>> head, neck and brain cancers, coming next "on call with the prairie doc." >> good evening, and welcome to "on call with the prairie doc." cancers that are known collectively as head and neck cancers may begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck, for example, inside the mouth, the nose, and the throat. or they can present as tumors attached to bone or deep within tissue. they can affect the gums, voice box, sinuses, tongue, brain, pretty much any area above the shoulders. we answer your questions as they arrive. should there be more questions than we have time to answer during the broadcast portion of the show, we will continue live streaming on our website after the show in our after hours portion of our evening.
make sure to watch that. to view the after hours answers, go online to www.oncalltv.org and follow the directions there. call in your questions at 1-888-376-6225. or email us at ask@oncalltv.org. to help with exploring these cancers and answering your questions tonight, i am joined by dr. john lee of the sanford ear, nose and throat clinic and dr. henk klopper of avera medical group neurosurgery. we've got an ear, nose and throat surgeon and we've got a neurosurgeon, brain surgeon, and just a lonely old internal medicine doctor. in the group tonight. thank you, both, for joining us. so, john, tell me a little bit about yourself. you were originally from where? >> i'm from a small dairy farm in northern minnesota,
and then i went to school in the west coast, came back for my training, and i stayed on forever at the university of iowa until i moved here about six years ago. >> oh, wow. and you did a lot of research at the university of iowa. >> i did. we still do. >> yeah. you're still involved with research. >> yup. >> so you went to some little school out on the west coast, what was that? >> it's named stanford. >> stanford, not sanford. >> close. [ laughter ] >> so, the cancer treatments that -- you're doing primarily cancer treatment. i mean, you're an ear, nose and throat doctor, primarily trained in that, but you address mostly cancers. >> yeah. people don't want to come and see me. >> they don't.
>> you know, it's just one of those things, most of the time we -- it's not the best news always but we get them through it. >> it's really nice to have you here when we need you. >> yeah. >> so, henk, you're a south dakota boy, aren't you? tell me about where you're from. >> well, i'm an immigrant, actually, rick. i was born in south africa and then when i was a young kid, my family immigrated to western south dakota. i'm a transplant. >> so, in south africa, you came to south dakota. how old? >> i was about 11 at the time, 11 or 12. >> wow. >> yeah. and then went to school out in phillip, south dakota. >> phillip. grew up in phillip. and your dad was a primary care doc. >> yup. he's still there practicing. >> still practicing. >> small-town doctor. >> in phillip? >> yup. >> do you think he's watching? >> you know, i don't know.
he's probably working, actually. [ laughter ] >> he has a vigorous life of practice, doesn't they? >> yeah. >> then what did you do from there? >> from there i went to college in sioux falls, medical school at the university of south dakota. and down to omaha at the university of nebraska for my residency training. and since then i've been back in sioux falls at mckinnon. >> so you've been here for how long? >> it will be four years this summer. >> four years doing neurosurgeon. i think you were a brand-new neurosurgeon when you were on the show the first time. >> hot off the press. >> hot off the press. >> yeah. >> south african and a dairy farmer from northern minnesota. >> do you think they had to go
from south and south. >> keep the south in the name. >> you're from southern dakota, you know. >> yeah. >> so, it's an interesting mix, because i wanted to have henk back on the show and i really -- dear friend of ours is also a person who you have cared for and we have collaborated together on and i wanted to have you on the show. gee, why not put the two because you do deal with cancers of the brain, not only cancers, though, you do other neurosurgical things. what other neurosurgical things do you do? >> right. as a general neurosurgeon, we deal with brain tumors, other problems associated with the brain, such as brain aneurysms, hydrocephalus, things like that. and then also spine surgery, the most common of which, that also includes some tumors, but the most common stuff is degenerative problems of the spine, arthritis of the spine.
and then a little bit of stuff involving the peripheral nerves, the nerves outside of the spine, nerves in the arms, legs, so on. >> right. great. so we're going to talk about cancer, though, tonight. and you deal with enough cancer that it makes you an extra expert. and we're following south dakota public broadcasting's show, it's a national show on cancer that came up. tell me a little bit about what you thought about that show, john. >> i think if you didn't get a chance to see that, i watched every episode, and it's an amazing documentary of where we've come from and where we're going for cancer. and, you know, even -- both -- i think it was thrilling for my daughter, who's 16 to watch it, as it was for me, so they did a nice job of really explaining it,
both in a way that i could still stay interested. it was just really good. >> well done, wasn't it? >> yeah, yeah. >> henk, did you get a chance to see any of it? >> i didn't. i just heard about it. i'm going to see if i can get it online. >> yeah. i saw the first show, then i was tied up on the other two. but it struck me how many people had to suffer through chemotherapy with maybe a little bit of hope and then they die anyway. >> yup. >> and there's still a fair amount of that. but the reason that people -- and this is the oncologist point, and i think i'd like to make it, that's the internal medicine side of things, that you only give this cancer therapy, the chemotherapy, to help people enjoy their life, make their life better by sometimes prolonging it and making it easier. sometimes, though, it doesn't work. and that's the reality of it. but we're better and better as we go, aren't we? >> yeah.
and i'm going to disagree with you a little bit there, rick. you know, i think that's an internal medicine perspective. i think it's a waste of my time unless i cure the patient. and as surgeons, that's what we look for. if we can't cut it all out, in many cases, of cancer, it will cure it. there are many therapies coming out, it's not just, we're going to kind of aim at getting you a couple more months, but, i mean, the "60 minute" thing was another thing, we were talking about earlier, there are newer therapies that are coming out that are really going to use our body's own response to cure the cancer. and it may not be in everybody, but when it does work, it's truly miraculous.
>> the injection of the polio virus in the brain cancer. >> that was on last week. >> you're doing other things, aren't you? you're injecting other viruses into tumors now? >> so there's two things. what i will say, it's like this, bacteria made their cell wall, all these antibiotics came out. >> right. >> you're probably old enough to remember. >> yes. >> are you? >> people actually died from their bacterial infection. >> yes. >> it's the same way. there's about 20 different compounds. they're learning how to allow us to cause a mild autoimmune response, where we use our own body to react to itself for these cancers. a lot of them have specific changes that go on, either viruses or different proteins that have changed, they had to change to have turned bad and to trigger that response, it's only going to get better.
the nice thing with those, in many cases, it's a complete cure, i'm sure you've seen it in your career, we've known for a long time that people can cure their cancer for hundreds of years, we just didn't know how to modulate it safely. but that's fairly, much more well understood. the hope, i think if you watch that show, the last 25 minutes of it were on immune therapy and how that's going to really kind of change the face. so i think for us, we don't want to just aim at, well, i'll give you two more months. you know? i mean, for me, i don't want to do a therapy like that. >> i'll argue, i'll argue, though, there are times when you don't have cure. >> right. >> you don't have that cure. >> that's true. >> and what you can give them is more than two months, maybe another couple years. >> yup. >> and i've just watched a
friend who finally died from cancer, a sanford physician friend. >> yup. >> and he had years because of the therapy. and we knew for the last four years that it wasn't going to cure him, but it gave him extra time. >> long time, yeah. >> henk, i mean, jump in, then we'll take a break. >> you know what i'll say from the brain standpoint, there are other types of tumors that are a little bit unique in the brain, that are benign, meaning they don't invade like an aggressive cancer, they don't invade the tissue and spread other places and spread like wildfire. but because of their location, behave malignantly because they can put pressure on critical areas of the brain. sometimes those can be cured with surgery, but there are also some new techniques that have come out that we can use to treat those cancers where they're not completely surgically accessible that have also been game changers. and specifically, you know what i'm talking about is what's called stereotactic
radiosurgery which has come a long way, where you can take a focused amount of radiation, very specifically target a high dose at the tumor and spare the healthy tissue that's close by. so, aside from what you guys were just talking about, there's been some good progress in the neurosurgery. >> you think about acoustic neuromas in particular. >> yup. >> they can be a bad actor, where they're at. >> yeah. they pop up in the deepest darkest nooks and crannies at the base of the skull. and can be very difficult to deal with. but we've made a lot of progress, even just in the time that i've been around, in treating those with these focused forms of radiation. >> great. well, we'll take a break now. >> let's take a look inside the body to see how cancer comes to be. cancer is, by definition, the process like normal cell growth but when the growth becomes uncontrolled and invasive into the territory of normal cells, destroying all
in its path, then that is a malignant process. this is an electron microscope picture of a breast cancer cell. it looks almost like a crab, which is literally latin for cancer. this abnormal growth starts from normal cells that have been chronically irritated from foreign substances, like tobacco or radiation or from infections like hepatitis c or human papillomavirus, or by lifestyle problems, inflaming the liver, like alcohol or obesity. and of course certain families predisposed to cancer by their genetics, like breast cancer. here we see the evolution of normal cells from a small genetic mutation, all over there, to hyperplasia to dysplasia to in situ cancer to invasive cancer. similar to the earlier illustration, this is a depiction of how cervical cancer evolved from normal on the left to cancer on the right. all triggered by a human papaloma, or wart viral
infection, for which we have a vaccination, by the way. also, an illustration of the evolution of colon polyps, left to right, benign toward malignant, illustrating depth of spread, increasing until the cancer is spreading into other organs. this is a chest x-ray of someone with cancer of the lung, likely a result from exposure to cigarette smoke. likely it's a primary over here, starting there and then has spread to the lymph system and then to both sides of the lung causing a very malignant process. this is a mammogram showing breast cancer. the arrow points to the primary site and then there's evidence of spread into the breast. cancer too often is uncontrolled and invasive, spreading into the territory of normal cells. knowing about this process helps us understand how to protect against and treat cancer. >> some weird guy in some scrubs there. but the issue of inflammation or irritation or chronic exposure to toxin bringing on cancer or an infection, viral infection, is a very important
one, then the pie chart that showed that 40% of us will have cancer of some kind eventually in our lifetime. we need your questions to have a good show tonight. would you please give us your calls? we can talk about head, neck and brain cancers or head and neck and brain issues, if you'd like, of any kind. call 1-888-376-6225 or e-mail us at oncalltv.org. this is your show. we really need your calls. please give us your telephone call. and i must say that we were talking about human papillomavirus on the cervix. what about human papillomavirus in the head and neck area? >> that's a great question. about 20 years ago when i was in iowa and i was a young resident, we started noticing two different types of cancers that were starting to come. and over the last year, last 20 years, we've realized that human papillomavirus causes cancer, especially in the tonsil area, almost exclusively, and that rate has gone from a rate of one per 100,000, now to 10 per 100,000,
in the last 30 years. nobody knows why, but now it's the most common cause of cancer that i see in the head and neck. >> now, i mean, of course, one thinks that oral sex that might bring, you know, a human papillomavirus there. but there are other reasons for papillomavirus to be there. >> yeah. what i would say on that is, so, the studies have been done, for certain sexual practices, especially oral sexual practices, there is an increased risk, but comparatively this virus is very resistant. it could be sitting on the surface of the -- >> my cup. >> it could be on the cup. and we put a lot of things in our mouth. where it's in the cervix, it's very specific how it can get in there. so i'll say that the data is like, you know, four or five-fold increase risk, compared to the cervix, 100% risk. so i will say, it's not completely a sexually transmitted virus. >> it might be. >> partly, yeah. >> with the human papillomavirus vaccine protect against that kind of cancer in
the throat? >> well, studies haven't been looked at yet. most people get it when they're 55. so if you think it's a protein-based vaccine, like when we give -- you get your shot for pertussis, that wanes after a long time so, i worry if we don't keep vaccinating, we may not keep that immunity in everybody. but i would still, my kids are vaccinated, you know. >> yeah. so are mine. >> yeah. henk, we're talking viral infections inducing tumors. anything in the brain in that regard? >> nothing specifically that we know about. it's definitely possible. but there's not been a direct link in brain cancer. >> right. are you doing any kinds of brain cancer treatment utilizing injection of viral infection like the polio virus thing at this time? >> no, we're not. so that's something that's in the very earliest stages of research in humans. that's research that's been
going on for a long time and has shown some promise in the lab and now it's making its way into the hospital. and being tested in humans. and it's a very exciting possibility. a lot of these tumors, we really haven't made a change in the survival, and the impact that we have with our best treatments in decades. so it's very exciting. >> so what this polio vaccine, what do the studies show? what were the numbers? >> well, so, they're in the phase of the trial where people are enrolled that have had the normal treatment and then the cancer's come back and, so, it's a very specific population of people. and the studies that are being done right now, the early stuff that's just come out that was recently on television, is from the first phase, which is to figure out the dosing. >> right. >> it's not designed to see how well it works. >> right. >> what the cure rate is going to be. but they've had some exciting findings, what i'd call
preliminary findings in that study. >> and the percentages are up there, way up there. >> yeah, i think it's about 50% that they've seen so far. >> that's a huge -- >> that will be ironed out as time goes on. >> compared to the 10% or 5% before. >> yeah. yeah. >> huge. so, i mean, you think about it, there's a lot of people who question science and are reluctant to believe in science and the advancement of science, particularly in oncology. boy, the things that have happened in the last -- in my lifetime, in particular, i mean, you know, the cures for testicular cancer, a friend of mine died of testicular cancer, the acute myelogenous, sure death sign, the cures for cancers that -- i mean it just goes on and on. >> yeah. >> we appreciate your calls. give us your calls if you could. some people who are diagnosed with cancer react with as positive an outlook as they can under the circumstances. not being pollyannaish but
having a realistic view of a good outcome potential. this attitude has many benefits for them as their treatment progresses. >> when i was talking to the doctor, i was having some issues with the right side of my ear. kept telling him, there's a nodule there. they kept putting me on medicine and the nodule would go away and about a month later it would come back. and then i started feeling more nodules. and it's like, this is not right. but after they had an aspiration, they were going to do an exploratory surgery, which was supposed to last about an hour and a half. it ended up being about a six and a half hour operation. while they're in there, they found ten lymph nodes that were inflamed or after the biopsy had cancer in it. one of them, according to my wife and the doctors, was about the size of a small softball. chemotherapy, side effects, symptoms, initially it wasn't really anything. it kind of felt like catching a cold, like i got now. but the longer we did it,
after about the fourth, fifth time, then you can actually start to tell that it's taking a toll on you. you get tired and you're not tired just for a few hours, you're tired for two, three days. that was rough. you know? especially, you know, they're doing it on your throat, you have a hard time eating anything because it hurts so darn bad. even today, i haven't had radiation since december, anything that has a vinegar taste to it or very spicy, i can't eat it. it burns my throat. i sleep a lot more. you know? you get wore out, little colds like i got now, it knocks you out in four hours. you're very very tired. pushing yourself too much. again, you get very tired. that's about the only thing that's bad about it right now. cancer is not scary. it's just another thing we have to go through. i guess the only other thing i got to say is, in my mind, if it weren't for the breast cancer organization, national organization, cancer research and cancer treatments would not be as far as it is today for my type of cancer or
anybody else's type of cancer if it weren't for that fact. i do believe that's one of the primary reasons i'm alive still is because it's so prevalent, everybody's so aware, everybody keeps pushing and donating to that. every little dollar you put in to help helps, not just breast cancer but cervical cancer, pancreatic, intestinal, head and throat. everything leads to a new breakthrough for something. just keep giving. keep helping. >> and that was a giving and loving thing to do for us, troy. thank you so much. he spoke about the issue of giving and donating and cancer organizations. henk, what's your take on that kind of a thing happening? >> on donations to cancer organizations? >> yeah. >> yeah, i think that's fantastic thing to do. i think you, like with everything, have to be careful and know what you're donating to. there are, unfortunately, some organizations
that don't use much of the money that's donated for cancer research. but there are some very good organizations. >> which is your favorite? >> well, the united way does some stuff and a lot of that stays locally. but i think oftentimes, and this is just an opinion, donating directly to the institution where research is done often ends up being the best, most efficient use of those dollars. >> any takes on that, john? >> i agree with his last comment 100%. i mean, i think if you know the individual and can direct the dollars with the lowest administrative costs, a lot of those times -- but it benefits the community, too, because that goes right back, hopefully, to bring better cancer treatments. >> locally. >> locally. and that's really what we need. >> and they're doing the research, both at sanford and mckinnon, avera.
so we -- as a guy who came here and didn't see a lot of that when we all started and we have watched the growth, particularly of the research in cancer of this state, i want to tell you personally how much i appreciate the work that's being done, both of you. so we'll go on to some questions. we've got good questions. 70-year-old from madison, comment on polio virus in "60 minutes." what are your thoughts and opinions? one more comment from you. you're hopeful, you think that it's good. henk did just speak to that polio. it will be a while before that comes to us. >> it's an amazing result. and not just for -- that was just -- and it's not just for -- that was just one. we have one that's going to start within a year, it's a virus that targets the h.p.v. virus, these things, what it's doing, it's triggering your body's response to that virus, just do it safely. and it's exciting.
you know what i mean? you can tolerate a little shot compared to a lot of chemotherapy or radiation or bad surgeon like myself. you know what i mean? i mean, it's really cool. so i guess i would encourage people to look up the data and keep following it and the nice thing, it's going to be happening here. >> yeah. >> in south dakota. you know? so, i'm sure both organizations, i know our plans, we have several trials open already, not for brain, but for head, neck, lung and breast. and these are having amazing results. if i showed you the c.t. scans, these people have metastatic disease and their tumor is melting away and it doesn't come back. >> wow. i mean -- >> i mean, it's like -- >> our immune system is doing the trick. >> and we don't get sick. if you had to pick a way to get rid of your cancer, i don't want to see the surgeon, i don't want to see the radiation oncologist, i don't want to see the medical oncologist because they make me sick.
and it's like tolerating a viral infection. >> yeah. >> also exciting if you take the 30,000-foot view, this probably is the dawn of a new era in the treatment of cancer in general. these immune therapies, different ways of stimulating the immune system and using the person's own immune system to fight these cancers. so i think -- i think we're on the brink of a major step forward in the next ten, 15, 20 years. >> yeah. >> wow. here's an 82-year-old from brookings, daughter fell on the ice, second-degree concussion, is wondering if the injury would cause a cancer? concussion, danger in irritating the brain, causing cancer. ever see concussion-induced, cancer higher in football players? >> no, there's not any clear link between brain injury and cancer. there has been some question in the past about a benign brain tumor, which comes from the lining of the brain being related to a knock to the head at some point.
but not very strong, not a strong link. short answer, no. >> no. okay. caller has a bone marrow transplant. doesn't know if this is related, she's had squamous cell papillomavirus on her tongue four times. can she stop it from reoccurring? so she's got a wart on the tongue that reoccurs and she's had a bone marrow transplant in the past. >> so, this is a hard one because she's probably immune suppressed. >> she's immunocompromised. >> and this virus lays around even in normal tissue. so it's going to be difficult. the only way to really get at is if her immune response gets better and it may clear. i mean, you can locally cut them out. but, you know, it's like any viral infection, it needs to get an immune response to it first. >> yeah. boy, i don't know if you've ever had -- you don't have to deal with warts.
i'm the primary care guy, right? i've got people coming in with warts on their foot, debilitating, miserable warts on their foot. and you keep delaying, hoping that the immune system will kick in. one of the things you can do is you can burn it or freeze it. or irritate it. and then hope that the immune system kicks in. but wart treatment, i mean, you can do it very very expensive kind or you can use a little bit of banana peel, upside down, and some duct tape. >> potato. >> and it works. or it doesn't work. just like the fancy laser therapy. >> yeah. >> how accurate is a cure for polio vaccine? well, we've addressed that enough. caller's mother had poor-fitting dentures that caused inflammation, which caller said caused cancer. she did not get her mouth checked until she had stage 4 cancer,
causing her death in two years. please stress that people with dentures should have regular oral checkups. >> that's a good point because most people, now the dentists do the screening for us, and, so, they'll call us and say, listen, we have something -- somebody without dentures still needs to get at least looked at. i guess what i would tell them, anybody who has a sore for more than two weeks, so everybody gets the ulcers, right, sore on the tongue, but it should go away in two weeks, if it doesn't, go in and see your local doc and then -- >> a sore that lasts longer than two weeks. >> two weeks is the cutoff. >> i kind of like that. how often is surgery done on the brain for a.v.m.? what is an a.v. malformation? >> a.v. malformation is a type of blood vessel abnormality that we're born with. abnormality that forms in utero. and it can sit there for a
long time and the person doesn't know that they have it until it causes some sort of symptom. the way that that can happen, it can cause a seizure by irritating the brain or it can bleed and cause a stroke. and, so, surgery is done for certain a.v.m. that can be taken out safely and there's a lot of stuff that goes into that. i won't get into all the details. that's another example of where the stereotactic radiosurgery, the very specific focused, highly accurate radiation is very effective. there are also some newer techniques that don't work great by themselves, but in conjunction with surgery or the radiation by treating it from inside the blood vessel can be very helpful. >> so those are a.v. malformation thing. do they ever turn into cancer? a.v. malformations? >> no. >> do they ever burst and you have a bleed and it kills a person? >> it can, yeah. >> that's part of the reason why we go in there.
are we doing these little spring-like things and put them in? how does that work? >> the coiling is done for aneurysms of the brain, which is a little bit different problem. you can have aneurysm that is are associated with an a.v.m. and sometimes that can be treated with coiling, in addition to some other treatment for the a.v.m. there are also glues and particles that they can inject into the a.v.m. to block some of the blood flow. >> right. >> and that's done in conjunction with the other treatment. >> and the word a.v. malformation means? >> arteriovenous malformation, abnormal connection between the arteries and the veins. >> okay. well, it can start with a little bump and some watchful waiting, but if it continues to grow, become painful enough to cause concern in the patient and the doctor, then it is time to take the next step. >> i had a lump started to develop on the side of my cheek, just in front of my ear.
and didn't really think too much of it. there was a small lump there. and it was hard. and hurt a little bit. but, anyway, my best friend is also my doctor. and, so, i had him check it and he felt it and we monitored it for a while. monitored it. and after, oh, i don't know, a couple of months, it seemed to be growing a little bit. and i was concerned about it. so we had it biopsied. and that was early in the summer. and it came back benign. they just did a needle biopsy on it. and it was benign. so i quit worrying about it. they did a scan and found a few more lymph nodes down in my neck. one or two that looked like hot spots. and, so, then they did another surgery and took a bunch of lymph nodes out of my neck. shortly after that, then they did radiation. i didn't have to have any chemo, they thought they'd gotten all the cancer. but they did want to do radiation just to make sure that the cancer was gone. that they hadn't left any
little -- all they have to leave is one cell, i think, and pretty soon you've got it again. so they radiated the side of my face. about up to my eye and then all down here and down my neck. they radiated that side of my head. i've got some dental work on that side, some crowns, which are mostly metal, and burnt quite a hole in my tongue. they said it was -- the radiation was scattering. they burnt quite a hole in my tongue and i couldn't eat anything. i suppose i went from thanksgiving until, oh, it was way past christmas before i could eat anything. i lost 60 pounds. i don't have any pain. none at all. i still don't have much taste. everything kind of tastes the same. and still a little bit of metallic taste in my mouth. but the taste is slowly coming back. the doctors, they've got it
figured out. you know, there's still a lot of people that do die from cancer. but i think they've probably neglected it or denied it, you know, they might be having some symptoms and they don't say anything to their spouse or to their children and they don't get treated until it's too late. so, get it treated. get it taken care of. >> and i don't think brian would mind that i would share that his p.e.t. scan was negative. no spread. and we've got a cure. i mean, it's a great percentage chance of cure. you know, when you're -- it's not a good -- easy thing to be a doctor in a smaller town, you know what i mean? your patients are also your dear friends. so we're so pleased and we thank him for saying that. and the point he made in that last ending point is, you got
something that's not quite right, don't cover it up. but get it checked. i think that's a good point. any other comments that you would make? you take care of him. >> yeah, i guess a couple things. the lump that doesn't go away like you talked about. but also, like you have a sore throat, we all get sore throats, if it doesn't get better with a typical course, just ask. i think that's a great time to trigger for us to take a look and see because we'd rather treat them when they're small than when they're big. they're much easier to treat when they're smaller and localized than when they get to be very large. >> right. the next question is, 63-year-old from alcester, had a lymphoma removed from her jaw seven years ago. what are the odds of it coming back? lymphoma is a different
character than the last two cases that we had on. lymphoma is almost more of a whole body thing. it's not something you typically treat. you see lymphomas in the brain, though, don't you, henk? >> we do. it's not terribly common, but we do see it. that's one tumor where surgery is not -- it's not part of the treatment. where we get involved is biopsy, to get the diagnosis typically. and sometimes putting in a port to be able to put chemotherapy directly into the spinal fluid, but we do see that not infrequently. >> when people have a lymphoma, it's in the lymph system, which means it's in the blood, it's in the lymph, it's in the whole body. >> well, there is an animal called a primary c.n.s. lymphoma, which is one -- >> just in the brain. >> kind of a strange thing, yeah. it shows up just in the brain and not in the rest of the immune system. and -- >> doesn't pass the blood
brain barrier? >> it's inside already. >> it's there. >> yeah. >> so talk about the blood brain barrier. >> so the blood brain barrier is this concept, it's essentially the way that the blood vessels, the microscopic blood vessels of the brain are designed to help protect the brain and keep out toxins and bad stuff. it's much more selective about what it lets through than the blood vessels in the rest of the body. and actually in some of the cancer treatments, that's a major problem because you can't get the chemotherapy, which is a type of toxin, into the brain where the tumor is. >> it has to be a higher dose to get it there but it burns everything else out. >> yeah. >> seems like with sinemet for parkinson's disease, you can't get it into the brain so you had to trick it with a blood brain barrier tricker. so the blood brain barrier is an amazing thing. it protects us. but in the lymphoma of the brain, does it keep it from
going elsewhere? >> that's the reason, actually, that i mentioned that port that we have to put in, to put chemotherapy into the spinal fluid, that's the way that you bypass the blood brain barrier, if you give the chemotherapy in an i.v. like you typically do for other cancers, the brain doesn't let it in to get to the lymphoma. so you have to inject it directly into the spinal fluid. >> that's fascinating. talk about detection of nonhodgkin's lymphoma, blood, what to look for. we're talking lymphoma. it's really nonhodgkin's lymphoma is one kind of lymphoma, then there's hodgkin's lymphoma, which is another cell type of the lymph system. any comments you want to say about nonhodgkin's lymphoma? we just discussed it. >> right. all the lymphomas that we deal with as neurosurgeons are nonhodgkin's lymphomas. the hodgkin's lymphomas, that's a little bit outside of my area,
but that tends to be in the chest and abdomen and different parts of the body. >> and i guess the only take-home on nonhodgkin's lymphoma, when there is a lump, you deal with lymphomas and lumps, you catch lymphomas, when you find a lymphoma in the head and neck area, what do you do? >> yeah, there's a couple things. feel your groin, in the shower, in the neck, the most common places to feel them, shooter marble, quarter-size marble. >> instead of the regular marbles, shooter. >> most of the lymph nodes are so small, you can feel them, they're hard to feel. they're a little bit firm. the other thing to watch for lymphoma, there are these things called b symptoms, i don't know why they're not called a symptoms, they're night sweats. >> unexplained weight loss. itching, and kind of general fatigue. feeling like you got a little bit, you got the flu and nobody understands why they come on fully, but those are
the things, too, for lymphoma and recurrence you got to be careful about. >> and you have a clue with the c.b.c. if i told you how many patients -- >> normal c.b.c. >> who did i say see today, i had a walk-in clinic, i saw 20 people, half of them had fatigue. so you got to... >> got to be careful. >> they didn't have lymphoma. >> yeah. >> one had gallbladder disease, another had pneumonia. i mean, it's a clue for a lot of other things. >> yeah. >> talk about benign tumor, was wondering if she should look into the radiation therapy that was mentioned. meningioma, does a person have to have a benign one treated? >> it depends on the size, the location and whether or not it's causing symptoms. a lot of times we end up just watching these and getting m.r.i.s at certain intervals
just to see how fast it's growing. they're typically very slow-growing tumors. and it's a very common scenario where someone is found to have one because they bumped their head, they get a scan for some other reason, then you see this thing that wasn't causing any symptoms. and, so, we end up watching them and they never end up causing a problem. so, they don't necessarily have to be treated. >> okay. all right. so, one caller said, why is the united states so far behind in treatments for cancer compared to europe? >> i would say that the united states is not far behind europe. you know, i guess i wouldn't agree with that statement at all. >> yeah. i would disagree as well. i would actually say more of the therapies are coming -- at least equal or more are coming out of the states than they are in europe. >> well, one of our premed student researchers in the
back room got that question and looked it up. and let's just take brain cancer. united states, the five-year relative survival rate or percent for selected cancers among individuals age 15 or older in select counties, brain cancer in the united states 26%, this is five-year related, relative survival rate, 17% england, 18 in denmark, 20% in austria, 1b 0in poland, 22% in belgium, 22% in germany, 17 in spain, 21%. so the survival rate is higher or better in the united states, in the brain. that's a better number than the rest of the place. breast cancer 89 in the u.s. 77, 80, 73, 78, 80, 82, 79. and we're 89. let's see if i can find hodgkin's lymphoma, 84, versus 78, 79, 79, 78. and if i can find head and neck. let's see. does it have head and neck? thyroid, 97% in the u.s. 77% in england. 76, 84, 82, 76. so, i think we've got data that suggests otherwise. now, this is -- who knows where this source is.
but the truth is, childhood cancers are the same way. it's close, but maybe even better in the u.s. >> and i think that comes, it's a good point to make, too, if you look at how many -- how much we've invested as a country in cancer research versus others, it comes as a result of that. you know, the places that put the money in to do the research and to do the trials that we've been talking about really are what are going to make the most advances, hopefully. >> right. >> you know, the access to diagnostic equipment in the u.s. is vastly different than a lot of these other places also. >> some would argue too much. >> too much. >> yeah. >> for a while, there were more m.r.i. scanners in sioux falls, south dakota, than in england, the whole country. >> yeah. >> you know? so, that's also part of it. >> what about the issue of cell phones and brain cancer? because i can tell you that my ear lobes are thicker on my
right side because i know i burned -- because it gets hot sometimes, and i've had long conversations and my ear lobe is -- if my ear orcale is thicker on the side that i've got that radiation going on, it is there, evidence. i wouldn't be surprised if there was evidence. what does the evidence say, henk? >> the vast majority of the evidence indicates that it does not. now, we haven't done studies that are good enough that i would say, this is 100% sure-fire no. but the nutshell answer, based on all the studies that have been done would be probably not and if it does, the increased risk from using a cell phone is tiny. >> right. and, so -- >> so probably not. >> stop smoking. >> stop smoking because there's a real cause. so you -- both of you are dads. so, you lost your good excuse, honey, you've got to get off
the doggone cell phone because it turns you -- it gives you cancer. >> right. >> what is the most common cancer of the head and neck, do you take care of, john? >> the most common one now is the tonsil cancer. so, it's going to be a sore throat, in that tonsil, it's going to show up as. >> tonsil cancer. now i see people have crypts, they have tonsils that have been infected multiple times so they have these little caves that are scattered. and if you look at it, oftentimes there's little pockets of kind of pus-like in the crypts, i don't care how clean they are, they're going to have little crypts in there, bunch of junk in there. what do you recommend? do you take those tonsils out or is there a risk for cancer in that group? >> i'm pretty conservative. what i tell them to do, soft toothbrush or water pick to that area. even though i'm an e.n.t. doctor, i know most people --
e.n.t.s make their money taking tonsils out. it's painful. all i can say is if you don't want to be able to swallow, it's painful, also a risk of bleeding. so if you can take care of it without having chronic infection, that's the best. and there has never been shown a risk -- i actually asked the question, does that increase your risk of tonsil cancer, there's some data from sweden that suggests no. >> no? >> it's not the lack of tonsils or the presence of tonsils. there's only been one study they looked at. but possibly no. >> and i have another question about the use of mouth tobacco instead of smoking, it's chewing tobacco or pouches or snoose or all these things. i suppose, i mean, you know, they're going to expect you to say, oh, it's bad, don't do it. do you think that there's -- we've got 30 seconds left. do you have strong data or comment about --
>> smoking, huge risk. there are certain types of, like, copenhagen, whatever, the rough stuff you just lay in there, compared to smoking, it's so much safer, but maybe 1.6 relative risk, which is very little. and then there's certain type of swedish tobacco, there's no increased risk because it's the fermentation process of the tobacco that causes the carcinogen. it's just like putting lettuce in your mouth. lettuce not safe? that's been -- so if you don't do it, but if you have to switch, do something different. >> all right. >> we'll be back right after this. >> quit smoking, and in just 20 minutes, your blood pressure returns to normal. in 12 hours, carbon monoxide levels in your blood drop. in 48 hours, your sense of smell and taste improve. within two weeks, your lungs feel better, nine months, means more energy, fewer illnesses. in five years, your risk of heart attack is half of what
it is now. take a deep breath. you can do this. >> there is something about that word cancer, the big c. when the pathology report displays those abnormal type cells on biopsy and the report spells out those six black letters, then, whether it is a simple treatable condition or one that will most certainly predict an earlier death, the patient hears cancer and it changes everything. through the years, i have had to inform too many patients about a new diagnosis of cancer and have learned there is often a paralyzing fear that comes with the word. due to advancements in science, many more people with cancer are surviving than when i started. still, when i have had to say to any one of them, "you have cancer," often the word "cancer" is the only word they will remember for days, and so i always plan to keep readdressing the topic until plans can be clarified. unfortunately, some people who hear the word "cancer" come to
face their mortality for the very first time, even when the chance of cure is good. i dare say this goes for too many of us, resulting both from unrealistic expectations in this scientifically advanced world, and the cover-up of the dying process in this everything is going to be all right society. this week a friend told me she and her husband were preparing to sell their house by thinning out their stuff collected over 15 years and remodeling with that new carpet they've needed for a long time. it reminded me of what a realtor friend once said, that he keeps his house ready for sale at all times. why not put in the carpet, paint the bedroom, and fix the step so that he can enjoy it right now? in a similar vein, i have heard it said that every once in a while, perhaps yearly, we should all have some kind of significant brush with death and then be rescued. maybe that would help us to get and keep our house in order.
and then when each of us has our turn to cross the river into that land of the sweet bye and bye, we can feel what the young neurosurgeon, paul kalanithi, said before dying of cancer, "i have found a joy, unknown to me in prior years, a joy that does not hunger for more and more, but rests, satisfied in this time, right now." we shouldn't have to come down with cancer to get our house in order. [music] >> this brings us to the end of our show this evening. i sincerely thank our fantastic guests tonight, john lee and henk klopper. our friends at the south dakota helpline center are hosting a 5k run/walk at the sdsu campus in brookings on saturday, april 11th to raise funds and awareness of suicide prevention. for more information or to register go to helplinecenter.org or call 211. join me because i'll be running.
mark twain figured the importance of your head like this. "what a wee little part of a person's life are his acts and his words! his real life is led in his head, and is known to none but himself." and until next time, from all of us here at "on call," stay healthy out there, people.
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