Cayman’s medical profession as well as students at the St Matthews School of Medicine enjoyed an informative evening late last year at the University when three top cancer specialists in their field gave enthralling presentations into the latest developments within their own practice field of the disease. Business Editor Lindsey Turnbull was in attendance and reports.
For a small jurisdiction such as the Cayman Islands, having three cancer specialists of such stature come and lecture to those residents interested in learning more about cancer was an important event and was well received by the Cayman Islands Cancer Society as well as the medical profession in general.
Dr. Stephen Fein, a specialist in hematology and oncology at Baptist Health South Florida discussed the varying different types of blood cancers, Dr. Avelino Piñon, a consultant prostate cancer specialist at Baptist Health, South Florida talked about the latest minimally invasive treatments for prostate cancer and Dr. James Akinwunmi, visiting consultant neurosurgeon with Chrissie Tomlinson Memorial Hospital spoke about the challenges of brain tumour treatment.
US cancer rates
Fein began his presentation with an overview of cancer statistics as they related to the US. He said that cancer was the second leading cause of death amongst Americans (heart disease being the number one killer) and then went on to detail the numbers of individuals who developed certain types of cancers and their chances of survival. According to Fein, prostate cancer was the most common form of cancer in the US, accounting for 232,000 new cases (in the year up to the symposium at the end of November 2009), while breast cancer came in second with 213,000 new cases. Third was lung cancer (173,000 new cases), followed by colon (145,000) and then cancer of the lymphatic system (64,000).
Out of those who developed lung cancer, 163,000 individuals died of the disease, 30,000 men with prostate cancer died, 56,000 people with colon cancer died, 41,000 people with breast cancer and 21,000 individuals with cancer of the lymphatic system died.
Fein said that the traditional way of combating the disease was a mixture of surgery, chemotherapy and radiation; however chemotherapy was being replaced with more modern bio-agents and that survival rates were on the increase. He also said that certain cancers, such as testicular, could sometimes be treated by chemotherapy alone, without the need for surgery.
“Our goals when treating cancer are to use surgery if possible, couple with as aggressive a chemotherapy regime as the patient can take, along with a great deal of support for the patient during this tough time,” he explained.
Cancers of the blood system
Moving on into more detail on his particular field of expertise, Fein explained that leukemia was not just one disease but in fact seven different types.
Leukemia is commonly known as cancer of the blood, but a more precise definition is a bone marrow disorder. Leukemia occurs when one abnormal white blood cell begins to clone itself; the clones do not fight infection properly, nor do they die at the same rate as other white cells, which inhibits the reproduction of healthy cells.
The seven main types of leukemia are classified as either acute, which progresses rapidly, or chronic, which progresses slowly. Leukemia is also classified according to which type of white blood cell is mutating.
Fein began by discussing acute myeloid leukemia, the most common form of leukemia which could be fatal if left untreated.
“AML can be fatal within a short time frame if not caught early enough,” he said. “I would suggest that anyone diagnosed with aml needs to seek a leukemia specialist immediately.”
Dr Fein said that doctors did not know why patients developed AML, which can affect children as well as adults, but that notable spikes in the disease were found after the atomic bomb blasts in the second world war in Hiroshima, Japan, as well as the nuclear power plant disaster at Chernobyl, Ukraine (then the USSR) which happened in 1986.
“It is always a shock when it is diagnosed and can sometimes be missed by doctors,” he said. “If the patient is young and healthy we will try our best to cure them, however sometimes the treatment might cause more suffering for the patient, particularly if they are elderly, so doctors have to let the patient make the decision whether it is better to treat them or let them die in peace.”
The treatment of aml is rigid in that the chemotherapy must be administered at specific regular times, which means extra strain is placed upon patients living far from their hospital (such as those in the Cayman Islands who must travel to Miami for treatment).
“We have to assess each individual’s ability to be treated,” Fein said.
He went on to say that genetics are playing an important part in treating aml patients and they work by blocking the mutation in the cells. New to the treatment of leukemia and lymphomas will be genetic testing, which, Fein predicted, will soon be able to reveal to doctors which patients needed the most aggressive treatment.
New drug treatments that created antibodies were also now being used in the treatment of aml, all of which meant a longer life expectancy for patients.
Although chronic myeloid leukemia was not as deadly as aml because of its slower growth, it still needed specific treatment. CML, found in adults only, responded well to effective treatment developed after extensive trials, giving patients an 88 per cent survival rate after six years with the disease.
Lymphoma affects the lymphoid tissues such s the lymph nodes, the spleen, bone marrow and takes the form of a solid tumour. The two types of lymphoma are Hodgkin’s lymphoma (Hodgkin’s disease) and non-Hodgkin’s lymphoma.
“Lymphoma often starts in other areas of the body, such as the lungs and the brain and then progresses to the lymphatic system,” Fein explained.
He then went on to discuss one particular rare type – Hodgkin’s lymphoma, a type of lymphoma which is a type of cancer originating from white blood cells called lymphocytes. The disease was named after Thomas Hodgkin, who first described abnormalities in the lymph system in 1832.
Hodgkin’s lymphoma is characterised by the spread of disease from one lymph node group to another and occurs in two peak age groups: the first in young adulthood (age 15–35) and the second in those over 55 years old.
“Young adults should take note of swollen glands and in particular doctors should recognise a chain of swollen glands which could indicate lymphoma,” Fein said.
“In young adults the disease is curable around 80 per cent of the time, while it is rarely curable in the over 60s.”
Standard treatment is required regularly, every two weeks for six months; however Fein said that breakthroughs in treatment were taking place, with clinical trials currently in place to test the effectiveness of brentuximab vedotin (SGN-35), an antibody-drug which appears to be halting the disease.
“Research is showing us that new treatments for Hodgkin’s lymphoma are less toxic to the system than original treatments (which can cause infertility as well as a higher chance of developing other cancers, such as breast, later on in life) and we are therefore able to identify those patients who would benefit from such new treatments.”
Fein also highlighted Non-Hodgkin’s lymphoma, which, he said, is actually a group of different lymphomas (other than Hodgkin’s lymphoma) varying from the indolent to the very aggressive.
Non-Hodgkin’s lymphoma is cancer of the lymphatic system, the body’s immune system. In the immune systems of people with non-Hodgkin’s lymphoma, abnormal lymphocytes emerge and divide uncontrollably and at an alarming rate, overcrowding the lymph nodes and impairing their functions. This type of cancer accounts for about five per cent of all cancer cases in the United States and can spread to anywhere in the body, including the bone marrow, liver, spleen, or other organs.