Early Detection is the Best Bet

By: Joan Stewart, RT(T), BA HCA Clinical Services Project Coordinator, TCCC

A common theme in cancer care is the earlier we can find it, the better our chance of curing it. Colorectal cancer is no exception. Unfortunately, early stage colon or rectal cancer has no symptoms. Therefore, we have to use some simple tests to find it. When you consider it is the second leading cause of cancer-related deaths in the United States, it appears those 50,000+ deaths annually were avoidable if we could have diagnosed earlier.

Who needs to be screened for colon or rectal cancer? Everyone who identifies with any of the following:
√ Age 50 years to age 75 years
√ Close relative with colorectal cancer
√ Personal history of colorectal adenomas, Crohn’s Disease or ulcerative colitis
√ Personal history of ovarian cancer
√ Familial adenomatous polyposis

All of these risk factors increase if you add excessive alcohol, smoking or obesity. Not only will these three elements increase your risk of getting colorectal cancer, if diagnosed they will decrease your chance of cure.

The Centers for Disease Control and Prevention recommends the following for adults age of
50 to 75 without any of the other risk factors:
√ A high-sensitivity guaiac Fecal Occult Blood Test (gFOBT) or Fecal Immunochemical Test (FIT) every year or a FIT DNA every 3 years
√ Flexible sigmoidoscopy every 5 years and a high-sensitivity gFOBT every 3 years
√ CT colonography (virtual colonoscopy) every 5 years
√ A colonoscopy every 10 years or a flexible sigmoidoscopy every 10 years with an annual FIT

If you are over 50 and you have additional risk factors, colonoscopy is the best path. The gFOBT can determine if you have a cancerous lesion with relative certainty, but its ability to identify a pre-cancerous lesion is much lower. The National Cancer Institute estimates a 60% reduction in death rates of colorectal cancer could be achieved by the use of colonoscopy when indicated.

The American Cancer Society lists the following as signs or symptoms of colorectal cancer:
√ A change in bowel habits lasting more than a few days
√ A feeling that you need to have a bowel movement that is not relieved by doing so
√ Rectal bleeding
√ Blood in the stool, which may cause the stool to look dark
√ Cramping or abdominal (belly) pain
√ Weakness and fatigue
√ Unintended weight loss

While there may be reasons other than colorectal cancer for these symptoms, any one of them should be discussed with your family physician. For those of you approaching 50, be sure to discuss this with your family physician at your next visit. If you do not have a family physician, please reach out to Trios Health, Lourdes Health or Kadlec to establish care. For those of you with a family history of colon or rectal cancer, ask your family physician when you should begin your own screening program.

For more information about colorectal cancer, visit the National Cancer Institute’s website.

For colorectal cancer information in Spanish:

SpaceOAR® Hydrogel

By: Carl Berkowitz, TCCC Volunteer

The prostate is a small organ located underneath the bladder and in front of the rectum in men that produces seminal fluid. It is also the site of one of the most common cancers among men. Approximately 160,000 men will be diagnosed with prostate cancer in the United States in a year, and 30,000 men will unfortunately succumb to their disease. The good news is that many cases of prostate cancer are curable if caught early.

One common treatment option is ‘external beam radiation therapy’ (EBRT), in which beams of radiation are focused on the prostate gland and surrounding areas from outside the body. While already effective and reasonably well tolerated, a relatively new technology has increased the safety of EBRT and can decrease long-term side effects.

Tri-Cities Cancer Center radiation oncologist Dr. Juno Choe says, “If I was going to have external beam radiation therapy for my prostate, I’d want to have the SpaceOAR gel placed prior to radiation”. He described SpaceOAR as a relatively new technology that physically separates the rectum and prostate gland during radiation therapy. This results in significantly lower radiation doses along the rectum, and this results in a decrease in associated side effects.

Images showing spacing between prostate and rectum with SpaceOAR gel. From https://www.spaceoar.com/physicians/

Results from a multi-clinic, randomized study of 222 men concluded the SpaceOAR technique was “…associated with low toxicity rates and a reduction in patients experiencing declines in bowel and urinary quality of life.” In fact, patients who received the SpaceOAR hydrogel product had declines in bowel, urinary, and sexual quality of life at a rate that were one-eighth of the amount in the control group. To which Dr. Choe notes that “Anybody getting external beam radiation should strongly consider the SpaceOAR hydrogel product as a supplement to their treatment.”

TCCC has all of the special equipment needed for this procedure. SpaceOAR can be inserted under local anesthesia, and it takes about 20 minutes to place. “We’ve found the gel insertion procedure to be relatively straightforward and painless” Dr. Choe says, and that the worse part of the procedure for his patients is a pinprick sensation that lasts for a couple of seconds as a numbing agent is injected. His patients then describe a short-lived sensation of pressure in the rectum as the gel is inserted which he explains “…results from a gentle pressure on the rectum. Our patients say this sensation of pressure usually dissipates almost immediately but may last a couple of days.”

Dr. Choe notes that “we’ve done a number of SpaceOAR insertions at the Center, and we have been pleased with both the relative ease of the insertion procedure and the separation achieved between the prostate gland and rectum. Patients have been very  happy with their radiation treatments with the use of the SpaceOAR hydrogel, and we have seen a very favorable side effect profile afterwards. ”

1 Int J Radiation Oncol Biol Phys, Vol. 92, No. 5, pp. 971 – 977, 2015

Terry Warnick and SpaceOAR®

By: Carl Berkowitz, TCCC Volunteer

The Gleason Score
There was concern in 2012 when Terry Warnick’s Prostate-Specific Antigen (PSA) levels went slightly above the ‘normal’ value of 4.0 ng/mL. But then his count went down. Then back up. Then down. This up-down cycle continued through 2015 when his PSA levels not only went up but stayed up followed by a biopsy to understand what was going on. The pathologist who examined the biopsied samples looked for two types of cell patterns known to be associated with prostate cancer, giving Terry a ‘Gleason Score’ of 3+3. Because the sum of these two numbers was less than seven, it was recommended that a watch-and-wait protocol be followed, with Terry’s PSA levels to be closely monitored on a regular basis.

Eventually Terry’s PSA levels climbed up to nine, well above the normal value, and another (his third) biopsy was done in 2017. This time Terry had a Gleason Score of 3+4, at which time Kadlec Clinic urologist Dr. Patrick Gavin said ‘let’s take action.’

The action started with Terry meeting Tri-Cities Cancer Center oncologist Dr. Juno Choe to learn what treatment options were best suited to his specific case. There were many options, but Terry says “Dr. Choe gave me a full hour of his time, educating me about what therapies were available, and clearly describing the pros and cons of each one.” They settled on radiation therapy, but with a new twist.

SpaceOAR enters the discussion…
Treatments of prostate cancer had come a long way since Terry’s father was treated with multiple implants of radioactive seeds during his last 15 to 20 years of life (he passed away from another condition). Dr. Choe told Terry that a new technology, ‘SpaceOAR’ had recently been introduced as a state-of-the-art treatment and he’d found that this supplement to radiation treatment greatly reduced the discomfort commonly associated with radiation therapy of the prostate. As Dr. Choe explained it to Terry, the SpaceOAR gel acts as a spacer, pushing the rectum (which is the ‘Organ At Risk’ in ‘SpaceOAR’) away from the prostate. This added space greatly reduces the exposure of the rectum to radiation as the prostate is treated, with a corresponding reduction in undesirable side effects.

Terry decided to give SpaceOAR and radiation therapy a try, and says he’s glad he did. “The discomfort associated with insertion of the SpaceOAR gel was nothing compared to the three biopsies I’d already had. There was a pinprick as Dr. Choe injected a numbing compound followed by a short-lived feeling of fullness as the spacer gel was inserted.” Terry’s radiation treatment started two weeks later. Post treatment, he noted some tenderness on his hip (where the beam of radiation passed through on its way to the prostate), some dryness of his skin and residual fatigue associated with most radiation therapy. But otherwise, he says he was symptom free, and he’s optimistic that a follow-up check this spring, after his PSA level settles down following his treatment, will result in a clean bill of health.

Asked if there were any surprises with the treatment, Terry noted that at the start of each radiation session the TCCC technicians would do a 3-dimensional x-ray scan to position the radiation beam and to check that he had an empty rectum and inflated bladder. The empty rectum was needed to minimize pressure on the prostate from behind, while an inflated bladder moved the front of this organ away from the prostate. Terry said the empty rectum part wasn’t too hard or too bad. But it was an ongoing challenge to get the timing and amount of the inflated bladder part right. “If I wasn’t fully ‘tanked up’ the technicians would send me back to the waiting area with instructions to start drinking.”

But he also joked that if he was fully ‘tanked up’ or, worse, ‘over tanked’… well, he only had to lie still on the radiation treatment table for a few minutes before relief was quickly sought!

Cancer Risk: Nature vs. Nurture

By: Joan Stewart, RT(T), BA HCA Clinical Services Project Coordinator, TCCC

It is human nature to look for quick fixes that solve health problems and cancer has a lot of quick fix news on the Internet. But with more than 100 related, but separate, diseases that are called cancer, can there be a quick fix? This is a disease with no single cause, and what seems to be an infinite number of unique ways to avoid a ‘fix’. Instead of trying to fix cancer once it comes, let’s put energy into avoiding or preventing the disease!

Most of us have heard of the BRCA cancer genes that increase a woman’s chance of getting breast or ovarian cancer. But it is only an increase in risk; having those genes doesn’t mean cancer is a foregone conclusion. Less than 10% of all cancers are directly related to genetics and only 5% of women with breast cancer are carrying a BRCA gene. Many other factors must come into play and that is where we get into nature vs. nurture. Nature (genetics) may have given you a risk, but the choices you make can either increase that risk or nurture your cancer avoidance. There is strong evidence that healthier lifestyles and simple cancer risk reduction choices can prevent one third of all cancers in the United States.

Let’s start with healthier lifestyles. Physical activity is paramount to maintaining a healthy weight, good circulation and an efficient metabolism. On the other hand, obesity is directly related to seven different cancers. Recommendations for physical activity start at a brisk walk for 30 minutes five times a week. So find some time for that walk or any exercise. Not only will you be working towards a healthy weight, you will be improving circulation which can flush out toxins and possible carcinogens like free radicals.

Proper diet is the next best addition to a cancer risk reduction program. It’s true: a diet high in red meat is linked to colon cancer. Too much processed meat leads to increased risk of colorectal and stomach cancer. Too much alcohol can lead to liver cancer. The recommendations from the American Cancer Society, the National Cancer Institute, the American Institute of Cancer Research, the World Health Organization and many others are very clear: eat a variety of colorful, fresh whole foods, mostly plant-based proteins and stay away from sugary or processed foods.

Researchers in cancer and nutrition have identified many naturally occurring substances in plant foods with the power to defuse potential carcinogens. Some of these nutrients and natural plant chemicals can neutralize toxins before they can cause cell damage that may lead to cancer. Others can assist the body to make repairs at the cellular level. Still others may help stop cancer cells from reproducing. Even after a cell begins to experience damage that can lead to cancer, what you eat and drink, and how you live can help prevent the cancer process.

As you work to improve the amount of fresh fruits and vegetables in your diet, the question of organic vs non-organic selections may come up. We hope you can choose well but if buying organic is a challenge please consider The Shopper’s Guide to Pesticides in Produce™ published by The Environmental Working Group. The guide lists certain foods they call the “dirty dozen plus two” (non-organic fruits and vegetables with the highest amount of pesticides) and the “clean fifteen” (non-organic fruits and vegetables with the least amount of pesticides). The EWG’s Guide is available at http://www.ewg.org/foodnews/summary.php

Next on the list of cancer risk reduction is to simply avoid carcinogens. Too much exposure to UVA & UVB rays causes skin cancer so wear your sunscreen or cover up. Tobacco products are carcinogens so quit smoking or chewing and avoid second hand smoke. Some viruses cause cancer so consider vaccinations (HPV and HepB).

Finally, stay current on the screenings used to detect cancer. Without exception, cancer is most treatable (and curable) in the early stages. Your Tri-Cities Cancer Center offers multiple free or low cost screenings every year for breast cancer, cervical cancer, skin cancer and lung cancer. We also offer free fecal immunochemical tests for colorectal cancer- just stop in and ask! It’s a do-it-yourself kit for those who aren’t ready for a colonoscopy. For a quick look at cancer screening guidelines go to: https://www.cdc.gov/cancer/dcpc/prevention/screening.html

For more on the link between diet, physical activity, weight management and cancer we recommend information from the American Institute of Cancer Research (www.aicr.org). There you will find interactive tools to assess what you can do to reduce your cancer risk of occurrence or re-occurrence.

To see if you are at a healthy weight, check your body mass index (BMI). See what your BMI is and other ways to evaluate healthy weight at: https://www.cdc.gov/healthyweight/assessing/bmi/index.html

New Year’s Resolutions

By: Lindsey Josephson, Naturopathic Physician, TCCC

According to a recent survey by U.S. News & World Report, 80% of New Year’s resolutions are abandoned by February. There are a number of reasons for this staggering statistic, but here are a couple strategies to help you beat the odds this January:

  1. Small changes sustained over a lifetime will have far more impact on your life and well-being than a mad rush to do everything “perfectly” for the duration of January.
  2. If you fail to plan, you plan to fail. This means breaking down your goal into actionable steps you can take every day.
  3. Make your goal specific. This allows you to know if you are on track to achieving that goal. One of the most common goals every new year is to “get healthier”. While everyone wants to be healthier this is a goal you can never achieve. If you get more specific, however, you can achieve it. So a goal like “quit smoking”, or “eat fish twice per week” will make you healthier if you follow through on it.

With those things in mind, I would like to propose some small, measurable goals that can go a long way to improving your health with little or very little effort. Also, remember that while the New Year is a very popular time to enact new positive changes you can actually adopt positive lifestyle habits at any time of year, so once you have gotten into the habit of one of these changes you can start another or make a new change that’s all your own.

  1. Increase your vegetable intake by one serving every day.
  2. Increase your water consumption by 8oz (1 cup) every day.
  3. Take three deep, calming breaths every day.
  4. Go for a five minute walk after lunch every day. If you already exercise regularly, try increasing your exercise by five minutes every day.

HPV Vaccinations for Adults

By: Joan Stewart, RT(T), BA HCA Clinical Services Project Coordinator, TCCC and Ambassador, American Cancer Society Mission: HPV Cancer Free

As some of you may have heard, a three dose regimen of the HPV vaccine has been approved by the FDA for adults from 27-45 years of age in October 2018. Prior to this, the vaccine in a two dose regimen was approved for children from ages 9-14 and a three dose regimen for those from age 15 through 26. So what does this mean? Should every adult under the age of 45 who has not had the HPV vaccine run out and get it?

The FDA approval was based on a 3.5 year study of 3200 women ages 27-45. The study showed the vaccine was 88 percent effective in the prevention of HPV infection and the various disease states related to the virus such as genital warts and precancerous cervical lesions. But FDA approval is a far cry from a public policy or medical professional recommendation.

According to the CDC, every year about 14 million Americans become infected with HPV; about 12,000 women are diagnosed with, and about 4,000 women die from, cervical cancer caused by certain HPV viruses. Additionally, we know HPV viruses are related to several other forms of cancer affecting men and women. Thus, a vaccine that can prevent an infection that could someday lead to a cancer is a good thing, but it may not be a necessity for every adult over the age of 26.

We await the recommendations for this vaccine from the Centers for Disease Control, the American Cancer Society and the United States Preventative Services Task Force. At this time, any decision regarding the use of this vaccine in the adult population should begin with a discussion with your family physician. Some people may find it would be prudent, others may find it unnecessary. In all cases, it may not yet be covered by insurance and will be an out-of-pocket expense. We recommend in this case, a conversation with your health care provider.

HPV Effects on Cervical Cancer

By: Dr. Daniel Bahnmiller, DO, Columbia Shores OBGYN

Recent changes have altered the age of receiving the HPV vaccine from ages of 9-25 to the ages of 9-45. This is exciting news, since high risk HPV accounts for causing over 99% of cervical cancers. HPV 16, and 18, which are two of the strains covered by the vaccine account for 50% and 20% of cervical cancers caused by HPV. This in turn will reduce cervical cancer up to 70%, depending on the number of women vaccinated, which is significant since cervical cancer is the second most common cancer in women.

Pap smears have reduced cervical cancer up to 80%, but these programs are expensive and are limited to those who have access. HPV vaccine prevention costs much less and has the potential to reach not only those with access, but those without. So the compliment of pap smears and HPV vaccination offers a bright future of significantly reducing cervical cancer.

25 Years of Caring

By: Ken Gamboa, Director of Marketing and Business Development, TCCC

We are extremely proud to be celebrating our 25th year of providing world-class cancer care to our community. As we kickoff this amazing year, I wanted to sit down with long time employee, Kristi Rhodes, Radiation Therapist, who started with the Tri-Cities Cancer Center when we first opened our doors back in 1994.

Tell me about when you first began working at the Tri-Cities Cancer Center?
I will never forget the weekend that we moved and unpacked all of the boxes the old Kennewick General. We were excited because the new space was so huge and we thought there was no way we were ever going to be able to fill it. It was overwhelming and beautiful and within six months, we knew we had to need to expand our patient services and get
new equipment.

Can you talk a little about what the Cancer Center was like when it first opened in 1994?
There were 12 employees who started working the very first day. Most of us were transfers from Kennewick General as well as a few new employees. It was such a small group and from the very get go we were a very close knit family. That is one thing I’ve always cherished about working here – we are family. We take care of each other, we look out for each other, and we help each other. Even with the growth, we are still a family.

As a long-time employee of the Cancer Center, if there is one thing you would like to share about our 25 year history, what would it be?
I am just so proud of what the community has done in creating the Cancer Center. It started as an idea, one little spark and it took off. It is exciting to see what our donors and three owner hospitals have been able to accomplish by pulling resources and building one great facility. I am very proud of our community and our donor hospitals.

The technology inside the Cancer Center is cutting edge; can you share your thoughts on our world-class treatment?
It makes me so excited to know that people in our community can actually receive world-class treatment right here at home. There are many things that are on par and or exceed what they are doing in some of the bigger cities around us. We have many patients that go to these bigger facilities to get second opinions and they are referred right back to us to get their treatment. They are able to get treatment right here at home where their support network is and that’s very exciting. That’s where you should be. You should be where your support is, where your loved ones and the people that want to rally around you are, so they can support you when you are going through your cancer treatment.

What has been the impact of the Tri-Cities Cancer Center on you?
For me personally, I can’t imagine having a more rewarding career. When I started in radiation therapy, I was a young 22 year old woman, newly married, and expecting my first child… I have grown up with the Cancer Center. I am so excited and proud of what we’ve been able to accomplish.

Over the years, there are usually personal memories that will always stick with you. Are there any that you will always remember?
Many years ago, I had a rough day and I was feeling tired and unaccomplished. We were treating one of the greatest guys, a young man with a bad disease and yet he had a super great attitude. We got done with his treatment and he said, “Hey, why don’t you come out to the waiting room so I can introduce you to my wife.” I thought, “Okay, I can do that.” So, I walked out to the front with him and this tiny little blond girl from across the room squeals, “Daddy, daddy, daddy,” and leaps out of her chair and runs across the room and jumps into his arms. He turned and looked at me and said, “Just in case you wondered, that’s why you came to work today.” It touched my heart and it meant so much to me. We all have bad days once in a while or when you’re not getting things accomplished the way you’d like. That’s when I remember the reason I am here today, and it’s to take care of people and I am honored to do that. Sometimes you just need those touchstone moments to put everything in perspective.

When you think of the Tri-Cities Cancer Center, what word comes to mind?
If I had to pick one word, it would be hope. I feel like we offer our patients and their families hope. Hope that things are going to get better. Hope for positive outcomes. Hope for more time with loved ones. Hope for improved quality of life. There’s always hope. The Cancer Center does a really great job with our navigation programs, support services, giving our patients and their caregivers and their families hope and support to help get them to a better tomorrow. That means a lot to me.

Thanks for taking time to share your story, Kristi.

Be sure to stay up-to-date with all of our stories and information on our website at tccancer.org/anniversary