Monthly Archives: November 2011

How the Royals deal with asbestos

 

Once widely used as a building material and insulator, asbestos has been linked to mesothelioma, Great Britain has one of the highest per capita rates of mesothelioma in the world with an estimated 4,000 deaths from the disease each year.  By contrast, about 2,500 people die of mesothelioma in the U.S.

Though asbestos use is now banned in new construction in the UK, the BBC has reported that as many 500,000 commercial and residential properties still contain the substance, including the apartment at Kensington Palace where the young Duke and Duchess of Cambridge, Prince William and Kate Middleton, plan to live. The last major renovation of the palace, originally known as Nottingham House, was in 1960 at a time when asbestos use was at its peak.

Like other homes of that era, the palace likely contains asbestos insulation and asbestos thermal coverings around hot water heaters and pipes.  Asbestos may also be found in the electrical system around wires or as a lining for fuse boxes. It is also not uncommon to find asbestos in floor and ceiling tiles, roof shingles, chimney flues, paint, sealants and wallboard in older homes. The older and more brittle asbestos-containing materials are, the more likely they are to crumble and release their toxic fibers into the air, increasing the risk of mesothelioma.

To safely remove asbestos from properties such as the aging palace, asbestos abatement professionals use a variety of techniques including wetting down the crumbling materials to reduce dust.  To protect themselves from mesothelioma, they may also use specially-designed protective clothing and respirators.

The planned palace renovation comes at a time when the issue of asbestos abatement is making headlines around the world.  In Australia, where mesothelioma rates are rising, especially among women, legislators are calling on the government to force Do-It-Yourself home renovation television shows to warn homeowners against removing asbestos themselves. The renovation and asbestos abatement at the royal couple’s news residence is expected to take a year.

 

 

A cultural weekend

With two weeks to the next scan, we packed in quite a lot this weekend, whilst the pain is under control. First it was off to see Sarah Millican, the comedian, this one was very much for me, as think he thought the audience would be very girly. In fact it was mixed and she was excellent, really funny, so we had a great evening.

Then on Saturday afternoon, it was off to the afternoon performance at our local theatre to see  a new play “Basket Case”. We often go to this performance as the tickets are discounted, also always makes us feel better , as just about the only place we can now go and feel young. Think the average age is about 80 and there is a definite aroma of lavender water, as well as a surfeit of surgical stockings.

Overall the play was fun, although did wonder if I had made a terrible decision when it started and found out it was about the death of the family dog , as someone who cried during “How to train your Dragon”, it doesn’t take much to set me off. Luckily the rest of the play was quite funny with Nigel Havers in the central role, pretty much playing Nigel Havers.

Went to our local Remembrance Sunday service at church, which was very poignant as a good friend lost her young nephew in Afghanistan, aged 19.So once again we gave thanks that Ray was still here and still fit enough to be attending the service.

Finally to finish off the weekend it was off to see Reginald D Hunter, another comedian. This time not quite so good, have seen him before but think this time we were a bit joked out, plus he had a support act, we didn’t rate, so this was possibly an evening out to far.

 

 

 

New research on mesothelioma prognosis

 

Further evidence of the global nature of this cancer this week, firstly , new research under way in Korea suggest they are going to see an increasing number of cases over the next 30 years. The a neew study from one of the country’s leading cancer centers suggests that the nuclei of mesothelioma cells may hold vital clues for predicting patient survival.

Though as an individual not sure you would want to know, but anything that suggest they are learning more about Mr Nasty has to be good.Epithelioid mesothelioma is the most common subtype.  Doctors often use the cancer’s stage – a measure of cancer extent and severity – to predict how well patients will respond to treatment.  But now a group of scientific researchers from Memorial Sloan-Kettering Cancer Center in the U.S. and Kagawa University in Japan believe they have found an even more effective prognostic indicator – inside the nucleus of mesothelioma cells.

To conduct their experiment, the researchers examined the slides of 232 patients who had been diagnosed with the epithelioid type of malignant pleural mesothelioma. They then examined the nuclei of the cell samples to evaluate them on seven different features.

Thorough analysis of each mesothelioma cell sample revealed that two of the features, nuclear atypia and mitotic count, were directly related to patient prognosis. 

“Not only was nuclear grade an independent predictor of overall survival, but it was also a stronger discriminator of survival than all currently available factors,”

Good to see that the research into this is going on all over the world

 

continuing developments in immunotherapy for cancer

The good news is the developments in immunotherapy seem to be really gathering pace, so much research into genetics , immune systems and targeted treatment is being done throughout the world, that it feels as though when the breakthrough in treatment comes, it will be significant.

The bad news is a lot is still at very early trial stages, so all meso warriers need to keep hanging on. It also shows how important the trials are that are currently underway.

The latest story  was in the BBc news only today with “Skin transformed for cancer fight”

 

Skin cells have been transformed into immune cells ready to fight cancer in the laboratory.Scientists have opened up the possibility of one day using cancer patients’ own skin to fight their tumours. Oxford University researchers transformed skin cells into immune cells, which could be used to trigger a hunt for cancer.

It was achieved only in the laboratory, not in people, meaning any therapy is a long way off. However, the researchers believe it will be possible. Harnessing the power of the immune system is a field being pursued by cancer researchers, such as in the search for cancer vaccines.

This study, published in the journal Gene Therapy, was focused on dendritic cells, which organise part of the immune response.By showing identifying markers – or antigens – they tell the immune system what to attack. If they display cancer markers, cancerous cells will become the target.

The next challenge is to confirm that these laboratory-generated cells will be suitable for immunotherapy-based cancer-treatments used in the clinic.The research team used advances in stem cell technology to create new dendritic cells from a patient’s skin. These were primed to trigger an attack on melanomas using a marker, Melan A, which is unique to the cancer.

Experiments in the laboratory showed these dendritic cells were able to activate both immune cells which produce antibodies and those which kill other cells.

Dr Fairchild said: “The patient would in effect be treated with their own immune cells to prime an attack on their tumour.”He acknowledges that any therapy is a distant prospect. The cost and a safe method of producing stem cells are two of the barriers.

Even then he pictures a treatment working alongside, rather than replacing, other therapies: “It is a long and arduous process compared with chemotherapy and radiotherapy. It’s extremely labour intensive.” Dr Caetano Reis e Sousa, a Cancer Research UK immunology expert, said: “By showing that normal body cells can be reprogrammed to become a sub-type of dendritic cells with superior activity, this research builds on previous work by Cancer Research UK scientists using blood stem cells as starting material.

 

 

 

Genetic developments in cancer treatments

A test that rapidly identifies which genetic mutations have caused a cancer could pave the way for personalised treatments to improve patients’ chances of survival.

Doctors in the US have developed a way to test patients for a wide range of gene variants simultaneously, allowing them to provide more effective, targeted therapy within a matter of weeks.

The test, called SNaPshot, has been used to identify mutations at more than 50 sites in 14 key genes in patients with non-small-cell lung cancer (NSCLC), and is now being offered to patients with a range of other cancers.

Analysis of the genetic makeup of cancers is becoming more common. But it is usually done for specific, single-gene mutations, so this is thought to be the first time such a wide-ranging test has been used clinically.

“Broad genotyping is going to become part of everyday care for lung cancer patients,” said Lecia Sequist the Massachusetts General Hospital, Boston, who co-authored the research published on Wednesday in the Annals of oncology.”Our study is exciting because it demonstrates it is possible to integrate testing for multiple genetic biomarkers into a busy clinic and steer patients toward personalised therapies.”

Sequist and her colleague Dora Dias-Santagata used a form of polymerase chain reaction ,a technique that generates multiple copies of a section of DNA, usually through heating and cooling cycles, to provide more material to test.

The advanced version, known as multiplex PCR, has been used by forensic laboratories for several years to target several genes at once. The recent proliferation of new cancer drugs that target cancers with specific genetic abnormalities is leading to increasing demands for such tests.

“The proportion of patients who can receive these targeted genotype-specific treatments is only going to increase,” said Sequist.

Of 589 patients with NSCLC who had the test, 546 had biopsy samples that contained enough tissue to generate results. Just over half, 51%, had one or more cancer gene mutations or an abnormality called a translocation, in which a section of DNA gets incorporated into the wrong chromosome.

The most common genetic variants found in the patients were in a gene called KRAS in 24% of cases, in EGFR for 13%, and in ALK in 5%.

Of 353 individuals with advanced disease, 170 had mutations or rearrangements that could be targeted with potential treatments. These patients could join clinical trials of drugs targeting the specific genetic makeup of their disease.

The test, which costs around ?310, is being offered in a network of 14 specialist lung cancer hospitals and clinics across the US.

Tarceva is used to treat lung cancer patients with EGFR gene mutations, while another drug called Xalkori was approved for US patients in August for those who have a mutation that means they produce too much of a protein called ALK.

“Choosing the right therapy can raise response rates in NSCLC patients from around 20-30% to 60-75% and may improve survival,” said Sequist.

Later this month, Cancer Research UK will launch its Stratified Medicine Programme a two-year pilot in which samples from 9,000 patients with breast, bowel, lung, prostate, ovarian and skin cancer will be tested for mutations in 21 genes ? known as a “gene panel test”.

James Peach, director of the programme, said: “It’s great to see the successful delivery of a cancer gene panel test in normal clinical practice. The next step is to build on these studies to develop a national network that can deliver high-quality, universally accessible and cost-effective gene panel testing.”

The Foundation for Genomics and Population Health last month published a report calling on the NHS to develop tools to take advantage of advances in genetic testing.

“This test is a prime example of the sort of genomic innovation we can expect to see improving normal cancer care within the next few years by allowing doctors to identify the best treatments for individual patients,” said Dr Philippa Brice of the foundation.

“However, moving new technologies into the NHS can be difficult, especially where they are effectively new sorts of test as opposed to improvements on existing tests, so planning is needed now to ensure that UK patients can benefit from the most useful new tests without unnecessary delays.”

A better day

After around 24 hours in bed, the invalid is up and managed breakfast and lunch. I am rather like the demented tea maker from Father Ted, as everyone keeps telling me to make sure to keep his fluids up. Ideally , I would have a drip, linked to a tea urn, attached to his arm

He does seem marginally better, although in keeping with Halloween week, does look pale enough to have been hanging up in a bat cave.

Still at least , he is up and about. Does make me wonder about the flu jab though, as to whether there is enough info, should the nurse have been more concerned about his sore throat?Would recommend anyone else chats it through in a bit more detail, plus make sure you don’t have a trace of a cold beforehand.

The good news is that by 6.00pm , he was feeling so much better and really hungry , so we went out to our favourite local restaurant for dinner . Given how terrible Saturday was , can’t believe we were sitting at a restaurant 24 hours later.

Spoke to soon

Having picked up a bit yesterday, today he has been totally pole axed and hasn’t been able to get out of bed. He is running a slight fever and all his muscles are really sore. In fact, it’s just as though he has really bad flu.

Was surprised they gave him the jab yesterday as he had such a bad throat. The surgery I go too won’t give you the jab if you have any trace of a cold or sore throat. Given his immune system is still compromised, think his body is having a tough time fighting everything off.

Effectively think the jab has triggered an immune response, which has overloaded his body. He has had some juice , but nothing to eat. He looks terrible, it’s very lonely sitting downstairs at the moment. I don’t want to keep disturbing him, but the temptation is to keep checking on him as well.

If it a reaction to the jab, then he should signs of improvement within 48 hours, so will keep an eye on him, if no improvement , will get the local GP out, make the locum earn their money with a home visit.

Much better

Having felt very sorry for himself yesterday, today is much better, the throat is a lot less sore. Luckily some lozenges from the local chemist helped- so we didn’t need to resort to a morphine based drug!!! I like to feel I helpfully pointed out, just because you have one big thing wrong, doesn’t mean you get an exemption from the usual niggles we all get.

He even managed to go down and get the flu job sorted. Though we had the usual fun with the receptionist- because at the moment he looks quite well, she wanted to know why he was eligible for the jab. obviously with a packed room full of local people, he didn’t feel like announcing terminal cancer, so suggested she went and checked. 30 seconds later return of chastened receptionist – I know they have a job to do, but given the appointment had been made by the doctor, why did she think he was there.

Will be taking it easy this weekend, to be fair, pretty much what we always do, although last Sunday we did have a burst of enthusiasm and Autumn cleaned the kitchen. Given Ray if much tidier than me ( I like to think of it as OCD), such that ideally all the tins would line up the same way, this became quite a big job.

W even found some remnants of alcohol, at the back, seemed a shame to waste them, so we had a couple of snifters along the way. rather worryingly I also found a large jar of olives, that expired in 2007. Given I have moved house at least twice since then, am concerned at the fact I packed and unpacked these as part of a move more than once.

By the end of the day, have an immaculate kitchen , with everything stored in a logical place and shelves that would do a supermarket proud. Discovered I have a surfeit of icing sugar, ( 3 bags) so could bake a very large christmas cake, but all other items appear normal……. and we only had a very small hangover the next day.

A very bad sore throat

After a few good days, with the pain killers working and the cough under control, it was obviously all too good to last. Today, he has a terrible sore throat, really painful, hard to swallow and lost his voice.

The problem of course, is , even with best of intentions, you instantly wonder if this is some new, terrible sign that the meso is going off in an entirely new direction. On the other hand, despite warnings he went out down to his dad’s boat yesterday to help him prepare it for winter and got wet through and cold because of the bad weather.

In any other situation, you’d think 2+2 makes 4, but the problem with meso, it makes everything suspicious. Decided to wait and see how he gets on tomorrow, most sore throats start to clear up after 2 days. He was due for his flu jab tomorrow, but we have put that on hold.

As his throat is so painful, even the usual ibrufen wasn’t having an impact. Of course, after so many painkiller prescriptions over the last few months, we have a veritable sweet shop of drugs available to us. Decided the morphine for breakthrough pain was possibly a little extreme for a sore throat, so have substituted dihydrocodeine for the usual ibrufen. This was the other one we had prescribed recently, so we know they are OK to take in combination.

Had to fight my my way home this evening due to Fulham playing at home, Earls’s Court full of Polish fans. Saw some great fireworks walking past the local park, so let’s hope for a good weekend and a recovering patient.