Take hope in new technologies, treatments and surgeries that are catching cancer earlier and increasing the odds of survival for those diagnosed with this terrible disease.
Cancer is a diagnosis no one wants to hear.
It’s a diagnosis that causes fear, sometimes so much that we avoid talking to our primary doctors about troubling symptoms, meaning we sometimes wait until it’s too late.
Luckily, that’s changing. Tremendous advances in diagnosis technologies, surgeries and treatments are gradually replacing fear with a new concept: hope. There’s hope that with new treatments, better prescreening and early detection methods, cancer patients now have much greater odds of surviving this disease.
Better Screening for Lung Cancer
Lung cancer is the No. 1 cause of cancer death in the world. More than 160,000 Americans die each year from this disease, primarily because it is seldom detected until its later stages.
The problem with lung cancer is that, until recently, there was no reliable screening for it and no specific early symptoms that primary-care physicians could detect. Even in the recent past, physicians would rarely send patients for testing, and tests such as chest X-rays and sputum cytology couldn’t detect lung cancer early enough to save lives.
In its earliest stages, lung cancer typically doesn’t cause signs and symptoms. According to the Mayo Clinic, symptoms can include a new cough that doesn’t go away or changes into a chronic cough, sometimes called “smoker’s cough.” Coughing up small amounts of blood is another sign of lung cancer, as is shortness of breath, chest pain, wheezing and hoarseness, unexplained loss of weight, and bone pain – all symptoms that can indicate any number of other diseases. Because of the complicated diagnosis, the majority of lung cancers are not caught until their late stages, when a cure is not possible.
Recently, the National Lung Screening Trial (NLST) found that low-dose CT scans are able to detect more early stage cancers. Places like Presence Saint Joseph Hospital, in Elgin, offer the CT screening for early lung cancers.
Dr. Stan Nabrinsky, a medical oncologist on staff at Saint Joseph for almost 20 years, sees the opportunity to help patients age 55 to 80, many of whom are former or current smokers, to get regular, reliable tests for lung cancer.
“Radiologists and administration at the hospital are willing to step in and help to make these tests easily affordable,” Nabrinsky says. “Plus, many insurers are covering this CT scan, as is Medicare.”
When a lung abnormality is detected on these CT scans, additional testing is done to determine whether it’s related to cancer or a different condition. While it’s helping to catch cancer sooner, the NLST screening is just one advancement.
“The advances in treatment of lung cancers include improved surgical techniques and improved radiation technologies that make the recovery time after surgery quicker and radiation more effective,” Nabrinsky says. “There are also dramatic changes in the way medical oncologists treat those patients for whom toxic chemotherapy, in the past, was the only option to prolong their lives.”
Newer, more-customized treatments are also helping to keep cancer at bay. “We are entering an entirely new era of personalized, targeted, more-gentle and still-effective therapies,” says Nabrinsky. “Plus, the most recently FDA-approved drugs for lung cancer are immunotherapies, which are able to stimulate a patient’s own immune system’s ability to fight the cancer.”
These are real breakthroughs in our armamentarium to fight cancers.
“Now, we can offer cancer patients a large variety of biological, targeted, personalized agents suitable for each individual patient,” he says. “We can test a patient’s tumor tissue for various mutated genes and aim the treatments accordingly.”
Unfortunately, these new treatments are very expensive, Nabrinsky says, but he’s optimistic that medical insurance availability under the Affordable Care Act should help some patients.
Treating Breast Cancer
Breast cancer was once considered a death sentence. Today, for patients whose breast cancer is diagnosed early, the five-year survival rate is in the 90th percentile. The reason for these improved statistics is a steady addition of breakthrough technology, procedures, treatments and medical advances, says Dr. Aaron Schwaab, board-certified general surgeon and co-medical director of the Centegra Gavers Breast Center in Crystal Lake.
“Not only have there been a number of new chemotherapy agents approved, but we also have a vital new diagnostic tool in our 3-D tomography,” Schwaab says. “It does not replace standard mammography, but is a secondary method of detecting tiny tumors when a patient’s breast tissue is denser than average.”
New technologies like this enable oncologists to begin treatment earlier than ever, Schwaab says. The surgeon has also found that new procedures are making a tremendous difference in how cancerous tissue is removed.
“We typically use a wire inserted into a patient’s breast to mark where the cancerous tumor is located, especially small ones that we cannot feel,” Schwaab explains. “It is done on the day of surgery and is not only uncomfortable, with the wire sticking out of the patient’s skin, but it’s also a concern because the wire could be dislodged or even come out. Starting in the new year, we will be replacing this procedure with one where a radioactive chip is implanted in the breast at the tumor site. This can happen at the doctor’s clinic as many as five days ahead of the surgery.”
The chip is perfectly safe, Schwaab says, and it has no radiation scatter. A Geiger counter locates the chip during surgery, thus confirming the accuracy of the incision and creating a clear margin to reduce loss of healthy tissue.
“We recently began using BioZorb markers during lumpectomy surgery,” Schwaab says. “The patient can request that these be used. These absorbable markers allow for precise radiation on the tumor bed because they don’t move around.”
Today, there are more options than the standard whole-breast radiation, a treatment given five days each week for about six weeks. This traditional method can damage healthy tissue along with the cancerous tumor. Schwaab says that for the past 10 years, an alternate treatment called SAVI has been offered to some women receiving radiation. More commonly known as breast brachytherapy, SAVI delivers a targeted dose of radiation to a lumpectomy site, not only affecting a smaller area of tissue but also cutting the radiation treatment down to five days of post-operative treatment – all with minimal side effects.
Another advance in post-operative care focuses on the patient’s breast reconstruction after mastectomy. Surgeons like Schwaab try to save as much skin and muscle tissue as possible, including the patient’s nipple.
“We have added a plastic surgeon to our employed practice for the first time,” Schwaab says. “Now, when the patient undergoes reconstructive surgery, her natural nipple is used along with her skin, making the end result as close to pre-op as possible. Patients feel more confident and natural than ever.”
In ongoing efforts to diagnose breast cancer as early as possible, Centegra has initiated a new program that screens and identifies women who are at a higher risk of developing the disease.
“When we detect anything that concerns us during screening, we arrange for special counseling to provide each patient with the information they need to make decisions regarding their risks,” Schwaab says. “Women who have the actual breast cancer gene have a 60- to 70-percent chance of developing breast cancer, while others may have a much lower risk rate, around 20 percent.”
The screening takes into consideration family history, genetic markers, the results of prior mammography and biopsies, whether or not they have had children, and other pathological evidence.
“When we diagnose breast cancer at Stage 1, there is a 95-percent chance of a five-year survival rate,” Schwaab says. “Even at Stage 2, the survival rate is in the 90-percent range. Because of all the scientific breakthroughs, women and even men diagnosed with breast cancer have a much better chance of not only surviving but of living full, productive lives.”
Approaching Hard-to-Treat Cancers
Unfortunately, not all cancer diagnostics and treatments offer so much promise. Liver and pancreatic cancers are particularly difficult to diagnose and treat because they are radically different from lung and breast cancer. Screening for these forms of cancer is in its earliest stages, but there is hope that this gap will close soon.
Part of the problem is that signs and symptoms of pancreatic cancer often don’t occur until the disease is advanced, according to the Mayo Clinic. When signs and symptoms do appear, they may include upper abdominal pain that radiates to the back, yellowing of the skin and eyes, loss of appetite, unexplained weight loss, depression and blood clots.
Dr. Richard Siegel, a board-certified medical oncologist and hematologist who practices at Northwest Community Hospital in Arlington Heights, says there really is no good way to screen for pancreatic cancer, so when he sees these patients, they are usually in the late stages. In patients with a strong family history of pancreatic cancer, endoscopic ultrasounds and CT scans done at regular intervals can aid with early detection. An endoscopic ultrasound is a procedure in which a gastroenterologist inserts a small camera through the mouth and down to the stomach. There, the endoscope uses ultrasound to get a close-up view of the pancreas and other nearby organs.
Most cancers that are found in the pancreas are primary cancers, and they can be localized to the pancreas, or spread to other parts of the body. It’s much less common for cancers to metastasize to the stomach from other sites.
“When the pancreatic cancer is found early enough, it can be removed surgically,” Siegel explains. “But the pancreas is located near a complex system of vital blood vessels, and involvement of these blood vessels often precludes resection. Approximately 15 percent of patients are able to undergo surgical resection, and in at least 80 percent of patients, the cancer still recurs.”
For patients with metastatic pancreatic cancer, there have been some advances in chemotherapy treatments.
Gemcitabine is a chemotherapy drug used in the treatment of pancreatic cancer. Until about three years ago, Gemcitabine alone had been standard therapy; it provided average survivals of about six months.
More recently, a combination of gemcitabine with a newer drug, nab-paclitaxel, has improved average survival to about a year. Another new regimen that combines three chemotherapy drugs also may extend the patient’s survival time to one year, and in some cases, to 18 months. This may not sound like significant progress, but any advancement in patient survival is significant, says Siegel.
Like pancreatic cancer, liver cancer presents many challenges, although new treatments are emerging. According to the Mayo Clinic, patients rarely show symptoms of liver cancer until later stages. Signals of the disease may include unexplained weight loss, loss of appetite, upper abdominal pain and swelling, nausea and vomiting, general weakness and fatigue, and a yellow discoloration of the skin and the whites of the eyes.
“We are also interested in a new approach to treating pancreatic and liver cancers with what is called Programmed Death-1 (PD-1) inhibitors,” Siegel says.
PD-1 focuses on molecules that can reinvigorate the patient’s immune system to attack cancer cells. PD-1 receptors act as a point of interaction for T-cell lymphocytes, allowing the immune system to eliminate the diseased cell from the body and prevent any abnormal tissue growth.
“We can see a lot of applications for this new therapy,” Siegel says. “There are also many new paradigms of treatments that are being investigated and are likely to dramatically change the way we treat not just metastatic pancreatic cancer, but cancers of all types.”
Hope for the Future
In just the past 50 years, cancer cures have taken such enormous strides that it’s now feasible to envision a time when patients will not fear diagnosis because they know that survival is possible. With new medicines, innovative biological treatment programs, and more-targeted chemotherapy and radiation applications, cancer is steadily becoming a disease to be cured, rather than feared.