafy vegetables, grapes, and lemon. This is incredibly rich in antioxidants and minerals.

Meal Plan Example

You’re probably incredibly overwhelmed and wondering how to integrate all these foods into your diet. A simple tip I love is to follow the Rainbow Diet; eat as many colors of the rainbow at each meal.

For breakfast, try organic unsweetened yogurt, berries, and top it off with some flax seeds and nuts.

Lunch could be leftovers from dinner or even a simple salad or roasted vegetables with a protein source like organic chicken or free-range eggs.

For dinner, try a massaged kale salad with roasted sweet potato, tomatoes, mushrooms and baked turmeric and lemon salmon.

Snacks should be high in protein and good fats. If you need the extra energy you could also choose a complex carbohydrate. Raw or lightly steamed vegetables and hummus, apple slices, cinnamon and almond butter, or a handful of nuts, blueberries, and raspberries make the perfect satiating snacks.

Lifestyle Tips

Michael T Murray, ND, and Joseph Pizzorno, MD, author of the Encyclopedia of Natural Medicine state that the four cornerstones of good health are:

  1. A positive mental attitude.
  2. A healthful lifestyle
  3. A health-promoting diet
  4. Supplementary measures

Focusing on these four foundations provides the strongest general protection against cancer. Choosing organic and locally grown produce is always encouraged whenever possible but it can get expensive and limit options. Below is a simple guide when choosing if you should purchase organic or conventional, otherwise known as the: clean fifteen and dirty dozen.

Dirty Dozen

  1. Celery
  2. Peaches
  3. Strawberries
  4. Apples
  5. Blueberries
  6. Nectarines
  7. Bell Peppers
  8. Spinach, Kale and Collard Greens
  9. Cherries
  10. Potatoes
  11. Imported Grapes
  12. Lettuce

Clean Fifteen

  1. Onions
  2. Avocados
  3. Sweet Corn
  4. Pineapples
  5. Mango
  6. Sweet Peas
  7. Asparagus
  8. Kiwi
  9. Cabbage
  10. Eggplant
  11. Watermelon
  12. Grapefruit
  13. Sweet Potatoes
  14. Sweet Onions
  15. Cantaloupe

The reasoning behind the dirty dozen and the clean fifteen (foods that fight cancer) is that the dirty dozen produce don’t have a layer of skin that protects it from pesticides. While it’s still important to wash produce, it’s impossible to wash off any pesticides that were sprayed on the farm. The key component of preventing cancer is to avoid cigarettes, drugs, exercising regularly and consuming alcohol in moderate amounts of not at all. While consuming whole foods vegetables, fruit, grains, nuts and seeds, organic meat and wild-caught fish.

References

The Encyclopedia of Natural Medicine Michael T Murray, ND, and Joseph Pizzorno, MD

Pathology The Canadian School of Natural Nutrition

Diet and Cancer, Acta Biomed. 2006 Aug; https://www.ncbi.nlm.nih.gov/pubmed/17172193

https://www.rd.com/health/conditions/10-foods-to-help-prevent-cancer/

https://www.rodalesorganiclife.com/food/acrylamide

What Cancer Therapy Is Good To Evaluate As A Second Opinion?

18 Jun 2018 Cancer

Are you looking for a second or third opinion of the cancer therapy for your beloved family member or yourself? If so, knowing the history of immunotherapy can be quite beneficial. That’s because immunotherapy has now been fully accepted by the medical profession as a viable treatment of cancer. Yet many doctors are unable to use this type of cancer therapy due to lack of training. It’s not part of the normal curriculum at medical school.

The First Medical Innovation That Led to Immunotherapy

Immunotherapy as a cancer therapy didn’t spontaneously evolve without any previous medical milestones. Actually, what happened first was that the development of vaccination procedures in the 18th and 19th centuries showed medical doctors proof that only 1-2% of smallpox victims would die from the horrendous disease. Those not vaccinated were shoveled into graves at a rate of 36% of those who had contracted the disease. This early vaccine demonstrated that immunity to smallpox was possible and plausible.

Other vaccinations were created after a revelation in medical ideology occurred, such as when Antonio Bassi proposed the idea that microbes caused disease in 1844. Some of those diseases included rabies, cholera, typhoid, diphtheria, pertussis, TB, and tetanus. After 1930, vaccines for different viruses such as yellow fever, flu, polio, measles, mumps and rubella were developed, and are still used today.

The field continued to develop, and through the 1980s, molecular biology, medicinal chemistry and immunological advancements were incorporated, releasing vaccines for prevention of meningitis and pneumonia due to the Pneumococcus bacteria as well as hepatitis B. This led to the idea that perhaps the immune system could be instrumental in fighting cancer in the 1980s.

It wasn’t the first time the idea about the tie between the immune system and cancer treatment had emerged. In the late 1800s, William B. Coley, a surgeon, was taken aback when his patient died of a sarcoma (solid tumor) that had metastasized. At that time, cancer centers and treatment centers for cancer were only thinking of poisoning the tumor or cutting it out. Cancer diagnosis didn’t include testing the immune system.

Coley bravely thought outside the box that perhaps immunotherapy would work and then vetted his idea with 47 case studies in the medical literature that gave him a clue that infection at the same time as cancer in these patients was responsible for the total turnaround of incurable cancers. He found that a Streptococcus infection in the deep layer of the skin called the dermis caused a remission of sarcomas.

When he vaccinated his sarcoma patients with heat-killed S. pyogenes and S. marcecsens bacteria (a Gram-positive and Gram-negative bacteria, respectively), he found that the immune system was stimulated. Other doctors cancer treatments couldn’t come close to his excellent long-term success cure rates. Interestingly, Dr. Coley’s immunotherapy-based cancer treatment remained unrivaled by medical science for 81 years after his death in 1936.

The only problem with Coley’s cancer treatment in his time was that he couldn’t explain it medically. Science hadn’t caught up to provide the biological basis of it. However, his discovery led researchers to uncover the following:

  • signaling factors that occur in the body that modulate immune function
  • receptors inside the body that detect infectious organisms through pattern recognition
  • checkpoint inhibitors inside the body that are used to affect cancer treatments

Cancer Therapy Now May Include Other Ways to Stimulate the Immune System

Doctors at cancer centers have found that cells that suppress the immune system surround certain types of cancers as if they were guarding the tumor. When this happens, the patient with cancer can’t really make any headway against the cancer. The purpose of the immune system is to fight any foreign invaders, cancer cells included.

When certain types of cancer treatments are used as therapy, it’s possible to activate the immune system. As examples, cryoablation, radiofrequency ablation (RFA), microwave ablation (MWA) and focused ultrasound (FUS) are the treatments for cancer that do exactly that. What these methods do is use cold, heat, ultrasound or radio waves to make the tumor implode/explode. The tumor is literally destroyed.

How These Cancer Treatments Really Work

But there’s something else that is happening with these cancer treatments. Ablation ends up making the protein antigens from the tumors available for the creation of a cancer vaccine right there in the area where the tumor was. The immune system is stimulated, and now the body can cause an all-out immune system response that has effects throughout the entire body.

If there were any additional tumors that started growing in other places of the body, the immune system will attack them. The process whereby a cancer treatment applied in one area of the body ends up causing the breakdown of other tumors in the body is called the abscopal effect. The effect has to be combined with other immunotherapies to be more effective and produce long-term anti-tumor effects by stimulating immunity.

Difference Between Ablation and Surgery

Ablation therapies have a goal similar to that of surgical resection where the tumor is removed. However, there is a difference between the two. Surgery removes the tumor as best as it can; ablation leaves the tumor material at the site.

Of course, most of the tumor has been destroyed, but fragments still remain. It’s the fragments that cause the triggering of the immune system and the subsequent destruction of any metastases. Surgery doesn’t do this.

What is Cryoablation and What are DAMPs?

Cryoablation creates a freeze-thaw cycle in the tumor via argon gas. It causes death of the cells, but the cells release antigens, damaged heat shock proteins, and damaged DNA. The damaged cells are also called damage associated molecular patterns or DAMPs for short.

The dendritic cells that eat up these damaged cells activate a part of the immune system that creates the expression of CD80/86 molecules, which in turn stimulates T cells in the body and ends up causing the immune system response in the entire body.

Some researchers call the process of cryotherapy loading up the dendritic cells with the antigens an in vivo dendritic cell vaccine. The words in vivo mean inside the body. Thus, the meaning of the whole term is that the body is creating its own vaccine, orchestrated by the dendritic cells. This whole process is quite intricate and amazing!

Researchers have also noted that the activation of the immune system by cryoablation is the most powerful type of ablation cancer treatment. Why? It’s because this cancer treatment actually creates the highest levels of immune system fighter cells, such as the interleukin-1 (IL-1), IL-6, NF-xB, and tumor necrosis factor-alpha.

At the site of the cryoablation therapy, the cold temperature causes the death of the tumor cells, too. These dead cells release protein antigens that the dendritic cells pick up.

The only difference is that the DAMPs won’t be released in the process. Without the DAMPs the immune system is not activated and may be suppressed. This is why it is said that cryoablation alone can cause stimulation or suppression of the immune system. It’s also the reason why cryoablation should be combined with immunotherapy. With the addition of immunotherapy techniques, they can avoid the suppression of the immune system.

How Radiofrequency Ablation Works

Radiofrequency ablation causes cell death by the heat produced in the process plus the death of the cells. When the cells die, they release the antigens and DAMPs. The dendritic cells pick up the damaged cell parts and cause the stimulation of the immune system throughout the whole body.

This cancer treatment causes a persistent increase in the antibodies against the tumor cells; however it also causes lower levels of oxygen that ends up making cancer cells that escaped from the area to grow in new locations. For this reason, doctors and scientists are combining immunotherapies to boost the immune system when radiofrequency ablation is used.

How Microwave Ablation and Focused Ultrasound Work

Microwave ablation uses an electromagnetic field that oscillates to release heat that damages cells cancerous and normal cells. The immune system response is a lot less than the previously mentioned treatments for cancer. Thus, few studies have attempted to look at what results would be like when microwave ablation is combined with immunotherapies.

Focused ultrasound, when it’s the high intensity version, causes death of the cells at a focal point. The cells die outright, and cells nearby as well my die. Antigens of the tumor cells and heat shock proteins as well as DAMPs will then stimulate the body’s immune system. This cancer treatment offers minimal immune system stimulation compared to cryoablation and radiofrequency ablation.

Different Types of Immunotherapies

Pharmaceutical drugs have been created for use as immunotherapy during cancer treatment. There are two categories of these agents: 1) those that activate the body’s innate immune system processes, and 2) those that activate the body’s adaptive immune system processes.

The innate part of the immune system responds rapidly because it uses pattern recognition to identify the cells to attack. The body’s adaptive immune system refers to the long-term memory of the immune system cells to attack invaders that have already been dealt with in the past.

For example, if you ever had a Staph infection, your body would develop antibodies against the type of Staph you, and store this knowledge in its data banks. When faced with the Staph bacteria again, your body’s cells would recognize it and then fight against it heartily.

Checkpoint inhibitors target the body’s adaptive immune response. There are regulatory checkpoints that prevent the activation of the immune system to occur inappropriately. When doctors inhibit these checkpoints, the immune system revs up its boosting powers. Checkpoint inhibitors have been approved for the treatment of the following:

  • melanoma
  • bladder cancer
  • Hodgkin’s lymphoma
  • Merkel cell carcinoma
  • solid tumors
  • renal cell carcinoma

One Stanford study showed that when a checkpoint inhibitor called anti-CTLA4 antibody was injected, there was toxicity to the immune system, but once it was used locally in low doses, the results were much better. It triggered a tumor attack throughout the entire body without toxicity to other organs.

In 2013, Fransen et al published medical research in the Clinical Cancer Research journal proving that CTLA-4 inhibitor antibody, when used in a slow release formula, was a very effective way to activate the T cell response that causes anti-tumor effects. A very small dose was used only one-eighth of the regular dose used in the past which ended up giving excellent results. The dose decreased the chance of any side effects.

Summary

From this discussion of how immunotherapy started to how different cancer treatments affect the immune system and finally including how specific types of immunotherapies work, you can see why Williams Cancer Institute is excited about the possibilities. They’ve been used ablation combined with immunotherapy for several years now, and getting excellent results. It’s because the cancer treatments used make sense.

If you or a loved one are looking for a second opinion, give them a call at Williams Cancer Institute.

Resources

Decker, William K.; da Silva, Rodrigo F.; Sanabria, Mayra H.; Angelo, Laura S.; Guimaraes, Fernando; Burt, Bryan M., and Kheradman, Farrah. Cancer Immunotherapy: Historical Perspective of a Clinical Revolution and Emerging Preclinical Animal Models. Front Immunol 2017;8:829. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539135/

Mehta A, Oklu R, Sheth RA. Thermal Ablative Therapies and Immune Checkpoint Modulation: Can Locoregional Approaches Effect a Systemic Response? Gastroenterol Res Pract. 2016;2016:9251375.

Chu KF, Dupuy DE. Thermal Ablation of Tumours: Biological Mechanisms and Advances in Therapy. Nat Rev Cancer. 2014;14(3):199 208.

van den Bijgaart RJE, et al. Thermal and Mechanical High-Intensity Focused Ultrasound: Perspectives on Tumor Ablation, Immune Effects and Combination Strategies. Cancer Immunol Immunother. 2017;66(2):247 58.

Bandyopadhyay S, et al. Low-Intensity Focused Ultrasound Induces Reversal of Tumor-Induced T Cell Tolerance and Prevents Immune Escape. J Immunol. 2016;196(4):1964 76.

Ng J, Dai T. Radiation Therapy and the Abscopal Effect: a Concept Comes of Age. Annals of Translational Medicine. 2016;4(6):118.

Sabel MS, et al. Rate of Freeze Alters the Immunologic Response After Cryoablation of Breast Cancer. Ann Surg Oncol. 2010;17(4):1187 93.

Marabelle, Aurelien; Kohrt, Holbrook; and Levy, Ronald. Intratumoral anti-CTLA-4 Therapy: Enhancing Efficacy While Avoiding Toxicity. Clin Cancer Res 2013 October 1;19(19). http://28risi1k3a541b3d3m2ufwoh-wpengine.netdna-ssl.com/wp-content/uploads/2017/05/intratumoralCTLA4.pdf

Fransen, Marieke F.; van der Sluis, Tetie C.; Ossendorp, Ferry; Arens, Ramon; and Melief, Cornelius. Controlled Local Delivery of CTLA-4 Blocking Antibody Induces CD8+ T-Cell-Dependent Tumor Eradication and Decreases Risk of Toxic Side Effects.

Immune-Stimulating Injection Eliminates Cancer Tumors In Mice

18 Jun 2018 Cancer

Injecting small amounts of two immune-stimulating agents into tumors in mice has shown to be able to eliminate the tumor, other untreated metastases and all traces of the same cancer according to a study by researchers at the Stanford University School of Medicine.

The Stanford researchers found activating T cells in tumors eliminated even distant metastases in mice, the technique been tested on mice with lymphoma, breast, colon and melanoma tumors. An interesting effect of activating the T cells not only impacts on the specific tumor. The activated T cells then leave the original tumor and can find and destroy other identical tumors in other areas throughout the body.

Professor of oncology,Ronald Levy, MD said: When we use these two agents together, we see the elimination of tumors all over the body. This approach bypasses the need to identify tumor-specific immune targets and doesn’t require wholesale activation of the immune system or customization of a patient’s immune cells.

Research continues with this finding and testing with clinical trials has been proposed. Lymphoma patients for a clinical trail is being planned to test the technique. The current clinical trial is expected to recruit about 15 patients.

Read the complete Stanford Medicine article.

Women Told Immunotherapy Would Not Cure Cancer, Doctors Were Wrong

Four young women had an extremely rare, aggressive and fatal form of ovarian cancer. They where not expected to live much longer as there was no standard treatment. These women, living in different countries, asked their doctors to try using new immunotherapy drugs for the treatment of the cancer. They were told the drugs were not a treatment for the ovarian cancer. The women where able to get the immunotherapy treatment and their cancers went into remission. It looks as if the doctors were wrong in these cases for immunotherapy being a successful treatment.

The women managed to successfully have the immunotherapy treatment, and have now returned to work and their lives returned to a state of normalcy after having this aggressive form of cancer. Scientists are struggling to understand why the drugs worked when they should have not been effective to treat the ovarian cancer. If researchers can figure out why it worked in these cases, it may open the door to new treatments for other cancers that have not been thought not to respond to immunotherapy treatments.

Read the entire New York Times Article.

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