HEALTHMATTERS

By Linda Hepler, BSN, RN

Living Longer With Cancer

(And Better)

Breakthroughs in Cancer Research and Treatments

Cancer is not just one disease, but many diseases, says Dr. David Riseberg.
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enevieve Fisher, who lives near Seattle, Washington, was only 22 when she was diagnosed with Hodgkins Lymphoma, a cancer of the lymphatic system. Now 40 and happy to be alive but struggling with a myriad of side effects from 9 months of chemotherapy followed by radiation treatment she remembers those terrible days. I was scared to death, she says. All I knew about cancer is that people die with it. Many people, like Jenevieve, are struggling with the ravages of cancer. According to the American Cancer Society, men have greater than a 44 percent risk of developing cancer over the course of a lifetime, and women have about a 38 percent lifetime risk. But while these are sobering statistics, there is some good news the chance of dying of cancer is less likely these days than ever before. And living a quality life with fewer side effects after cancer treatment is even more likely. If you need to be treated for cancer, it's

a pretty good time (in history) to be alive, says Sandra Vermeulen, MD, a radiation oncologist and Executive Director of the Swedish Radiosurgery Center in Seattle, Washington. Today, you can be treated more effectively and with fewer side effects. As scientists gain more understanding about exactly how cancer cells grow, divide and invade the body, there has been an increasing amount of development in the mainstays of treatment surgery, radiation and chemotherapy. These days, treatments are combined in unique ways and tailored to combat specific molecular types and behaviors of cancers. What is more, newer technology allows doctors to treat cancer with more precision and also to visualize the effects of treatment more easily. To understand how cancer treatments work, you need to know the basics about the disease or diseases according to David Riseberg, MD, a medical oncologist who practices at Mercy Medical

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Center in Baltimore, Maryland. Cancer is not just one disease, but many diseases, he says. What we do know is that specific types of cancer have certain genetic defects or changes that drive the disease. In other words, cancer starts when body cells begin to grow out of control. Normal cells have an organized life cycle: they grow, divide and die. But sometimes the DNA (a part of the cell that contains genetic instructions for cellular development and functioning) becomes damaged. This can occur because of internal factors such as heredity or immune conditions, or external factors such as tobacco, infectious organisms, chemicals or radiation. While many of these damaged cells are repaired by the body (or they die), they may also continue to grow and divide, making new (and abnormal) cells that the body doesn't need, called cancer cells. These abnormal cancer cells, if unchecked, will invade healthy tissue, spreading throughout the body. According to Dr. Riseberg, different types of cancers have different genetic changes that govern the way they behave; they grow at different rates and respond differently to treatment. What is more, he adds, the same type of cancer may act differently in different people, which makes a one-size fits all treatment ineffective. And that is the basis for cancer treatment today: trying to understand the genetic signature and tailor treatment to destroy cancer cells without harming too many normal cells surrounding the cancer. This means that those who work in oncology (the field of medicine devoted to cancer) are able to help their patients live with cancer and live as normal a life as possible rather than to die, says Armando Sardi, MD, FACS, surgical oncologist and Director of the Institute for Cancer Care at Mercy Medical Center in Baltimore, Maryland. But, he adds, There is still a long way to go and at the end of the day, the most important thing is prevention. People still don't go to the doctor when they have symptoms of concern. And early diagnosis is the most important part of a cancer cure. MS&F

NEW HOPE Through

Promising Cancer Treatments

Radiation is a form of energy that can travel through space and penetrate certain materials. Ionizing radiation, or atomic particles that carry energy, has been used since the early 1900s for imaging tests (x-rays). Shortly afterward, it was discovered that daily doses of high energy x-rays given over a period of time can emit sufficient energy to kill cancer cells and allow a better chance of cure. Today, radiation is used to shrink tumors prior to surgery, as a stand-alone treatment to eradicate cancer cells and also to relieve symptoms from cancerous tumors. Cutting-edge radiation treatments include TomoTherapy, CyberKnife Radiosurgery and Proton Therapy.

Radiation

TOMOTHERAPY

is a CT (computed tomography) scan and a radiation machine in one, says Sandra Vermeulen, MD, a radiation oncologist and Executive Director of the Swedish Radiosurgery Center in Seattle, Washington. Used for hard-to-reach or extensive tumors that sit close to healthy tissues and organs, the real-time imaging allows us to see the shape and position of the tumor each time we treat so we can direct the radiation more precisely, she adds. This allows irradiation of large areas of the body while still minimizing damage to healthy tissue. TomoTherapy is used for many types

of cancers, including mesothelioma, an asbestos-related cancer of the lining of the lung or the abdominal cavity.

CYBERKNIFE ROBOTIC RADIOSURGERY is

one of the most precise radiation treatments available, says Dr. Vermeulen. It can track motion in real time, so it's ideal for moving targets, such as the lungs or prostate. It's like hitting a bullseye, using large doses of radiation and treating less of the adjacent (healthy) tissue.

PROTON THERAPY

is the best option for treating cancerous tumors in children, says William Hartsell, MD,

a radiation oncologist and Medical Director of CDH Proton Center in suburban Chicago. A proton is a hydrogen atom that lost its electrons, so it has a positive charge, he adds. This charge is attracted by atoms within the body, giving the proton less energy as it enters the body and allowing it to stop at the cancerous tissue that is to be treated. This gives less radiation dose to normal tissues, which is especially important for children because radiation itself can cause tumor growth 10 to 30 years later, says Dr. Hartsell. Proton therapy is also used on adults to treat a wide variety of cancers, including prostate, lung, brain, head and neck.

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The big news in surgery today, says Armando Sardi, MD, FACS, surgical oncologist and Director of the Institute for Cancer Care at Mercy Medical Center in Baltimore, Maryland, is that we don't often have to do as extensive surgeries that cause major life changes for the patient. We can be more accurate. This accuracy, he explains, is related to advanced imaging techniques that allow better identification of the cancerous tissue that needs to be removed, as well as surgical treatments that are personalized to both the type and behavior of the cancer cells as well as the needs of the patient. Two cutting edge surgical treatments are HIPEC (Hyperthermic Intraperitoneal Chemotherapy) and robotic surgeries, such as the da Vinci Surgical System.

Surgical Procedures

The AntiCancer Diet

Kelly O'Connor, RD, LDN, a registered dietician at the Institute for Cancer Care at Mercy Medical Center in Baltimore, Maryland, says that a good diet is important in helping to prevent cancer. Although studies aren't conclusive about one specific anti-cancer diet, O'Connor offers the following general tips: 4 EAT LESS FAT: Being overweight or

HIPEC is an aggressive
treatment used for a patient with peritoneal surface malignancy (cancer of the lining of the abdomen, often caused by colorectal, ovarian or gastric cancers), says Dr. Sardi. In this procedure, he explains, the surgeon removes all visible cancer, and then uses a heated sterile chemotherapy solution that circulates through

the abdomen for a maximum of two hours designed to kill the remaining cancer cells. I have patients that are alive 18-19 years after HIPEC that not too many years ago would have been sent home to die, says Dr. Sardi.

ROBOTIC SURGERY
options such as the da Vinci Surgical System offer a minimally invasive approach

for complex surgical procedures. With this type of surgery, small incisions are made to allow the insertion of a high-definition 3D camera and miniaturized instruments. With the aid of the magnified, high-resolution 3D image, the surgeon sits at a special console and works the robotic arms, directing precise movements of the surgical instruments to remove cancer cells.

obese raises the risk of developing many cancers, such as cancer of the breast, colon, thyroid and pancreas. And too much fat in the diet can contribute to obesity. Limit your daily fat intake to no more than 25 percent of your total food calories by choosing lean meats (or no meat at all) and low-fat dairy. A healthy weight will decrease the risk of many diseases besides cancer, such as heart disease, says O'Connor.

4 EAT THE RIGHT FAT: Diets high in

Chemotherapy, or the use of chemicals to destroy cancer cells, was born during World War II, when scientists found that those exposed to mustard gas had a low count of white blood cells, (a type of rapidly growing blood cell). This finding led to research and the eventual use of otherwise toxic compounds to destroy cancer cells. But because different types of cancer cells respond to treatment differently, and because chemotherapy is toxic to healthy body tissue as well as to cancer cells, new ways of using drugs to treat cancer have been developed.

Advancements in Chemotherapy

saturated fats, found in foods like butter, hard cheese, beef, lamb and shortening, as well as in hydrogenated fats, found in packaged, processed and fried foods, have been linked with certain cancers. Your best bet, according to O'Connor: monounsaturated fats like olive oil and polyunsaturated fats such as the omega 3 fatty acids found in fatty fish.

4 AIM FOR A PLANT BASED DIET: Fruits

TARGETED CANCER THERAPIES are drugs

or other substances that block the growth and spread of cancer at the molecular level in several different ways, says David Riseberg, MD, a medical oncologist at Mercy Medical Center in Baltimore. But all of them are targeting some specific aspect of a cancer cell. Some targeted therapies, like Gleevec (used for certain kinds of leukemia and
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gastrointestinal tumors) target proteins involved in cellular division and cell death. Others, like Velcade (used to treat multiple myeloma, a type of blood cancer), cause cancer cell death directly.

CANCER VACCINES, OR CANCER IMMUNOTHERAPY,

interferes with the growth of cancer cells by boosting the immune system's ability to defend the body against foreign invaders. Most

cancer vaccines are preventative against infectious agents that may cause cancer. An example of this is the HPV vaccine, which is used to prevent the human papilloma virus responsible for many cervical and other genital cancers. Another cancer vaccine (called a therapeutic vaccine because it treats those who already have cancer), is PROVENGE, used for treatment of advanced prostate cancer. MS&F

and vegetables provide vitamins, minerals, fiber and antioxidants that can help to reduce the risk of cancer, says O'Connor, who recommends organic or locally grown pesticide-free products. Can't give up meat totally? It may be more realistic to limit the amount and frequency of meats, she adds.

4 DO YOUR D: Some studies suggest

that vitamin D, found in canned tuna and salmon, fortified milk, yogurt, cereal and orange juice as well as through unprotected exposure to sunshine (a big no-no) may decrease the risk of certain cancers such as colorectal cancer. Because it's hard to get enough vitamin D through food sources, many experts recommend supplementing your diet with 1,000mg of vitamin D each day.

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