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Has anyone ever not heard of the word Cancer?

Im sure every teen or adult in the world has


heard about the word Cancer. Its a small but frightening word. Most people may know someone who
has survived, died, or is diagnosed with Cancer. Well there are some treatments for all kinds of Cancer
diseases today.
There are many types of Cancers that a person may have. There are: Breast Cancer, Cervical
Cancer, Leukemia, Lung Cancer, and others as well. Lets start by asking the question, What is
Cancer? In a simple term, Cancer can be described as a non-normal cell that grows and divides
uncontrollably and doesnt know when or how to stop. The DNA sequence in a cell becomes mutated
before it grows uncontrollably. Normal cells grow, divide, stop and then eventually die. Cancer cells
dont die. The small units that make up all living things can also be the scariest thing also.
Tumor is another word that weve heard very often also. A Tumor is usually a clump of cancer
cells that grow together. Sometimes some of the Cancer cells actually break away and thats how the
Tumor spreads to other places in a person, forming other Tumors or just spreading the Cancer cells
around the body. The term for the spread of Tumors is called Metastasis. To treat tumors, doctors, often
surgeons, will do a biopsy. A biopsy is a surgery that gets fresh Tumor cells from the patient and then is
put into a test tube to let it grow. After testing with the Tumor cells, theyll know which drugs to use on
the Tumor to help it.
Cancer is not contagious, so you cant catch it from somebody like the flu or cold. If you know
someone who has cancer, then its okay to hug or accompany them in doing other activities. Physicians
dont know why the majority of people dont get cancer and some do, its still a mystery. There are ways
of increasing the risk of getting Cancers, for example: smoking and/or drinking alcohol. If you know a
loved one that is doing these, you can stop them to prevent them from getting any kind of Cancer.
Infections for people at a certain age may be harder for physicians to find out about Cancer. For
kids, rather than adults, who might be infected takes longer for physicians to find out if they have
Cancer or not. Kids often have the flu, a cold, or a fever so its harder for physicians to know. They can
bypass it sometimes, but if they suspect something, they can extract blood from them to test if Cancer is
the problem to their health. To test a patient for infection, the physician extracts blood, and then sends it
to a lab where the infected blood or tissue can grow. The reason for this is so that they can see what
medical treatment will be right for the Cancer, whichever medical treatment or antibiotic works best in
the lab will be used for treating the patient.
There are other treatments for Cancers as well, depending on the level of it. There is the level
where you find what type of cell or tissue is causing the abnormal growth, and then theres the level
where the Cancer has already spread; Tumor. You can treat these levels of Cancer with surgery,
chemotherapy, or radiation. When currently using chemotherapy to help treat Cancer, you have to get an
intravenous shot, often called IV. The liquid goes into the veins and spreads throughout the body to
attack Cancer cells. Another treatment is radiation, when a patient is seated in a machine and high
energy waves are used to destroy the Cancer cells. Your body may get side effects from this and it may
cause your skin to be irritated. Also you can lose your hair and your appetite. The reason for this is
because the treatment is excellent for destroying Cancer cells, but it also destroys healthy cells.
Fortunately there are medicines patients can take to feel better when they undergo these treatments.
Cell Culture Drug Resistance Testing (CCDRT) or Chemotherapy Sensitivity and Resistance
Assays (CSRAs) is another way of testing of a patient's own cancer cells with drugs that may be used to
treat the patient's cancer (Pawelski 2). This helps doctors to not waste antibiotic medicines they use.
Doctors will give and look for the most effective antibiotic medicine. From already extracting some
Cancer cells from the body and letting it grow in a laboratory, doctors will test which antibiotic works
best. This will also help the patient because if doctors do not use this method, they wont know whether
or not the medicine is working. Not knowing if an antibiotic is effective or not can be bad for the patient
also. He or she can be taking a non-effective antibiotic medicine and itll just be a waste or overdose for
the body. Cancer cells can also be Immune to the antibiotic that physicians give them. This cannot be
prevented but can be found and a new antibiotic medicine can be used. All available chemosensitivity
tests are able to report drug 'resistance' information. The Cancer resistance means that when a patient's
cancer cells are affected by an antibiotic in the laboratory, the cancer cells will still continue to live and
grow. Some chemosensitivity tests are able to show the sensitivity level of the Cancer cell also. The
Sensitivity level means that when a patient's Cancer cells are affected by a certain kind of antibiotic, it
will kill the Cancer cells and also most likely wont come back. It is basically the weakness of a Cancer
cell. Once treated for a while, doctors will check your blood again to see if the Cancer cell still exists, if
they dont, you will be in Remission. Remission is when all the Cancer cells in your body are destroyed;
free of Cancer!
Ive known many people that have had Cancer. Some have survived and in some cases, Cancer
has strived and won. My most beloved person, my grandma, had been diagnosed with Leukemia, a
cancer disease inside the bone affecting the bone marrow. When I had heard that my grandma has
Leukemia, it was an awful and sad feeling. I had remembered that she was just so healthy the other day.
My grandma didnt undergo any treatment because she was very religious. She rather us do a religious
ritual for her than being treated in the hospital; she hated it in the hospital. Once she had gotten home in
from the hospital, she was really happy to be home and ready to start the cultural religion. I had known
that it would not help against the awful disease, but this was her only wish, her last will. For once in my
life, I had really wanted this ritual to work and heal my grandma, being free from Leukemia, in
remission.












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Issue 117 - November 2005

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Articles in this issue:
Case Study Issue 117: How Three Miscarriages Have Affected Me
Kylie Holmes
Depression - Promising Treatment Approaches
Jonathan McGookin
The Role of the Transpersonal Dimension in Life-Threatening Illness
Beata Bishop
Cancer Chemosensitivity Testing
Gregory D Pawelski



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Cancer Chemosensitivity Testing
by Gregory D Pawelski (more info)
listed in cancer, originally published in issue 117 - November 2005
When a patient has an infection, doctors often send a sample of infected blood or tissue to a lab where they can
grow the bacteria and see which antibiotics are most effective (called Bacterial Culture and Sensitivity Testing).
Chemosensitivity testing is an attempt to do something similar for cancer; fresh samples of the patient's tumour
from surgery or a biopsy are grown in test tubes and tested with various drugs. Drugs that are most effective in
killing the cultured cells are recommended for treatment. It is highly desirable to know what drugs are effective
against your particular cancer cells before highly-toxic agents are systemically administered to your body.
Assay-testing is based on a biological principle that when a drug is effective, it will induce cell-death (apoptosis)
in the cancer cell (this is the new technology). If the cancer cell is resistant to a drug, apoptosis will not occur.
Assay-testing for apoptosis will determine whether a drug kills the tumour. Chemosensitivity testing (assay-
testing) can take the guesswork out of cancer treatment. Currently, physicians select a drug and must wait about
six months to see whether it is effective on a particular patient.
These cell-culture assay-tests provide much more powerful prognostic information. They tell you that a given
form of treatment has an above-average probability of being associated with a clinical response and/or with being
associated with above-average survival. Likewise, they indicate that given treatment is associated with a below
average probability of response and/or survival.
One approach to individualizing patient therapy is Chemosensitivity Testing. Chemosensitivity assay is a
laboratory test that determines how effective specific chemotherapy agents are against an individual patient's
cancer cells. Often, results are obtained before the patient begins treatment. This kind of testing can assist in
individualizing cancer therapy by providing information about the likely response of an individual patient's
tumour to proposed therapy. Chemosensitivity testing may have utility at the time of initial therapy, and in
instances of severe drug hypersensitivity, failed therapy, recurrent disease, and metastatic disease, by providing
assistance in selecting optimal chemotherapy regimens.
All available chemosensitivity assays are able to report drug 'resistance' information. Resistance implies that when
a patient's cancer cells are exposed to a particular chemotherapy agent in the laboratory, the cancer cells will
continue to live and grow. Some chemosensitivity assays also are able to report drug 'sensitivity' information.
Sensitivity implies that when a patient's cancer cells are treated with a particular chemotherapy agent in the
laboratory, that agent will kill the cancer cells or inhibit their proliferation.
The goal of all chemosensitivity tests is to determine the response of a patient's cancer cells to proposed
chemotherapy agents. Knowing which chemotherapy agents the patient's cancer cells are resistant to is important.
Then, these options can be eliminated, thereby avoiding the toxicity of ineffective agents. In addition, some
chemosensitivity assays predict tumour cell sensitivity, or which agent would be most effective. Choosing the
most effective agent can help patients to avoid the physical, emotional, and financial costs of failed therapy and
experience an increased quality of life.
Fresh samples of the patient's tumour from surgery or a biopsy are grown in test tubes and tested with various
drugs. Drugs that are most effective in killing the cultured cells are recommended for treatment. Chemosensitivity
testing does have predictive value, especially in predicting what 'won't' work. Patients who have been through
several chemotherapy regimens and are running out of options might want to consider chemosensitivity testing. It
might help you find the best option or save you from fruitless additional treatment. Today, chemosensitivity
testing has progressed to the point where it is 85%-90% effective.
Conventionally, oncologists rely on clinical trials in choosing chemotherapy regimens. But the statistical results
of these population-based studies might not apply to an individual. For many cancers, especially after a relapse,
more than one standard treatment exists. There is rarely a situation where you would get everyone to agree that
there's only one form of therapy. Physicians select drugs based on their personal experience, possible side effects
and the patient's condition, among other factors. The system is overloaded with drugs and underloaded with
wisdom and expertise for using them.
Chemosensitivity testing might help you find the best option, or save you from fruitless additional treatment.
Another situation where chemosensitivity testing might make particularly good sense is in rare cancers where
there may not be enough experience or previous ideas of which drugs might be most effective.
Finally, there has been a veritable deluge of new approvals of cytotoxic drugs in recent years as the tortuous FDA
process has been speeded and liberalized. In many cases a new drug has been approved on the basis of a single
very, very narrow indication. But these drugs may have many useful applications and it's going to take years to
find out. Chemosensitivity testing offers a way of seeing if any of these new drugs might apply to your specific
cancer.
Laboratory Tests Assays
Cell Culture Drug Resistance Testing (CCDRT) or Chemotherapy Sensitivity and Resistance Assays (CSRAs)
refers to laboratory testing of a patient's own cancer cells with drugs that may be used to treat the patient's cancer.
A group of lab tests known as Human Tumour Assay Systems (HTAS) can aid oncologists in deciding which
chemotherapies work best in battling an individual patient's form of cancer. The assay is a lab test performed on a
biopsy specimen containing living cancer cells. It's used to determine the sensitivity or resistance of malignant
cells to individual chemotherapy agents. Depending on how well the tumour cells respond to each chemotherapy
agent, they are rated as sensitive, resistant or intermediate to chemotherapy. The concept is that you are better off
using a chemotherapy drug that your tumour reacts to strongly than one your tumour resists.
There have been over 40 publications in peer-reviewed medical literature showing correlations between cell-death
assay test results and the results of clinical chemotherapy in more than 2,000 patients. In every single study,
patients treated with drugs active in the assays had a higher response rate than the entire group of patients as a
whole. In every single study, patients treated with drugs inactive in the assays had lower response rates than the
entire group of patients. In every single study, patients treated with active drugs were much more likely to
respond than patients treated with inactive drugs, with assay-active drugs being 7 to 9 times more likely to work
than assay-inactive drugs. A large number of peer-review publications also reported that patients treated with
assay-tested 'active' drugs enjoyed significantly longer survival of cancer than patients with assay-tested 'negative'
drugs.
Progress Among Medical Professionals
The fact that some doctors don't agree isn't stopping many cancer patients from taking this matter into their own
hands, and sending their live path specimens off to one of the above private labs for assay-testing to be done. In
fact, approximately 10,000 individual patient specimens are currently being submitted for testing by more than
1,000 clinical oncologists, surgeons and pathologists annually in the United States. It seems probable that a self-
educated oncologist, genuinely on the cutting-edge would tend to be aggressive in actual treatment beyond mere
rhetoric and make use of running tests on the biopsy before selecting a chemotherapy option.
Dr Ian Cree, Director, Translational Oncology Research Centre, Queen Alexandra Hospital, Portsmouth UK
performed the very first prospective, randomized clinical trial of physician's choice chemotherapy versus ATP
assay-directed chemotherapy in non-surgically debulked, platinum-resistant ovarian cancer and presented it at the
May, 2005 American Society of Clinical Oncologists (ASCO) meeting in Orlando, Florida.
The results were highly suggestive of an effect due to the assay, and the most successful drug regimens used were
nearly all developed using the assay. UK results in cancer are always lower than in the US for a variety of
reasons. Part of this is probably lead time bias, but data on surgical debulking may be part of the explanation.
Patients in the US get a whole lot more surgery along the way than in Europe.
According to Dr Ian A. Cree, " There certainly is resistance to this approach from some oncologists, but no one
has ever shown that harm could result from the use of these technologies, and there is a considerable body of
evidence to support their use. The tests provide a valuable research resource and have been used to develop new
drugs for cancer."
In 1983, medical publications introduced assays based on 'cell-death' (not cell-growth). This was a good five years
before understanding the concept of apoptosis (apoptosis is a genetically programmed cell death pathway which
exists in all cells, which is supposed to cause them to commit suicide if they become functionally deranged, but
doesn't function properly in cancer cells, allowing them to grow abnormally without committing suicide, which
can be triggered to occur by effective anti-cancer drugs).
Because clinical oncologists did not understand apoptosis then, these pioneering publications with 'cell-death'
(instead of cell growth) endpoints were ignored, and neither clinical trials nor the application of cell death drug
resistance assays were supported by academic and private practice clinical oncologists. The clinical utility and
clinical accuracy of cell culture drug resistance testing with cell-death endpoints has now been proven.
There has been much discussion about whether assay (in vitro) tests are of any use, as the in vivo response to a
drug may very well be different in the body than in the petri dish. But they said the same for Bacterial Culture and
Sensitivity Testing. Doctors cannot remember a time when they didn't have this technology. It is a 'gold' standard.
So will Chemosensitivity Testing. After all, cutting-edge techniques can often provide superior results over tried-
and-true methods that have been around for many years.
In the US, the Gynecologic Oncology Group (GOG) has decided to move forward with a study in platinum-
resistant ovarian cancer, utilizing a different assay called EDR, to direct chemotherapy. However, this assay is
specifically designed to identify 'inactive' rather than 'active' drugs. In this light, the EDR assay has the advantage
of telling you who will 'not respond' but cannot in any way change the negative outcome by selecting an 'active'
alternative. At least here in the US, it's a start!
There are other medical oncologists in the US, headed up by Drs Larry Weisenthal and Robert Nagourney, that
are making proposals for a separate study, a front-line randomized trial with head to head comparison of several
assays (EDR, ATP, DISC, MTT, as well as Caspase 3/7). These assays correlate very well with each other on
direct comparisons of different methods. Different methods of assay results should be applied in choosing a
particular drug regimen to be used in treating an individual patient's cancer.


Cancer Chemosensitivity Testing
(Article from Health Application of Flower Essences, November 2005)




By Aaron Vang (Biology 10 Student)






Biology 10 Lab, Tuesday at 1000
Lab Instructor: Stephanie Wong

Reference Cited:

1) Positive Health Online Integrated Medicine for the 21 century Website:
http://www.positivehealth.com/issue-view.php?issueid=113
2) Kids Health for Kids Website:
http://kidshealth.org/kid/health_problems/cancer/cancer.html
3) ECancer Medical Science Website:
http://www.ecancermedicalscience.com/articles-current-articles.asp
4) National Cancer Institute U.S National Institutes of Health Website:
http://www.cancer.gov/cancertopics/what-is-cancer