Kadlec Tri-Cities Cancer Center

The thyroid gland is an organ of the body’s endocrine system in the front of the neck. It is responsible for secreting a hormone, conveniently named “thyroid hormone,” which helps regulate the body’s metabolism and temperature.

It is not uncommon for a patient to notice a painless lump along the front of their neck and, most of the time, it is nothing to be concerned about. The lump may be an enlarged lymph node from an infection, or possibly a side effect of medication. Even when the lump is on or in the thyroid gland itself, it is often nothing serious. On rare occasions, however, it may be a sign of cancer.

Thyroid cancer was once a rare disease. However, over the last 20 years, its incidence has sharply increased, in fact more rapidly than any other cancer in the United States. An estimated 65,000 people will be diagnosed with the disease this year.

Most of this increase in new cases of thyroid cancer can be explained by improvement in, as well as increased access to, early detection methods. Thyroid ultrasounds are now widely available even in primary care offices. If an abnormal thyroid nodule is found, it may be followed with subsequent imaging studies or biopsied to rule out cancer.

Instances of thyroid cancer peaks near the age of 50. Women are more commonly affected than men, but mortality rates are higher in men with the disease. Most cases arise in patients without a family history of the disease.

Fortunately, thyroid cancer has an overall excellent prognosis, with approximately 98% of patients surviving five years after diagnosis. By far, the most important predictor of outcome is the patient’s age at diagnosis, and younger patients tend to have better survival. Other important characteristics include the size of the disease, whether it is completely contained within the thyroid, and whether lymph nodes are involved.

Treatment of thyroid cancer nearly always starts with surgery. The portion of the thyroid gland that is removed during surgery is given to a pathologist to examine. The pathologist will look at the disease under a microscope in order to make a final diagnosis and report on the size of the cancer as well as any other aggressive features. Certain findings may increase the chance that the cancer will return and will lean toward a recommendation for further treatment which may include radiation therapy.

Radiation therapy for thyroid cancer is most often accomplished by a form of “internal radiation” using a radioactive isotope of iodine called iodine-131, or simply I-131. I-131 can be thought of as a Trojan horse of sorts. Thyroid cancer cells, just like normal thyroid cells, take up iodine from the food we eat and use it to create thyroid hormone. I-131 is a radioactive form of iodine which, once ingested, is taken up by any existing thyroid cancer cells and, in the process, destroys those cells. Our team at the Tri-Cities Cancer Center often partners with area Endocrinologists for the delivery of I-131 and Ear, Nose and Throat (ENT) physicians for the treatment of thyroid cancer.

Some thyroid cancers, such as anaplastic or medullary, have mutated to become even more different from thyroid cells and no longer take up iodine. In those cases, I-131 may not help and “external radiation” using X-rays may be needed. This form of external radiation is one of the special capabilities of the Varian Edge at the Tri-Cities Cancer Center.

“It started as a soft lump on the back of my shoulder, about walnut size. The initial diagnosis was just a little fatty tumor, but not cancer.” said Maurice Schmidli, “But a year later it had grown to the size of a mango cut in half.”

Which was when his primary care provider at the Seattle V.A. Hospital said it had to be removed. Although the surgeons were initially concerned about doing the procedure on a 90 year old WW II veteran, their concerns vanished when they met Maurice and saw the great condition he was in. Then there was no question about how to proceed.

“They said I was in better shape than most 60 year olds. And the procedure went well although a biopsy of the removed tumor showed I had a rare and potentially deadly form of liposcarcoma that would require more treatment.”

The V.A. initially wanted Maurice to get 6 weeks of daily treatment in Spokane. But Maurice and his wife, E’Reani (also a cancer survivor), had a farm in Pasco that needed attention every day. So neither an extended stay in Spokane nor a two hour drive to Spokane, twice a day, for six weeks was feasible.

As an alternative, they proposed that the treatment be done in the Tri-Cities. E’Reani argued that “…we have a world class cancertreatment center just 15 miles from our house. It made no sense for us to travel to Spokane for what could be done right here.” Based on the information E’Reani sent the V.A., the Tri-Cities Cancer Center (TCCC) was contacted, administrative details were worked out and the treatment plan for Maurice was finalized.

Which is how former U.S. Army Sgt. Maurice Schmidli met former U.S. Navy Lieutenant Commander Dr. Sue Mandell, the Medical Director at the TCCC.

The two vets hit it off right away. “We were very impressed with her competency and her warmth. She’s been a wonderful doctor to work with.” Although cancer is a scary thing to deal with, and death is something many patients think about, Maurice had a different attitude. He felt that, as a result of the treatment he was receiving at the Seattle V.A. Hospital and the TCCC, his bout with cancer didn’t begin to approach his closest brush with death.

This occurred more than 70 years ago during the Battle of the Bulge where he served in the infantry for one of the bloodiest battles ever fought by the United States and what is considered by many to have been the turning point of the war in Europe. “I was a kid of 18 years who just accepted where I was and did what I had to do.“ But he admitted that he didn’t fully realize the pressure he was under until he was given R&R back where the artillery pieces were positioned, far behind the fi ghting line. “Only then did I realize how much pressure we felt during these battles.”

His philosophy towards battling cancer was similar. When it was identifi ed, he accepted it and did what had to be done. “You have to learn the ramifi cations of your choices and decide what to do, what not to do and what will happen if you do or don’t do something.” To which E’Reani added “And also head for Kennewick if you have cancer”.

Lt. Cdr. Dr. Mandell recently gave Sgt. Schmidli a clean bill of health. Now he and E’Reani continue to stay in shape by working in their big garden, maintaining 5 acres of beautiful farmland in Pasco and staying active in the community through organizations that include the Tri-Cities Elks and the Tri-Cities Wine Society. They are in great condition today, full of life, vigor and warmth. Their advice to other cancer patients is to accept where you are, search out the best medical care you can, and do what has to be done. Also “…have a glass of good wine every day…preferably a shiraz or tempranillo.”

Did you know the Tri-Cities Cancer Center offers services by appointment to those undergoing treatment at no cost? These services are just a very small part of all the different services that we offer our patients and their families.

Luxury Facials
Sunny Almeida from Aesthetic Journey will welcome you into our aromatherapy-filled spa room and provide a 50-minute facial that will leave you revived, refreshed, and with a healthy glow. Enjoy being pampered by Sunny as she provides this complimentary luxury facial.

Hair and Wig Styling
Franki Anderson from Franki & Co. will assist patients who have lost their hair from cancer treatment with selecting a complimentary wig and provide personalized wig styling. You will look great when you walk out!

Have you heard this before? “I’m a survivor.” “He is so awesome, what a survivor.” “My BFF is a breast cancer survivor.”

Survivorship has been a buzzword for some time; a term reflecting life after cancer treatment. But now we recognize survivorship needs more focused attention. As the number of people living for long periods after a diagnosis of cancer increases, it has become evident there should be a focused plan of care after treatment. That plan is called a survivorship care plan.

Cancer and its treatment can certainly take their toll. Issues cancer survivors may face after therapy include pain, fatigue, fear of recurrence, living with uncertainty, neuropathy, lymphedema, bone loss, sexual dysfunction, cardiovascular disease, memory issues, and future cancer risk. While some of these issues will fade with time, others may linger. A Survivorship Clinic looks to minimize these issues and overcome them when possible.

The development of a Survivorship Clinic is in keeping with quality measures as outlined by the American College of Surgeons Commission on Cancer and the National Comprehensive Cancer Network guidelines. Your Tri-Cities Cancer Center adds this to our support services as part of our mission to provide and coordinate the highest quality compassionate cancer care for the community we serve.

Frequently Asked Questions
How do I benefit from this?
The goal of a survivorship plan is to help each cancer survivor understand where they have
been and what lies ahead. Most cancer survivors find their experience a life changing event. We want to help them move forward with individualized resources and referrals. This personalized survivorship care plan is shared with the entire health care team: medical oncologist, radiation oncologist, any specialist involved and the primary care provider. This will facilitate strong coordination and reduce the potential for unnecessary appointments or testing in the future.

Am I a candidate for a Survivorship Clinic?
Most cancer care teams are offering a survivorship visit but it is a new development that has a lot of room for growth. The Tri-Cities Cancer Center is currently reaching out to breast cancer survivors regarding their interest in survivorship care. In the future, we will expand the program to include other cancers.

Will my insurance cover this visit?
Most insurance plans consider Survivorship Clinic appointments a necessary visit for individuals who have received treatment for cancer. Before coming in for an appointment, we will review your coverage and assess any out-of-pocket expenses. Our Patient Financial Services Representative is available to provide counseling for those with questions or concerns.

Where can I find more information on survivorship?
We recommend these helpful websites:

Home

http://www.cancer.gov/about-cancer/coping/survivorship
http://www.cancer.net/survivorship
http://www.nccn.org/patients/resources/life_after_cancer/default.aspx

For the next 26 weeks while the Center is in its remodeling phase, over 45 volunteers will provide over 135 hours of work a week, totaling 3,510 hours during our construction project. These volunteers are serving in positions where they will greet new patients and accompany them down the halls to the new clinic. Each volunteer is committed to the safety of our patients. But their dedication to our mission simply makes them a true blessing and great addition to our team.

As the technology of radiotherapy has evolved over recent years, so has our ability to safely and accurately deliver a high dose of radiation to a target while allowing us to spare tissues that are just a fraction of a millimeter away. These technological advances have allowed us to shorten our treatment courses for cancers and other disorders from several weeks to as few as a single painless treatment. When a single high dose of radiation is delivered to an area in the brain or spine, it is known as radiosurgery.

Over the last several years, radiosurgery has grown in its utility and it now gives us the ability to treat not only cancers in the brain, but also non-cancers such as Trigeminal Neuralgia, Acoustic Neuroma, Arteriovenous malformations, meningiomas, and certain tremors. There was a time when patients who needed radiation to their head would be referred to a facility where a metal headframe was bolted onto their head with surgical screws. The patient would wear this headframe for several hours while a number of tests were performed followed by the procedure itself.

This technique is now obsolete. In the modern era, frameless radiosurgery is the standard of care and we are proud to offer these frameless stereotactic radiosurgery procedures with the Varian Edge at your Tri-Cities Cancer Center. Patients can now be fitted with a plastic molding of their face which allows us to stabilize their head for the procedure. On a separate day, the patient can have all other imaging that may be needed for planning of their treatment. This technique does not compromise accuracy or outcomes and it improves patient comfort and convenience.

Skin cancer is by far the most common cancer in the world. Although several risk factors exist, most skin cancers occur in older patients and are a result of ultraviolet light from years of exposure to sunlight or your local tanning bed.

Skin cancers can generally be classified into two main categories: melanoma and nonmelanoma. Melanoma is an unpredictable disease with a penchant for spreading throughout the body. Of the nonmelanoma skin cancers, basal cell and squamous cell carcinomas are the most common. These cancers rarely spread to other sites of the body, but do have a tendency to grow locally and thus still require treatment.

Fortunately, nonmelanoma skin cancers respond well to modern treatments, so the goal is not simply to cure the disease, but to do so with maximal preservation of function and cosmesis. Each patient is different and each tumor is different, therefore any treatment must be customized to account for individual factors. Surgery, including Moh’s surgery, may be the most effective and efficient means to address skin cancer, but depending on the location and size of the tumor, radiation therapy is often the better option.

Hopefully, if you’ve been treated for skin cancer, the option of radiation therapy (RT) was one of many that were discussed. RT tends to be an excellent treatment for patients age 60 or older with skin cancers involving the face (especially near the nose, check, lip, or eyelid) as it offers high cure rates as well as an excellent cosmetic outcome. RT may also be indicated in cases when the tumor appears particularly aggressive or is not completely removed after surgery, known as positive margins.

The downside to radiation therapy is convenience. The treatment involves daily (weekday), 30-minute, visits to the Tri-Cities Cancer Center for 3-6 weeks. Fortunately, the treatments themselves are short and painless. Numerous studies have been published on this approach and tumor control rates are consistently above 90% with very mild side effects, including skin dryness, peeling, and irritation when the treatment is performed by experienced radiation oncologists.

In the majority of cases, skin cancers are diagnosed by dermatologists who are trained to perform skin biopsies and surgical removal. Naturally, when a skin cancer
is found, and a skin surgeon is standing right in front of you, it’s easy to think surgery is what should be done, but patients should always be made aware of other treatment options. Thus, it is important for all patients who are diagnosed with skin cancer to have a second opinion with a radiation oncologist before they decide on the best treatment for them. A word of caution, radiation therapy should never be recommended, offered, or delivered outside of a radiation clinic at a cancer center and only be delivered by a trained radiation oncologist.

A precancerous form of squamous cell carcinoma, known as actinic keratosis, is also effectively treated with a non-surgical treatment known as photodynamic therapy (PDT). PDT is a very unique approach that was developed at the National Cancer Institute. This treatment involves injection of a photosensitizing agent which accumulates in abnormal cells. This agent is then activated with a certain wavelength of light that results in destroying these precancerous cells. Results from this treatment approach appear better than other current approaches including cryotherapy.

September is a special month for Monte Sample. On September 8, 2012 he asked for Wendy Henne’s hand in marriage. And just six days later, on September 14th, he was diagnosed with a deadly tumor in his brain. Then, on September 14, 2013, exactly one year after the tumor diagnosis, Monte and Wendy were married.

“I always look for a way to turn a bad thing into a good thing,” Monte stated. “Getting married on the same date as a brain cancer diagnosis was a natural way to do this.” But Monte is quick to note that the September 14, 2012 cancer diagnosis was incorrect, although it was an incorrect diagnosis from which he learned a great deal.

Trips to the emergency room in 2012 for recurring headaches led to an MRI that revealed a mass deep within Monte’s brain. This was initially diagnosed as a Stage IV glioblastoma (GBM), a diagnosis associated with a survival rate of 3 months. He was given the option of same day emergency surgery with all the inherent risks of brain surgery, but he deferred, wanting the weekend to talk with his children and family.

The MRI and diagnosis puzzled Tri-City neurosurgeon Dr. Brian O’Grady, who said that while the mass looked like a GBM, Monte just wasn’t acting like someone with had a GBM. A biopsy supported Dr. O’Grady’s hunch. The mass was identified as a slow growing pilocytic astrocytoma that could have been in Monte’s brain since he was a juvenile. Or, as Monte said, “I have the brain tumor you want to have if you’re going to have a tumor.” The depth of the tumor in Monte’s brain made full removal very

complicated using traditional surgical procedures. Since then, he’s learned of treatments using state of the art radiation therapy, as was recently described by TCCC radiation oncologist Dr. Guy Jones in the article, ‘Radiation Therapy: it’s not just for cancer (see the February 2016 issue of the TCCC newsletter). New technologies, such as the TCCC’s Varian Edge, can deliver localized doses of radiation useful in combating a variety of diseases with abnormal growth patterns, including difficult to reach tumors in the brain. And as Monte notes, another plus of the Tri-Cities Cancer Center’s Varian Edge is simply that this
capability is available here in the Tri-Cities.

While Monte’s tumor was found to be non-malignant, he still had many of the symptoms that brain cancer patients endure including bouts of vertigo, disorientation, fatigue, short term memory loss, and complications associated with high doses of dexamethasone, the later including avascular necrosis that has resulted in bilateral hip replacement.

All of which gave Monte a strong sense of empathy for brain cancer patients. This sparked the idea of working with the Tri-Cities Cancer Center to develop a focus group for persons with this diagnosis. He envisions a program where patients, along with their families and friends, can talk about their fears and concerns, and have a place they can share therapy experiences and plans. Visits by specialists from the Tri-Cities Cancer Center and other medical facilities would talk about new research treatments and technologies like the Varian Edge.

Which is to say that Monte is once again looking to turn a negative into a positive, and he’s hoping others will join him in doing the same. TCCC Chaplain Margaret Ley will be working with Monte to start a focus group. Individuals interested in participating or learning more can contact Margaret at (509) 737-3400.