Advances In Lung Cancer Treatment

- [voiceover] thesepatients weren't prepared for a diagnosis of cancer, and their reactions were as varied as the number of different cancers; from trepidation, to dismay, to humor. behind the diverse reactionsis a fear of the unknown. it seems we don't cope wellwith the reality of cancer. but advances in strategic treatment now bring us newfound hope

for living with cancerin central illinois. about 1.6 million new cases of cancer will be diagnosed in the current year. and the american cancer society predicts nearly 600,000 americanswill lose their battle with various forms ofcancer this year alone. the cancer society estimates the four most commonly occurring cancers this year will be breast, prostate,lung, and colon cancers.

there will be more than 200,000 cases for each of the first three cancers, far more than any other form of cancer. individuals with lung cancer die at terrifyingly high rates. the lack of a good screening program is partially responsiblefor the high death rate in lung cancer; however,a new scanning technique brings hope for fewer deaths.

- the tri-county areafor the state of illinois is one of the higher parts in the state for actual incidence of lung cancer. probably has to do with our professions that we have in this area as well as our smoking historiesthat we have in this area. - lung cancer is thethird most leading cause of cancer in the united states. and it's the number onecause of cancer death

in the united states so it's preceded by prostate cancer, breast cancer, and then lung cancer, and then followed by colon cancer. lung cancer accounts, in2013, for approximately 160,000 deaths which is more than all of those cancers combined. the screening programs that exist for those other malignancies has brought

their mortality rate down,and that allows cancer, lung cancer to be really a standout as needing a screening study. - if you look at overall cancersurvivor for lung cancer, in the last 20 yearswe've made no progress. - ^by the time people usually present with symptoms of cough,or shortness of breath, and turn out to have lung cancer, it's too late to do a lot of things

that we can cure them for. so what we're trying to do is screen for lung cancer earlier by finding with cat scans smaller, tiny spots, or nodules in the lungs, we could potentially cure those patients. - it's really difficultwith chest x-ray imaging to detect early cancers. we have had ct scan for over 30 years,

so why haven't we used ct scan to diagnose lung cancerearly in a screening format? well, the technology didn't exist to where we could perform a quality exam at a low radiation dose. and the mantra of screening exams is to first do no harm, and then have a risk-benefit ratio that favors doing the screening study.

- [voiceover] with recenttechnology improvements, physicians now have a low-dose ct scan that can deliver better resolution. to accompany that advancement, osf saint francis medicalcenter has established a screening program forqualified older citizens who have a history of smoking. - this is a free low-dose cat scan, low-dose radiation cat scan

for certain types of patients exactly ages 55 to 75. they can be current smokers. if they've quit smoking,they've had to quit in the last 15 years. - the images are sentover to our workstation which is basically a computer system, and we review the images. it could be anywhere from two, to say,

300 images that we review, and we look for any suspicious lesion, that's suspicious for malignancy. - [voiceover] once diagnosed, the treating physicians meet as a group to look at test results to determine the best course of treatment. - the lung cancer clinicreally helped form to try to help bringtogether all the specialties,

and shorten the duration of time it takes a patient to actually get treated for their cancer oncethey receive a diagnosis. - when a patient presents with symptoms to the time of treatmentplan if that indeed turns out to be canceraverages around 90 days. at saint francis, wehave it down to 17 days. - it's important to have a screening. a stage i lung cancer does far better

than the stage iii and the stage iv. - right now surgery is an option only for about 30% ofthe patients that we see. with screening we hope to shift that to about 70% of the patientshaving an early lesion that could theoreticallybe managed with surgery. - [voiceover] robertgordon had no problems with his breathing, but he chose to have a screening anyway.

he expected to get a clean bill of health because he had quit histwo pack a day habit. - the low-dose cat scan showed a spot in his left upper lobe, and this prompted a further evaluation or workup so he got a biopsy of that lesionwhich showed a lung cancer. - couldn't believe it 'cause i hadn't smoked in so many years and i felt good so then i told my children

i had lung cancer and they were devastated and so was i. - this spot right hereturned out to be his cancer, and this spot right here did not actually have any cancer in it. it was a old infectiousprocess for which he'd had. the great thing about the ct is it allows multiple views and multiple of (mumbling) or types of imaging.

this is the same ct scan except without the lung windows. what we look at in this situation is we look at lymph nodesand what we really see ... this is his big blood vessel in his body called his aorta, andwe look for lymph nodes along his aorta which will be little bumps which we really, to be honest with you, don't see any enlarged bumps.

there's a little node right there. he then was staged witha pet scan and an mri, and then he was given a physiologic test called pulmonary function test to see how well he breathes. once all that informationwas brought together, we then discussed him atour lung cancer clinic and felt that surgery wasprobably his best option, and that's when he then came to see me.

- i saw dr. anderson, i think on friday, and on tuesday i was operated on. - he had a localize lesionin his left upper lobe. did not spread to any lymph nodes. had not gone outside of his lung itself, and so i performed a leftupper lobectomy on him. - dr. anderson told me he got everything so i felt good about that. i was in the hospital for about four days.

- your left upper lobetypically contributes about 20% of your total lung function. there is some little math that we can do and figure that out and that'swhat i try to figure out when i look at his pulmonary functions. i look at what hispulmonary functions are now, and i say, "okay, i'm gonna take out "his left upper lobe. "this is what they would probably be

"after i take out his left upper lobe." and when he meets with me, that's part of the discussionthat we usually have. - oh, it's not quite a hundred percent, but i don't really have any problems. i mean i play golf, andi still do some work, and i go to the gym and workout, and you're short. you can tell that you don'thave a hundred percent,

but it's not that bad. - this is what i workfor is to see somebody who's a year out doing well back doing what he normallydid before we even met. that's really what i want to see. - [voiceover] lung cancerif caught early, is curable. the same cannot be saidfor multiple myeloma regardless of when it's diagnosed. but progress has been made using

stem cell transplants that will add years to a patient's life. - multiple myeloma is acancer of the bone marrow, and in particular it's a cancer of a type of a white bloodcell called a plasma cell. and these are cells that make antibodies or what we callimmunoglobulins in the body. so oftentimes, it's acancer that's detected on the basis of having abnormalities

in protein levels thatare present in the blood. you can see somethingcalled a protein spike that is present. - they continued to do blood work every three months towatch my m-protein level. and they said when itgot to a certain level, that we would start treatment. - the current standard that has been shown to be effective is to dothis induction chemotherapy

for a period of time,typically about three to four months that weuse with the chemotherapy. and in patients that are young and healthy that we then have a recommendation in most situations to move forward wtih something calleda stem cell transplant. in particular, this is called an autologous stem cell transplant which means gettingstem cells from himself.

- august 3rd, they put aport in and drew stem cells. took two days to ... i think they drew 6.2 million stem cells. - and we freeze those stem cells to allow some recovery fromthe collection process. after that collection process is completed and patients have recovered, usually about two weeksto four weeks later, we bring them back into the hospital

and administer a veryhigh dose of chemotherapy that is designed to try to wipe out as much residual cancer cellsthat are present as we can. but also unfortunately that has an impact on the normal cells,the normal bone marrow. it wipes that out as well. so the role of doinga stem cell transplant is actually to rescue the body from those high doses of chemotherapy

that are used in that situation. - we started the transplanthere at methodist on august 17th. got two days of high dose chemos. the third day i had off, and then the fourth daywe started the transplant. - these stem cells are just administered via a infusion similarto a blood transfusion that we do and they have the ability

to find their way back to the bone marrow to then repopulate and reestablish the normal blood counts that people need. after the transplant, people still have somewhat of a suppressedimmune system though, and that actually can lastfor a longer period of time, three to 12 months that we can still see some general decreasesin the immune system. so there still are somesusceptibility issues

to infection that we see in that sense. - it was about five months recovery, and they just waited for my red and white blood cell counts to come back so i wouldn't pick up an infection. - the most important isthe white blood cell, and that's because thewhite cells are involved in fighting infections. - dr. gerstner traced everything.

he's still tracin'. we pulled blood every three weeks. he's watching my m spike. it's the lowest it's ever been since 2007. - commonly for patientswith multiple myeloma, we also then go onto do what we call maintenance therapy afterthe transplant is done in an effort to keepthe disease in remission for as long as we can,

and in part the hopes that we can develop other new treatments that may come along and be more beneficial. in this particular instancefor multiple myeloma, a stem cell transplant, a autologous stem cell transplant is not a curative process. - i understand it's not a cure. we gotta have hope, andhopefully we prolong

and we can get more drugsto help multiple myeloma. - his prognosis is generally good although certainly not anormal individual's prognosis. anytime with a myeloma, the life span is still unfortunately reduced. but that we have everyreason to hope and believe that he'll live foranother 10 to 15 years. and as we develop more and more treatments for multiple myeloma, my hope is

that we continue to push that envelope further and further. - well, ya gotta keep a positive attitude. you can't get down. you only got one chance. - [voiceover] sarah adamscredits her upbeat approach with helping to recoverfrom a breast malignancy that measured six centimeters across. - i received the call on may 10th of 2013

that i had breast cancer. - the cyst was already more advanced, and very often we find very small tumors. hers was a larger tumor. - so my case was taken to what they call tumor board, and it was discussed amongst not only the oncologists, but also the radiologistsand the surgeons. and that really made me feel good

that there was multiple people weighing in on my course of treatment. - her tumor was so-called her2 positive which means it has areceptor which tells us it's a more aggressive kind of cancer. but we also know if wetreat that specifically with a targeted medication that she has a great chanceto survive the breast cancer and go on with her life.

- at first they had thought that they could start chemotherapy and shrink the tumor. and when i met with my surgeon, he and i were really more on the same page that we just wanted to get that out. so i opted to have surgery first, and then follow with the chemotherapy, and then follow up with radiation.

- the chemotherapy is in general like a five month's process. because of the kind ofbreast cancer sarah had which was her2 positive,we added trastuzumab which is the targeted medication. that medicine is given for a whole year. - [voiceover] sarah did not complete the entire five monthsequence of chemotherapy because she developed some complications

near the end of the treatment. - my fingernails had really started to be compromised. they started to lift off the nail bed and were quite painful. i actually ended up having four of them surgically removed justto provide some relief, and also because i was afraid of getting a bacterial infection.

- sarah's doing greatso she's cancer free. we have no evidence thatthere's any breast cancer in her body right now. she has done the majorpart of her treatment. she's still on the hormone pill. after she has completed the hormone pill, her chance to get breast cancer is about 10%. - so today i can say i'm cancer free,

and i'm just trying to get back to what they call the "new normal" life. - [voiceover] detection was fortuitous in sarah's situation. her cancer was diagnosedbecause she had a mammogram, but she got the mammogramearlier in her life than she had planned. - we recommend for everywoman age 40 and older to have yearly mammograms,

and many physiciansstart between 35 and 40 to have like a baseline mammogram, and then they start the regular mammograms at age 40. - the first time that i had a screening was really at the recommendation of a nurse practitioner at a office visit. she asked me if i had had a mammogram. my first comment was, "i'm not 40."

- [voiceover] there aregenes that can be predictors for some families with ahistory of breast cancer. - brca one and two genes,these are two genes we have identified in families, and we know that these families have a very high risk fordeveloping breast cancer. so if a patient has a family member with that genetic mutation, we definitely recommendto be tested as well,

and if one has the genetic mutation but doesn't have breast cancer, the risk is about 50 to 80% to develop breast cancer during lifetime. - i did have the brca test performed and my results were negative. - we know that two things are risk factors for breast cancer; overweightand lack of exercise. so we are focusing on these two things

and we have a nutritionist at the mills breast cancerinstitute to help patients to keep their weight stable. - so the lifestyle changesthat i've made so far having been through cancer treatment are increased exercise,and a change in diet. - [voiceover] much like the tumor board, the group of doctorsthat jointly determined the best treatment for sarah,

a team of medical experts developed the therapy program for roger hawk who had been diagnosedwith squamous cell cancer. - we have what we calla multi-disciplinary tumor board conference where we bring the specialists from allthe different specialties together in a meeting room, and we look at all theradiographic imaging, the pathology, and sort of the nuances

of each particular patient's case. - the person on this end of town, and the person on this end of town, and the person in thisbuilding get together to look at cases. and i thought it has tobe about communication, and i liked that factor. - we get input from eachdifferent physician, and the pros and cons of each different

type of treatment whetherit be radiation therapy, surgery, or chemotherapy, and come up with the best treatment plan. - [voiceover] roger hadsquamous cell carcinoma on his left cheek. it is a cancer thatoriginates in the epidermis. surgery was only a firststep in his treatment plan. - the surgeon was not able to remove the tumor altogether completely.

because of the microscopic cells that were left behind, we needed to offer radiation therapy as insurance that it wouldn't grow back. when you want to treatwith radiation therapy, you want to target specificallythat operative bed, or the tumor bed wherethose microscopic cells are and where they couldpotentially spread to. so the problem is is thatit's in close proximity

to the tissues that you want to protect; for example, the eye, the mouth, the nose, the brain, the spinal cord, the esophagus. all those structures arewithin the head and neck, and you don't want to damage them or irritate them much from the radiation. so using tomotherapy,you can minimize the dose that those surrounding tissues get. it uses a built-in ct scanner

into the treatment machine, and you're able to hit the target from 360 degrees around, and you create these, what we call, multiple beamlets. so the beam is broken up into a thousand different beamlets, and in that way you're able to turn off certain beams so thatwhen the parotid gland,

or the mouth, or anycritical normal tissue is within the field, youcan shut down or limit the dose to that area whilestill hitting the target. - i'm in there like seven minutes, but it's a very intimate world. it's not a fearful world. it's not a scary world. - we had to make sure thathe held still every day because if he moved during the treatment,

we would obviously miss the target. - you get the mask that's the mold that they have to put on you when you have radiation. - that mask is locked onto the table so that assists immobility, and we're able to makethose translational shifts in the couch as it goes through the hole or the torus of the ctscan treatment machine,

or the tomotherapy machine. - so they put me on that table, and they did what they had to do. the routine was always the same. i had a dot, a mark, on one side. i had a mark on the other. it was all to make sure i was square, and so that they hit this spot. - [voiceover] roger had33 radiation treatments

after his surgery. while radiation therapy is effective, there are still side effects although they are often less pronounced than with older radiation programs. side effects may vary by patient. in roger's case, he didnot suffer much fatigue, but did face two other issues; a temporary loss of taste,

and a burn where his cheekand neck were radiated. - the eventual result was this burn just kept getting more serious like a first degree, second degree, third degree, and so it was very raw. - the redness is like a sunburn effect from the radiation beam. so the skin can get red. it can peel. it can flake.

it could potentially blister, and just what you would expect with a typical sunburn. - because it affected my salivary glands, one of the side effects, and i knew this, was i would possibly lose my taste during the treatment process, and for an unpredictableamount of time after it. - that meant that he would get dry mouth,

or thick secretions, thick saliva, whatever's left, and when it gets dry, there's a loss of taste, and there's also a possibility of maybe getting some dental cavities because the normalfunction of saliva or spit is to wash away the bacteria. the patient's fatigue is caused by their immune system reacting

to the radiation therapy. so certain mediators andantibodies are released, and that causes a fatigue in the body. as we start to get tumor kill, the response to that tumor kill is a sense of fatigue or tiredness. what we've found is that compared to the previous radiationwith tomotherapy, patients can sail through treatment

with a lot less side effects. previously, we'd have to maybe break their treatment. they would get such a severesunburn of their skin, or blistering, we hadto pause or take a break from the radiation. now we're able to get patients through without that break. - right now medically, isee the doctor monthly.

that is about ... this is my first anniversary,the month of february was. and next i will go probably to a two month check. with the dermatologist,i'm on a three-month check. - we have him come infor periodic checkups to monitor any potential side effects, and to make sure that he's still what we call disease free,

or no evidence of disease. - and i just met with the radiologist, and i've obviously gotten on her nerves, and she said to me, "youdon't have to come back "for a year." (laughs) and that's good. medically, that's good news. - [voiceover] roger's humorhelped in the recovery process as did sarah's positive disposition,

as did encouragement from scott's family. - my wife was great support. our church was great support. we had a lot of family and friends that helped in time of need. - [voiceover] but lifestylechanges are as important as attitudinal approaches. for example, dietary changes can help after and even before cancer is diagnosed.

- the importance of eating around the parameter of the store is that you're gonna getyour most natural sources of food that way. what i want to do is actually reduce inflammation in your body, and added sugars, and preservatives, and added bad unhealthy fats will actually increase inflammation in the body.

so what i really want you to focus in on is all of the really rich nutrients that you get from fruits and vegetables as well as nitrate-freemeat products and cheeses, and a lot of really goodvitamins and minerals. the richer the color, so a blackberry, blueberries, raspberries,they are gonna give you more nutritional value than let's say something of a lightercolor like a cauliflower.

if you're eating the skin,you should buy it organically just because all of those pesticides really seep into that fruit and vegetable through the skin. but if it has a really thick skin like an orange, or a pineapple, those types of things you can actually buy conventional. with a lot of your moldier cheeses,

those are aged cheeses, andif they're not pasteurized, you're actually getting a lot of live and active cultures much like yogurt. so you're getting a lotof good probiotics in 'em. your leanest and best cuts of meat are gonna be your sirloins as well as your round cuts. things to really look for when you're going for a deli meat,

is to ask for ones that are nitrate free. nitrates are actually a known carcinogen. they add them in as a preservative, but a lot of your deli meats will have nitrates in them unless you ask them not to take the ones that have the nitrates in them. for nutrient value, i would probably go with a hundred percent pure orange juice

with the pulp. you'll get extra fiber that way. when you're looking at breads, if it says a hundred percent whole grain, that's the best one to go with. they kind of trick you with the 10 grain, 15 grains, seven grain breads 'cause that necessarily doesn't mean that it's whole wheat.

just look at the first ingredient. if it says a hundred percent whole wheat, then that's where you're gonnaget a lot of that benefit. - [voiceover] the fear is easing. the unknown is better understood, and treatments have progressed. we have taken steps forward in our fight against cancer. yet there are many steps that lie ahead.

- we want to havecontrol of our destinies, and i do think in the end we'll be able to prove that these areall great things to do. we just have not refined our interventions and told people how to do it. (upbeat techno music)