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75 Years of Cancer Care
“With today’s advances in treatment and technology, a diagnosis of cancer doesn’t always mean the end of hope,” says Ellen Willard, M.D., a board certified hematologist/medical oncologist with Pinehurst Medical Clinic. “In fact, today, millions of women and men are living with cancer or have been successfully treated.” Two recent national reports confirm Dr. Willard’s optimistic outlook. Cancer survival rates have more than tripled over the past 30 years, and death rates have decreased for 11 of the top 15 cancers in men and eight of the top 15 cancers in women. In 2001, 9.8 million Americans were living with cancer, up from 3 million in 1971, according to the Centers for Disease Control and the National Cancer Institute. Early detection and diagnosis “Historically, physicians have used basic X-rays and physical exams to identify malignant masses inside the body, but over the years technology has given us reliable alternatives such computed tomography (CT) scans, magnetic resonance imaging (MRI), ultrasound, nuclear medicine and more,” says Dr. Willard. One of the newest and most precise diagnostic technologies is positron emission tomography, or PET scanning, which FirstHealth has offered since 2003. During this noninvasive outpatient procedure, a small amount of radioactive glucose is injected into the bloodstream. A highly sensitive electronic scanner then traces the path of the glucose inside the body, helping physicians pinpoint the location and activity of even the smallest tumors.
In the 1970s, mammography was a relatively new technology with limited use. Since then, however, routine screening has become commonplace, leading to earlier detection of breast cancer and lifesaving treatment for millions of Americans. In 2000, more than 70 percent of women age 40 and over had received a mammogram, up from 29 percent in 1987. For women in North Carolina, nearly 80 percent reported receiving a mammogram in 2000-2002. Improvements in technology have also benefited women with abnormal mammogram results. Instead of open biopsy, an older procedure that requires large incisions into the breast, FirstHealth physicians now use a less-invasive procedure called stereotactic breast biopsy. In this procedure, the patient lies on a specially designed table and inserts her breast through an opening that allows it to hang down. Digital computer mapping is then used to precisely determine the location of any abnormality detected by a mammogram. The computer provides a three-dimensional image of the abnormality. Once the area is found, a needlelike device is directed to the mass to retrieve a tissue sample.
“Because polyps often form and grow without any other symptoms, this cancer may reach an advanced stage before you realize something is wrong,” says Dr. Willard, who recommends routine colonoscopy after age 50 as a screening test. “Colonoscopy is one of the most widely used and reliable methods of detection, and Medicare beneficiaries are now eligible for routine colorectal cancer screening,” she says. Making gains in treatment “While this plan of attack is still used in modern medicine, advances in technology, surgical techniques and chemotherapy have armed patients with more treatment options than ever before,” Dr. Willard says. “Treatment philosophies have progressed also, emphasizing the preservation of healthy tissue over radical removal.” Surgery: Curing solid tumors associated with breast, colorectal, lung, and prostate cancer—the four most common cancers in the United States—usually requires surgery. At FirstHealth’s Community Comprehensive Cancer Center, highly skilled surgeons use minimally invasive procedures whenever appropriate. In addition to protecting healthy tissue, their meticulous surgical technique aims to minimize blood loss and scarring, and reduce recovery time. Radiation Therapy: In the 1920s and 1930s, when radiotherapy was emerging as a new standard in cancer care, doctors relied on a “trial-and-error” approach to determine the appropriate dose. “Physicians were still learning how to use radiation and deliver treatment safely,” says Jeffrey C. Acker, M.D., a board certified radiation oncologist with Pinehurst Radiology Oncology Inc. and Medical Director of the Community Hospital Comprehensive Cancer Center. Throughout the 1940s to the 1960s, extensive clinical research led to increased patient safety and understanding of how radiation affects cancer cells and surrounding tissue, and how radiation can be used in combination with surgery and chemotherapy to kill cancer cells. Earl radiation treatments included radium needle implants and radioactive cobalt machines. In the 1970s, linear accelerators emerged as the new standard of care. Since then, the program has expanded into a full-service Radiation Oncology department that now offers some of the region’s most innovative digital imaging and computerized treatment planning and simulation. One of the most significant treatment breakthroughs in more than 30 years is Intensity Modulated Radiation Therapy (IMRT), a computer-based, three-dimensional treatment planning and delivery system. “IMRT precisely targets cancerous tumors and pinpoints the exact course the radiation will take before it enters the patient’s body,” Dr. Acker says. “This helps us visualize the healthy surrounding tissue and protect it from the radioactive beams.”
Breast brachytherapy is a particularly effective and preferred choice for women undergoing treatment for breast cancer. This minimally invasive, outpatient procedure concentrates radiation in one area, so doctors can administer higher doses while minimizing exposure to the lungs and surrounding skin. “The course of treatment can be completed in five days, a significant benefit over traditional external beam radiation, which takes six weeks to complete,” Dr. Acker says. Chemotherapy: Thirty years ago, patients receiving chemotherapy required hospitalization, but treatment today is usually provided on an outpatient basis. “We have seen significant advances in chemotherapy, including therapies that target specific types of cancers, those that use the body’s own immune system to attack cancer cells, and drugs to help patients manage treatment side effects,” says Dr. Willard. According to the Pharmaceutical Research and Manufacturers of America, 395 new anticancer medicines were under development and six were approved by the U.S. Food and Drug Administration (FDA) in 2003. Of the 395 in clinical testing or awaiting FDA approval, 70 target lung cancer, 45 are designed to treat skin cancer, 49 are for breast cancer, and 44 take aim at prostate cancer. The six newly approved products include a new class of medicines to control nausea associated with chemotherapy. Collaborative care As the process of diagnosing and treating cancer has evolved over the years, so, too, has the fundamental philosophy of patient care. Recognizing that a diagnosis of cancer touches many aspects of a patient’s life, multidisciplinary treatment teams have emerged to collaboratively care for all the complex needs of patients with cancer. At FirstHealth, this team includes specially trained and certified medical oncologists, radiation oncologists, surgeons, pathologists, nurses, therapists, pharmacists, registered dietitians and social workers.
“The medical professionals at FirstHealth’s Community Hospital Comprehensive Cancer Center work closely with referring physicians, patients and family members to achieve optimum results,” says Dr. Willard. “We carefully consider the type and stage of the cancer, the patient’s age and overall health, the risks and benefits of various treatment options, and the patient’s personal preferences.” Over the decades, cancer support groups have become an integral part of treatment. Meetings sponsored by FirstHealth allow patients, caregivers and survivors to share personal stories and find strength in others who understand what they are experiencing. In addition, raising awareness about the importance of early detection and managing risk factors has become a priority in the health care field. At FirstHealth, you’ll find a number of programs designed to help you quit smoking, become more physically active, and learn other strategies that can help you reduce your risk of developing cancer and other serious illnesses. Low-cost prostate and breast cancer screenings are provided through FirstHealth mobile vans and on an outpatient basis at FirstHealth hospitals. “The outlook for surviving cancer is better than ever, and patients today have many more options than they did just a few decades ago,” Dr. Willard says. “Knowing your risk factors, recognizing symptoms and getting screened regularly can help you keep one step ahead of the disease.”
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"Living with cancer" may seen like a contradiction in terms, but millions of Americans are doing just that, thanks to decades of progress in cancer detection, diagnosis and treatment.
No matter where in the body cancerous cells may develop, finding the disease in its earliest stages can greatly improve your chances for successful treatment and recovery. With dramatic developments in diagnostic imaging, doctors now have access to a wide array of sophisticated screening tests for cancer in the breast, prostate, colon, lungs and more.
PET scanning is particularly effective for staging lymphomas and cancers of the breast, head and neck, and lungs. It also helps physicians monitor previously treated tumors to see if they are shrinking.
When it comes to detecting and diagnosing colorectal cancer, the second leading cause of cancer deaths in the United States, technology is saving lives as well. The disease usually develops from small growths, called polyps, in the lining of the colon or rectum.
In recent years, high-dose brachytherapy has gained widespread use for gynecological and prostate cancers treated by FirstHealth radiation oncologists. The procedure destroys tumors through carefully focused beams of high-energy radiation.
