Physicians Want Lung Cancer Patients to Know This After a Positive DiagnosisA positive cancer diagnosis can be an emotionally overwhelming time for the patient and their families. Dr. Wallace Akerly, lung cancer specialist at Huntsman Cancer Institute, says one of the most…
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November 02, 2016
Cancer Interviewer: What does a physician want their lung cancer patient to know after a positive diagnosis? We'll find out next on The Scope. Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope. Interviewer: Dr. Wallace Akerly is at Huntsman Cancer Institute. He's a lung cancer expert and I want to have a brief conversation. After you have a patient that has a lung cancer diagnosis, what are typically some of the things that you would tell them? Because at the time, it's probably a little overwhelming so this might give that patient opportunity to hear that information again? Dr. Wallace: So the first thing we talk about with a patient is typically explaining what's happened is in the past and every patient has to know what the cancer is and where it has spread. So the test they may or may not understand, but the what part is a biopsy and they've probably already had that before they come to see me. We look at it under the microscope and explain or look at these cancer cells and see that these were once normal cells that are behaving very differently. And they can see that under the microscope that the cell that's supposed to be contained to the lung has somehow figured out a way to grow right through basement membranes. So the biopsy says that this cell is not behaving correctly, it's a cancer. The second part is where has it spread. And the patient has typically gone through a CT scan or a PET scan and draw out a picture that says these are the places where your cancer is present. Knowing where the cancer has gone and that it is a cancer helps the patient explain in their own mind or understand what their symptoms are and why they're feeling the way they're feeling. It may be cancer-related or it may not be. But as we then start to treat these symptoms, it gives the patient the understanding to say, "I can treat this as an arthritis or I can treat this with my as-needed medications they have at home as a cancer." Interviewer: What else do you try to explain to a patient? Dr. Wallace: So the next thing is to understand what made the cancer the cancer and so the old world, we looked at a biopsy and said, "This is what the cancer cell looks like." The new world is taking it one step further and we are now doing gene studies. Genes of the cancer that tell the cancer what to do and we can find which of these genes is responsible in very many cases for making the cancer the cancer. So a cancer is our normal cells, except that one part of our normal function has been hijacked and is damaged. If I can understand what step it is that's causing that, well, then we can talk about drugs to block that pathway or at least try to blunt it if I can't correct the pathway. Alternately, I can pick out a pathway and potentially prescribe them a targeted therapy or a specific therapy that makes the cancer the cancer. Surprisingly, these therapies can be much more well tolerated and more active. So everything is a balance of how well does it work, how many side effects does it cause. And these targeted therapies could easily be a pill that one takes at home and can have the side effects of almost taking an antibiotic, something so different than the chemotherapy that we've been giving for 20 or 30 years. Interviewer: What's the importance of family members in this whole process? Dr. Wallace: Family is so, so important. It's sometimes harder on the family than it is on the patient. The family tends to have to keep stiff upper lip and say they'll be strong for the patient so matter what. And yes, it's hard for the patient, but the family suffers with this too so I think it's very important to have family members there. They hear the same background information that the patient hears and their role is to listen and try to understand it as well as the patient because the patient, very commonly, is just overwhelmed by this information. And even though I write this down and I hand out printed information, people can't always remember it. They sometimes just totally get stuck on the word "cancer." Sometimes they're surprised, but very common they go home that evening and say, "I didn't remember anything that they said," and they look at these handwritten notes we pass out and they say, "Jeez. This note says this," and they can then remember with that trigger what it was that we talked about. We typically talk about standard treatments. "We'll do this and see how it goes," but everything is simple in cancer. We measure something, we give a treatment, we measure it again. If the cancer has gotten smaller, we're doing the right thing. If the cancer hasn't gotten smaller, we need a new plan. And so we will list the number of potential treatments we have and we usually end off with where do we think the world is going because the first thing the family does and the patient does when they get home is they get on the internet and they look around. Interviewer: Sure. Dr. Wallace: So it's important they understand, "This is where I am. This is how I'm going to cope with it. This is how my nurses and social workers and physician are going to support me as I get through this. This is my team that will educate my family members so they will help support me," and we'll run through these therapies as appropriate. We'll balance the benefit versus the side effects. And if possible, we'll try to get them involved with therapies that might be available in two to three years. Interviewer: So it sounds like it's not just a diagnosis of a physical ailment, there is also treatment for the mental and the spiritual and there is a lot of supporting roles involved other than just you telling somebody, "I'm sorry. You have lung cancer. Let's go do this treatment." Dr. Wallace: That's so correct. We treat as a team. No one person stands alone. We have many expertises. We have surgeons, radiation therapists and pathologists and so on in the physician group that is interested in the cancer. But we care about so much more than that. It's important to have social workers in the cancer wellness center and the cancer learning center and all of these other things to give the patient the strength to be able to get through this. It's a terrible diagnosis, but there is hope and there are many new therapies. In the last couple of years, there have been a number of drugs approved. In my disease, for lung cancer, there have been two new therapies approved that work by completely different mechanisms. Very, very promising. Announcer: Thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com. |
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Better Alternatives to Chemotherapy EmergingAggressive new treatments for cancer may no longer include losing your hair. The effectiveness of chemotherapy is being rapidly overtaken by new targeted therapies that attack specific lung cancer…
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January 07, 2015
Cancer Interviewer: What's the difference between using chemotherapy or targeted therapy for treating lung cancer? We're going to find out next on The Scope. Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Interviewer: Dr. Wallace Akerley is at Huntsman Cancer Institute. He's a lung cancer expert and we're going to talk today about some new, exciting, targeted therapies, and how that differs from chemotherapy, something that a lot of people are familiar with. So how do they differ? Dr. Akerley: Chemotherapy is a broad therapy. It works on anything that grows fast. Cancers grow fast, so it's a great idea. In that sense, it's the best therapy possible. The problem is, part of us grow fast also. Any wet membrane in our body grows fast. We have wet membranes in our mouth, and it might give us mouth sores. We have a stomach that's a wet membrane. We could get nausea. My hair grows fast. I could easily lose my hair with most chemos. Most important, my white cells in my body that protect us from infection grow fast, so chemotherapy can take away my ability to protect myself from infection. Interviewer: Those are all the side effects you hear associated with chemotherapy. I never realized that's why. It's the stuff that grows fast that you lose. The sores in your mouth, your hair . . . Dr. Akerley: As well as the cancer. So that's where the treatment helps in terms of treating the cancer. It's uncontrolled, it grows quickly. It can make the cancer go away. We'd love to give a bigger dose of chemotherapy to get rid of that last bit of cancer. The big problem is, my body has parts of it that grow fast, and we can't handle it. So it's that differential between what the body can tolerate versus what the cancer can tolerate. Interviewer: It's kind of a brute force attack, chemotherapy is. Dr. Akerley: Absolutely. Interviewer: Unfortunately there's collateral damage, which in a lot of cases is the person. Dr. Akerley: Yes. Interviewer: So targeted therapies, how do they differ? Dr. Akerley: Targeted therapies are the new world. We actually look at cancers and try to understand what makes the cancer different from us. In the laboratory, if we can understand what particular pathway made the cancer the cancer, we can give a drug that blocks only that pathway. So now the treatment doesn't care about growing fast. It cares about what makes the cancer the cancer. In that case we can give a treatment that hurts the cancer selectively and has a whole different set of side effects. With chemotherapy, we mentioned just earlier, there can be risks to life and limb at any time. With these targeted therapies, there may be no side effects whatsoever. That's fantastic. Alternately, we may get lesser side effects, typically a skin rash or something, but nothing that's life-threatening like a pneumonia or an infection in the absence of white cells. Interviewer: And do these targeted therapies actually do a better job of getting the cancer as well? Dr. Akerley: They do a much better job in taking care of the cancer. The challenge is all cancers aren't the same. So lung cancer that I take care of was once called non-small cell lung cancer. If you listen to that word it says it's just anything that's not the small cell type under the microscope. We actually know that there are probably 50 cancers there. At this time we've picked out at least six, and the interesting part is those specific six cancers we used to say all behaved the same. Now that we've looked at their genes that make them the cancer, we can see that each of these behave a little bit differently. Interviewer: That's exciting. Is that exciting for you? Did you ever dream of a day like this? Dr. Akerley: It's completely changed everything that I was taught. We were always taught you do what the book says. What we've found now is you can let the cancer tell you what makes the cancer, and treat the cancer the right way. These things were promised to us to some degree in medical school, for me, 30 years ago, but we had no idea what tools we'd have at this point. Interviewer: And seen a lot of success. Dr. Akerley: Dramatic success. Better than anything I had hoped for. Interviewer: If somebody wanted more information on targeted lung cancer therapies, where would you recommend that they go? Dr. Akerley: There are some fabulous resources at the Huntsman Cancer Institute. The Cancer Learning Center is the place to go. They'll help you in person. HuntsmanCancer.org is another net-based resource. Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com. |
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Silent Killer: Radon Is the 2nd Leading Cause of Lung CancerRadon is radioactivity that seeps up from the ground, stays in closed spaces, sits on your lungs’ surfaces and causes lung cancer; it’s a silent killer and most people are unaware of it.…
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January 02, 2014
Cancer Scot: We all know the number one cause of lung cancer but do you know what number two is? That's coming up next on The Scope. Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Scot: Smoking is the number one cause of lung cancer but what about number two? Dr. Wallace Akerley from Huntsman Cancer Institute, what is the second cause of lung cancer? Dr. Wallace Akerley: Well radon is the second leading cause of lung cancer in the United States, probably responsible for approximately 20,000 cancer deaths per year. People aren't aware of it. It's a silent killer. Its radioactivity, it seeps up from the ground and it stays in closed spaces. It can sit in your house. If anyone inhales it this radioactive material sits on your lung surfaces and it causes lung cancer. So first off people don't know that it causes lung cancer and secondly they don't know that it's around. Scot: Sure. And here in Utah from what I understand it's quite a bit worse than a lot of other places in the United States. Dr. Wallace Akerley: We've done testing in the state and been able to collect that data and it seems one in three houses in the state of Utah has excessive levels of radon. Scot: So exactly how dangerous is radon? Dr. Wallace Akerley: It's mostly dangerous if you don't know that it exists. One has to test for it and you can find that it's there. I work in a lung cancer clinic and I see patients with lung cancer every day. The majority of the patients I see actually are no longer smokers but we see maybe a third of patients who have never used a cigarette in their life. And people just assume lung cancer and cigarettes go together but in this circumstance radon is a very big cause, maybe 15% of all lung cancers in the United States are due to radon. Scot: If my level of radon is high does that pretty much guarantee me that I'm going to be getting lung cancer? I mean, at the end of the day I see its high, how concerned do I really need to be? Dr. Wallace Akerley: It depends on whether you're a smoker or not a smoker. If you are a non-smoker it gives you a lifetime risk of approximately 1%... Scot: Okay Dr. Wallace Akerley: ...chance of developing lung cancer. On the other hand, if you're a smoker there's terrible synergy unfortunately and your risk goes up about eightfold. Scot: And it sounds like testing is the best first step. Dr. Wallace Akerley: It's the only first step. You have to know that it exists and one can measure it quite easily. In fact, the majority of the states in the US have laws that require testing or at least that people be made aware. The state of Utah has called on all businesses, institutions, physicians, schools, etcetera to go out and have your houses tested. Scot: Is it something I have to hire somebody to do or can I get a testing kit on my own? Dr. Wallace Akerley: Testing kits are easy to obtain and easy to perform. So the Department of Environmental Quality has made arrangements for a test to be provided to residents of the state at a low cost. Radon.utah.gov. At that website one can sign up for a test and the test costs $7. Basically it's a canister, you put it in your basement, keep it two feet from the floor or the ground. Open it up, leave it there 48 hours, send it in. A result will come back to you and it will tell you if your levels are high, normal or excessive and whether you should do something about it or not. Scot: So my levels are high let's say in the test. What do I do then? Dr. Wallace Akerley: It's actually fairly easy to fix. Sometimes something as simple as sealing your basement will help out. More often than not though some sort of a remediation or mitigation test has to be performed. What they do is they put a pipe that goes from below your basement to the roof of the house and it eliminates the radon gas that would seep up to your house, it lets it bypass the house going through the pipe. Scot: Do you know, right now is that part of building code or is that something I have to tell my contractor if I'm getting a new house, "I want this." Dr. Wallace Akerley: You will find some contractors tell you. Scot: Okay. Dr. Wallace Akerley: Because it is something they offer that others don't but it is not part of code. Scot: Okay, all right. Do you have any final thoughts on the topic of radon? Dr. Wallace Akerley: Most important issue is to be aware that it exists. If you know that it exists you can do something about it. The test can be obtained at radon.utah.gov and they are very, very cheap. If you go to the local store it'll be much more expensive. Announcer: We're your daily dose of science. Conversation. Medicine. This is The Scope. University of Utah Health Sciences Radio. |