Your Best Life 2023

Sunday | October 22 | 2023

cancer YOU and

KEEPING YOU WELL

Cancer and You | Sunday | October 22 | 2023

Reporting by Leslie Cardé and Amanda McElfresh | Edited by Annette Sisco Layout, design and cover by Brian Golden

Visit us online! nola.com/bestlife/

Section highlights advances in screening, treatment of cancer

I

n this edition of Your Best Life, we highlight the progress medicine has made in research, early detection and treatment of cancer. We also feature the true stories of people determined to fight a cancer diagnosis.

These days, screenings for many forms of the illness are extraordinarily precise and sensitive. Scientific findings are making it possible to screen for disease sooner than ever.

Meanwhile, treatments have become more sophisticated, as advanced protocols

are developed and shared. Pinpoint surgery and revolutionary new medications give our loved ones their best chance yet of surviving and thriving after a cancer diagnosis.

Of course, none of this would be possible without our community’s dedicated medical professionals.

We hope the advances in the field, along with the inspiring real-life stories of those who have faced cancer, inspire all our readers — especially those coping with cancer — to live your best life.

– Alisha Owens | aowens@theadvocate.com

Leslie Cardé is an award-winning New Orleans-based journalist. She covers topics ranging from medicine to entertainment while working as a special projects medical producer for CBS. Visit her website at lesliecarde.com.

Alisha Owens is vice president of sales for Georges Media.

Schedule a Mammogram Each year during Breast Cancer Awareness Month, Baton Rouge General makes it our mission to encourage women 40 and older and others at risk for breast cancer to schedule a mammogram and Protect Your Pumpkins!

Scan this QR code or Call (225) 769-1847 to schedule a mammogram

With increasingly sophisticated tests, early detection saves lives

What causes cancer?

Scientists investigate risk factors to head off disease

Joe Ramos, Ph.D.

By Leslie Cardé

W

hat is cancer? It often arrives without warning, with no indication that there is anything awry within our bodies. But it is not an alien invader of unknown origin. In fact, it is a mutiny on the part of our body’s own healthy cells.

For reasons that still elude scientists, the transformation of ordinary cells to out-of-control cancer cells that multiply and destroy otherwise healthy tissue is not easily understood.

It can happen anywhere in our bodies, from the brain and the breasts to the lungs and the colon. With the advent of medical research and discovery, we have learned how to screen for many cancers.

Mammograms give patients a good idea that breast cancer may be looming, helping to catch cancer at its earliest stage. Annual pap smears can detect abnormal cell activity and have gone a long way to diminish the incidence of cervical cancer. And the colonoscopy is the gold standard for finding polyps and potential malignancies before they have a chance to metastasize, spreading their poison to other areas of our bodies.

Screenings, however, are not available for some of the deadliest cancers and most aggressive ones. In many cases, by the time symptoms crop up, the cancer is far from its infancy, and has traveled

Philippe Prouet, M.D.

through the lymphatic system and bloodstream to contaminate sites far from the original lesion.

“With pancreatic cancer, we rarely discover it when it’s still at stage 1, when it is still confined to the pancreas itself,” said Philippe Prouet, M.D ., medical oncologist, Ochsner Cancer Center of Acadiana. “At that point, you still only have a five-year survival rate of 45%. By the time you have lymph node involvement, you’re down to 15-20%, and if you’re stage 4, wherein the cancer has spread to other organs, the odds of survival are reduced to just 3%.”

As Prouet notes, if one happens to notice jaundice (a yellow tint to the skin or eyes), or coincidentally someone appears in the emergency room following a car accident, gets a CT scan,

and the cancer happens to be detected early, you’ve discovered it at stage 1 — but that is a rarity.

The reality, as of today, is that many cancers, whether it’s brain cancer or ovarian cancer, do not have symptoms until the spread precludes any sort of cure.

Still, we are learning much more about genetics and who is most susceptible to contract certain cancers.

That means measures can often be taken to thwart cancer before it ever has a chance to infiltrate our organs or bloodstreams.

We also have a much better understanding of the conditions under which cancer can flourish, and newer treatments are targeting the genetic makeup of tumors, with precision medicine aimed at stopping the specific way the particular cancer proliferates.

Cancer has proven to be a formidable foe for clinicians and researchers alike.

But great strides have been made, even in the last few years.

Immunotherapy, although still in its infancy, has been instrumental in helping our own immune systems battle the invading cancers, and many more targeted therapies are on the horizon, giving all of those who have been diagnosed with any sort of cancer incredible hope for the future.

Many of the cancers we see are not only caused by a genetic predisposition or a susceptibility, but by the environment in which they thrive. Is there a toxic environment contributing to cancer cases? And, how much does lifestyle play into the equation? These are the reasons that specific cancers may be more prevalent in certain areas of the world, and even different here in the U.S. from state to state. So, how does Louisiana stack up?

“Louisiana ranks No. 3 in the nation in terms of cancer deaths,” said Joe Ramos, director and CEO of the Louisiana Cancer Research Center, a research institute headquartered in New Orleans. “There are so many factors that contribute to cancer. Among them are smoking, obesity, toxic air or water, a lack of exercise, and less education — which translates to less screening. They all combine in Louisiana to increase the risk of cancers.”

Ramos works with research centers throughout the state to determine what’s prevalent, and works on innovative ways to encourage screenings, while trying to determine cause and effect in many of the dominant cancers. Ramos is a firm believer that knowledge is power and that if people better understand the risks and the importance of detecting cancers in their formative stages, we can reduce the state’s cancer numbers dramatically.

“Lung cancer has the highest death rate in the state,” Ramos noted. “By bringing more researchers here, and advocating for more screening, we could see those numbers shift. At the moment, only 3% of high-risk people are screened for this cancer, and we need to get at least 50% of the people screened. We’re advocating that people work with their doctors. Low-dose CT scans can pick up pencil-point or even smaller tumors. The testing is covered by insurance, and it’s life-saving.”

According to Ramos, unraveling the genetic codes to some of these cancers is the key to finding cures. He says our knowledge is growing exponentially.

We can sequence the DNA in a single cell, look at cancers spatially, and can now see that cancers are not just one thing, but varied, as there can be genetic differences in the same tumor in the same person.

“If you can understand these cancers really well, you can work on tools to fight them. We now know how to target cancers not just with chemicals, but with engineered proteins, antibodies, and vaccines.”

Ramos is hoping for a blood test in the next five years that will denote the presence of cancer in the body, which can then be delineated with further testing. Hope, he feels, is decidedly on the horizon.

Skin cancers can be treated in a variety of ways.

But prevention is No.1, experts advise.

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here are well over 100 different types of cancer, many obscure, and some extremely dangerous, hard to detect and hard to treat. Among the most common types, which affect hundreds of thousands of people every year, in order of prevalence, are breast, prostate, lung, and colorectal cancers.

Those four cancers account for 50% of all cancer deaths every year.

But, far and away, the most widespread form of cancer, at nearly five times the frequency of breast cancer, is skin cancer.

Studies show that 5.4 million basal and squamous cell carcinomas are diagnosed every year, with 98,000 melanomas added to that list. The more serious melanomas will result in 8,000 deaths. We’ve lost Bob Marley, Al Copeland, and most recently Jimmy Buffett to different skin cancers.

Prevention is simple. Protect yourself from the sun, or more to the point from dangerous UVA and UVB rays.

“Even worse than unprotected sun exposure is the damage that’s done by the ultraviolet rays in tanning beds,” said Suneeta Walia, M.D,, dermatologist and Mohs surgeon, Ochsner M.D. Anderson Cancer Center in New Orleans.

“Tanning beds have a bigger link to skin cancers than smoking has a link to lung cancer. We’ve long known that early intense exposure to UVA and UVB rays is more dangerous than chronic exposure over time. I’m dealing with more 30-yearolds with melanoma than ever before, due to the very potent carcinogens produced by tanning beds.”

The most common and least dangerous form of skin cancer is the basal cell carcinoma. It presents as a shiny pearly bump or a flat red scaly lesion, sometimes resembling a wart. Although basal cells rarely spread (1%), they can crust and bleed as they progress. Left untreated,

Suneeta Walia, M.D.

they can eat through the skin.

Squamous cell carcinomas, more serious than basal cells, can metastasize or spread, although it is still rare. Both skin cancers can be treated through a variety of methods, depending upon what they look like upon analyzis with a biopsy, once a small piece of tissue is removed.

That can consist of scraping and burning, freezing through cryotherapy, or can even be treated topically with creams that stimulate the immune system.

For skin cancers of the head and neck, Mohs surgery is often indicated. It is the specialty of fellowship-trained Dr. Walia, and is named after the doctor who discovered the procedure back in the 1940s.

It is the process of planing off the cancerous layers of the skin, with the goal to remove as little skin as possible while making sure to excise all of the cancer.

“I remove the cancer on the surface first, plus a two-millimeter border fanning out from the cancer,” explained Walia. “The tissue is then processed while the patient waits. I examine it under a microscope to ensure I’ve gotten all of the cancer. If not, I remove another

By Leslie Cardé

layer, until eventually, all of the margins are clear. Most patients require two or three passes, but I’ve removed as many as 13 layers.”

Most patients will see granulation occur where new skin forms to fill in the holes left behind from the tissue removal. If that doesn’t occur, skin grafts or flaps may be required.

Melanomas are far more aggressive, and left untreated can metastasize throughout the body.

Bob Marley thought he had a soccer injury to his foot and didn’t seek medical attention until it was eventually diagnosed as a malignant melanoma under the nail of his big toe. It finally spread to his lungs and brain, which caused his death at the age of 36.

Melanomas are best treated early, and depending upon the particular stage may require surgery, chemotherapy, immunotherapy or targeted drugs. It is important to have regular full body checks by a dermatologist once a year to avoid finding this sort of cancer at a late stage.

A new vaccine to prevent recurrences of melanoma is currently in phase three clinical trials, but the jury is still out.

“Most cancer vaccines have been largely unsuccessful, but this is the first one using mRNA technology (the same technology used in making the Covid vaccines)”, said Daniel Johnson, M.D., hematologist/oncologist at Ochsner MD Anderson Cancer Center. “Phase 2 data from the trial shows adding this vaccine to Keytruda (approved immunotherapy for stage 3 melanoma) improves recurrence free survival, but whether this provides an overall survival benefit can only be determined once the study is complete.”

Be safe in the sun.

Here’s how.

The cancer responsible for the deaths of local entrepreneur Al Copeland and singer-songwriter Jimmy Buffett is known as Merkel cell cancer. It is the least prevalent form of skin cancer and the most lethal.

“It is extremely rare and involves the touch receptors by the nerves in the top layer of skin,” explained Walia.

“Topical sun exposure is the culprit, although there is some level of genetic susceptibility. It primarily affects males over the age of 50.”

The key, according to Walia, to preventing all of these cancers is to guard against sun damage early on. Sun damage is cumulative, and surprisingly, most sun damage happens before we’re 20 years old. Exposure to UVB produces cell mutations, which affect DNA and cause cancer. Exposure to UVA rays causes aging. But, it’s never too late to prevent further damage. Following are some tips to prevent finding yourself in a surgeon’s office down the road.

• After 10-15 minutes in the sun, apply sunscreen.

• Always reapply after two hours, or sooner if it’s being washed off in the water.

• Use physical sunblocks which contain zinc and titanium dioxide, as opposed to chemical sunscreens which do not reflect the rays.

• High altitudes, water and snow intensify exposure and call for stronger blocks.

• For maximum protection, wear clothes with ultraviolet protection factor (UPF).

• Hats provide protection for the scalp, where many skin cancers hide under the hair.

• While lighter skin has a higher risk factor, darker skin has only minimal protection and still requires sunblock.

• Protect your children from future skin cancers by starting them on a skin protection regimen early in their lives.

MAMMOGRAM: A FEW MINUTES FOR A LIFETIME

TAKE TIME TO SQUEEZE IT IN Make a commitment to yourself and schedule your mammogram today.

Those 15 minutes may save your life.

To schedule an appointment call (337) 470-SCAN (7226) or discover more at LourdesRMC.com/mammogram.

Breast self-exams

saves lives, so pay attention

to body’s small changes

P

By Leslie Cardé

erhaps we should all trust our gut instincts. That’s what physician Tina Atherton (not her real name) said about her initial response to rolling over in bed and thinking she felt a lump in her breast.

“I had a feeling that something just wasn’t right, but in trying to locate it again, I couldn’t find it, so I blew it off, assuming it might have been my imagination,” Atherton said. “What I thought I felt seemed to be in the upper quadrant, and as a doctor I knew that was near the lymph nodes and could be dangerous, but in palpating the tissue, I could no longer feel it.”

Six months later, on a routine mammogram, her radiologist discovered a mass in the upper quadrant of her right breast. The biopsy showed it was cancer, which had already spread to the armpit lymph nodes.

After a consultation with a surgeon, Atherton opted for a double mastectomy, out of an abundance of caution. Her cancer was discovered at Stage 2B, and with treatment her chance of five-year survival was 90-95%. Post-op, she would have radiation first, and then be on oral chemotherapy for the next seven years.

At the four-year mark, she feels it’s a small price to pay to stay alive and tumor free. However, not all patients opt for mastectomies.

Lindsey Fauveau, M.D.

Lucio Miele, M.D., PhD

“If you have breast cancer and we find a mutation like BRCA, you have a choice to make,” said Lindsey Fauveau, M.D., breast surgical oncologist at Ochsner MD Anderson Cancer Center in Baton Rouge. “With a previous cancer and a mutation, you need to weigh your options.”

Some women who don’t want mastectomies opt for what doctors call high-risk observation. This entails twice yearly MRI imaging, and sometimes risk-reducing medications. Even with radiation, the possibility of a second event is anywhere from 40-80% with a mutant gene like BRCA, Fauveau said.

“Everyone’s risk tolerance is different,” Fauveau said.

Having a mastectomy, on the other hand, reduces your risk by 90%, the doctor said, but no one can get it to 100% because there are always microscopic bits of breast tissue under the skin, in which malignant nodules can grow, even rarely.

The best rates of survival depend on finding these cancers early.

“With breast cancer, stage 1 has a five-year survival rate of 95%, which is why mammograms are so important,” said Lucio Miele, M.D., Ph.D., Chair of Genetics and Director of Precision Medicine at LSU Health Sciences Center in New Orleans. “People ask me all the time if there’s a cure for cancer. I

say ‘yes... it’s called early detection.’

Finding tumors when they are still small is critical because larger tumors have more cells, and all you need is for one to mutate and become resistant to treatment, and it lowers your odds of recovery.”

The importance of self-examination cannot be overstated. As Miele recounts, the initial primary lesion may be so small as to be undetectable on a mammogram initially, because mammograms rely on calcification.

Tumors are so variable that some of these tumors metastasize early, and by the time they are noticed they may already be late stage, with spread of the disease to other places outside the breast.

Much of breast cancer is hormone driven, that is, the tumor needs hormones to survive. So, treatment consists of a delicate balance of starving the tumor of whatever it needs — estrogen or progesterone, for example.

Even with precision, targeted medicine, chemotherapy may still be added, because tumors are survivors that mutate to get around treatment. In fact, 20% of breast cancers have the HER2 positive gene mutation.

“It’s a protein on the outside of the cell which protrudes out and sends signals to the inside of the cell, telling the cancer to go ahead and proliferate widely,” Miele said. “In this case, the primary treatment is monoclonal antibodies which bind to the HER2 gene and block it.”

If that sounds too easy, it is. Although Herceptin is one of the agents that blocks HER2, it is often still combined with chemotherapy.

Miele explained that some types of chemo cannot be combined with Herceptin, because it’s toxic. It can cause heart damage. Patients can die of congestive heart failure.

“My friend died this way, before anyone knew about the fatal combination,” Miele said. “Tumors can also become resistant to Herceptin.

Sometimes these tumors mutate into the brain, so we now use small molecules that can get through the blood-brain barrier to attack the tumor there.”

If this sounds like a battleground, that’s an apt comparison. In fact, Miele uses a lot of military analogies when explaining just how the body fights

to survive these tumors: tumors that are determined to be the ultimate survivalists.

These tumors even have the ability to make protective curtains, so the medications cannot get in. When our own immune systems falter, it’s important to boost them, but there’s a fine line between an adequate immune system and one that doesn’t know when to stop.

“Your T-cells fighting the cancer are little military guys who want to bomb terrorists, but not the nearby village,” Miele said, in this armed forces analogy.

“So, the plane has radio sensors where the guys on the ground say, bomb here but not there. T-cells, the fighters, have receptors on them called immune checkpoints so when they are overactivated, normal cells that are seeing the onslaught of the damage say, ‘It’s OK, you’ve destroyed your target.

Cease fire.’

“Our immune system needs to know when to stop, otherwise we get autoimmune diseases, where good cells are destroyed along with the bad.”

It’s a precarious tightrope, demanding just the right combination of chemo and immunotherapy to cure the cancer — without killing the patient.

Advanced vaccines may be cancerfighters’ best shot The future of treating many cancers may be a vaccination.

The vaccine depends on mRNA, the genetic material that was used to produce the COVID-19 vaccine so quickly. What most people don’t know is that the German company BioNTech was working on vaccines for cancer when researchers were interrupted by the wave of COVID that overtook the world.

But the underpinnings of the technology were already there.

As Miele explained it, if you take a breast tumor and you analyze it, you can find the various mutations. Then, you make a mixture of a vaccine that has all the mutations .... for instance, there is a type of melanoma which has 34 mutations. Pancreatic cancer has 25.

“We are essentially doing a COVID vaccination to the immune system,” Miele said. “That’s the most promising cancer research out there —molecularly tailored treatment. It’s the wave of the future.”

LCMC Health uses breast cancer surgery advances to give patients better overall treatment and results

minds made up that they want a certain procedure, especially if they have a family history of breast cancer or specific concerns. I’ll add my perspective and opinion, but the important thing is to educate the patient on what is involved in each procedure. We try to empower them so they can choose the option they feel is best for them.

By By Amanda McElfresh amcelfresh@theadvocate.com

Alfred J. Colfry III, M.D.

This article is brought to you by LCMC Health.

Y

ears ago, when a woman needed an operation to remove breast cancer, the procedure often left them feeling disfigured, leading to low self-esteem and more emotional struggles during what is already a challenging time.

Fortunately, breast cancer surgery has improved tremendously in recent years.

Dr. Alfred J. Colfry III, a breast surgical oncologist with LCMC Health, said physicians from different disciplines often work in tandem to perform procedures that preserve more of a woman’s breast, leaving her with an appearance that she feels comfortable with while also being an effective cancer treatment.

“In 2023, you must have a comprehensive team taking care of you – physicians, nurses, therapists, support staff – all working toward the goal of a cure,” Dr. Colfry said. “Gone are the days of removing a breast cancer and rebuilding the breast later. Today,

it’s all done at the same time. It saves the patient from having to go through multiple surgeries and the risks that are associated with that. Things are much more streamlined now.”

Here, Dr. Colfry talks more about the surgical improvements and how LCMC Health physicians are putting them into practice.

What are some of the biggest advancements in breast cancer surgery in recent years?

There are two main options, a lumpectomy and a mastectomy. With a lumpectomy, we can remove a cancer and give the patient a cosmetic lift and reduction at the same time. People can keep their own breast without having a hole and feeling like they look mangled.

We can rearrange tissue to make it look very natural.

With a mastectomy, as long as none of the disease approaches the skin or the nipple, it’s completely safe to preserve the

outer shell of the breast including the skin and the nipple. In these procedures, we keep the skin and nipple in place, and remove the breast tissue through an incision that’s hidden completely beneath the breast. The plastic surgeon fills that space with an implant or the patient’s own tissue. We have decades of data that shows the cancer recurrence and survival rates are the same when we keep the outer shell of the breast intact.

How do doctors and patients work together to determine which procedure is best for them?

Sometimes, the decision is made by the cancer. If the tumor is large, a lumpectomy isn’t possible. If it’s small, that makes it an easy call to move forward with a lumpectomy. If it’s anything in between, we present the patients with their options. A lumpectomy normally goes hand in hand with radiation, so that’s a factor.

Some patients come in with their

w e n ot try s g n i th

KEEPING YOU WELL

What steps can women take to address their concerns about breast cancer?

Genetic testing has become more prevalent in recent years. If someone has several family members, particularly first-degree relatives, who have had breast cancer, it’s a good idea to talk to your doctor about genetic testing. Only 10% of breast cancer cases are caused by genetics, but if we know ahead of time that someone has a gene, we can take preventative measures.

LCMC Health has created a new cancer service line with its academic partners, LSU and Tulane, to continue to increase access and offer comprehensive, specialized care. LCMC Health and LSU are pursuing the first and only National Cancer Institute designation in the region to support families and communities impacted by cancer. The NCI Cancer Centers program is an anchor of the nation’s cancer research efforts, recognizing centers around the country that meet rigorous standards for developing new and better approaches to preventing, diagnosing and treating cancer.

What causes lung cancer?

Scientists are working to

F

By Leslie Cardé

or Sharon Fisher, the lung cancer diagnosis came as a gut punch.

A simple cold had turned into a lingering feeling of congestion, with a dry cough. Eventually diagnosed with pneumonia, a closer look revealed a lesion in the left lobe of her lung. But, how? After all, she’d never been a smoker, was an avid hiker, was still the same weight she’d been since high school, had no history of illnesses, and was a foodie who ate no processed foods and cooked healthy meals for herself, in spite of her hectic work schedule.

What most people do not realize is that in approximately 15% of lung cancer diagnoses, the patient has never smoked.

And, they had no exposure to known carcinogens.

While this fact has baffled the medical community, further exploration revealed that there were many more female neversmokers (as they are referred to) who were contracting this cancer, and at an earlier age, than smokers.

Analyzing the tumors of these never-smokers, a study by the National Cancer Institute revealed that there was an accumulation of genetic mutations within this group. Scientists are still trying to connect the dots to figure out what exposures may have added to the risk.

connect the dots

.

For patient Fisher, the lung cancer was already Stage 2 at diagnosis, and required a surgical lobectomy, wherein one of the five lobes of her lungs was removed.

After chemotherapy there was no further evidence of disease. But, the fiveyear survival rate for stage 2 lung cancer, after treatment, is only 35%.

Over the next few years, Fisher’s tumors would return in other areas of her lungs, and despite being a part of clinical trials for her specific cancer mutations and receiving various forms of immunotherapy and targeted treatments, she died of the disease four years later. She was 70 when she passed away, in 2019.

“This is why it is so important to catch lung cancer in its earliest stages,” said Ramsy Abdelghani, M.D., Tulane’s Director of Interventional Pulmonology.

“At stage 1, your 5-year survival rate is 95%. But, in Louisiana, 80% of those diagnosed are either stage 3 or 4. At these advanced stages, survival rates drop precipitously. At stage 4, you’re looking at a five-year survival rate of 5%. We’re not doing well here with lung cancer screening.”

Detecting lung cancer early is easier said than done, and in fact, most people are unaware there is any screening at all for lung cancer.

To receive the low-dose CT scan (10% of the normal radiation) that can detect the earliest of lung cancers, one must meet certain criteria. Patients must be between the ages of 50 and 80, either be a current smoker, or someone who has quit in the last 15 years.

And, the smoking history must be significant — that equates to 20 years of smoking a pack a day, or 10 years of smoking two packs a day. If these criteria are met, patients are entitled to one scan a year, covered by insurance.

But, those who have family histories of lung cancer should certainly be in that mix, as they are twice as likely to contract the disease.

Sadly, there are no signs or symptoms in the earliest of stages, so screening is vital. Finding these cancers at stage 2 means there can still be microscopic areas of disease that are present even after surgery, but are not always detectable.

The key is to know your family history, honestly discuss your smoking history with your primary care physician, and take advantage of the ability to screen for this deadly disease.

Abdelghany is meeting with primary care physicians to ensure that patients’ histories are triggering notifications that will lead to early screening.

Even if you’re not a smoker, exposure

Ramsy Abdelghani, M.D.

to radon is the second leading cause of lung cancer. It is a colorless, odorless, radioactive gas that is often found in soil and water.

Although radon decays quickly, it gives off tiny radioactive particles which can leach into buildings and homes and be inhaled. When that happens, it damages the cells that line the lungs.

Long-term exposure can lead to lung cancer. According to the National Cancer Institute, it is the only cancer proven to be associated with inhaling radon.

Diagnosis for lung cancer has become far more sophisticated of late. Biopsies are less invasive and pinpointing the exact location of a tumor has become far more accurate.

“I do robotic bronchoscopies by navigating an endoscope through the intricate branches of the bronchi, then do intraoperative imaging to confirm my location,” Abdelghany said. “This is a quick, minimally invasive technique to isolate the lesion, and get it analyzed, so treatment can begin.”

Major strides are being made in treating all types of lung cancer

Lung Cancer Patient Sharon Fisher

Although not technically lung cancer, mesothelioma is a type of cancer that starts in the membranes that cover the lungs. If you didn’t know much about this disease prior to the barrage of television ads now asking those with the disease to join class-action lawsuits, you have now probably learned that 80% of these cases are caused by exposure to asbestos — much of it from factories.

Tiny bundles of asbestos fibers which fly through the air can be inhaled. This causes cell turnover, which leads to cancer.

There is a high mortality rate associated with this cancer, as there are no early signs or symptoms that would lead someone to treatment. It is critical that

anyone working with asbestos wear a proper mask that filters out all particulate matter.

Major strides have been made over the last decade, relative to all types of lung cancer.

Before these new treatments, the only recourse for treating lung cancer was surgery, chemotherapy or radiation.

Now, by knowing the exact type of cancer you have and determining what stage it is, along with knowing what factors within the tumor can be targeted, precision medicine can go after specific markers within the tumor. As researchers like to say — it is important to know the enemy, so you can find the right tools to fight it.

Our Lady of the Lake Cancer Institute pioneers care in Baton Rouge with accredited expertise and innovative technology to head off disease

By By Amanda McElfresh | amcelfresh@theadvocate.com

E

This article is brought to you by Our Lady of the Lake.

ach day, physicians in Baton Rouge work side by side and in collaboration with national experts to advance cancer care for Louisiana patients. Through their work, Our Lady of the Lake Cancer Institute has become a regional destination for treatment. With multiple national accreditations, the Institute has proven time and again that its patients receive care for any stage in their cancer journey all under one roof. That excellent care aligns with best practices and incorporates the latest proven technology and treatment methods.

Dr. John Lyons III, a surgical oncologist at Our Lady of the Lake, spoke about the Institute and how its teams work to improve health outcomes for patients.

How does the Cancer Institute bring together different cancer specialists to help improve treatment for patients?

We first developed multidisciplinary teams because of a grant we received about 10 years ago. We have continued that because we see the benefits.

Oncologists who specialize in certain types of cancer meet at least quarterly to discuss patient care. Sometimes, it’s about addressing day-to-day issues like wait times for chemotherapy or biopsy orders. We also have continuing education with guest speakers and discuss treatments that we’ve seen at other cancer centers across the country.

The idea is that it makes us all better. It sparks a little competitive fire because we want to do the same things in Baton Rouge that they’re doing in other parts of the country.

We also have tumor conferences that meet regularly to discuss individual cases. This is where we bring together physicians, clinical trial specialists, radiologists and other experts. The cases are presented without the patient’s name and we reach a consensus about the best next steps, whether that means more chemo, additional tests, surgery or some other treatment.

What makes the surgical oncology services stand out at Our Lady of the Lake?

A surgical oncologist is a general surgeon who has had many additional years of training in cancer, including research and clinical fellowships. The surgeries we do here tend to be pretty complex and involve things that others might not be as comfortable with. At least once a month, a patient will come

to us because another surgeon does not have the resources at his or her center.

Most of the time, in those cases we can successfully complete an operation to remove the cancer. It’s all about the attitude of the people here. We see these surgeries as a team approach and everyone is always willing to step up and play their part.

How do Our Lady of the Lake physicians use technology to improve patient care?

We use AI to look at certain CT and MRI scans to identify precursor lesions so we don’t miss them with the human eye. We’re also using technology to increase screenings for liver cancer.

With our electronic medical records (EMR), an automatic reminder is sent to a patient’s primary care doctor if they have a concerning liver diagnosis,

such as cirrhosis. This reminder prompts them to screen for liver cancer.

It’s an opt-out system that removes the potential for human error or oversight.

We’ve also embraced using robotics for surgeries where it makes sense. We started with one robot and n robot, there are four small incisions made, then the robotic arms are placed inside.

The surgeon controls the instrument while a nurse and a technician are at the patient’s bedside. The visuals are amazing. It’s in 3D and magnified. When you tell it to go somewhere, it goes there and stays. Things like that enable us to do really complicated procedures with a minimally invasive approach, which means quicker recovery times for patients.

What is it like to be able to provide this high-quality care in Baton Rouge?

It’s really rewarding. Most of our patients are within 100 miles of Baton Rouge, w hich means they can get this care while staying close to home and not having to spend as much time traveling. The people are so resilient and appreciative. We all feel very fortunate to do this work here.

For more information or to find a provider, visit www.ololrmc.com/cancer.

MORE THAN 650 SPECIALISTS WITH YOU EVERY STEP OF THE WAY

Comedian and actor Ben Stiller brought attention to EARLY

SCREENING for

prostate cancer

By Leslie Cardé

W

ith nearly 250,000 new cases diagnosed every year, prostate cancer is the most common organ cancer in men, and the second most common cause of death in men after lung cancer.

It kills as many men every year as die in automobile accidents. It is also the third most prevalent cancer in the United States, with only skin and breast cancer diagnosed more frequently.

Prostate cancer is certainly survivable.

Robert DeNiro, Warren Buffett and Colin Powell have all had it, and are now cancer free.

But it was the comedian and actor Ben Stiller who brought attention to early screening when he went public with his prostate cancer diagnosis in 2016 on the Howard Stern radio show. He was 48 when he discovered that the result on his PSA (prostate-specific antigen) test came back high.

His doctor ordered a follow-up test six months later, and the results were even higher. Further tests revealed he had prostate cancer, and to treat this,

his prostate gland was removed. Stiller credits a routine PSA test on his yearly physical with saving his life, and urged others to have this test done.

“It is important to remember that there are absolutely no early warning signs or symptoms of prostate cancer,” said Neil Baum, M.D., Professor of Clinical Urology at Tulane Medical School, and co-author of “Prostate Cancer – Expert Advice for Helping Your Loved One”, and “How’s It Hanging?”

“It is critical that men by age 50 begin to get regular PSA tests. For those at high risk, tests should be initiated at 45, and include African Americans, and those with relatives such as fathers, brothers, or uncles who have had prostate cancer.”

Baum notes that by the time you experience bone pain, weight loss or anemia, you have a late-stage diagnosis where the cancer has already spread to other organs.

Detection has leaned away from needle biopsies, as ultrasound is now used to pinpoint a cancerous lesion after abnormal PSA tests.

Advances in treatment have done a better job of removing the cancer.

Cryotherapy (freezing) and high intensity focused ultrasound destroys cancerous tissue. Although surgical removal of the prostate lessens recurrence, there is a 25% risk of erectile dysfunction, and 3-5% of those who have this surgery risk urinary incontinence.

However, if the cancer is confined to the prostate, a new type of surgery called focal therapy treats only the cancerous part of the prostate and leaves the rest of the gland intact.

Although not exclusively a male cancer, bladder cancer is far more prevalent in men. 82,000 new cases will be diagnosed every year and 62,000 of those will be men. Of the nearly 17,000 deaths, over 12,000 will be men. It is heavily influenced by smoking, which triples one’s risk of bladder cancer.

The one saving grace about this cancer is that unlike prostate cancer, there are early warning signs. Blood in the urine and frequent urination with urgency can both be signs that you need to see a doctor.

Treatment involves going through the urethra (the tube which connects the bladder to the outside of the body) with a cystoscope and burning out the tumor without destroying the whole bladder. If the cancer has penetrated the muscle, then the bladder must be removed. Urinary diversion devices will then be required.

Testicular cancer primarily affects young men, ages 20-45. Fifty years ago, this cancer was 90% lethal, and now it’s 95-98% curable.

“We’ve really gotten the word out about testicular self-exams,” Baum said.

“If you palpate the testicles and they are soft and spongy, that’s normal. If you feel anything rigid or hard, it could be cancer. But, it’s not a death sentence any longer. We now know that unless it’s an extremely aggressive form, we can remove the cancer by removing just one testicle, which still allows men to father children.”

And, there are now tests utilizing tumor markers which indicate if the cancer has spread beyond the testicles.

Chemotherapy has proven effective for this type of cancer.

Getting in the habit of routine care As young women outgrow their pediatricians, almost all move on to continue care with an obstetrician/gynecologist. The same premise seems not to apply to men.

“Because most men never see a urologist until they are 50 years old, they aren’t getting regular screenings or urological exams,” said Baum. “Unfortunately, many men subscribe to the philosophy that if it ain’t broke, don’t fix it. But, if you’re not regularly screened, you won’t know anything is broken, and oftentimes it’s just too late to fix it.”

Neil Baum. M.D.

Some men who have symptoms are too afraid to get bad news, when in fact some symptoms like difficulty urinating do not necessarily mean cancer, and can be attributed to a condition called BPH (benign prostatic hyperplasia) which simply put means the prostate gland is enlarged.

It can be treated in many instances by decreasing caffeine or the bladder irritants caused by some foods.

Along with medications that shrink the prostate, there are uncomplicated procedures that can be done in the doctor’s office. Never assume that symptoms indicate the worst.

Mary Bird Perkins supports cancer patients and caregivers with comprehensive services to meet all needs

By By Amanda McElfresh | amcelfresh@theadvocate.com

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This article is brought to you by Mary Bird Perkins Cancer Center.

avigating the emotional challenges of cancer treatment is difficult for patients and their families, but Mary Bird Perkins Cancer Center provides comprehensive support and resources in conjunction with its oncology services.

“Cancer in general has changed tremendously in the last 20 to 30 years. With new therapies, patients are living much longer. We’ve expanded our services similarly,” said Dr. Andre’ Bonnecaze, a hospice and palliative care physician at Mary Bird Perkins.

“It’s become apparent that patients need to have a team that pays close attention to symptoms, side effects and their quality of life.”

Dr. Bonnecaze is part of the team at a dedicated palliative medicine clinic that Mary Bird Perkins opened in September 2022. Physicians at the clinic help patients who are going through cancer treatment address issues like chemotherapy

side effects, loss of appetite, anxiety, pain, emotional distress and more.

Most clinic visits are wide-ranging and in-depth, so patients are never rushed. In general, Mary Bird Perkins oncologists will recommend patients for palliative care.

“Being embedded into the overall cancer center, we interact daily with the other physicians,” Dr. Bonnecaze said. “It makes it easy when you can walk down the hall and talk to another doctor about a patient who is struggling.”

In addition, Mary Bird Perkins offers on-site counseling services.

Kitzia Bordlee, a licensed clinical social worker, said oncologists refer patients to her if they have certain scores on tools that screen for anxiety, depression and general distress.

“If anxiety or depression is really bad, it can interfere with someone’s ability to undergo treatment,” she said.

“Sometimes, patients have underlying

Andre A. Bonnecaze, M.D.

mental health issues that are exacerbated by cancer. Other patients have no history of those issues and are experiencing these feelings for the first time. In every situation, it’s a patient-centered approach.”

Bordlee said the addition of the counseling services last year is an added benefit at Mary Bird Perkins, since it can be hard to otherwise find mental health care in a timely fashion. The services are also

available to patients’ families and caregivers who may be facing their own emotions and challenges.

“It’s a safe space to talk and work through emotions so people are better equipped to have conversations with their family after they’ve talked through it here,” she said. “We give them a comfortable place to unload some of that.”

Micah Davis, who is undergoing treatment at Mary Bird Perkins, said he’s been impressed with not only the wide range of services available at the Cancer Center, but also the way everyone has an upbeat attitude and cares for people as individuals.

“You can tell the people there remember you. They smile and wave when they see you and make you feel welcome,” he said. “Instead of just being treated like a number, they treat you like a person. They’ll remember something you said before and ask about it again.”

Davis, who previously was treated for cancer while living in Texas, said he’s been impressed with how comprehensive the treatment is at Mary Bird Perkins and that the convenience is a significant benefit.

“It’s really nice to go to one place and have everything done in house,” he said. “Anytime you need something at Mary Bird Perkins, they have it available.”

For more information on services at Mary Bird Perkins, visit www. marybird.org.

How can all of us catch this cancer in its earliest stage?

For colorectal cancers, family

Knowledge is power, and knowing what to look for is very important.

history matters, and ‘there’s a lot of hope on the horizon’

By Leslie Cardé

T

he COVID-19 pandemic threw a wrench into many people’s routine medical care. For some, the interruption in basic services cost precious time.

In 2020, Will Tolar received a diagnosis of diverticulitis, a benign inflammation of the pockets inside of the colon. Normally harmless, it is often treated with antibiotics and the elimination of fibrous foods. This digestive disorder often goes away with simple treatment.

Jack Saux, M.D.,

Will was 36 years old at the time, not old enough for the standard medical recommendations associated with a colonoscopy, which experts say is at age 45. But his diverticulitis diagnosis meant he was eligible for that screening.

With the test scheduled within just two weeks, the world suddenly shifted dramatically when the COVID-19 pandemic swept across the world.

Routine testing and non-emergency procedures in hospitals came to a halt.

With no hard recommendations for the procedure, it was put on the back

burner, as the viral pandemic raged on.

In the meantime, Will’s diverticulitis was being treated and symptoms had subsided.

In 2022, however, at the age of 38, Tolar passed blood in his stool and called his doctor. A colonoscopy was ordered. A tumor was found inside his colon and a biopsy revealed that it was cancerous. Subsequently, a PET scan revealed that it had spread to his liver and omentum, the organ responsible for immune regulation and tissue regeneration.

“I was suddenly confronted with Stage 4 cancer and the prospect of chemotherapy,” Tolar said. “Of course, I couldn’t help wondering if I’d had that colonoscopy two years earlier, if I would have found this cancer at a more treatable stage. But I can’t go backwards. I have a wife and two young girls, and I’m planning to fight this.”

There are a number of factors that can play into a diagnosis of colorectal cancer, according to oncologist, and Will’s physician, Dr. Jack Saux, M.D., of the Mary Bird Perkins Cancer Center in Covington. And, in Louisiana, where this cancer is prevalent and above the national averages, there are specific reasons why.

“Certainly there can be genetic links, as in the mutations we may carry, but it may be familial as well, and it’s important to know your family history,” Saux said. “Have your close relatives had cancer, and what type of cancer?

In South Louisiana, people don’t leave, so the gene pool is smaller than it is in a lot of areas. We are also at the end of one of the largest rivers in the country,

Daughter Elizabeth with colon cancer patient Will Tolar

so there are a lot of things that are flowing downward and exposing us to many things we are aware of, but many we don’t know or understand.”

As it turns out, Will Tolar’s family does have a history of cancer that he was previously unaware of. In fact, a grandparent specifically had colon cancer. Why does this matter?

The guidelines for those with family histories are different, and it means that colonoscopies are indicated 10 years before the national guidelines. That means Tolar would have been screened at 35, which could have made all of the difference in his ultimate diagnosis.

“Colorectal cancers caught at an early stage through a scope are very successfully treated,” Saux said. “Those cure rates are 91%. But, when you’re talking about Stage 4, where the cancer has metastasized into other organs, survival rates at two years are 50%, and by five years, it’s 14%.”

As time goes on, those numbers will grow with better drugs and new techniques. And, there will always be people like Tolar who will end up playing roulette with different drugs if the cancer mutates, Saux said. So far, he responds well to his medications, and he’s in a small percentage of patients who tolerate them well without major side effects.

Fourteen months into treatment, Will is on maintenance chemotherapy. Scans are done every three months to see if the cancer has mutated, and might respond better to different drugs.

At the moment, there is no evidence of disease, and the mass that had been in his colon, which was too big and too

• Find out about your family history because your first-degree blood relatives share approximately 50% of your genes. Grandparents should be considered, too.

• Without a family history, get a colonoscopy at 45. A clean scan means there’s no need for another screening for 10 years. Or, DNA tests like Cologuard can be used in between colonoscopies, every three or four years.

• Pay attention to any changes in bowel habits. That includes infrequent bowel movements, stomach cramps, and any blood in the stool. Those symptoms require that you check in with your PTP or a gastroenterologist.

•Be aware that any inflammatory digestive disease like Crohn’s, chronic diverticulitis, inflammatory bowel disease, ulcerative colitis and others can foreshadow larger problems. These GI disorders which cause chronic inflammation can be precursors to cancer, and patients should be diligent about watching for any signs or symptoms that could lead to a cancer diagnosis.

“We have made huge strides in treating colorectal cancers,” said Dr. Jack Saux, M.D., of the Mary Bird Perkins Cancer Center in Covington. “Robotics do better and cleaner dissections of tumors or polyps, the drugs we now have are better engineered and more effective, and we’re making a lot of headway with immunotherapy. There is a lot of hope on the horizon.”

dangerous to operate on previously, had shrunk with chemo and was removed at the end of September, largely because it was causing a bowel obstruction.

According to Saux, some Stage 4 colorectal cancers can be eradicated completely, depending upon how well the cancer responds to treatment, how much it mutates, and how many new drugs are out there to treat the everchanging lesions.

“I always hope for long term survival, in spite of bad diseases,” Saux said. “No matter what the statistics say, there are always some people who will beat the odds.”

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Dentists catch oral cancers, while primary care docs may discover blood cancers

By Leslie Cardé

T

he connection between smoking and lung cancer has been known for decades. It’s not hard to fathom, then, that since the conduit to get the nicotine and tar into your lungs is through your mouth, oral cancers bear the brunt of smoking and related habits as well — whether it’s cigarettes, chewing tobacco or vaping.

Emily Kamen, M.D.

“Alcohol is also inflammatory and increases many different cancers,” said Emily Kamen, M.D., head and neck surgical oncologist at Ochsner’s St. Tammany Cancer Center.

“Essentially, you’re bathing the area in something irritating, which can either be at the surface level, or later incite DNA damage, which causes cancer,” she said.

“These substances interrupt your cell’s normal way of doing things.”

We’re not talking about social drinking, considered to be one drink a day for women and two for men. We’re talking about excessive drinking and binge drinking, where someone may have all seven drinks allotted for the week at one time.

We now know that the virus known as HPV, the primary cause of cervical cancer, is also a major contributing factor to throat cancer. Doctors are now recommending the vaccine for those age 9 to 46.

Although oral cancers, which affect the esophagus, larynx, pharynx, trachea, sinuses, mouth, tongue, and salivary glands, account for only 3% of all cancers, the surgery that’s sometimes required

to remove these cancers can not only be disfiguring, but can cause permanent problems with swallowing, speaking and breathing.

See your doctor if you have any of these symptoms: an ulcer that doesn’t go away, loose teeth, a cut in your mouth that doesn’t heal for two weeks or more, swollen salivary glands or lymph nodes.

It’s a good idea to have regular dental checkups. Dentists are critical in discovering these cancers.

Apart from cancers that manifest as solid tumors, there are blood cancers like leukemia, myeloma, and lymphoma, often called liquid cancers.

“Blood cancers originate in the bone marrow or the lymphoid tissue,” said Suki Subbiah, M.D., LSU hematologist and oncologist. “They are not treated surgically, can involve stem cell transplants, depending on the particular type of blood cancer, and spread differently than solid tumors.”

According to Subbiah, patients often see a primary doctor complaining initially of enlarged lymph nodes somewhere on the body, fevers, nightsweats, weight loss, fatigue, easy bruising or bleeding, chest pain or shortness of breath.

Those at greatest risk have had exposure to chemicals or radiation or have a predisposition to bone marrow conditions. Patients who have received chemotherapy or radiation treatments in the past may also be at risk for the various blood cancers.

Although some forms of these cancers can be very aggressive, like

Suki Subbiah, M.D.

acute lymphoblastic leukemia, modern treatment is helping patients survive.

New chemotherapies, innovative immunotherapies, and CAR-T treatment, which involves removing a patient’s own T-cells, re-engineering them, and putting them back, allow the patient essentially to help heal himself.

“As research continues, doctors are hoping for more targeted therapies and less stem cell transplants,” said Subbiah. “For all of us, the hope is more effective therapy with less toxicity.”

Brian Moore, M.D.

A promising partnership brings cutting-edge cancer treatment to Louisiana The advances that have been made from around the world to partake in,” in the field of cancer have come about he said. largely because of patients who are The partnership with Ochsner and willing to work alongside researchers others allows MD Anderson to have to find new and better treatments. a broader population base, which is The importance of clinical trials always important for data with any that require patients to explore the research. efficacy, interactions and side effects In 2021 MD Anderson came to of experimental drugs, modalities and Ochsner to determine whether the vaccines cannot be overstated. facility would meet their tough criteria To that end, it is often in the best for being a partner. interest of patients if information from “They investigated everything — from one center is shared with another, how we take care of instruments and especially when a noted how well trained our research facility consistently clinicians are, to how University Health ranking at the top of U.S. much time each specialist in Phoenix was cancer centers takes on spends on which cancers,” the first partner. partners in order to have a Moore explained. “We Along with partners broader and more diverse were evaluated based now in San Diego, patient base. on some very tough San Antonio, Ten years ago, the criteria, and MD Anderson Jacksonville, University of Texas MD determined they wanted to Camden, New Anderson Cancer Center move forward.”

Jersey and in Houston started a The idea is that when a Indianapolis, partnership program. It patient comes in, there Ochsner Health provided a shared vision is an aggregated team of in New Orleans is for research and problem specialists with a team the latest center to solving. ready to go from Day 1. come on board as a In a 10-year deal with the If the patient wants, partner.

No. 1 ranked cancer center Ochsner doctors can ask in the country (U.S. News & questions or confer with World Report), Ochsner will collaborate other Texas doctors or ask about a trial with the Texas facility on patient care to see if a patient here might become a and therapies, as well as clinical drug part of that. trials.

They can present their case to both For decades Louisianians have headed the tumor board here at Ochsner as for Texas to be a part of cutting edge well as the board at UT MD Anderson. trials, which in many instances will Conferring back and forth optimizes now become integrated into Ochsner, good outcomes for the patients in as well as the other six nationwide Louisiana, and for all of the partners centers. who share information.

“Although we draw from a 250-mile Cancer has far and away been radius, a substantial number of people medicine’s deepest, darkest mystery. who had been diagnosed here with Unraveling its causes and subsequent cancer were leaving the state to be treatments has been the life’s work of treated at MD Anderson in Houston,” researchers all over the world. said Brian Moore, M.D., medical director Advances are coming quickly with of the Ochsner MD Anderson Cancer more fine-tuned precision medicine Center, who did his fellowship in head for every individual cancer, and most and neck oncology at the Texas giant. scientists feel that with new immune “We approached them five years therapies, better more targeted ago as we wanted to do more for the chemotherapies, and revolutionary people of this state, having access to vaccines, there may finally be light at the clinical trials that people travel the end of a deep, dark tunnel.

HOW DENTISTS CAN PLAY A KEY ROLE in oral cancer prevention, detection and treatment Research has shown that simple steps can also help prevent oral cancer.

Here are some things people can do to reduce their risk: • Quit smoking and avoid all tobacco products.

• Limit alcohol consumption or abstain from it altogether.

• Eat a balanced diet rich in fruits and vegetables. These have essential vitamins and antioxidants that help maintain oral health.

• Visit your dentist regularly for checkups. Dentists are trained to detect early signs of oral cancer, such as lumps or suspicious lesions.

Submitted article

This article is brought to you by Pearl Dental Group.

A

s a dentist practicing in Baton Rouge since 2001, Dr. Andre’ Bruni has seen firsthand the devastating impact that oral cancer can have on patients. According to the American Cancer Society, about 54,540 people will be diagnosed with oral cancer this year. In most people, the cancer forms in the lips, tongue, cheeks, floor of the mouth, hard and soft palate and salivary glands. Oral cancer often starts as small, painless lesions or sores that can easily go unnoticed. But, the good news is that oral cancer is highly preventable, and early detection can

significantly improve patient outcomes.

Dentists play a pivotal role in the early detection of oral cancer by conducting regular screenings during dental check-ups. If a dentist discovers suspicious lesions or abnormalities, further tests may be recommended. In addition, patients should pay attention to possible symptoms that could indicate oral cancer, including persistent pain, difficulty swallowing or changes in speech. Individuals should schedule an appointment with a doctor as soon as possible if they experience any of these issues.

• Parents should consider vaccinating their children against HPV to reduce the risk of HPVrelated oral cancer. Pediatricians can provide more information.

• Protect your lips from excessive sun exposure by using lip balm with sunscreen and wearing a hat when outdoors for extended periods.

• Perform monthly self-exams of your mouth and throat. Look for unusual changes, such as sores, red or white patches or lumps. Consult your dentist immediately if you notice any abnormalities.

• Limit sugar intake to help prevent tooth decay and gum disease, which are risk factors for oral cancer.

In the event that someone is diagnosed with oral cancer, their dentist can be a key part of the medical team and play a role in developing a treatment plan. Dentists can help manage oral health and address treatment side effects like dry mouth, mucositis and increased susceptibility to infections. In cases where surgery or radiation affects a patient’s ability to eat, speak or swallow, dentists may provide specialized prosthetics to restore function and appearance.

Effective collaboration among healthcare professionals, including dentists, is crucial for the best possible outcome for oral cancer patients.

Individuals are encouraged to speak to their dentists about addressing their oral cancer risk factors and alerting them to any oral health concerns.

Pearl Dental Group has Baton Rouge locations on Perkins and Jones Creek. Dr. Andre’ Bruni and his highly qualified staff provide treatment and care for all dental needs in an environment where excellence meets innovation.

Visit www.pearldentalgroup.com to schedule an appointment.

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Good screenings have reduced the dangers of some female cancers

T

ihe diseases known as female cancers are wide ranging. Two have great survival rates, early symptoms, and good screenings, while another is one of the deadliest cancers that doctors and patients face.

There are over half a million new cases of cervical cancer reported every year, many of them picked up on routine Pap smears done in the office of a woman’s gynecologist. For years it was thought that the herpes-simplex virus caused this cancer.

But, in 1976, a German virologist discovered that the cause of cervical cancer was HPV, the human papilloma virus. Responsible for 98% of these cancers according to the National Institutes of Health, the sexually transmitted infection was not preventable until 2006, when a vaccine was introduced. Today it is the gold standard for prevention.

“The HPV vaccine is incredibly efficacious, preventing 90% of all cervical cancers, and has been proven to be safe in clinical trials, said Ana Valente, M.D., gynecological oncologist with the Ochsner Health System. “It has been FDA approved for ages 9–46 and most effective if it’s administered during childhood vaccines, before sexual activity begins.”

Less effective if given after exposure to HPV, the vaccine protects against nine different strains of the virus, so the likelihood is that if you’ve only been exposed to one of the strains, you would still have protection from the other eight. So, it’s never too late to get vaccinated.

The Pap smear, around since 1928, is

Ana Valente, M.D.

still used, but currently in conjunction with a PCR test which detects changes in the DNA due to cancer cell development. With these two tests, cervical cancer can be detected early at a routine office visit.

Most of these cancers are found at Stage 1 and have a 90% survival rate. Although hysterectomies are recommended, those of child-bearing age may wish to discuss other options with their healthcare professional.

When it comes to uterine cancer, there are two types. The most common is endometrial cancer, which affects the lining of the uterus. The less common types affects the muscular layer of the uterine wall, which can develop sarcomas, malignant tumors.

One of the biggest symptoms is bleeding after menopause, which according to Valente is not normal and should always be investigated.

At Stage 2, this cancer has invaded the cervix. Stage 3 means the disease is more advanced and may involve the fallopian tubes, ovaries, and

lymph nodes. At Stage 4, it has spread elsewhere in the body, and the survival rate is only 15%. This cancer can easily be picked up early if symptoms are not ignored.

Ovarian cancer statistics are not encouraging. Ovarian cancer ranks fifth in cancer deaths among women, and accounts for more deaths than any other cancer of the female reproductive system. Around 20,000 will be diagnosed annually with the disease, but according to the American Cancer Society, more than 13,000 will die.

Comedian Gilda Radner and activist Coretta Scott King succumbed to the disease, but people like actress Kathy Bates have survived through surgery and chemotherapy.

Even with the startling statistics, the number of cases and deaths are down from previous decades with more women on oral contraceptives now than ever before. Women on “the pill” ovulate less than those who aren’t, and the less you ovulate the better your chances of preventing ovarian cancer.

This is why women who have been pregnant are less likely to contract the cancer, as the menstrual cycle has been interrupted during pregnancy.

Fewer women in the 2020s are on menopausal hormone therapy, as well.

That’s because links have been made between hormones like estrogen and the risk of uterine and ovarian cancers.

Adding progesterone to the menopausal treatment has decreased the risks, but many women have chosen to endure hot flashes rather than deal with the possible risks associated with hormone therapy.

“The biggest problem with ovarian cancer is that we have no good screening modalities at a more curable stage,” Valente said. “Beyond that, curing this cancer is difficult, even with surgery and chemotherapy. Despite infusions with biologic agents and many new drugs, recurrences are very common in ovarian cancer, especially at Stages 3 and 4, when 85% will recur.”

Valente notes that at the moment the only blood test we have is used once a patient has been diagnosed, and that’s to see if she is responding to treatment.

There is nothing for screening.

And, any anti-cancer vaccines that scientists may be working on now have not been approved by the FDA. Hope springs eternal that one day there will be a way to diagnose this cancer much earlier.

Annual exam is key to curing women’s cancers So, how do women gain control over cancers that seem to sweep in without warning?

According to Dr. Ana Valente, M.D., women must have a good relationship with their gynecologists. And, she says, it’s important to make sure you’re scheduling yearly screening tests, even though the recommended interval for a Pap smear is every three years.

A pelvic exam, generally, is part of good gynecological care. She suggests finding someone you feel comfortable chatting with about bleeding after intercourse, pelvic pain, or a host of other issues you may be having that require an in-depth conversation.

The patients Valente sees with advanced malignancies are often women who haven’t seen their gynecologist in a decade and are now confronted with cancers at a late stage, which are more difficult to treat, and sometimes impossible to cure.

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Scientists are working for a breakthrough on pancreatic cancer

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By Leslie Cardé

t was April of 2022, and Debra (who asked that her last name not be used) was being seen for abdominal pain which had persisted for months.

Jason Breaux, M.D.

As an RN, she knew that something was off when she was screened for ulcers and other GI issues, and the medicines she was prescribed failed to tackle the problem. An ultrasound ordered by her physician revealed nothing, and her pain was becoming more intense.

Because Debra had survived breast cancer and a double mastectomy 10 years earlier, she saw her oncologist regularly. When her cancer doctor heard the story, she ordered a CT scan immediately, knowing Debra carried the BRCA2 mutation.

The CT showed three tumors in the tail of her pancreas, hidden from view on the original ultrasound by her stomach. Diagnosed with Stage 4 pancreatic cancer, her doctor told her that based on statistics, she had between two and six months to live.

Debra got her affairs in order and even planned her own funeral. In the meantime, a decision was made to try different approaches — intense chemotherapy for the tumor, which had

only previously been used on breast cancer, and Lynparza, a drug used to deal with her BRCA2 positivity. The treatment was brutal.

“The side effects of the drug were terrible, so I began antiemetics for the vomiting,” Debra recalled. “I had other drugs for my terrible long-bone pain — narcotics. It was a very tough few months, but it’s amazing what you’ll try when death is the alternative.”

“Throwing everything at a cancer is what clinical trials are all about, so throwing other successful treatments for other cancers at something like pancreatic cancer, may be the way to go ... especially if you’re at the Stage 4 diagnosis,” said Philippe Prouet, M.D., medical oncologist, Ochsner Cancer Center of Acadiana.

Debra is still alive today, although she will be the first to tell you she doesn’t know for how long. For the moment, she feels well and is on a maintenance dose of drugs.

As those who treat pancreatic cancer will tell you, it’s difficult to survive this particular cancer for a variety of reasons.

“Traditionally about 80% of patients, by the time they’re symptomatic, have an incurable disease, said Jason Breaux, M.D., surgical oncologist and medical director of Ochsner Lafayette General Medical Center.

“Fifty percent have cases that are not amenable to surgery, or they already have metastatic disease which has spread elsewhere.

“The only good news is that we’re seeing more early-stage cancers because of the widespread use of CT for other reasons.”

For instance, those in automobile accidents who find themselves in emergency rooms are often scanned for possible injuries. Through nothing more than a stroke of luck and good timing, a radiologist may pick up a pancreatic tumor while looking for traumatic injuries.

For the 15-20% of patients who find their cancer early enough to have surgery, that isn’t the end of their problems. There is the looming matter of recurrence.

“We know about the tumor we’re removing based on what we see, but there’s a lot we don’t see,” said Omeed

Encouraging the immune system to fight back

Omeed Moaven, M.D.

Moaven, M.D., assistant professor of surgical oncology, LSU Health, New Orleans.

“It’s a very aggressive cancer, and it gets into the bloodstream quickly.

There are tumor cells floating around sometimes that aren’t visible, but they can seed and then come back.

“That’s why chemotherapy is important as a companion treatment, and in some selective patients who will benefit, you can even use radiation.”

Unlike many other cancers, pancreatic cancer has become very adroit at protecting itself from treatment.

According to Moaven, the very nature of the tumor means it has an environment around it that produces materials that look like scar tissue — thick, dense, fibrotic tissue that creates a physical barrier and shields the tumor from your body’s own immune response. This is why it doesn’t respond well to immunotherapy.

And as far as targeted precision medicine, pancreatic cancer cells have thwarted those efforts as well, even as that sort of therapy has produced breakthroughs in breast and colorectal cancers.

“You’re looking for molecular markers. Is there something in this cancer we can target?”, Prouet said.

“Often there are no positive markers in pancreatic cancer, or if it seems there are, they still don’t respond to treatment. That’s because cancers vary.

Chemo only kills actively dividing cells.... including your hair. Precision medicine means targeting specifically what’s causing the cancer to grow.”

Without this, everyone agrees, it’s a scattershot approach to define what works for each individual patient.

The only hope to improve the outcomes for this deadly cancer is research. It may all boil down to how well your own body is able to fight off the invaders.

Scientists have known for a long time that two people exposed to the same environmental toxins can respond very differently. We need a better approach to using our own systems to attack these tumors.

“Let’s say you’re exposed to pollution or smoking, and your genetic composition might be more or less susceptible to them,” explained Omeed Moaven, M.D., assistant professor of surgical oncology, LSU Health, New Orleans.

“The human body certainly has the ability to fix some of these factors that can cause cells to divide out of control and produce cancer,” he said.

“But if they don’t fight hard enough, or can’t, then tumors get through. It’s our job as scientists to figure out how to embolden our own immune systems.”

The major problem with pancreatic cancer is not knowing the at-risk population. Other than the familial connection, which certainly is a factor, we don’t have warning signs, like polyps in colorectal cancer. The precursors to disaster just aren’t there early on.

As a result, the mortality for this cancer is not yet in the downward trajectory that everyone has hoped for.

“Right now, pancreatic cancer is the third leading cause of cancer-related deaths,” said Moaven. It will be second by 2030, because this is not one of the cancers where we’ve been able to successfully treat these tumors. We just don’t have great tools, yet. Sadly, in seven years, it will overtake colorectal cancer, where better strides have been made in both diagnosis and treatment.”

Meanwhile, Debra’s family history may have foretold the future. Of the six girls in the family, five have the BRCA2 gene.

All of them had breast cancer; five have had mastectomies.

Her father and his father both died of pancreatic cancer, along with a male cousin. The mutant gene came from her dad’s side. Her father’s two sisters both died of breast cancer. She is the first in the family to contract both cancers.

No one knows the future. As doctors tell us, statistics are just that — statistics. Each patient is a statistic of one.

Debra and her husband have decided to travel the world while she’s feeling well. British Columbia, Lithuania and French Polynesia have been on this year’s itinerary.

What the future holds is uncertain, but so many are hopeful that a scientific breakthrough is just around the corner.

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For this personal trainer, brain cancer treatment demanded

strength

and perseverance

By Leslie Cardé

Renée Ware

I

n June 2020, Renée Ware of Gray, Louisiana, noticed drooping on the left side of her face. Thinking it was Bell’s palsy, she made a doctor’s appointment.

But on the morning of her appointment, she had a seizure. Then her left side went numb, while her 11-year-old son witnessed the entire event.

An EMT in the neighborhood stayed with her until the paramedics came and medevac’ed her to the Thibodaux Regional Multi-Specialty Clinic. She had seizures for an hour and a half.

A CT scan revealed a brain tumor the size of a golf ball, which they suspected was malignant. Knowing this would need specialized care, they sent her to West Jefferson General Hospital to see neurosurgeon Dr. Frank Culicchia of Culicchia Neurological, who is the chairman of the department of Although no one is sure what causes brain tumors, known factors are exposure to pesticides and other chemicals, some genetic conditions that lead to tumors, and previous radiation therapy to the head. However, there are still many unknown factors.

New research is going on at institutions everywhere, giving those with brain tumors increasing hope.

Scientists are concentrating on being able to predict recurrences before they ever show up on an MRI with serum biomarkers that could show up in the blood.

neurosurgery at LSU Health, New Orleans. His specialty is brain tumors.

Renée was 36 years old.

The next morning, an MRI was done, which confirmed the brain tumor, and two days later she would have surgery.

Prior to the operation, she swallowed a substance called Gleolan, which gives neurosurgeons the ability to visualize the outer reaches of the malignant tumor.

“I proceed with the surgery as I normally would, removing all the tumor until I get a clear white bed, and then I shine the blue light on the area that fluoresces because of the swallowed chemical substance,” Culicchia said.

“Suddenly, I can see additional cancer cells. This substance pushes the envelope to remove more of the cancer cells that were previously undetectable even under a microscope.”

After the surgery, the biopsy

determined it was a glioblastoma, a Stage 4 type of glioma, which has a 4-5% survival rate at five years.

Ninety per cent of Renée’s tumor was excised during the surgery, but the other 10% was in an area called the eloquent part of the brain, containing such vital centers that control functions like speech, vision, and motor skills.

To rid her of the remaining fragments of the tumor, she would receive radiation treatment at the Mary Bird Perkins Cancer Center in Houma, closer to her home, along with oral chemotherapy. This would last for 45 days. Every month after that, for the next year, she would receive five days of chemotherapy.

“It was quite an experience,” remembered Ware. “While undergoing radiation, I had to wear face molds to protect other areas of my head. I looked like something out of a horror movie. ... I was getting scans every month to check on my progress, and now it’s every three months.”

Thirteen thousand glioblastomas are diagnosed every year in America. It is an aggressive brain tumor with no cure.

Ware’s neuro-oncologist, wanting to give her the best possible chance with chemo, sent her excised tumor to a lab in Arizona for genetic testing. The results showed that she should respond well to treatment.

Considering the dire statistics, she is still alive, and has gone back to her job as a personal trainer. At this point, there is no evidence of disease.

Whether there are hidden cells lurking unseen isn’t something anyone can know.

In a metastatic tumor, (which comes from somewhere else) doctors can remove it completely, Culicchia said.

“In a glioblastoma, with its tentacles,

Promising vaccines increase survival rate CAR-T therapy, which involves reprogramming a patient’s own T-cells and which has been effective in treating other cancers is being looked at for brain cancer and is currently undergoing clinical trials.

A cancer-killing virus for glioblastomas is being developed at MD Anderson at the University of Texas.

Researchers at UCLA have developed the first personalized vaccine for brain

tumors, claiming to increase survival in patients by a year.

And, there are other promising vaccines being studied at multiple centers. One is in Phase II trials in Buffalo. The immunotherapeutic treatment (vaccine) is still in Phase 2 Trials of 63 patients. It attacks Survivin, a cancer molecule, which is present in all glioblastomas, and keeps the tumor alive. A larger trial has now been ordered.

Frank Culicchia, M.D.

you can fluoresce the area during surgery, but individual cells don’t light up, tissue lights up. So, there are no guarantees.

“The rare people with glioblastomas where you can resect the tumor and get clear margins, and scans show nothing else growing, are still alive 12-15 years later... but that’s rare.”

Ware is doing well, in spite of the chemotherapy pushing her into early menopause at the age of 40. But, she’s exercising regularly, is off sugar, and maintains a low-carb diet as it’s best for her treatment.

The 10% of her tumor that couldn’t be surgically removed has been eradicated with chemo and hasn’t returned, based on her most recent scan.

Culicchia notes that when he first started practicing 30 years ago, to see a patient live a year was amazing. Now, it’s not unusual to see people survive for two years. To see them die at three to six months, he says, is not unusual either.

But, overall, he believes with better chemo, more research, and the advent of neuro-oncologists, we have a better focus on this area. The combined efforts bode well for a patient’s survival.

Another vaccine is in Phase III trials outside of Providence, Rhode Island, and involves 300 patients. Claiming the treatment doubles the fiveyear survival rate to 13% from 5%, the injections seem to activate the patient’s neuroimmune cells, causing them to attack the cancer.

And a whole new class of cancer drugs has come out of Columbia University in New York City.

This is just the tip of the iceberg. The momentum to conquer this disease is slowly but surely building.

e r e to get out th

KEEPING YOU WELL

At LCMC Health, we help people get the most out of life. That means keeping you well so you can get out and experience what life has to offer. It’s what drives us, through more than two million patient visits each year, from births to surgeries to checkups to emergencies, from head to toe. And we’re not slowing down. With thousands of healthcare professionals in nine hospitals and dozens of clinics and practices across the New Orleans area and beyond, LCMC Health continues to make extraordinary care an expectation. We’re dedicated to keeping you, and every member of the communities we serve, well.

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