Mayo Clinic Health Matters

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Raising awareness of childhood cancer Sep 16, 2022

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While childhood cancer is rare, 1 in every 266 children and adolescents will be diagnosed with cancer by age 20, according to the American Cancer Society. Each September, advocacy groups, health care institutions, patients and families recognize Childhood Cancer Awareness Month to help families who receive a cancer diagnosis.

“A lot of people still don't know what to do if a child is diagnosed with cancer or where to go,” explains Dr. Wendy Allen-Rhoades, a Mayo Clinic pediatric hematologist and oncologist. “We want people to know that we know that a cancer diagnosis is scary. We know that it’s life-altering. But we also want you to know that there's hope, that we are doing really good things here at Mayo Clinic and elsewhere. And there is hope for a cure, and there is life after childhood cancer.”

Dr. Allen-Rhoades says funding is needed for more pediatric cancer research to continue to improve treatments. One area of focus for her has been sarcomas. Sarcoma — the term for a group of cancers that begin in the bones and in the soft or connective tissues — is one of the more common types of childhood cancer.

Fortunately, recent treatment advances have increased survival rates. Of children diagnosed with cancer, 84% now survive five years or more. One of the advances in treatment has been improvement in radiation therapy techniques and the use of proton beam therapy to treat pediatric cancers.

"Radiation therapy works very well for sarcomas," says Dr. Wendy Allen-Rhoades, a Mayo Clinic pediatric hematologist and oncologist. "And the difference between conventional radiation and proton therapy radiation is that our radiation oncologists are able to contour a little bit tighter with proton therapy. Therefore, the surrounding tissue that is normal is spared from some of the side effects. This is really important in children who are growing because we want them to be able to grow normally."

In addition to sparing healthy tissue from the effects of radiation, people who must undergo radiation therapy early in life are less likely to have long-term side effects and complications, such as secondary cancers, with proton beam therapy than with conventional radiation therapy.

While treatments and cure rates for sarcomas have improved, Dr. Allen-Rhoades hopes for even better results in the future.

“Sarcomas have been a tough nut to crack for sure in terms of research and novel innovative therapies,” says Dr. Allen-Rhoades. “We still have a ways to go, but we're doing much, much better than we were 20—30 years ago. But until we can cure everyone, it will never be enough.”

On the Mayo Clinic Q&A podcast, Dr. Allen-Rhoades discusses pediatric sarcomas and the importance of funding for research and support of families dealing with pediatric cancer.

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Early diagnosis of peripheral artery disease reduces risk of amputation, heart attack and stroke Sep 13, 2022

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Peripheral artery disease, or PAD, affects almost 10 million people in the U.S. Approximately one-third of patients will die within five years of a peripheral artery disease diagnosis, and 20% will experience a heart attack or stroke.

Peripheral artery disease usually involves pain in the lower limbs caused by reduced blood flow due to narrowing of the arteries. Its symptoms, like reduced ability to walk due to leg pain, often are brushed off as signs of aging. While age is a factor, younger people with diabetes or who smoke also should be checked for the disease.

"If you have risk factors for lower-extremity PAD — diabetes, tobacco use, high cholesterol, high blood pressure, as well as age — it's really important to have those conversations with your provider about your ability to exercise or walk if you are having any limitation," explains Dr. Amy Pollak, a Mayo Clinic cardiologist.

Peripheral artery disease is detectable and treatable, but it's often not diagnosed early enough. This means patients are often not treated with the most aggressive therapies. Health disparities play a big role, with the highest rates of peripheral artery disease occurring in Black men and women.

"There is an amputation epidemic," says Dr. Pollak. "And I don't use that word epidemic lightly. In today's climate, I use it intentionally. Depending upon where you live in our country, you may be at a higher risk of having an amputation for lower-extremity PAD, and not always be offered a revascularization procedure. So there is a lot of work that needs to be done to raise awareness of PAD, both for patients and health care providers."

A new PAD Action Plan spearheaded by the American Heart Association is hoping to do just that.

The plan serves as a roadmap for reducing the burden of peripheral artery disease by improving the awareness, diagnosis and treatment of PAD. The plan also highlights the many gaps and opportunities in PAD research to further reduce preventable complications and deaths for future generations.

"The incidence of PAD is set to triple in the United States in the coming years," says Dr. Pollak, who is a co-chair of the PAD Action Plan. "So we have an important opportunity to not only prevent that from happening, but to prevent heart attacks and strokes to help people live longer lives with a greater degree of functional ability by diagnosing and treating PAD. When it comes to the health disparities, we need to be doing even more outreach to populations that have been historically not focused on with that important information about what PAD is, how it can present, and what treatment options there are."

On the Mayo Clinic Q&A podcast, Dr. Pollak discusses the importance of early diagnosis of PAD to reduce the risk of amputation, heart attack and stroke.

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Ask the Mayo Mom: Tumor type, grade determine treatment for pediatric brain tumors Sep 09, 2022

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Treatment for brain tumors in children can differ from treatment for brain tumors in adults, so it is important to seek care from specialists in pediatric cancer and neurology.

Pediatric brain tumors are masses or growths of abnormal cells that occur in a child's brain, or the tissue and structures near the brain. Of the many types of pediatric brain tumors, some are noncancerous, or benign, and some are cancerous, or malignant.

Common brain tumors in infants, children and teenagers include:

Gliomas
These tumors begin in the brain or spinal cord. Types of gliomas include pilocytic astrocytomas, ependymomas and oligodendrogliomas.
Medulloblastoma
A medulloblastoma is the most common cancerous brain tumor in children. It starts in the lower back part of the brain, called the posterior fossa, and tends to spread through spinal fluid.

Treatment and chance of recovery depend on many factors: the type of tumor, its location within the brain, whether it has spread, and the child's age and general health.

"The good news is that the really bad tumors are fairly rare," says Dr. David Daniels, a Mayo Clinic pediatric neurosurgeon. "When we look at tumors, we look at their type or classification, and then a grading that goes along with that."

Often, a biopsy of the tumor is performed to determine its type and grade. This information helps guide the course of treatment, which can include surgery, radiation therapy and chemotherapy.

"The biggest thing is that grading," explains Dr. Daniels. "Is this a grade one tumor, which is very benign, or is this a grade four tumor, which is really aggressive? And so our treatment has to match the aggressiveness of that tumor, so to speak."

Because new treatments and technologies are continually being developed, several options may be available at different points in treatment. As part of the Mayo Clinic Children's Center, pediatric specialists in Mayo's Pediatric Brain Tumor Clinic work together as a team to develop an individual treatment plan for each child.

Typically, a pediatric neuro-oncologist specializing in brain tumors is the child's primary doctor. This doctor coordinates access to other specialists from the pediatric brain tumor treatment team, including pediatric neurology, pediatric neurosurgery, neuroradiology, pediatric endocrinology, neuropathology, pediatric radiation oncology, pediatric oncology, child psychology and pediatric rehabilitation.

On this Mayo Clinic Q&A podcast, pediatrician and Ask the Mayo Mom host, Dr. Angela Mattke, is joined by Dr. Daniels to discuss common pediatric brain tumors. Dr. Daniels covers treatment, including when surgery may be an option, and highlights the latest in brain tumor research.

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What is a cancer survivorship clinic? Sep 06, 2022

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Many institutions that provide cancer care also offer cancer survivorship clinics. These clinics focus on helping people with cancer manage the physical, emotional and social effects of cancer and cancer treatment, as well as improving the overall health and well-being of cancer survivors.

"Cancer survivorship visits can be very beneficial for the patients," says Dr. Meghna Ailawadhi, a Mayo Clinic general internist specializing in cancer survivorship. "They can provide a bridge between your primary care and your oncologist, and help patients sort out the posttreatment journey a little bit easier."

Cancer survivorship clinics may focus on a specific cancer type or a specific age group, such as children, adults, or adolescents and young adults (ages 15 to 39). Many different specialists may be involved, including medical oncologists; rehabilitation specialists; nutritionists; and other specialties, like cardiology and gastroenterology, if needed.

These clinics often help cancer survivors develop a survivorship care plan — a plan tailored to the individual survivor to make sure that person gets the most out of life after a cancer diagnosis. The care plan also can help inform the primary care physicians who care for these patients after active treatment is finished.

"A survivorship care plan entails the details of their treatment, the details of their cancer journey, their pathology reports, and what kind of treatment — radiation, chemotherapy — they have received," explains Dr. Ailawadhi. "And there's also an assessment and a care plan for the future of how often these patients need to have their surveillance scans, what labs to look for, what signs to look for. It also addresses some of their long-term needs if they are suffering from peripheral neuropathy, chronic diarrhea or other posttreatment effects. So it's an extremely useful document both for the patient and for their primary care providers."

On this Mayo Clinic Q&A podcast, Dr. Ailawadhi discusses Mayo Clinic’s cancer survivorship clinics, what services they offer, and how to find similar services in your area.

Also, check out these cancer survivorship articles:

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Updated COVID-19 boosters target omicron variants Sep 02, 2022

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The first significant change to COVID-19 vaccines since their rollout came this week as the Food and Drug Administration granted emergency use authorization for updated Moderna and Pfizer COVID-19 boosters aimed at the omicron variants. The Centers for Disease Control and Prevention (CDC) also signed off on the recommendation, clearing the way for the new COVID-19 booster to be administered.

The new boosters are bivalent vaccines, meaning they target more than one strain of the virus. The new formulation targets the BA.4 and BA.5 omicron variants, in addition to the original coronavirus strain. BA.5 is responsible for nearly 90% of all new COVID-19 cases in the U.S., according to the CDC.

The Pfizer bivalent booster is approved for people 12 and up if they have already received their primary COVID-19 vaccine series and it has been at least two months since their last vaccine dose. The Moderna bivalent booster is available on the same timeline to people 18 and up.

"This booster recommendation is in anticipation that there will be yet another surge as college students, grade school and high school students are gathering back together," explains Dr. Gregory Poland, head of Mayo Clinic's Vaccine Research Group. "We're also preparing for cooler weather, meaning more indoor activities, family gatherings and the holidays — often without masks, unfortunately. We still need to take COVID seriously."

Another big concern for vaccine experts is the upcoming flu season. The Southern Hemisphere is often an indicator of what's to come for the U.S. Australia's flu season exceeded its five-year average, particularly affecting children under age 5, according to a recent report.

Experts worry that the relaxing of masking and social distancing recommendations that were in place for COVID-19 purposes the past two winters will be a factor. These measures also protected people from the flu.

"When cold weather moves us indoors, a high viral circulation occurs in schools and other indoor settings. I think we are very likely to see a bad flu year," says Dr. Poland. "Now I know we've been predicting that for two years, but for the most part, people wore masks and it didn't happen. I don't think that'll be the case this year. People are not wearing masks, and we are very likely to get hit hard by influenza."

On the Mayo Clinic Q&A podcast, Dr. Poland discusses the latest COVID-19 news and touches on other news, including monkeypox, polio and the upcoming flu season.

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Helping kids prepare for back-to-school success Aug 30, 2022

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In some parts of U.S., school has already begun, and over the next several weeks, almost all children will be back in the classroom after the Labor Day holiday.

Setting up students for success at school includes parents and caregivers helping kids develop routines and good habits for time management, nutrition and sleep.

"Having routines is so important not only for our kids, but actually for our families and for us as adults, as well," explains Dr. Tina Ardon, a family medicine physician at Mayo Clinic in Florida. "And routines focusing on sleep are a huge part of how we can do well in an academic setting, but also really important for health in general for our kids. That's why kids grow. That's when brain development can happen. So focusing on a really good sleep schedule and routine is just so important for us to be prioritizing as families."

Another important step to prepare for school is to make sure that a child's vaccinations are up to date.

"With any illness, but particularly for our kids, if we want to keep them from missing school, from missing things that we can prevent, then we should take advantage of the tools we have available," says Dr. Ardon. "So vaccines are one of those great tools that we have, at helping either prevent disease or helping us not get quite as sick from disease."

In addition to routine childhood vaccinations, Dr. Ardon recommends all children age 6 months and up be vaccinated against COVID-19 and also receive a flu vaccination when it's available.

Another important part of preparing for school is dealing with the anxiety about the unfamiliar — a new environment, a new school, a different classroom. So how can parents help kids navigate the uncertainty?

"Keeping open lines of communication with your kids is so important," says Dr. Ardon. There are lots of ways for us to kind of prepare ourselves for either a new classroom or a new school. We can look online at pictures of the new school. We can take advantage of return-to-school activities where you can meet the teacher and walk around preparing your child for that first day. We can talk about what they're maybe excited about or nervous about. Is it homework? Is it new friends, old friends? Just allowing your child to have that conversation with you can alleviate a lot of that stress, as well."

On the Mayo Clinic Q&A podcast, Dr. Ardon offers tips on helping kids prepare for back to school.

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Ask the Mayo Mom: Back-to-school Q&A Aug 26, 2022

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Getting ready for a new school year can be exciting for children, parents and caregivers. But it also can be stressful and scary. Whether kids are heading to school for the first time or moving to a new school, it is common to be nervous when facing change.

"It's important to let our kids know that it's really normal to feel this way," says Dr. Marcie Billings, a Mayo Clinic pediatrician. "Just try to support your kids and let them talk through their fears, talk through their challenges that they're dealing with. And don't think that you need every answer. It's really just about listening."

Another common concern for parents is mental health and wellness and preparing their children to deal with the challenges of a new school year.

Adding to the challenge is the fact that this is now the third school year affected by the COVID-19 pandemic. Parents and students will need to understand masking and vaccination recommendations to help navigate the classroom setting as safely as possible.

In addition to COVID-19 vaccinations, it is important to make sure children are up to date on other childhood immunizations, including preparing to get a flu shot as soon as it is available this fall.

"Being vaccinated against COVID-19 and current on all childhood vaccinations is a really important part to returning to school safely," says Dr. Nipunie Rajapakse, a Mayo Clinic pediatric infectious diseases physician.

Dr. Rajapakse points out that masking recommendations may differ by school and region based on levels of transmission, but children who choose to wear masks should be supported by staff and other students.

"There are certain children, for example, children with weakened immune systems or children who have people in their family with a weakened immune system, who may still choose to mask even if community transmission is low," explains Dr. Rajapakse. "I think it's important to recognize that anyone who wants to wear a mask in an indoor setting should be supported in doing so."

On the Mayo Clinic Q&A podcast, "Ask the Mayo Mom" host Dr. Angela Mattke, a pediatrician in Mayo Clinic Children’s Center, is joined by Dr. Billings and Dr. Rajapakse for a discussion on back to school topics, including COVID-19, monkeypox, mental health in kids and teens, nutrition and sleep.

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Successful treatment of cardiac amyloidosis depends on early diagnosis Aug 23, 2022

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Cardiac amyloidosis is a type of amyloidosis, which occurs when the body produces abnormal proteins that bind together to form a substance called amyloid. Amyloids can deposit in any tissue or organ, including the heart, kidneys, liver and nerves.

When amyloid collects in the heart muscle, it causes irreversible thickening of the heart wall and disrupts heart function. It reduces your heart's ability to fill with blood between heartbeats, resulting in less blood being pumped with each beat. This can result in shortness of breath. Cardiac amyloidosis also can affect your heart's electrical system, resulting in a disturbed heart rhythm.

Cardiac amyloidosis typically presents as a form of congestive heart failure. It is often overlooked because the symptoms can masquerade as other conditions. Unfortunately, there aren't any preventive strategies for cardiac amyloidosis, says Dr. Melissa Lyle, a Mayo Clinic cardiologist.

"So the key, really, is early detection," says Dr. Lyle. "We want to make sure that we can detect these patients earlier, to get them on the right treatments."

Dr. Lyle says it's important that patients bring any concerning symptoms to their health care provider as soon as possible.

At Mayo Clinic, people with symptoms that indicate they might have cardiac amyloidosis are diagnosed and treated by a team of experts in the Cardiac Amyloidosis Clinic. This specialized care is available at Mayo Clinic’s locations in Arizona, Florida and Minnesota.

“This approach is a collaborative effort amongst several different specialties, including hematology, cardiology, transplant cardiology, as well as neurology and nephrology,” explains Dr. Lyle. “And our goal is really to provide an efficient evaluation for our patients so that we can quickly come to the correct diagnosis and offer the best treatment option. And we're engaging all of our different specialties for this comprehensive visit to provide the best overall care.”

On the Mayo Clinic Q&A podcast, Dr. Lyle discusses diagnosis, standard treatment options and new therapies for treating cardiac amyloidosis.

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Protect your skin from the summer sun Aug 19, 2022

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Whether swimming in the pool, a trip to the lake or a day at the beach, summertime often means sun exposure. And protection from the sun is the focus of Summer Sun Safety Month every August.

Skin cancer is the abnormal growth of skin cells. While it most often develops on skin exposed to the sun, but it also can occur on areas of skin not ordinarily exposed to sunlight. Skin cancer is the most common form of cancer in the U.S.

"And the incidence of skin cancer is rising," says Dr. Dawn Davis, a Mayo Clinic dermatologist. “We all want to be on the Earth longer, and we appreciate time and aging. But the older we are, the higher our risk for skin cancer.”

The three major types of skin cancer are basal cell carcinoma, squamous cell carcinoma and melanoma. Early detection of skin cancer gives you the best chance for successful skin cancer treatment.

While it is common to have freckles and moles develop over time, it is important to know your skin and recognize when changes occur.

"It's important to know what skin lesions you have," explains Dr. Davis. "Know what they look like, so that if they change, you can come to the dermatologist or health care provider for evaluation."

Melanoma is the most serious and deadly form of skin cancer. Dr. Davis says the "melanoma alphabet" can help with early detection:

Asymmetry
Look for moles with irregular shape.
Border
Look for moles with irregular, notched or scalloped borders.
Changes in color
Look for growths with different or uneven colors.
Diameter
Look for new growth of more than one-quarter of an inch in diameter.
Evolving
Look for changes over time.

While melanoma is more common with age, pediatric melanoma can occur.

“Often, it's not on everyone's radar because we don't believe that children can have skin malignancy, but that is not true,” says Dr. Davis. “It's simply less common. When children get melanoma, they can present with the same signs and symptoms as adults. However, they can also have different symptoms. Pediatric melanoma tends to be skin-colored or amelanotic more commonly than dark or pigmented. So, if a child develops a skin-colored, pink or red bump, or something that used to be flat and then becomes raised, that would be of concern.”

On the Mayo Clinic Q&A podcast, Dr. Davis discusses skin cancer detection and treatment. Dr. Davis also recommends steps to take to protect your skin including avoiding ultraviolet rays, and wearing sunscreen and protective clothing.

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What happens after colorectal cancer treatment? Aug 16, 2022

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While colorectal cancer is still the third leading cause of cancer deaths in the U.S., continuing improvements in screening and treatment mean many people diagnosed with colorectal cancer now can expect to survive long after diagnosis.

The American Cancer Society estimates there are more than 1.5 million survivors of colorectal cancer in the U.S.

But what happens after treatment for colorectal cancer is complete? Do survivors of colorectal cancer return to life as they knew it before their diagnosis?

"I think there are three main things that I see our patients really concerned with when they start thinking about finishing their treatment for colorectal cancer," says Dr. David Etzioni, a colorectal surgeon and chair of the Department of Surgery at Mayo Clinic in Arizona. "The first and biggest concern they have is whether or not their disease will completely go away and stay gone. And this is, I think, a fundamental concern for any patient treated for cancer of any kind."

Dr. Etzioni explains the other two common concerns for survivors of colorectal cancer are how the treatment will affect their day-to-day quality of life, and whether or not they will need an ostomy bag temporarily or permanently.

An ostomy is a surgically created opening in your abdomen that allows waste or urine to leave your body and be collected in a bag or pouch. For survivors of colorectal cancer, this may be temporary to give the colon time to heal. But, depending on the extent of surgery to remove the cancer and the location of the cancer, sometimes a permanent ostomy bag is needed.

Dr. Etzioni says education can alleviate the fears patients have about needing an ostomy bag.

"When I do have a patient who's worried what the bag is and what it might mean for their life — it might be a temporary or permanent bag — we have a lot of educational resources here at Mayo available to them. We often will send them to our osteo nurses, so they can actually try just wearing the appliance before they've undergone the surgery. They can see what it might be like to wear that underneath their clothes," explains Dr. Etzioni.

"We also have a support group that consists of patients who have an ostomy. They discuss with each other what challenges they faced, and they're very supportive with each other. And I have a group of patients who are now with an ostomy who I can call on to reach out to a new patient of mine and talk about what it might mean to live with an ostomy. And that's something that I found to be very effective and can really help patients to get over that hump to accept that possibility for cancer treatment."

Finally, Dr. Etzioni says the support of family, friends and loved ones is an important part of the journey for patients with colorectal cancer.

"The patients who undergo treatment with a strong, consistent, omnipresent support system, they simply do better — not just emotionally, but also just in terms of the ability to tolerate treatment," says Dr. Etzioni. "I think they literally have better medical and surgical outcomes."

On this Mayo Clinic Q&A podcast, Dr. Etzioni discusses what people can expect after colorectal cancer treatment ends, and how to achieve the best possible quality of life.

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