Colorectal Cancer
This is not the first article to document the potential efficacy of the antifungal agent, itraconazole. Multiple studies have shown that itraconazole inhibits cancer, not only through WNT inhibition, but also, through reversing MDR (multidrug resistance gene), inhibiting the Hedgehog pathway, and inhibiting angiogenesis. Human data have been published using itraconazole with prostate cancer, NSC lung cancer, triple neg breast cancer, ovarian cancer, as well as other cancers.
I refer physicians to the following article, “Repurposing Drugs in Oncology (ReDO)—itraconazole as an anti-cancer agent.” There are many drugs that have other FDA-approved indications that can and should be repurposed for use in cancer. I have personally used itraconazole in a patient with stage III NSC lung cancer who refused chemotherapy; he remained without progression of disease for 1.5 years, until he died of a drug overdose.

 

May 28th, 2019

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small-daily-dose

 A small, daily dose of Viagra may reduce colorectal cancer risk – an article by ScienceDaily can be accessed here.

Comments from Dr. Rosenberg on the Article:

Over the last decade, researchers have elucidated the roles that impairment of cGMP signaling pathway by PDE5 activity inhibition plays in the regulation of tumor development, and progression.

PDE5 inhibition could be associated with a decreased risk of human cancer development and suppression of tumor progression in several malignancies including those of the lung, prostate, breast and colon. PDE5 inhibitors may also provide an additional anti-tumor immune response in patients affected by myeloma and head and neck squamous cell carcinomas. In addition, a synergistic effect with current chemotherapeutic regimens and monoclonal antibodies has been reported.

Although it likely will not cause harm to use PDE5 inhibitors as both a cancer preventative, as well as an adjunct to existing therapies, some questions need to be answered:

1. Which are the most effective class of PDE5 inhibitors against cancer?

2. Within each class, which drug(s) is the most effective?

3. Optimal dosage?

December 20th, 2018

Posted In: cancer care, Cancer Prevention, Healthy Lifestyle

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Colon Cancer

The following study from the Dana Farber Cancer Institute reveals the connection between colorectal cancer containing the bacterium Fusobacterium nucleatum. A plethora of data has revealed that your gut microbiome can affect your risk for disease, as well as an immune response to illness and disease. Animal studies using the latest immunotherapy drugs for cancer (PD-1 inhibitors and CTLA-4 inhibitors) have shown that the animal’s gut bacterial flora plays a large role in determining whether these drugs will be effective.

Bottom line: Consider studying your patients’ bacterial flora and ALWAYS ensure they regularly take a quality probiotoc.

~ Dr. Rosenberg

A new study provides some of the strongest evidence to date that microorganisms living in the large intestine can serve as a link between diet and certain types of colorectal cancer, the lead authors at Dana-Farber Cancer Institute and Massachusetts General Hospital report.

The paper, published online today by JAMA Oncology, focuses on Fusobacterium nucleatum, one of hundreds of types of bacteria that dwell in humans’ large intestines, and one that is thought to play a role in colorectal cancer. By tracking the diets of more than 137,000 people for decades and examining more than 1,000 colorectal tumor samples for F. nucleatum, the researchers determined that individuals with a “prudent” diet – rich in whole grains and fiber – had a lower risk of developing colorectal cancer containing the bacterium, but their risk for colorectal cancer that lacked the bacterium was essentially unchanged.

Prudent diets appear to protect against colorectal cancer. The new study suggests that healthy foods may achieve these benefits, in part, by altering the relative amounts of various microorganisms in the digestive tract, including F. nucleatum.

“Though our research dealt with only one type of bacteria, it points to a much broader phenomenon – that intestinal bacteria can act in concert with diet to reduce or increase the risk of certain types of colorectal cancer,” said Shuji Ogino, MD, PhD, of Dana-Farber, Harvard T.H. Chan School of Public Health, and Brigham and Women’s Hospital, the co-senior author of the study with Charles Fuchs, MD, MPH, director of the Gastrointestinal Cancer Center at Dana-Farber and Brigham and Women’s, and Andrew Chan, MD, MPH, of Massachusetts General Hospital, Brigham and Women’s, and the Broad Institute of MIT and Harvard.

“These data are among the first in humans that show a connection between long-term dietary intake and the bacteria in tumor tissue. This supports earlier studies that show some gut bacteria can directly cause the development of cancers in animals,” added Chan.

The research drew on dietary records of 137,217 participants in the Nurses’ Health Study and Health Professionals Follow-up Study – large-scale health-tracking studies – some of whom developed colon or rectal cancer over a period of decades. The researchers measured the levels of F. nucleatum in the patients’ tumor tissue and blended these data with information of diet and cancer incidence.

“Recent experiments have suggested that F. nucleatum may contribute to the development of colorectal cancer by interfering with the immune system and activating growth pathways in colon cells,” Ogino remarked. “One study showed that F. nucleatum in the stool increased markedly after participants switched from a prudent to a Western-style, low fiber diet. We theorized that the link between a prudent diet and reduced colorectal cancer risk would be more evident for tumors enriched with F. nucleatum than for those without it.”

That is precisely what the study results showed: Participants who followed a prudent diet had a sharply lower risk of developing colorectal cancer laden with F. nucleatum. But they received no extra protection against colorectal cancers that didn’t contain the bacteria.

“Our findings offer compelling evidence of the ability of diet to influence the risk of developing certain types of colorectal cancer by affecting the bacteria within the digestive tract,” Ogino commented.

“The results of this study underscore the need for additional studies that explore the complex interrelationship between what someone eats, the microorganisms in their gut, and the development of cancer,” said Chan.

Source: Dana-Farber Cancer Institute

The lead authors of the paper are Raaj Mehta, MD, of Mass General, Yin Cao, ScD, of Mass General and Harvard T.H. Chan School of Public Health, and Reiko Nishihara, PhD, of Dana-Farber, Brigham and Women’s, the Broad Institute, and Harvard T.H. Chan School of Public Health. Co-authors are Kosuke Mima, MD, PhD, Zhi Rong Qian, MD, PhD, Keisuke Kosumi, MD, PhD, Tsuyoshi Hamada, MD, PhD, Yohei Masugi, MD, PhD, Susan Bullman, PhD, and Jeffrey Meyerhardt, MD, MPH, of Dana-Farber; Wendy Garrett, MD, PhD, of Dana-Farber, the Broad Institute, and Harvard T.H. Chan School of Public Health; David Drew, PhD, of Mass General; Mingyang Song, MD, ScD, of Mass General and Harvard T.H. Chan School of Public Health; Jonathan Nowak, MD, PhD, and Xuehong Zhang, MD, ScD, of Brigham and Women’s; Aleksandar D. Kostic, PhD, of the Broad Institute; Kana Wu, MD, PhD, and Curtis Huttenhower, PhD, of Harvard T.H. Chan School of Public Health; Teresa T. Fung, ScD, RDN, of Simmons College; Walter Willett, MD, DrPH, and Edward Giovannucci, MD, ScD, of Harvard T.H. Chan School of Public Health and Brigham and Women’s.

This work was supported by U.S. National Institutes of Health (grants P01 CA87969, UM1 CA186107, P01 CA55075, UM1 CA167552, P50 CA127003, R01 CA137178, K24 DK098311, R01 CA202704, R01 CA151993, R35 CA197735, and K07 CA190673); and by grants from The Project P Fund for Colorectal Cancer Research, The Friends of Dana-Farber Cancer Institute, Bennett Family Fund, and the Entertainment Industry Foundation through National Colorectal Cancer Research Alliance.

March 14th, 2017

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CLORECTAL Cancer Awareness Creative Grey and Blue Poster. Brush Stroke and Silk Ribbon Symbol. National Colon Cancer Awareness Month Banner. Brush Stroke and Text. Medical Square Design.

March is National Colorectal Cancer Prevention month so I thought I’d give my readers some tips about how to prevent colon cancer.  More than 90% of people diagnosed with colon cancer are over the age of 50 – the age recommended for initial screening.  If you’re over age 50, you’ll want to read about what’s new in colon cancer research as well as what you can do to prevent getting it.

Colon Cancer Awareness

The Centers for Disease Control (CDC) says that 140,000 people every year are diagnosed with colon cancer and more than 50,000 people die from it.  Yet, this does not have to be the case.  The good news is that colon cancer can be cured if found early and underscores the importance of screening.

Risk

Colon cancer affects men and women equally and your risk for getting it increases with age. It is thought associated with poor diet – low nutrient, high dietary toxin – intake.  It can be hereditary as well – it tends to repeat throughout family generations.  It also has a higher risk of occurrence with people who have inflammatory bowel conditions like irritable bowel syndrome, diverticulitis, or Crohn’s disease.

Symptoms

The symptoms of colon cancer are usually few, if any, but may include: change in bowel habits (going too much, not enough), persistent stomach pain, cramps, blood in stool, or unexplained weight loss and chronic fatigue.  Of course, having these symptoms does not necessarily mean colon cancer; they can also accompany other issues.  Yet, if you have these symptoms that continue, do see your doctor for further investigation.

Screening Tests 

Health researchers recommend colon screening soon after the age of 50. This can consist of:

  • HS-FOBT – high sensitivity fecal occult blood test.  This is a chemically pre-treated card that a minute amount of your stool is smeared on.  If there is blood present in the stool, the chemical reaction indicates it.  Blood in stool may be a warning sign of colon cancer, but it may also just indicate hemorrhoids.
  • Flexible sigmoidoscopy – examination of just the sigmoid portion of the colon which is recommended every 5 years.
  • Colonoscopy – examination of the entire colon which is recommended every 10 years.
  • Virtual colonoscopy – no instruments are inserted into the sigmoid or colon.  You still have to undergo the same preparation as regular methods though.  The bowel is looked at through a type of x-ray that shows the internal bowel on a special monitor.  If any abnormalities are found, you will still need to undergo regular screening to address these.

Having a sigmoidoscopy or colonoscopy is not painful.  Yet, the preparation for them can be a little uncomfortable in that it causes you to empty your bowel frequently.  Recently, some commercial preparations have been found to have unhealthy side effects. These have been replaced by milder regimens that clean the bowel sufficiently without the side effects. You may experience some skin irritation from going so often, however.

How To Prevent Colon Cancer 

I always tell my patients that preventing disease is much easier than treating it.  Colon cancer is usually associated with poor diets such as high animal fats, low fiber, not enough antioxidants,  high alcohol and other dietary toxins – like nitrite food preservatives – intake.

Keeping the colon healthy and cancer-free has a lot to do with something called ‘transit time’.  This is the amount of time it takes for digestion to take place and waste to leave your body through bowel movements.  If your transit time is slow, due to low fiber, lack of adequate water intake, and you tend to be constipated often, toxins can adhere to your bowel easily.

Recent research has shown that high fiber foods like bran, brown rice, fruits and vegetables, increase transit time to get rid of waste toxins much faster.  It is recommended that you eat at least 25 grams of fiber a day.  One bowl of high fiber bran cereal has about 14 grams of fiber in it – eating at least 1 serving a day, in addition to other fiber-nutrient dense foods, will help lower your risk of colon cancer.  According to a Loma Linda University study, people who ate brown rice (a high fiber grain) at least once a week reduced their risk of colon cancer by 40%.

Other research out of the Dana-Farber Cancer Institute has shown that diets high in starchy carbohydrates and refined sugars – i.e. cakes, pastries, cookies, other dessert foods – up the risk for colon cancer.  These foods raise blood sugar and insulin levels which create inflammation throughout the entire body.  Similarly, people who are obese and/or have diabetes, are at higher risk for developing colon cancer.

Vitamins A and E (both gamma and delta tocopherols) have also been found in research to protect the bowel against cancer, as well as Omega-3 fatty acids.  Foods rich in these nutrients include yellow/orange vegetables and fatty fish like salmon and mackerel.  Try to have several servings per week.

Colon cancer is the 2nd leading cause of death in the United States.  With efforts aimed at better preventative nutrition, as well as screening, about 60% of these deaths could be avoided.

To Your Health,
Mark Rosenberg, M.D.

March 8th, 2017

Posted In: cancer care, Cancer Prevention

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