Monthly Archives: June 2016

Skin Cancer after Fun in the Sun

The 4th of July Holiday is upon us. This makes us think about summer time fun. Long days sitting by the lake or high adventure hiking or a family picnic after the local parade. We love the sun! The sun feeds our soul with warmth and our bodies with much needed Vitamin D that helps give us energy. But too much of a good thing can have a downside. The negative side of sunshine is of course, skin cancer.

Since we were young children, we have been taught how to prevent sun damage. Wear sunscreen, wear a loose long sleeve shirt, put on a hat, stay in the shade, and on and on. Yet despite the fact that most skin cancers are preventable, more than 1 million people will be diagnosed with a new skin cancer this year. If treated very early, skin cancer can be no more than simple 2 minute procedure at the dermatologists office. But for the more advanced skin cancers, there are options aside from a simple scrape or freeze.

SURGERY FOR SKIN CANCER

Most commonly dermatologists will do simple excision surgery or the Mohs surgery. Both are done under local anesthia and can be very effective. Mohs surgery requires the surgeon to painstakingly take off one layer of skin at a time until no more cancer cells can be seen under a microscope. This does allow the surgeon to feel confident that enough skin has been removed to eliminate the cancer cells. However, both types of surgeries carry risks of bleeding and scarring in addition to the mild anethestic risks. And for those patients that have thin blood, diabetes or other conditions that affect their wound healing, even simple surgery can lead to big complications.

GENTLER RADIATION THERAPY

Radiation therapy offers an alternative. Leipzig Robotic Radiation treatment targets small skin cancers without pain or damaging surrounding tissue. This is a very superficial radiation therapy that cause no scarring and no bleeding complications caused from cutting into the skin like surgery. A patient simply experiences a ‘sunburn’ in the treatment area as the cancerous skin is destroyed. Once new skin has grown, it is healthy and fresh just like a newborn baby.

Traditional electron beam radiation is a wonderful alternative for more advanced skin cancers. It delivers powerful cancer-fighting radiation to the involved layers of the skin and spares the tissues and organs beneath. Normal tissue surrounding the cancer have time to heal after small daily doses of radiation, while the skin cancer cells do not grow anymore.

KNOW YOUR ABCDE

The key to the success of any of these types of cancer treatment is to detect skin cancer in it’s earliest stage. See your dermatologist or primary care physician once a year and ask for a full body skin check. Use this chart below to help you determine when you need to make an appointment immediately.

Call your doctor if you notice any of these changes.

Call your doctor if you notice any of these changes.

First Dayton Cancer Care can help you decide what type of treatment is best to cure your skin cancer without cutting, bleeding, scarring or pain. Call Dr. Ed Hughes at 1-855-DAYTON1 today.

Your Risk for Breast Cancer-Genetics vs. Lifestyle?

Did your genetics put you at risk for breast cancer or your lifestyle choices?

Did your genetics put you at risk for breast cancer or your lifestyle choices?

In a landmark study in 2015, Dr. Bert Vogelstein of the Johns Hopkins School of Medicine showed that 2 out of 3 breast cancers are due to bad luck – changes in your DNA caused by lifestyle choices.  But if nature deals you a bad set of genes, all is not lost.  There is hope. 

By analyzing genetic and lifestyle risk factors for breast cancer in over 26,000 women, Dr. Nilanjan Chatterjee of the Johns Hopkins School of Public Health concluded the 28.9% of all breast cancers could be prevented. In fact, women with the highest genetic risk factors were no more at risk if they did not smoke, drink a lot of alcohol, use hormonal therapy at menopause, or had maintained a normal body weight.  Dr. Chatterjee’s study was reported in the May 26, 2016 issue of the Journal of the American Medical Association Oncology.  

Healthy lifestyle changes really are important to prevent cancer.  Even if you have a family history of breast cancer.  A 30% reduction in your risk of breast cancer is under your control.  So eating right, exercising, and getting yearly mammograms are key to not only preventing breast cancer but catching it early. 

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

3 New Studies On Prostate Cancer You Need to Know About

1.  Stop PSA Screening  –   Not so Fast!

In 2012, the US Preventative Services Task Force (USPSTF) came out against routine PSA screening  for prostate cancer in men, regardless of age.  But the major study used for this recommendation was likely flawed.

More importantly, since 2012, the number of men diagnosed with advanced stage prostate cancer is increasing (Cancer Epidemiology Biomarkers Prev.  2016; 25:259-263).

Dr. Richard Hoffman, an expert in shared decision-making about prostate screening, told Medscape Medical News that “abandoning PSA screening is proving harmful.”

 From my own vantage point in our clinic, PSA testing for men ages 55-70 makes a lot of sense.  Urologists and radiation oncologists are now well aware of overtreatment of patients with early-stage prostate cancer.  Active surveillance can be offered for a number of our patients.  But missing advanced stage prostate cancer or aggressive prostate cancers can be deadly.  Most of the patients that I see in my clinic are not aware of the fact the prostate cancer is the second biggest killer of men in the US, second only to lung cancer.

2.  Artery-Sparing Radiation May Help with Erectile Dysfunction 

Dr. Patrick McLaughlin of the University of Michigan Medical School reported on the benefits of using MRIs in radiation planning for patients with early stage prostate cancer.  His study was published recently in the British journal, Lancet Oncology.  While sparing the critical arteries and nerves going into the prostate gland, Dr. McLaughlin and colleagues reported that 92% of men were still able to be sexually active even 5 years after radiation. 

In my opinion, Cyber Knife offers the best sparing of the arteries and nerves leading into the prostate of any of the radiation technologies.  And at First Dayton Cancer Care, our patients have the choice of Cyber Knife or IMRT or IMRT combined with temporary, robotic seed implants.

3.  Atkins Diet Can Help Some Side Effects of Hormonal Therapy for Prostate Cancer 

Dr. Stephen Freedland of Cedars-Sinai Medical Center in Los Angeles reported on the low carbohydrate diet and hormonal therapy at the recent American Urologic Association (AUA) annual meeting.

While on hormonal therapy for prostate cancer, the Atkins diet or low carbohydrate diet resulted in better blood sugar control and weight loss than in those men who ate a regular diet.

So there is some hope in managing the side effects of hormonal therapy or androgen deprivation therapy (ADT) for patients with prostate cancer.  Unfortunately, there was no difference in PSA levels. 

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1.

10 Steps to Beat Lung Cancer

CT Scans are painless and non-invasive.

CT Scans are painless and non-invasive.

Screening for lung cancer can save lives – 26,000 to 36,000 Americans every year – by use of low dose CT scans. Dr. Florian Fintleman from Massachusetts General Hospital in Boston reported on the 10-step model at the 2016  American Roentgen Ray Society (ARRS) meeting in Los Angeles.

Dr. Fintelman’s program can be summarized as follows:

  1. Patient Eligibility:
    • Current smokers age 55-77 years old
    • Former smokers age 55-77 with a 30-pack-a year history
    • Former smoker who quit within 5 years
  2. Physicians and Patient Education:
    • Educating primary care physicians on the US Preventative Services Task Force (USPSTF) guidelines and results. Stressing that nearly 30,000 lives can be saved every year. Only 15% of lung cancer patients are found with stage I or stage II disease, with survival rates of 80-85%. With lung cancer screening, that percentage can nearly be doubled, saving many more lives when the lung cancer is caught early.
    • Medicare (CMS) requires a visit between the referring physician and patient, with the visit focusing on “counseling and shared decision making”, i.e. part of a routine visit.
  3. Ordering screening lung CT scans:
    • CMS guidelines call for a physician or qualified non-physician provider such as a nurse practitioner, physician assistant or nurse specialist to order the low dose CT scan.
    • Patients who would simply like a CT scan screening may self refer as long as they meet the screening criteria.
    • First Dayton Cancer Care has special LDCT Lung Screening order forms with the established criteria. We will even acquire the prior authorization if needed. Call us today.
  4. Image Acquisition:
    • The American College of Radiology (ACR) and CMS established parameter for low dose, non-contrast CT scan optimal for lung screening.
    • First Dayton Cancer Care is an approved imaging facility through the Intersocietal Accreditation Commission with the longest accreditation term that they grant so you can be rest assured that the best possible low-dose, non-contrast CT lung screenings will be given here.
  5. Image Review:
    • At First Dayton Cancer Care our scans are read by board certified diagnostic radiologists from ProScan Imaging, a nationally recognized group of radiologists based in Cincinnati.
  6. Communication with Physicians:
    • Clear and concise reporting to referring physicians is provided within 24-48 hours of scan.
    • Images are available for viewing by physicians who so desire.
    • Images are compared to any previous screening scans if made known by the patient or ordering physician.
    • Referring physicians will get a telephone call from the Medical Director, Dr. Edward Hughes, to follow up on any positive CT Scans. Referring physicians can call Dr. Hughes for his medical opinion regarding further follow up, like biopsies and/or PET/CT scans.
  7. Communications with the Patient:
    • First Dayton Cancer Care will educate the patients with a negative screening to continue to follow up with their General Practitioner and the importance of routine care and need for future screenings.
    • Clinical research showed that an unexpected result from screening was the patients with a negative CT scan felt they have a new lease on life and continue to smoke. So we stress that a smoking cessation and or an appointment with their General Practitioner to discuss this habit is imperative.
  8. Quality Improvement
    • CMS has begun a program to collect data on lung screenings. They are just beginning to role out this registry but the hope is that these results will help fine-tune the guidelines and provide some benchmarks for further understanding the importance of these screenings.
  9. Cost/Insurance Coverage
    • Since December 2013, many private insurers will cover the cost of this routine screening for those meeting the criteria.
    • CMS covers lung cancer screening by its own criteria since February 2015 for those enrolled in the registry. Medicare is rolling this registry program out and hopefully soon all screening centers will be enrolled.
    • For other eligible patients, a low dose CT scan is only $99, the cost of a couple of cartons of cigarettes.
  10. Research Frontiers
    • As always, many questions remain unanswered, like the optimal interval between CT scans and how long should one have low-dose screenings.
    • Stereotactic radiosurgery, like that delivered by the Cyber Knife, has the same results as open surgery, but without the risk of thoracotomy. And the risk of surgery is not only confined to surgical complications, but there is a defined risk of death from thoracotomy, especially in elderly patients with multiple medical problems.

If you have any questions, please feel free to write or to call me, Dr. Edward Hughes at 855-DAYTON1.