FOOD FOR THOUGHT

* A trial has shown that Doxepin rinse may reduce pains from oral Radiation induced Mucositis.

*Radiation post lumpectomy does improve survival even in the elderly
*Memantine 20 mg daily did alleviate loss of cognitive functions post whole brain Radiation
* Now that Tamoxifen can be given for 10 Years, people are still suggesting that switching at 5 years to Letrozole in postmenopausal women, is better but may be we need another clinical trial?  It is reported that switching to Letrozole lead a a 48% drop of Recurrence and 24% drop in chance of death!

*Should maintenance alpha interferon be given in Esophageal and gastric cancer with Non-mutated Interferon receptors? or cancer with over expressed NF-kB.
does overexpression of FOS predict response to Interleukin or Interferon.

*It is wrong to stop inhibitor to VEGF IN CANCER TREATMENT UNTIL DISEASE PROGRESSION, AND INSTEAD OF STOPPING, REPLACE IT BY AN MTOR INHIBITOR, THIS WILL ADD AN OPTION TO COLON CANCERS!
ESMO DID SHOW THAT UPFRONT COMBINATION OF AVASTIN AND MTOR FAILED TO IMPROVE RESULTS (renal cancers) BUT GIVING MTOR AFTER AVASTIN FAILURE IS STILL BELIEVED TO BE BETTER (PROOF OF CONCEPT.  DOES THE ESCAPE MECHANISMS TO AVASTIN OFFER AN OPPORTUNITY TO MTOR INHIBITOR FOR ACTION OR ACTIVITY? WHAT ARE THE PREDICTORS TO MTOR INHIBITORS 'ACTION?  IS TISSUE HYPOXIA SECONDARY TO ENDOTHELIAL DISTURBANCES RESULTING FROM AVASTIN A PREDISPOSITION TO MTOR INHIBITOR ACTION?

*SHOULD WE GO AHEAD AND USE NAB-PACLITAXEL AND GEMZAR IN ADJUVANT SETTING NOW?(PANCREATIC CANCER)

*ADDING ERLOTINIB TO AVASTIN AS MAINTENANCE THERAPY AFTER FIRST LINE CHEMOTHERAPY OFFERED BETTER PROGRESSION FREE SURVIVAL (1 MONTH BETTER) IN A PHASE III TRIAL PRESENTED AT ASCO 2012! (COLON CANCER)

BRCA 1,2  
BR=Breast   CA=cancer
Tumor suppressor gene which encodes a protein regulator of transcription gene involved with cell proliferation (once again it is a regulator that is involved!)

1. Prophylactic Bilateral mastectomy reduces the short term risk of Breast cancer, and overall risk by 90%
2.Adding Bilateral Salpingo-Oophorectomy decreases risk of Breast and Ovarian cancer.
3.BRCA1 high grade and Hormone Receptor Negative, majority are basal like subtype  (but also more Atypia and Medullary histology found here!
4.whereas BRCA2 are more likely receptor positive and of luminal subtype
5. Risk of contralateral breast cancer in those with the disease 50-60%
6.BRCA 2 increases risk of Gastric,bilary,gallbladderand pancreatic cancer also.
7. The 2 HITS Theory assumes that the first hit is to have the abnormality but with the protecting presence of the normal BRCA gene.  The second (environment factor) Hit knock out the normal BRCA to unleash the effect of the abormal BRCA1-100
IF YOU HAVE IT
1-Abide by strict surveillance protocol
2-Bilateral protective Mastectomy
3. Bilateral protective Oophorectomy
4. participation in preventive research drug (Tamoxifen,Raloxifen)

and know about possibility of insurance issues that may arise
SEE A GENETIC COUNSELOR PRIOR TO TESTING!