New research is helping to both prevent and better treat the often deadly disease
In 1956, Collier’s magazine ran an article titled, “Can Chemicals Cure Cancer?” Sixty years later, west suburban oncologists agree that yes, maybe chemicals can cure cancer — with an assist from radiation, electronics, surgery and gene therapy.
“This is one of the most exciting times ever for cancer research,” maintains Dr. Patrick Stiff, director of Loyola University’s Cardinal Bernardin Cancer Center. “We’re finding new cures for some cancers, and we’re making cancer in general a chronic disease that people will be able to manage while living a normal lifespan. There’s a lot of excitement and
a lot of hope here.”
More and more cancers are being stopped before they even get started, notes Dr. Courtney Coke, a radiation oncologist at Presence St. Joseph Hospital in Elgin. “We’re in transition to preventing cancer rather than just curing it,” he says. “Since the BRAC-1 and -2 tests have proven successful, we’re developing tests to identify many other genes that put people at hereditary risk for specific cancers.”
While most cancers spring from environmental causes, such as smoking or exposure to toxic chemicals, about 10 percent of them occur in people who were born with an inherited genetic mutation that reduces their bodies’ ability to destroy cancerous cells in a particular organ. When the BRAC-1 and -2 genetic tests for genetic mutations that promote breast and ovarian cancers became available, thousands of women with family histories of those cancers took the tests to see if they’d inherited those faulty genes. While a positive test result doesn’t guarantee that the test subject will develop cancer, the warning of elevated risk that can’t be controlled by lifestyle changes does let that patient schedule more frequent screenings, or undergo preventive mastectomies or oophorectomies, to prevent cancers or catch them earlier. Such preventive procedures have slashed the incidence of breast and ovarian cancers in women with the mutated genes by 80 percent or more, according to a study by the National Center for Biotechnology Information.
Now people whose family medical histories include high incidences of pancreatic, colorectal, melanoma and prostate cancers can undergo genetic testing to see if they’ve inherited faulty genes that increase their risks for those cancers. “These tests will go a long way toward helping people manage hereditary risks,” Coke states.
Cancer screening tests have also evolved to better fit into people’s lifestyles. Take colorectal cancer screening, for example. For decades one of the most dreaded signs of being “over the hill” has been to undergo a colonoscopy sometime after one’s 50th birthday to check for cancerous or precancerous polyps in the colon and rectum. The procedure involves fasting for 24 hours beforehand and taking a powerful laxative to empty the digestive tract, then curling up like a fetus on an examining table while a doctor maneuvers a tiny camera mounted on a flexible tube through the rectum and large intestine, looking for polyps and other irregularities in the lining tissue.
“It’s an invasive and inconvenient test, so many people find excuses to put it off indefinitely,” Stiff notes.
These days, people who have no unusual risk factors for colorectal cancer can opt for a fecal test that they can take in their own homes and mail to a laboratory for processing. Most kits test the fecal matter for blood, which can leak from a cancerous polyp, and for DNA evidence from malignant cells that slough off polyps.
While a positive test result generally requires a full colonoscopy to pinpoint the source of the blood and/or mutated DNA, taking the fecal test each year can let people postpone a colonoscopy until — or if — a positive result happens.
“The test isn’t quite as accurate as a colonoscopy, but it’s close enough to be a good initial screening tool — and it’s much better than not having any screening done at all,” says Stiff.
Since early detection boosts the cure rate for colorectal cancer to 90 percent, having an alternative to colonoscopies can potentially save more than 200,000 lives over the next two decades, asserts Carolyn Bruzdzinski, regional vice president of the American Cancer Society. This month the Cancer Society is launching the “80% by 2018” campaign to promote colorectal cancer screening for everyone age 50 and older. About 52 percent of Illinois residents n their 50s get screened each year now, she adds.
“A lot of people don’t realize that other options to colonoscopy are available,” Bruzdzinski comments. “There are so many reasons why people don’t get colonoscopies — they can’t take time off work, they don’t have insurance coverage for it, they’re just too busy or they find it distasteful or embarrassing. But this lets them get the early warning that they need by just spending a few minutes preparing a sample in their own homes, so we want to educate them about it.”
Older men also have traditionally dreaded the PSA screening. The blood test, which looks for elevated concentrations of prostate-specific antigen that indicate the body is battling a prostate tumor, is simple and almost painless. But a positive test result leads to a biopsy that is anything but painless and, quite often, ineffective — until the development of multi-parametric MRI biopsy, a new procedure that lets doctors see images of the prostate as they insert the needle to collect tissue samples.
“This procedure is taking the Chicago area by storm,” says Dr. Gopal Gupta, a urologist and professor of urologic oncology at Loyola University. “Even when we were armed with the warning signs of prostate cancer, there was no good way to find the tumor because getting an image of the prostate is so difficult. The standard procedure is to take 12 tissue samples at different locations, which covers a tenth of one percent of the prostate gland’s volume. How can we trust this when it’s so easy to miss a tumor and get a false negative result?”
The multi-parametric MRI procedure starts with the insertion of a small magnetic resonance coil into the patient’s rectum so that it sits next to the prostate gland. The coil scans the prostate and transmits the images to a computer screen. “We can get beautiful pictures of the prostate because there’s nothing in the way and we can see the entire surface,” Gupta states. “With this technology we can spot suspicious-looking surface areas and pinpoint their locations for the biopsy.”
At that point the doctor can link the MRI images with real-time ultrasound and a GPS device that lets him see what section of the prostate the biopsy needle
is targeting. Because the tissue sample locations are no longer random, the doctor can take fewer samples and still get more accurate results than with a traditional biopsy, Gupta asserts.
"It’s better for both the patient and the doctor,” he says. “There are a lot of risks to a prostate biopsy, including pain, infection, erectile dysfunction and anxiety, but the more exact we can be when taking tissue samples, the lower those risks become.”
Radiation therapy also has taken a giant step forward with the advent of stereotactic radiation surgery, oncologists agree. Despite its name, the procedure doesn’t involve making incisions or cutting out diseased tissue. Instead, a semicircular bracket holding up to a dozen lasers is placed over the site of the tumor. Using real-time CT scans, the doctor aims each laser at the tumor, then activates them all at once. While each laser is weak enough to pass through healthy tissue without damaging it, their combined strength at the point of intersection inside the tumor destroys malignant tissue and seals off the capillaries that provide the tumor’s blood supply. Most stereotactic therapies can be administered in a single treatment, though some soft tissue cancers in the body can take up to five treatments.
“Stereotactic radiation surgery allows us to go to a higher radiation dose than would normally be safe,” notes Dr. Bryan Macrie, a radiation oncologist at Presence St. Joseph Hospital in Elgin. “It gives patients a higher cure rate with fewer long-term side effects than traditional radiation. Someday it will replace traditional cancer surgery because it’s so accurate.” The procedure is particularly beneficial in treating brain tumors because it lets doctors destroy the tumors without opening the skull or irradiating healthy brain tissue, he adds.
When an abdominal cancer has spread from its original organ — such as the ovaries, prostate, liver or kidneys — to spawn many tumors throughout the abdominal cavity, doctors usually advise patients to get palliative care while they prepare to die. Now hyperthermic intraperitoneal chemotherapy offers some terminal cancer patients new hope by applying powerful drugs straight to the tumors instead of delivering them through the bloodstream.
“HIPEC is useful to a relatively small number of patients. Our facilities perform 30 to 40 of them per year. But it has greatly benefited many of those patients, and work is continuing on improving its performance,” says Dr. Alex Hantel, a medical oncologist at Edward Hospital’s Edward Cancer Center in Naperville, of the six-year-old technology.
The procedure starts as traditional surgery, in which the surgeon removes as much cancerous tissue as possible throughout the abdominal cavity. Then the inside of the abdomen is washed with a concentrated chemotherapy drug that’s been heated to 42 degrees Celsius — almost 108 degrees Fahrenheit.
“The drug can be stronger because it’s not being distributed through the entire body through the circulatory system before reaching the tumors, while being heated makes it more effective in killing malignant cells,” Hantel explains. “It’s not always a cure, but it has been shown to prolong patients’ lives with few or no serious side effects.”
Decades after the use of asbestos was outlawed in most construction because it’s so carcinogenic, more than 20 million Americans are at risk of developing mesothelioma — cancer of the membrane that encloses the lungs — because they were exposed to asbestos fibers at school, work or in their homes. About 3,000 new mesothelioma cases are diagnosed each year, and most of those patients die within five years of their diagnosis, according to the Centers for Disease Control.
While no one has yet found a cure for mesothelioma, a thoracic surgeon at Loyola Medical Center has developed a new surgical procedure that helps patients live longer and more fully with the disease. Dr. Wickii Vigneswaran uses robotic surgery to remove as much of the membrane tumor as possible without damaging the lungs, which traditional surgery often does.
“This surgery most benefits younger patients,” says Vigneswaran, adding that the slow-growing cancer often doesn’t fully develop until 50 years after the patient’s initial exposure to asbestos. “Performing a pleurectomy may not excise the entire tumor, but it will make it easier for patients to breathe and do normal daily activities. To remove the entire tumor requires more extensive surgery that takes part of the lung along with the tumor.”
Perhaps the most far-reaching advances in cancer treatment involve immunotherapy, which teaches the patient’s body how to fight the cancer that’s invading it.“
Dr. Michael Nishimura of Loyola University is conducting the first of several clinical trials to determine the safety and effectiveness of genetic manipulation as a cure for melanoma. He extracts cancer cells and T-cells — a type of white blood cell that attacks bacteria and other disease agents — from the same patient, then analyzes the protein markers on the cancer cell surfaces. He then engineers the T-cells to recognize and target the cancer cells for destruction; clones the modified T-cells until he has enough
to trigger changes in the body’s T-cell production mechanism; and injects them into the patient’s bloodstream.
“The advantage is that we can provide the body with an immune response that’s tailored to that specific type of cancer at a molecular level so that the body can kill the cancer itself,” he explains. “The disadvantage at this point is that the process is ridiculously expensive and it still has to overcome regulatory hurdles set by the Food and Drug Administration, the National Institutes of Health and the university. Once we get regulatory approval, it will take more research to find ways to make the technology affordable.”
Maintaining a healthy lifestyle is key for cancer survivors
Surviving cancer can be like escaping a monster tornado. You’re immeasurably grateful to be striding forward instead of wasting away in a hospice bed, but there’s a whole lot of cleanup and rebuilding to do before you can restart normal life.
“Survivorship issues are a growing part of what we address here,” observes Nancy Vance, executive director of LivingWell Cancer Resource Center in Geneva. “There have been so many great strides forward in cancer treatment over the last few years that more people are either beating cancer or living longer with it. Now we’re helping them to not just live, but to live well.”
“We want to ensure that every cancer patient has a survivorship plan because so many more patients are surviving than did in the past,” notes Carolyn Bruzdzinski,
regional vice president of the American Cancer Society. “We’re investing in looking at survival issues and developing programs to help patients resolve them."
Many cancer survivors are still coping with physical damage and lingering side effects from their treatment. Breast cancer patients who had lymph nodes removed from their armpits during their mastectomies are prone to lymphedema, which causes swelling in their upper arms and chests as trapped lymph fluid seeks new ways to circulate without the excised ducts. Chemotherapy and radiation can cause chronic fatigue as well as long-lasting skin damage and discoloration, explains Vance.
Even patients who enter remission or meet their five-year cure dates often suffer chronic anxiety over finding another lump or failing one of the many recurrence screenings they’ll have to take for the foreseeable future.
“Anxiety is a natural reaction for survivors when they think about their cancers recurring,” says Bruzdzinski. “It’s important that we recognize that, because it can seriously affect their quality of life after cancer.”
The best therapy for most survivors is to focus on leading a healthy lifestyle that will lower their risk of going through cancer treatment again, asserts Kathleen Omerod, a nurse navigator at DuPage Medical Group’s integrated oncology program. “Physical exercise has been shown to lower the incidence of colorectal cancer, breast cancer and prostate cancer, while eating red meats and processed meats can raise the risk of colorectal cancer and obesity worsens the risks of dying from any cancers,” she explains.
“Even before you finish treatment, you should do everything possible to maintain a sense of balance in your life, because feeling like you are more than your cancer is what’s going to get you through fighting it.”Edit Module