Stephen Mangar:Good afternoon everyone
AXAPPPhealthcare:Dr Stephen Mangar is from BMI
Princess Margaret Hospital and BMI Clementine Churchill Hospital,
Stephen Mangar:thank you may I just quickly
introduce myself. I am a clinical Oncologist specialising in
prostate, bladder, bowel and lung cancers
728997: Good afternoon Dr. Mangar, my father is 83 yrs old and was diagnosed last year with pancreatic cancer - he had cyberknife radiation last July 2011, the tumor had shrunk, but he is now complaining he is in a lot of pain, he is using patches to reduce the pain, but has not started his morphine tablets, and is now always tired and cannot eat anything (complains of pain), I would like to know if you can estimate how long he has to live.
Stephen Mangar:728997- I am sorry to hear about
your father, could you tell me whether he had disease confined to
the pancreas or whether it was metastatic
728997: When we had the scan done in October last year there was no indication that it had metastised, but we have not had another scan done as his Oncologist advised that there is no point, as he is now terminal. Because of his diabetes and because of his age and condition, it was decided that he shouldn't have any surgery or chemotherapy.
Stephen Mangar:728997- The cyberknife
radiotherapy is usually given when the cancer is localised.
Although pancreatic cancer is associated with a poor prognosis
usually measured in months. If the disease is truly localised then
he could do relatively well. Obviously his age and other medical
problems will dictate his management if he is not fit for surgery
or chemotherapy then Macmillan nurse input will be key to
delivering best supportive care.
728997: Is there anything I can do to make him
more comfortable? He is sleeping a lot of the time.
Stephen Mangar:728997- if he is in a lot of
pain which does not seem to be responding to his current pain
killers it would be worthwhile contacting his Macmillan nurse
specialist or his local Oncologist for review of his medications.
There are potentially reversible factors for his tiredness such as
being anaemic or having high blood sugars which could be treated,
was a hospice ever discussed?
728997: Yes he is currently at home, and is
under the care of his hospice who has advised that they are limited
to the care they can give in unless he is moved to the hospice, but
he (and my mother) are both extremely reluctant to move into the
hospice and prefer to spend his last days at home
Stephen Mangar:728997- As long as you can
manage adequately with him at home but know that help is always at
hand and do not be afraid to ask.
728997: Thanks lot Dr Mangar, bye
Rita: I have high esonophiles 1.5 and high
platelet count 458, can this be anything to do with cancer. I had
breast cancer 7-8 years ago
Stephen Mangar: Rita- then I do not think this
is connected to your breast cancer
Rita: Ok, great, thank you Dr Mangar
Patient: Is vestibular schwannoma treated with
chemotherapy. Any alternative to highly invasive surgery might be
interesting alongside the option of radiotherapy?
Stephen Mangar: Patient -a schwannoma is a
benign lesion - i.e. one that does not spread. However it can cause
pressure symptoms and hence surgical removal or radiotherapy is
required to reduce the size. You should do well with whatever
treatment. There are very highly specialised radiotherapy
techniques such as cyberknife or stereotactic radiosurgery with
gamma knife that have shown very good results similar or even
better than surgical outcomes. Not available widely though
AXAPPPhealthcare: As we have a spare five mins,
we'll post a question from a blog reader: From Rollason
- I read this weekend that a quarter of an aspirin a day keeps
cancer away and also assists in the after treatment of cancer. This
appears to be confirmation of what has been known for a
considerable period of time. Papers on this subject are being, or
have now been, presented. Why has this information not been made
available to the general public before and should the ministry of
health now be putting efforts into this to ensure that the public
is made aware of the benefits of aspirin and also be considering
the cost benefit to the health service,
Stephen Mangar: This is a very interesting
question and certainly one that will be continued to be debated.
Certainly Aspirin has properties that may help reduce the risk of
cancer and blood clots however, this comes at a price of side
effects namely stomach ulcers and bleeding thus these factors have
to be taken into account for each individual before deciding
whether this would be of benefit
AXAPPPhealthcare: Thanks for answering that,
does anyone else have any questions?
PeterLND: Hello, how regularly should I get my
Stephen Mangar: PeterLND- This depends on 1-
your age, 2- whether you have any urinary symptoms and 3- whether
or not there is a family history of prostate cancer and 4- your
ethnic origin. In America most men get their PSA checked
around about the age of 50. If the blood tests is normal then
screening every 2-3 years is probably ideal.
PeterLND: I'm 38 2. No 3. My uncle had prostate
cancer when he was 50 but luckily he survived 4. White British
Stephen Mangar:PeterLND- I think it is very
unlikely that your PSA would be raised, however, when you next go
to your GP it would be worthwhile getting a baseline PSA given your
Jj23: Hi Dr Mangar, what is the prostate?
Stephen Mangar: jj23- it is a gland that sits
just beneath the bladder and in front of the rectum (back passage).
It is responsible for the production of seminal fluid which
nourishes sperm that is produced in the testes
Jj23: I read that it was prostate cancer
awareness month but I've not really heard much about it before, is
it older men who tend to get it?
Stephen Mangar: jj23- this is correct, March is
prostate cancer awareness month and much welcomed. You are right it
is a disease of the elderly. Roughly 7 out of 10 men will have some
form of prostate cancer over the age of 70 however, only a small
proportion will actually need treatment
Jeff: I am 63 years old and I have found that
passing urine is not as easy as it used to be. I was aware of the
possibility of prostate cancer so I consulted my GP who took a
blood sample, which came back as clear. However, I still found that
passing water was not as it used to be, although to be fair, it is
not a major difficulty, so I went back to my GP who prescribed
Doxazosin (1mg). This has made only a minor change. If this is just
a symptom of growing older, I can live with it but is there still a
chance that it is prostate cancer?
Stephen Mangar: Jeff- you need to ask your GP to
refer you to a urologist. It is likely that you have a benign
(non-malignant) condition called BPH which if causing lots of
waterworks symptoms that does not respond to tablets can be dealt
with by a small operation known as a TURP
Jeff: Many thanks
Ra1: Hi, my aunt (mum's sister) was diagnosed
with bowel cancer just over a year ago. Is this something I need to
be more aware of in the future?
Stephen Mangar: Ra1- hello there, do you mind me
asking how old you are?
Stephen Mangar:Ra1- no but it always helps to
be on the lookout for symptoms. Normally bowel cancer starts to
develop mid to late 30's and screening normally takes place from
around the age of 40. The symptoms to look out for are a change in
your bowel habit, passing blood in your stool, weight loss and
unexplained abdominal pains. The screening tests traditionally have
involved analysing your stool for blood (faecal occult). Nowadays
you can have a test called a virtual colonoscopy
Ra1: I will be aware having seen what she has
had to go through to fight it. So from what you are saying, this is
not likely to be a higher risk for me as she isn't a direct
Stephen Mangar: No but it does no harm to be
Ra1: Okay - that is good to know. Thank you
Jj23: Hi Dr Mangar, sorry about prostate cancer
again - are tests for the cancer available from my GP, do I need to
ask for one or will he suggest it once I get to a certain age
Stephen Mangar: jj23- that's absolutely fine,
the most common prostate cancer test that can be performed by your
GP is the PSA blood test. If you are over 50 you may well be
invited to have a general health screen which can sometimes include
the PSA routinely otherwise your GP could organise this at any time
if you present with problems with your waterworks
Jj23: Ok great thank you
AXAPPPhealthcare: As we have a spare five mins,
are you able to answer a question although it may not be your area
of specialism? From Carol - "A year or two ago my doctor told me I
did not need any further tests for cervical cancer. I haven't been
able to establish why and should like to know if you agree. I am 73
years of age and assume I could still get cervical cancer Is it
possible to book myself in for a test as I do for the breast cancer
screens and if so where do I go to do that.
Stephen Mangar: Whilst you can still get
cervical cancer in your 70's, it would be unlikely if you had a
normal screening test a few years ago, as there is a long lag
period between the development of cancer and pre-cancerous changes.
However it would do no harm to discuss with your GP if you are
worried about any symptoms that you are experiencing.
AXAPPPhealthcare:We have a another question
from the blog: "Is it something that should be investigated if an
older woman starts to find their breasts feeling sore, or is that
just part of getting older with breasts starting to lose their
firmness and drop a little? I am mid fifties and 6 years into the
menopause. I have noticed them being sore when I wake up and just
generally feeling sore the last few months.
Stephen Mangar: Hazel - it is very common to get
breast pain (mastalgia) at and around the menopause and although it
is likley to be related to changes in your hormone levels if the
pain persists then it would be worthwhile getting it checked out at
Spindis: Hi, my husband was diagnosed last month
with stage 4 sclc at the age of 47. He is on a standard protocol of
etopiside and cisplatin every 3 weeks for 3 days... Is there
anything else out there at the moment that is in clinical trials
for this type of cancer that you are aware of ? I note that this
was something that you have been looking at ? Thanks
Stephen Mangar: Spindis- hello there I am sorry
to hear about your husband. How is he coping with the chemotherapy
and has he responded to it so far?
Spindis: He's doing well physically and although
is a little tired in the week after the chemo (mostly due to the
steroids keeping him awake). His bloods are coming back very good
every time, better than the consultant expects and so far the
tumour has responded well and had reduced by about a quarter after
the first 2 rounds. However, they don't seem to be very positive.
It hasn't spread although after the 2nd CT they think that there
may be a couple of spots on his spine, but they're not sure so will
monitor it, but it's not gone to the brain. The tumour was 9.8cm by
7 (ish) at the start.
Stephen Mangar: One of the characteristics of
small cell lung cancer is that it responds to both chemotherapy and
radiation treatment, but ultimately it comes back again. Second
line chemotherapy is only rarely used because most patients are not
fit enough to receive more intensive chemotherapy, are are too
fatigued after the first round. However radiation treatment to the
spine may be of help in terms of symptom control. The main emphasis
of any treatment at this stage is on symptom control and
quality of life rather than trying to cause the tumour to
Spindis: OK thanks... when you say second line
chemo I take it you mean another lot after the first 6 cycles ?
Spindis: Yes after the first 6 cycles, sometimes
the oncologist would recommend changing to a different
Niceday: My husband has very fair skin, freckled
and blonde. As a gardener, he works outdoors all the time. While I
do remind him to wear sun lotion and hat in the summer, I do worry
about skin cancer due to his fair skin. How can I spot early
symptoms or warning of skin cancer?
Stephen Mangar: Niceday- the first obvious sign
of skin cancer would be that of a change in appearances of either a
freckle or a mole i.e. increase in size, change in colour, or
whether it bleeds spontaneously
AXAPPPhealthcare: Thanks to Dr Mangar for your
work this afternoon - final question. My sister had uterine cancer, had a hysterectomy and has
undergone chemo and radiation. They have told her the cancer has spread but she
said the chemo was so awful she can not have anymore. She is now doing gerson
therapy and went to Mexico
to learn what to do. She believes this will cure her. Do you have a point of
view on this?
AXAPPPhealthcare: Whilst Dr Mangar is answering
the last question, we've got time to inform you that this chat room
contains information of general interest about current medical
issues, but does not give any specific medical advice. AXA PPP and
BMI Healthcare Limited do not endorse, nor advertise any particular
treatments or products for the treatment of cancer. If you are
currently receiving treatment, or will shortly undergo treatment,
we would strongly recommend that you seek further advice from your
GP or consultant in the first instance.
Stephen Mangar: Linda - I am sorry for your
sister. I do understand that chemotherapy is not for everyone and
different people react differently. Likewise people react
differently to different chemo regimes, and there are still second
line chemotherapy options which have some benefit. Obviously
combined modality treatment with radiotherapy will make overall
side effects worse, with chemo potentiating the radiation side
effects. In addition there may be other avenues to explore
for example using biological response modifiers. I do not think
there is any randomised data to support the use of the GERSON diet,
but I do not think it will do any harm to try.
AXAPPPhealthcare: Thanks for staying on to
answer that final question. We've now come to the end of our live
chat for today, thank you Dr Mangar, we hope you enjoyed your time
with us today
BMI Healthcare: Thank you very much Dr Manger
and the earlier Consultants, Dr Hogg, Miss Hanna and Mr Pakarian
for your time today. Thank you AXA also for hosting.
AXA PPPhealthcare:It's been really good thanks
Dr Hogg, Miss Hanna, Mr Pakarian and Dr Mangar.
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