Physicians employ a variety of treatment options to combat cancer diagnoses, and while some treatments and procedures are tried and true, emerging technologies and research can add to their arsenal. This month, we explore both established and emerging techniques and technologies that local healthcare providers have found helpful in assisting cancer patients.
Skin Cancer Prevention & Treatment
According to physicians at Audubon Dermatology, skin cancer is the most common cancer in the United States, with current estimates indicating that one in five Americans will develop skin cancer in their lifetime. The trend in dermatology is preventative care, and to that end fighting pre-cancers or actinic keratosis with liquid nitrogen has been a common treatment. The highly effective treatment “freezes” the pre-cancer and destroys it.
“What this therapy does not do is rid the surrounding high-risk skin of pre-cancerous cells,” says Dr. Deidre Hooper. “The latest technology in skin cancer helps totally eradicate the pre-cancerous cells and also prevent regrowth of these lesions. We now have several FDA approved creams and an in-office FDA-approved treatment that not only treat the lesion, but the very important surrounding skin,” she says. According to Hooper, these advanced creams and treatments can help prevent the next skin cancer by eradicating clinical and sub-clinical (not yet seen or felt) pre-cancers.
“Many dermatologists focus on the eradication of existing pre-cancerous skin lesions and don’t take the time to talk to patients about the benefits of treating the entire ‘field’ of sun-damaged, cancer-risk skin to prevent future pre-cancers and cancers,” adds Dr. Sarah Jackson. While physicians have been using photodynamic therapy and cancer fighting creams for years, new dosing strategies and strength variance can be used to better tailor treatment plans to each patient.
Skin cancer can sometimes require more invasive treatment than creams, and at The Skin Surgery Centre, Drs. Keith LeBlanc Jr. and Elizabeth F. Bucher primarily focus on Mohs micrographic surgery (surgery to remove skin cancer) and reconstruction. While some cosmetic services are offered at the Centre, Drs. LeBlanc and Bucher don’t offer general dermatological services, but rather focus on procedures, such as Mohs.
“About 90 percent of nonmelanoma skin cancers are associated with unprotected ultraviolet (UV) exposure.”
“While I would not consider Mohs surgery ‘new’ I do believe that it’s cutting-edge and yet under-appreciated by the public at-large,” says LeBlanc, and despite skin cancer’s staggering statistics, many people have never heard of the long-established procedure.
“Fellowship-trained Mohs surgeons are uniquely able to serve as cancer surgeon, pathologist, and reconstructive surgeon all in one setting. This allows us to precisely identify and remove skin cancers layer by layer until margins are cleared, leaving the surrounding healthy tissue intact and unharmed,” says LeBlanc. According to LeBlanc, the procedure has numerous benefits including cure rates over 99 percent in some instances and often the possibility of a one-day in-office treatment using only local anesthesia.
“To me, Mohs surgery is cutting-edge because of its extremely high cure rate, even in tumors, which have previously been treated unsuccessfully using other modalities. Additionally, we’re in the midst of a skin cancer epidemic, so skin cancer treatment modalities have never been so needed or useful,” he says.
Dr. Alan Lewis of Crescent DermSurgery is also a Mohs surgeon and is the former Director of the Mohs Surgery section at the Tulane Cancer Center. To help explain how the surgery works, Lewis uses the analogy of peeling an onion to demonstrate the way in which surgeons remove just a small portion of tissue at a time to identify exactly where cancer is present without removing too much tissue.
“Mohs is indicated for higher risk tumors in locations such as the head and neck, hands and feet and lower legs – places where you don’t have much skin or tissue, or where you have functional or cosmetic healing concerns,” says Lewis. By removing only small portions of tissue at a time, the physician is able to minimize the wound and consequent scarring or distortion of the critical site.
“Fellowship-trained Mohs surgeons are uniquely able to … precisely identify and remove skin cancers layer by layer until margins are cleared, leaving the surrounding healthy tissue intact and unharmed …”
According to Lewis, the surgeon examines the edges and underside of the removed tissue and then outlines the exact location of any areas of cancer. If more cancer is found, the procedure is repeated in stages until it’s determined that no cancer cells remain. Typically the process is completed in two to four hours, although in more complicated cases, it can take several hours.
Both Drs. Lewis and LeBlanc emphasize the need for more awareness and prevention of skin cancer.
“About 90 percent of nonmelanoma skin cancers are associated with unprotected ultraviolet (UV) exposure,” says LeBlanc. “We as dermatologists and Mohs surgeons need to make the public aware of the ways that patients can protect themselves from the sun’s harmful rays and prevent skin cancers in the future.”
Methods of protection include seeking shade when possible, avoiding sun during peak hours (10 a.m.-4 p.m.), wearing protective clothing and hats, and using a broad-spectrum sunscreen with SPF 30 or above applied as directed.
“A big thing people may not realize,” says Lewis, “is that for sunscreen to be effective, it needs to be reapplied every two hours. It doesn’t stay on.”
Breast Cancer Detection and Treatment
Dr. A. John Colfry III, a fellowship-trained Breast Surgical Oncologist with Touro’s Crescent City Physicians, specializes in diseases of the breast, which includes both benign and malignant disease. Colfry’s preferred treatment method falls under the tried and true, established variety and is commonly referred to as a lumpectomy. When feasible, Colfry believes in breast conservation for breast cancer surgery, which includes removing the tumor with a healthy rim of non-cancerous tissue around the tumor.
“For decades lumpectomy has been used to treat breast cancer; however, the field of oncoplastic surgery has transformed a once disfiguring procedure into a more cosmetically appealing result,” says Colfry. “For women who desire breast preservation, I use specific oncoplastic techniques during surgery to improve cosmesis.”
“Young women need to demand ultrasounds. … Most people don’t know that that’s something they should be getting.”
In addition to treating a large volume of breast cancer patients, Touro’s Crescent City Physicians also has a benign disease clinic and a high risk clinic for patients with a strong family history of breast cancer and who may need genetic testing and genetic counseling. According to Colfry, knowing family history of cancer is an important component to breast cancer prevention.
“Depending on which family members have a positive breast cancer history and their ages of diagnosis, you may fit criteria for genetic testing,” says Colfry. The results of genetic testing may then affect how a patient and their physician move forward with screening and preventative measures.
Before a lumpectomy occurs, a physician must first locate and diagnose breast cancer, and according to Dr. Penelope Treece of Southern Aesthetics, “As far as detection, there’s really no new tumor finder.” Treece recommends breast ultrasounds as an effective method for identifying lesions. After reviewing a patient’s mammogram results, Treece will conduct a breast ultrasound to correspond with the mammogram. The results of the ultrasound then determine if a biopsy or other diagnostic option is needed.
“Depending on which family members have a positive breast cancer history and their ages of diagnosis, you may fit criteria for genetic testing.”
“Young women need to demand ultrasounds,” says Treece. “Most people don’t know that that’s something they should be getting.” The American Cancer Society guidelines for early detection of breast cancer are currently being updated, but for the past few years have included regular clinical breast exams for women in their twenties and annual mammography at age 40. For people with a family history of breast cancer, however, Treece encourages patients to be proactive in asking for a breast ultrasound and to research the possibilities with their physician and insurance company.
“Ultrasound speaks volumes over a mammogram,” says Treece.
Radiation is commonly used as a method of fighting cancer, sometimes on its own and sometimes in conjunction with chemotherapy. Areas of the body that are treated with radiation can often be scarred much in the way of a burn. Since 2006, Dr. Stephen Metzinger has offered an advanced method of treating post-radiation injury at Aesthetic Surgical Associates, a cosmetic surgery practice that also offers a number of reconstructive options for cancer patients.
For patients with post-radiation injury, Metzinger offers structural fat grafting, also known as fat grafting with adipose derived stem cells.
“We discovered by fat grafting these areas that we are able to restore volume using natural tissue and secondly able to improve the quality and texture of the overlying skin.”
“While fat grafting has been used for years for volume replacement, this is new in terms of a treatment for radiation injury,” says Metzinger. “We discovered by fat grafting these areas that we are able to restore volume using natural tissue and secondly able to improve the quality and texture of the overlying skin.”
According to Metzinger, the largest number of stem cells stored in the body are located in fat cells, and it is believed that the improved quality of skin after structural fat grafting is due to the presence of the adipose derived stem cells. While many patients are referred to Aesthetic Surgical Associates, consultations are available. One caveat though – this type of therapy is still considered new and rarely covered by insurance.
While the names of St. Jude, M. D. Anderson and Johns Hopkins may be common when it comes to pediatric cancer treatment, many Louisianians don’t realize that cutting-edge cancer treatment for children exists here at Children’s Hospital in New Orleans. Children’s Hospital’s Cancer Program is a member of the prestigious Children’s Oncology Group (COG), a national study group of premier research institutes in the United States and Canada.
“COG is a group of institutions and board-certified or board-eligible physicians – and is the only pediatric cooperative group – providing trials to both understand and treat different types of cancer that occur in children,” says Dr. Lolie C. Yu, Division Chief and Director of Pediatric Hematology-Oncology/HSCT at Children’s Hospital.
“Many people are quite surprised when they are diagnosed because they never imagined that they themselves would ever get the big ‘C.’”
Thanks to COG’s efforts, Children’s Hospital is now achieving successful outcomes by incorporating targeted treatment that uses the immune system to destroy cancer cells.
“We learned we can identify the different antigens on the surface of tumor cells and use antibodies, which can be developed to try and get rid of cancer cells,” says Dr. Yu. In the case of neuroblastoma, a malignant tumor most commonly found in the adrenal gland, this targeted treatment, which is now FDA-approved and administered following chemotherapy, has increased survival rates from a previously dismal <20 percent to a range of 65-70 percent, according to Dr. Yu. The principle of targeted treatment is now being applied to other types of cancer in ongoing clinical trials.
Prevention, Screenings, & Support
As a hematology and oncology specialist at Touro, Dr. Scott Sonnier encounters a number of patients who find themselves suddenly and often surprisingly in need of cancer treatment.
“We see cancers develop in both young and old people in all walks of life. Many people are quite surprised when they are diagnosed because they never imagined that they themselves would ever get the big ‘C,’” he says. “The best way to not get this surprise is to follow cancer preventive strategies including preventive diet, lifestyles, screening tests and evaluation of family history.”
A long-established health provider, Touro has over a century of work experience in treating cancer and blood disorders. According to Sonnier, the hospital is continually using new therapies as they’re developed and made available to the community. In addition, he says, they participate in clinical trials, often evaluating therapies before they are made available.
Touro offers a number of classes, seminars and screenings throughout the year, which can be found on the hospital’s website, Touro.com.
Aesthetic Surgical Associates
3223 8th St., Suite 200
3525 Prytania St., Suite 501
Dr. A. John Colfry III
Touro’s Crescent City Physicians, Inc.
3434 Prytania St., Suite 320
4421 Chastant St.
The Skin Surgery Centre
1615 Metairie Road, Suite 101
3815 Hessmer Ave.
Dr. Lolie C. Yu
200 Henry Clay Ave.