E4
Research reveals diversity of cancer
cancer continued from E1
the defect is widely shared.
Misleading appearances
Harold J. Burstein, a physician and researcher at the Dana-Far- ber Cancer Institute in Boston, likes to draw an analogy between cancer and pneumonia. A lot of cancers look fairly sim- ilar under the microscope, just as many types of pneumonia look similar on X-rays. But appear- ances are misleading, because the invisible differences are more important in the long run. You really don’t understand pneumo- nia (and probably can’t treat it very well) until you understand how different the disease caused by influenza virus is from the one caused by the tuberculosis bacte- rium or the histoplasmosis fun- gus. “The kind of ‘speciation’ that microbiologists figured out was behind pneumonia a hundred years ago is what is now happen- ing in cancer medicine,” Burstein said. Most experts think it takes more than one derangement in a cell’s genes to “transform” it into a cancer cell. What’s indisputable is that cancers tend to acquire more errors over time, gaining behavior — such as the ability to spread to distant organs (metas- tasize) or resist the effects of drugs — not present in the first small cluster of tumor cells. The piling-up of errors is also why a tumor isn’t a pure-bred collec- tion of cells but a mixture, with many cells having their own pri- vate defects in addition to the ones they share with their breth- ren. Targeting these errors with drugs that locate and block a de-
How cancer begins
Cancer occurs when the body’s normal process of cell growth and death goes awry, allowing cells to grow uncontrolled. That unchecked growth can occur in different ways, resulting in different types of cancer.
ONCOGENES: GOOD GENES GONE BAD
12
Chromosomal rearrangement
Parts of two chromosomes break off and form a new gene that causes uncontrolled growth of certain types of cells.
Chromosomes break
Gene mutation
A building block in a gene's DNA chain becomes defective, either through heredity or through exposure to a carcinogen in the environment. Genes normally repair the problem or the cell dies off, but occasionally defective genes are formed and cells will run amok.
Mutated gene
Gene amplification
In this process, a gene is mistakenly duplicated, sometimes many times, which amplifies its impact. This rarely initiates cancer but occurs as a cancer progresses and becomes more aggressive.
Breast tumor cells
OTHER MECHANISMS
34
Inactivation of tumor suppressors
Some genes function as DNA repairmen, fixing errors that creep into genes and preventing cancer-causing mutations. If these repair genes are inactivated, this inborn surveillance for cancer is lost.
Normal
Repaired
Broken gene
chromosomes
Example
In chronic myeloid leukemia, a blood
cancer, parts of chromosomes 9 and 22 combine to allow a type of blood cell to multiply unchecked.
Normal chromosomes Changed
Unchanged chromosome
Example
Mutations in a family of genes called RAS are commonly seen in lung,
colon and pancreatic cancers.
SOURCES: National Cancer Institute, Columbia University, Mayo Clinic, Nature Education Inc.
External agent
Example
Women undergoing breast cancer
treatment are tested for protein from the HER2/neu gene. Over-expression of this gene can be treated with a drug.
Cells with twice the number of dark gene signals in a test image are considered
HER2/neu-positive. No repair Chromosome
Example
In Lynch syndrome, a condition that usually leads to colon cancer, people inherit tumor suppressor genes that don’t function properly.
Abnormal
5
Altered microRNAs
MicroRNAs are tiny molecules that regulate genes by “silencing” them and blocking their normal function at specific times. The loss of microRNAs, or their overactivity, can turn on oncogenes or turn off tumor suppressors.
Gene function
Gene creates messenger RNA (mRNA)
MicroRNA function
MicroRNA binds
to mRNA, blocks message
Example
Gene is “silenced;” protein is not produced
MicroRNA activity is lost in some breast and lung tumors but is excessive in other breast and lung tumors, as well as
in some liver and pancreas cancers.
DAVID BROWN, BONNIE BERKOWITZ AND ALBERTO CUADRA /THE WASHINGTON POST
mRNA
produces protein
KLMNO
QUESTIONS IN CANCER TREATMENT
TUESDAY, APRIL 27, 2010
fective gene or its protein prod- uct is the newest strategy of can- cer treatment. This “targeted biological
therapy” may be less toxic than conventional chemotherapy, which seeks to kill all rapidly di- viding cells and inevitably takes down a lot of normal ones in the process. Like chemotherapy, it can extend survival, sometimes by years. But targeted therapy doesn’t appear able to cure, which chemotherapy occasional- ly does. It simply leaves too many untargeted cells alive at the end of the day. Whether that will change when physicians have dozens of new biologic drugs at their dis- posal is a big unanswered ques- tion in oncology.
The first step
If cancer is a disease of accu-
mulated errors, the first error is the most important. It sets a new trajectory for the cell and is pre- sent in all the descendants. Most cancer researchers believe that if one were able to undo that first step, or block its effects, long- lasting benefit would result even if cure didn’t. That’s what appears to be hap- pening with imatinib (Gleevec), a drug used to treat chronic my- elogenous leukemia. It targets the defective form of a gene called ABL that all patients with the disease seem to have and that, once acquired, initiates this kind of leukemia. Gleevec causes remission of the cancer in 95 percent of pa- tients; nearly that percentage are still alive five years later. “It is the best anti-cancer drug
ever developed,” said Carlo M. Croce, a physician and cancer ge-
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Dennis had major league back pain. So when he started exercising he was supposed to feel stronger and more flexible—not wreck his back! But in no time at all intense pain made him quit:
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Unseen Spinal Disc Disease!
It only stands to reason—when something’s wrong with your back, it “stays wrong” until you FIX IT— or change what’s making it bad in the first place.
That’s where the danger lies with those cover-up medications and remedies...
Hospitalized Twice with Spasms!
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...they make you FEEL better while more damage may be going on under the surface. Some of the worst of this damage is called degenerative disc disease. It’s like termites working, unseen, on the foundation of your house, eating it away, bit by bit.
PRESSURE
You see, when your spine, feet, knees, pelvis or feet are out of alignment or unbalanced, another part of your body tries to make it right. But do you know which part of your body gets beaten down trying to carry a load it was never meant to handle?
If your disc starts to bulge, it presses on the nerve and causes SEVERE pain!
It’s those poor, overstressed vertebra and discs that sit right at your beltline.
imbalances in your muscles, pelvis and hips—by trying to bend a little more, twist a little more and carry a little more of the load...and sometimes in the worst possible, even dangerous positions.
It’s like the tires being out of alignment on your car. They grind away at the treads until you notice the wear or you have a flat and lose control on the freeway.
With your tires, you just buy a new set and get them aligned. But what about your back? Since you can’t get new parts, what do you do?
A NEW HOPE for EVEN the WORST Kind of Back Pain
The good news is there’s a new breakthrough treatment called PROGRESSIVE CLASS IV DEEP TISSUE LASER TREATMENT. This technologically advanced treatment delivers deep penetrating photonic energy to the injured and damaged areas of your body to produce deep levels of healing. Additionally, COMPUTERIZED NON-SURGICAL SPINAL DECOMPRESSION is another advanced treatment featured at HealthSource Progressive Rehab. of Rockville, which is used in combination with PROGRESSIVE CLASS IV DEEP TISSUE LASER.
Copyright @ 2009 HealthSource
Deep Tissue Laser: RELIEF For So Many Kinds of Pain!
They try to make up for
It was just what Dennis needed when he couldn’t take anymore pain and the doctors were recommending surgery.
They told Dennis his chances for recovery were about 50%—NOT including the risk of infection and complications. So his family tried to talk him out of it.
That’s when he heard about the computerized “back machine” at HealthSource Chiropractic™— and when his life turned around.
After his first time using this gentle new computerized “back machine”, he said:
“...I already felt a lot better. That’s when I realized there’s still hope for me to walk normally again. It was the best feeling in the world!”
It’s Computerized & Gentle
Here’s how it works. Your discs are sort of like jelly filled donuts. Over time, with gravity, stress, and imbalances, the “filling” between the discs can get squished out toward the edges where it pushes on the nerves...
...and the amazing thing about Spinal Decompression is, we carefully “open up” the squashed discs while you comfortably rest on your back. The computer does the work by creating a very precise, gentle, pumplike action to help relieve disc pressure.
Then, a mild vacuum effect is created INSIDE the disc—sort of like a turkey baster. This helps bring the gooey stuff back into the center of the disc and away from the pinched nerves.
It’s so comfortable and gentle, some of our patients actually fall asleep during their treatments—it’s such a relief.
IMPORTANT: Why You Need
More than Just Pain Relief
If we eliminate your pain and it comes right back, isn’t that just a waste of time? That’s how we look at it and why we’ve created our exclusive combination approach to pain called Progressive Rehab™.
Because it’s important to get to the reason WHY you’re having pain or numbness or weakness in the 1st place— the imbalances in the joints, discs, nerves, and muscles. That is why we use a combination of healing techniques incorporating PROGRESSIVE CLASS IV DEEP TISSUE LASER and COMPUTERIZED NON-SURGICAL SPINAL DECOMPRESSION. We also utilize muscle techniques and full therapy/rehab., to get you out of pain and help you stay that way..
We’re not promising a cure or claiming to be superior, we simply like to believe that our clinic is built on helping people feel better. You see, we want you to be able to:
O Bend down to tie your own shoes— even put on your own socks!
O Turn over in bed at night—pain free! O Lean over to pick up the grandkids
O Start power walking—maybe even go to the fitness center
O Get in and out of the car without back pain when you lift you legs
O Vacuum—even move chairs and shove the recliner out of the way
O Reach down fast to wipe up the spill that’s spreading on the kitchen floor
What’s YOUR Back Pain Like?
Don’t worry, we’ve seen almost every kind of back pain, and it’s amazing how many respond to our combination of Spinal Decom- pression and Progressive Rehab™—even problems like:
ICE-PICK-like pain...at the belt-line or in your hips A “TOOTHACHE” in your shin...and numbness in your toes
PRICKLING...in your thigh, or down to the outside of your foot
Nasty SQUEEZING in your back...and spasms for
no good reason
STIFF and ACHY in your low back...so you can’t tie
your shoes
FIRE!—straight down the back of your leg (sciatic nerve)
Sudden WEAKNESS...you never know when it’s going to give out
INFLAMMED!...always feels swollen and even a little hot
WE CAN EVEN HELP WITH THE DISCS IN YOUR NECK!!
Here’s the sciatic nerve where you feel the “FIRE!”
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Includes: Consultation with Dr. Weinberg and actual treatment utilizing painless laser and decompression. Your 1st two visits to our office will be absolutely FREE. This assures us that your condition will respond effectively to this amazing treatment and gives you the confidence that your problem can be actually helped once and for all! Any future treatment is offered a conditional MONEY BACK GUARANTEE to qualified patients.
If you suffer from Back, Hip or Leg Pain or Herniated, Bulging, Degenerated Discs or Stenosis. Neck, Shoulder, Arm Pain, or Arthritis. Fibromyalgia, Headaches, Numbness or Weakness. Carpel Tunnel Syndrome, Rotator Cuff and Knee injuries.
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900 23rd Street, NW Washington, DC 20037 202-715-4000
www.gwhospital.com
(Next to the Foggy Bottom Metro Station)
HealthSource Progressive Rehab of Rockville Dr. Avram Weinberg
(located behind White Flint Mall and near the White Flint Metro, right off of Rockville Pike)
5268-S Nicholson Lane, Rockville, MD 20895
Physicians are independent practitioners who are not employees or agents of The George Washington University Hospital. The hospital shall not be liable for actions or treatments provided by physicians.
Get Back on Your Feet
FREE Seminar
Wednesday, May 12 7:00 p.m. - 8:30 p.m.
Location: GW Hospital Auditorium
Back or neck injury got you down? The GW Hospital Spine Center can help. Orthopaedic surgeons, neurosurgeons, pain and rehab specialists work together to treat back and neck problems, from the simple to the complex. Learn how physicians are using advanced technology and conservative and minimally invasive treatment options to help get you back to your active life – without the threat of pain.
Presenter:
Anthony Caputy, MD
Chairman, Department of Neurosurgery
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1-888-4GW-DOCS
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neticist at Ohio State University Medical Center. The trouble is that for most cancers — and especially those of “solid organs,” such as breast, lung, colon and pancreas — the initiating defect isn’t known. For most of those in which it is known, including some blood cancers other than chronic my- elogenous leukemia, there aren’t yet drugs that target the defect. But cancer research isn’t a
story of never-ending complex- ity, as much as it appears to be. Thanks to whole-genome scanning of many tumors, scien- tists think they’ve identified nearly all the big actors in can- cer: the genes commonly mutat- ed across many types of cancer. That, in turn, has revealed the existence of perhaps a dozen “core pathways” in cell physiol- ogy and behavior that are dam-
aged in cancer.
“Out of all this complexity there may be some common themes,” said Victor Velculescu, a physician and cancer researcher at Johns Hopkins University who has done much of this work. “There are common pathways shared between many tumors, even though the individual genes affected in a pathway are differ- ent.” The search is underway for drugs that target pathways rath- er than damaged genes. The goal is to block the chain reaction of events leading to uncontrolled cell growth somewhere down- stream from the one (or more) genes that are causing the prob- lem. That way one “targeted therapy” could target numerous cancers. It will be a long war.
browndm@washpost.com
Most common types
Estimated new U.S. cancer diagnoses in 2009:
Men
Prostate
Lung / bronchial Colorectal
Urinary bladder Skin melanoma
Women
Breast
Lung / bronchial Colorectal Uterine
Lymphoma*
*Non-Hodgkin
192,280 116,090 75,590 52,810 39,080
192,370 103,350 71,380 42,160 29,990
SOURCE: National Cancer Institute, Columbia University, Mayo Clinic, Nature Education Inc.
THE WASHINGTON POST
Informational Booklet
FREE
This offer does not apply to federal insurance beneficiaries and ACN participants.
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