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Is it or isn't it cancer?

By Keith Roach, M.D. on

DEAR DR. ROACH: In 2015, I was diagnosed with a myeloproliferative neoplasm, essential thrombocythemia. My question is simple: Is it cancer or not? There seems to be a fundamental disagreement between my oncologist and my hematologist about the "c" label. Not that it makes any difference treatment-wise, but I would like clarification. -- L.F.F.

ANSWER: Cancer is the term given to hundreds of diseases that share uncontrolled cell division and the potential to spread to other parts of the body. Myeloproliferative neoplasms meet that definition and so are classified as blood cancers. However, as you say, whether it is or isn't cancer (it didn't use to be considered cancer) isn't very important. There are many types of cancers that have very good prognoses, including essential thrombocythemia. The overall survival in people with ET is good, and they have a normal life expectancy.

The major issues with essential thrombocythemia ("essential" is an old term meaning "we don't know why it happens"; "thrombocythemia" means there are too many clotting cells, called platelets, in the blood) are the potential for blood clotting, as you might expect with many platelets. However, bleeding is a risk as well, because the platelets don't always work normally. There are symptoms, thought to be related to damage to small blood vessels, which include headache and lightheadedness. The most feared complication is transformation to acute leukemia or myelodysplasias. The fact that they can transform highlights why these are considered cancers. The prognosis in patients with ET that transforms to leukemia has historically been poor, but newer treatments are changing that.

DEAR DR. ROACH: I am writing in response to your comment that "For most people with a healthy diet, vitamins are probably useless." I eat five to six servings of vegetables and fruit daily but do not know many people who eat more than one or two daily servings. I still take a multivitamin, because two eye doctors have told me there are two ways to delay onset of cataracts: 1. Always wear sun protection for your eyes (and he mentioned that all prescription glass has built-in sun protection now) and 2. Take a multivitamin for at least 10 years. I am 70, have been taking multis for 30 years or more and have no sign of cataracts, though both my parents had them. My spouse, who is 72, had to have cataract surgery in his 60s and, until recently, had never taken multis.

Would you please comment/clarify your multivitamin stand as pertains to eye health and cataracts? -- S.G.

ANSWER: Although some individual trials have shown small benefit (9% fewer cataracts in one trial among multivitamin users), a recent review of nine clinical trials showed no benefit of multivitamins in preventing cataracts. Sunlight is a known risk factor for cataracts, so sunglasses and a broad-brimmed hat make sense. But the major risk factor for cataract is age, and as one expert told me, if you live long enough, you will develop a cataract.

 

I would be the first to champion vitamins if they helped, but the evidence remains that multivitamins have very limited proven benefit except in people with deficiencies.

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Dr. Roach regrets that he is unable to answer individual letters but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

(c) 2022 North America Syndicate Inc.

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