.

>> Good evening.

Thank you so much for watching HealthLine on PBS Fort Wayne, I'm your host Mark Evans.

Great to have you along.

>> We'll talk about a very important topic this evening blood cancer which has seemed to come to topic of conversation and is trending because Tatiana Schlosberg who is JFK granddaughter has been diagnosed with blood cancer and we'll talk a little bit more about that during the show.

But we're going to talk mainly to Dr.

Matthew Bartok who is a hematologist.

We appreciate you being here tonight and this is your first time on HealthLine.

Yeah, I'm excited to be here for having me.

Are nervous at all a little bit.

>> Don't be don't be just pretend we're having a conversation at dinner and people are eavesdropping and stopping by and asking questions.

And speaking of which, that telephone number is on your screen 866- (969) 27 two zero call at any time in the next half an hour.

We are a public television.

We don't stop down for commercials.

So this next half hour is all yours and I like to go ahead and start out.

>> Of course you have been reading about Tatiana and her diagnosis of blood cancer.

>> How far along is she with this?

She's quite far along.

She's been through what we call induction therapy and she's received a transplant.

So that tells us No.

One, this is an aggressive disease and then unfortunately it appears the disease has still come back and you know, at this time it is not a great prognosis to have.

I think that we do have ongoing therapeutic developments, clinical trials that you may come along the line for her but I do remain hopeful for this disease still.

>> Yeah, there's still hope so.

>> Well, we thank you for being with us and I'd like to start up by as I do every show talk about your specialty or your profession.

>> You're a hematologist.

What exactly does that mean?

Yeah, so I focused primarily in my practice is based on blood disorders and blood cancers so blood disorders can be anywhere from anemia low white blood cells, low platelets, blood clots and then on the other hand more aggressive diseases like blood cancers and blood cancers is a very broad term.

>> We use to define any cancer that's derived from either the blood cells, the bone marrow where we make all these beautiful blood cells or the lymphatic system.

>> OK, so so what is blood cancer?

And I know that there's more in just one particular blood cancer but what is blood cancer in general and and how many people are dealing with this on an annual basis?

>> So there are again many different types of blood cancer.

There are lymphomas and there's two different categories of lymphomas and we classify these as Hodgkin or non Hodgkin's lymphoma.

We have leukemias and there's many different types of leukemias.

There's acute leukemia such as acute lymphoblastic leukemia, acute myeloid leukemia or more chronic leukemia like chronic lymphocytic leukemia or chronic myeloid leukemia.

And then we go into pre leukemic disorders such as Maiolo proliferative neoplasm which affect bone marrow scarring or high growth of platelets or high growth of red blood cells or myelodysplastic syndrome which means irregularly forming blood cells within the bone marrow which can be a precursor to leukemia.

>> You mentioned Hodgkin's and non Hodgkin's.

Can you explain the differences between those two so the differences are often determined by the types of cells we see under the microscope.

So something called a Reed Sternbergh cell and we use different biomarkers or stains to see the cells under the microscope.

>> And when we talk about Hodgkin's lymphoma, it's a very treatable disease and in many cases can be potentially curable.

And on the other hand we have non Hodgkin's lymphomas which there's over 50 different types of wow.

>> And this can involve slow growing lymphomas.

Some in fact may never need treated or it may take several years on observation before treatment requires is required or we have aggressive lymphomas that need immediate action or it will result in bad outcomes.

>> Yeah well and just amazing and I just read it was from the CDC that one point two or so million people a year are affected by blood cancers.

>> Correct.

We're getting better at diagnosing them also patients are living longer these days.

Yeah.

So we are seeing more and more in our clinics which is wonderful.

I mean I'm having amazing ability to meet these patients and help them on their journey.

>> So the research is fairly aggressive on this.

>> Correct.

We just had our largest blood conference, the American Society of Hematology conference over this past weekend.

There were thousands of abstracts, wonderful presentations, beautiful developments going on in this field.

>> Yeah, I have to think of any of my relatives or friends that I can recall I don't think except for one who has ever had a blood cancer so is a blood cancer if you rank those among the cancers where would that rank I mean is it more the more I shouldn't say popular but one of the most common was it depends on what age you know.

So blood cancer is when we talk about, you know, when is it most common, for instance, a childhood?

Well, when we talk about acute lymphoblastic leukemia, it tends to be one of the more common childhood cancers.

Many types of lymphomas, you know, can't have what I call bimodal age distribution where it can occur in the youth or can occur in the elderly.

>> Of course this can occur out of that spectrum and multiple myeloma which is a different type of blood cancer tends to occur and the more elderly population with an average age of diagnosis at the age of sixty nine .

Oh wow.

So we see any patients I treated patients eighteen and I'm treating patients well into their 90s now with blood cancers.

>> Wow.

So who's mostly affected by it and why I guess that we're talking risk factors here.

Yeah that's a great question.

I can't say that there's any specific risk factor but there are risk factors that are known prior chemical exposures such as formaldehyde, benzene, roundup can increase the chance of blood cancers.

I still see Vietnam veterans who have suffered from agent Orange exposure and are ultimately diagnosed with blood cancer years later prior radiation exposure.

>> I took care of a wonderful man who was on Marshall Island during atomic bomb testing.

>> Oh wow.

Also, you know, unfortunately chemotherapy can lead to different types of blood cancer so it's kind of a double edged sword.

Certain viruses can increase risks of blood cancers such as HIV or Epstein Barr virus.

But for most of my patients the identifiable cause is not there.

There is no different course of action that could have prevented the disease from happening is a random act of error.

So think about the bone marrow is a factory and in this factory we're making five hundred billion cells a day.

It's a lot of machinery to keep working and at some point that assembly line can go awry where we don't fix an abnormal cell and that cell starts to propagate or grow uncontrollably and is smoking contributor to this?

>> It is unlikely to be a direct contributor but I think that smoking elevated BMI or obesity can increase the risk.

>> There is a wonderful gentleman back in the nineteen thirties name of Heinrich von Wartburg who discovered cancer cells thrive on sugar.

Now fast forward to the PET scan and the PET scan.

What does it use?

It uses a sugar with a radio label on it and when exposed to radiation it lights up or cancerous.

If we take that forward to the ongoing obesity epidemic I don't think this is coincidence.

>> I think that in some cases this may drive and fuel cancer.

>> Can you inherited possibly so we have gotten a great understanding of how cancer, colon cancer some Gianotti urinary cancers are inherited blood cancer.

It's estimated that maybe five percent of indolent or slow growing lymphomas may be inheritable.

There may be some genetic mutations that patients are born with which may increase their risk and we need to screen these patients appropriately.

That's why it's so important to establish the primary care physician to know your family inheritance and you know what what diseases run with my family and if we have five cancers and very close family members we should get that looked at and we should maybe see a genetic counselor well hinging on risk factors we do have a call from James.

>> He prefers to be off the air .

>> That's fine because we'll transcribe your question and we do and we do encourage your questions because that's what this show is all about.

But James James wants to know is there a correlation between blood type and blood disease?

>> That's a great question, James.

Yeah, it is.

So we have several different types of blood types and when I think about the blood types, it's no direct correlation towards leading to a diagnosis of cancer.

But we do use blood types very commonly for things like a stem cell transplant and that might accept a better donor by having a matched blood type.

Certain blood types may have some abnormal proteins such as multibrand and that's a different type of benign bleeding disorder.

I guess it can be aggressive in some folks but there is no known correlation to my knowledge of blood types and direct link between certain blood cancers.

>> OK, I'm sure the research is continuing on that as well as the genetic side of it as well.

>> So let's get into the signs and the symptoms of blood cancer.

>> Does it take a while for these symptoms to arise or are you going to wake up one morning go Oh I wonder if I have blood cancer.

>> How does that work?

Great question mark.

So in my patient population I have had patients who come to me completely asymptomatic.

They just saw their primary care physician and their blood work looked very abnormal and I've had other patients that I've seen the same abnormalities on them for 11 plus years before they're referred to me and I do an evaluation and find cancer.

So again going to the indolent or slow growing cancers in some patients these symptoms may be more aggressive and the most aggressive symptoms that I find in my population is what I call type B symptoms B as in boy and this refers to drenching night sweats, unintentional weight loss which is defined as 10 percent body weight loss in six months without trying wow and drenching night sweats.

>> So these aren't the type of sweats where you get a little sweat on your brow.

These are a type where you can bring your shirt out.

>> Got to go take a shower.

Other symptoms that patients may have that bring them to a physician or the hospital are abnormal bruising or bleeding issues, kidney failure, abnormal electrolytes again these would be tested for blood tests, debilitating fatigue.

But again a lot of patients depending on the type of cancer may not have any symptoms or the symptoms may arise abruptly and that depends on what type of disease it is.

>> Well, if they don't have any symptoms per say as we've discussed, how does a physician figure out that hey, we might be on to something you might have blood cancer?

Is that through a blood test?

Is it a certain platelet check or what happens there?

>> Great question.

So typically when a patient sees me or sees a primary care physician, you know, they're getting some evaluation whether it be a wellness check and they're just getting a once a year blood count check in a metabolic panel in other patients who are presenting with symptoms.

Yes, we kind of direct the workup based off of what symptoms they're having, you know, if they're having bleeding.

Yep.

We're going to check a CBC.

We're going to check some coagulation studies.

>> We're going to see what medications they're on.

But once we find you know, the initial blood work and we see what we're leaning towards are we leaning towards a lymphoma and yep, I see a large lymph node on the exam where I'm noticing, you know, the patients having a lot of weight loss and we need to maybe do CT scans so we'll start with some CT scans to find out where else the lymph nodes may be and we need to do a biopsy in some cases, you know, we see low blood counts and we may do an evaluation.

We'll find iron deficiency and we we replace the iron and the hemoglobin.

The red blood cells go back to a normal range.

But if we do this evaluation and we still can't find an identifiable cause, oftentimes we'll have to proceed with a bone marrow biopsy which it is an outpatient procedure involves having a patient lay on the other side or their side and we'll clean them thoroughly, numb their skin with lidocaine and we'll use a needle to get a very tiny sample of the bone and sample the fluid within the bone.

>> Where does that go in your chest so we can't do them from the sternum obvious for obvious reasons the heart being right behind that we do our best to not do that these OK the most common place is the back of the hip.

I see.

And once we get the sample we send it to pathology.

They look at the sample under the microscope, we look at certain stains and most importantly these days we're looking at drivers or mutations of the disease which we're learning how to target what causes the drenching night sweats, the fever what what would trigger that if you had blood cancer?

>> Another good question it could be potentially the underlying burden of the disease when we think about aggressive blood cancers, we're actively rapidly dividing blood cells and even some of these blood cells are dying in the process.

So that can lead to unleash a storm of inflammation within the body leading to sweats.

>> OK, so you might have or you may not have blood cancer.

>> You don't know you're going to see your primary physician but there might be some suspicion.

>> So how is blood cancer going to be diagnosed?

Yeah, so blood cancer and oftentimes this can take some time to diagnose.

I followed patients for a couple of months and we're gradually piecing the puzzle together and some patients you know where we don't have that time we have to bring them into the hospital to get our urgent biopsy whether it be of a bone marrow or a lymph node and at least stabilize the disease.

>> All right.

So are we talking we're talking blood tests.

Are we talking any type of imaging tests that might be required?

>> So for more aggressive leukemias we often don't need imaging.

We may need some specific imaging of the heart based on what type of therapy we're giving because some therapy can affect the heart if it's a lymphoma we often will need CT scans in order to stage the disease.

In some cases we can actually diagnose the disease based off of the blood work alone which is wonderful but in most cases and lymphomas we are doing imaging to establish a staging system if you will.

>> Now when I go to the physician on an annual basis, sometimes a little more often than that they want to feel my neck in the lymph nodes.

Is that one of the reasons they're trying to figure out if there's a possibility of blood cancer or what else are they checking for ?

Correct.

I mean there's a lot going on in the neck with the blood vessels.

We have arteries, veins, nerves, thyroid and of course lymph nodes.

So we have lymph nodes throughout our body but the most easily found lymph nodes are in the neck above the clavicle and the armpit region and then in the groin region.

OK, so in all of my patients when you know I have concern for lymphoma, I'm doing these exams to see can I feel anything is there anything that I should specifically dedicate my imaging towards?

>> All right.

We still have plenty of time to go on HealthLine tonight.

The telephone number is 866- (969) 27 two zero.

>> If you have any questions regarding blood cancer, we're talking to Dr.

Matthew Barton who is a hematologist.

>> So is there any way you talked about these but I'm just really curious to detect you said there are some times that it takes a while to detect whether or not you have blood cancer, but is there any way to detect it early at this time?

>> Unfortunately no.

Oh, it is my hope that with time we'll be able to come up with those factors but we don't have a mammogram which can detect early cancer or colonoscopy to detect early colon cancer for blood cancers at this time or a particular blood test that says yes, you have blood cancer, you don't have blood cancer.

>> Unfortunately at this time there is not you would think that there might be and I'm not I'm not slamming the medical profession but it's just one of those quandaries that is just that's just amazing to me.

That's why again, I think it's so important if a patient has an ongoing lingering symptom that again we need to have some trust in our medical providers and seek help.

>> Yeah, certainly.

So we're talking about diagnosis and talking about the risk factors.

>> So how are blood cancers treated?

Great question again so we can do a brief overview of each individual therapy and then break it up more into disease site specific therapies.

>> OK, but we have many therapies available and you know, one of the most common that we think about is chemotherapy.

What does this do?

It kills fast acting fast dividing cells and it does tend to have many off side effects as well.

It doesn't discriminate after these fast acting cells.

We have targeted therapies so we've gained knowledge about how to find a mutation and we've developed Pils in some cases to target these mutations like chronic myeloid leukemia before the twins.

That was a very grim prognosis to have.

Now we have a pill that patients are living long almost normal lifespans on these drugs.

We have immune therapy so we are learning how to engage the immune system to go find and kill cancer.

So there's a chance that in my body right now I have a cancer cell and my immune system recognizes as bad for you shouldn't be here and kills it.

Cancer can be sneaky.

It can evade the immune system.

So we're finding ways to reengage the immune system to go find and kill cancer.

We have antibody based therapies and antibodies float throughout the blood.

They're trying to find something bad to bind to and once it binds to something bad it signals the immune system to come on and kill it.

We have drugs to do that against some cancers radiation therapy can be used.

>> A bone marrow transplant is also used in certain types of blood cancers such as multiple myeloma, leukemia and lymphoma.

The bone marrow transplant has always been fascinating to me.

How does that work?

It's an absolutely fascinating procedure so I am not a transplant or to be clear but there's two main types of bone marrow transplant.

There's autologous what we refer to as auto stem cell transplant and this uses someone's own stem cells.

So what we do is we get the disease into remission and then we collect these stem cells and again the stem cells are important cells because they could divide into any one of the blood cells, the red blood cells that deliver oxygen, the platelets that prevent us from having bruising and bleeding issues and the white blood cells that hopefully prevent infections or fight infections.

>> That's the big one, right?

That's the big one.

So once we have the disease into a good spot, a good remission, we give extremely high doses of chemotherapy to the point where it may take months for the patient's bone marrow to recover to make their own blood cells.

>> So after we give that chemo we come and rescue them with their own stem cells so they make their way back to the bones and start to grow again.

>> I see now on the other hand, there's an allogeneic stem cell transplant which uses someone else's stem cells and in some cases we can use a family members a child's or what we call a mud matched unrelated donor and the thought that we can still give her chemotherapy is still there and we rescue them with stem cells.

But it also provides something called graft versus host disease.

So where the donor cells can attack the recipient's body so this can affect the skin, the lungs, the gut, the liver.

But we have found that patients do have a little bit of graft versus host disease.

They actually fare to do better.

The reason being that there is any residual cancer cells left that they may recognize them as bad as born and the donor cells can go and kill them so it actually improves survival so I guess what I'm reading into blood cancer is not necessarily totally curable.

>> Some of the blood cancers are absolutely curable.

OK, we can never guarantee a curing cancer but some types of lymphomas leukemias are absolutely curable.

>> Good, good.

Now when we think about diseases like myelodysplastic syndrome again potentially be curable but not outside of a transplant but treatable outside of a transplant multiple myeloma we have over 12 different therapies these days for these patients it is a disease that we can live with for often many years in some types of indolent or slow growing lymphomas.

>> Most patients who have chronic lymphocytic leukemia may not need treatment up front and we can often observe the patient with labs and exams every three to six months and they can go years sometimes without needing treatment and that's often difficult for patients and families to understand.

So I like to explain it as follows.

If I'm in the army and I'm going to war and if I spend every bullet at the range I'm not going to have anything to fight with when I really need it.

But to further that there's been studies that show that early treatment does not improve survival.

So do I want to bring patient symptoms from therapy and not change survival?

Were use a line of therapy that we could have used down the road for their disease?

>> So if it's not entirely survival in other words you wouldn't be able to survive it completely.

You could still elongate someone's lifetime.

>> They're correct and that's great because of the medications and because of the treatments we have available.

>> Correct.

And some of these diseases I'm done treating into the 90s and the treatments these days can even involve pills this patient takes at home.

>> Yeah, that's that's great.

So how can you lower your risk?

>> Great question.

Lowering the risk day I think again exercise maintaining a healthy natural as possible diet I can't necessarily say organic because it's not sustainable these days.

I think trying to avoid excessive use of alcohol, trying to avoid smoking I think the biggest thing is establishing care with the provider you trust and who is going to follow through on what symptoms you may be experiencing.

>> And you mentioned smoking.

What about secondhand smoke?

Should you try to stay away from that as much as possible?

>> Absolutely.

OK, you're the man.

You're the man.

All right.

So if you have blood cancer, is there anything that we can do as family members, friends and so forth to help support to help these patients and what challenges do these patients actually experience that we may not be aware of ?

>> And I think my patient population as many challenges and then this can be from the burden of the disease and you know, that could be bruising or bleeding issues fatigue.

>> It can be debilitating.

Some of the patients you know it can't have right assistance.

I have some patients or some blood cancer patients are coming to clinic one to three times a week to get blood checks and possible transfusion support.

That's a lot of caregiver burden.

>> The financial burden is immense and it's not just from the treatment but it's from the lab checks the rides to and from in the transplant patients where we have to live next to a transplant facility for up to one days.

>> It requires housing support.

Yeah, the paperwork is immense from insurance papers and bills and if anyone can help out with that, that's fantastic scene with the rides we're cooking a meal for them shoveling a driveway a lot a little that can go a long way and to support them to help them as much as possible and try to relate to what they're going through and and how they're basically feeling.

They're probably not feeling all the best when they have blood cancer.

Absolutely.

I think their energy level is down.

There's a lot of fear of the unknown.

There's anxiety, there's depression and just being a friend listening you never know what someone's going through.

Yeah, You go into further you know what else we can do.

I think blood donations are extremely important and absolutely I support giving platelets are giving blood or even signing up for the bone marrow transplant list.

Yeah.

So there is a website and I'm DPE National Marrow Donor Program where you fill out a little bit stuff online and they send you a mouth swab if you qualify and you could be a potential donor to save someone's life .

>> That is great stuff right there.

Dr.

Bartok, thank you so much for being here tonight.

Thanks for having me.

And we have to have you again, OK?

Absolutely.

Thank you very much.

And remember you can watch this episode as well as other HealthLine programs on YouTube and we thank you very much for watching tonight and we thank you for your calls, your questions and we hope that you have a wonderful holiday season until next time.

>> Good night and good