Oncology Questions and Answers with Dr. Gast
Questions and Answers with Dr. Gast.
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You can email Dr. Gast your questions about cancer to:kvann@fsro.net
June 16, 2013
Question: What does a skin cancer look like and how common are they?
Answer: Skin cancer is the most common cancer we have–we don’t even keep official track of them as we do other cancers, which are registered with patients tracked through SEER (Surveillance, Epidemiology and End Results Program). The most common skin cancers are basal cell carcinoma and squamous cell carcinoma. At least 500,000 basal cell skin cancers and 150,000 squamous cell skin cancers occur every year. This number, however, is thought to be under reported and on the rise. Basal cell skin cancer can look like a pink bump on the skin, and as it grows bigger, it can develop a scab that won’t heal. In the past, this cancer was called the “rat” cancer because left unattended it would grow to the point where it looked as if a rat had eaten a hole in the person! Squamous cell skin cancer is often a dry, rough, darker area that can be itchy. These can also scab and not heal over time. Although basal cell skin cancers tend to stay right where they are, squamous cell skin cancers can spread to distant sites. The rarer but scarier melanoma is the skin cancer that is tracked and reported into the SEER data. It looks generally like a mole that has changed. If you have any skin changes, make an appointment with your local dermatologist. Those with a previous history of a skin cancer should also have yearly skin exams.
June 9, 2013
Question: My 16 year old daughter just completed treatment for thyroid cancer. What is her long-term prognosis? Do I need to worry about it coming back?
Answer: Thyroid cancer comes in a number of different varieties, but all have very high survival statistics for stages 1-3. Thyroid cancer is usually treated with surgery followed by radioactive iodine treatments. Patients then will have periodic follow-ups to evaluate for recurrence or spread of the disease. Regarding pediatric patients, follow-ups are critical since the patients are still growing and changing while receiving treatment for the cancer. All patients and families worry about recurrence of a cancer no matter what the type. But, the good news is that thyroid cancer has a very low risk of recurrence when compared with other cancers. The best advice is for patients to continue their yearly exams throughout their lives.
June 2, 2013
Question: Why did Angelina Jolie remove both breasts when she didn’t even have cancer? What is BRCA?
Answer: BRCA is a mutation that increases a person’s chance of breast and ovarian cancer. The mutation is present in only 0.24% of the population and accounts for fewer than 10% of all breast cancer cases. Not everyone should be tested for this gene since it is present in only 24 out of 10,000 people. Women who do possess the gene are at 5 times the normal risk of breast cancer and 10-30 times the normal risk of ovarian cancer.
Testing positive for this gene, as in the case of Angelina Jolie, results in what is often a very emotional and personal decision regarding options. These options can include a double mastectomy and removal of ovaries or follow-up mammograms and MRI scans for the earliest detection.
May 26, 2013
Question: Can using antiperspirants or deodorants cause breast cancer?
Answer: If you search the internet, you can find many sites and articles that warn women that antiperspirants and deodorants can cause breast cancer. However, researchers at the National Cancer Institute (NCI) have reviewed all the scientific data and researched all the studies that have been performed. The NCI has reported that they found no link between antiperspirants and deodorants and breast cancer. Therefore, another urban myth can be laid to rest, and we can all stay clean and smell good!
May 19, 2013
Question: What are the signs and symptoms of thyroid cancer? Is there a screening to detect this cancer?
Answer: Thyroid cancer usually doesn’t cause any signs or symptoms until it has grown for quite a while. At this time, noticeable signs can be a lump in your neck, a change in your voice, difficulty with swallowing, throat or neck pain, swollen glands in your neck, or a cough not related to a cold. No screening is available for thyroid cancer, but if you do develop any of these symptoms, consult your physician. If a lump is found, your doctor will most likely order an ultrasound of your neck and possibly a blood test to measure the level of thyroid-stimulating hormone in your body.
May 11, 2013
Question: How exactly does radiation work to kill cancer?
Answer: Highly precise planning is used when radiation is prescribed for cancer treatment. A machine called a linear accelerator is used to deliver radiation to the area that requires treatment. As radiation passes through the cancer and normal cells alike, the energy of the radiation causes changes in the cells. These changes result in damage to the cell’s genetic material, the DNA. The damage to the DNA causes the cancer cells to die. Even though small amounts of normal tissue around the cancer cells also receive radiation, these normal cells are able to repair any resulting damage. Often, the affected tissue will be replaced by scar tissue, formed in response to inflammation from tissue injury. This response is the body’s way of healing injury.
April 28, 2013
Question: Is thyroid cancer 100% treatable, and what do you do to treat it?
Answer: Thyroid cancer is a very rare cancer, which fortunately is often diagnosed early. Therefore, typically, most patients do well. The standard treatment for thyroid cancer is surgery, often followed by radioactive ablation. Radioactive ablation is the use of radioactive iodine, given in a pill or liquid form, which is then taken in by the thyroid gland. Because the thyroid absorbs iodine, the radioactive iodine collects in any thyroid tissue remaining in the body and kills the cancer cells. Other treatments such as external beam radiation therapy and chemotherapy are rarely used except in later stages of the disease. Thus, yes, thyroid cancer, like all cancers, is certainly treatable.
April 21, 2013
Question: My son has pleomorphic sarcoma. What kind of cancer is this?
Answer: Pleomorphic sarcomas are cancers that come from the supporting tissue of the body, such as bone, muscle, cartilage, tendons, and ligaments. This cancer is different from carcinomas, which arise from the lining of organs, and cancer of the blood and bone marrow, which are called leukemia or multiple myeloma.
A pleomorphic sarcoma can also be called a malignant fibrous histocytoma, a name given to a sarcoma when no more accurate identification is possible. Affecting males more than females, pleomorphic sarcomas occur mostly in extremities. When this type of cancer is detected in its early stages, a combination of surgery and radiation treatments is usually effective at eradicating the cancer from the body.
April 14, 2013
Question: Can you catch cancer from someone else?
Answer: Cancer is unique to each person. It is the individual’s cells that have become cancerous cells. Cancer cells from one person are generally unable to live in the body of another healthy person. A healthy person’s immune system recognizes foreign cells and destroys them, including cancer cells from another person. A few cancers are caused by certain viruses. The human papilloma virus (HPV) and the Epstein-Barr virus (EBV) are two examples of viruses that are linked to certain types of cancer. You can “catch” the virus from another person but the viral infection alone usually does not lead to cancer. A weakened immune system, other infections, risk factors (such as smoking), and other health problems allow cancer to develop more readily. But, the bottom line is—cancer is not contagious.
April 7, 2013
Question: Is colon cancer passed on in families? If my mom had colon cancer, am I more likely to develop this cancer?
Answer: Colon cancer covers the entire large bowel from the end of the small bowel to the rectum. When combined with rectal cancer, it is often referred to as colorectal cancer. Yes, risk for colon cancer may increase based on family history of colon cancer by a first degree relative, such as mom, dad, brother, sisters. Additionally, if several family members are affected, or if they were diagnosed with colon cancer at an early age, risk increases. If at risk because of family occurrence, what actions should be taken? Most colon cancers develop from polyps slowly over several years. In fact, it can take over ten years for a polyp to turn into a cancer. Colonoscopy is one screening tool that does decreases the risk of getting colon cancer by 90% since during this procedure polyps are removed, thus, eliminating the possibility of their developing into cancer. Also, some studies have shown that aspirin or ibuprofen use can decrease risk as well. The best action to take is to talk to your medical doctor about when you should start the screening process based on your family history.
March 24, 2013
Question: I read in a national health news article that radiation treatment for women with breast cancer can actually hurt them and cause heart problems later. Is this true?
Answer: It is well known that the treatments used to kill cancer cells can also cause lasting and sometimes permanent side effects. Chemotherapy drugs can damage organs such as the liver, brain, lungs, and bone marrow. Radiation treatments can cause scar tissue in any area of the body that the radiation passes through. Both chemotherapy and radiation can cause a secondary cancer to occur decades later. The study you are referring to in the national press reported that women treated with radiation for breast cancer are more likely to develop heart problems later. But, the study only showed that normally 4 to 5 of every 100 women will develop a major cardiac problem by age 80, and radiation treatment would add just one more case. When a person is diagnosed with cancer, a candid discussion should be held with their doctor to review the side effects of their treatment options. The person will then need to decide if they would like to proceed based on the risk of treatment (side effects) versus the benefit (cure) of the treatment.
March 17, 2013
Question: What stage is a prostate cancer when during a prostatectomy (surgery to remove the prostate) it is found that the cancer has spread to the surrounding lymph nodes? How is this treated and what is the prognosis?
Answer: When staging prostate cancer, the doctor has to look at the extent of the disease in the prostate and at whether it has spread to lymph nodes or other parts of the body. When a prostate cancer has spread to the nearby lymph nodes, it is labeled a Stage IV cancer. In the case where the prostate has been removed, the patient should then be referred to a radiation oncologist to discuss radiation therapy to the pelvis area where the lymph nodes are located. Even though the positive lymph nodes make this cancer a Stage IV, the survival rate is nearly 100% five years from diagnosis. The survival rate drops to 70-80% 10 years after diagnosis. In conclusion, most men with spread of the prostate cancer to nearby lymph nodes can live a very long time with the proper care and treatment.
March 10, 2013
Question:
I have heard that the budget cuts will greatly affect research for finding a cure for cancer. Is this true and if it is, where will doctors find the money to continue their research?
Answer:
According to the latest news coming out of Washington, this is very true. The National Cancer Institute is expected to lose a significant amount in funding. Unfortunately, the budget for cancer research has always been low in the United States when compared to other countries where scientists have found that grants are more readily available. However, other than government funding, the second largest supplier of funding for cancer research is the American Cancer Society and its Relay For Life fundraisers. The American Cancer Society has funded 46 Nobel Peace Prize winners and countless scientists over the last 100 years. They have also spent more than $3.5 billion on cancer research since 1948 and have played a role in nearly every cancer breakthrough in recent history. My advice is to find your nearest Relay For Life walk and participate! It will take all of us helping the American Cancer Society by raising funds for their research to continue the goal of finding a cure for cancer.
March 3, 2013
Question:
My mom was just diagnosed with stage IV breast cancer. She has bone cancer and a brain tumor. Does she have three different cancers, and what does stage IV cancer really mean?
Answer:
The majority of cancers are staged based on the extent of the original (primary) tumor and on whether or not cancer has spread in the body. To help determine if the patient’s cancer has indeed spread either regionally or distantly to other organs, oncologists use x-rays, CAT scans, MRI scans, and PET scans. Most cancer stages are assigned a number from I-IV, with I being an isolated cancer and IV being a cancer which has spread, or in cancer terms, metastasized. A patient with a stage IV cancer does not have a new or different cancer throughout the body since metastatic cancer has the same name and same type of cancer cells as the original cancer.
February 24, 2013
Question:
How can someone who has never smoked get lung cancer?
Answer:
When discussing lung cancer, doctors tend to lump smokers and non-smokers together, but lung cancer in non-smokers is really a different disease with, obviously, different causes. The incidences of lung cancer in non-smokers are significant, making up 10-15% of lung cancers, with two-thirds of these found in women.
Besides smoking, what else can cause lung cancer? Many of the other causes are environmental. In fact, the number one suspected cause of lung cancer, other than smoking, is radon gas in the homes. Other environmental causes include second-hand smoke, which accounts for 3000 lung cancer cases a year; fumes from wok cooking, thought to be a cause of lung cancer in Asian countries; and asbestos exposure, which can cause a special type of lung cancer called mesothelioma. Other than environmental causes, genetics often play a role. Having a first-degree family member (parent, sibling, or child) with lung cancer roughly doubles the risk. Having a second-degree relative (aunt, uncle, niece, or nephew) with lung cancer raises the risk by around 30 percent.
Currently, whether smokers or non-smokers, lung cancer patients are treated the same. In the future, treatments could become more specialized based on the fact that these cancers are different on a genetic level. Until then, the most important things to do to lower the risk of lung cancer as a non-smoker are to check homes for radon and avoid secondhand smoke.
February 17, 2013
Question:
My father has lung cancer. After diagnosing it as a Stage 4 small cell, his doctor told him treatment wouldn’t be worth it and recommended hospice. Is there treatment available?
Answer:
Small cell lung cancer accounts for 15% of all lung cancers and usually is caused by smoking. Without any treatment, small cell lung cancer grows rapidly and spreads quickly, usually taking the person’s life in two to four months. However, small cell lung cancer is the most responsive type of lung cancer, which means it’s very sensitive to chemo and radiation. When patients are given chemotherapy, life expectancy can jump up to one year. Unfortunately, in more than half of the people with small cell lung cancer, the cancer also spreads to the brain. Because of this possibility, for people whose lung cancer has responded to chemotherapy, doctors may additionally prescribe radiation therapy to the brain to help prevent this spread. This procedure is known as prophylactic cranial irradiation, which may add another six months to the patient’s life expectancy. Therefore, yes, treatment for small cell lung cancer does exist and can give the patient considerably more time with friends and family.
February 10, 2013
Question:
I have been diagnosed with cancer and have been told I will need radiation therapy. What can I expect?
Answer: When you are referred for radiation therapy, you will meet your radiation oncologist and her nurse. After they review your records, reports, and x-rays, your doctor will perform an exam. Your radiation oncologist should offer to review your x-rays and scans with you. During this visit the doctor must decide whether or not you require radiation treatment and discuss with you all the risks, side-effects, and benefits of the treatment. You, the patient, will then decide to proceed or not with radiation treatment.
Once treatment is decided, the next step is simulation. Simulation is typically a CT scan used to obtain data for designing your radiation plan. All patients have a unique radiation plan that has been customized just for them, their bodies, and their cancers. Your plan will be unique to you. After completion of the simulation, you will leave with positioning marks on your skin (made with a sharpie marker or a paint pen) and an appointment to return for treatment. When you arrive at your next visit, your plan will have been completed. Radiation therapists will be ready to deliver your treatment. Usually lasting 5-10 minutes administered once a day for 2-7 weeks, radiation therapy is painless: you will not feel anything.
February 4, 2013
Question:
Ar there any clinical studies that prove that prostate cancer treatments, such as surgery, prolong life?
Answer:
Second only to lung cancer-causing deaths, prostate cancer is the most common cancer in men. One in six men will have prostate cancer during their lifetime. The treatments for prostate cancer range from surgery, radiation therapy, anti-androgen therapy, observation or watchful waiting.
To answer your question, it would be impossible to conduct a study or trial where some patients received no treatment while others underwent surgery or radiation. Patients in trials are randomized, which means they do not have a choice on which treatment they receive.
But, good news came out just this month from the UK, which has found an 18% lower death rate from prostate cancer than reported 20 years ago. This reduction is most likely from improved treatments and early detection. Therefore, yes, finding prostate cancer early can save lives. As our population ages and lives longer, we should also expect additional improvements in survival rates.
January 27, 2013
Question:
My dad died from stage four esophageal cancer a little over a year ago. He had been diagnosed with Barrett’s esophagus. My question is Barrett’s esophagus hereditary? Could having Barrett’s esophagus have caused his cancer?
Answer:
Barrett’s esophagus is an abnormal change in the lining of the distal end of the esophagus (food tube). Because it appears at the end of the esophagus closest to the stomach, reflux is thought to be the cause. However, Barrett’s is found in patients who may or may not have reflux symptoms. Unfortunately, no reliable way to determine which patients with Barrett’s esophagus will go on to develop cancer is available. Also, no data shows it could be hereditary.
The risk of developing esophageal cancer is highest in the United States in white males over the age of 50 with more than 5 years of symptoms which can include trouble swallowing, weight loss, and pain. Treatment for esophageal cancer can range from surgery, to radiation, to chemotherapy, to possibly all three.
Question:
My grandfather was just told he has bladder cancer. Can you tell me more about this?
Answer:
Bladder cancer grows on the lining of the bladder. Symptoms include frequent, urgent, painful, or bloody urination. The treatment for bladder cancer depends upon the type. Some types are superficial and grow like mushrooms inside the bladder. Usually slow growing, this type of bladder cancer requires removal by use of a scope. At times, this type may also need chemotherapy drugs placed in the bladder after removal to help prevent the cancer from recurring. Other types of bladder cancers can be invasive and require much more extensive treatment, such as surgery, radiation, and chemotherapy. Some patients even need to have their bladder surgically removed. Because invasive bladder cancer has a high risk of spreading to distant organs, a full workup is needed at the time of diagnosis.
Bladder cancer is once again another cancer linked to smoking. Also, people exposed to arsenic, as well as chemicals used in the manufacture of rubber, dyes, textiles, plastics, paints and leather run a higher risk of developing bladder cancer.
September 1, 2012
Question:
At what point after receiving a cancer diagnosis should an oncologist be brought on the case? How long have you been an oncologist in Arkansas and did you go to school here also?
Answer:
Your oncology team should really be assembled fairly quickly, as in a 2-3 week period of your diagnosis. The team would of course include all the doctors who would at some point participate in your care…surgical, medical and radiation oncologist. I personally have practiced oncology for over 22 years, 15 of which have been here in Arkansas. My training was in Kansas at the University of Kansas Medical School.
