The Treatment of Lymphedema

Lymphedema of the arm and/or breast is commonly associated with breast cancer surgery and/or radiation therapy for breast cancer. Surgery that involves removal of the lymph nodes under the arm (axillary dissection) can cause lymphedema because of the mechanical disruption Read more

Testicular Cancer: What Every Man Should Know

However, it is the most common malignancy in men between 20 and 34. There is considerable geographic variation with the highest incidence being in North American White males. Factors such as cryptorchidism (undescended testis), or gonadal dysgenesis are known Read more

Skin Cancer

Skin cancers are divided into two general types –Melanoma and Non-Melanoma Non-melanoma cancers are primarily basal cell carcinomas and squamous cell carcinomas. 75% of skin cancers are basal cell carcinomas with 2.8 million cases diagnosed annually. Basal cell carcinomas tend Read more

The Treatment of Lymphedema

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Lymphedema of the arm and/or breast is commonly associated with breast cancer surgery and/or radiation therapy for breast cancer. Surgery that involves removal of the lymph nodes under the arm (axillary dissection) can cause lymphedema because of the mechanical disruption of fluid flow within the arm. In other words, if a person were to get an infection or undergo mechanical compression of the arm, usually the arm is able to accommodate the infection or compression by using the lymphatic channels to drain away the infection or fluid that can accumulate. After an axillary dissection, the lymphatic channels are absent and cannot drain away the infection or fluid so it backs up into the arm or breast, causing swelling and/ pain. The same mechanical event occurs after radiation therapy to the axilla.


couple-talk-to-docLymphedema is the accumulation of fluid within the tissues of the body that can cause swelling, pain and limited range of motion. Lymphedema occurs when the lymphatic channels have been disrupted by such events as surgery, radiation treatments, and infection.

Signs of lymphedema of an extremity are swelling, redness of the skin, blotchy skin, tight fitting jewelry without any corresponding weight gain. Breast edema is usually a firm, enlarged breast. In the past, lymphedema was an untreatable event that caused significant morbidity with pain. Currently, however, if lymphedema is diagnosed early, it can be treated and even reversed.


Treatment depends primarily on the cause of the lymphedema and involves antibiotics, compression devices, physical therapy. The best prevention, however, is to avoid the causes – infections, compression of the extremity, injury. If lymphedema is diagnosed, early intervention is important.

Testicular Cancer: What Every Man Should Know

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consultation-male-patient3However, it is the most common malignancy in men between 20 and 34. There is considerable geographic variation with the highest incidence being in North American White males. Factors such as cryptorchidism (undescended testis), or gonadal dysgenesis are known risk factors. Ten percent of patients with testicular cancer have a history of cryptorchidism. The  usual presentation is a painless swelling in the scrotum though 10% of patients will report a history of pain. Heaviness and tenderness are not uncommon. Many patients report a traumatic event prior to diagnosis; however, this is more of a coincidence than cause. Back pain and/or abdominal swelling can be seen if there is marked lymph node involvement. There are essentially two types of testicular cancer – seminoma and non-seminoma. Both are seen in equal frequency. Seminomas generally have a better prognosis.


If a testicular mass is detected, an ultrasoundis obtained to determine if the mass is solid or cystic. If a solid mass is found, bloodwork is obtained. There are two tumor markers found in testicular cancer – alpha fetoprotein (AFP) and betahuman chorionic gonadotropin (B-HCG). Depending on the type of testicular cancer, one or both will be elevated. Some, but not all, seminomas produce B-HCG. AFP elevation is never seen in seminoma. Non-seminomatous tumors can produce AFP and/or BHCG. The bloodwork will help differentiate the type of tumor. If a solid mass is seen on ultrasound and/or the bloodwork is abnormal, surgery will be recommended. Prior to surgery, a chest x-ray and computed tomography (CT scan) of the abdomen are obtained for staging. The surgery involves removal of the entire testicle, also known as a radical inguinal orchiectomy. If a non-seminoma is diagnosed preoperatively, thelymph nodes in the abdomen may be dissected as well. The testicle is sent for pathological review at the time of surgery. Tumor markers will be obtained after surgery to help ensure all disease has been removed.

“Testicular cancer is rare. There are approximately 8800 cases per year with an incidence of 5.2 per 100,000 males.”


Most testicular cancers are Stage 1 (i.e. no evidence of spread to lymph nodes). For Stage 1 seminomas, radiation to the pelvis andlymph nodes in the mid-abdomen is recommendedin this country for most patients after orchiectomy (removal of the testicle). There are some studies questioning whether radiation is necessary, however, standard of care in the United States is postoperative radiation. Stage 1 non-seminomas can be cured with surgery alone. There is no role for radiation in the treatment of early stage non-seminoma.

Testicular cancer is a highly curable disease. Testicular self-exam as well as annual examination by a physicianis the key to detection, diagnosis, and cure. However awkward or embarrassing, this simple, life-saving evaluation should not be ignored or taken lightly. Prior to receiving treatment, fertility issues should be discussed with the urologist. Many patients may be subfertile or infertile because of the tumor. Surgery can also reduce fertility. If radiation is recommended, a sperm count should be obtained prior to treatment and sperm banking may be recommended as the radiation will also reduce fertility.

Skin Cancer

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Skin cancers are divided into two general types –Melanoma and Non-Melanoma

skin_cancer_preventionNon-melanoma cancers are primarily basal cell carcinomas and squamous cell carcinomas. 75% of skin cancers are basal cell carcinomas with 2.8 million cases diagnosed annually. Basal cell carcinomas tend to occur on the head and neck and in sun exposed areas. These are rarely fatal, but can be disfiguring. Squamous cell cancers are the second most common skin cancers. These also are due to sun exposure and are more likely associated with premalignant conditions. These are usually flat lesions that are irregularly shaped. The incidence of squamous cell carcinoma has increased over 200% over the past three decades

Melanoma can be the most serious skin cancer and comprise about five percent of skin cancers diagnosed annually. Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old. The overall 5-year survival rate for patients whose melanoma is detected early, before the tumor has spread to regional lymph nodes or other organs, is about 98 percent in the US. The survival rate falls to 62 percent when the disease reaches the lymph nodes, and 16 percent when the disease metastasizes to distant organs. A person’s risk for melanoma doubles if he or she has had more than five sunburns. One or more blistering sunburns in childhood or adolescence more than double a person’s chances of developing melanoma later in life.

uVSkin cancer is the most common malignancy diagnosed in the United States. There are 3.5 million cases each year diagnosed in two million people every year. To put this incidence in perspective, there are more skin cancers than cancers of the breast, prostate, lung and colon combined. One in five Americans will be diagnosed with skin cancer. Skin cancer risk is related to the amount of melanin, or pigment, in the skin. Therefore, they tend to be most common in red/blond hair and blue eyes. Risk is related to sun exposure also. For example, skin cancers are more common in Scandinavians who emigrate to Australia than in those who do not. The sun exposure risk is cumulative for most skin cancers.

Regular daily use of an SPF 15 or higher sunscreen reduces the risk of developing squamous cell carcinoma by 40 percent and the risk of developing melanoma by 50 percent. There are 32,000 cases of melanoma diagnosed each year and 8500 deaths per year. The incidence has more than doubled in the last ten years. Prognosis depends on stage of disease, which is related to depth. There is a higher likelihood of spread and therefore a worse prognosis than non-melanoma cancers.

For any type of skin cancer, treatment depends on size, location and any other previous treatments. For most lesions, various surgical treatments and radiation therapy have roughly equivalent cure rates. Surgical resection is usually chosen because of cost and expediency. However, radiation therapy for facial lesions generally has a better cosmetic outcome. Radiation therapy as a primary treatment should be considered for lesions of the ear, lip, eyelids, large lesions, recurrent lesions, multiple lesions, or lesions with local lymph node involvement. Radiation treatments are safe and effective for skin cancers, but may involve several weeks. Other treatment options include cryotherapy to freeze the lesion and topical chemotherapy. Melanoma treatments can vary depending on stage of disease.

The important things to notice about any skin lesions is as easy as ABCD. A is for appearance, which means is it thick and piled up looking or flat. B is for borders which means is it a perfect circle or does it have irregular edges. C is for color. Is it red, black , blue ,etc and does it change colors over a period of time. D is for diameter. Is it growing? If you are not sure of a spot on your body, see your doctor for evaluation . Early diagnosis is the key to cure.

Prevention of skin cancers is one of the simplest cancer preventions— avoid excessive sun exposure! This includes tanning booths as well.

Managing Cancer Pain

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Pain is a subjective symptom. A pain scale is usually used to rate a patient’s level of pain. The scale is from 0-10 with 0 being pain free and 10 being the worst pain the patient has experienced. For pain on a scale of 1-3, physicians usually recommend over the counter drugs like acetaminophen (ex: Tylenol), ibuprofen (ex: Advil, Motrin) or naproxen (ex: Aleve). The choice of which medication depends on the type of pain and the patient’s other medical conditions. For pain on a scale of 4-10, narcotics are generally necessary. Sometimes the over the counter medications are continued. The most commonly used narcotics are acetominophen with codeine (ex: Tylenol #3), oxycodone with acetominophen (ex: Percocet, Roxicet, Tylox), hydrocodone with acetominophen (ex: Vicodin). These drugs are in a group of drugs called opioid analgesics.

Other narcotics used are in a group of drugs called opioid agonists. These are drugs like codeine, fentanyl (ex: Duragesic), meperidine (ex: Demerol), morphine sulfate (ex: MS Contin, Roxanol, Oramorph SR), oxycodone (ex: Oxycontin, Roxicodone), and propoxyphene (ex:Darvon). These do not contain acetominophen or aspirin as most of the opioid analgestics do.

doctors-process-payments-check-insurance-instantly-with-drchrono-app-e3c70b674b If you are experiencing pain due to cancer or its treatments, openly discuss this with your doctor. There is no reason to suffer in silence when there are many options available to you.


The type of narcotic necessary depends on the type of pain, duration of the and overall prognosis. Many patients become concerned about addiction to these drugs. This is a reasonable concern but studies have shown that patients truly in pain, generally do not become physiologically addicted to narcotics. One significant side effect to opioids is constipation. This is primarily managed with laxatives, drugs to increase gastric motility and enemas.

There are non-medicinal forms of pain management also. Accupunture has shown some benefit in physically and mentally relieving pain. Sometimes, nerve blocks are necessary to cut off the stimulus of the pain. Hypnosis has subjectively shown to be of benefit in a small subset of patients.

If you are experiencing pain due to cancer or its treatments, openly discuss this with your doctor. There is no reason to suffer in silence when there are many options available to you.

Diagnosis Cancer: The Fear Factor

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Lost-Confused-600The diagnosis elicits fear, anger, and denial – some of the same emotions seen when mourning a death. Many times the patient is afraid to inform family and friends for fear of alienation. The fear can be elevated if at the time of diagnosis, treatment options are given. This is where the physician plays a critical role. Anger is common and is usually manifest as anger towards close family and friends. It is another coping mechanism that is masking fear. Denial is usually the first reaction. “This can’t be happening to me” or “there must be some mistake”. Again, this is usually just another form of fear.


Once acceptance of the diagnosis has been made, several events tend to occur, which all can cause more stress. Other physicians may need to be consulted, surgery may be necessary with a long healing process, and chemotherapy and/or radiation therapy may be indicated. Each procedure requires a different physician. Multiple physicians being involved can be confusing for the patient. Most patients emotionally feel better once treatment is initiated. After treatment is completed, follow- ups can be the next cause of stress. Many patients are concerned as to what may be found during an examination or radiographic study. Once they are told, “everything is ok”, the stress and anxiety resolve.

The diagnosis of cancer is one of life’s most stressful events.Stress-jpg


The most distressing time for patients and families can be during the phase of terminal care. Sometimes hospice services are recommended because the physician feels the patient may benefit from such services at that time or in the near future. Hospice provides an excellent service with both medical and emotional support during the end of life. Many patients and family are concerned about pain and suffering during this difficult time. Hospice can provide significant pain relief through medication. Chemotherapy and radiation therapy are also now
allowed for pain relief.

The Diagnosis Of Cancer Is A Difficult One.

It is important for patients to know they are not alone. There are many support groups, chat lines, websites, etc that are now available. It is important for patients to feel comfortable with their caregivers – family, friends, and physicians – to openly discuss their fears and concerns. Many times there is no basis for the fears. Cancer treatments and cures have come a long way and the future looks bright.

Cancer of the Uterus: What Every Woman Should Know

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80406212According to the American Cancer Society, an estimated 53,000 women in the United States will develop uterine cancer in the year 2014 and an estimated 9000 will die of the disease. These estimates include both endometrial cancers and uterine sarcomas. About 2% of uterine body cancers are sarcomas, so the actual numbers for endometrial cancer cases and deaths are slightly lower than these estimates.

Endometrial cancer is rare in women under the age of 45. Most (about 3 out of 4) cases are found in women aged 55 and over. The average chance of a woman being diagnosed with this cancer during her lifetime is about one in 37.

There are over 600,000 women who are survivors of this cancer. This cancer is slightly more common in white women, but black women are more likely to die from it.

Alternative Cancer Treatments = Quackery?

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Livingston-Wheeler is a classic example of an alternative treatment that was popularized in a specialist clinic, not in a traditional cancer center. The founder believed all cancer is caused by a bacterium, Progenitor cryptocides, an organism that has not been described anywhere else. The treatment offered at the Livingston-Wheeler Clinic in San Diego, California consist of effort to strengthen the immune system by “detoxification” through diet and enemas and the administration of special vaccines. A study was conducted by University of Pennsylvania comparing patients with advanced colorectal cancer, lung cancer, pancreatic cancer, or melanoma. All had a predicted survival of no more than one year. There was no difference in survival between groups treated with standard treatment versus those treated at the clinic. This study refutes the clinic’s claim at having an 82% cure rate.

1402662766_teenagers“Contrary to popular opinion, oncology has always existed next to alternative forms of therapy. Many chemotherapeutic drugs, like Taxol, are derived from plants. As oncologists, we support any treatment that has shown in scientifically controlled studies to show some improvement. Unfortunately, some of the more popular alternative forms of therapies have not shown any difference and in some situations, have allowed patients to progress because standard treatment was deferred or delayed.” 

High-dose vitamin C was popularized many years ago with the claim that patients treated with vitamin C lived longer than those treated at a neighboring hospital. The thought was that vitamin C improved “host resistance”. A randomized trial was conducted with 150 patients with advanced cancer received either vitamin C or placebo. Survival was short in both groups but the vitamin C group did not do any better than the placebo group.

Laetrile is derived from apricot pits. In a study conducted with 179 patients with advanced cancer, 90% of the patients had disease progression within three months. Shark cartilage received much media coverage in the early 1990s following the publication of a book “Sharks Don’t Get Cancer”. 50,000 Americans were using shark cartilage in the mid-1990s. A study was conducted with 60 patients with a variety of tumors who had Stage IV disease. No improvement in survival or quality of life was noted. However, there does appear to be some benefit in shark cartilage in cancer treatment. It acts as an inhibitor to blood vessel growth and therefore, could help to cut off the blood supply to a tumor. A company in Canada is currently investigating this use.

The Bottom Line Is:

Do not defer standard therapies for something that promises cures or treatments without side effects. If it sounds too good to be true, it probably is too good to be true. Also, discuss any alternative therapies you may wish to pursue with your physicians. Some of these treatments can interact or interfere with chemotherapy and or/radiation therapy.


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Skin Brachytherapy

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Skin Brachytherapy – A Great Option for the Treatment of Non-Melanoma Skin Cancer


The Cancer Center at Gaithersburg is the first in Washington, DC area to offer skin cancer treatment using an innovative form of radiation as an alternative to surgery, known as Skin Brachytherapy. These treatments allow a painless, non-surgical approach to skin cancers. The treatments take 15 minutes with only 6-10 treatments. Skin brachytherapy involves the use of an applicator placed directly on the skin. Any part of the body can be treated with this technique. Skin Brachytherapy is an alternative to surgery for patients who cannot have surgery due to other medical conditions such as diabetes, vascular disease, or are on blood thinners. It is also well suited to be used after surgery. Other than some temporary redness of the skin, there are no other significant side effects. The cosmetic results are excellent!

The Cancer Center at Gaithersburg offers all forms of radiation therapy specialized to meet a patient’s needs including stereotactic radiosurgery, IMRT and image guided radiation therapy. The Center is located off of Rt 270 in the heart of Montgomery County.

The Center is headed by Anu Gupta, MD. She is a board certified radiation oncologist with over 15 years of experience. She received her medical degree from Eastern Virginia Medical School in Norfolk, Virginia and did her radiation oncology residency at the world renowned Georgetown Hospital Lombardi Cancer Center. She has repeatedly been recognized by Washingtonian Magazine as a Top Doc. Dr. Gupta has also been seen on ABC and NewsChannel 8 as an expert in oncology.

Promise for Tomorrow Campaign

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Fairfax City, VA – October 15, 2008 – In recognition of October’s National Breast Cancer Awareness Month, Associates in Radiation Oncology, a private practice radiation
therapy facility based in Fairfax City, Va., that provides comprehensive cancer treatment, is launching a new campaign called ‘Promise for Tomorrow.’

The campaign includes themed care packages for healthcare providers in Northern Virginia with promotional items for patients as well as literature on cancer treatment. The campaign also includes public relations and marketing initiatives to help raise awareness of Associates in Radiation Oncology’s commitment to its patients.

Other initiatives include:

  • Personalized cancer consultations during radiation treatment with patients and their families
  • Ongoing educational programs for breast cancer patients on radiation treatments
  • Community outreach (in-kind support for local/ national cancer awareness programs)
  • Web-based testimonials from Associates in Radiation Oncology’s patients on what ‘Promise for Tomorrow’ means in their lives. This will help other patients
  • understand their treatment program will entail.

“When I spend time with our breast cancer patients, I see women from all walks of life that are encouraged by our efforts to fight breast cancer,” said Dr. Anu Gupta, medical director at Associates in Radiation Oncology. “Their feedback was instrumental in recognizing the need to create a more external awareness program. Our goal is to build relationships with physicians
diagnosing cancer, support our patients with community outreach and provide educational resources on radiation treatments to help them experience better outcomes.”

According to the American Cancer Society (ACS), about 182,500 new cases of invasive breast cancer are expected to occur among women in the United States in 2008. Statistics Associates in Radiation Oncology Launches ‘Promise for Tomorrow’ Campaign show that a woman has a one in eight chance of developing invasive breast cancer in her lifetime.

Associates in Radiation Oncology also plans to extend its campaign to support men battling prostate cancer.

About Associates in Radiation Oncology
Associates in Radiation Oncology (ARO) is dedicated to the treatment of cancer using a comprehensive approach that begins with state-of-the-art technologies that are integrated into a caring and compassionate environment. ARO believe personal attention to detail is as important as delivering optimal treatments. ARO is the only free-standing facility in Northern Virginia and is certified by American College of Radiology (one of only five radiation therapy facilities in the state of Virginia to receive this accreditation). ARO is led by Dr. Anu Gupta recognized in Washingtonian magazine as one of Washington, D.C.’s top doctors. For more information, visit