Curative vs. Palliative Surgery

Mesothelioma has a complex growth pattern that makes complete surgical removal a very difficult task, which is why surgery that aims to remove all cancer cells is more accurately described as “potentially curative” rather than “curative”.

Part of what makes cancer such a stubborn malady is that it’s very difficult for surgeons to remove all cancer cells, and any cells that are left behind can grow, divide and lead to the cancer’s return.

To try and prevent this from happening, the surgeon removes as much tissue as the patient can safely tolerate.

More extreme surgeries attempt to remove visible cancerous tissue as well as tissue that is a likely site for metastasis.

Not all patients are healthy enough for more invasive mesothelioma surgeries, however, and sometimes the cancer is too widespread to be removed completely. In these instances, “palliative surgery”—or surgery meant to ease cancer symptoms instead of potentially curing the cancer—may be performed.

Palliative mesothelioma surgery can extend a patient’s life and improve their quality of life.

Multimodal Therapy

Whether surgery is performed for curative or palliative purposes, it is rarely performed in isolation. Surgery is almost always accompanied by the other standard treatments for mesothelioma: chemotherapy and radiation.

Neoadjuvant therapy for mesothelioma is chemotherapy or radiation administered to a patient before surgery in order to shrink mesothelioma tumors and make their removal more manageable.

Adjuvant therapy is chemotherapy or radiation administered post-surgery to help prevent the recurrence of tumors.

Mesothelioma Surgery

For patients who are in the process of being diagnosed or have just been diagnosed with malignant mesothelioma, surgery is typically one of the standard treatment options doctors will want to consider.

Depending on your health and the stage of your cancer, mesothelioma surgery may be used to prolong your life, prevent symptoms or ease your pain.

Typically, surgeries are divided into three types:

Diagnostic Surgeries: As soon as a doctor suspects a person is showing symptoms of mesothelioma, diagnostic surgery techniques may be used to explore the chest or abdominal cavities to check for definitive signs of the cancer.

Some examples of diagnostic surgeries for mesothelioma are thoracoscopy, laparoscopy, thoracotomy and laparotomy. A biopsy is usually done during this surgery to test for mesothelioma cells.

Potentially Curative Surgeries: Mesothelioma has a complex growth pattern that makes complete surgical removal a very difficult task, which is why surgery that aims to remove all cancer cells is more accurately described as “potentially curative” rather than “curative.”

Part of what makes cancer such a stubborn illness is that it’s very difficult for surgeons to remove all cancer cells, and any cells that are left behind can grow, divide and lead to the cancer’s return.

To try to prevent this from happening, the surgeon removes as much tissue as the patient can safely tolerate. More extreme surgeries attempt to remove visible cancerous tissue as well as tissue that is a likely site for metastasis.

Some examples of potentially curative surgeries for mesothelioma are extrapleural pneumonectomy and pleurectomy/decortication.

Palliative Surgeries: Not all patients are healthy enough for very invasive mesothelioma surgeries. And sometimes the cancer is too widespread to be removed completely.

In these instances, “palliative surgery” — or surgery meant to ease cancer symptoms — may be performed. Palliative mesothelioma surgery can ease a person’s pain and improve the quality of life.

Some examples of palliative surgeries for mesothelioma are pleurocentesis, paracentesis and pleurodesis.

Vitamin B causes cancer in men?

Feeling tired out? Want to boost your energy level in a fast and allegedly healthy way? A lot of us turn to vitamins, which explains why 50 percent of people in the United States take some form of dietary supplement, as the Atlantic reported.

Unfortunately, a recent study published in the Journal of Clinical Oncology suggests that taking vitamin B6 and B12 supplements in high doses seems to triple or almost quadruple the risk of lung cancer in men. So far there has been no evidence of a heightened risk for women.

The Ohio State University research found men who take too much of these two popular vitamins greatly increase their cancer risk, particularly if they smoke.

The U.S. Preventive Services Task Force is deliberating whether vitamin supplements make any difference in the average person’s risk of heart disease or cancer.

“What we found was that men who had used dietary supplements, in particular B6 and vitamin B12, at high doses for 10 years, were at significant increased risk of developing lung cancer,” said Dr. Theodore Brasky, who led the study at OSU’s Comprehensive Cancer Center, according to Newsmax.
“In fact, all men who used these supplements in high doses for a decade had approximately double the risk developing lung cancer, and in men who smoked, the risk was three to four times as great.”

The recommended daily allowance for vitamin B6 for men is only about one and a half milligrams, and for vitamin B12, it’s less than two and a half micrograms per day. The trouble there is way more than than packed into the average vitamin pill. Let the buyer beware.
“But if you look at these supplement bottles, they’re being sold in pill form at up to 5,000 micrograms per dose, which is much, much higher than the daily recommended amount,” said Brasky, as Newsmax noted. “It’s very easy to get all the vitamin B you need in this country, from eating meats, chickpeas and foods like cereal that are fortified with them, so there really is no reason to supplement your vitamin B intake at these levels, and certainly not for years on end.”

Why Pregnant Women Are More Susceptible to Zika Virus

We know that Zika virus can be especially risky for pregnant women, increasing the risk of birth defects. But a new study from the University of Southern California’s Keck School of Medicine may have insight as to why.

Researchers looked at how the virus affected the blood of healthy men, pregnant women, and non-pregnant women aged 18 to 39. Much like HIV, researchers found that Zika targets the white blood cells that typically swallow up viruses, bacteria, and debris to keep the body healthy.

In expectant mothers, though, virus strains only had to infect 4% of white blood cells to increase immune suppression: An African Zika strain increased suppression by 10% and an Asian strain by 70%.

“Pregnancy naturally suppresses a woman's immune system so her body doesn't reject the fetus — essentially it's a foreign object," said senior study author Jae Jung, professor and chair of Keck's department of molecular microbiology and immunology. “Zika exploits that weakness to infect and replicate."

Prior research from the Centers for Disease Control and Prevention (CDC) found that one in ten pregnant women who contracted the virus gave birth to children with birth defects. And the risk for pregnancy complications is reportedly highest for women who contract the virus during their first or second trimester.

Interestingly, pregnant women are not involved in trials testing possible Zika vaccines, said Jung.

"The Zika virus vaccines in development seem to be highly effective, but they're being tested among non-pregnant women with different body chemistry compared to pregnant women," Jung said.

The mosquito-borne virus is still prevalent in Central and South America, the Caribbean, Central Africa, and Southeast Asia. The CDC maps countries with Zika and is still offering travel warnings and safety guidelines to consider for visits.

Precautions against the virus include preventing mosquito bites and practicing safe sex, but pregnant women and couples trying to conceive should not travel to areas with risk of Zika, according to the CDC.

The healthiest part of an avocado may get thrown away

The avocado has become synonymous with trendy cuisine and numerous health benefits. The yellow-green flesh inside the fruit is packed with essential vitamins and nutrients and is a good source of healthy fats.

But new research suggests a part of the avocado that’s normally thrown in the trash may actually be the most valuable.

According to a study presented at a meeting of the American Chemical Society this week, the husks of avocado seeds are “hidden gold mines” packed with a previously unrecognized array of chemical compounds. While the husks and seeds are not edible, researchers say the compounds they contain could one day be used in medicines to treat a host of diseases.
“It could very well be that avocado seed husks, which most people consider as the waste of wastes, are actually the gem of gems because the medicinal compounds within them could eventually be used to treat cancer, heart disease and other conditions,” researcher Debasish Bandyopadhyay, Ph.D., said in a statement.

He added, “Our results also suggest that the seed husks are a potential source of chemicals used in plastics and other industrial products.”

Across the globe, nearly 5 million tons of avocado are produced annually, with Americans consuming 1.9 billion pounds each year.

Guacamole lovers devour the “meat” or flesh of the avocado, while the seed is thrown in the trash. While certain manufacturers extract avocado oil from the seed, they remove the husk surrounding it and discard it before processing.

For the study, Bandyopadhyay and his team wanted to see exactly what that part of the avocado was made of. They ground about 300 dried avocado seed husks into 21 ounces of powder and then further processed the powder into three teaspoons of seed husk oil and about an ounce of seed husk wax.

An analysis showed 116 compounds in the oil and 16 in the seed husk wax — many of which do not appear to be found in the seeds themselves.

Some examples of the compounds researchers found in the oil include behenyl alcohol, an important ingredient used in anti-viral medications; heptacosane, which might inhibit the growth of tumor cells; and dodecanoic acid, which increases high density lipoprotein (known as HDL, or “good” cholesterol) and, as a result, could potentially reduce the risk of clogged arteries.

In the wax, Bandyopadhyay and his team identified a “plasticizer” compound used to promote flexibility in synthetic products such as shower curtains and medical devices, and compounds used in cosmetics.

Much more research is needed, but Bandyopadhyay says in the future he hopes to be able to modify these natural compounds to help create better medicines with fewer side effects.

Can poor sleep lead to Alzheimer’s or dementia?

One in three Americans doesn’t get enough sleep, and 45% of the world’s population doesn’t either.

The US Centers for Disease Control and Prevention calls that a “public health problem,” because disrupted sleep is associated with a higher risk of conditions including diabetes, stroke and cardiovascular disease.

What about Alzheimer’s and other forms of dementia?

It’s well known that people with Alzheimer’s suffer sleep issues. Insomnia, nighttime wandering and daytime sleepiness are common for them, as well as other cognitive disorders such as Lewy body dementia and frontal lobe dementia.

But could poor sleep earlier in life actually cause dementia?

 

REM sleep and dementia

A new study in the journal Neurology, the journal for the American Academy of Neurology, finds that people who get less REM, or dream-stage sleep, may be at higher risk for developing dementia. REM is the fifth stage of sleep, when the eyes move, the body heats up, breathing and pulse quicken and the mind dreams.

Researchers followed 321 people with an average age of 61 for a dozen years, as part of the famous Framingham Heart Study. Sleep cycles were measured for each person, and their cognitive skills were assessed in person at regular intervals. Over the duration of the study, 32 people developed dementia. Of those, 24 were determined to be Alzheimer’s disease.

The study found that people who took longer than the typical 90 minutes to enter REM were more likely to get dementia. They also spent only about 17% of their sleep dreaming, compared to 20% in those who did not develop dementia.

No association with dementia was found for any of the other four stages of sleep.

“Our findings point to REM sleep as a predictor of dementia,” study author Matthew P. Pase, of Swinburne University of Technology in Australia, said in a news release. “The next step will be to determine why lower REM sleep predicts a greater risk of dementia. By clarifying the role of sleep in the onset of dementia, the hope is to eventually identify possible ways to intervene so that dementia can be delayed or even prevented.”

Sleep and Alzheimer’s plaques

A growing body of research in both mice and humans shows that disturbed sleep leads to higher levels of soluble beta amyloid, the protein that folds and forms the sticky plaques that kill brain cells and bog down information processing.

Depositing amyloid in brain tissue is the first known preclinical stage of Alzheimer’s and happens well before any obvious symptoms of dementia begin.

A few studies in cognitively normal people and one in mice have shown a connection between chronic sleep disruption and the development of amyloid plaques. The research in mice was particularly interesting because it showed that mice who slept well reduced their levels of beta amyloid, effectively clearing the toxin from their brains.

A study in Neurology looked at the relationship between sleep quality and levels of various proteins and inflammatory markers in the cerebrospinal fluid of 101 cognitively healthy adults with an average age of 63.

All participants had known risk factors for Alzheimer’s, such as family history or evidence of the APOE gene, which is associated with a greater chance of developing the disease. Their sleep quality was rated on a standard scale that measured amount, quality and trouble sleeping, along with daytime drowsiness and naps.

“Participants in our study were willing to undergo a lumbar puncture to move research on Alzheimer’s disease forward,” said co-author Barbara Bendlin of the Wisconsin Alzheimer’s Disease Research Center. “Analyzing this fluid allowed us to look at markers related to Alzheimer’s disease such as plaques and tangles, as well as markers of inflammation and nerve cell damage.”

Tangles and cell damage

Tangles are created by damaged tau, a protein responsible for cell stability and structure. Recent research points to tau-tangle accumulation as a possible step beyond amyloid plaques in the development of actual signs of Alzheimer’s disease.

By comparing the spinal fluid against self-reported sleep problems, Bendlin and her colleagues found that the subjects who had sleep issues were more likely to show evidence of tau pathology, brain cell damage and inflammation, even when other factors like depression, body mass, cardiovascular disease and sleep medications were taken into account.

“Our findings align with the idea that worse sleep may contribute to the accumulation of Alzheimer’s-related proteins in the brain,” Bendlin said. “The fact that we can find these effects in people who are cognitively healthy and close to middle age suggest that these relationships appear early, perhaps providing a window of opportunity for intervention.”

That’s important, Bendlin added, because delaying the onset of Alzheimer’s in those at risk by a mere five years “could reduce the number of cases we see in the next 30 years by 5.7 million and save $367 billion in health care spending.”

“Another new finding in this study is that daytime sleepiness, and not just disrupted nighttime sleep, is associated with early changes of Alzheimer’s disease,” said Dr. Yo-El Ju, an assistant professor of neurology at Washington University’s Sleep Medicine Center.

Ju co-wrote an accompanying editorial for the study and just published research of her own in the journal Brain in which she found that healthy middle-age adults who slept badly for just one night produced an abundance of beta amyloid. A week of disrupted sleep increased the amount of tau, another protein responsible for the tangles associated with Alzheimer’s, frontal lobe dementia and Lewy body disease.

“Overall, these studies confirms the relationship between early Alzheimer’s disease and sleep disturbance,” Ju said, “and expand — in terms of both time and symptoms — the window in which sleep-wake problems can be assessed for and treated, with the hope of reducing the risk of dementia due to Alzheimer’s disease.”

One of the limitations of Bendlin’s study was that the sleep problems were self-reported. Bendlin and her colleagues are recruiting people at risk for Alzheimer’s to be studied in a sleep lab, where objective measurements can be taken.

“If it turns out to be the case that an intervention which improves sleep also results in less amyloid being deposited in the brain, that would provide strong support for implementing interventions before people start to show cognitive decline associated with Alzheimer’s disease,” she said.

Dr. Rudolph Tanzi, who directs the genetics and aging research unit at Massachusetts General Hospital, agreed.

“Increasing amounts of evidence indicate that getting at least seven to eight hours of sleep is essential for brain health and function,” Tanzi said. “In the deepest stage of sleep, the brain cleans itself out of plaque and other toxic materials that trigger Alzheimer’s disease. This reduces brain inflammation and is entirely consistent with this exciting new study.”

Which problem came first?

Not everyone with sleep problems in Bendlin’s study had abnormalities in their spinal fluid. For example, those with obstructive sleep apnea showed no association. With over 18 millions Americans diagnosed with the condition, obstructive sleep apnea is one of the most common sleep disorders. It’s characterized by loud snoring and waking by gasping or choking, which occurs when throat muscles relax and constrict the airway during sleep.

But research presented in July at the Alzheimer’s Association International Conference in London found a connection between obstructive sleep apnea and buildup of amyloid and tau proteins in the brain.

Researchers looked at 1,639 adults in their mid-70s who either were normal cognitively or had mild cognitive decline. The research found an association between obstructive sleep apnea and an accelerated increase of amyloid and tau deposits in both normal and cognitively impaired adults.

Bendlin stresses that much remains to be discovered about the link between sleep and dementia.

“Not everyone who experiences sleep problems should now worry about developing dementia due to Alzheimer’s disease,” she said, adding that therecnn & is not yet a clear cause and effect relationship.

“Animal studies suggest sleep affects development of brain changes, but brain changes in turn also affect sleep,” Bendlin said. “In terms of figuring out which comes first, brain changes or sleep problems, that will be difficult to tease apart, because the effects really do appear to be going in both directions.”

“In experimental studies, there does seems to be evidence of both chicken and egg,” said neuroscientist Jeffrey Iliff of Oregon Health and Sciences University. “You can drive it either direction. So there may be a bio-directional interaction.”

That’s good news if true, he said, because it means we have may have some control over whether we develop dementia.

“No, the public can’t remove amyloid plaque,” Iliff said. “But if sleep disruption is promoting this process, then improving sleep is half of the solution to slowing the process of dementia as it develops over one’s life.”

Keith Fargo, director of scientific programs and outreach for the Alzheimer’s Association, agreed: “There may be an opportunity to improve cognition and possibly reduce dementia risk through early diagnosis and effective treatment of sleep disorders.”