There’s been exponential progress in finding ways to diagnose and treat various cancers. Learn what physicians in our region are excited about.
Cancer is a black cloud of a diagnosis, but advanced technology is the silver lining. As medications improve and treatment becomes more patient-specific, there’s more reason than ever to hope for positive outcomes.
For decades, physicians have been using precision medicine to some degree to treat cancer patients. But as science and technology advance, precision medicine also improves.
Dr. Gary Grad, medical oncologist at Northwest Oncology and Hematology, says precision medicine is the understanding of the unique biology of each patient’s cancer and correlating it with evidence-based real world outcomes data to deliver the best treatment to individual patients.
“So for instance, in breast cancer, and other cancers, certain tumors might respond more or less well to certain chemotherapies, endocrine therapies or immune therapies based on their molecular fingerprints,” Grad explains. “So we can be more selective in choosing appropriate treatments for our patients as opposed to looking at everybody the same way.”
In the “old days,” patients were treated homogeneously, Grad notes. All breast cancer patients, all lung cancer patients – the same treatment was applied to everyone. With new technology, Grad says, a tumor’s molecular fingerprints came into play. The biology of a tumor reveals insights as to why patients might respond differently to various treatments.
Although chemotherapy has advanced to become more tolerable for patients over the past few decades, it still carries risks and common side effects of nausea, diarrhea and hair loss. By implementing precision medicine, oncologists can determine which patients are more likely to benefit from chemotherapy and which patients won’t.
Another new development is the use of analytic technology.
“So now we can use artificial intelligence that can take huge volumes of tumors that are sequenced at the genetic level and correlate them with outcomes data in order to gain insight that helps guide therapies,” Grad says.
Precision medicine can be a valuable tool even before a person has cancer. Since certain cancers are associated with a hereditary risk, it might be a good idea to get a genetic risk assessment if someone in your family has had cancer. This can be done through a blood test, cheek swab or a saliva sample.
“If you carry certain mutations, you may be at a much higher risk than the general population of developing different types of cancer,” Grad explains. “And if we can identify those, we can screen you appropriately, and there are actually interventions that can be undertaken to lower the risk of the impact of those cancers. At Northwest Community Healthcare (NCH), we can inform you and your family of such risks as well as provide expert genetic counseling and hereditary risk testing.”
But for those who are already diagnosed, the next level of genetic testing is the use of prognostic molecular profiles, Grad says. For the patient, this involves a biopsy, or the excision of a tumor, which gets sent to a laboratory for testing. By evaluating the molecular makeup of the tumor, oncologists can predict the benefit or lack of benefit from certain preventive or adjuvant treatments. This information can also help to predict the risk of recurrence of certain cancers.
“Most importantly, perhaps, is that we understand who’s not going to benefit from chemotherapy, so they could avoid the toxicity involved,” Grad says.
For patients with more advanced stage cancers, precision medicine can help guide choices among several treatment options that may exist, Grad adds. Or, if standard treatment is no longer effective, precision medicine can shed light on new emerging targeted or tumor agnostic treatment options or investigational options.
As precision medicine continues to evolve with more and more data, Grad believes molecular profiling will become commonplace for every cancer.
“The observations from precision medicine are evolving rapidly but will require validation,” he says. “However, I think the efficiency of clinical trials can now be much better optimized and streamlined, and the yield of clinical trials moving forward will be exceedingly better than it’s been over the past decades.
“I think we can expect exponential progress in understanding the relevance of the biology of individual tumors and improving the treatment of patients with cancer,” Grad says.
There are many types of oncologists – medical, surgical, pediatric and gynecologic, for example – and each specializes in a certain area of cancer treatment. As a radiation oncologist at Northwestern Medicine McHenry Hospital Cancer Center, Dr. Rena Zimmerman primarily uses X-ray technology to treat cancer and other malignancies.
“We do radiation therapy in the curative sense, which can be combined with surgery, chemotherapy, or hormonal therapy, depending on the tumor site – and then we also use radiation therapy for palliation of symptoms,” Zimmerman explains. “So if you have cancer that’s gone to a bone and it’s very painful, we treat that as well. It’s very effective in helping to reduce the pain in the area.”
About 50 percent of cancer patients end up receiving radiation therapy as part of their treatment, Zimmerman says. But patients today benefit from advancements that weren’t around even just 20 years ago.
“I think the advances have been primarily related to the technology we have,” Zimmerman says.
For example, during the early days of her career, if a patient came to Zimmerman with a relatively small lung cancer tumor that could not be removed surgically, she would treat that small lesion for about six to seven weeks. Treatments would be Monday through Friday – five days a week – for about 15 minutes per treatment. “And the chance of me controlling that small tumor in the lung with that kind of fractionation, which is how many times you come, and the dose that we gave, was probably 30, 35 percent,” Zimmerman says.
Now, for a small lesion like that, Zimmerman can do stereotactic body radiation therapy, where she gives a high dose to the tumor in only three to five treatments, separated by a couple days between.
“So instead of 33 treatments, it’s five, and then the control rate is probably 80 to 90 percent,” Zimmerman says. “So it’s our current technology that makes that possible.”
In addition, treatments have become more localized to specific areas.
“If I’m treating head and neck cancer, for example, we can really define the area that needs to be treated while not giving as much dose to the areas that don’t need to be treated,” Zimmerman says. This is a big improvement from when she first started. Head and neck cancer patients would need to have all their teeth removed first.
“It was just miserable,” Zimmerman says. “Now, because of these incredible machines, we can deliver radiation therapy as it’s rotating around the patient, doing what we call dose painting, which is giving a little more dose here, a little bit less there, using intensity modulated radiation therapy.
“And at the end of it, the patient’s cure rate is better, but their side effects, even with the higher dose, are actually less long-term. So the technology is unbelievable,” Zimmerman adds.
In the future, Zimmerman hopes that radiation therapy courses can be shortened even more. But most of all, she hopes there’s a day when her field goes away all together.
“I wish all my business would dry up, frankly,” she says. “Nobody ever wants to see a radiation oncologist. But if you need to come to us, we take good care of you.”
Gynecological Oncology/Ovarian Cancers
It may not be the most common type of gynecologic cancer, but ovarian cancer claims more lives than cervical, endometrial, or any other type of gynecologic cancer. About 22,000 women are diagnosed with ovarian cancer each year in the United States, and around 14,000 women die each year from the disease.
“So as you can see, it’s a very deadly cancer,” says Dr. Assaad Semaan, a gynecologic oncologist at AMITA Health.
The disease is partially so deadly because typically, patients don’t seek treatment until they have an advanced stage of the disease, with symptoms like severe bloating, abdominal swelling and breathing difficulty from excessive fluid in the abdomen, nausea, vomiting and decreased appetite, Semaan says. A CT-scan of the abdomen, a blood test and sometimes a needle biopsy confirms the diagnosis.
Patients with early stage ovarian cancer either have no symptoms or minimal symptoms that can be easily mistaken for gastrointestinal troubles, such as bloating or pelvic discomfort, Semaan adds.
“When symptoms are related to cancer and not just any other GI issue, they tend to be more consistent than just a background annoyance,” he explains. “But only about 20 percent of ovarian cancer patients present at an early stage.”
To treat ovarian cancer, surgery is an ideal option.
“We want to make sure we can remove all the tumors and leave the patient with no evidence of any disease after the surgery,” Semaan says. But it’s not a simple procedure for the patient.
Typically, patients have to go through what’s called a debulking surgery, which is meant to resect all tumors in the abdomen, starting with removal of the fallopian tube, the ovaries, the uterus, the lymph nodes that are enlarged, the omentum (the fat pad that lies over the colon) and any tumor in the abdomen and pelvis. Afterwards, the patient typically needs six rounds of outpatient chemotherapy.
But if a patient doesn’t qualify for surgery – the disease is in non-resectable areas of the abdomen, or the patient is too sick – then chemotherapy is typically the first option pursued.
“The most important thing is to make sure the patient is actually being treated by a gynecologic oncologist,” Semaan says. “We’re specially trained and are versed in the surgical techniques that allow us to remove these tumors when we do the debulking surgery.”
Fortunately, minimally invasive surgery can be offered in specific cases of early disease or very low-volume disease. In terms of medical advancements, Semaan is seeing more targeted treatments that spare non-cancerous cells. These include anti-angiogenic agents that prevent the formation of new blood vessels.
“The other type of targeted drug that’s a really hot topic these days is what we refer to as PARP inhibitors,” Semaan continues. “They constitute most exciting advancement in treatment of ovarian cancer in the past few years. These drugs specifically target tumor cells and spare normal cells. We see much less of the historic side effects associated with chemotherapy like hair loss, nausea, vomiting and neuropathy. These drugs are now being used much more widely, and they’re changing the treatment of ovarian cancer drastically.”
For him, immunotherapy – using the patient’s own immune system and directing it toward fighting the cancer, is where the future of ovarian cancer treatment lies.
Meet Dr. Greg Richards
Dr.Gregory Richards, board certified radiation oncologist, is one the latest physicians to join Mercyhealth Cancer Center-Rockford. He cultivated his expertise by working for nearly 10 years at the University of Wisconsin-Madison and five years at MD Anderson Cancer Center, in Chicago.
“I feel I can bring the elevated level of care from those large academic centers to Rockford, where there’s certainly a need for cancer services like radiation therapy,” he says. “Part of the reason why I’m here is because the medical oncologist here, Tom McFarland, and the radiation oncologist up at Mercyhealth-Janesville, Kevin Kozak, are both people I worked with at the University of Wisconsin. I really feel that it’s a top-notch team.”
As he builds up his new Rockford practice, one goal in mind is to improve community outreach. He’s not afraid to get in the trenches and speak directly to people about cancer screenings, preventative care and other related subjects.
“There’s an underserved patient population who could be better served if they had more awareness of the things we can do,” Richards says.
These outreach programs, which Richards hopes to establish with Mercyhealth, can help give individuals the tools they need to reduce their risk of developing cancer, or even find out if they have cancer early on. Since most people know someone who has been affected by cancer, it also strikes an emotional chord.
“Rockford has many community-driven clubs and activities, whether it be a rotary club or social club, and oftentimes throughout the year they have time slots where they present community talks,” Richards explains. “I always find they’re very rewarding because people like to hear from the physicians of the community, especially when it comes to cancer.”
Ultimately, when it comes to radiation therapy, Richards hopes patients don’t need to travel far to get the specialty care they deserve.
“We’re going to care for patients identically to big universities – that’s the goal with the team we’ve created,” he says.