Nearly 41 percent of us will be diagnosed with cancer in our lifetimes, but thanks to new technologies and procedures, many cancer patients are finding safer and easier treatments. Here are a few.
This year, about 1.66 million men and women in the U.S. will be diagnosed with cancer, according to the National Cancer Institute. Overall, nearly 41 percent of Americans will be diagnosed with cancer in their lifetimes.
It’s a grim statistic, indeed, but tremendous advances in treatment are curing patients, preventing recurrence and prolonging lives. Chemotherapy, radiation therapy, immunotherapy and hormone therapy are among the innovative techniques, procedures and drugs that doctors are using to achieve better outcomes for many cancer patients.
For centuries, surgery was the only treatment for cancer. Even now, with innovative procedures, highly advanced therapies and ever-improving equipment, surgery remains an important component of cancer treatment.
Dr. John Brems, a board-certified general surgeon who’s fellowship-trained in liver transplantation as well as hepatobiliary, is director of the Center for Advanced Liver and Pancreatic Care at Advocate Sherman Hospital in Elgin. Since Brems began practicing in 1986, surgical oncology has improved dramatically.
“The first and most obvious difference is the size of the incisions,” he says. “We used to make big incisions. If we couldn’t take the cancerous tumor out because it had spread, we simply closed.”
Thanks to vastly improved imaging equipment, including MRI, CAT and PET scans, surgeons now operate knowing where the cancer is and whether or not it has spread. In addition, laparoscopy is a surgery whereby a thin, lighted tube is inserted through a small incision to search for abnormal growths, as well as to take tissue samples for biopsy. It’s rare that a surgeon is surprised during an operation.
“Twenty years ago, only 10 to 15 percent of pancreatic cancers were resected,” Brems says. “Now, it’s around 85 percent. Since the advent of laparoscopy, we can determine if the cancer has spread before we make a decision to resect or not.”
PET scans now play an essential role in detecting cancer, allowing physicians to detect malignancies and distant metastases. “PET scans detect cancer in the pelvis and other areas that are more challenging to diagnose,” Brems says. “I credit today’s imaging, along with minimally invasive surgical techniques, for eliminating the old open-and-close procedures, as well as improved survival rates. Combined with radiation and chemotherapy, cancer surgery is more successful and less invasive than it has ever been.”
In addition, endoscopic ultrasounds (EUS) allow physicians to biopsy a patient’s cancer and evaluate it for invasion of major blood vessels. “We know exactly what’s involved,” says Brems. “So, when we do surgery, there are usually no mysteries or surprises.”
Thanks to minimally invasive laparoscopic techniques, surgeons can resect tumors through small incisions, allowing patients to spend less time in the hospital. This can mean the difference between a two-day or 10-day hospital stay.
Another technological boon is the evolution of robotic surgery, which has vastly improved gynecological and urological procedures. “Before, when men had prostate surgery, they faced the risk of impotence or urinary problems,” Brems says. “Now, using the robot, we’re able to do more precise surgery that lowers postoperative morbidity significantly.”
There have been advances in the detection of metastic disease in the treatment of breast cancer as well. Not so long ago, in order to determine if the cancer had spread, surgeons were forced to remove several or all of a patient’s axillary lymph nodes. This procedure results in permanent nerve damage, as well as the risk of developing lymphodema, a painful swelling of the arm. “Now, we inject radioactive dye to determine the sentinel [first] node, and biopsy it to determine if the cancer has spread,” Brems says. “We can evaluate if the sentinel is cancerous. If it’s not, we can avoid axillary node resection.”
Combined, in some cases, with surgery and radiation, chemotherapy actually began as a toxic cocktail infused throughout the patient’s body. It attacked healthy and diseased cells, often causing side effects such as nausea, hair loss and mouth sores.
Chemotherapy today is much improved. Dr. Stanley Nabrinsky, a board-certified oncology hematologist practicing at Presence Saint Joseph Hospital in Elgin, says that in the late 1990s, sophisticated medicines were developed that targeted select cancerous tumors, seeking out specific receptors.
“With around 200 different large surface and internal cancers, along with their ability to mutate and spread, treating any one of them meant aiming at a moving target,” Nabrinsky says. “But in 1998, a new form of cancer therapy was created that specifically targeted breast cancer molecules, stopping their growth. By 2000, another medication was developed that targeted lymphoma. The breakthrough has been followed by many more cancer-specific drugs.”
Because these new forms of chemotherapy focus on one cancer, at one site, dosages are more easily tolerated, and healthy tissue is no longer compromised or damaged. Although targeted chemotherapy is available for breast, colon, lung and kidney cancer, it is not available for liver, stomach or prostate tumors.
“I foresee a day when chemotherapy is patient-specific as well as cancer-specific,” Nabrinsky says. “Every cancer has its unique signature and is individual to every patient.”
The downsides are high costs and insurance hurdles.
“Research and development is an expensive process,” he says. “Most of the new cancer drugs are still under patent. And because there are no generic versions available at this time, it means they can cost patients between $5,000 and $10,000 a month.”
Nabrinsky says that he hopes the scientific community will someday find a balance between the price of survival and the need for helping patients.
More than half of all cancer patients will receive radiation treatment at some time during their illness. In the past 10 years, radiation therapy has evolved rapidly, becoming a godsend to patients struggling to overcome cancer.
For Dr. Catherine Park, a board-certified radiation oncologist at Advocate Good Shepherd Hospital in Barrington, one of the most important advances is 3-D imaging, which allows doctors to more clearly see cancerous tumors.
“In the past, we were only able to see the tumor in two dimensions,” she says. “With modern techniques, we have the ability to see the tumor in 3-D. Furthermore, the radiation beam can be modified to the shape of the tumor. Since we can target our tumors more accurately, we can avoid damage to adjacent healthy tissue.”
Additionally, image-guided radiation therapy helps to localize the cancer immediately before, and even during, treatment. Localizing the cancer each day is helpful, Park says, because some tumors – in the lung and prostate for example – can move during treatment.
Advocate Good Shepherd is one of only two medical centers in the Chicago area to offer intra-operative radiation therapy (IORT), an innovative treatment for breast cancer patients. With IORT, radiation is administered at the same time the surgeon removes the breast cancer.
“While the patient is on the operating table, we treat the cancer site with 20 to 30 minutes of focused radiation therapy,” Park says. “In some patients, this may be the only radiation required. IORT vastly differs from traditional radiation therapy, in which the patient may need daily treatment for approximately six weeks.”
Radiation can also be used to treat cancer that has spread into areas such as the brain or spinal column, where surgery and chemotherapy are not practical or even possible.
“Recently, a new radium product, Xofigo, was approved to treat men with advanced prostate cancer that has metastasized into the bones,” Park says. “This is an important breakthrough because prostate cancer is the leading cause of cancer death among men. Xofigo targets the cancer cells in the bones while causing fewer side effects and improving survival. It also reduces skeletal fractures and lowers pain. We inject the radium six times every four weeks.”
Xofigo proved so effective, Park says, that research trials closed early.
“Long-term, we’re looking at ways to decrease the side effects of radiation while maintaining or improving survival,” she says.
Cancer treatment since the 1970s has consisted mainly of traditional chemotherapy, called cytotoxic chemotherapy. These drugs kill cells that divide rapidly, a specific trait of cancer cells.
“Unfortunately, these drugs often have severe toxicity, as we have normally functioning cells in our body that divide rapidly, including hair follicles, bone marrow and the lining cells of the intestines,” says Dr. Richard Siegel, a board-certified oncologist and hematologist at Northwest Community Hospital in Arlington Heights. “These drugs can often cause significant nausea and vomiting, although newer anti-nausea medicines have improved our ability to prevent and control nausea.”
Lately, drugmakers have approached new chemotherapy solutions by creating “targeted therapy,” which is therapy focused on a precise part of the body.
“There is a tremendous drive to develop drugs that act on specific targets on cancer cells, which would make treatments both more effective and less toxic,” Siegel explains. “Some forms of targeted therapy have been around for many years. Hormone, or endocrine, therapy has long been the mainstay of breast cancer treatment for women whose cancer is driven by the female hormone estrogen. Since estrogen is the primary driver of breast cancer development and growth, treatments that either decrease estrogen levels or block the action of estrogen are ‘targeted’ therapies.”
With the tremendous explosion of knowledge in the field of molecular biology, literally hundreds of potential targets are being investigated as possible drivers of different cancers. There are already many drugs that have been approved in the past 10 to 15 years that work by inhibiting specific targets in cancer cells.
For example, one blocks the action of a mutated protein that leads to a specific type of leukemia, chronic myelogenous leukemia (CML). This new drug has dramatically transformed CML from a disease with a very poor prognosis to one in which patients live many years in complete remission.
“In a type of lung cancer labeled adenocarcinoma, some patients have a mutation in a gene called EGFR,” Siegel says. “Another newly developed drug induces excellent responses in patients whose cancer harbors an EGFR mutation.”
Another paradigm of cancer treatment involves attempts to stimulate the body’s immune system to attack cancer cells, acting almost like a vaccine. Attempts at harnessing the immune system to fight cancer have, with few exceptions, been unsuccessful over the past few decades; however, new targets in the immune system have recently been elucidated.
“It’s the job of some proteins to keep the immune system in check, and prevent it from being too active, so it doesn’t attack normal cells,” Siegel says. “New drugs that can block these regulating proteins, called checkpoint inhibitors, are able to enhance the immune system response against cancer cells.”
Siegel points out that at the most recent American Society of Clinical Oncology meeting, held in Chicago, several presentations showed that these immune system checkpoint inhibitors caused significant reductions in tumor size, in patients whose cancer was progressing despite multiple previous chemotherapy regimens.
“This brings hope to those who have not found success with traditional chemotherapy,” Siegel says. “As one can see, the treatment of cancer is moving further away from indiscriminate cytotoxic chemotherapy, toward more effective, targeted and less-toxic therapies. This is a very exciting time to be an oncologist.”
Never in the long history of cancer treatment have patients had a better chance of surviving cancer and living a close-to-normal lifestyle. As fresh research findings are translated into new technology, techniques, equipment and medicines, there is promise that today’s grim statistics will give way to a more hopeful diagnosis in the future.