#Cancer/Oncology

[aarunresearcher]

The United States IVD market is experiencing robust growth, driven by the increasing prevalence of chronic and infectious diseases, including diabetes, cardiovascular disorders, cancer, and infectious diseases such as COVID-19. This, in turn, has heightened the need for accurate and timely diagnostic tools like IVD, thus creating lucrative growth opportunities for the market. 

[reasonsforhope]

I'm worried about the rising rate of young adults getting cancer.

For what it's worth, we've actually made a shocking amount of progress against cancer - especially the most common cancers like breast cancer, and especially in the past 30 years.

Cancer rates have been falling, often dramatically (x, x, x, x, x, x). One of the best examples it that breast cancer deaths in the United States dropped 58% between 1975 and 2019 (x).

Right now, we're at the beginning of an absolute revolution in cancer care that promises to increase survival rates even further. This revolution has been going on to a lesser degree since the first human genome was successfully sequenced in the early 2000s (and in fact, the first gapless sequencing of a human genome was finally finished just two years ago, in 2022), and to a greater extent since CRISPR DNA-editing technology was first successfully tested in 2013, and since medical digitzation/digital communication and vaccination were massively spurred ahead in 2020, by the COVID pandemic (x, x).

Right now, the results of this revolution are only beginning to trickle out into actual treatments. But I guarantee you, in the next one to three decades, the way we fight cancer will be massively transformed.

We're talking personalized genome sequencing for each person with cancer - not just for early and better detection, but even to figure out what types of treatments will work best. (x, x, x, x)

We're talking using CRISPR-based DNA editing to literally cut cancer-causing mutations out of your DNA, to edit the genes of immune cells to better detect and kill cancer cells, and to kill cancer-causing viruses. (x, x, x, x)

We're talking using CRISPR-based screening to figure out how chemotherapy resistance works, so that we can overcome it - and even weaponize it. (x, x)

We're talking using CRISPR to edit immune cells so that they recognize and target the mutations of a single individual's specific tumor. (x)

We're talking new types of testing that can predict if cancer will return years before it shows up on scans. (x)

We're talking using (non-generative) AI to massively increase the accuracy and earliness of cancer detection - which by the way is already starting to happen, there are several AI-based systems that detect cancer earlier and more accurately than doctors do. (x, x, x, x, x, x)

Also, the more we transition to a green, sustainable, and ethical future, the fewer cancer-causing substances will be in the environment (fossil fuels, oil drilling, and mining are massive sources of carcinogens at every point in the process).

Cancer is awful. That is a massive understatement. But the fight against cancer is one where there are so many reasons for hope.

[mostlysignssomeportents]

How to have cancer

THIS WEEKEND (November 8-10), I'll be in TUCSON, AZ: I'm the GUEST OF HONOR at the TUSCON SCIENCE FICTION CONVENTION.

I've got cancer but it's probably (almost certainly, really) okay. Within a very short period I will no longer have cancer (at least for now). This is the best kind of cancer to have – the kind that is caught early and treated easily – but I've learned a few things on the way that I want to share with you.

Last spring, my wife put her arm around my waist and said, "Hey, what's this on your rib?" She's a lot more observant than I am, and honestly, when was the last time you palpated your back over your left floating rib? Sure enough, there was a lump there, a kind of squishy, fatty raised thing, half a centimeter wide and about four centimeters long.

I'm a 53 year old man with a family history of cancer. My father was diagnosed with lymphatic cancer at 55. So I called my doctor and asked for an appointment to have the lump checked over.

I'm signed up with Southern California Kaiser Permanente, which is as close as you come to the Canadian medicare system I grew up under and the NHS system I lived under for more than a decade. Broadly speaking, I really like KP. Its app – while terrible – isn't as terrible as the other apps, and they've taken very good care of me for both routine things like vaccinations and checkups, and serious stuff, like a double hip replacement.

Around the time of The Lump, I'd been assigned a new primary care physician – my old one retired – and so this was my first appointment with her. I used the KP app to book it, and I was offered appointments six weeks in the future. My new doc was busy! I booked the first slot.

This was my first mistake. I didn't need to wait to see my PCP to get my lump checked over. There was really only two things that my doc was gonna do, either prod it and say, "This is an extremely common whatchamacallit and you don't need to worry" or "You should go get this scanned by a radiologist." I didn't need a specific doctor to do this. I could have ridden my bike down to the KP-affiliated Urgent Care at our local Target store and gotten an immediate referral to radiology.

Six weeks go by, and my doc kind of rolls the weird lump between her fingers and says, "You'd better go see a radiologist." I called the Kaiser appointment line and booked it that day, and a couple weeks later I had a scan.

The next day, the app notified me that radiology report was available in my electronic heath record. It's mostly technical jargon ("Echogenic areas within mass suggest fatty component but atypical for a lipoma") but certain phrases leapt out at me: "malignant masses cannot be excluded. Follow up advised."

That I understood. I immediately left my doctor a note saying that I needed a biopsy referral and set back to wait. Two days went by. I left her a voice message. Another two days went by. I sent another email. Nothing, then a weekend, then more nothing.

I called Kaiser and asked to be switched to another Primary Care Physician. It was a totally painless and quick procedure and within an hour my new doc's intake staff had reviewed my chart, called me up, and referred me for a biopsy.

This was my second mistake. When my doctor didn't get back to me within a day, I should have called up KP and raised hell, demanding an immediate surgical referral.

What I did do was call Kaiser Member Services and file a grievance. I made it very clear that when I visited my doctor, I had been very happy with the care I received, but that she and her staff were clearly totally overloaded and needed some kind of administrative intervention so that their patients didn't end up in limbo.

This is a privilege. I'm a native English speaker, and although I was worried about a serious illness, I didn't have any serious symptoms. I had the ability and the stamina to force action in the system, and my doing so meant that other patients, not so well situated as I was, would not be stuck where I had been, with fewer resources to get un-stuck.

The surgeon who did the biopsy was great. He removed my mass. It was a gross lump of yellowy-red gunk in formaldehyde. He even let me photograph it before it went to pathology (warning, gross):

https://www.flickr.com/photos/doctorow/54038418981/

They told me that the pathology would take 2-5 days. I reloaded the "test results" tab in the KP website religiously after 48 hours. Nothing was updated. After five days, I called the surgical department (I had been given a direct number to reach them in case of postsurgical infections, and made a careful note of it).

It turned out that the pathology report had been in hand for three days at that point, but it was "preliminary" pending some DNA testing. Still, it was enough that the surgeon referred me to an oncologist.

This was my third mistake: I should have called after 48 hours and asked whether the pathology report was in hand, and if not, whether they could check with pathology. However, I did something very right this time: I got a phone number to reach the specialist directly, rather than going through the Kaiser main number.

My oncologist appointment was very reassuring. The oncologist explained the kind of cancer I had ("follicular lymphoma"), the initial prognosis (very positive, though it was weird that it manifested on my rib, so far from a lymph node) and what needed to happen next (a CT/PET scan). He also walked me through the best, worst and medium-cases for treatment, based on different scan outcomes. This was really good, as it helped me think through how I would manage upcoming events – book tours, a book deadline, work travel, our family Christmas vacation plans – based on these possibilities.

The oncologist gave me a number for Kaiser Nuclear Medicine. I called them from the parking lot before leaving the Kaiser hospital and left a message for the scheduler to call me back. Then I drove home.

This was my fourth mistake. The Kaiser hospital in LA is the main hub for Kaiser Southern California, and the Nuclear Medicine department was right there. I could have walked over and made an appointment in person.

Instead, I left messages daily for the next five days, waited a weekend, then called up my oncologist's staff and asked them to intervene. I also called Kaiser Member Services and filed an "urgent grievance" (just what it sounds like) and followed up by filing a complaint with the California Patient Advocate:

https://www.dmhc.ca.gov/

In both the complaint and the grievance, I made sure to note that the outgoing message at Nuclear Medicine scheduling was giving out false information (it said, "Sorry, all lines are busy," even at 2am!). Again, I was really careful to say that the action I was hoping for was both a prompt appointment for me (my oncologist had been very insistent upon this) but also that this was a very broken system that would be letting down every patient, not me, and it should be fixed.

Within a couple hours, I had a call back from KP grievances department, and an hour after that, I had an appointment for my scan. Unfortunately, that was three weeks away (so much for my oncologist's "immediate" order).

I had the scan last week, on Hallowe'en. It was really cool. The gadget was awesome, and the rad-techs were really experienced and glad to geek out with me about the way the scanner and the radioactive glucose they infused in me interacted. They even let me take pictures of the scan visualizations:

https://www.flickr.com/photos/doctorow/54108481109/

The radiology report was incredibly efficient. Within a matter of hours, I was poring over it. I had an appointment to see the doc on November 5, but I had been reading up on the scans and I was pretty sure the news was good ("No enlarged or FDG avid lymph nodes are noted within the neck, chest, abdomen, or pelvis. No findings of FDG avid splenic or bone marrow involvement").

There was just one area of concern: "Moderate FDG uptake associated with a round 1.3 cm left inguinal lymph node." The radiologist advised the oncologist to "consider correlation with tissue sampling."

Today was my oncology appointment. For entirely separate reasons, I was unable to travel to the hospital today: I wrenched my back over the weekend and yesterday morning, it was so bad that I couldn't even scratch my nose without triggering unbearable spams. After spending all day yesterday in the ER (after being lifted out of my house on a stretcher), getting MRIs and pain meds, I'm much better off, though still unable to get out of bed for more than a few minutes at a time.

So this morning at 8:30 sharp, I started calling the oncology department and appointment services to get that appointment changed over to a virtual visit. While I spent an hour trying various non-working phone numbers and unsuccessfully trying to get Kaiser appointment services to reach my oncologist, I tried to message him through the KP app. It turns out that because he is a visiting fellow and not staff, this wasn't possible.

I eventually got through to the oncology department and had the appointment switched over. The oncology nurse told me that they've been trying for months to get KP to fix the bug where fellows can't be messaged by patients. So as soon as I got off the phone with her, I called member services and filed another grievance. Why bother, if I'd gotten what I needed? Same logic as before: if you have the stamina and skills to demand a fix to a broken system, you have a duty to use them.

I got off the phone with my oncologist about an hour ago. It went fine. I'm going to get a needle biopsy on that one suss node. If it comes back positive, I'll get a few very local, very low-powered radiation therapy interventions, whose worst side effect will be "a mild sunburn over a very small area." If it's negative, we're done, but I'll get quarterly CT/PET scans to be on the safe side.

Before I got off the phone, I made sure to get the name of the department where the needle biopsy would be performed and a phone number. The order for the biopsy just posted to my health record, and now I'm redialing the department to book in that appointment (I'm not waiting around for them to call me).

While I redial, a few more lessons from my experience. First, who do you tell? I told my wife and my parents, because I didn't want to go through a multi-week period of serious anxiety all on my own. Here, too, I made a mistake: I neglected to ask them not to tell anyone else. The word spread a little before I put a lid on things. I wanted to keep the circle of people who knew this was going on small, until I knew what was what. There's no point in worrying other people, of course, and my own worry wasn't going to be helped by having to repeat, "Well, it looks pretty good, but we won't know until I've had a scan/my appointment/etc."

Next, how to manage the process: this is a complex, multi-stage process. It began with a physician appointment, then a radiologist, then a pathology report, then surgery, then another pathology report, then an oncologist, then a scan, then another radiologist, and finally, the oncologist again.

That's a lot of path-dependent, interdepartmental stuff, with a lot of ways that things can fall off the rails (when my dad had cancer at my age, there was a big gap in care when one hospital lost a fax from another hospital department and my folks assumed that if they hadn't heard back, everything was fine).

So I have been making extensive use of a suspense file, where I record what I'm waiting for, who is supposed to provide it, and when it is due. Though I had several places where my care continuity crumbled some, there would have been far more if I hadn't done this:

https://pluralistic.net/2024/10/26/one-weird-trick/#todo

The title of this piece is "how to have cancer," but what it really boils down to is, "things I learned from my own cancer." As I've noted, I'm playing this one on the easiest setting: I have no symptoms, I speak and write English fluently, I am computer literate and reasonably capable of parsing medical/technical jargon. I have excellent insurance.

If any of these advantages hadn't been there, things would have been a lot harder. I'd have needed these lessons even more.

To recap them:

See a frontline care worker as soon as possible: don't wait for an appointment with a specific MD. Practically any health worker can prod a lump and refer you for further testing;

Get a direct phone number for every specialist you are referred to (add this to your phone book); call them immediately after the referral to get scheduled (better yet, walk over to their offices and schedule the appointment in person);

Get a timeframe as to when your results are due and when you can expect to get a follow-up; call the direct number as soon as the due-date comes (use calendar reminders for this);

If you can't get a call back, an appointment, or a test result in a reasonable amount of time (use a suspense file to track this), lodge a formal complaint with your insurer/facility, and consider filing with the state regulator;

Think hard about who you're going to tell, and when, and talk over your own wishes about who they can tell, and when.

As you might imagine, I've spent some time talking to my parents today as these welcome results have come in. My mother is (mostly) retired now, and she's doing a lot of volunteer work on end-of-life care. She recommends a book called Hope for the Best, Plan for the Rest: 7 Keys for Navigating a Life-Changing Diagnosis:

https://pagetwo.com/book/hope-for-the-best-plan-for-the-rest/

I haven't read it, but it looks like it's got excellent advice, especially for people who lack the self-advocacy capabilities and circumstances I'm privileged with. According to my mom, who uses it in workshops, there's a lot of emphasis on the role that families and friends can play in helping someone whose physical, mental and/or emotional health are compromised.

So, that's it. I've got cancer. No cancer is good. This cancer is better than most. I am almost certainly fine. Every medical professional I've dealt with, and all the administrative support staff at Kaiser, have been excellent. Even the doc who dropped the ball on my biopsy was really good to deal with – she was just clearly drowning in work. The problems I had are with the system, not the people. I'm profoundly grateful to all of them for the help they gave me, the interest and compassion they showed, and the clarity and respect they demonstrated in my dealings with them.

I'm also very grateful to my wife, my parents, and my boss at EFF, all of whom got the news early and demonstrated patience, love, and support that helped in my own dark hours over the past couple of months.

I hope you're well. But you know, everyone gets something, eventually. When you find yourself mired in a broken system full of good people, work the system – for yourself and for the people who come behind you. Take records. Make calls.

Look after yourself.

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/11/05/carcinoma-angels/#squeaky-nail

[mindblowingscience]

A personalized vaccine for glioblastoma – the most aggressive and fatal type of brain cancer – has extended the survival of four humans in the first clinical trial of its kind. The newly fashioned medicine works by supplying the immune system with a way to 'recognize' the tumor and an 'instruction manual' for its entire transcriptome. This reveals where each and every gene in the tumor can be turned on or off. Equipped with such vital information, the immune system can reprogram the cancer's defenses and launch a more successful attack.

Continue Reading.

[heardatmedschool]

“When no one knows the mechanism, we always blame cytokines.”

About the pro-thrombotic tendencies of most neoplasms.

[bootleg-nessie]

Newly formed cancer cell: oh boy! I can’t wait to see the world and maybe multiply a bit

My immune system: I’m boutta put the POP 🔫💥 in apoptosis

[neshamama]

The woman in question wears only a blue head scarf, signifying she’s married. She clutches just below her right breast, which exhibits several telltale signs of breast cancer, as the experts noted. He areola is not visible, and her nipple is puckered, in a manner her other one isn’t. Two lumps also emerge. One is visible on the right side of the breast in question, just above an area of orange-hued discoloration that appears to be “an artistic effect rather than a typical peau d′orange,” the study stated. The other is visible just before her armpit, indicating she may have swollen lymph nodes, another common side effect.

incredibly good stuff from the medical side on other representation of breast cancer in michelangelo's sculptural work:

The Breasts of “Night”: Michelangelo as Oncologist

Published November 23, 2000

N Engl J Med 2000;343:1577-1578

DOI: 10.1056/NEJM2000112334321

[grits-galraisedinthesouth]

The Princess delivered such a clear & well written statement for the layperson. She displayed unparalleled poise, courage, and compassion under the harshness of the global spotlight.

I feel for her. Unlike Charles (IMO), Catherine never anticipated that she might have been battling cancer symptoms. Hearing the pathology results was devastating. They deserve our compassion.

And yet THIS:

Knowledge is Power

I already created a post to help the layperson better understand "preventative chemotherapy."

The use of preventative chemotherapy means Catherine's lymphatic system is concerning and warranted aggressive action to ensure that she is cured of this disease.

Sometimes a malignant tumor is removed and the body is cancer free [Sarah York/Guiliani Rancic].

Thankfully Catherine's magins are cancer free as there is no evidence the cancer metastasized.

Despite those cancer free margins, the cancer gained access to the lymph channels (not her lymph nodes), hence she was prescribed a course of a "preventative" form of poison (chemotherapy) to arrest & annihilate the wandering cancer cells in every system of her body. 😥

[guiding-key]

HelIo! I don't make any personal posts on this page but I really wanted to talk about this one! twitch.tv/burstbeat

I watch and donate to Jackscepticeye's Thankmas every year, but this year is something really special to me. And I. AM. STREAMING. FOR. IT.

I have always struggled with mental health but earlier this year I was diagnosed with stage 3 breast cancer (triple positive). I am currently post-chemo and post-mastectomy and things are looking really good! I still have radiation coming up, so my journey isn't over yet. But throughout the whole process I've really struggled with my mental well being. I am eternally grateful to my medical team for supporting me every step of the way, but after losing my hair and one of my breasts, on top of everything else, I absolutely dipped into a bit of ~the despair~. So when Jackscepticeye announced that this year was focused on supporting mental health, I knew it was time for me to get more involved. I am SO ready to spread the joy and awareness this season! ❤️

Before my treatment started, I loved streaming JRPGs. I took a pretty significant break during the tougher portion of my treatment but I think I'm ready to get back into it. And what better time than Thankmas! AND with Kingdom Hearts!!

I'll be playing the first Kingdom Hearts game (because nostalgia of course) starting Friday December 6th, 2024 @ 6PM EST. And I'll be going for as long as I possibly can, especially if I have people donating to and spreading the word for such a great cause. I have so much love for this game and honestly I think I need some good ol' KH nostalgia right now. I need more Sora in my life during these trying times! I really hope all of you beautiful people join me and help spread awareness for mental health this Thankmas!

P.S. The picture I used for this post is me entirely bald; I've been wearing a wig (and probably will for stream) for weeks while I get back to work, but I'm trying to be more comfortable with my bald ass head. I'd like to bring more awareness to cancer treatments, especially in younger adults like myself, and help normalize the process from a physical and mental perspective. No matter what, thank you so much for reading this small novel I ended up writing lmao

P.P.S. There is a good chance my orange cat will hog the face cam like the attention ho he is, so if you like cats then this stream will so be for you.

[mccek]

Rimango sempre dell’idea che se riesci a rendere felice un bambino, facendogli tornare il sorriso, in quel momento capisci quale sia il senso della vita. Fantastico Matti.🕸️

[starsandmoonys]

My grandma told me to go to sleep bc of college tomorrow like YOU THINK I CAN SLEEP RIGHT NOW?! OUR LIVES ARE ON THE LINE HERE GIRL😭 leave me and my wine alone pls

[corvidaedream]

me to my coworkers: when you request time off, you should not give the assistant dept head any additional info on why you're requesting it, it's none of her business and may be used against you

me requesting time off after my requests keep getting denied/overlooked the past few months: telling kelly explicitly that this one is an oncology appointment bc i want her to feel bad :)

[reasonsforhope]

"In a first-ever human clinical trial, an mRNA cancer vaccine developed at the University of Florida successfully reprogrammed patients’ immune systems to fiercely attack glioblastoma, the most aggressive and lethal brain tumor.

The results in four adult patients mirrored those in 10 pet dog patients suffering from brain tumors whose owners approved of their participation.

The discovery represents a potential new way to recruit the immune system to fight treatment-resistant cancers using an iteration of mRNA technology and lipid nanoparticles, similar to COVID-19 vaccines, but with two key differences: use of a patient’s own tumor cells to create a personalized vaccine, and a newly engineered complex delivery mechanism within the vaccine.

“Instead of us injecting single particles, we’re injecting clusters of particles that are wrapping around each other like onions,” said senior author Elias Sayour, M.D., Ph.D., a UF Health pediatric oncologist who pioneered the new vaccine, which like other immunotherapies attempts to “educate” the immune system that a tumor is foreign.

“These clusters alert the immune system in a much more profound way than single particles would.”

Among the most impressive findings was how quickly the new method spurred a vigorous immune-system response to reject the tumor, said Sayour, principal investigator at the University’s RNA Engineering Laboratory and McKnight Brain Institute investigator who led the multi-institution research team.

“In less than 48 hours, we could see these tumors shifting from what we refer to as ‘cold’—very few immune cells, very silenced immune response—to ‘hot,’ very active immune response,” he said.

“That was very surprising given how quick this happened, and what that told us is we were able to activate the early part of the immune system very rapidly against these cancers, and that’s critical to unlock the later effects of the immune response,” he explained in a video (below).

Glioblastoma is among the most devastating diagnoses, with median survival around 15 months. Current standard of care involves surgery, radiation and some combination of chemotherapy.

The new report, published May 1 in the journal Cell, is the culmination of seven years of promising studies, starting in preclinical mouse models.

In the cohort of four patients, genetic material called RNA was extracted from each patient’s own surgically removed tumor, and then messenger RNA (mRNA)—the blueprint of what is inside every cell, including tumor cells—was amplified and wrapped in the newly designed high-tech packaging of biocompatible lipid nanoparticles, to make tumor cells “look” like a dangerous virus when reinjected into the bloodstream to prompt an immune-system response.

The vaccine was personalized to each patient with a goal of getting the most out of their unique immune system...

While too early in the trial to assess the clinical effects of the vaccine, the patients either lived disease-free longer than expected or survived longer than expected. The 10 pet dogs lived a median of 4.5 months, compared with a median survival of 30-60 days typical for dogs with the condition.

The next step, with support from the Food and Drug Administration and the CureSearch for Children’s Cancer foundation, will be an expanded Phase I clinical trial to include up to 24 adult and pediatric patients to validate the findings. Once an optimal and safe dose is confirmed, an estimated 25 children would participate in Phase 2."

-via Good News Network, May 11, 2024

-video via University of Florida Health, May 1, 2024

[mindblowingscience]

Moderna CEO Stephane Bancel told AFP his company's experimental vaccine against melanoma could be available in as little as two years, in what would amount to a landmark step against the most serious form of skin cancer. Globally there were an estimated 325,000 new melanoma cases and 57 ,000 deaths from the disease in 2020. "We think that in some countries the product could be launched under accelerated approval by 2025," he said in an interview.

Continue Reading.

[bpod-bpod]

Mushroom for Improvement

Burrowing into the brains of young caterpillars, Cordyceps militaris is a fungus with control in mind. Yet it also produces a “promising” natural chemical, cordycepin, shown to kill certain human cancer cells. Promising chemicals aren’t always practical or free from side effects, though, so establishing the underlying details is essential to their success in treating patients. Although Cordyceps has had a place in Chinese medicine for over 1500 years, cordycepin was first extracted from a bubbling mushroom broth in 1950. The intervening decades have revealed details carefully – challenged by the compound’s fast metabolism; cordycepin breaks down quickly inside living cells. Now, delving deeper into how cordycepin kills cells, scientists find exciting molecular clues: cordycepin is able to block growth factors that might otherwise help cancers grow, by guiding a set of intracellular signals known as mTOR. This information will be vital to fulfilling on the Cordyceps’ promise.

Written by John Ankers

Image by Holger Krisp from Wikimedia Commons

Research from the School of Pharmacy, Biodiscovery Institute, University of Nottingham, UK

Image originally published with a Creative Commons Attribution CC-BY-3.0

Research published in FEBS Letters, November 2024

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