Cancer care is more advanced today than ever before. Patient outcomes look more and more favorable, and the credit goes to a variety of medical professionals and even patients themselves. Learn how medical experts in our region play a part in curing care.
Cancer is a scary word. When heard in a hospital setting, it often foreshadows physical and emotional pain.
For some of the medical experts in our region who work to cure patients of cancer, the mission is personal.
“My grandmother had cancer,” says Dr. Weihong He, chief medical physicist at Centegra Sage Cancer Center, in McHenry. “I was in college, and I thought ‘OK. I want to go into this industry and help people.’ It’s why I turned to medical physics instead of just physics.”
For others, the mission provides a great deal of personal and professional satisfaction, even though delivering the news of a diagnosis is never easy.
“It’s one of the biggest challenges of all,” says Dr. Neeraj Desai, interventional pulmonologist at Northwest Community Hospital, in Arlington Heights.
“You can’t take it lightly because this is a life-changing moment for the patient. For them to be comfortable with their diagnosis, we need to spend time with them and be empathetic. Most of our patients are a little scared, but they know they have a strong team working for them.”
So, despite the fear of the unknown, patients and their families can at least feel secure in whom they trust with their health needs. The experts in our region have the intelligence, experience and compassion to help ensure the best outcomes.
“I’m honored when patients and their families entrust me to guide them through a stressful period of their lives,” says Dr. Bryan Macrie, radiation oncologist at Presence Saint Joseph Hospital, in Elgin. “I take that responsibility seriously.”
Radiation Therapy Step By Step
In order to fight cancer, multiple people must be involved. Behind the doctors and nurses, an entire team provides an advanced level of technical support. At Centegra Sage Cancer Center, chief medical physicist Dr. Weihong He is the leader of a team that fights all forms of cancer with radiation therapy, a common cancer treatment.
“My responsibility is to make sure radiation therapy is both safe and quality assured,” He says. “I monitor patients through the whole process of their treatment. The output of a machine is not something you can see, but as a physicist, it’s something I can see.”
If a patient gets a referral to the Center for radiation therapy, information is obtained on the medical history and diagnosis. Then, a meeting is called with a radiation oncologist to schedule the patient for a consultation. If it’s decided that the patient is a good candidate for radiation therapy, there is yet more discussion on what modality of radiation therapy is the best option.
The patient has a say in the matter, too.
“We always try to do our best to provide the patient with information so they can be part of their own cancer cure,” He says. “We tell them what comes next, or what they need to prepare, so we respect their dignity. Centegra is dedicated to providing service with a convenient and comfortable environment.”
If the patient agrees that radiation therapy is indeed the best course of action, a simulation technologist obtains images of the patient from a CT scan or PET/CT scan, which helps to understand the situation of the cancer. Where is it? How big is it? This step is important, as radiation treatment planning is dependent on the tumor situation.
From here, it’s up to the dosimetrist to mathematically calculate the dose of radiation necessary to kill the cancerous cells. This part of the process can be especially time-consuming, as accuracy is of the upmost importance. Meanwhile, He is monitoring everything, and safety is a top concern. It’s impertinent that the radiation dose adheres to regulations set by both the state and nation.
“As chief physicist, I have to supervise the whole procedure from the beginning,” He says. “I have to make sure the dose is consistent with national and state guidelines, so we can target the cancer and protect healthy tissue.”
Though the dosimetrist’s dose calculation is rarely incorrect, He says, someone still must double-check the work. The radiation dose is administered to a phantom – a man-made replacement for the human body that’s made of water-equivalent materials – before it’s administered to the patient.
Once He knows that it’s safe to deliver the dose, all the documentation, from the first step to the end, has to be proofread. There’s a cross-check on everything.
“We’re not just hiding in the office and telling people that we did the work,” He says. “We have to report everything to the senior level, and in my standards, that’s still not enough. I also get a second opinion on the dose from the lab. Radiation therapy is a team effort.”
These steps are consistent for all patients who seek treatment at Centegra, where 40 to 50 patients are treated on a daily basis. Patients receive radiation therapy only after this careful process is complete.
Before coming to Centegra at the beginning of 2017, He was in charge of medical physics at four cancer centers in New Jersey and Pennsylvania. The technology at Centegra, coupled with a dedicated team of employees, is what drew him to the Midwest.
“When I interviewed here, I realized people at Centegra are constantly looking for ways to improve, which I like,” He says. “Continuing our education is so important. Today we are the most advanced we’ve ever been in cancer care. In 10 years, we won’t be unless we continue to keep ourselves updated.”
Diagnosing Lung Cancer
Of all types of cancer, lung cancer remains one of the deadliest. According to the American Cancer Society, it’s the leading cause of cancer death among both men and women, and accounts for about one-fourth of all cancer deaths.
Dr. Neeraj Desai, at Northwest Community Hospital, helps to save people from this deadly disease. As a interventional pulmonologist, Desai specializes in minimally invasive procedures that diagnose and palliate lung cancer.
The earlier a patient can be diagnosed, the greater their chances are for survival.
“Most of my patients are people who have abnormal lung findings,” Desai says. “When they suspect any abnormalities, I’m the first contact for the patient. I look at the patient’s CT scans, PET scans and decide if we should proceed with a diagnostic procedure.”
When Desai meets with patients, they’re often anxious to see him. They’ve been told they have an abnormal lung scan – that a nodule or a mass was found. So, when they see Desai, they’re often expecting the worst.
It’s Desai’s job to alleviate their anxiety, and efficiently find an answer to the patient’s burning question: Do I have lung cancer?
“The patient wants to know exactly what is going on, so they can get treatment as soon as possible,” Desai says. “That’s what we do at Northwest. Some centers take up to a month to get an answer, but we have a multidisciplinary team that can get you a treatment plan in a week. If you need surgery or radiation, we’ll refer you right away.”
There are several minimally invasive procedures that Desai uses to diagnose lung cancer. One is navigational bronchoscopy, a procedure that combines electromagnetic navigation with real-time 3-D images. A bronchoscope, which is a small camera, goes into the patient’s mouth and then to the airways while he or she is asleep, and the camera displays images of the distant regions of the lungs. Previous CT scans indicate where potential tumors may be lurking.
“It’s a very fancy system with electromagnetic navigation,” Desai says. “It’s similar to a car GPS, in that it helps us get from point A to point B.
It’s hard to get to these lung nodules, but this technology makes it much easier. The risk of the procedure is lower, so now more patients are being diagnosed early.”
Desai also employs an endobronchial ultrasound to diagnose and stage lung cancer. This relatively new procedure helps to determine if the disease has spread to other parts of the body, such as the lymph nodes.
During the procedure, a thin, flexible instrument called an endobronchial ultrasound bronchoscope, which has an ultrasound device on the tip, is guided through a patient’s mouth and airways. The ultrasound helps identify if anything is wrong with the lymph nodes, which are outside the lung. The minimally invasive procedure is highly effective and is the best diagnostic option in diagnosing and staging lung cancer.
“Without making any incision, we can take a biopsy and get an answer right away,” Desai says. “Diagnosing and staging can now happen during the same procedure, and staging is important for delivering the best treatment.”
For stage 1 of lung cancer, surgery is often a common course of treatment if the patient’s breathing and lung function are satisfactory. For stage 1, the cancer has not spread to the lymph nodes or anywhere outside the lungs. If the cancer is more advanced, treatment may include chemotherapy and radiation therapy. The cancer, at this point, has usually spread outside the chest.
People who are former or current smokers should talk with their primary care providers or pulmonologists about being screened for lung cancer, especially if over the age of 55, says Desai. Northwest Community Hospital performs hundreds of lung cancer screening tests, which help to detect early lung cancer.
In the six years that Desai has been with Northwest Community Hospital, he has been actively involved in the lung cancer progrm. NCH provides a robust multidisiplinary treatment approach to lung cancer. From nurse navigators and nurses to physicians, interventional pulmonologists, surgeons and oncologists, everyone is involved in a patient’s care.
“The highlights of the program are the promptness in diagnosing lung cancer and the collaborative nature of our care,” Desai says. “It’s truly a strong program. The most gratifying part is when patients come back to us three or four months into treatment to tell us that they’re doing well because they were able to start treatment early.”
Options for Prostate Cancer
According to the American Cancer Society, prostate cancer is the second-most common cancer among men. The good news is that it has high cure rates. The bad news? There are controversies regarding detection and treatment.
“Many physician groups and medical societies advocate for less prostate cancer screening because of the risk of overtreatment,” says Dr. Bryan Macrie, radiation oncologist at Presence Saint Joseph Hospital. “Some men may have a prostate cancer that would never have caused them problems in their lifetimes because of very early, slow-growing disease or competing medical problems that pose a greater risk to their longevity. For this group of men, detecting and treating the prostate cancer increases the risk of treatment-related side effects, but provides no improvement in survival.”
Prostate cancer is more than half of what Macrie treats. Unlike lung cancer, where behaviors such as smoking are known connections with disease, prostate cancer lacks well-established risk factors. Macrie says most cases are believed to occur sporadically because of a random mutation. However, genetics may come into play if a patient has a family history of the disease.
Prostate cancer is most commonly first detected through a blood test measuring prostate specific antigen (PSA), a protein produced by normal and cancer cells in the prostate. A patient whose test shows high levels of PSA may need further testing. A physical examination of feeling the prostate for abnormalities can also aid diagnosis.
If a patient has elevated PSA levels or an abnormal exam finding, a urologist may perform a prostate biopsy to retrieve tissue, which a pathologist then diagnoses. Should cancer cells be found, the tissue is evaluated for how aggressively those cells grow.
If cancer is confirmed, then a patient is placed into a risk stratification system – a measure of whether there’s a low, intermediate or high risk based on the combination of the patient’s PSA score, physical exams and prostate biopsy results.
“A patient’s risk classification must be interpreted in the context of his other medical issues and personal preferences, in order to select the very best treatment options,” says Macrie.
One option for patients with low-risk disease is active surveillance, which does not offer treatments but does involve close observation to track the progress of the cancer.
“Active surveillance is a good option for many men with prostate cancer,” Macrie says. “We will generally have the patient submit blood on a routine basis to follow their PSA, and the patient may also undergo additional imaging studies or repeat prostate biopsies at a predetermined time. If something changes to indicate that the cancer is progressing, then we have a discussion about pivoting toward administering a curative form of therapy.”
If the cancer is more advanced at diagnosis or a patient is uncomfortable with active surveillance, several treatments are available, one of which may be surgery. The one-time procedure can, in many cases, completely cure the disease, however, like with any surgery, there are risks. Short-term risks may include bleeding and infection, while long-term risks may include incontinence or erectile dysfunction.
Another means of treatment, radiation, comes in two options. The first option is external beam radiation therapy, which uses a linear accelerator to direct radiation at the prostate, seminal vesicles and, in some cases, lymph nodes in the pelvis. For eight to nine weeks, a patient receives daily external treatment until enough radiation has been administered to destroy the cancerous cells. Sometimes, this is combined with medication to block testosterone, which deprives the cancer cells of a fuel source.
“Since you need to come in Monday through Friday for two months, this option can be tedious and logistically challenging,” Macrie says. “So, seed brachytherapy, which can be administered in a single day, represents an attractive alternative.”
With seed brachytherapy, a patient undergoes a one-time surgical procedure in which radioactive seeds are placed into the prostate gland. The seeds emit radiation into the prostate over the course of several months, thus destroying cancer cells. The plus side of this treatment is that it can be done in one day, allowing patients to quickly return to their lives. However, since the seeds are permanent and radioactive for several months, the patient emits low-dose radiation everywhere he goes, for as long as the seeds are active. This means it’s imperative that patients exercise precaution during treatment.
“To patients for whom the radiation safety precautions are not a problem, seeds are a very attractive and effective option,” Macrie says. “The reality is that all forms of treatment, surgery, radiation with seeds or external radiation, can be effective. So, choosing the most appropriate option for a patient needs to be an individualized choice, made after a person hears all of the pros and cons of each option.”
Macrie notes that the prostate treatment program at Presence Saint Joseph has continued to excel year after year and remains one of the hospital’s strongest programs. He also notes that the field of radiation for prostate cancers is heading in an interesting direction.
“Since treatment is tedious, there’s an emerging interest in an approach to external radiation treatments, known as hypofractionation, that can shorten the overall length of treatment time without compromising the effectiveness or increasing risk side-effects,” Macrie says. “Basically, there’s slightly more radiation dose given per day, enabling a shorter overall length of treatment time. The available data looks promising, so there’s a lot of interest in that approach right now.”