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 patients themselves. Learn some truths about cancer from medical experts in our region.
Cancer is not necessarily a death sentence.
Yes, the thought of having cancer can be terrifying. But the more informed we become, the less power the word “cancer” holds over us.
Many cancers are actually quite curable.
September is Gynecological Cancer Awareness Month, National Prostate Cancer Awareness Month, Leukemia and Lymphoma Awareness Month, and Childhood Cancer Awareness Month. Medical experts in our region have some light to shed on these diseases.
About Endometrial Cancer
Bonnie Turner is stubborn. For months, she wrote off her bad cramps as “no big deal.” Her husband was going through kidney cancer treatment, which included surgery in February 2017. His well-being was Turner’s main priority – not her own health.
“I was trying to take care of him and get him back to work,” Turner says. “I wasn’t really thinking about myself. So, it was a couple of months before I finally saw a doctor for my own pain.”
It was early April 2017 when Turner discovered that she, too, had cancer. Her severe menstrual cramps were a symptom of endometrial cancer, also known as uterine cancer. According to the American Cancer Society, more than 60,000 American women are diagnosed with endometrial cancer every year. It’s the most common type of gynecologic cancer.
Usually, however, endometrial cancer happens in women age 55 and older. Turner was only 44 when diagnosed.
“I was dumbfounded,” she says. “I just couldn’t believe this was happening. My husband and I moved up here from the South, he had just had his kidney removed, and now, a few months later, I was diagnosed with this. It felt like my heart dropped to the pit of my stomach.”
Right away, her doctor referred her to see Dr. Ali Mahdavi, a gynecologic oncologist at Mercyhealth Cancer Center who specializes in treating cervical, uterine, vaginal, ovarian and vulvar cancers.
Dr. Mahdavi took a biopsy of the inner lining in Turner’s uterus and explained the procedure results to her face-to-face.
“The first major challenge for a patient is the realization that they have cancer, which is a scary word,” Mahdavi says. “Also, most women do not have in-depth information about gynecological cancers, which means they’re caught off guard when the biopsy is done. In my practice, I make sure to take the time to explain the biopsy results and also make sure the patient understands the type of cancer that she has and what the treatment options are.”
Fortunately, most endometrial cancer cases are curable with surgery, Mahdavi says. In some cases, additional radiation or chemotherapy might be necessary.
For Turner, surgery wasn’t quite enough. She had a hysterectomy – a surgical operation removing her uterus – and felt normal again after a week of recovery. Her energy returned and she no longer felt pain or fatigue. Still, cancer cells lingered in her blood vessels. Turner is currently receiving chemotherapy every three weeks to keep the cancer from coming back. Hopefully, she’ll be done with treatment by late November or early December.
“Dr. Mahdavi has just been awesome through this whole experience,” Turner says. “Anything I need, Mercyhealth has been on top of it. I’m looking forward to going back to work.”
Mahdavi urges women, especially menopausal women, to report any abnormal vaginal bleeding to their physicians.
“That is the earliest and most common symptom of endometrial cancer,” Mahdavi says. “In many cases, for most gynecologic cancers, we can cure the cancer and provide a better quality of life.”
About Cervical Cancer
Dr. Tamer Refaat Abdelrhman, a radiation oncologist, treats all types of cancer at the FHN Leonard C. Ferguson Cancer Center in Freeport, but he has a particular passion for treating cervical cancer.
After attending medical school, Refaat earned his doctorate degree in clinical oncology and nuclear medicine from the University of Alexandria, in Egypt. His thesis dealt specifically with cervical cancer research.
“I treated 40 cervical cancer patients with radiation therapy and monitored them for at least three years,” Refaat says. “My thesis showed that survival was 100 percent with this treatment. The data were published in 2014 after the thesis was defended in 2011.”
Women with cervical cancer oftentimes experience fatigue, vaginal bleeding and/or discharge and pain during intercourse, Refaat explains. That’s because cancer cells in the cervix are dividing rapidly, leading to abnormal growth, local symptoms and regional symptoms.
However, this doesn’t just happen overnight.
“It takes time to develop,” Refaat says. “The normal cells gradually change into pre-cancerous cells. It can take several years to change into cervical cancer. The earlier you seek medical advice, the faster the care, the better the treatment outcome.”
The easiest way for women to prevent and early detect cervical cancer is to regularly see a gynecologist for a Pap test, Refaat adds.
If cervical cancer does occur, Refaat believes concurrent radiation therapy and chemotherapy should be the standard for treating bulky cervical cancer – a more advanced form of the disease.
“This not only decreases the likelihood of recurrence, but it prolongs survival,” Refaat says. “This treatment also improves the patient’s quality of life compared to combined surgery and radiation for bulky and advanced cervical cancers. Typically, cervical cancer is treatable as long as it hasn’t spread to other organs.”
As a radiation oncologist, Refaat uses high-energy beams to kill cancer cells. This may be delivered outside the body from external beam radiation or internally with brachytherapy – where radioactive implants are inserted directly into the tissue, or in proximity of the tissue. But first, a patient must undergo a CT scan to optimally evaluate the location and extent of the cancer. Then, the exact radiation dose is calculated accordingly.
“In general, cervical cancer patients come in five days a week for five weeks to receive external beam radiation therapy, which is followed by four to five brachytherapy treatments,” Refaat says. “We can use 3-D image guidance to focus the radiation on the tumor itself and spare nearby organs.”
Refaat additionally urges parents to make sure their daughters age 11 to 12 receive a vaccination for human papilloma virus (HPV). Infection from HPV is the most common risk factor for cervical cancer and is linked with multiple other cancers, he adds.
“HPV is very difficult to eradicate, so vaccination is very important,” Refaat says. “Also, I can’t emphasize enough the importance of regular screening with a gynecologist. It’s very easy, and it might save your life.”
About Prostate Cancer
Dr. Iftekhar Ahmad, also a radiation oncologist, treats all types of cancer at the Patricia D. Pepe Center for Cancer Care at OSF HealthCare Saint Anthony Medical Center.
A large portion of his practice deals with prostate cancer.
“With prostate cancer, radiation, like surgery, can be a definitive treatment, which means it’s the main treatment given to cure the disease,” Ahmad says. “In general, about two-thirds of all cancer patients will need radiation through the course of their treatment, regardless of the type of cancer.”
According to the American Cancer Society, more than 3 million American men have been diagnosed with prostate cancer. Aside from skin cancer, it’s the most common cancer among men.
The No. 1 risk factor is age, Ahmad says. There’s also a genetic component – those with a family history of prostate cancer are more likely to get the disease.
Most commonly, prostate cancer is first detected through a blood test measuring prostate specific antigen (PSA), a protein produced by normal and cancerous 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, and the gold standard for diagnosis is the actual biopsy of the prostate.
“There’s a lot of controversy surrounding when and if you should get a PSA test,” Ahmad says. “It’s definitely a conversation to have with your doctor. Typically, doctors recommend starting around age 50 or maybe even age 60.”
The controversy stems from the risk of overtreatment, Ahmad explains. Sometimes a man has a slow-growing disease that would not cause problems in his lifetime. Therefore, treating the prostate cancer may increase the risk of treatment-related side effects, which can decrease the quality of life overall.
That’s why active surveillance is a good treatment option in many instances of prostate cancer, Ahmad says. With active surveillance, men with prostate cancer undergo PSA blood tests on a regular basis and typically have a prostate biopsy about once a year to monitor if the cancer progresses.
“With people living longer, most men will have some level of PSA increase in their lifetime,” Ahmad says. “But, if we run into a situation where further treatment is recommended for prostate cancer, the main options are surgery in younger patients – which involves the removal of the prostate and surrounding tissues – and/or radiation therapy.”
With radiation therapy, there are a couple of options.
First, there’s 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 about eight 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 their fuel source.
Since this option requires a patient to see a radiation oncologist almost daily for two months, some patients opt for brachytherapy instead. With this treatment, the 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.
There are also increased urinary side effects of brachytherapy, which can require the use of a catheter for several weeks. According to Ahmad, brachytherapy is only recommended for a low-risk, early stage disease and is not as common as external beam radiation.
“You don’t want to jump the gun with treatment,” Ahmad says. “I believe age 50 is fine for a checkup with a PSA test because I think it’s important to stay vigilant about your health. It’s not the test itself – it’s how it’s interpreted. There’s no harm in having the knowledge; it’s what you do with it that counts.”
The word “leukemia” can incite great fear. But Dr. William Schulz, an oncologist/hematologist at the SwedishAmerican Regional Cancer Center, has a few myths to bust.
“I think everybody would fear getting cancer, especially leukemia, but it’s actually curable in many cases,” Schulz says. “Treatments today are a lot better than what we had even a few years ago. Sometimes, people might not even need treatment.”
Leukemia is a cancer of the bone marrow and blood. Although it’s the most common cancer in children under age 14, the majority of leukemia patients are diagnosed at ages 20 and older, according to the National Cancer Survivorship Resource Center.
Most incidents of leukemia can be classified into one of four main groups: acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML) and chronic myeloid leukemia (CML).
The acute leukemia types are fast-growing, while the chronic leukemia types have a much slower growth rate, Schulz says. Acute leukemia needs to be treated aggressively but is oftentimes curable. Chronic leukemia typically isn’t curable, but people can sometimes live with the disease for many years without experiencing any problems.
“People with the acute leukemia types get pretty sick,” Schulz says. “We can use aggressive chemotherapy, blood transfusions and antibiotics to treat the patient. Chronic leukemia, if the patient even has symptoms, can usually be treated on an outpatient basis with medications. As for myeloid versus lymphocytic leukemia, it all depends on which type of white blood cell is affected.”
Occasionally, a bone marrow transplant might also be part of a leukemia patient’s treatment. Fortunately, research has been advancing in this area.
“Before, you needed to find a donor with the exact same tissue type as the patient,” Schulz says. “Now, there are some new techniques that transplant centers are using with donors who are only a partial match.”
Schulz refers to leukemia as an “equal-opportunity cancer,” since there isn’t a particular demographic that’s prone to the disease.
Risk factors may include pre-existing bone marrow conditions and exposure to radiation or certain chemicals. But, for the most part, anyone is susceptible.
“Most people will suddenly start feeling a lot more tired than usual, or they might have problems with bleeding, bruising or infections,” Schulz says. “With these symptoms, it’s usually not a long time before people are diagnosed. They’ll go to their doctor or the emergency department and get a blood test.”
Though Schulz treats many cancers, he finds leukemia treatment to be one of the most rewarding aspects of his profession.
“I’ve always enjoyed the challenges of seeing and taking care of leukemia patients,” he says. “Especially some of the really sick patients, we’re going to be seeing them every day or very frequently, and we get to know a lot about them.
“You really become part of their lives, and I think that part is very rewarding.”