From MayoClinic.com
Special to CNN.com

After your cancer treatment, you were eager to nurse your body back to health. But beyond your initial recovery, you might be interested in ways to improve your long-term health so that you can enjoy the years ahead as a cancer survivor.

The advice for cancer survivors is no different than the advice for anyone who wants to improve their health: Exercise and improve your diet. But for cancer survivors these strategies have added benefits — research shows these simple steps can improve your quality of life, smoothing your transition into survivorship. Follow this guide to what you can do to take care of your body after cancer treatment.

Exercise

Regular exercise increases your sense of well-being after cancer treatment and can speed your recovery. Cancer survivors who exercise often experience:

• Increased strength and endurance
• Stronger immune systems
• Fewer signs and symptoms of depression
• Less anxiety
• Reduced fatigue
• Less difficulty sleeping
• Improved mood
• Higher self-esteem

Adding physical activity to your daily routine won’t take a lot of extra work. Focus on small steps to make your life more active. Take the stairs more often or park farther from your destination and walk the rest of the way. Check with your doctor before you begin any exercise program.

With your doctor’s approval, start slowly and work your way up. The American Cancer Society recommends adult cancer survivors exercise for at least 30 minutes five or more days a week. As you recover and adjust, you might find more exercise makes you feel even better.

Sometimes you won’t feel like exercising, and that’s OK. Don’t feel guilty if lingering treatment side effects, such as fatigue, keep you sidelined. When you feel up to it, take a walk around the block. Do what you can, but know that rest is important to your recovery as well.

While exercise has many benefits, there’s no evidence that exercise can keep your cancer from coming back. Many cancer survivors are concerned about cancer recurrence and want to do all they can to avoid it. It’s not clear why cancer recurs in some people but not in others. Exercise won’t stop your cancer from recurring, but it can make you feel better and help prevent other diseases, such as heart disease.

Eat a balanced diet

Vary your diet to include lots of fruits and vegetables, as well as whole grains. When it comes to selecting your entrees, the American Cancer Society recommends that cancer survivors:

• Eat five or more servings of fruits and vegetables every day
• Choose healthy fats, including omega-3 fatty acids, rather than saturated fats or trans fats
• Select proteins that are low in saturated fat, such as fish, lean meats, eggs, nuts, seeds and legumes
• Opt for healthy sources of carbohydrates, such as whole grains, legumes, and fruits and vegetables

This combination of foods will ensure that you’re eating plenty of the vitamins and nutrients you need to help make your body strong.

While it may be tempting to supplement your diet with a host of vitamin and mineral supplements, resist that urge. Some cancer survivors think that if a small amount of vitamins is good, a large amount must be even better. But that isn’t the case. In fact, large amounts of certain nutrients can hurt you. If you’re concerned about getting all the vitamins you need, ask your doctor if taking a daily multivitamin is right for you.

No special diet is known to prevent cancer from recurring. However, some preliminary research in breast cancer survivors indicates that a low-fat diet may reduce the chance of breast cancer recurring. In this study, which has yet to be completed, it isn’t clear whether the slight reduction in breast cancer recurrence was from women eating less fat or from women losing weight on the restricted diet. It also isn’t clear if a low-fat diet has any application to other cancer survivors.

Maintain a healthy weight

You may have gained or lost weight during treatment. Try to get your weight to a healthy level. Talk to your doctor about what a healthy weight is for you and the best way to go about achieving that goal weight.

For cancer survivors who need to gain weight, this will likely involve coming up with ways to make food more appealing and easier to eat. You and your doctor can work together to control nausea, pain or other side effects of cancer treatment that are preventing you from getting the nutrition you need. Losing even more weight can reduce your quality of life and make recovery more difficult.

For cancer survivors who need to lose weight, take steps to lose weight slowly — no more than 2 pounds a week. Control the number of calories you eat and balance this with exercise. If you need to lose a lot of weight, it can seem daunting. Take it slowly and stick to it. Any amount of weight loss can help you feel better about yourself and improve your health.

Stop using tobacco

Kick the habit once and for all. Smoking or using chewing tobacco puts you at risk of several types of cancer. Stopping now could reduce your risk of cancer recurrence and also reduce your risk of developing a second type of cancer (second primary cancer).

If you’ve tried quitting in the past but haven’t had much success, seek help. Talk to your doctor about resources to help you quit.

Drink alcohol in moderation, if at all

If you choose to drink alcohol, keep it to a minimum. At most, women and anyone over 65 should drink no more than one drink a day, and men should drink no more than two drinks a day.

Alcohol does have health benefits in some people — for instance, consuming a drink or two a day can reduce your risk of heart disease. But it also increases the risk of certain cancers, including those of the mouth, throat, liver and breast. While it isn’t clear whether drinking alcohol can cause cancer recurrence, it can increase your risk of a second primary cancer.

Weigh the risks and benefits of drinking alcohol carefully and talk it over with your doctor.

Do what you can

While you may fear it will take an entire overhaul of your lifestyle to achieve all these goals, do what you can and make changes slowly. Easing into a healthy diet or regular exercise will make it more likely that you’ll stick with these changes for the rest of your life.

· Cancer survivors: What to expect with follow-up care

· On the job with cancer: Managing common workplace challenges

· Cancer survivors: Relationships with family and friends after treatment

· Cancer survivors: Late effects of cancer treatment

· Cancer survivors: Managing your emotions after cancer treatment

· Sexuality after cancer treatment: What women can expect

· Sexuality after cancer treatment: What men can expect

· Cancer recurrence: What it means and how to cope

October 05, 2005

Cancer pain: Relief is possible

From MayoClinic.com
Special to CNN.com

Not everyone with cancer experiences cancer pain, but one of out three does. If you have advanced cancer — cancer that has spread or recurred — your chance of experiencing cancer pain is even higher.

Cancer pain strikes in many ways. Your pain may be dull, aching or sharp. It could be constant, intermittent, mild, moderate or severe. Timothy Moynihan, M.D., a cancer specialist at Mayo Clinic, Rochester, Minn., offers some insight into cancer pain, reasons why people might not get the pain treatment they need and what they can do about it.

What causes cancer pain?

Cancer pain can result from the cancer itself. Cancer can cause pain by growing into or destroying tissue anywhere near the cancer. Cancer pain can come from the primary cancer itself — where the cancer started — or from other areas in the body where the cancer has spread (metastases). As a tumor grows, it may put pressure on nerves, bones or other organs, causing pain.

Recent research has shown that cancer pain may not just be from the physical effect of the cancer on a region of the body, but also due to chemicals that the cancer may secrete in the region of the tumor. Treatment of the cancer can help the pain in these situations.

Cancer treatments — such as chemotherapy, radiation and surgery — are another potential source of cancer pain. Surgery can be painful, and it may take time to recover. Radiation may leave behind a burning sensation or painful scars. And chemotherapy can cause many potentially painful side effects, including mouth sores, diarrhea and nerve damage.

How do you treat cancer pain?

There are many different ways to treat cancer pain. The ideal way is to remove the source of the pain, for example, through surgery, chemotherapy, radiation or some other form of treatment. If that cannot be done, pain medications can usually control the pain. These medications include:

• Analgesics, such as aspirin or acetaminophen (Tylenol, others)
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others)
• Weak opioid (derived from opium) medications, such as codeine
• Strong opioid medications, such as morphine, oxycodone, hydromorphone, fentanyl or methadone

These drugs can often be taken orally, so they’re easy to use. However, it you’re unable to take medications orally, they may also be taken intravenously, rectally or through the skin using a patch.

In September 2006 the Food and Drug Administration approved a new form of the opioid fentanyl (Fentora) that dissolves in your mouth. This medication may be particularly effective for intermittent pain episodes, which are sometimes called “incident pain.” These fentanyl tablets dissolve rapidly, and the drug is absorbed through the lining of your mouth.

Specialized treatment, such as nerve blocks, also may be applicable. Nerve blocks are a local anesthetic that is injected around or into a nerve, which prevents pain messages traveling along that nerve pathway from reaching the brain. Other therapies, such as acupuncture, acupressure, massage, physical therapy, relaxation, meditation and humor, may help.

In your experience, what are some reasons for not receiving adequate treatment for cancer pain?

Unfortunately cancer pain is often undertreated. There are many factors behind that, some of which include:

• Physician knowledge. One factor has to do with a physician’s knowledge and ability to treat and recognize pain. Some physicians and other health care professionals may not specifically ask about pain, which should be a normal part of every cancer patient’s visit. Cancer patients should be asked if they are having any pain. If they are, the physician should stop there and deal with the issue. Some doctors don’t know enough about proper pain treatment. If this is the case, your doctor might refer you to a pain specialist.
• Patient reluctance. A second factor might be a patient’s own reluctance. Some people might not want to “bother” their doctors with the information, or they may fear that the pain means that their cancer is getting worse. Some are reluctant to report it or report it as thoroughly as they should because they’re worried about what doctors or other people might think of them if they complain. They might feel that because they have cancer, they’re supposed to have pain and be able to deal with it. That simply isn’t true.
• Fear of addiction. Another factor might be a person’s fear of becoming addicted to the pain medications. This is something that we know doesn’t typically happen if you take medications for pain. If you take them when you’re not in pain or to get high, then, yes, you can get addicted. But the risk of addiction for people who take pain medications in an appropriate fashion — for pain — is very low, so this shouldn’t be a concern.
• Fear of side effects. Some people fear the side effects of pain medications. Many are afraid of being sleepy, unable to communicate with family and friends, acting strangely, or being seen as dependent on medications. People are also sometimes afraid that taking morphine may shorten their life. There is no evidence of any of these happening if the medication is dosed appropriately. And although strong pain medications can cause drowsiness when you first take them, that side effect usually goes away with steady dosing.

What side effects can you expect from cancer pain treatment, and what can you do about them?

Each pain treatment may be accompanied by its own unique side effects. For example, radiation treatments may cause redness and a burning sensation of the skin. And, depending on what part of the body the radiation is applied to, the radiation may cause diarrhea, mouth sores or other problems, such as fatigue. Chemotherapy certainly can cause side effects, such as nausea, fatigue, infection and hair loss, but it can be effective in relieving pain if it shrinks the tumor. There are medications to help with nausea. Relaxation techniques also may help.

Pain medications each have their own unique side effects that should be reviewed with your physician before taking them. One of the common side effects of the stronger pain medicines is constipation — common to opioids. It can be treated with appropriate bowel regimens as prescribed by your doctor, such as adding a stool softener and something to stimulate the bowels. Preventing constipation is much easier than treating it, so anyone who takes these strong pain medications should automatically begin a regimen to keep their bowels moving. Some of the other side effects of the strong pain medications include confusion, lethargy and sleepiness. The severity of these effects varies from person to person and commonly occurs with the first several doses. But once a steady amount of the medicine stays in your body, the side effects usually resolve. Hallucinations and behavior changes are uncommon.

The less potent pain medications actually may have more side effects, which also should be discussed with your physician before taking them. For instance, anti-inflammatory drugs might damage your kidneys, cause ulcers or increase your blood pressure. Aspirin can cause gastrointestinal bleeding, and acetaminophen (Tylenol, others) can cause liver damage if you take too much.

When should you discuss cancer pain with your doctor, and what points should you bring up?

Report any bothersome pain to your physician. If there is a minor pain that goes away, don’t worry about it. But if the pain interferes with your life or is persistent, it needs to be reported and should be treated. Although no one can guarantee that all pain can be completely eliminated, most pain can be lessened to the point where you can be comfortable.

It may help to keep track of your pain by noting how strong it is, where it’s located, what makes it worse, what brings it on, what makes it better and anything else that happens when you have the pain. A pain-rating scale from 0 to 10 — with 0 being no pain and 10 being the worst pain you can imagine — may be helpful in reporting pain to your doctor. In addition, pay attention to what happens when you attempt to relieve your pain. If you take medicine, do you feel any ill effects from it? If it’s a massage or something physical that relieves the pain, those therapies are important to report, too. Note whether they cause any ill effects.

What steps can you take to make sure you’re receiving adequate cancer pain treatment?

First, you need to talk to your doctor or health care provider if you’re having pain. Second, you and your doctor should set a goal for pain management and monitor the success of the treatment against that goal. Your doctor should track the pain with a pain scale, assessing how strong it is. The goal should be to keep the pain at a level with which you’re comfortable. If you aren’t achieving that goal, talk to your physician. If you’re not getting the answers you need, request a referral to a facility more skilled in the care of pain, particularly a major cancer center. All major cancer centers have pain management programs. For the most part, the medications and treatment for pain are covered by standard insurance.

The immune system is the system of specialized cells and organs that protect an organism from outside biological influences.

If the immune system weakens, its ability to defend the body also weakens, allowing pathogens, including viruses that cause common colds and flu, to grow and flourish in the body.

The immune system also performs surveillance of tumor cells, and immune suppression has been reported to increase the risk of certain types of cancer..

For more information about the topic Immune system, read the full article at Wikipedia.org, or see the following related articles:

Natural killer cell — Natural killer cells (also known as NK cells, K cells, and killer cells) are a type of lymphocyte (a white blood cell) and a component of innate …  > read more

White blood cell — White blood cells (also called leukocytes or immune cells) are cells which form a component of the blood. They help to defend the body against …  > read more

T cell — T cells are a subset of lymphocytes that play a large role in the immune response. The abbreviation “T” stands for thymus, the organ in which their …  > read more

Antiviral drug — Antiviral drugs are a class of medication used specifically for treating viral infections. Like antibiotics, specific antivirals are used for …  > read more

Note: This page refers to an article that is licensed under the GNU Free Documentation License. It uses material from the article Immune system at Wikipedia.org. See the Wikipedia copyright page for more details.

ScienceDaily (June 30, 2008) — Scientists at Wake Forest University Baptist Medical Center are about to embark on a human trial to test whether a new cancer treatment will be as effective at eradicating cancer in humans as it has proven to be in mice.

The treatment will involve transfusing specific white blood cells, called granulocytes, from select donors, into patients with advanced forms of cancer. A similar treatment using white blood cells from cancer-resistant mice has previously been highly successful, curing 100 percent of lab mice afflicted with advanced malignancies.

Zheng Cui, Ph.D., lead researcher and associate professor of pathology, will be announcing the study June 28 at the Understanding Aging conference in Los Angeles.

The study, given the go-ahead by the U.S. Food and Drug Administration, will involve treating human cancer patients with white blood cells from healthy young people whose immune systems produce cells with high levels of cancer-fighting activity.

The basis of the study is the scientists’ discovery, published five years ago, of a cancer-resistant mouse and their subsequent finding that white blood cells from that mouse and its offspring cured advanced cancers in ordinary laboratory mice. They have since identified similar cancer-killing activity in the white blood cells of some healthy humans.

“In mice, we’ve been able to eradicate even highly aggressive forms of malignancy with extremely large tumors,” Cui said. “Hopefully, we will see the same results in humans. Our laboratory studies indicate that this cancer-fighting ability is even stronger in healthy humans.”

The team has tested human cancer-fighting cells from healthy donors against human cervical, prostate and breast cancer cells in the laboratory — with surprisingly good results. The scientists say the anti-tumor response primarily involves granulocytes of the innate immune system, a system known for fighting off infections.

Granulocytes are the most abundant type of white blood cells and can account for as much as 60 percent of total circulating white blood cells in healthy humans. Donors can give granulocytes specifically without losing other components of blood through a process called apheresis that separates granulocytes and returns other blood components back to donors.

In a small study of human volunteers, the scientists found that cancer-killing activity in the granulocytes was highest in people under age 50. They also found that this activity can be lowered by factors such as winter or emotional stress. They said the key to the success for the new therapy is to transfuse sufficient granulocytes from healthy donors while their cancer-killing activities are at their peak level.

For the upcoming study, the researchers are currently recruiting 500 local potential donors who are 50 years old or younger and in good health to have their blood tested. Of those, 100 volunteers with high cancer-killing activity will be asked to donate white blood cells for the study. Cell recipients will include 22 cancer patients who have solid tumors that either didn’t respond originally, or no longer respond, to conventional therapies. The study will cost $100,000 per patient receiving therapy, and for many patients (those living in 22 states, including North Carolina) the costs may be covered by their insurance company. There is no cost to donate blood.

For more information about qualifications for donors and participants, go to http://www.wfubmc.edu/LIFT (Web site will be available the evening of 6/27.) Cancer-killing ability in these cells is highest during the summer, so researchers are hoping to find volunteers who can afford the therapy quickly.

“If the study is effective, it would be another arrow in the quiver of treatments aimed at cancer,” said Mark Willingham, M.D., a co-researcher and professor of pathology. “It is based on 10 years of work since the cancer-resistant mouse was first discovered.”

Volunteers who are selected as donors — based on the observed potential cancer-fighting activity of their white cells — will complete the apheresis, a two- to three-hour process similar to platelet donation, to collect their granulocytes. The cancer patients will then receive the granulocytes through a transfusion — a safe process that has been used for more than 30 years. Normally, the treatment is used for patients who have antibiotic-resistant infectious diseases. The treatment will be given for three to four consecutive days on an outpatient basis. Up to three donors may be necessary to collect enough blood product for one study participant.

“The difference between our study and the traditional white cell therapy is that we’re selecting the healthy donors based on the cancer-killing ability of their white blood cells,” said Cui. The scientists are calling the therapy Leukocyte InFusion Therapy (LIFT).

The goal of the phase II study is to determine whether patients can tolerate a sufficient amount of transfused granulocytes for the treatment. Participants will be monitored on a regular basis, and after three months scientists will evaluate whether the treatment results in clear clinical benefits for the patients. If this phase of the study is successful, scientists will expand the study to determine if the treatment is best suited to certain types of cancer.

Yikong Keung, M.D., a medical oncologist, is the chief clinical investigator of the study. Gregory Pomper, M.D., assistant professor of pathology and the director of the Wake Forest Baptist blood bank, will oversee the blood banking portion of the study.

ScienceDaily (July 11, 2008) — Medical science may be a significant step closer to climbing into the driver’s seat of an important class of immune cells, researchers at Washington University School of Medicine in St. Louis report in Nature Immunology.

The researchers showed that a single protein, HS1, enables key functions of natural killer (NK) cells, which kill early cancers and fight off viral infections. The protein allows the NK cells to pursue their targets, latch on to them and configure the cellular machinery it uses to kill them.

“Further study of how HS1 controls these processes may open up new possibilities for revving up the NK cells to fight infection and cancer,” says senior author John Cooper, M.D., Ph.D., professor of cell biology and physiology. “We also may be able to use this same protein to inhibit the activities of other immune cells and prevent them from contributing to autoimmune conditions such as diabetes.”

Cooper, who is a member of the Siteman Cancer Center at Washington University and Barnes-Jewish Hospital, studies how different types of cells use a primary component of their skeletal system known as an actin network. Earlier, his laboratory had probed the role of a protein called cortactin in specialized cells that break down bones. They showed that cortactin’s effects on the actin network made it possible for the cells to form a tightly sealed bond with bones.

“This bond is analogous to a plunger,” says first author Boyd Butler, Ph.D., a postdoctoral fellow in Cooper’s laboratory. “The cell sits down on the bone, seals tightly, and then starts secreting the acid and other compounds that break down the bone.”

NK cells have to form a similar plunger-like bond, known as a lytic synapse, with the targets they attack. They do not make cortactin but produce HS1, which is a very similar protein. Butler decided to see what would happen to NK cells in human blood samples if he turned down their ability to make HS1. The resulting cells were severely disabled: They couldn’t effectively pursue target cells, bind to them or prepare to kill them.

Prior research by other scientists had revealed that when NK cells are in motion or attacking a target, HS1 has chemical modifications attached to it at specific points. Giving the NK cells normal HS1 restored their lost functions, but when researchers gave the NK cells HS1 where these attachment points had been altered, the cells were selectively disabled. Changing one attachment point prevented them from pursuing target cells, while changing the other impaired their ability to bind to targets and kill them.

“Tight regulation is very important to prevent NK cells from harming the body’s own tissues,” Boyd says. “This ability to switch where the control signal goes makes HS1 a powerful regulator of NK cell activity–it allows the cells to provide just the right services at the right time.”

Cooper and Boyd plan follow-up studies that will start at the attachment points on HS1 and trace connections with and influences on other proteins.

“NK cells are very good at nipping early cancers in the bud,” says Cooper. “If we can better understand how they’re activated, this could lead us to ways to make them better killers of cancers and cells infected by viruses and other invaders.”

Funding from the National Institutes of Health, the National Institute of Allergy and Infectious Diseases and the Siteman Cancer Center supported this research.

Journal reference:

1. Butler B, Katendieck DH, Cooper JA. Differentially phosphorylated forms of HS1 mediate distinct functions in natural killer cells. Nature Immunology, Online June 29, 2008

Adapted from materials provided by Washington University in St. Louis, via EurekAlert!, a service of AAAS.