Thanks to new advances, some forms of cancer are becoming recognized as preventable and curable. Learn about four such forms, and find out how new technologies are helping doctors to diagnose and treat this disease.
It wasn’t all that long ago that a diagnosis of cancer was considered a death sentence. But in recent decades, the terms “preventable” and “curable” have become more closely associated with cancer. Public awareness and education, major advancements in detection, diagnosis and treatment, along with improved health practices, have changed not only treatment options, but also people’s perceptions of the disease.
Still, cancer is in no way conquered. Lung cancer still ranks as the most deadly form, affecting more than twice the number of patients than any other form of cancer in the United States, according to the American Cancer Society. But Dr. Michael Soble, medical oncologist at Advocate Good Shepherd Hospital in Barrington, points out that lung cancer would be easy to prevent if patients just didn’t smoke.
“Between 85 and 90 percent of lung cancers are the result of smoking,” he says. “Cancers are named according to the point of origin. Some cancers do migrate to the lungs from other areas of the body, but these are not considered lung cancer.”
People can develop lung cancer with few or no obvious risk factors, Soble says. While it’s nearly impossible to determine why such patients have lung cancer, it might be the result of second-hand smoke or environmental influences. The fact that lung cancer presents no symptoms until it’s fairly well advanced makes it all the more deadly.
“Persistent coughing that has no particular cause, coughing up blood, shortness of breath and chest pain are indicators,” Soble says. “Trouble is, some of these symptoms are common with other health problems such as heart disease or gastroesophageal reflux disease [also known as GERD].”
Treatment begins when a patient’s primary physician orders a CT scan or chest x-rays. Upon confirmed diagnosis, the patient undergoes an MRI brain scan, a PET scan to determine how far the disease has spread, and breathing tests to determine if the patient is healthy enough for surgery. If the cancer hasn’t spread, surgical removal of the cancerous lung sections is the first procedure.
“Advanced treatment may now include newly approved chemotherapy pills for non-small cell lung cancer,” Soble says. “Pathological studies on tissue biopsies indicate if a patient has abnormal epidermal growth factor receptors on the surface of the cancerous cells. These protein receptors occur on normal cells as well. These new pills are most commonly appropriate for women and non-smokers.”
If a second marker, called anaplastic lymphoma kinase is present, patients can be treated with newer pills.
“These were first found on the lymph nodes and in some lung cancers,” Soble explains. “Chemo pills are more effective and less toxic.”
Prognosis for lung cancer patients depends on what stage the cancer is in when found.
“If non-small cell lung cancer can be surgically excised, there’s approximately a 50-percent cure rate,” Soble says. “If caught too late for surgery, even with the best possible treatment, about 35 percent of patients will live one year. Five percent may live two years.”
Small cell lung cancer is even more aggressive, but responds better to chemotherapy and radiation treatments.
“Still, cures are rare, and most small cell lung cancers come back,” Soble says. “Even with treatment, patients seldom live longer than a year, most only 10 months.”
While the number of lung cancer diagnoses has leveled off in the past two decades, melanoma (skin cancer) cases are on the rise.
“The fact is, melanoma cases are increasing,” says Dr. Geoffrey Smoron, a radiation oncologist with Centegra Health System, McHenry. “They’re second only to lung cancer, which peaked in the 1980s. Today, the number of melanoma cases worldwide is increasing faster than any other cancer. Between 1973 and 1997, the incidence rates tripled in American males and doubled in American females. In 1935, the risk was one in 1,500 for Americans. By 2002, the risk grew to one in 68, and it’s still rising. In Australia, the risk is much higher than in the United States.”
While some patients are predisposed to melanoma because of heredity and skin sensitivity, exposure to the sun’s powerful rays is by far the most common cause. Because tanning beds intensify this type of exposure, they’re considered to be carcinogenic by the World Health Organization (WHO). The adverse effects of too much sun are recognized worldwide as well.
“Five years ago, I was vacationing in the Caribbean,” Smoron says. “We were touring on a double-decker boat which had a covered lower deck and a top deck open to the sun. As we pulled away from the dock, the captain suggested that people could take seats on the lower deck or the melanoma deck. People are really tuned in to the risks of sun exposure.”
This is far different from decades ago, when women wore long-sleeved gowns and carried parasols to counter the sun’s influences, he says. Now, people go outside barely covered at all.
Melanoma can occur at any site on the human body, including the eye, which makes a good case for regular eye exams. “The head, neck and genital areas are places we find melanoma,” Smoron adds. “We even find melanoma internally. Why? We have no idea.”
Caught early, when it’s shallow, melanoma is easily treatable. But when a cancerous nodule grows deep, the chance that it will spread through the body is far greater.
“We see patients whose melanoma requires radiation because the cancer has reached lymph nodes,” Smoron explains. “The other primary reason why melanoma patients are referred to us is because their cancer has recurred or metastasized.”
Radiation doses are scheduled on an individual basis, guided by the melanoma type and location.
“Melanoma seems to absorb electrons, which actually protect the cancerous tumor,” Smoron explains. “We often use higher-than-usual doses of radiation over the course of treatment, lasting four to six weeks. If the head, neck or lymph nodes are involved, the level of radiation is adjusted to be sufficient to reduce the risk of recurrence.”
Prognosis varies, depending on the type of melanoma and how early it was diagnosed. A lot depends on the depth of the tumor.
“If the melanoma is superficial Stage I, and removed surgically, about 90 percent of patients can be cured,” Smoron says.
Survival after treatment is somewhat reduced in Stage II melanoma patients, but if someone is diagnosed with Stage III melanoma, chances of survival drop to between 15 and 40 percent, because of the greater potential of the disease to reoccur or spread.
“With Stage IV melanoma, a patient’s chance of surviving five years is practically zero,” Smoron says. “The good news is that we have two new drugs released by the Federal Drug Administration that can prolong life expectancy by a number of months. If he or she has Stage III or IV melanoma, these new oral medications, or interferon and chemotherapy, can help to reduce the tumor.”
The downside is that these drugs have side effects. One of the new drugs is effective in half of melanoma patients, while the other seems to benefit only about 20 percent.
“These oral drugs just became available, and the clinical results are promising,” Smoron concludes. “Melanoma is an unpredictable disease, because it can occur anywhere in the body. People need to know that any mole the size of an eraser head should be evaluated for removal, as should one that suddenly changes in size or color. Moles that are irritated by clothing should also be evaluated for removal, as a preventative measure.”
After melanoma, prostate cancer is the most common form found in American men, occurring in 17.8 percent of the population, or about one in six. Until relatively recently, prostate cancer was considered to be unpreventable. Dr. Courtney Coke, radiation oncologist at Provena Saint Joseph Hospital in Elgin, says studies conducted on specific categories of potential patients indicate that certain dietary supplements may reduce one’s risk.
That’s good news for men with family histories of prostate cancer. Still, the disease can strike men without warning. Symptoms may include obstructed urination or the inability to completely empty one’s bladder. General practitioners who suspect a patient might have prostate cancer order a PSA blood test. If results indicate an elevated risk level, the patient is referred to a urologist and, if conditions warrant, to a radiation oncologist such as Coke.
“Surgical procedures depend on the stage the cancer has reached,” Coke explains. “If it’s in Stage I, then all options are open. For younger patients, we recommend a prostatectomy, which removes the prostate gland, seminal vesicles and any connective tissues that might be involved. For patients whose cancer has moved beyond Stage II, and who are older, surgery isn’t usually an option.”
For these patients, intensity modulated radiation therapy treatments using a linac machine are conducted over a period of seven weeks. Coke says a balloon is placed in the rectal area to push aside non-affected tissue. The linear accelerator uses multiple angle configurations to conform to the contour of the prostate structure, to ensure that radiation is applied precisely. Patients may experience gastrointestinal discomfort during the process.
A second treatment option involves implanting irradiated seeds directly into the affected area. Treatment is designed to meet the specific needs of each patient.
“The prognosis is actually very good if the prostate cancer is caught early,” Coke says. “According to the Memorial Sloan-Kettering Cancer Center, 85 to 90 percent of patients with Stage I cancer can survive 10 years or longer. For Stage II, the percentage drops to 75. Stage III patients have a 50 to 60 percent chance of surviving 10 years, but with Stage IV, that drops to 30 percent or less.”
Colorectal cancer remains the third most commonly diagnosed cancer in the world, primarily affecting populations in more developed nations. WHO’s GLOBOCAN cancer statistic report, released in 2010, estimates that, in 2008, 1.24 million new colon cancer cases were diagnosed worldwide, resulting in 610,000 deaths. Of those mortalities, about 24,500 were in the United States. Those people most likely to be affected are between 60 and 70 years of age. The risk of colorectal cancer is significantly lower in younger people.
Dr. Heliodoro Medina, a gastroenterologist at Delnor Hospital in Geneva, says there’s no specific way to prevent colorectal cancers, although a healthy lifestyle helps. Red meat, insufficient fiber, smoking and alcohol are believed to influence the development of colorectal cancers.
“Genetics and family history, whether or not the patient smokes – these factors can determine a patient’s predisposition to colon cancers,” says Medina. “Waste and toxin exposure in the intestines can trigger abnormal growths. Obviously, development of these growths increases with age. Worse, there aren’t many symptoms to warn patients and doctors that the cancer is developing. Patients may not necessarily experience pain, but if there are changes in bowel habits, or blood is found in the stool, that’s cause for concern. However, non-bleeding polyps may be present.”
The best way to prevent colorectal cancer is through regular screening, beginning at age 50 and repeated every 10 years, for patients with no family history of the disease. If a family member has been diagnosed with colorectal cancer, the start date for regular colonoscopies is moved back to age 40 and repeated every five years, or to 10 years prior to the age the youngest family member was when he or she was affected by the disease.
Considered the “gold standard” screening, colonoscopies find the large and small polyps, which are like little skin tags, wherever they exist in the colon. All polyps are removed and analyzed.
“We find two different kinds of polyps, both of which are benign on their own,” Medina explains. “A hyperplastic polyp is totally benign, while an abnormal adenoma polyp, if left in place, can progress to cancer. We really can’t tell by sight or size, so biopsy is vital to assessing whether or not the polyp is a precancerous adenoma. Some polyps grow on little stalks or stems, while others are flatter. If the polyps are actually cancerous but on a stalk free of cancerous cells, the patient is considered cured.”
If the colorectal cancer is isolated to the inside wall of the bowel, surgical resection is the first line of treatment. If the cancer has not metastasized, the cancer is considered cured. But should CT scans and laboratory tests indicate the cancerous cells have spread into the soft tissues of the abdominal region or lymph nodes, chemotherapy may be necessary.
“We biopsy adjacent lymph nodes to check for microscopic spread,” Medina says. “If the cancer has spread, the chances for survival drop significantly. A lot depends on what stage the cancer is in. That’s why early detection is so important.”
Mouth and Throat Cancers
Cases of mouth and throat cancers are increasing or being diagnosed more often, says Dr. Chilakamarri Yeshwant, a medical oncologist at Fox Valley Hematology/Oncology Ltd. About 52,000 new cases are expected to be diagnosed in the United States in 2011, representing about 3 percent of all new cancer cases.
The patients Yeshwant sees at Sherman Hospital in Elgin have more advanced cancers, requiring a combination of radiation and chemotherapy treatments.
“Mouth and throat cancer is caused by chronic irritation, primarily from smoking or chewing tobacco, and heavy alcohol use,” Yeshwant says. “It also can be the result of poor dental hygiene and care. Chewing betel nuts is another irritant that can lead to cancer.”
The human papilloma virus (HPV) that’s linked to uterine and cervical cancers also appears to be connected to mouth and throat cancers. Patients who are carrying or have been exposed to HPV 16 are at higher risk for cancer of tongue and tonsils. Epstein-Barr virus also is implicated in head and neck cancers.
“Cancer is never a one-hit thing,” says Yeshwant. “It can be a number of irritants that cumulatively damage the mucous membranes, leading finally to cancer, and it doesn’t happen overnight. We don’t know exactly how long it may take, but I know I see it more often in older patients.”
Mouth cancer can be detected during routine dental appointments, during which the patient’s mouth is examined closely for white spots or lesions that can be precursors to cancer. Because cancer can hide in many nooks of the mouth and throat, careful examination not only of the mouth, but of the entire throat, by an ear, nose and throat (ENT) specialist, is needed, to rule out cancers of the head and neck.
“Unfortunately, mouth and throat cancers have few warning symptoms,” Yeshwant says. “What people call smoker’s cough and hoarseness can be indicators of cancer, as are unexplained bleeding or sore areas in the mouth that don’t heal. Patients normally feel little or no pain. The cancer actually may travel to the lymph nodes in the neck before it’s diagnosed.”
Patients are usually referred to an oral surgeon or ENT specialist, who will first biopsy the area. Once cancer is confirmed, the patient will need additional surgical intervention, with or without radiation, based on the location, stage and patient’s medical condition. Patients can have as much as half their tongue removed and still be able to function nearly normally, because of significantly improved surgical techniques. But when the cancer spreads through the lymph nodes, patients need more aggressive treatment.
“I don’t see patients that early in the process,” Yeshwant says. “And many of those I see are older patients who also have heart or lung conditions, which make radical surgeries too risky. Also, the cancer may be surgically unreachable. We use a coordinated treatment of radiation and chemotherapy, to ensure the patient has a better chance of survival with minimal side effects.”
Today’s tumor-killing radiation doses are more precisely delivered, sparing healthy tissue and reducing harsh side effects that include damage to the skin, mucous membranes and the esophagus.
“Patients must be carefully prepared before radiation and chemo,” Yeshwant emphasizes. “They undergo thorough dental management, including extractions of teeth, before we start. Then, we may need to implant a feeding tube into the stomach to maintain nutrition during and immediately after the treatment, because good nutrition is a very important component of therapy for cancer.”
If diagnosed in early stages, cancers of the mouth and throat can be cured. “If we catch it in Stage I or II, we have a good chance of curing mouth and throat cancers,” Yeshwant says. “By the time it reaches Stage III or IV, obviously, we can’t guarantee that treatment will affect a cure. Prevention in the first place, by avoiding smoking and excessive drinking, of course, can’t be overstressed.”
Preventable. Curable. These words of hope are changing the future for millions of potential cancer patients. Still more are benefiting from tremendous progress in cancer diagnosis and treatment programs, adding an even more promising term: survival. ❚