Technical FAQs – Cancer

PAM50 (Prosigna) is a gene expression test that is used to analyze the activity of 50 genes in breast cancer cells. The test provides information about the risk of recurrence of early-stage breast cancer in postmenopausal women who have been diagnosed with hormone receptor-positive, HER2-negative breast cancer. It is used in combination with other clinical information, such as the size of the tumor and lymph node involvement, to help guide treatment decisions for early-stage breast cancer.

Gleevec (imatinib) is a targeted therapy medication used to treat certain types of cancer, particularly chronic myeloid leukemia (CML) and gastrointestinal stromal tumors (GISTs). It is taken orally in the form of a tablet, usually once or twice a day. The dosage and duration of treatment depend on the type and stage of cancer being treated, as well as other individual factors. Gleevec has been a significant breakthrough in cancer treatment and has significantly improved the prognosis and quality of life for patients with CML and GISTs.

RT-qPCR is a laboratory technique used to measure the amount of RNA present in a sample, and it is widely used in cancer research to detect and monitor cancer. In some cases, cancer cells produce specific RNA molecules that are not present in healthy cells. By analyzing blood or tissue samples from patients suspected of having cancer, RT-qPCR can be used to detect these RNA molecules and diagnose the presence of cancer. This allows clinicians to identify and monitor cancer at the molecular level, which can help guide treatment decisions and improve patient outcomes.

Radiation therapy, also known as radiotherapy, is a medical treatment that uses high-energy radiation to kill or shrink cancer cells. The radiation is usually delivered by a machine that directs the radiation beams to the specific area of the body where the cancer cells are located. Radiation therapy is used to treat various types of cancer, including lung cancer, breast cancer, prostate cancer, and brain tumors. The type of radiation therapy used depends on the location and stage of cancer, as well as the patient’s overall health and other medical conditions.

Common side effects of radiation therapy include fatigue, skin irritation, nausea, and diarrhea. However, these side effects usually go away after treatment is completed.

[answer]

Gene testing, also known as genetic testing or DNA testing, is a medical test that examines a person’s DNA to identify any changes or mutations in their genes. This type of testing can provide information about a person’s risk of developing certain diseases or conditions, as well as help diagnose genetic disorders. Gene testing can be done using a variety of methods, including blood tests, saliva tests, and cheek swabs. The results of the test can provide valuable information about a person’s health and can help inform medical decisions and treatment options.

Coping with CIPN can be challenging, but there are several strategies that can help patients manage their symptoms:

1. Talk to your doctor: If you are experiencing CIPN, it is important to talk to your doctor about your symptoms. They may be able to adjust your chemotherapy dosage or prescribe medication to manage your pain.
2. Physical therapy: A physical therapist can help you improve your strength and balance, and teach you exercises that can help alleviate your symptoms.
3. Manage your pain: There are several over-the-counter and prescription medications that can help manage pain associated with CIPN. Talk to your doctor about which options may be best for you.
4. Practice good foot and hand care: Taking care of your feet and hands can help prevent further damage and reduce symptoms. This includes wearing comfortable, well-fitting shoes, moisturizing your skin, and avoiding extreme temperatures.
5. Try alternative therapies: Some patients have found relief from CIPN through alternative therapies such as acupuncture, massage, and meditation. Talk to your doctor about whether these options may be right for you.
6. Stay active: Regular exercise can help improve circulation and reduce symptoms of CIPN. Talk to your doctor about safe exercise options that are appropriate for your condition.

Coping with CIPN can be challenging, but with the right strategies and support, patients can manage their symptoms and maintain their quality of life.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of chemotherapy that can cause pain, numbness, tingling, and weakness in the hands and feet.

Some common late side effects of radiation therapy include:

1. Radiation fibrosis: This condition occurs when the radiation causes scar tissue to form in the area that was treated. This can lead to stiffness, pain, and difficulty moving the affected area. (Ramia et al., 2022, Clin Med Insights Oncol)
2. Radiation-induced secondary cancers: In rare cases, radiation therapy can cause new cancers to develop in the area that was treated or in nearby tissues. (König et al., 2022, Cancers)
3. Cardiovascular disease: Radiation therapy to the chest can increase the risk of heart disease. (Armanious et al., 2018, Curr Probl Cancer)
4. Lung damage: Radiation therapy to the chest can also cause damage to the lungs. (Majeed & Gupta, 2022, StatPearls [Internet])
5. Lymphedema: Radiation therapy to the lymph nodes can cause swelling in the arms or legs, which can be uncomfortable and make it difficult to move. (Warren et al., 2014, Int J Radiat Oncol Biol Phys)
6. Infertility: Radiation therapy to the pelvis can damage the reproductive organs and lead to infertility. (Fan et al., 2023, Postgrad Med J)

The specific late side effects that a patient may experience depend on several factors, including the type and location of cancer, the radiation dose, and the patient’s individual health.

Tumor angiogenesis is the growth of new blood vessels that tumors need to grow. This process is caused by the release of chemicals by the tumor and by host cells near the tumor.

Metastasis means that cancer has spread to a different part of your body part than where it started. When this happens, doctors say the cancer has “metastasized.” When tumor cells metastasize, the new tumor is called a secondary or metastatic tumor, and its cells are similar to those in the original or primary tumor. This means that if breast cancer metastasizes to the lungs, the secondary tumor is made up of abnormal breast cells, not of abnormal lung cells. The tumor in the lung is then called metastatic breast cancer, not lung cancer. Metastasis is a key element in cancer staging systems such as the TNM staging system, where it represents the “M”. In overall stage grouping, metastasis places a cancer in Stage IV. The possibilities of curative treatment are greatly reduced, or often entirely removed when a cancer has metastasized.

EMT is a biological process that allows a polarized epithelial cell, which normally interacts with basement membrane via its basal surface, to undergo multiple biochemical changes that enable it to assume a mesenchymal cell phenotype, which includes enhanced migratory capacity, invasiveness, elevated resistance to apoptosis, and greatly increased production of extracellular matrix components. The completion of an EMT is signaled by the degradation of underlying basement membrane and the formation of a mesenchymal cell that can migrate away from the epithelial layer in which it originated.

Secondary cancers can arise in two ways: a new primary cancer (different from the original cancer) that develops after the treatment of the first type of cancer, or tumors that arise from the migration of cancer cells into a different location (also called metastatic tumors), through a process known as metastasis of a primary cancer. This could be done through a series of steps:

1. growing into nearby normal tissue
2. entering nearby lymph nodes or blood vessels
3. traveling to other parts of the body using our blood vessels and/or lymphatic vessels
4. stopping in blood vessels at another location far away from the primary tumor and moving into the surrounding tissue
5. growing in this tissue until a tiny tumor forms
6. causing new blood vessels to grow (see more in our FAQ on angiogenesis), which creates a blood supply that allows the secondary cancer to continue growing

The sentinel (lymph) node is the first lymph node (or nodes) on a direct lymphatic drainage pathway from a primary tumor site, and as such, is hypothesized as the most likely location to harbor occult metastasis.

Source: Essentials of Nuclear Medicine and Molecular Imaging (Seventh Edition), 2019

Stage 4 cancer refers to a cancer that has already spread to other organs or parts of the body through the process of metastasis. This means that secondary cancers would have likely formed.

Monoclonal antibodies (mAbs) are a type of medicine that are specifically created in the lab to invoke your immune system to start targeting cancer cells and/or infections in general. This is typically known as immunotherapy. Most of the time, the names of monoclonal antibody drugs end with the suffix -mab (e.g., denosumab).

Denosumab (also known as Prolia and Xgeva) is a human monoclonal antibody (hence the mab at the back of its name) used to treat bone destruction due to metastatic cancer, osteoporosis and rheumatoid arthritis (RA).

Cancer immunotherapy is the stimulation of the immune system to treat cancer, improving on the immune system’s natural ability to fight the disease. This is typically done using a monoclonal antibody to activate the immune system to fight the cancer.

Some drugs…

Examples include tamoxifen, doxorubicin, daunorubicin, ixabepilone, mitoxantrone and docetaxel.

Some steps you could take to manage the changes in your nails include:

• Keep nails trimmed and clean to reduce the risk of infection.
• Wear gloves when gardening or housecleaning to avoid infection.
• Paint your nails to hide blemishes and increase nail strength. Make sure to use a nail polish you’ve used before to decrease the risk of having an allergic reaction.
• Remove nail polish with a non-acetone-based remover — it can be less drying than an acetone-based remover.
• Don’t bite or tear at your nails. This habit can put you at risk for infection.
• Buy thin cotton gloves that you can wear around the house to help you break this habit.
• Don’t pick at your cuticles if you have dry skin around the nail bed or frayed cuticles.
• Use a cuticle remover cream or gel to keep cuticles tidy. You can push your cuticles back gently using a wooden cuticle stick.
• Massage cuticle cream into the nail area to prevent dryness, splitting, and hangnails.
• Limit the time your limbs are in water. Excessive exposure to water can lead to fungal infections in the nail bed.
• Avoid professional manicures. If you must have your nails done in a shop, bring your own sanitized instruments.
• Do not use artificial nails. Artificial nail adhesives have chemicals that may cause an allergic reaction, such as swelling or inflammation. Fake nails also can trap bacteria that may cause infection.
• If you develop an ingrown toe or fingernail, try soaking it in warm water and putting some antibiotic cream on the area. If the area is still painful or there is pus or redness that seems to be spreading, call your doctor immediately.
• Tell your doctor if you have any signs of inflammation or infection. If you’re having pain or draining fluid from your nail, call your doctor immediately.

(Source: Breastcancer.org)

Side effects of chemotherapy differ from person to person as well as the type of drug combination that was used. Some common side effects include:

• Nausea and vomiting
• Loss of appetite
• Fatigue (tiredness)
• Sleep disturbances
• Diarrhea or constipation
• Mouth sores or ulcers
• Hair loss
• Skin changes
• Nail changes
• Infections
• Numbness of hands and feet
• Bleeding or bruising
• Anemia
• Hypersensitive (allergic) reactions, which may be life threatening
• Infertility
• Secondary cancers (e.g., leukemia) – rare

Hormonal therapy is a type of cancer treatment that is used to slow down or stop the growth of certain types of cancer that are hormone-sensitive. Hormonal therapy is also known as hormone therapy, endocrine therapy or anti-hormone therapy.

HER2 (human epidermal growth factor receptor 2) is a type of protein that is found on the surface of some cells, including breast cells. HER2 receptors play a critical role in cell growth and division, and they are involved in the development and progression of some types of cancer. HER2-positive breast cancer is a type of breast cancer that tests positive for HER2 overexpression or amplification. HER2-positive breast cancer is more aggressive than HER2-negative breast cancer and requires targeted treatments that specifically block the HER2 receptor. Targeted therapies for HER2-positive breast cancer include drugs such as trastuzumab (Herceptin), pertuzumab (Perjeta), and ado-trastuzumab emtansine (Kadcyla), which can improve outcomes for patients with HER2-positive breast cancer.

BRCA1/2 are tumor suppressors. They protect cells from transformation; when mutated cells can progress to cancer, usually in combination with other genetic changes.

BRCA1 is involved in the DNA repair process, where it recruits other factors to carry out DNA repair through the process of homologous recombination. It mediates the sensors and effectors in DNA repair.

BRCA2 is mainly involved in the homologous recombination process. It facilitates the recruitment of other factors to carry out homologous recombination on single-stranded DNA (usually our DNA is double-stranded).

Poly-ADP-ribose polymerase (PARP) plays an important role in DNA damage detection and repair. It is typically implicated in ovarian, breast, and pancreatic tumors harboring BRCA1/2 mutations, as well as castration-resistant prostate cancers with homologous recombination repair (HRR) mutations (Pham et al., 2021, Trends Cancer).

CDK4/6 inhibitors are a class of medicines used to treat certain types of hormone receptor-positive, HER2-negative breast cancer. These medicines interrupt the process through which breast cancer cells divide and multiply. Some examples include palbociclib, abemaciclib and ribociclib. (Sobhani et al., 2019, Cells)

Hormonal therapy is a type of cancer treatment that is used to slow down or stop the growth of certain types of cancer that are hormone-sensitive. Hormonal therapy is also known as hormone therapy, endocrine therapy or anti-hormone therapy.

BRCA1/2 are tumor suppressors. They protect cells from transformation; when mutated cells can progress to cancer, usually in combination with other genetic changes.

BRCA1 is involved in the DNA repair process, where it recruits other factors to carry out DNA repair through the process of homologous recombination. It mediates the sensors and effectors in DNA repair.

BRCA2 is mainly involved in the homologous recombination process. It facilitates the recruitment of other factors to carry out homologous recombination on single-stranded DNA (usually our DNA is double-stranded).

Poly-ADP-ribose polymerase (PARP) plays an important role in DNA damage detection and repair. It is typically implicated in ovarian, breast, and pancreatic tumors harboring BRCA1/2 mutations, as well as castration-resistant prostate cancers with homologous recombination repair (HRR) mutations (Pham et al., 2021, Trends Cancer).

BRCA1/2 are tumor suppressors. They protect cells from transformation; when mutated cells can progress to cancer, usually in combination with other genetic changes.

BRCA1 is involved in the DNA repair process, where it recruits other factors to carry out DNA repair through the process of homologous recombination. It mediates the sensors and effectors in DNA repair.

BRCA2 is mainly involved in the homologous recombination process. It facilitates the recruitment of other factors to carry out homologous recombination on single-stranded DNA (usually our DNA is double-stranded).

Poly-ADP-ribose polymerase (PARP) plays an important role in DNA damage detection and repair. It is typically implicated in ovarian, breast, and pancreatic tumors harboring BRCA1/2 mutations, as well as castration-resistant prostate cancers with homologous recombination repair (HRR) mutations (Pham et al., 2021, Trends Cancer).

BRCA1/2 are tumor suppressors. They protect cells from transformation; when mutated cells can progress to cancer, usually in combination with other genetic changes.

BRCA1 is involved in the DNA repair process, where it recruits other factors to carry out DNA repair through the process of homologous recombination. It mediates the sensors and effectors in DNA repair.

BRCA2 is mainly involved in the homologous recombination process. It facilitates the recruitment of other factors to carry out homologous recombination on single-stranded DNA (usually our DNA is double-stranded).

Poly-ADP-ribose polymerase (PARP) plays an important role in DNA damage detection and repair. It is typically implicated in ovarian, breast, and pancreatic tumors harboring BRCA1/2 mutations, as well as castration-resistant prostate cancers with homologous recombination repair (HRR) mutations (Pham et al., 2021, Trends Cancer).

Crizotinib, sold under the brand name Xalkori among others, is an anti-cancer medication used for the treatment of non-small cell lung carcinoma (NSCLC) and relapsed anaplastic large cell lymphoma (Passerini et al., 2014, JNCI). It inhibits the action of the EML4-ALK fusion protein as an inhibitor (Lei et al., 2022, Oncol Lett).

Crizotinib, sold under the brand name Xalkori among others, is an anti-cancer medication used for the treatment of non-small cell lung carcinoma (NSCLC) and relapsed anaplastic large cell lymphoma (Passerini et al., 2014, JNCI). It inhibits the action of the EML4-ALK fusion protein as an inhibitor (Lei et al., 2022, Oncol Lett).

In most cases, you should be covered under two types of insurance, namely health insurance and critical illness (CI) insurance.

1. Health insurance covers hospital bills (including scans, treatments, surgery etc.) – Integrated Shield Plan (go to the CPF to see which insurer, then go to respective insurance portal – redirect to insurance website)
2. CI insurance pays lump sum upon diagnosis

If you need help, call your advisor and find your policy documents if you can, understand which doctors are on your insurance panels, and work on insurance claims.

If you have done your checks and the doctors have given you a clearance, feel free to look into getting your health and/or CI insurance.