Health Matters 2017

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Surviving Cancer When it comes to cancer, knowledge is power.

Photo: Š2017 thinkstock

BY CAROLYN DIX REMER

MARCH 2017 Columbus monthly

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Cancer: It’s a harsh reality that has touched too many. In fact, the American Cancer Society reports that an estimated 66,000 Ohioans were diagnosed with some form of cancer in 2016.

While advances in screenings and treatments have allowed for earlier detection of and higher survival rates for some cancers, not every cancer can be caught early. Three of the fastest-moving cancers—liver, pancreatic and brain—are also the hardest to detect.

With these cancers, “early detection is hard because symptoms don’t present until it’s too late,” says Dr. David Arrese, a surgical oncologist with OhioHealth Cancer and Surgical Specialists.

But as they say, the best defense is a good offense; knowing the risk factors and earliest signs of these cancers can make a difference.

Liver Cancer The liver is a large organ located in the abdomen; it is responsible for making proteins that help break down fat, producing chemicals for digestion and detoxifying. “It is essential for survival,” Arrese says.

The American Cancer Society reports that in 2016, an estimated 39,230 people nationwide were diagnosed with liver cancer, and 1,020 Ohioans died from it.

One reason liver cancer can be difficult to detect—and as a result, survive—is because the liver is able to hold large tumors, which grow and invade the blood vessels, without showing any symptoms, says Dr. Carl Schmidt, associate professor of surgery and director of the Surgical Oncology Fellowship Program at Ohio State University. By the time

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symptoms are present, the tumor is often extremely large or the cancer has metastasized, or spread to other regions of the body.

So what are the warning signs of liver cancer? As with many cancers, several of the symptoms are nonspecific, such as unexplained weight loss, fatigue, nausea or vomiting. While they may not seem like much, anyone presenting with these symptoms should visit his or her primary care physician to see what is going on, says Dr. Sameh Mikhail, oncologist and hematologist with the Mark H. Zangmeister Center.

A more telling sign of possible liver cancer is jaundice, the yellowing of the skin and of the whites of the eyes, says Mikhail. Urine may become darker and stool lighter. He adds that abdominal pain and distension of

the stomach due to fluid accumulation may be signs as well.

Once a mass is discovered, treatment options may include chemotherapy or surgery to remove the tumor or part of the liver. Ablation therapy—burning the tumor to destroy it—is a less invasive alternative to surgery. For candidates who meet very strict criteria, a liver transplant may be possible. A successful transplant leads to the best chance of overall survival, says Dr. Lowell Chambers, a surgeon with Central Ohio Surgical Associates.

However, the best way to beat liver cancer is to reduce the risk of getting it in the first place, predominantly through living a healthy lifestyle.

Of all cancers that originate in the liver, hepatocellular carcinoma is the most common, but it is fairly rare in the U.S., says Chambers. It’s the leading cause of cirrhosis, a condition in which liver cells die and are replaced by scar tissue, and may be brought on by alcohol abuse, hepatitis B and C or a fatty liver caused by obesity.

Smoking and anabolic steroids can also increase one’s risk of liver cancer, adds Arrese.

On the other hand, some studies suggest broccoli and coffee can actually reduce it. So splurge on that latte—your liver may thank you.

Photo: ©2017 Thinkstock

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Pancreatic Cancer Pancreatic cancer is rarely curable, and it does not discriminate. From Patrick Swayze to Steve Jobs, pancreatic cancer has dimmed the brightest stars and minds. The five-year survival rate of all pancreatic cancers is a shockingly low 5 percent, according to the American Cancer Society, which reported that it claimed the lives of 1,800 Ohioans last year.

Pancreatic cancer is so deadly because it is difficult to detect, thanks to the pancreas’ location deep within the abdomen, which makes it hard to observe a mass growing there. “Even a very small tumor, the size of a marble, can metastasize,” Schmidt says. “Other cancers need a larger tumor to do that.” When that happens, the cancer becomes easier to detect … and much, much harder to treat.

But symptoms do exist and may include new onset diabetes, unexplained weight loss, fatigue, fatty bowel movements and pancreatitis, Chambers says. The most common symptom, however, is jaundice, and it is often noticed by family members rather than the patients themselves.

If someone is diagnosed with pancreatic cancer, surgery or chemotherapy may be appropriate depending on the location and

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stage of the cancer. For advanced stages, the only option may be to manage symptoms to make the patient more comfortable.

As with liver cancer, reducing one’s risk is key. “The most important risk factor is smoking,” says Arrese, noting that smokers’ risk is twice as high as nonsmokers. Twenty to 30 percent of all pancreatic cancers are thought to be caused by tobacco use.

Obesity is also a factor, with people who are extremely overweight being 20 percent more likely to develop pancreatic cancer, he adds. Other risk factors include diabetes, chronic pancreatitis and genetics. Arrese notes that about 10 percent of pancreatic cancers are hereditary. And while there are no specific guidelines for screening, due to costs, false positives and unnecessary biopsies that can lead to complications, those with an increased risk can be put on a specialized screening program to look for signs of tumors.

Brain Cancer While less common than the previous two cancers—the American Cancer Society reported an estimated 630 deaths due to brain and nervous system cancers in Ohio in 2016— glioblastoma, the malignant cancer formed in

the brain, is aggressive, says Dr. Janet Bay, neurosurgeon and system vice president for OhioHealth’s neuroscience program.

Symptoms can vary widely based on where in the brain the tumor is located, but severe headaches, vomiting, seizures and focal weakness are all major red flags. Any major change in behavior is another warning sign—for example, a change in speech could indicate a tumor in the left frontal lobe.

A patient’s survival rate with brain cancer depends on a few factors, including the location of the tumor and whether it is surgically accessible, the stage of the cancer and the age of the patient—Bay says younger patients tend to have better outcomes. And while brain cancer is survivable, less than 5 percent of patients live more than five years after diagnosis, she notes.

Unfortunately, there no known risk factors for glioblastoma, including cell phone use or living near power lines, says Dr. Robert Gewirtz, a neurosurgeon with Mount Carmel Central Ohio Neurological Surgeons. So once again, the best option to reduce risk is to live a healthy lifestyle.

Regardless of the type of cancer, patients should seek treatment at a facility with a variety of physicians available to them, including

Photo: COurtesy OhioHealth

Neurosurgeon Janet Bay in the operating room

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CanCer SCreeninGS

While brain, liver and pancreatic cancers do not have routine screenings, other common cancers do. Adhering to a screening schedule will increase your chance of survival through early detection and treatment. The American Cancer Society has guidelines to help you know what to get screened for, and when. Just like cancer treatments, screenings are not “one size fits all.” If you are at a higher risk for any of the following cancers based on your family history or other factors, talk to your doctor about the best screening schedule for you.

CERVICAL CANCER: Pap smears are recommended every three years for women ages 21 to 29. Women ages 30 to 65 should have them every five years, and women 65 and older who have had regular cervical cancer screenings with normal results over the past 10 years do not need to be tested.

BREAST CANCER: Mammograms are recommended annually for women ages 45 to 54, and every two years for women 55 and older.

COLORECTAL CANCER AND POLYPS: Both men and women should get a colonoscopy every 10 years starting at age 50.

Additional tests are available as well, including a flexible sigmoidoscopy, a double-contrast barium enema and a CT colonography.

Speak with your doctor about the best option available for you. According to the American Cancer Society, barriers such as fear may prevent someone from doing a screening, and having options can help reduce that fear. “The best test is the one that gets done,” says Nikki Williams, communications manager with the American Cancer Society.

LUNG CANCER: Most people don’t need regular screenings for lung cancer, with one exception: Smokers, or those who have quit within the last 15 years, who are between 55 and 74 years old and have at least a 30 pack-year smoking history should talk to their doctors about receiving an annual low-dose CT chest scan. (A pack-year, according to the American Cancer Society, is determined by multiplying how many packs of cigarettes you smoke in a day times the number of years you have smoked. Smoking a pack of cigarettes a day for 30 years or two packs a day for 15 years both result in a 30 pack-year history.)

Cancer Care Begins with an expert Team

Sonia Abuzakhm, M.D.

Brent C. Behrens, M.D.

Scott C. Blair, M.D.

Christopher S. George,M.D. Andrew V. Grainger, M.D.

Joseph K. Hofmeister, M.D.

Peter Kourlas, M.D.

Kavya Krishna, M.D.

J. Philip Kuebler, M.D.

Erin Macrae Macrae, M M.D. D

Thomas J. Sweeney, M.D.

Nse Ntukidem, M.D.

Columbus Oncology and

Hematology Associates

AN OHIO ONCOLOGY & HEMATOLOGY, LLC PRACTICE

coainc.net

810 Jasonway Ave., Columbus, Ohio 43214 For general cancer information please call OhioHealth’s Cancer Call (614) 566-4321

Tel: (614) 442-3130

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