Local doctors share with you new developments in cancer screening, diagnosis and treatment, and what you should know about them.
DEVELOPMENTS
Pinpoint Radiation
“Whereas chemotherapy is systemic, that is, treating the whole body – through a pill or needle delivery – radiation is localized, and therefore negative side effects following radiation are more localized as well” explains Dr. Clay Gould, Radiation Oncologist at West Jefferson Medical Center. Thanks to advances in radiation equipment, patients are able to receive more localized treatment than ever before. Through “pinpoint radiation” or “stereotactic radiation,” doctors can deliver radiation to cancerous tissue and minimize the radiation delivered to nearby, healthy tissue. When faced with the option of surgery or pinpoint radiation, many patients will elect pinpoint radiation, which is more precise, non-invasive and significantly less time consuming.
As a Radiation Oncologist at Touro Infirmary and Assistant Professor at LSU Health Science Center, Dr. Elesyia Outlaw is also enthusiastic about pinpoint radiation. In addition to increased precision, the technology allows doctors like Dr. Outlaw to develop individualized radiation plans that are tailored to a patient’s disease and body structure, as opposed to a one-size-fits-all treatment. Dr. Outlaw gives the example of radiation for breast cancer: Before, “patients might die – not because of the cancer – but because of scar tissue on the heart caused by the radiation.” In the case of breast cancer, pinpoint radiation narrows the radiation field, allowing for treatment without as much damage to surrounding structures.
MRI-Ultrasound Fusion Biopsy
Dr. Sean Collins of East Jefferson General Hospital is a MD Anderson-credentialed Urologist, whose practice focuses on prostate, bladder and kidney cancers. Suspected cancer typically calls for an ultrasound or Magnetic Resonance Imaging (MRI). Lately, Dr. Collins reports, technological advances have enabled doctors to marry the two approaches in what’s known as an MRI-Ultrasound Fusion Biopsy to diagnose prostate cancer. According to the Journal of Urology, a study conducted by the University of California, Los Angeles indicates that this fusion technology is more accurate, “may lead to a reduction in the numbers of prostate biopsies performed and allow for early detection of serious prostate cancers.”
Accelerated Partial Breast Radiation
Another encouraging development is Accelerated Partial Breast Radiation (APBR), a procedure that Dr. Outlaw and her staff use after a lumpectomy to kill any remaining cancer cells. Developed in the past five years, APBR works by a catheter insertion of a radioactive “seed” or balloon, like SAVI or Mamosite, in the breast tissue that delivers the radiation quickly and effectively. APBR is a valuable tool for those women who wish to conserve their breasts. Additionally, APBR reduces both treatment and recovery time. “An early stage breast cancer may now be treated over the course of one week, two times a day for five days,” says Dr. Outlaw.
Genetically Based Pediatric Cancer Treatment
“Everyone has a tumor-suppressor gene that should protect us and stop cancer at an immature stage, but some people lose these protections,” explains Dr. Lolie C. Yu, Pediatric Hematologist/Oncologist and Division Chief at Children’s Hospital. This loss of protection makes understanding the role genes play in pediatric oncology especially important. “The most important step to improve the outcome is to make the proper diagnosis,” states Dr. Yu, and “In order to understand the cancer, we have to understand the biology of it,” she says. Because of the role genes play, two different patients can have two different responses to treatment, despite having an identical diagnosis and treatment. By using translational therapy, that is, taking what’s learned in clinical trials to the patient’s bedside, doctors can improve outcomes. “Once we identify your genetic makeup and how you respond, we can tailor your treatment accordingly,” says Dr. Yu.
Targeted Treatment & Immunotherapy
According to Dr. Vijay M. Patel, Hematologist/Oncologist at West Jefferson Medical Center, Targeted Treatment is an exciting new avenue for patients and doctors alike. Unlike typical chemotherapy drugs, Targeted Treatment drugs can target only the problematic cells and avoid damage to healthy cells, which, as Dr. Yu explains, results in lower toxicity and decreased side effects. According to The American Cancer Society (ACS), Targeted Treatments “[go] after cancer cells’ inner workings – the programming that makes them different from normal, healthy cells.” The ACS explains that this treatment prevents the cancerous cells from growing and spreading by interfering in “carcinogenesis,” the process by which cells reproduce or form tumors. Targeted Treatment drugs instruct the cell to cease “parts of the cellular changes and signals that are needed for a cancer to develop and keep growing,” says the ACS. Another similar treatment advance is immunotherapy or biotherapy, which stimulates the immune system and enables the body to survey itself and fight only the cells causing the cancer.
BE AWARE
Get a Check-up
Though many causes of cancer are unknown, most people are aware of preventative measures that can be taken to decrease the likelihood of getting cancer, including avoiding smoking, tanning beds and drinking alcohol, as well as getting exercise and eating moderately. Aside from behavior modifications, regular check-ups and annual exams are important for monitoring one’s health and detecting problems early. “I am amazed by the number of people that I see who have never been to a doctor,” says Dr. Gould. Self-monitoring is also important; if someone has an irregularity, he or she should seek out a physician. Rectal bleeding, lumps, bumps, growths or masses can be signs of serious problems.
Consider a PSA Test
Prostate-specific antigen (“PSA”) tests aren’t perfect and may miss a cancer (a “false negative”) or wrongfully detect a problem (a “false positive”), which may lead to an unnecessary biopsy. For this reason, The U.S. Preventive Services Task Force (USPSTF), which conducts reviews of clinical preventive services and makes recommendations for clinicians and health systems, including Medicare, recommends against being screened for prostate cancer. This “irresponsible” position outrages Dr. Sean Collins. “This [PSA test imperfection] doesn’t mean we should stop looking,” says Dr. Collins. Most males will eventually develop prostate cancer, and though not all prostate cancers are harmful, the goal is to identify those that are and treat them early, before they spread throughout the body.
According to the American Urological Association (AUA), prostate cancer is the most common non-skin related cancer in men in the United States, as well as the second leading cause of cancer death in men. The AUA and Dr. Collins advocate for a more measured approach, whereby doctors counsel their patients, who can make an informed decision about whether or not to be screened. Similar to the AUA, “[ACS] recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer,” states Rhonda Mendez, Associate Director and Mission Delivery Communications of the ACA’s Mid-South Division. The ACA recommends that discussions about screening should occur at age 50 for those with an average risk, or at 40 or 45 for those with a greater risk. A digital rectal exam (DRE) may also be done as a part of screening, and the PSA level will impact the frequency for the need of retesting. Dr. Collins states that the screening of men between ages 55 to 69 results in the reduction of mortality rates.
Talk About Family History
Breast cancer screenings are very important to women 40 and over, stresses Dr. Outlaw, who says, “some people assume that if they have no family history of breast cancer, they will not get it.” To the contrary, breast cancer is the most common cancer found in women in the United States, excluding skin cancer. Dr. Outlaw wants people to know that “the two biggest risk factors for breast cancer are (1) increasing age and (2) being a woman.” Nonetheless, family history is still important. Talking about and being aware of family medical history can encourage people with increased risk to be screened early. ACA’s guidelines indicate that, “Breast cancer is 98 percent curable when detected and treated in the early stages.” Early detection occurs through Mammography, which can find tiny lumps well before physical symptoms occur. The ACA recommends that starting in their 20s, women should perform self breast exams and receive clinical breast exams every three years, and women should begin getting annual Mammograms in their 40s or sooner if they have a family history of breast cancer.
Be a STAR Survivor
Just as diagnostics and treatments have improved, so have post-cancer care techniques. After a good outcome, some facilities offer a comprehensive oncology rehabilitation program. Touro offers “STAR,” which Dr. Outlaw describes as “a multidisciplinary team of doctors, including oncologists, physical therapists, occupational therapist, dietitians and counselors, who help the patient with his or her side effects and getting back into better health status.”
Take Teens and Young Adults to Pediatric Oncologists
Dr. Yu says that a child with cancer should be treated in an accredited, credentialed facility where all subspecialists are available, such as facilities affiliated with Children’s Oncology Group, a national cooperative group studying and developing protocols for pediatric cancer. Additionally, it’s important for people to understand that pediatric oncology includes those from birth to 21 years of age. Science has demonstrated that people in their late teens and early 20s have improved outcomes with pediatric oncology treatments over adult treatments. Because pediatric treatments differ from adult treatments, it’s important the patient sees the appropriate oncologist.
Participate in Clinical Trials
In his effort to encourage patients to enter clinical trials, Dr. Yu wants to clarify that clinical trials are not experimental, but rather a method of collecting data on treatment, side effects and outcomes. These are Phase 3 trials, which use a standard treatment or combination of treatments with additional drugs added to improve the outcome. Phase 3 clinical trials don’t use experimental drugs but rather monitor closely the patient’s status and response to treatment for data collection purposes. Clinical trials also give patients access to the newest drugs available. In the bigger picture, clinical trials improve understanding of cancer treatment. Dr. Yu states that, “In pediatric oncology, the overall survival rate is 85 percent, but this tremendous outcome only came about because most are entered into clinical trials.” Through such trials, the staff is able to refine the treatment needed in a particular situation. “Our aim to provide a cure for every single type of patient,” says Dr. Yu, “and we think we will.”
