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Cervical Cancer: How it can be Prevented and Treated

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January was Cervical Cancer Awareness Month — and awareness has played a big role in its shift from the leading cause of death among women in the United States to the most preventable of female cancers. This is due largely to the emphasis placed on annual screenings and the emergence of vaccines for the human papilloma virus (HPV), the primary cause of cervical cancer.

While this progress is encouraging, more than 14,000 women are still expected to be diagnosed with cervical cancer in the U.S. in 2021, and more than 4,000 will die. Which is why it is so important to continue educating women — and men — about cervical cancer and how to prevent it.

Causes and Symptoms

The main cause of cervical cancer is HPV, a sexually transmitted disease that infects about 14 million men and women in the U.S. each year. Smoking, multiple sexual partners and taking oral contraceptives for longer than five years can also increase a woman’s risk.

Symptoms of cervical cancer include pelvic pain, abnormal discharge and abnormal periods, fatigue, nausea, weight loss and pain during intercourse. It is also very common for women not to have any symptoms at all, which is why keeping up with annual screenings is so important.

Preventative Measures

The most effective measure in guarding against cervical cancer is an annual Pap smear test, a procedure that involves collecting cells from the cervix and analyzing them for the presence of precancerous or cancerous cells. These annual screenings are crucial because cervical cancer, when diagnosed in the early stages, is very treatable. Too often, by the time symptoms present themselves, the cancer has already metastasized to other areas of the body.

Another effective measure is the HPV vaccine, which is typically given to females from ages 12-15, or before they become sexually active. While cervical cancer occurs only in women with a cervix, HPV can be passed from female to male and male to female, so it is a good idea for boys of the same age to receive the HPV vaccine as well. There are also new HPV vaccines recommended for an older population under the age of 45.

Treatment Options

One common method in the treatment of cervical cancer is the loop electrosurgical excision procedure (LEEP). Often performed in a gynecologist’s office, a LEEP features a heated wire loop that removes the area of the cervix affected with the abnormal cells. This is typically the first stage in treating cervical cancer, and some patients who undergo a LEEP don’t experience a reoccurrence. More advanced treatments include immunotherapy for certain types of cervical cancer, and chemotherapy and radiation when the cancer is more extensive.

Precision therapy is being studied as another possible way to treat cervical cancer. However, its use is not yet widespread because there is not always a genetic component to cervical cancer and its primary cause is a virus.

Power in Partnership

At Zangmeister Cancer Center, we pride ourselves in delivering high-quality care to cancer patients right in their own backyard. Partnering with American Oncology Network (AON) two years ago has enhanced our ability to treat our patients, including those with cervical cancer.

AON provides us with extended resources and enables us to accept a wider array of insurance plans, which allows us to help even more patients. Most importantly, working with AON allows us to expand patient education and provide more in-depth information on all types of cancer. This includes cervical cancer, which, with the right amount of vigilance, is preventable as well as easily treatable in early stages.

Advancements in Lung Cancer Treatment

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Though lung cancer may not be the most common type worldwide, it nonetheless kills more men and women in the United States each year than any other type of cancer. Thankfully, the number of people dying from non-small cell lung cancer—the most common type of lung cancer—has sharply declined in recent years, according to a study published in the New England Journal of Medicine by Howlader et al. This is a result of both the decline in tobacco use (particularly among men) as well as the increased effectiveness of new lung cancer treatments.

At Zangmeister Cancer Center, we offer all the cutting-edge, Food & Drug Administration (FDA) approved treatments available, as well as investigational treatments being studied through the National Cancer Institute Community Oncology Research Program (NCORP).

The Benefits of Precision Medicine

Precision medicine is an approach for disease treatment and prevention that takes into account individual variability in the genes, environment and lifestyle for each person. It has significantly impacted how cancer care providers help patients with lung cancer. Currently, physicians select the best treatment based on an in-depth analysis of the patient’s tumor. This analysis allows for the search for genetic alterations that could be treated with therapies that target that specific alteration (targeted therapies) and helps sort out patients more likely to benefit from other treatments such as immunotherapy. These targeted therapies and immunotherapies have helped drive down lung cancer mortality rates at an accelerated rate over the last seven years.

Targeted therapies have a high success in controlling disease growth, with shrinkage of tumors that can be seen in roughly 80% of patients using this treatment. This is significant in comparison to a 30%-40% rate of response with chemotherapy treatments — and can add 10-12 months and in some case more than 20 months to a patient’s survival compared to chemotherapy.

Currently, immunotherapy, through drugs called immune checkpoint inhibitors, have firmly established a role in the treatment of advanced non-small cell lung cancer. In this type of treatment, medicines are used to help a person’s own immune system identify and attack cancer cells. One out of every four patients with advanced non-small cell lung cancer receiving these treatments are alive at five years.  Since not every patient receiving these treatments obtains the same benefit, the scientific community is actively looking for different strategies to identify those that would benefit the most, as well as how to increase the number of patients that have good outcomes.

Newer Treatment Strategies Are on the Way

Both immunotherapy and targeted therapies are making inroads in the treatment of patients with locally advanced and early stages of lung cancer, which had previously been treated only with surgery or radiation and/or chemotherapy.  The use of these therapies in early-stage lung cancer seems imminent in the near future. 

While lung cancer CT screens have a significant impact in the reduction of lung cancer mortality rates, the strategy is underutilized due to a variety of reasons such as logistics and cost. Consequently, liquid biopsies are currently being tested as a potential strategy to overcome the limitations of low-dose lung CT screening.

Liquid biopsies could help doctors screen for cancer long before a patient has any symptoms and could also be administered after surgery to check for the presence of any residual cancer. Other screening strategies, such as the analysis of exhaled volatile organic compounds and quantification of lipids in the blood of patients, are currently being tested as well.

Brighter Future for Lung Cancer Patients

Prior to the development of targeted therapies and immunotherapy, a patient with advanced lung cancer had a less than 5% chance of being alive after two years.  Currently, approximately one in four patients with advanced lung cancer can be alive at five years. Newer technologies such as liquid biopsies, artificial intelligence and “omics” approaches are exciting opportunities that could have the potential of further improving the outcomes in patients with lung cancer at all stages.

The Benefit of a Centralized Pharmacy

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Each day, American Oncology Network (AON) employees are doing everything they can to make sure our patients are as comfortable as possible as they undergo treatment. This includes the dedicated and knowledgeable team working at our centralized, state-of-the-art pharmacy, which is celebrating its two-year anniversary.

Our in-house specialty pharmacy offers patients access to the most current and effective oral cancer medications along with round-the-clock access to our pharmacists. Having an in-house pharmacy with a robust back-office infrastructure also eases individual practices’ administrative burden by taking care of the heavy lifting associated with refills, prior authorizations and financial assistance so their staff can concentrate on our top priority: our patients.

Access to Oral Oncolytics

Because of their tolerability and effectiveness, which can lead to a better quality of life for patients, the use of oral oncolytics is skyrocketing. AON’s ready access to 99% of these medications means we can rapidly fill and ship prescriptions right to the patient’s doorstep.

Oral oncolytics are beneficial because they allow patients to receive the treatment they need in the comfort of their own home rather than having to come to one of our clinics. This eliminates disruptions to their day and eliminates the need to miss work.

Oral medications are also a type of targeted therapy, which means they zero in on cancer cells and mostly leave a patient’s healthy cells alone. These drugs are better tolerated by patients and help them avoid some of the uncomfortable side effects such as nausea that accompany more traditional forms of therapy.

A Tool for Patients and Practices

AON’s centralized pharmacy not only benefits our practices, but the patients they treat too.

Our pharmacists have access to the charts and medical histories of all the patients in our network, allowing them to check lab work, notes and a host of other information that helps them make recommendations to clinicians. This allows for higher-quality, more personalized treatment than is possible at other pharmacies that don’t have ready access to such comprehensive patient information.

After the medications are shipped, pharmacists reach out to the patient to see how they are feeling and if they have any questions or concerns. Some medications have harsher side effects than others, so patients are educated before they start treatment about what to expect and how to diminish some of the discomfort. This is important, because patients who are aware of the side effects are much more likely to keep taking their medications, which of course leads to better results.

As for the practices in the network, AON handles all the administrative work, including assisting the patients and clinic in obtaining prior authorizations, financial assistance and refill requests. Finally, our pharmacists are available 24 hours a day, seven days a week to answer patient questions and provide advice, which cuts down on the number of phone calls that need to be handled by clinic staff.

Expanding Space and Benefits

American Oncology Network is consistently adding more practices and expanding staff. To accommodate the higher demand generated by this growth, we have opened a new 20,000-square-foot pharmacy in Fort Myers, FL.

The new location is equipped with high-tech automation and conveyor systems to make operations even more efficient and accelerate the process of filling and sending prescriptions, getting them into patients’ hands faster than ever before.

Our centralized, in-house pharmacy is one of the many benefits AON offers to its partner practices. It is part of our dedication to ensuring we are doing everything we can to support both a clinic’s staff and patients—leveraging our expertise to ensure they are comfortable and well on their way to a positive outcome.

The Future of Breast Cancer Treatment

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Breast cancer is the second-most common form of cancer in women with 13% expected to develop the disease at some time in their life. Breast cancer can also happen to men — though it makes up for 1% or less of all breast cancer diagnoses.

October marks Breast Cancer Awareness Month, the ideal time to not only remind women about the importance of annual mammograms and self-examinations but to also take a closer look at the progress being made in treatments — all of which are helping breast cancer patients live longer and better lives while offering hope for the future.

Newer, More Effective Treatments

Several new medications have been approved for patients diagnosed with both early and late stages of breast cancer. One such treatment is immunotherapy, which helps the body’s immune system identify and destroy cancer cells.

In clinical trials, immunotherapy has yielded positive results and demonstrated increased response rates in patients with both early and late stages of breast cancer. Immunotherapy is approved for patients with advanced triple-negative cancer, which often grows and spreads faster than other types of breast cancer. Treatment options for triple-negative patients have been limited in the past, making the approval of immunotherapy an exciting breakthrough.

Hormonal therapy, which targets the estrogen receptor, and subsequently, the most common type of breast cancer, can be used before or after surgery, reducing the risk of breast cancer recurrence by approximately 50%. Hormone therapy, either alone or in combination with targeted therapies, is also highly effective in the treatment of late-stage breast cancer.

Targeted therapies are developed when researchers identify what causes a tumor to mutate, such as certain proteins that are present or overproduced in cancer cells compared with healthy cells, and then develop a treatment to stop that mutation. Targeted therapies against the HER2 protein, present in 15%-20% of breast cancers, significantly reduce the risk of breast cancer recurrence and improve overall survival in both early and late stages of disease.  Clinical trials demonstrate that targeted therapies significantly reduce the risk of cancer progression and lead to an increased response rate when given in combination with standard therapies or compared with standard therapies.

The Future of Cancer Treatment

Precision medicine refers to treatment based on the genetic understanding of a patient’s disease.

With precision medicine, doctors can use information about a patient’s own genes or tumor mutations to assist with the diagnosis and treatment of cancer. In a patient who has been diagnosed with breast cancer, precision medicine helps to determine whether certain targeted therapies and immunotherapy will be beneficial in their treatment.

Not only can precision medicine help doctors put together very specific plans that often lead to a more accurate diagnosis and more effective cancer treatment, but it can also let a patient know if they are a high risk for developing breast cancer. Having this knowledge allows for a proactive approach to early detection, which includes more frequent and better screening tests.

The Benefits of Community-based Treatment

At Messino Cancer Centers, we use the most up-to-date approved treatments including hormonal-based therapies, chemotherapies, immunotherapies and targeted therapies, and offer patients access to a robust list of clinical-based trials. We have many support services available to our patients including social and behavioral therapy, a cancer-specific dietitian and a care management team.  We also offer the DigniCap Cooling System, which has been clinically proven to help prevent hair loss from certain chemotherapy treatments.

Because we are a community-based practice, our patients don’t have to worry about traveling out of the area for treatment and are able to stay close to their support system of family and friends. It also allows our nurses and physicians to create strong, trustful relationships with our patients, who feel less like a number and more like an individual who is truly cared for.

The strong support of a community-based staff coupled with exciting therapeutic treatment advances give breast cancer patients more hope than ever in their quest to live happier, healthier and longer lives.

Stomach and Esophageal Cancer Q&A

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While cancers of the stomach and esophagus are rare, these cancers are usually advanced by the time they are detected. An expert medical oncologist sheds light on diagnosis, risk factors and treatment.

How are stomach and esophageal cancers diagnosed?

Patients diagnosed with esophageal cancer often start with concerns about difficulty or pain during swallowing, weight loss or a cough and hoarseness. Those diagnosed with stomach cancer often first notice a general discomfort in the stomach, loss of appetite, weight loss and vomiting. Screening generally includes an upper endoscopy, a procedure in which a thin scope with a light and camera is used to look inside the upper digestive tract.

Why do stomach and esophageal cancers occur?

Smoking, heavy alcohol consumption, and diets rich in fats and salt and lacking in fresh fruits and vegetables can lead to these cancers. Increasing age, gender (men are more likely to develop these cancers than women), obesity and lack of physical activity are also potential culprits.

Once diagnosed with stomach and esophageal cancer what are the treatment options?

Multimodality treatment (surgery, radiation and chemotherapy) is often used. Sequencing of treatment is determined by the stage, size and location of the tumor.

What types of surgeries are performed for stomach and esophageal cancer?

A process known as “endoscopic mucosal resection” removes the cancerous area through an endoscope. Subtotal gastrectomy, removal of part of the stomach, is used for cancer located in the upper part of the stomach. If the cancer has spread throughout the stomach, a total gastrectomy will remove the stomach and rework the digestive tract. For esophageal cancer, surgery may remove some or most of the esophagus through an esophagectomy.

How are radiation therapies used?

  1. Prior to surgery if the cancer is localized to the esophagus. Studies show the survival rate is improved when chemotherapy and radiation therapy are given together before surgery
  2. With stomach cancer and occasionally esophageal cancer, if patients undergo surgery without getting radiation or chemotherapy prior to surgery, it is sometimes advisable to give chemotherapy and radiation therapy after surgery to help clean up the cells that may have been left behind at the time of surgery.
  3. Radiation therapy can sometimes be used to control pain or bleeding from cancer. In this case a short course of radiation therapy is given, usually without chemotherapy, for local control of a tumor that is causing pain or bleeding even if patients have metastatic disease.

What is the best chemotherapy regimen for stomach and esophageal cancer?

Chemotherapy treatment options usually include between one and three drug combinations. The three-drug combination tends to induce the highest responses but also has the highest rates of side effects.

Why do some people have radiation therapy and chemotherapy while others just have chemotherapy?

Radiation therapy is used when cancer is localized to one area like the esophagus or stomach.  When cancer spreads outside the local area to the liver or lungs it usually spreads through the blood.  When this occurs, the cancer is no longer localized and other treatments are needed. 

What are the benefits of adding chemotherapy to radiation therapy?

Adding chemotherapy to radiation therapy augments the effects of radiation therapy. Chemotherapy also helps control cancer cells that might be trying to escape into the blood.  When given alone or in combination with radiation therapy, chemotherapy may help alleviate symptoms related to stomach cancer. In patients with more advanced stomach cancer in whom surgery is not possible, chemotherapy may also improve both the length and quality of life.

GI Cancer: The Promise of Targeted Therapies

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Targeted therapy offers a new hope for cancer patients and opens the door for the development of new treatment strategies for patients who carry certain genetic mutations in their tumors.

One condition treated effectively with targeted therapies is gastrointestinal stromal tumors (GIST), the most common type of sarcoma which occurs when abnormal cells grow in the gastrointestinal track. With July recognized as Sarcoma Awareness Month and July 13th as GIST Awareness Day, it’s the ideal time to draw attention to the growing body of evidence suggesting that GIST tumors—which don’t respond well to chemotherapy or radiation—can be treated effectively with targeted therapies such as tyrosine kinase inhibitors (TKIs).

All cells in the body are regulated by DNA that controls cell growth. Cancer cells typically have DNA mutations—changes in the normal DNA—that can cause rapid and unregulated growth of the cancer cells, leading tumors to grow and spread to various organs.

Specific mutations have been identified as main drivers for growth in GIST tumors. Targeted therapies combat these mutations by blocking the molecules that allow tumors to grow. TKIs can treat the tumors effectively or shrink them enough that surgery becomes an option. This approach precisely targets mutations that are predominantly present in cancer cells and offers a new way to control cancer cells without significantly affecting normal cells.

Our physicians at the Zangmeister Cancer Center strive to provide patients who have certain genetic mutations with access to clinical trials that include new targeted therapies. This is done by gathering information on the patient’s personal and family history of cancer. We then biopsy the tumor and send the tissue sample to a lab for genetic analysis. The results are then carefully reviewed to determine if targeted therapy—some of which are FDA approved while others are part of clinical trials—may be effective. This is an alternative to the more conventional “one-size-fits-all” approach to treatment and helps sidestep the cost and side effects associated with treatments that may not work on certain mutations.

This approach continues to evolve, and most likely will help increase the number of targetable mutations and available targeted therapies available to patients over the next years. This is an exciting time to be treating cancer, implementing new therapies that will lead to even more new tools for success.

Breast Cancer in Men: Recognizing Symptoms, Reducing Risk

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Breast cancer is most often associated with women, which is understandable as more than 276,000 women are expected to be diagnosed in 2020. Yet, breast cancer occurs in 1 of every 83 men and carries a 5% mortality rate.

Consequently, men need to be vigilant and educated about the symptoms and signs of breast cancer and should feel comfortable discussing them with their physician.

Symptoms of Male Breast Cancer

The clinical features of breast cancer in men are no different than they are in women. Symptoms include a lump or thickening in or near the breast or underneath an arm. A dimpling or puckering of the skin—known as peau d’orange—can also be a symptom, particularly of inflammatory breast cancer, and the nipple of the breast may be inverted. Another thing to look for is nipple secretion, which can be especially concerning if the drainage is blood.

No one is immune to cancer, but there are some factors that can heighten the risk of breast cancer in men, including exposure to radiation and a history of breast cancer in their family. An increase in a man’s estrogen level can also heighten the chances of breast cancer, so conditions such as Klinefelter’s syndrome and cirrhosis are risk factors. Transgender men using estrogen injections are also at an increased risk.

Self-Examination and Treatment

Like women, men should do routine self-examinations and check for thickening or lumps in the breasts. The best screening is a simple palpating of the tissue and checking in a mirror for any changes in the look of the breast’s skin or nipple. This should be done once a month, especially for men with a family history of cancer.

If any irregularities are noticed, reach out to a physician immediately. In the event of a tumor, the procedure for men is the same as women – a biopsy followed by a diagnosis, and then the decision whether to do surgery with or without chemotherapy or radiation therapy.

One of the biggest differences regarding breast cancer treatment in men and women is endocrine therapy. Aromatase inhibitors, which stop estrogen production in postmenopausal women, are used to treat women whereas men are typically treated with tamoxifen, which blocks the effects of estrogen in breast tissue. The reason for the difference is the insufficient amount of data supporting use of aromatase inhibitors to treat male breast cancer.

Erasing the Stigma

Cancer takes an emotional and mental toll on anyone it strikes. But because breast cancer is so strongly associated with women, men often face additional psychological challenges.

Some may feel their manhood is in question once they hear the diagnosis or they may become embarrassed by it. While stigmas are real and can be debilitating, the reality is that male and female breasts are made of the same tissue.

Consequently, psychological care is a big component of treating breast cancer in men, especially for patients with estrogen-receptor-positive cancer—the most common form of breast cancer wherein estrogen receptors on the surface of the cell bind to estrogen and enable the cancer to grow. In men, this means they are creating more estrogen than progesterone, which can make them feel like less of a man. Therefore, taking extra time to address stigma is an extremely important element of care.

Scarring is another concern. Reconstructive plastic surgery isn’t offered for men who undergo surgery to treat breast cancer, so it is important to remind male patients that the scar does not make them less of a person. In fact, the scar should be looked at as a symbol of the surgery that may have saved their life.

Resources for Men

In tandem with the multitude of female-driven support systems in place for women, such as the saturation of pink every October to mark Breast Cancer Awareness Month, there are also good resources for men battling breast cancer.

The Male Breast Cancer Coalition and the Young Survival Coalition are helpful resources offering information about male breast cancer, as well as hotlines and support groups.

It is important to remember that cancer can happen to anyone – and while breast cancer in men is rare, it is real and can be deadly. As providers and oncologists, it is important that we recognize the physical and mental components of working with male breast cancer patients and provide the support systems that deliver optimal care outcomes.