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Saint Thomas Health Medical Mondays -- Advances in Cancer Treatment -- April 22, 2013 -- Dr. Patrick Wolf & Dr. Kent Shih

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SAINT THOMAS HEALTH MEDICAL MONDAYS 
Monday, April 22, 2013
TOPIC: Advances in Cancer Treatment
Patrick Wolf, MD: surgical oncology
Kent Shih, MD: medical oncology

News notes via webMD.com and cancer.org

What Is Cancer?

Cancer is the general name for a group of more than 100 diseases. Although there are many kinds of cancer, all cancers start because abnormal cells grow out of control. Untreated cancers can cause serious illness and death.

Normal cells in the body

The body is made up of trillions of living cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries.

How cancer starts

Cancer starts when cells in a part of the body start to grow out of control. Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells. Cancer cells can also invade (grow into) other tissues, something that normal cells cannot do. Growing out of control and invading other tissues are what makes a cell a cancer cell.

Cells become cancer cells because of DNA (deoxyribonucleic acid) damage. DNA is in every cell and it directs all the cell's actions. In a normal cell, when DNA gets damaged the cell either repairs the damage or the cell dies. In cancer cells, the damaged DNA is not repaired, and the cell doesn't die like it should. Instead, the cell goes on making new cells that the body doesn't need. These new cells all have the same abnormal DNA as the first cell does.

People can inherit abnormal DNA, but most DNA damage is caused by mistakes that happen while the normal cell is reproducing or by something in the environment. Sometimes the cause of the DNA damage may be something obvious like cigarette smoking or sun exposure. But it's rare to know exactly what caused any one person's cancer.

In most cases, the cancer cells form a tumor. Some cancers, like leukemia, rarely form tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate through other tissues where they grow.

How cancer spreads

Cancer cells often travel to other parts of the body where they begin to grow and form new tumors. This happens when the cancer cells get into the body's bloodstream or lymph vessels. Over time, the tumors replace normal tissue. The process of cancer spreading is called metastasis.

How cancers differ

No matter where a cancer may spread, it's always named for the place where it started. For example, breast cancer that has spread to the liver is called metastatic breast cancer, not liver cancer. Likewise, prostate cancer that has spread to the bone is called metastatic prostate cancer, not bone cancer.

Different types of cancer can behave very differently. For instance, lung cancer and skin cancer are very different diseases. They grow at different rates and respond to different treatments. This is why people with cancer need treatment that is aimed at their kind of cancer.

Tumors that are not cancer

Not all tumors are cancer. Tumors that aren't cancer are called benign. Benign tumors can cause problems – they can grow very large and press on healthy organs and tissues. But they cannot grow into (invade) other tissues. Because they can't invade, they also can't spread to other parts of the body (metastasize). These tumors are almost never life threatening.

How common is cancer?

Half of all men and one-third of all women in the US will develop cancer during their lifetimes.

Today, millions of people are living with cancer or have had cancer. The risk of developing many types of cancer can be reduced by changes in a person's lifestyle, for example, by staying away from tobacco, limiting time in the sun, being physically active, and healthy eating.

There are also screening tests that can be done for some types of cancers so they can be found as early as possible – while they are small and before they have spread. In general, the earlier a cancer is found and treated, the better the chances are for living for many years.

No matter who you are, we can help. Contact us any time, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org.

 

How Is Cancer Diagnosed?

The earlier cancer is diagnosed and treated, the better the chance of its being cured. Some types of cancer -- such as those of the skin, breast, mouth, testicles, prostate, and rectum -- may be detected by routine self-exam or other screening measures before the symptoms become serious. Most cases of cancer are detected and diagnosed after a tumor can be felt or when other symptoms develop. In a few cases, cancer is diagnosed incidentally as a result of evaluating or treating other medical conditions.

Cancer diagnosis begins with a thorough physical exam and a complete medical history. Laboratory studies of blood, urine, and stool can detect abnormalities that may indicate cancer. When a tumor is suspected, imaging tests such as X-rays, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and fiber-optic endoscopy examinations help doctors determine the cancer's location and size. To confirm the diagnosis of most cancers , a biopsy needs to be performed in which a tissue sample is removed from the suspected tumor and studied under a microscope to check for cancer cells.

What Causes Cancer?

Cancer is a complex group of diseases with many possible causes. In this section you can learn more about the known causes of cancer, including genetic factors; lifestyle factors such as tobacco use, diet, and physical activity; certain types of infections; and environmental exposures to different types of chemicals and radiation.

The Seven Warning Signs of Cancer

The American Cancer Society uses the word C-A-U-T-I-O-N to help recognize the seven early signs of cancer:

Change in bowel or bladder habits

A sore that does not heal

Unusual bleeding or discharge

Thickening or lump in the breast, testicles, or elsewhere

Indigestion or difficulty swallowing

Obvious change in the size, color, shape, or thickness of a wart, mole, or mouth sore

Nagging cough or hoarseness

The following symptoms may also signal the presence of some types of cancer:

  • Persistent headaches
  • Unexplained loss of weight or loss of appetite
  • Chronic pain in bones or any other areas of the body
  • Persistent fatigue, nausea, or vomiting
  • Persistent low-grade fever, either constant or intermittent
  • Repeated infection

Call Your Doctor About Cancer if: You develop symptoms that may signal cancer, that are specifically not related to another cause, or that persist for more than two weeks. If this occurs, schedule a medical examination. If the cause of your symptoms is cancer, early diagnosis and treatment will offer a better chance of a positive prognosis. If the diagnosis is positive (cancer is present), other tests are performed to provide specific information about the cancer. This essential follow-up phase of diagnosis is called staging. The most important thing doctors need to know is whether cancer has spread from one area of the body to another. If the initial diagnosis is negative for cancer and  symptoms persist, further tests may be needed. If the biopsy is positive for cancer, be sure to seek a confirming opinion by a doctor who specializes in cancer treatment before any treatment is started.

Your Cancer Specialists

 

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Cancer is a complex and tricky disease, so you may need to see several different cancer specialists during your treatment. Treatment often involves the combined care of several cancer specialists at once.

What Type of Cancer Specialists Do You Need?

Basically, there are three ways to treat cancer: with medicine (as well as with hormone therapy and immunotherapy), with radiation, and with surgery. Each treatment may be handled by a different specialist. Not every person will need all three types of treatments. It depends on your type of cancer and the stage of your cancer. However, here's a rundown of the cancer specialists you might see:

  • Medical oncologist. This is the cancer specialist you'll probably see most often. Usually your oncologist will oversee your general care and coordinate treatments with other specialists. Your oncologist will also be in charge of chemotherapy, hormone therapy, and immunotherapy. You'll likely visit your medical oncologist for long-term, regular checkups.
  • Radiation oncologist. This cancer specialist treats cancer with radiation therapy.
  • Surgical oncologist. This is a surgeon who has special training in treating cancer. Your surgical oncologist may be called in to diagnose cancer with a biopsy. Surgical oncologists also treat cancer by removing tumors or other cancerous tissue.

Depending on your case, you may also need to see other types of doctors for special cancer care. For instance, you may need to see a hematologist, who specializes in treating disorders of the blood, bone marrow, and lymph nodes. Sometimes, surgery might be done by a general surgeon instead of a surgical oncologist. Or you might need to see a plastic surgeon if you need reconstructive surgery after treatment. You might also wish to see a psycho-oncologist, a psychiatrist who specializes in the psychological challenges of coping with cancer.

What Should You Look for in a Cancer Specialist?

  • Experience. A cancer specialist should have a lot of experience treating the specific type of cancer that you have. Ask how many cases your doctor has treated over his or her career and over the past year. How many is enough? There's no easy answer. But you should have the feeling that your doctor is treating people like you on a regular basis.
  • Good training. Those framed degrees on a cancer specialist's wall aren't just for decoration, says Terri Ades, DNP, FNP-BC, AOCN, director of cancer information at the American Cancer Society in Atlanta. Look at them closely. Where did your doctor train? Ask if he or she has other special qualifications or areas of interest. Ask if he or she has published any relevant journal articles on cancer treatment.
  • Board certification. Board-certified doctors are trained in a specific area of medicine and must pass an exam testing their knowledge and skill. So if your doctor is board-certified -- in medical oncology or surgery, for instance -- you can be confident that he or she is highly qualified in that field. That said, board certification is not available for every subtype of cancer treatment. So not being board certified is not necessarily a bad sign.
  • Openness to your questions. This is one of the most important things to look for in a cancer specialist. You need to feel like your doctor is listening to you and answering your questions. Also, make sure your doctor will be available to you when you need to talk to him or her -- even after you leave the office.

How Do You Find a Cancer Specialist?

  • Usually, your primary care doctor will refer you to a cancer specialist. Many people rely on recommendations from friends and relatives. Your insurance company may also have a specific list of providers that they will work with.
  • There are other ways to get the names of cancer specialists. You could call your local hospital and ask for the names of cancer specialists who are on staff. You could get the names of cancer specialists through different medical organizations, like the American Medical Association, the American Society of Clinical Oncology, American College of Surgeons, or your local medical society. And you could contact top medical schools or cancer treatment centers in your state for references.

 

What Are the Treatments for Cancer?

Depending on the type and stage of cancer, treatments to eradicate the tumor or slow its growth may include some combination of surgery, radiation therapy, chemotherapy, hormone therapy or immunotherapy. 

Cancer Support

Supportive care from nurses and other professionals should accompany cancer treatment. The goal is to relieve pain and other symptoms, maintain general health, improve quality of life, and provide emotional, psychological, and logistical support to patients and their families. Similar supportive treatment is available to rehabilitate patients after curative treatment. Supportive therapy such as hospice care for cancer patients nearing the end of their lives provides relief from pain and other irreversible symptoms. Most mainstream care is geared toward providing supportive treatment through the broad resources of a cancer treatment center. Complementary cancer therapies, which are generally provided outside a hospital, can also provide supportive care.

Exercise and Cancer

Exercise can help control fatigue, muscle tension, and anxiety in those with cancer. Patients tend to feel better if they do exercises such as walking or swimming. Exercise has also been shown to improve the outcomes associated with cancer treatment.

Mind/Body Medicine for Cancer

Some mind/body therapies improve quality of life for cancer patients through behavior modification; others encourage expression of emotions. Behavior therapies such as guided imagery, progressive muscle relaxation, hypnotherapy, and biofeedback are used to alleviate pain, nausea, vomiting, and the anxiety that may occur in anticipation of, or after, cancer treatment. Individual or group counseling allows patients to confront problems and emotions caused by cancer and receive support from fellow patients in a group setting. Patients who pursue these types of therapies tend to feel less lonely, less anxious about the future, and more optimistic about recovery.

Nutrition, Diet, and Cancer

Scientific evidence suggests that nutrition may play a role in cancer prevention. Observational studies have shown that cancer is more common in some people with certain dietary habits -- such as colorectal cancer in people who have diets rich in meat products. So far, data has not supported the use of any vitamins or supplements to decrease the risk of cancer. In fact, studies on beta carotene and vitamin E, have shown that they actually increase cancer risk.

As a rule, patients should avoid any diet that claims to cure cancer, that advocates abandoning standard treatment, causes severe weight loss or weakness, requires severe food restriction, or costs a lot of money. Keep in mind that there are no diets that slow, reverse, or cure cancer. 

Acupuncture and Acupressure

Acupuncture and acupressure are examples of "complementary" medicine for cancer. While neither claims to cure the disease, some evidence shows that they help reduce symptoms and side effects of the illness and its treatment.

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