Research Paper

Research Paper Design Plan and Topic Proposal

After doing, the photo essay I realize that I am not interested enough in exoplanets to do a whole paper on it. I do have a desire to know more about health related subjects so this paper I really want to focus on something that I have a passion for and that’s medicine mainly cancer. I know there are so many different types of cancers that it is hard to keep track of and though I know, we have made major improvements in treating patients. There are still some forms that do not have a very good prognosis and that are what I want to learn about. I have a basic knowledge of cancer which I think any person would know but I want to get an in depth knowledge of some types of brain cancers, melanoma, and pancreatic cancers. I know that many of these can be very lethal and I would love to see what new advances are being made to help patients with these forms.

            My strategy for this research paper is to find data on past treatments and present treatment that doctors are using to treat these forms of cancer and to find innovations or improvements that might be on the way in the near future. I want to find pictures of what each form of cancer looks like I also want to get graphs with survival rates comparing the survival rates of these forms of cancer verses other forms that have a better prognosis. I want the graphs to show that there is a big difference in survival when it comes to these types of cancers. I would also like to get some information and pictures of the type of tests and treatments that they administer to patients. The arrangement of the paper will be a series of pictures, graphs, and other statistics concerning these various forms of cancer. I will be producing this research paper in paper form and it will be uploaded to my blog.

            The argument that I hope to make is to give people hope. I want to find that there are advances being made to help cure these cancers or at least give patients a fighting chance. No person should ever have to experience being given a death sentence like the one my grandmother did. I want to figure out why these forms are so deadly and hard to treat and what is and can be done about it.

            I would imagine people would agree everywhere you go you will always find at least one person who has been touched and affected by cancer. I could not imagine anyone not thinking that this argument and research is not worth doing.

            The only thing I know about the topic is that these forms of cancer can be very hard to treat. In addition, some forms of these cancers can have a terrible prognosis from the start. Cancers are mutations in our body that happen over time some are worse and more inconspicuous then others that that can make them harder to find and treat. I know there is not a lot of information about brain cancer because the brain is such a sensitive structure and you cannot get in the brain many times to achieve that type of research. I know that melanoma if caught early has a good prognosis but if it metastasizes, those rates drop dramatically.

            I plan to conduct this research by speaking to a few oncologists and get a better idea on how they treat and approach these forms of cancers. I plan to get some information from the National Cancer Institute as well as some diagnostic journals. I want to make sure I can find sources that have the various stages and what changes in prognosis does metastasize present.

            After this research, I hope on getting more peace of mind when it comes to cancer. I hope to work in the field of oncology so I want to know all I can possibly find about the subject. The more I know the more I can help. I do not want people to ever have to experience losing a loved or being diagnosed with a disease like cancer. Since I know that day is far away I want to give as much hope to the ones that have to deal with it.

 Fatal Cancers

          Cancer is a disease caused by mutations that causes cells to overgrow uncontrollably and to perform abnormally. The prognosis for cancer patients have improved significantly over the years due to new treatments as well as better techniques. However, when it concerns some forms mainly pancreatic, melanoma, and malignant gliomas there has not been the significant improvement in prognosis and survival rate. There needs to be a remarkable improvement with these forms of cancer if people are ever going to have hope of beating these horrible diseases. These forms of cancer have poor survival rates either because they are not diagnosed early enough , and are very aggressive forms that in most cases spread quickly, which can be resistant to treatment as well as doctors not having the research as well as techniques to solve some of the main issues that these diseases possess. Even though the prognosis will change with any form of cancer when you have metastases, the prognosis drops significantly with these forms unlike some others. In some cases, the treatments can also cause many complications in addition to the cancer itself. The research in these forms is in dire need for new information as well as new treatments. There needs to be better screening and testing so that some of these people can catch the cancer early enough to intervene before It becomes too late so that the treatment and surgery are still options for them. I also believe that there are some decisions that have been made that do not help the patient prolong life no matter what the prognosis may be.

Melanoma is a very aggressive skin cancer caused by melanocytes. Melanocytes are responsible for making melanin, which gives the color to our skin. Melanoma is a form of cancer that still needs to see a major improvement in survival rate and treatment. The researchers at the New England Medical Journal have discovered although melanoma only accounts for 4 percent of skin cancers melanoma accounts for 80 percent of skin cancer deaths and once this cancer metastasizes, only 4 percent of patients actually survive 5 years (New England Journal of Medicine 2006).  Which shows how disproportional the mortality rate is compared to the actual number of cases. When a cancer metastasizes it spreads to other parts of the body which, changes the prognosis dramatically especially with this type of cancer. The biggest hurdle is that doctors and researches still have a lot to learn and there remain many unknowns about this disease, its treatments, and the mechanisms of the disease and why it spreads so aggressively. What they have found through research is one of the biggest risk factors for this cancer is familial history along with atypical nevi or moles and a history of melanoma in the past (New England Journal of Medicine 2006). The immunosuppressed and people exposed to UV radiation also pose a risk. It is important to use sunblock while in the sun because if you are sunburned as children often and as an adult now use sunscreen you are still very much a risk for melanoma due to a history of sunburn. In 2006, a discovery found that tanning regularly before the age of 35 can increase ones risk of melanoma by 87 percent. The key to improving the survival rate of this type of cancer is early awareness and becoming knowledgeable of the risk factors as well as taking the necessary precautions to keep your risk levels low. People should follow the ABCDE’s when examining the body (Journal of American Medicine 2011). The “A” represents asymmetry, which means if cut in half each side looks different.  The next characteristic a mole should have is a smooth border it should not be irregular and jagged. A mole should have consistent color throughout and should not be two toned; the diameter for the mole should be no more than a pencil eraser and you should watch for an evolution and elevation of your mole. Any of these signs can be the beginning stages of melanoma. Even though it might present as just an abnormal mole the cancer is spreading and penetrating far below the surface of the skin to your blood, lymph nodes, and to other organs as well. What worries me the most about this cancer is it can spread from a small mole to the rest of your body. You might not even see or notice the mole or patch of skin until it is too late.  The type of metastases affects the prognosis of the patient as well. The Lancet Journal expounds on The New England Medical Journal’s data by describing the estimated survival rates on specific forms of metastases. When the patient has distant metastases, where it spreads to distant organs far from the origin the survival time is only about 6 to 9 months (Clinical and Experimental Dermatology 2000). Whereas if it spreads to the brain, bone, or liver you only have about 3 to 4 months (Clinical and Experimental Dermatology 2000). The only prognosis, which has a slightly higher survival time, is metastasize to lymph nodes, which gives you about 12 to 15 months (Clinical and Experimental Dermatology 2000). If caught very early, melanoma can be treated. The issue is the majority of cases are already advanced and present with metastases through the body, which causes complications. Unfortunately, doctors and researchers still do not understand why melanoma is so resistant to chemotherapy, which is one of the reasons why it is so deadly. In addition, as explained patients do not have very long to live and therefore, do not have the time to try different techniques and treatments that could improve prognosis, which is another issue. However, the researchers in the department of dermatology in Wurzburg, Germany have seen some promising results from immuno-modularly techniques (Clinical and Experimental Dermatology 2000). Immuno-modulary techniques use the body’s own defenses like antibody’s and white blood cells from either a donor or the patient to fight the cancer rather than using only radiation and chemotherapy, which is helpful because even though chemotherapy kills cancerous cells it also kills healthy cells. Immuno-modulary does not have the risks of chemotherapy because it is specific and will only kill the cancerous cells. However, these treatments have not been used in a large enough group of patients to see how much of an improvement the treatment is making. This type of therapy has been used for other types of cancers as well with more definite results.

Figure 1 Aymmetry

Figure 2 Border

                                                                              

Figure 3 Color

Figure 4 Size

Figure 5 Evolution

                 Even though mortality rates for most cancers are on the decline pancreatic cancer deaths are rising. Pancreatic cancer is the fourth leading cause of cancer deaths. Which leads me to believe that not enough progress has been made with this form of cancer as well.  This form of cancer is classified depending on where the cancer is. The exocrine part of the pancreas is responsible for making digestive substances and the endocrine is responsible for insulin and other hormones. The endocrine part of the pancreas makes up about 95 percent of the pancreas (The Lancet Journal 2011). Therefore, most pancreatic cancers arise here. A major issue with pancreatic cancer is it has an insidious onset and there are either no symptoms or benign symptoms, which could be as simple as back pain. Symptoms usually do not arise until the cancer is already in the advanced stages and has spread. The discovery of this cancer once it is advanced is true in 80-85 percent of patients (The Lancet Journal 2011). Only about 4 percent of people with pancreatic cancer will live 5 years. A survival rate of 4 percent for cancer is rare with most other forms. Even though so much progress has been made as well as new techniques developing over the years to increase, survival rates of cancer these few forms remain very low. The most significant risk factors for this disease are family history and smoking. Cigarette smoking accounts for 20 percent of pancreatic tumors (The Lancet Journal 2011).  This occurs because smokers with cancers have more mutations rather than a non-smoker (The Lancet Journal 2011).  

Pancreas with Tumors

Another significant drawback to this cancer is that people as well as clinicians do not pay attention to the fact that familial history can play a huge role in this cancer. The use of this information could save lives. Therefore knowing your family history is an essential tool in assessing your health as well as risks. If 

 someone is able to recognize they have a  familial risk they can undergo genetic testing and cancer screenings to help assess the risk and maybe catch a mutation early. This is one of the only ways that the disease can be prevented from becoming fatal is the early detection or prevention by testing, healthy diet and by not or to quit smoking. However, as the facts and survival rates show this screening and use of familial history are not utilized enough. Another issue with this disease is that it is not very susceptible to chemotherapy. In most cases adjuvant therapy is used, which consists of chemotherapy given after surgery, which can help manage the disease. Unfortunately, with this cancer, treatment only prolongs and makes life more comfortable. Curing the cancer is not the goal as it is unrealistic. When patients enter the advanced stages of the disease, the main treatment is palliative care rather than curative. Palliative care is treatment only used to treat pain and discomfort. When most patients reach the advanced stages, sometimes the cancer leaves them too weak and immune compromised to the point where they cannot even use the treatment, as it would cause more damage than good (The Nurse Practitioner 2010). From personal experience, I have never seen a cancer as aggressive as pancreatic. When it happen with my grandmother like most other cases her symptoms were benign and did not cause much alarm until the late stages. Unfortunately, by that time there was not much they could do because of the advanced nature. As well as the ineffectiveness of chemotherapy. It took less than a month from diagnosis to the time she passed away. Sadly, this is the story for many patients that suffer from pancreatic cancer.
                Brain cancer specifically malignant gliomas are forms of cancer that are far behind as well when it concerns the treatment and prognosis of patients. Malignant gliomas are very invasive tumors and are only considered malignant when they are in Stages 3 and 4 of the disease. The main issue is that this cancer is rare and has an abnormally high mortality rate. Therefore, people have a median survival rate of only 1 to 2 years. A main problem that lead investigator Susan Chang M.D. saw is that only 700 patients were in clinical trials to receive new or upcoming treatments and even though there is, a plethora of research that indicates chemotherapy prolongs life, only 54 percent of patients are prescribed it by his or her oncologist (The Journal of the National Cancer Institute 2005). That is a major issue is that treatment for this cancer has not been consistent so much so that 54 percent of patients are going without treatment. It should not matter how bad a prognosis is you should always give a patient any treatment possible to prolong life. A main issue with this cancer is that it is reoccurring. Reoccurring malignant gliomas will grow back even after every cancerous part of the tumor has been taken out so much so that it occurs 90 percent of the time (New England Journal of Medicine 2008). Even though cancer can be somewhat resistant to therapy, it has many side effects that include cognitive dysfunction, deep vein blood clots, seizures and fluid retention around the tumor (New England Journal of Medicine 2008). Some of the side effects alone could be life threatening. This problem was also outlined in The Clinical Journal of Oncology where researchers found a lot of patients are not made aware of  the extent these complications can affect your life during and after treatment mainly the cognitive difficulties (Clinical Journal of Oncology Nursing 2009). This is a main issue in my opinion even though patients are only concerned about treatment and prolonging their life they should always be made aware of the risks and complications associated with treatment. It is a responsibility of the doctor to inform a patient of all information fully and clearly. Treatment for this cancer is difficult as well for the very reason that it can be resistant to chemotherapy so instead they use radiation therapy. However once again it does not treat the cancer it can only prolong life and since the cancer reoccurs 90 percent of the time increasing the radiation does not help or deter that from happening (New England Journal of Medicine 2006). As well as at some point surgery is no longer an option because the tumor has become so invasive and has spread so far that it becomes inoperable due to the sensitivity of the brain. My opinion on the fact that this cancer is far behind in terms of improvement was shared by Bernadine Donahue M.D. which said through research they have found that this cancer is in the same place breast cancer was 15-20 years ago (Journal of the National Cancer Institute 2005 ). The low prognosis along with the aggressiveness and difficulties with treatment make this a very difficult form of cancer to overcome.

Figure 7Fatal Malignant Glioma

            Cancer is a horrible disease that researchers and doctors have been working hard to try to overcome. Yet these forms have fallen far behind when it comes to the options people have to prolong their life. No one should have to deal with having a death sentence when it comes to any disease. Some mistakes made by doctors regarding treatment as well as not assessing familial history properly are not helping people have a better chance at surviving. There is also a responsibility on the patient to check for signs and to be checked regularly if they see something that looks abnormal, they must get it looked at as it could save his or her life. It is going to take a combination of vigilance on the end of researchers and doctors as well as people themselves to make the changes that need to happen in these diseases because not enough progress as it stands now. However, the sad fact remains that the research and prognosis of these forms of cancer are far behind the times and unfortunately, more people will succumb to these diseases before it gets better.

            References

Miller, Arlo J, M.D., PhD. and Mihm, Martin C, Jr, M.D. Mechanisms of Disease: Melanoma." The New England Journal of Medicine 355.1 (2006): 51-65. ProQuest. Web. 3 Apr. 2014.

Vincent, Audrey, et al. "Pancreatic Cancer." The Lancet 378.9791 (2011): 607-20. ProQuest. Web. 3 Apr. 2014.

Evens, K, and VS Eschiti. "Cognitive Effects Of Cancer Treatment: "Chemo Brain" Explained." Clinical Journal Of Oncology Nursing 13.6 (2009): 661-666. CINAHL Complete. Web. 7 Apr. 2014.

Sun, Virginia. "Update on Pancreatic Cancer Treatment." The Nurse practitioner 35.8 (2010): 16-22. Print.

Brower, Vicki. "Large Variations seen in Treatment of Adults with Brain Cancer." The Journal of the National Cancer Institute, sec. 97: 478. 2005. Print.

Pluta, Ryszard M, M.D., PhD. & Burke, A. E., M.A. (2011). Melanoma. JAMA, 305(22), 2368.

Becker, J C, E Kämpgen, and E Bröcker. "Classical Chemotherapy for Metastatic Melanoma." Clinical and Experimental Dermatology 25.6 (2000): 503-508. MEDLINE Complete. Web. 15 Apr. 2014.

Wen, Patrick Y., M.D., and Kesari, Santosh, M.D., PhD. "Medical Progress: Malignant Gliomas in Adults." The New England journal of medicine 359.5 (2008): 492-507. ProQuest. Web. 30 Apr. 2014.

"Asymmetry". Photograph. Skin Cancer. Web. 28 Apr. 2014. http://www.skincancer.org/skin-cancer-information/melanoma.

---.”Border”

---.”Color”

---.”Size”

---.”Evolution”

"Pancreas with Tumors". Photograph. Wikipedia. Web. 28 Apr. 2014. http://en.wikipedia.org/wiki/Pancreatic_cancer.

"Fatal Malignant Glioma". Photograph. Web. 28 Apr. 2014. https://lookfordiagnosis.com/mesh_info.php?term=glioblastoma&lang=1.