Cancer live chat

29 March 2012

For the final session on what was a very busy event, we were extremely pleased to welcome Consultant Clinical Oncologist Stephen Mangar to online our live chat on the subject of cancer. Here are the full question and answers from the session:

Stephen Mangar:Good afternoon everyone

AXAPPPhealthcare:Dr Stephen Mangar is from BMI Princess Margaret Hospital and BMI Clementine Churchill Hospital, welcome

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 prostate checked?

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 family history

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 relative?

Stephen Mangar: No but it does no harm to be vigilant

Ra1: Okay - that is good to know. Thank you Stephen.

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.
Hazel ."

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 your GP

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 shrink.

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 combination

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.