Monthly Archives: December 2015

The Top 3 Breakthroughs in Cancer in 2015

happy-new-year-flowers-2016-beautiful-11. IMMUNE CHECKPOINT INHIBITOR DRUGS 

Immune checkpoint inhibitors, like Opdivo and Keytruda, are drugs that unleash the body’s own immune system against cancer.  In fact, a poll of top medical oncologists showed that 37 of 50 cancer specialists cited these drugs as “game changers.”  “Immune checkpoint inhibitors were found to be useful in such immune sensitive malignancies as melanoma, renal cell carcinoma and Hodgkin’s disease,” said my former professor Dr. Robert Mayer of the Dana-Farber Cancer Institute in Boston.  “It has now shown major promise in more difficult cancers, such as squamous cell carcinoma or adenocarcinoma of the lung, and even a subset of colon cancer, gastric cancer, and esophageal cancer.”  Each and every month it seems that more cancers are added to the list-like metastatic breast cancer and multiple myeloma. 

2.  TWO THIRDS OF ALL CANCERS MAY JUST BE DUE TO “BAD LUCK” 

Dr. Bert Vogelstein, an internationally recognized medical geneticist from Johns Hopkins, analyzed the mutation rate of stem cells in 31 different tissues.  Dr. Vogelstein and colleagues concluded that two thirds of all cancers were the result of random mutations-with the environment and lifestyle playing a much smaller role than previously thought.  Dr. Vogelstein went on to conclude that much more effort needs to be placed on screening and detection-catching cancer early. But his “controversial study” remained at odds with the Federal government’s efforts to limit screening for major cancers like breast cancer and prostate cancer. 

3.  EMERGING ROLE OF STEREOTACTIC RADIOSURGERY IN LUNG CANCER 

Stereotactic radiosurgery, like that delivered by Cyber Knife, was shown to be equivalent to open surgery for all lung cancer patients with early stage cancer.  Previous studies showed that Cyber Knife was the best way to treat patients who were considered “medically inoperable.”  That is to say, medically inoperable patients were unable to undergo surgery because of their multiple medical problems, like COPD or heart disease.  But in 2015, a number of studies have shown equivalent results with stereotactic radiosurgery compared to lobectomy, a major surgery.  In fact, stereotactic radiosurgery was even better than wedge resection.  The exciting possibility in the coming year is combining stereotactic radiosurgery with immune checkpoint inhibitors, not only for lung cancer patients, but for patients with other cancers. 

As 2015 is coming to an end, I wish my staff, my colleagues, and most of all my patients a Happy New Year.  There is now real hope for cancer patients 2016.

 

 

The CyberKnife Explained by Dr. Ed Hughes, Radiation Oncologist

As you see family and friends this holiday season, we hope that you are not faced with being told that a loved one has cancer. But if you are, you need to know about the CyberKnife Radiation Therapy treatment. First Dayton Cancer Care is the only center in Southwest Ohio with this treatment option. Learn more today. Let us know if we can help you or a loved one beat  cancer. Watch here.

 

WDTN Living Dayton’s Katie learns about the CyberKnife from Dr. Ed Hughes, Radiation Oncologist.

“A New Test for Early Stage Prostate Cancer – If Medicare Approves Oncotype DX Prostate Cancer, It Must Be Good.”

prostate02A man has to make many decisions in his life.  Over 1 million American men each year undergo prostate biopsy and 240,000 men face the decision about the right treatment for their own prostate cancer.  But for many men, no treatment at all may be a good option.  It’s called “active surveillance”-a fancy term for what used to be called “watch and wait.”  The “active” part is men now taking responsibility, in a major way, for their own prostate health.

Whether or not to treat prostate cancer is a hard decision.  There are lots of options-so many, I think, that men can get overwhelmed by the choices.  But the more we learn about the biology of prostate cancer, the more we recognize, as cancer specialists, that not all men with prostate cancer need to be treated with surgery or radiation.

The New Oncotype DX Prostate Cancer Test Helps Men with Early Stage Prostate Cancer

Each and every week, I face newly diagnosed men with prostate cancer who have a lot of questions.  How fast is my prostate cancer growing?  How aggressive is my cancer?  How can you be sure that the biopsies reflect all the cancer in my prostate?  Is my prostate cancer localized or spreading?  What are my options?  What are the side effects?  Is radiation or surgery the only answer?  Can I watch and wait?

As prostate cancer patients and prostate cancer specialists, it is only human to want a single test to have all the answers.  It’s just not that simple.  But the results of the Oncotype DX prostate cancer test go a long way in helping us to answer whether men with low risk prostate cancer need immediate treatment or not.  The results of a major study were presented at the 2015 American Urologic Association meeting held in New Orleans this spring.

This first large-scale study of 4,000 prostate cancer patients was analyzed with the Oncotype DX prostate cancer test showed positive results.  Of those men with so-called “low risk” prostate cancer, 36.9% had results indicating “very low risk,” while 11.3% had worse disease with higher risk prostate cancer. So about one third of those men with low risk disease by standard criteria were felt appropriate for a watch and wait approach.

So What’s a Man with Early-Stage Prostate Cancer to Do?

Clearly, the Oncotype DX Prostate Cancer test is not the one and only test we all hoped for; but I think it‘s another important tool for prostate cancer specialists to be aware of.

My recommendations for watch and wait approach are the following:

  • PSA less than 10 ng/mL
  • PSA doubling time of greater than 12 months
  • Gleason score 6 or lower and no perineural invasion
  • No more than 2 positive biopsies
  • No prostate nodule on digital rectal exam
  • No family history of prostate cancer
  • No extracapsular extension on MR scan
  • A low Oncotype DX prostate cancer score

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1.  I guarantee that I will see you within 1-3 days of your call.

Prostatectomy versus Radiation-Are All Medical Studies Created Equal?

Quality of Life Matters when making decisions.

Quality of Life Matters when making decisions.

Exaggerating and bending the truth-just turn on the TV and you’ll hear the Presidential candidates doing it each and every day.  The magazine “Politico” even awards up to 4 “Pinocchio’s” for the politician telling the biggest whopper.

Americans now seem to tolerate well-documented political exaggerations.  But should patients blindly accept all medical studies as facts?  Are all medical reports really equal? 

So how good is the case for radical prostatectomy over radiation for men with intermediate risk and high risk prostate cancer?

An internationally recognized prostate cancer expert, Dr. Mack Roach of the University of California San Francisco and his biostatistician colleagues, recently wrote a critical review entitled “Radical prostatectomy versus radiation and androgen deprivation therapy for clinically localized prostate cancer: How good is the evidence?” The paper was published in the December 1, 2015 issue of the prestigious International Journal of Radiation Oncology, Biology, and Physics.

What is noteworthy about this critical review is that Dr. Roach evaluated the quality of the medical evidence by 2 different systems; the well-established GRADE system as well as a “reliability score.”  Thousands upon thousands of prostate cancer patients treated with surgery or radiation therapy were analyzed in 14 major publications.  The overall quality of the reports was dramatically different from study to study.  And the conclusion was a blockbuster.  The most reliable studies indicate that the differences, at 10 years, of dying from prostate cancer were small whether men were treated with surgery or radiation therapy.  In fact, the difference was less than 1% – too close to call. 

So what does this mean for men with prostate cancer?

Simply put, radiation therapy combined with hormonal therapy (androgen deprivation) is equal to radical prostatectomy for men with intermediate or high risk prostate cancer. It stands to reason that treatment decisions can be based on quality-of-life factors.  And radiation therapy is likely to result in better quality-of-life, with the risk of incontinence very small. A man can now decide what is important to him in regards to not only physical side effects like urinary  and erectile function, but also consider treatment time and length of recovery.

This new tool of carefully looking at “Big Data,” and not just number crunching, is a real breakthrough in medical research.  We’re all human -even doctors- and we all have our own points of view and our own biases when making healthcare decisions.  But this new method can help temper those critical healthcare decisions so that we as cancer patients and cancer specialists can factor in “quality medical facts” and not just our own pre-conceived notions or biases.

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-Dayton 1.

 

 

 

Bad Luck May Account for 2 out of 3 Cancers

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You may not be in as much control as you think.

 

 

Can You Prevent Cancer Just by Eating Right and Exercising?

As the Season Holidays are upon us, you’ll hear a lot about improving your health through lifestyle choices. The ads to sell you expensive fitness equipment will be coming on strong.  So get out your list of bad habits and dust off your holiday resolutions.  You’ll also hear a lot about how healthier lifestyle choices can reduce your risk of cancer. But by how much?  And where do you get the most bang for your buck? At the gym? At the dinner table? Colleen Doyle, MS, RD the managing director of the American Cancer Society’s “Healthy Eating, Active Living Environments” program stated “Right now, at a time when it’s estimated that 14% of all cancer deaths in men and 20% in women are related to being overweight, 64% of adults are overweight, including 28% who are obese.” In October, the World Health Organization pulled out all the stops by placing eating red meat and processed meat like bacon in the same cancer-causing category as tobacco, asbestos and formaldehyde.  Don’t get me wrong, I think exercising, eating right, stopping smoking, limiting alcohol, and staying out of the sun really can help in preventing cancer. But hold on, it appears you can’t control everything.    

Are Lifestyle Changes Really the Whole Answer?

In a breakthrough study in the January 2, 2015 issue of the prestigious journal Science, the internationally recognized cancer researcher Dr. Bert Vogelstein and his bio-mathematician colleague Dr. Cristian Tomasetti from Johns Hopkins Medical School concluded “Two thirds of all cancer incidence across tissues is explained by random mutations that occur when stem cells divide.”  To put it another way, the bad luck of random mutations or changes in DNA account for 2 out of 3 of all cancers. So does this mean that most causes of cancer are out of our control? Lifestyle choices and family heredity certainly play a role, and account for 1 out of 3 of all cancers.  The key finding is that the “bad luck” of stem cell mutations or changes in your DNA that happen by chance over your lifetime play a much bigger role-twice as much.

Maybe We Should Focus More  On Screening?

Drs. Vogelstein and Tomasetti came to a blockbuster conclusion and stated, “We should focus more resources on finding ways to detect such cancer at early, curable stages.”  From their study of stem cell mutations as the cause of cancer, it seems we should focus even more of our efforts on screening, not less.  Recently, the American Cancer Society recommended drastically decreasing screening for breast cancer with mammography.  The US task force recommended not screening at all for prostate cancer with a PSA test.

But I believe we need to double down on screening.  Medicine has developed powerful tools for screening the common cancers, and better tests are being developed all the time.  For my money, Dr. Vogelstein’s study shows that it’s more important to screen for cancer.  And in some ways, it’s easier to do.  So add cancer screenings to your list of resolutions for 2016.

Breast cancer – 2D and 3D mammograms

Cervical cancer – Pap smears and pelvic examinations

Colon cancer – colonoscopy

Lung cancer – low-dose CT scans

Prostate cancer – PSA and digital rectal exams