Diagnosing and treating simple forms of cancer is becoming easier than ever, thanks to new advancements. Meet the doctors dedicated to helping patients fight this preventable disease.
Those who work in the fields of cancer research, diagnostics and treatment have made tremendous strides in stabilizing or reducing the incidence of cancer in the past two decades. Yet two of the most deadly forms, lung and melanoma, claim more and more victims each year.
The World Health Organization (WHO) estimates that about 1.4 million people worldwide died from lung cancer in 2010, more than twice the number claimed by any other type of cancer. The Skin Cancer Foundation reports that in 2010, one American died each hour from melanoma and its spread. In fact, one in five Americans will develop melanoma at some point.
Why do these cancers continue unabated, even when early diagnosis offers patients a reasonable chance of survival?
Dr. Fauzia Khattak, medical oncologist with the SwedishAmerican Regional Cancer Center, Rockford, sees more people diagnosed with lung cancer each year, despite increased awareness and advances in lung cancer diagnosis.
“Most of them are smokers, because smoking is a substantial risk factor, either actively or passively,” she says. “Sadly, we usually see these patients in advanced stages, because that’s when the symptoms present themselves.”
A recent CT scan clinical trial by the National Cancer Institute (NCI) demonstrated that the mortality rate for heavy smokers can be reduced with early detection, similar to the way that mammograms and PAP tests have decreased the mortality rate for breast and cervical cancer patients.
“Until now, we haven’t had screening recommendations for early lung cancer detection, because it wasn’t considered to be a cost-effective strategy,” Khattak explains. “But the National Cancer Institute study indicates that screening CT scans can decrease mortality for high-risk patients.”
In the NCI study, high-risk patients were defined as those with a history of smoking 30 to 35 packs of cigarettes per year, or former heavy smokers who quit within the past 15 years.
“In November 2010, the results of the trial indicated that screening CT scans can help diagnose lung cancer earlier,” Khattak says. “Use of CT scans to screen for lung cancer is still not a formal recommendation, and we anticipate problems from insurance agencies before it can become a practicality. Lung cancer is curable if it’s detected early.”
About 90 percent of lung cancer patients are smokers.
The disease is most often caught early only when an X-ray or CT scan is done for other reasons, like elective surgeries. “Patients presenting with pneumonia may get X-rayed, and a lung mass may be caught,” Khattak says. “Symptoms are usually late in presenting and may include a persistent, unexplainable cough, weight loss, shortness of breath and pain, if the cancer has involved the spine, bones, ribs or nerves.”
When a high-risk patient brings symptoms to his or her primary doctor’s attention, a baseline chest X-ray should be ordered.
“Lung cancer falls into two broad categories – non-small cell and small cell,” Khattak says. “With non-small cell cancer, the patient may be considered a surgical candidate if the cancer is not too advanced and if the lung function is adequate to withstand surgery. Surgery is the main curative option, and therefore, the key is early detection. Depending upon the extent and stage of the disease, determined from the surgical pathology, further recommendations for other treatment modalities can be made, like chemotherapy and radiation.
“In small-cell lung cancer, surgery is not an option,” Khattak continues. “This type of cancer is usually treated with chemotherapy and/or radiation. Because small-cell lung cancer is more aggressive, undiagnosed and untreated patients die in a relatively short time. Even with chemotherapy and radiation, small-cell has a high risk of recurrence, but it can be cured if it’s caught early.”
Regardless of the form they have, lung cancer patients usually have a tough fight ahead of them.
SwedishAmerican’s Multidisciplinary Lung Cancer Center, which is part of the hospital’s cardiovascular surgical and pulmonary department, offers patients a focused, experienced team of medical experts. The center is co-directed by thoracic surgeon Dr. Karen Thompson and pulmonologist Dr. Jon C. Michel.
Nurse navigator Andrea Sapron, RN, BHN, works alongside Khattak. She says medical oncologists, a pulmonary specialist, radiologists and other physicians meet weekly to evaluate patient CT scans and chest X-rays when abnormalities are discovered.
“We call it our lung conference,” Sapron says. “We assess the test results, regardless of what’s going on with the patient. The mass may be lung cancer, or it could be an infection. We put these patients on a list, then study the tests to arrive at an accurate diagnosis. We decide if a biopsy is needed, and we contact the patient the next day to explain our determinations.”
Advanced diagnostics may include additional CT scans, a needle biopsy or a bronchoscopy to study the mass. As soon as the pathology report is prepared, it’s brought to the pulmonary specialists immediately. If lung cancer is diagnosed, the medical oncologist, pulmonary specialist, thoracic surgeon and pathologist consult with the patient.
“Usually, there are four of us in the room with the patient and family,” Sapron says. “It’s usually myself and Dr. Michel giving the diagnosis, along with whatever family members the patient brings. I stand to one side until the doctors are finished, then stay after to answer any questions they have. Most of the time, I sit quietly and let the family absorb the shock of the diagnosis. Then the questions come pouring out. I listen closely to assess their feelings. I give them my contact information, and am literally on call 24/7 whenever they need advice or someone to listen.”
Along with writing down patients’ pertinent information, Sapron provides resources and informational brochures, DVDs and a medical management binder to help patients keep all of their papers together.
“My job is to explain, to comfort and to stay as long as I’m needed,” Sapron explains. “I help monitor recovering patients, who are seen in anywhere from six months to five years for follow-up. I make sure they get to their tests and that they know when to call me.”
While lung cancer is hidden to the naked eye, malignant melanoma presents as a visible lesion on the skin. It accounts for one in three cancer diagnoses, according to WHO, and has been diagnosed in a growing number of patients each year for the past 30 years. Basal cell and squamous cell carcinomas are the most common.
Those most at risk have a family history of the disease, especially patients with light hair and eyes, fair skin and freckles. A large number of moles on the body, particularly on the arms, legs, back and face, combined with recreational sun exposure and a history of sunburn, contribute to the development potential of melanoma.
Radiation oncologist Dr. Iftekhar U. Ahmad and medical oncologist Dr. Shylendra B. Sreenivasappa treat patients diagnosed with malignant melanoma in OSF Saint Anthony Medical Center’s Center for Cancer Care in Rockford. An estimated 70,000 cases will be diagnosed in the United States this year, says Ahmad.
“It’s one of the few cancers that has increased over the past decade,” Ahmad says. “It’s important to treat it before it metastasizes, or the outcome is pretty grim.”
Sreenivasappa explains that malignant melanoma is the fifth most common cancer in older men, with one in 39 affected. Women are less susceptible, with one in 58 diagnosed, making it the seventh most common cancer for female patients.
Ahmad says that the use of tanning beds is proven to have a direct link to malignant melanoma, in the same way that smoking is linked to lung, throat and mouth cancers. In fact, WHO considers tanning beds to be carcinogens. “Using them increases the risk two- to threefold,” Sreenivasappa says.
After an initial diagnosis by a primary physician, and a biopsy by a dermatologist, the patient sees a surgeon, who does a wide local excision to remove the tumor and a sufficient margin of tissue around it to avoid recurrence. If necessary, the patient is referred to Ahmad and Sreenivasappa for advanced treatment.
“It’s not so much the size of the cancerous lesion on the surface that concerns us, as much as the depth of the tumor,” says Ahmad. “That’s the key, because the deeper the tumor is, the more likely it is that lymph nodes are involved.”
Ahmad says that surgery is the only treatment needed if the melanoma has been diagnosed early. Sreenivasappa adds that patients diagnosed with localized melanoma have excellent odds for survival.
“If the tumor is two millimeters or larger, and has spread to nearby lymph nodes, we usually offer interferon, a drug that enhances the patient’s system ability to fight off the cancer,” Sreenivasappa says.
Radiation is added to the treatment plan if a larger number of lymph nodes is involved. “With the surgery, survival chances are good, so long as we catch the cancer early,” he says. “We monitor the patient closely. Once the malignant melanoma spreads into the lymph nodes, patients have between 25 and 30 percent survival rates. In patients who need interferon and radiation, chances of survival are very much lower, because once the cancer spreads to the lymph nodes, it can appear just about anywhere else in the body.”
To catch skin cancer as early as possible, Ahmad and Sreenivasappa urge people to use the A-B-C-D-E check method. The A stands for asymmetry, in which moles are not evenly shaped in circles, ovals or ellipses. The B stands for border irregularity – any mole or freckle with odd or irregular edges that are still symmetrical. The C reminds people to check for color changes in any mole. The D is for diameter – any mole that grows to 6 millimeters or larger could be a problem. The E is for rapid enlargement, sudden growth of a mole that was more or less the same size for a long time.
The term “precancerous” is used to indicate skin pigmentation that suggests the potential for melanoma. However, unless the area of concern begins to grow or exhibit any of the indicators described, patients who bring it to the attention of their doctors will probably find no reason for immediate concern, says Sreenivasappa.
“If a patient is worried, a biopsy will help to alleviate his or her concerns,” Ahmad says. “The mole can be excised to eliminate any possible future problems.”
Cancer affects not only patients but also their family members, colleagues and friends in profound ways. From the point of diagnosis, through treatment and altered lifestyles, people need support beyond that provided by medical professionals. This is where a specialist such as Sue Hageman, RN, BSN, OCN, steps in. From her office on the first floor of Commerce Towers, adjacent to Katherine Shaw Bethea (KSB) Hospital in Dixon, Hageman fulfills her role as a certified cancer resource nurse, by helping everyone who walks through her doors. And like Sapron at SwedishAmerican, Hageman offers practical comfort to those who experience anxiety and fear after a cancer diagnosis.
“I’m here for everyone, from patient to family, for those who have just been diagnosed, to those who are undergoing treatment,” Hageman says. “I have literature and handouts, a lending library and resource information. I also have a wig bank through the American Cancer Society (ACS). I help women pick a free wig from about 60 on hand, in different colors and styles, or if necessary, I can order something appropriate. I also have hats, turbans and scarves, all especially nice, for any age cancer patient.”
In the process of choosing head covers, patients connect with Hageman. Once the conversation gets rolling, she often spends up to an hour talking with them. This gives Hageman the opportunity to educate patients and offer links to the ACS and other programs, including Home of Hope, a cancer support center located just off Route 2 between Dixon and Sterling.
“After they tell me their stories and I begin to see what’s going on with them, I can suggest formal support groups or one-on-one support,” Hageman says. “As an oncology-certified nurse, my advice leans toward the medical side. I’ve been a cancer nurse through the years, starting with inpatient oncology and then in an outpatient chemotherapy setting.”
Hageman also sees patients in KSB Hospital, offering them extra support and connecting them with other resources.
“KSB works with the local oncologists seeing cancer patients who come in for diagnosis, IV and antibiotic treatments, as well as end-of-life care,” she says. “I’m also on several hospital committees and work at health fairs, give talks to groups and conduct lunch-and-learn programs at Home of Hope. I network with the Northern Illinois Cancer Treatment Center and various health departments.
Each year, I get involved in the breast cancer programs and other outreach efforts throughout the
Hageman describes herself as the go-to person for anyone diagnosed with cancer, as well as their family members. She brings her experience and insight to a position that’s been filled by caring nurses for the past 25 years.
“The main purpose is to listen with an objective ear,” she concludes. “With family and friends, a great deal of emotion is involved. I can be nonjudgmental, and because of my past experiences in cancer treatment, I understand more clearly what they’re going through.”
Medical experts agree that the best way to reverse lung cancer and melanoma statistics is through public education and increased self-awareness. By avoiding activities such as smoking and sunbathing, and by knowing what to watch for, patients can help to prevent these cancers from exacting their deadly tolls. ❚
The ABCDEs of Melanoma Detection
Check the moles on your body for:
A – Asymmetry
B – Border irregularity
C – Color change
D – Diameter
E – Enlargement
Patients noting any of these indicators should bring it to the attention of their doctors.