good evening and welcome to doctors on call I'm Dr Ray Christensen faculty member from the Department of Family Medicine and biobehavioral health at the University of Minnesota medical school here on the duth campus and I'm a physician at the Gateway Family Health Clinic in Moose Lake I am your host for our program tonight on cancer prevention diagnosis and treatment the success of this program depends on our viewers so please call in with your questions or email them to ask at pbsn north.org the telephone numbers can be found at the bottom of your screen our panelists this evening include Dr Matthew brawe Dr and an oncologist with Essentia Health Dr Roberto Fernandez an oncologist with St Luke's Regional met cancer center and Dr E toga hanhan a family medic son physician at St Luke's Lake View Medical Clinic in Two Harbors our medical students answering the phones tonight are Lindsay monag from Sock Rapids Minnesota McKenzie Peterson of leverne Minnesota and Alexandria Alexandra walner from Monto videoo Minnesota and now on to tonight's program on cancer prevention diagnosis and treatment as I start the night I'm going to take just a personal moment and on behalf of the university and Linda lisis who who is the person that really makes this program happen thank Dr Greg gr for his many many years as the producer of this program this has been a great relationship and it's been really a lot of fun to work with him we wish him very well in his ex in his retirement and also a welcome to Nina Frederickson who is going to be the producer going forward to both of you uh thank you very much for all the work that you've done for wdsc for North Eastern Minnesota and for those of us at the University tonight's topic is pretty big and pretty wide uh it's pretty hard to figure out how to put our arms around it but Dr Hanan what is cancer I think at its most basic level is uh so cells that are basically growing and uh don't stop I mean if you think about how the human body is developed we all have messages in ourselves when when does something start uh stop kind of dividing uh pick any organ the eye right there's cells uh that make up the eye and at a certain point those cells just stop dividing and because of various kind of cross messages that can go haywire and some cells start dividing and growing and that can cause problems in the human body and it can be in many different organs as we're going to talk about tonight tell me a little bit about your practice ice I forgot to ask you that yeah so I'm a family doctor up in Lake View Clinic in Two Harbors and we uh have a hospital uh up in Two Harbors as well so I practice in that hospital as well as in clinic and we do a lot of primary care uh we talk a lot about cancer screenings when people come in for their physicals uh and whatnot Dr Fernandez you're a oncologist at St Luke's correct um tell us a little bit about your practice and then maybe if you could stray on after that talk a little bit about the diagnosis of cancer yeah sure thank you so uh I work at uh uh St Luke's Regional cancer center and I have for this will be my fifth year I'm originally from Iowa um and you know it's it's been a great place to live here in the Northland so I really do enjoy it uh I'm a general oncologist so I do see a lot of different kinds of cancers including leukemias lymphomas and solid tumors as well as a bunch of blood disorders uh including benign blood disorders um but specifically for cancer you know diagnosis of cancer can be very challenging at times other times maybe more straightforward um it's Reliant often on screening for cancer at least for some cancers um and when we're able to uh catch cancer early it can be curable in some cases um however it can be more challenging if the cancer itself is is aggressive and difficult to treat or if there are limited treatment options as we'll talk about um but the diagnosis of cancer it it takes uh into account you know the patients history they have to uh typically undergo several tests including biopsies uh often of various tissues or blood testing and then the results of that you know go through several different uh Pathologists and and Laboratories and then we tend to discuss that with them in our consultations Dr brawe you're a oncologist of theena uh correct tell us a little bit about your work and then if you take us into the treatment a little bit kind of open that door up for us yeah thank you um so I think uh the work I do is very very similar to Dr Fernandez I'm a medical oncologist as well as a practicing hematologist um I'm relatively new to the duth area in the Northland having uh moved up here this summer and started working at Ascension September um so I like Dr Fernandez I see patients um with a variety of cancers and I also see patients with uh both cancerous and non-cancerous blood conditions um my clinic is largely here in duth and I also see patients uh kind of down the I35 Corridor that get treatment in sandstone and Moose Lake one day a week that's a nice broad background let's talk a little bit about what's what's a good lifestyle uh we talked a little bit ahead of time about lifestyle and the importance of early early diagnosis uh you're the family doc told kga what are what are your thoughts for a good lifestyle for a person yeah boy if there's one thing I think we could do in our lives to prevent cancer from happening in the first place is avoiding tobacco tobacco is one of the bigger um causes of uh cancer and many different cancers actually it stems well beyond lung cancers so avoiding tobacco uh maintaining uh a good weight uh so uh living a healthy lifestyle uh eating well um and probably uh limiting or avoiding alcohol as well so substances do play a role uh in terms of cancers Dr Fernandez is how does alcohol factor in with cancer so it's complex um but ultimately excessive alcohol can affect the liver in many ways and the liver is one of the body's filters um and over time it if that is damaged or you develop excessive weight due to the excessive alcohol use then those fat cells can also um release various chemical mediators which can put a patient at risk down the road of developing uh C cancer which is also known as carcinogenesis um and so it's it's a substance in very small amounts that is is typically okay but when it's excessive that can lead to various problems and not just cancer it can also affect a person risk of cardiovascular disease heart attack stroke and various other issues one of the people that called in has a spot on the liver how how would they go about getting that checked out that yeah so um I assume at this point you know they found this spot on the liver uh based on an Imaging study like a CAT scan or an MRI or an ultrasound um sometimes different Imaging modalities can give us a good idea of what that's spot might be um so certain cancerous lesions and non-cancerous lesions can look a certain way on the image but in a lot of cases to know what something is for certain it requires a tissue biopsy where a a radiologist or proceduralist would maybe use some Imaging guidance to direct a needle into that spot in the liver remove a piece of that tissue and send it to the Pathology Lab for them to look at under the microscope and come to a more definitive diagnosis toga have you seen changes in the liver tests um now that we're talking about the liver a little bit it seems like there's been kind of an increase in some of the enzymes and those of us that are overweight uh there's the question of fatty liver and then how does that relate into the possibility of a liver cancer uh yeah so when liver enzymes are elevated often times that's just due to inflammation and you're right I mean if you're overweight uh that inflammation can be from excess fat by itself and inflammation in general um Can promote various cancers um uh uh of many uh different parts of the body Roberto I see you nodding on this one you want to add in yeah so you know we know for example with liver therosis that can predispose to hepatocellular carcinoma also known as primary cancer the liver but interestingly fatty liver as you mentioned or hepatosteatosis that can also predispose I want to say anywhere anywhere between 7 to 10% can directly um evolve to primary cancer of the liver too so it's important to maintain a healthy weight for that reason also um because often that can be reversible if uh you know you're able to intervene you know early on with lifestyle modification Matt you're the hematologist I guess you both are you both are yeah I shouldn't you give all the hard questions okay you guys can fight over this one uh this person uh has myoid leukemia what is the long-term prognosis uh survival rate and talk about a little bit what is myoid leukemia in the first place um so myoid leukemia is a fairly aggressive type of blood cancer that arises from the myoid cells in the bone marrow um you know it typically progresses very quickly and can be a medical emergency when initially diagnosed and the need to start treatment right away is usually pretty crucial um it it can be a very challenging disease to treat um so uh you know we we treat it with the goal of cure in certain patients that are candidates for um intensive chemotherapy um for many years we didn't have a lot of options to treat these patients that weren't candidates for aggressive therapy but over the last few years we have other drugs that can uh treat acute myoid leukemia and and help give patients uh more time um though these treatments tend to not be Curative in nature okay you guys comfortable uh Two Harbors so I'll pass this one to you why is pancreatic cancer so difficult to diagnose until its later stages yeah that's a a great question and it's very problematic so we do not have a screening modality for pancreatic cancer is one of these things where by the time somebody has symptoms be it abdominal pain uh weight loss or other uh GI problems oftentimes the tumor is too big and by that time uh it's really it can be quite problematic uh because by then oftentimes we're past the point where it can be um surgically removed uh or very treated very effectively so it does have very high mortality rate but when we catch it early it's usually uh almost luck it's caught up on caught on some image and if it's small enough then yes we can take care of that surgically uh but most of the time we catch it when it's really too late Roberto uh what are effects of chemother start over are the effects of chemotherapy cumulative with more treatments over time or yeah that's a good question I think um some of them can be certainly there are definitely long-term effects of chemotherapy um there are rare uh Adverse Events that can occur through just from being exposed to chemotherapy they're rare and uncommon um but even secondary cancers can sometimes occur less than 1% of the time in patients who've been exposed to chemotherapy or radiotherapy for that matter um but the things I think about more commonly longterm would be cardiovascular disease cerebrovascular disease um in the short term uh you know we think about things like nausea vomiting diarrhea um fatigues being very uh very commonly described um you know patients will often wonder if they're going to have hair loss um you know and whether or not they're going to be able to go about their daily routines or continue to work that sort of thing and so it does depend on a lot of factors the patient's age comorbidities other medical conditions something called performance status so their ability to take care of themselves at home independently um and you put all of that together to kind of assess how they're going to you know be able to tolerate the chemotherapy um and some patients you know will fly through it with flying colors I've had patients in their upper 80s even early 90s sometimes which they surprise you with their ability to tolerate chemotherapy others in their 20s may have terrible you know side effects and it's so hard to predict um and we don't know know unless we try but we have great medications these days to help prevent a lot of the side effects and to support patients when they do develop side effects and if we have to we can modify the doses or the uh frequency of how we give the chemotherapy because it is you know one of the types of treatments that are effective in treating cancer Matt comments no I I I think uh Roberto really nailed it on the head you know there are side effects that we see you know that can happen just with one dose of chemotherapy and and others that can happen as accumulation each dose is given that become more common so I don't think I have too much to add there I think the other thing is that it's changed a lot over the decades uh I go back to when I started practice a long time ago when we used to hang 5fu on the on the valance in the on the window and and run it in IV to where you are today as you work on drugs and what you have and then the outcomes that you're able to come away with uh there's been a lot of change breast cancer has changed and is fairly curable I believe these days is that true that that's true a good proportion of women with early stage breast cancer are cured and you know usually these are women where it's found uh confined to the the breast and the surrounding lymph nodes um and and we are able to thankfully cure many women with breast cancer toga how much does the p how much does patient Choice play into overall treatment plans and I give you that as a family doc and you're probably going to want to pass it but uh if I'm sitting in your office what's that like uh well I I think the biggest choice that we deal with in Primary Care besides you're right uh it's it's referral to see uh one of my colleagues here but I I think um the bigger choice that some people uh will need to kind of decide which path they want to go on and that depends on a lot of things where people are in life what their goals are for the rest of their life um but some people may choose for example to not seek treatment and uh so I have a lot of conversations with patients about that do we want to pursue treatment or do we want to pursue just working on making the remaining days of your life as good as they can be just focus on quality good answer and I I guess it's always nice to have your opinions too what do you guys think on that one agree you yeah I I think Dr Hanan you know also you know mentioned some really important points you know we see patients every day who have a variety of you know beliefs or values on how they want uh to be treated at the various points in their life and so one of the things I always say is you know you're the captain of the ship you know your body better than anyone else and our job is more to facilitate the information and share that with you and the evidence to help you make a decision that's right for you Matt have there been recent advances in the treatment of prostate cancer there have been a number of advances in the treatment of of prostate cancer um I think even you know just in the last 10 years the landscape has changed entirely um you know for for men with metastatic or very Advanced prostate cancer the Cornerstone of treatment has has been uh depriving the body of testosterone which we know is the main driver of prostate cancer growth and so we we currently have a number of different oral medications that work to inhibit uh testosterone's effect on the cancer in other ways we have chemotherapy drugs um that have been found to be very effective and uh probably the biggest change within the last year or so has been a new drug called litium psma which is available for men with with very heavily pre-treated prostate cancer and this drug is a radioactive isotope where um you give a patient a drug that um has an antibody that seeks to find the prostate cancer cells bind to it and deliver a very focused dose of radiation to the cells and so that's something that I think is very exciting it is it's amazing it's fun to read about yeah there's been some great great changes toga I think I'm going back to you skin cancer um how do you differentiate it uh in biopsy and so on do you want to just run through basic skin cancer sure um I think the first thing is uh trying to protect yourself uh from too much UV radiation you know sunscreen and avoiding tanning beds Etc but um skin cancers uh are a little tricky to find um oftentimes they're found during a physical exam or uh just by yourself in the shower and you just notice a little change in the skin and so it's important to bring these things up uh to your primary care uh provider and um uh a to a trained eye for the most part we can pick up something that doesn't belong but uh we don't know it's really cancer unless we actually take it off the body and then send it to the pathologist to look at under a microscope um often times they're small enough where we might just with this little razor blade like device just scoop it all away and that's kind of the end of it uh if it's big enough and or if we didn't get enough of it out at the office uh the patient might need to go to a dermatologist or a plastic surgeon uh to have more removed with the pathologist in the room looking at it uh the sample under a microscope is as is uh getting cut off Roberto the change again a family member has a blood disorder cancer from a jack 2 mutation he's on a chemo pill could you discuss this yeah so Jack 2 is is a mutation there are many it's kind of an alphabet soup that we have to sift through as hematologists and oncologists and it can be challenging to kind of explain that um uh to patients also but basically what it sounds like you're describing is a Milo proliferative disorder or MPN for short um and if they are on a medication for uh that and they have a jack 2 mutation if I had to guess uh the chances are it's something called ET um which stands for Central thrombocytemia and typically we start by using a drug called hydroxy Ura or hydria um which is an oral medication it's a type of chemotherapy we use it for other blood uh conditions including CLE cell anemia um but but in myo proliferative neoplasms which do have a um a risk of evolving to acute myoid leukemia which we discussed earlier this is a way to help um uh control that condition uh before it makes that transformation Matt what uh what impact does chemo have on a person's teeth that's a good question I think one of the most common things we can see sometimes in patients receiving chemotherapy are are um a risk of you know oral or dental infections because of the immunosuppression that's associated with chapy and its effects on wound healing so sometimes when patients are needing very intensive chemotherapy where their immune system may be suppressed we um try and get them in to see a dentist if they need dental work done to sometimes remove teeth that need to be removed or address some of these issues prior to them receiving some of these drugs that we know can lower their immunity toga there's question about nutrition why do we not use metabolic or nutritionist nutrition to try to change and treat cancer uh there's seems like there's a a lot of discussion about that but it's really not used much at least by us um I think that's true uh we know that um it's important to have a healthy diet maintain good weight like we've been talking about tonight um but uh there aren't a lot of strong studies that I'm aware of that link nutrition with uh curing a cancer for example or treating a cancer to the group what are some symptoms that might indicate cancer well I would say the majority of cancers can be asymptomatic uh so they won't have symptoms unfortunately and that's why we do a lot of screening tests for them them um but in general you know especially if you're thinking of some of the blood uh cancers like the leukemias and the lymphomas we think of things um that we call constitutional symptoms and this could include involuntary weight loss um you know it could include shaking chills high fevers that don't have any infectious explanation um those tend to be the things I think about uh drenching night sweats we call them where they're changing the sheets every night um those would be some of the classic symptoms but um some of the solid tumors you may have the weight loss you may have pain in some area um but it can be very vague um and so we don't always know until you know there's a screening test or a a scan that incidentally shows something that they weren't expecting if I could maybe add one other thing you know it's it's hard to predict you know what someone may have because cancer can really affect any part of the body and so I think it's important for patients if they're having a new symptom that is new getting worse or otherwise unexplained they should be you know Consulting with their physician or or provider to look into that issue in more detail and keep after us if you don't think we're answering as we should so that's important too so one of you two why is hematology specialty always associated with oncology I'll give a stab at it and please weigh in as well Roberto but but I think you know the roots of hematology have been linked with oncology because of the study and treatment of blood-based cancers especially leukemia so the pioneers of early chemotherapeutics were people that were treating leukemia yeah I would completely agree with that what are targeted drugs Roberto targeted drug about 30 seconds to a minute broad category it's hard to get me to stop talking sorry uh no so uh targeted drugs is is essentially in reference to um we kind of mentioned mutations a little bit earlier so patients can have what we call driver mutations which uh you can think about them as driving the cancerous process within the body and we don't know about every single type of driver mutation out there but we know of many and they've developed drugs that can actually pinpoint and Target the cancers that Express uh certain proteins or that have certain mutations and so that's where that uh comes from thank you great job guys I want to thank our panelists Dr Matthew braith white Dr Roberto Fernandez and Dr toga hanhan and our medical student volunteers Lindsay monag McKenzie Peterson and Alexandra wolner please join Dr Mary Owen next week for a program on influenza pneumonia and empyema her panelists will be Dr Jane Rudd Dr Sandy Stover and Dr Andrew Thompson thank you for watching have a great [Music] night [Music] [Music]