Cancer Resource Guide 2014

Cancer Resource Guide

BRAvo! Mammogram “Saved My Life”

My Personal Story

Cancer is a Diagnosis No One Wants to Hear

Precision Cancer Therapy

Cancer Center

Hope Grows Here.

October 5, 2014 Breast Center

Susan thought she’d be ALONE in her battle with cancer.

Then she met...

Jenny,

Susan Williamson Richmond, IN

and Kristen. and Lisa,

Kristen Cole, RN

Jenny Davis, Office Assistant Lisa Mustaine, RN

Award Winner

2014 Breast Imaging Center of Excellence

We’re with you every step of the way.

1100 Reid Pkwy, Richmond l (765) 935-8773 l ReidHospital.org/CancerCenter

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Reid Breast Center designated ‘Breast Imaging Center of Excellence’ The Reid Breast Center has been designated a Breast Imaging Center of Excellence by the American College of Radiology (ACR).

By awarding facilities the status of a Breast Imaging Center of Excellence, the ACR recognizes breast imaging centers that have earned accreditiation in mammography, stereotactic breast biopsy, and breast ultrasound (including ultrasound-guided breast biopsy).

Peer-review evaluations, conducted in each breast imaging modality by board-certified physicians and medical physicists who are experts in the field, have determined that this facility has achieved high practice standards in image quality, personal qualifications, facility equipment, quality control procedures, and quality assurance programs.

The ACR is a national professional organization serving more than 36,000 diagnostic/interventional radiologists, radiation oncologists, nuclear medicine physicians, and medical physicists with programs focusing on the practice of medical imaging and radiation oncology and the delivery of comprehensive health care services.

RESOURCES INDEX Mammogram Saved my Life page 4 & 5 My Personal Story page 5 & 6 Self Breast Exam page 7 Bra Competition Raises Awareness page 8 & 9 Low-down on Breast Cancer page 9-11 Many Diseases One Name page 12 Cancer Survivors, Long-Term Follow Up page 13 A Diagnosis No One Wants to Hear page 14 & 15 Precision Cancer Therapy page 16 Physician Led Care Teams page 17 Special Certification for Oncology page 18 Prostate Cancer page 19 Colon Cancer page 20 Recommendations for Colorectal Cancer page 21 & 22 Kids and Your Diagnosis page 23

Reid Breast Center

2014 Breast Imaging Center of Excellence BRAvo! Signature Event Oct. 18: BRAvo! Signature Event, 6-10 p.m. in Lingle Grand Hall and MacDowell Gallery with a silent and called auction, announcement of the most popular decorated bras, dinner and other festivities. Tickets are $75 each, and registration is available on the BRAvo! website at reidbravo.org.

Info: (765) 983-3102 or reidbravo.org.

Chad Bolser will return this year for his 4th time as emcee of the live auction at the BRAvo! Signature Event.

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BRAvo! Mammogram “Saved My Life”

On a nice day, Claudia Middleton is outside – hiking, swimming, fishing and spending time with her husband, Donnie. She is a free-spirit and she appreciates life now more than ever. In 2012, Claudia celebrated her parents’ 60th wedding anniversary in Florida. When she returned, life as she knew it came to a screeching halt.

Claudia reached to scratch her side as she was going about her day. Then she felt a small lump. She knew she needed a mammogram right away. “I had no medical coverage,” Claudia said. Her husband worked in construction and didn’t have insurance. “I knew I could get free mammograms at Reid.”

She called and was able to get an appointment just a few days later. “It was really simple,” she said. When a patient

calls Reid Central Scheduling, they ask a few easy questions, and if a woman is over 40 years old and uninsured, the screening is covered by the Community Benefit Mammogram program and funded through BRAvo! The staff explained to Claudia there was a need for an ultrasound and later, a biopsy. Surgeon Dr.Thomas Grayson performed the procedure. She soon received the diagnosis of breast cancer. “Dr. Grayson told me all my options, and I went home and talked to Donnie,” she said. “Donnie told me to do what I needed to do. The choice was mine and he would support me no matter what.” After giving it thought, Claudia chose what she considered to be the safest option days later. “It was really simple,” she said. When a patient Continued on Page 5

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Continued from Page 4 calls Reid Central Scheduling, they ask a few easy questions, and if a woman is over 40 years old and uninsured, the screening is covered by the Community Benefit Mammogram program and funded through BRAvo! The staff explained to Claudia there was a need for an ultrasound and later, a biopsy. Surgeon Dr.Thomas Grayson performed the procedure. She soon received the diagnosis of breast cancer. “Dr. Grayson told me all my options, and I went home and talked to Donnie,” she said. “Donnie told me to do what I needed to do. The choice was mine and he would support me no matter what.” After giving it thought, Claudia chose what she considered to be the safest option and had a mastectomy.

One week later, Claudia’s father, Gene, was also diagnosed with cancer – for the second time. As Claudia was navigating through procedures and decisions, her father was doing the same. And her mother was in poor health as well.

“The entire cancer department was awesome,” said Claudia.

Reid cancer navigators walked them through each step, providing them with necessary resources and answering any questions they had. Navigator Kathy MacDonald helped Claudia apply for health coverage through Indiana Breast and Cervical Cancer Program (BCCP), which covers testing and treatment for underserved and underinsured women who qualify for services.

As Claudia lay on the surgical bed awaiting surgery, she became very nervous. “I was starting to freak out, and I said

BRAvo!/Cancer Resources

‘Where is Dr. Grayson?’” Claudia explained. “He came right over and held my hand until I was out.”

Claudia and Gene took turns with chemotherapy – one in the morning, the other in the afternoon – so they could take Claudia’s mother to and from dialysis and doctor appointments. Chemo was followed by radiation. “Kristen Cole (nurse) knew exactly what I wanted. She met me with pillows and blankets and let me sleep through my treatments,” Claudia said. “Dr. Riggs and her nurse, Lisa Mustang, were awesome!”

“I remember the day they told me I was cancer-free. I called my dad first,” Claudia said. “I said, ‘Dad, we did it!’ We both cried.”

Gene came through with flying colors as well, and was given nearly two more years with his family before facing a heart issue. He cared for the love of his life until her dying day, and Claudia cared for him until he recently passed away.

“My dad was so strong. I was so proud of him,” Claudia said. She is thankful for the care she and her parents received. “The Breast Center, Cancer Center, Heart Center and Hospice – they are all amazing! Nice is great, but in the long run I want skilled – Dr. Grayson and Dr. Riggs were both.”

Claudia is strong like her dad. She overcame adversity and challenges with grace, and now she is back to appreciating and enjoying life with her husband.

“Without BRAvo!, I probably would have died of cancer.

It saved my life, and probably lots of others…thank you.”

My personal story

by Rachel E. Sheeley

Tests that check for cancer can be unnerving for someone with a history of cancer in their family.

You want to be proactive, to locate cancer at the earliest possible moment because that provides the best opportunity to conquer it. But you’re fearful to hear such a diagnosis.

In 1996, I was a 29-year-old reporter who heard a lot about women dying from breast cancer. I wanted to provide hope to the Palladium-Item readers rather than gloom. I chose to write about breast cancer survivors to show that a cancer Continued on Page 6

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Continued from Page 5 diagnosis did not equal a death sentence.

Mammogram scheduling

I have continued to write about brave women and men annually, and many have graciously shared their stories each year.

• To schedule a mammogram at the Reid Breast Center, call central scheduling at (765) 983-3358 or preregister at bravomammogram.org.

Over time, the stories about cancer survivors have become more personal. I lost my mother to breast cancer in 2007 and I have many other friends and acquaintances whose lives have been touched or hurt by cancer.

As the years passed, I realized that the person with cancer — any cancer, not just breast cancer — is not the only survivor. Every family member and friend who cares, who delivers dinner, sends an email or offers a prayer, also is a survivor of the experience.

• Anyone with concerns about the cost of a mammogram should consult their health-care provider or contact Reid Foundation. Reid Foundation’s annual BRAvo! campaign promotes breast cancer awareness and raises money to pay for mammograms for women who cannot afford them.There is never an out-of-pocket expense for a screening mammogram -- not even a deductible!

It made me admire the survivors — and their families — even more.

What I didn’t admire was the fear in my own heart, inspired more by my mother’s death than any survivor’s story I’d written, the fear to have a mammogram. At age 40, the same year my mother died with breast cancer, I had my first mammogram. It was clear. And then, well, I stopped going.

Because I have a family history of breast cancer, I know it is important to remain vigilant through self-exams and mammograms. But fear is a funny thing. It helps you find excuses to keep from doing the right thing.

In October 2012, I faced my fears. I had the mammogram I’d been putting off for fear of bad news. I took Palladium-Item readers along on the trip, something that strangely took less courage than scheduling the mammogram.

The screening was mostly positive and less scary than I imagined. I’ve been back each year.

There was some concern about an area seen in my first mammogram, but a six-month checkup cleared that.The next year remained clear, too.

Mammograms shouldn’t be relied upon as the only way to diagnose breast cancer, but it is one of the best tools in a woman’s arsenal.

Women also should have regular physician examinations,

• Reid Breast Center offers Women’s Health Day, a special day each month that enables women to schedule a mammogram and PAP during the same appointment.The appointment includes the opportunity to have DEXA osteoporosis screening plus receive complimentary chair massage and a gift bag. Appointments last about two hours, and the number available each month is limited.

do self-exams and know their breasts. If something seems wrong, such as nipple discharge or a change in the breast’s appearance, see a physician.

Many breast cancer survivors have told me that their inner voice or their instincts told them something was wrong before any test confirmed it. And early detection, however much we might not want to hear it, provides the best chance for survival.

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How-to conduct a breast self-exam

Early detection of breast cancer can improve survival rates and lessen the severity of treatment options. Routine mammograms are essential to catching signs of breast cancer early on but so can home-based breast exams.

Over the years there has been some debate over the effectiveness of breast self-exams, or BSEs, is effective.

Different breast cancer organizations have different views on the subject.

Some studies have indicated that a BSE is not effective in reducing breast cancer mortality rates. Some argue that these exams also may put women at risk -- increasing the number of potential lumps found due to uncertainty as to what is being felt in the breast.

This can lead to unnecessary biopsies.

Others feel that a BSE is a good practice, considering that roughly 20 percent of breast cancers are found by physical examination rather than by mammography, according to BreastCancer.org.

The American Cancer Society takes the position that a BSE is an optional screening tool for breast cancer. For those who are interested in conducting self-exams, here is the proper way to do so.

• Begin with a visual inspection of the breasts. Remove clothing and stand in front of a mirror.Turn and pivot so the breasts can be seen at all angles. Make a note of your breasts’ appearance.

Pay special attention to any dimpling, puckering or oddness in the appearance of the skin. Check to see if there is

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any change in symmetry or size of the breasts.

• Continue the examination with hands placed by the hips and then again with your hands elevated overhead with your palms pressed together.

• Next you will move on to a physical examination.This can be done either by reclining on a bed or the floor or any flat surface.The exam also can be done in the shower.To begin examining the breasts, place the hand and arm for the breast you will be examining behind your head. Use the pads of your pointer, middle and ring fingers to push and massage at the breast in a clockwise motion. Begin at the outer portion of the breast, slowly working inward in a circular motion until you are at the nipple. Be sure to also check the tissue under the breast and by the armpit.

• Do the same process on the opposite breast. Note if there are any differences from one breast to the other.

If you find any abnormalities, mark them down on an illustration that you can bring to the doctor. Or if you can get an appointment immediately, draw a ring around the area with a pen so that you will be able to show the doctor directly where you have concern.

It is a good idea to conduct a BSE once a month and not when menstruating, when breasts may change due to hormone fluctuation. Frequent examinations will better acquaint you with what is normal with your breasts and better help you recognize if something feels abnormal.

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Bra competition raises awareness, money in fight against deadly disease

By Rachel E. Sheeley Every decorated bra — like every woman or man diagnosed with breast cancer — has a story.

Reid Foundation’s BRAvo! Busting Out Against Breast Cancer initiative’s fourth annual decorated bra competition has secured 117 entries.

The BRAvo! initiative, organized by Reid Foundation, promotes breast cancer awareness and raises money for no-charge mammograms provided through Reid Hospital & Health Care Services for those experiencing financial hardships.

“Through Reid Foundation’s BRAvo! fund and a grant from Indiana Breast Cancer Awareness Trust, up to 500 uninsured women per year receive no-cost mammograms,” said Melissa Vance, events and communications coordinator for Reid Foundation.

“Early detection makes all the difference. BRAvo! was created to eliminate the excuses and encourage all women to be proactive with their health,”Vance said. “This endeavor has truly become a community initiative, and lives are being saved.”

Annual mammograms are recommended by the American Cancer Society for women age 40 and older because they are a key tool in breast cancer diagnosis.The sooner the disease is discovered, the greater the chance of surviving.

According to Reid Foundation, 37 percent of women in the hospital’s service area who are age 40 or older have not had a mammogram during the past 12 months. Additionally, an estimated 53 women in the area die each year from breast cancer.

Since BRAvo! began in 2011, the number of area women receiving no-cost mammograms has increased.

Support for the program has increased as well, with creative residents putting forth more than 100 decorated bras each year for the competition, which coincides with

National Breast Cancer Awareness Month.

Those participants keep developing new themes.

“It’s amazing the creativity that comes in consistently,” Vance said. “The neat thing is seeing the stories that come in with them.

“When people are decorating these bras, they have special people in mind. For some, this is the first year they are remembering someone they lost or celebrating with someone who is a survivor. That’s the special part of it,” she said.

Each bra is a contest entry and the story of how a life has been touched by breast cancer.There are bras made by breast cancer survivors, bras made by family members of women who triumphed over breast cancer and by those whose loved ones succumbed to breast cancer.There are bras by healthcare workers, men, women, families, coworkers, organizations and businesses.

Last year, several bras used the popular TV reality show, “Duck Dynasty,” as the basis for their theme.This year, there are four bras inspired by the Disney movie, “Frozen.”

“They are all different and they are all absolutely beautiful,”Vance said.

The decorated bras will be displayed at locations throughout the area before returning to the hospital for the signature event Oct. 18. Bras can be viewed in person or online, where the majority of the voting takes place, at the BRAvo! website reidbravo.org. Voting concludes October 14.

In the past, the top 12 vote-getters have been featured Continued on Page 9

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Continued from Page 8 in a calendar. This year, the top 12 will grace a note card collection that will be available for purchase before the holidays. Also included in the note card collection will be the top fundraisers in three categories: Reid departments, corporations and businesses, and community individuals.

Many of the bras, along with many donated items, will be sold during the silent and live auctions at the gala Signature Event. About 170 people attended last year, raising more than $20,000 through their bids in the two auctions.

“There are a lot of strong women in our community. It’s neat to have an opportunity to celebrate them,”Vance said.

Hoppe Jewelers submission, Shine Like a Diamond, received the most votes in 2013.

Get the low-down on breast cancer

How many women get breast cancer?

The American Cancer Society’s most recent estimates for breast cancer in the United States are for 2012: • About 226,870 new cases of invasive breast cancer in women • About 63,300 new cases of carcinoma in situ (CIS) will be found (CIS is non-invasive and is the earliest form of breast cancer).

• About 39,510 deaths from breast cancer (women) Breast cancer is the most common cancer among women in the United States, other than skin cancer. It is the second leading cause of cancer death in women, after lung cancer.

The chance of a woman having invasive breast cancer some time during her life is about 1 in 8.The chance of dying from breast cancer is about 1 in 36. Breast cancer death rates have been going down.This is probably the result of finding the cancer earlier and better treatment. Right now there are more than 2.9 million breast cancer survivors in the United States.

Risk • Most women are older than 60 when diagnosed with breast cancer.

• White women are more often diagnosed with breast cancer than any other race.

• Physically inactive women have an increased

risk for breast cancer.

Compiled from CDC.gov, NIH.gov and apps.nccd.cdc. gov/uscs/.The USCA is produced by the Centers for Disease Control and Prevention and the National Institutes of Health in collaboration with the North American Association of Central Cancer Registries (NAACCR).

Risk Factors Even without any risk factors, every woman is at risk for breast cancer.The most common risk factors are: • Family and personal history • Certain chromosomal changes • Certain gene changes (BRCA1 and BRCA2) • Race (most commonly diagnosed in white women) • Radiation therapy to the chest • History of taking DES during pregnancy • Large areas of breast density as it appears on mammogram • Over age 40 • Early period • Late menopause • Years of menopausal hormone therapy • Late age when having first child • Late age at first full-term pregnancy • Never having a child Continued on Page 10

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Continued from Page 9 • Obesity and postmenopausal obesity • Alcohol consumption • Physical inactivity Recent birth control pill use has been linked to increased breast cancer risk, according to the American Cancer Society and the National Cancer Institute. However, the risk seems to decrease over time and return to normal more than 10 years after use of the pill is stopped.

Researchers are still studying many other lifestyle and genetic factors that might increase breast cancer risk.Taking fish oil supplements, having a fatty diet and hormones in general and during pregnancy are topics currently under study.

However, some proposed causes of breast cancer have no clear causal relationship, according to the ACS. Currently no scientific evidence supports association between breast cancer and: • Antiperspirant use • Underwire bras • Breast implants Tips to reduce your risk of getting breast cancer While there is no way to eliminate the risk of getting breast cancer altogether, some studies indicate that the following tips could help reduce the risk: • Be vigilant about breast self-exams, clinical breast exams and mammograms.

• Contact your doctor if you notice breast changes, lumps or changes to your skin or nipples.

• Use condoms instead of the pill.

• Use naturopathic therapies instead of hormone replacement therapy.

• Eat right and limit fat in your diet.

• Exercise regularly.

• Maintain a healthy weight.

• Limit alcohol consumption.

• Use chemoprevention (Tamoxifen, Raloxifene and other drugs).

• Have prophylactic mastectomy and/or oophorectomy.

• Participate in a cancer prevention clinical trial.

Research is under way to determine the impact of herbs and dietary supplements on reducing breast cancer.

Note that conflicting study results show that diet and vitamins, active and passive smoking, environmental and chemical factors and oral contraceptive use might or might not impact breast cancer risk, according to the National Cancer Institute.

Steps to breast cancer early detection Reid Hospital cites the American Cancer Society’s recommendation that women older than 40 get a screening mammogram once a year. Appointments can be made by calling Reid Central Scheduling at (765) 983-3358.

No-cost screening mammograms are available to women age 40 and over who do not have insurance, Medicaid, or Medicare.These no-cost mammograms are made possible by BRAvo!.

Without doubt, early detection of breast cancer saves lives. Becoming aware of what your breasts look and feel like normally will help you when following these American Cancer Society guidelines to breast cancer early detection: • Monthly breast self-examinations beginning at age 20.

• Clinical breast exams every year beginning at age 40.

• Mammograms every year beginning at age 40.

• MRI (magnetic resonance imaging) and mammogram every year beginning at age 40 for women at high risk.

Incidence of breast cancer Every woman is at risk for breast cancer. Unfortunately, that’s one factor that so far cannot be changed. Statistics show the following relative to race, age and stage: • Excluding skin cancers, breast cancer is the most common cancer in U.S. women ages 40-49.

• In 2006, 2.5 million living women in the United States had a history of breast cancer.

• In the United States, more than 200,000 women are diagnosed with breast cancer each year.

• Over age 45, white women are more likely than black women to be diagnosed with breast cancer.

• Under age 45, black women are more likely to be diagnosed with breast cancer.

• Black women at any age are more likely than white women to die from breast cancer due to later detection.

• Other ethnic groups have a lower incidence and death rate than either black or white women.

• Men also develop breast cancer, but their risk is considerably lower. Each year about 2,000 men are diagnosed with breast cancer in the United States.

• The relative survival rate five years after diagnosis is 89 percent.

Survival rate by stage: Stage: 5-year Survival Rate 0 I II III IV

100% 100% 93% 72% 22%

Table source: Cancer.org, last revised 09/11/13

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Continued from Page 10 Understanding the stages Stage 0: There are 2 types of stage 0 breast carcinoma in situ: ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). DCIS is a noninvasive condition in which abnormal cells are found in the lining of a breast duct (a tube that carries milk to the nipple).The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues, although it is not known how to predict which lesions will become invasive cancer. LCIS is a condition in which abnormal cells are found in the lobules (small sections of tissue involved with making milk) of the breast.

This condition seldom becomes invasive cancer; however, having LCIS in one breast increases the risk of developing breast cancer in either breast.

Stage I: Stage I breast cancer is divided into stages IA and IB. In stage IA, the tumor is 2 centimeters or smaller and has not spread outside the breast. In stage IB, (1) no tumor is found in the breast, but small clusters of cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes; or (2) the tumor is 2 centimeters or smaller and small clusters of cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes.

Stage II: Stage II breast cancer is divided into stages IIA and IIB. In stage IIA, (1) no tumor is found in the breast, but cancer is found in the axillary (under the arm) lymph nodes; or (2) the tumor is 2 centimeters or smaller and has spread to the axillary lymph nodes; or (3) the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes. In stage IIB, the tumor is (1) larger than 2 centimeters but not larger than 5 centimeters and has spread to the axillary lymph nodes; or (2) larger than 5 centimeters but has not spread to the axillary lymph nodes.

Stage III: Stage III breast cancer is divided into stages IIIA, IIIB, and IIIC. In stage IIIA, (1) no tumor is found in the breast, but cancer is found in axillary (under the arm) lymph nodes that are attached to each other or to other structures, or cancer may be found in lymph nodes near the breastbone; or (2) the tumor is 2 centimeters or smaller and cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or the cancer may have spread to lymph nodes near the breastbone; or (3) the tumor is larger than 2 centimeters but not larger than 5 centimeters and cancer has spread to axillary lymph nodes that are

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attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone; or (4) the tumor is larger than 5 centimeters and cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or the cancer may have spread to lymph nodes near the breastbone. In stage IIIB, the tumor may be any size and cancer (1) has spread to the chest wall and/or the skin of the breast; and (2) may have spread to axillary lymph nodes that may be attached to each other or to other structures, or the cancer may have spread to lymph nodes near the breastbone. In stage IIIC, there may be no sign of cancer in the breast or the tumor may be any size and may have spread to the chest wall and/or the skin of the breast. Also, cancer (1) has spread to lymph nodes above or below the collarbone, and (2) may have spread to axillary lymph nodes or to lymph nodes near the breastbone. In operable stage IIIC, the cancer is found (1) in ten or more axillary lymph nodes; or (2) in the lymph nodes below the collarbone; or (3) is found in axillary lymph nodes and in lymph nodes near the breastbone. In inoperable stage IIIC, the cancer has spread to the lymph nodes above the collarbone.

Stage IV: cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.

Stage definitions source: National Cancer Institute Dictionary of Cancer Terms

THE OFFICIAL SPONSOR OF BIRTHDAYS

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WHAT IS CANCER?

Many diseases One name Cancer is the general name for a group of more than 100 diseases in which cells in part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because abnormal cells grow out of control.

The body is made up of trillions of living cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person’s life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries.

Cancer cell growth is different from normal cell growth.

Instead of dying, cancer cells continue to grow and form new, abnormal cells.They can invade (grow into) other tissues, something that normal cells cannot do.

Courting Cancer

Who is most at risk?

Essentially, everybody is at risk of developing cancer. Half of all men and one-third of all women in the US will develop cancer during their lifetimes.Today, millions of people are living with cancer or have had cancer.The risk of developing most types of cancer can be reduced by changes in a person’s lifestyle, for example, by avoiding tobacco, limiting time in the sun, being physically active, staying at a healthy weight, limiting alcohol, and healthy eating.

For most types of cancer, the sooner a cancer is found and treated, the better the chances are for living for many years.

No one knows the exact cause of most cases of cancer.

We know that certain changes in our cells can cause cancer to start, but we don’t yet know exactly how it all happens.

Scientists are studying this problem and learning more about the many steps it takes for cancers to form and grow. Although some of the factors in these steps may be a lot alike, the process that happens in the cells is generally different for each type of cancer.

Some cancers are caused by things people do or expose themselves to. For example, smoking can cause cancers of the lungs, mouth, throat, bladder, kidneys, and other organs.

Of course, not everyone who smokes will get cancer, but

Abnormal cell invasion defines cancer In most cases, cancer cells form a tumor, also called a mass or a lump. Some cancers, like leukemia, involve the blood and blood-forming organs, and the cancer cells circulate through other tissues where they grow.

Cancer cells often travel to other parts of the body, where they begin to grow and form tumors that replace normal tissue.This process is called metástasis. It happens when the cancer cells get into the bloodstream or lymph vessels of our body.

(Not all tumors are cancer.Tumors that aren’t cancer are called benign. Benign tumors can cause problems, but they do not invade other tissues and are almost never life threatening.)

No matter where a cancer may spread, it’s always named for the place where it started. For example, breast cancer that has spread to the liver is still called breast cancer, not liver cancer. Likewise, prostate cancer that has spread to the bone is metastatic prostate cancer, not bone cancer.

Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases.They grow at different rates and respond to different treatments.

That’s why people with cancer need treatment aimed at their particular kind of cancer.

smoking increases a person’s chance of cancer, as well as their chance of heart and blood vessel disease.

Being in the sun too much without protection can cause skin cancer. Melanoma is a very serious form of skin cancer linked to sunlight and tanning bed exposure.

Certain chemicals have been linked to cancer, too. Being exposed to or working with them can increase a person’s risk of cancer.These chemicals are called carcinogens.

Cancer may come from family genes. Of every 20 cases of cancer, about 1 is linked to genes that are inherited from parents.

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CANCER SURVIVORS

Reid Oncology Associates Offers LongTerm Follow-Up for Cancer Survivors When Karen Wilson’s nine months of cancer treatment came to an end in June 2014, she was thrilled. No more radiation therapy! No more hair loss from chemo! Best of all, imaging tests showed no signs of the endometrial cancer that had taken her by surprise the year before.Yet… Karen was not quite ready to say goodbye to her medical team at Reid Oncology Associates. So when her oncologist, Dr. Jeevan Sekhar, recommended she participate in their new cancer survivorship program, Karen immediately said yes.

The program, called “Living Through Cancer,” helps cancer survivors take charge of their health. Any patient who has completed cancer treatment is eligible to participate, regardless of where they received their care.The centerpiece of the program is a one-hour appointment at Reid Oncology Associates that includes a: • Thorough physical • Screening for depression and anxiety • Recap of the patient’s course of treatment • Discussion of the patient’s current symptoms and side effects • Conversation about preventive health measures that are tailored to the patient’s health history “This program is very reassuring and helpful to cancer survivors, who often feel lost after their course of treatment ends,” said Turner. “I tailor all of my recommendations to their specific needs, focusing on nutrition, physical activity and preventive measures, such as the importance of using sunscreen and getting periodic health screenings.”

Karen Wilson met with Turner in August 2014 and found their time together to be very helpful. “I’d never had cancer before, so it was reassuring to talk about some of the normal after-effects of chemotherapy and radiation, such as fatigue and memory loss,” said Karen, a Richmond resident.

“She gave me a binder full of helpful information, plus a cancer survivor pin, which I wear every day.”

Another Richmond resident and cancer survivor, Kim Carter, was equally impressed with the program. Kim, 41, was diagnosed with stage 3 breast cancer in April 2012.

She underwent treatment in Virginia, and in 2013 moved to Richmond with her family when her husband became president of Bethany Theological Seminary. “When you are being treated for cancer, multiple doctors and nurses are monitoring you closely all the time,” she said. “But when

“This program is very reassuring and helpful to cancer survivors, who often feel lost after their course of treatment ends.”

Tamika Turner, NP

treatment ends, it can be a scary time, because you have a lot of questions—like, is my cancer going to come back?

Why can’t I remember my oncologist’s name? Is my appetite normal? Tamika answered all of my questions, and she also provided emotional care and comfort.”

Turner can make referrals if she notices any red flags during the appointment. Some common concerns include an inability to pay for medication, difficulty managing symptoms such as nausea and fatigue, and intense fear about the risk of cancer recurrence. Patients remain under the care of their cancer specialist and primary care physician, and are encouraged to return to the clinic for an annual check-up or whenever they have concerns. As the program grows,Turner plans to offer support groups and educational presentations for cancer survivors.

To make an appointment, please call Reid Oncology Associates at (765) 935-8773.

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SUPPORT GROUPS

Cancer is a Diagnosis No One Wants to Hear

Kathy Macdonald, RN, BSN OCH, Quality Manager, Oncology Service Line; Brenda Bowman, RN, BSN, Cancer Navigator; Tammie Angeles, MSW, Social Worker; Jill Miller, RN, Cancer Navigator; Dianne Bailey, RN, BSN, Cancer Navigator

By Pam Tharp For the Palladium-Item Cancer is a diagnosis no one wants to hear.

When a patient at Reid Hospital gets that diagnosis, the Reid Cancer Center staff is ready to help, both in fighting the disease and assisting patients in managing their emotions and other concerns.

Oncology social worker Tammie Angeles said patient support groups were an important component in planning the cancer center, which opened two years ago.

Angeles knows first-hand the feeling a cancer diagnosis brings because she had basal cell skin cancer.

“The cancer navigators saw a need for emotional support for patients,” Angeles said. “We’ve had a patient support group for about 18 months.”

The oncology support group usually is small, about 5 or

so patients, Angeles said.

“We try to help people reach out to whatever support community they have. Sometimes it’s family or a faith community or friends,” Angeles said. “Having a good support system is very important.”

Many patients diagnosed with cancer have found that joining a support group helps them manage the wide range of feelings and fears they experience during and after their cancer treatment, Angeles said.

Support groups also help family members and friends handle the countless emotions they experience when a loved one receives a cancer diagnosis, according to the American Association for Cancer Research.

Studies have found cancer support groups can enhance self-esteem, reduce depression, decrease anxiety and improve relationships with family members and friends.

Support groups may also help patients better cope with a diagnosis and increase their knowledge of cancer and

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treatment options.

Many Reid patients come to the support group asoon after they receive the first diagnosis, Angeles said.

“They have a lot of concerns about what to expect.They learn about the resources available,” Angeles said. “Cancer can be very stressful and very anxiety-provoking. Not all patients have family nearby, so we may be their only support.

It’s comforting to know you have someone you can call whenever you need to.”

Patients whose cancer later returns often return to the support group for help and comfort, Angeles said.

“The person-to-person connection is very valuable,” Angeles said.

Susan Williamson of Richmond is greeted by Kristen Cole, RN.

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Precision Cancer Therapy Reid Cancer Center’s radiation therapy department was the first in the state to offer “TrueBeam,” a precision radiotherapy technology to benefit cancer patients.

Reid’s “TrueBeam” radiation therapy system, in use since 2011, makes it possible to target tumors with more precision, protect healthy tissue and shorten treatment sessions for the patient.The system advances the treatment of all cancers by combining sophisticated computer software and a powerful medical linear accelerator to deliver radiation with unprecedented accuracy, said Dr. Arvind Kumar, medical director of Radiation Oncology at Reid.

Tumor movement challenges the precision of radiation therapy for all cancers, especially of the lung, breast, abdomen and liver, according to Dr. Kumar. “Movement can be caused by the patient coughing, shifting his or her body on the table or just breathing,” explained Dr. Kumar.

“TrueBeam is one more reason patients don’t have to travel for state-of-the-art treatment in their fight against cancer,” said Dr. Kumar. “They can get what they need right here in Richmond. For now, the fact is they can’t get this breakthrough treatment anywhere else.”

“TrueBeam delivers precise radiation treatments while monitoring and compensating for tumor motion,” Dr. Kumar said. “Also, treatment sessions are much shorter. A session that once took 10 to 30 minutes now can be completed in less than two, once we position the patient in some cases.

This means a more comfortable experience for the patient.”

The technology allows imaging, targeting and treating the tumor from multiple angles. “Old technologies require caregivers to manually re-position the radiation equipment many times during a single session to target the tumor from a limited number of angles,” Dr. Kumar said. “TrueBeam’s programming allows rotation around the patient’s body to deliver the prescribed radiation from nearly any angle.”

TrueBeam is just one example of the quality of care available at Reid Cancer Center. The Center offers comprehensive services with a personal touch that helps set

“Movement can be caused by the patient coughing, shifting his or her body on the table or just breathing.”

Dr. Arvind Kumar

it apart for patients and their families. And the support team makes it possible for patients to have someone working with them through every step of their journey.

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Physician-led team at Reid Cancer Center enhances patient care

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Medical oncologists Heather Riggs, MD; Derek Serna, MD; and Jeevan Sekhar, MD, of Reid Oncology Associates.

Physicians are driving the success of Reid Cancer Center, providing leadership that fosters clinical excellence and better coordination of care.

The team includes three medical oncologists — Drs. Heather Riggs, Jeevan Sekhar and Derek Serna of Reid Oncology Associates—and radiation oncologist Dr. Arvind Kumar.They work closely with a variety of other specialists, as well as cancer navigator nurses, infusion therapists, dietitians, social workers and many others. “Because of the complexity of their disease, cancer patients see multiple specialists during their course of treatment,” said Dr. Serna.

“Not a day goes by that we don’t talk to a variety of physicians with regards to patient care. It’s critical that the care team works together so that treatment is carried out in a coordinated and efficient way.”

The Cancer Center’s tumor board is essential.The board meets every other week, discussing five to 10 cases at a time. “Every cancer patient is different, and we need input from many specialists as we decide upon the best course of action,” said Dr. Kumar. “ Up to 15 people attend tumor board meetings, including cancer physicians, surgeons, pathologists and radiologists, cancer navigator nurses, infusion therapists and other ancillary caregivers.”

The goal is to reach consensus about a treatment plan as soon after diagnosis as possible. For example, a breast

cancer patient typically is presented following the initial biopsy. After one physician provides an overview of the case, other physicians contribute. A radiologist might share mammography images; a pathologist interprets diagnostic findings. If the lymph nodes are involved, a discussion about chemotherapy prior to surgery may take place. Meanwhile, the surgeon will make recommendations about whether a lumpectomy or mastectomy would be more effective.The patient’s preferences are taken into account as well.

“Research shows that multi-modality treatment results in fewer side effects while producing outcomes that are as good as or better than single-modality treatment,” said Dr. Kumar. “The tumor board is an opportunity to discuss which modalities are best for a particular patient, and in which order they should take place.”

Once treatment begins, cancer navigators play a key role, Dr. Serna added. “Cancer navigators help set up doctor appointments, make sure patients are getting the support services they need and answer questions about the treatment plan,” he explained. “They are kind of the glue that holds together the patient experience.”

To learn more about the Reid Cancer Center, please visit ReidHospital.org/CancerCenter.

To refer a patient for cancer care, please call (765) 935-8934.

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Reid Oncology Associates receives special quality certification Reid Oncology Associates has been recognized by the Quality Oncology Practice Initiative (QOPI®) Certification Program, an affiliate of the American Society of Clinical Oncology (ASCO). The QOPI® Certification Program provides a three-year certification for outpatient hematology-oncology practices that meet the highest standards for quality cancer care.

“This certification is another example of our commitment to provide the highest in quality care by voluntarily holding our practice to the highest of standards,” said Heather Riggs, M.D., one of the physicians with Reid Oncology Associates. “And our patients already are very familiar with the compassionate care provided by our team members, who walk with them every step of their journey.”

ASCO President Clifford A. Hudis, M.D., FACP, said, “QOPI is designed by clinical experts in oncology to give practices the ability to continuously improve the quality of care they provide. The QOPI Certification Program helps practices determine whether they are providing the best possible treatment and care to their patients and demonstrates their commitment to excellence and lifelong learning.”

Craig Kinyon, Reid President/CEO, said the certification is another example of numerous voluntary efforts by the Reid team of physicians and caregivers to strive for excellence, “in addition to an equally recognized dedication to compassionate care that goes the extra mile in taking care of the needs of patients and their families.” He said the oncology team makes individual care “very personal” that sets the patient experience apart. “These are the efforts that have given Reid such a great reputation for unsurpassed quality and yet genuinely personal care we provide patients and families every day,” Kinyon said.

QOPI® is a voluntary, self-assessment and improvement program launched by ASCO in 2006 to help hematology-oncology and medical oncology practices assess the quality of the care they provide to patients. Through the QOPI program, practices abstract data from patients’ records up to twice per year and enter this information into a secure database. More than 850 oncology practices have registered in the QOPI program.

The QOPI® Certification Program (QCP™) was launched in January 2010, with more than 200 practices already certified. This certification for outpatient oncology practices is the first program of its kind for oncology in the United States. Oncologists can achieve certification by meeting the highest standards of care. The QCP seal desig-

nates those practices that not only scored high on the key QOPI quality measures, but meet rigorous chemotherapy safety standards established by ASCO and the Oncology Nursing Society (ONS).

QOPI® analyzes individual practice data and compares these to more than 160 evidence-based and consensus quality measures. The information is then provided in reports to participating practices. Individual practices are also able to compare their performance to data from other practices across the country. Based on this feedback, doctors and practices can identify areas for improvement.

To become certified, practices have to submit to an evaluation of their entire practice and documentation standards. The QCP staff and steering group members then verify through on-site inspection that the evaluation and documents are correct and that the practices met core standards in areas of treatment, including: • treatment planning; • staff training and education; • chemotherapy orders and drug preparation; • patient consent and education; • safe chemotherapy administration; • monitoring and assessment of patient well-being.

The QOPI Certification Program is a project of ASCO’s Institute for Quality, an ASCO affiliate dedicated to innovative quality improvement programs. For more information, please visit: http://qopi.asco.org/certification.html.

About ASCO: Founded in 1964, the American Society of Clinical Oncology (ASCO) is the world’s leading professional organization representing physicians who care for people with cancer. With nearly 35,000 members, ASCO is committed to improving cancer care through scientific meetings, educational programs and peer-reviewed journals. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation, which funds ground-breaking research and programs that make a tangible difference in the lives of people with cancer. For ASCO information and resources, visit www.asco.org. Patient-oriented cancer information is available at www.cancer.net.

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PROSTATE CANCER

One of the Most Common Cancers in Men

By Pam Tharp For the Palladium Item

Prostate cancer is among the most common cancers in men, but new concerns about the accuracy of testing for the illness has resulted in new testing guidelines.

The American Urological Society and the U.S. Preventive Services Task Force are responsible for the new testing recommendations, said Jill Miller, a Reid cancer navigator who works with prostate cancer patients.

It’s now recommended men ages 55 to 69 undergo a PSA (prostate specific antigen) blood test and a digital rectal exam annually or as determined by their physician after a shareddecision session, Miller said.

African-American men and those with a close relative with prostate cancer are at a higher risk for the disease. Men in those categories should discuss the risks and benefits of testing at age 40 with their family physician, Miller said. Prostate cancer, though, doesn’t have as strong a family connection as some cancers, she said.

Prostate cancer is tricky because some cancers are so slowgrowing a man is unlikely to ever die from it. Other prostate cancers are much faster-growing and pose a real threat. Current prostate cancer tests aren’t always able to determine which cancers are aggressive and which are not, according to the American Cancer Society.

The guidelines for routine testing don’t include men under age 55 because the PSA test is not as accurate predictor of cancer in that age group, Miller said. Routine screening is also not recommended for men 70 years old and above, or for those with less than 10 to 15 years of life expectancy, Miller said.

Reid Hospital offers prostate cancer testing three times a year: September, December and in April.The April testing is done at the Wayne County Health Clinic, which often reaches more African-American and Hispanic men, Miller said.

The prostate exam and testing at Reid is popular, with more than 250 men using the service in the past 12 months, Miller said. Physicians volunteer their time to do the exams, Miller said.

“It’s really worthwhile to come out for the testing,” Miller said. “We correlate the results and if there’s anything of concern, we notify the patient and their family physician.”

Because prostate cancer is a disease whose treatment may affect sexual performance, that’s a frequent concern for patients, Miller said. New treatments options are available to reduce those problems, she said.

Reid’s cancer navigators provide assistance to cancer pa-

Penny Goff, Pharmacy Technician mixes custom doses of IV oncology medications for individual patients.

tients for an array of problems, and emotional concerns, Miller said.

“Performance a topic men still don’t like to discuss, but it is a concern,” Miller said. “We do counsel on performance concerns and we refer patients to the urologists to discuss their concerns.”

Screening Guidelines for

Prostate Cancer Starting at age 55, men should talk to a doctor about the pros and cons of testing so they can decide if testing is the right choice for them. If they are African American or have a father or brother who had prostate cancer before age 65, men should have this talk with a doctor starting at age 45.

If men decide to be tested, they should have the PSA blood test with or without a rectal exam. How often they are tested will depend on their PSA level.

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COLON CANCER

Early Detection is Important

By Pam Tharp For the Palladium Item Colon cancer is an illness that increases with age, making screening for the condition most important for those who are age 50 and above.

A colonoscopy, a test in which a gastroenterologist examines the interior of the colon, is recommended for both men and women who are 50 or older or as recommended by their physician, said Kelly Witter, director of Reid Hospital’s oncology services. Nine of 10 colon cancer patients are age 50 years or above, according to the American Cancer Society. copy is done, they don’t,” Witter said. “The preparation for a Inflammatory bowel diseases like ulcerative colitis or colonoscopy is not pleasant, but the peace of mind it brings is Crohn’s disease or a family history of colorectal cancer or worth it.” polyps increase a patient’s risk of colon cancer.

A yearly wellness visit, where a patient and doctor discuss Screening Guidelines for concerns and consider possible screening tests, is vital to Colorectal cancer and polyps catching colon cancer and other conditions, Witter said.

Beginning at age 50, both men and women should follow “Early detection is important,” Witter said. “It increases the one of these testing schedules: possibilities for a positive outcome and may result in less invaTests that find polyps and cancer sive treatment if cancer is found.”

• Flexible sigmoidoscopy every 5 years*, or In Wayne and surrounding counties, colon cancer is among • Colonoscopy every 10 years, or • Double-contrast barium enema every 5 years*, or the top five cancers, Witter said. Nationwide, excluding skin • CT colonography (virtual colonoscopy) every 5 years* cancers, colon cancer is the third most common cancer diagTests that primarily find cancer nosed in both men and women, according to the American •Yearly fecal occult blood test (gFOBT)*,**, or Cancer Society.The ACS estimates there will be 102,480 new •Yearly fecal immunochemical test (FIT) every year*,**, or cases of colon cancer in the U.S. this year and 40,340 new • Stool DNA test (sDNA)*** cases of rectal cancer in 2013. * If the test is positive, a colonoscopy should be done. ** The multiple stool take-home test should be used. One Diet is an important factor in promoting bowel health, Witter said. Eating a proper diet, which includes plenty of fiber test done by the doctor in the office is not adequate for testing.A colonoscopy should be done if the test is positive. and lots of fruits, promotes good bowel health, she said. Exer*** This test is no longer available. cise is also beneficial for healthy bowel function, she said The tests that are designed to find both early cancer and polyps Some people avoid colonoscopies because the preparation are preferred if these tests are available to you and you are willing to have one of these more invasive tests.Talk to your doctor about which to clean out the bowel isn’t much fun.The occult stool test, test is best for you. where a stool sample is obtained from the rectum and tested Some people should be screened using a different schedule for the presence of blood is still used by some physicians, but because of their personal history or family history.Talk with your isn’t a test the hospital uses, Witter said. doctor about your history and what colorectal cancer screening “It has a lot of false positives. It puts people through undue schedule is best for you. stress thinking they have cancer and then when a colonos-

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American Cancer Society recommendations for colorectal cancer early detection People at average risk The American Cancer Society believes that preventing colorectal cancer (and not just finding it early) should be a major reason for getting tested. Finding and removing polyps keeps some people from getting colorectal cancer.Tests that have the best chance of finding both polyps and cancer are preferred if these tests are available to you and you are willing to have them.

Beginning at age 50, both men and women at average risk for developing colorectal cancer should use one of the screening tests below: Tests that find polyps and cancer •Flexible sigmoidoscopy every 5 years* •Colonoscopy every 10 years People at increased or high risk If you are at an increased or high risk of colorectal can-

cer, you should begin colorectal cancer screening before age 50 and/or be screened more often.The following conditions make your risk higher than average: •A personal history of colorectal cancer or adenomatous polyps •A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease) •A strong family history of colorectal cancer or polyps •A known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC) The table below suggests screening guidelines for those with increased or high risk of colorectal cancer based on specific risk factors. Some people may have more than one risk factor. Refer to the table below and discuss these recommendations with your doctor. Based on your situation, your doctor can suggest the best screening option for you, as well as any changes in the schedule based on your individual risk.

American Cancer Society Guidelines on Screening and Surveillance for the Early Detection of Colorectal Adenomas and Cancer in People at Increased Risk or at High Risk INCREASED RISK – Patients With a History of Polyps on Prior Colonoscopy Risk Category

Age to Begin

Recommended Test(s)

Comment

People with small rectal hyperplastic polyps

Same as those at average risk

Colonoscopy, or other screening options at same intervals as for those at average risk

People with 1 or 2 small (less than 1 cm) tubular adenomas with low-grade dysplasia

5 to 10 years after the polyps are removed

Colonoscopy, or other screening options at same intervals as for those at average risk

People with 3 to 10 adenomas, or a large (1 cm +) adenoma, or any adenomas with high-grade dysplasia or villous features

3 years after the polyps are removed

Colonoscopy

Those with hyperplastic polyposis syndrome are at increased risk for adenomatous polyps and cancer and should have more intensive follow-up.

Time between tests should be based on other factors such as prior colonoscopy findings, family history, and patient and doctor preferences.

Adenomas must have been completely removed. If colonoscopy is normal or shows only 1 or 2 small tubular adenomas with low-grade dysplasia, future colonoscopies can be done every 5 years.

People with more than 10 adenomas on a single exam

Within 3 years after the polyps are removed

Colonoscopy

Doctor should consider possibility of genetic syndrome (such as FAP or HNPCC).

People with sessile adenomas that are removed in pieces

2 to 6 months after adenoma removal

Colonoscopy

If entire adenoma has been removed, further testing should be based on doctor’s judgment.

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INCREASED RISK – Patients With Colorectal Cancer Risk Category Age to Begin Recommended Test(s) People diagnosed with colon or rectal cancer

At time of colorectal surgery, or can be 3 to 6 months later if person doesn’t have cancer spread that can’t be removed

Colonoscopy to view entire colon and remove all polyps

People who have had colon or rectal cancer removed by surgery

Within 1 year after cancer resection (or 1 year after colonoscopy to make sure the rest of the colon/rectum was clear)

Colonoscopy

INCREASED RISK – Patients With a Family History Risk Category Age to Begin Recommended Test(s) Age 40, or 10 years before Colonoscopy Colorectal cancer or adenothe youngest case in the matous polyps in any firstimmediate family, whichever degree relative before age 60, is earlier or in 2 or more first-degree relatives at any age (if not a hereditary syndrome).

Same options as for those at Age 40 Colorectal cancer or adenoaverage risk. matous polyps in any first-degree relative aged 60 or older, or in at least 2 second-degree relatives at any age HIGH RISK Risk Category

Comment If the tumor presses on the colon/rectum and prevents colonoscopy, CT colonoscopy (with IV contrast) or DCBE may be done to look at the rest of the colon.

If normal,repeat exam in 3 years.If normal then,repeat exam every 5 years.Time between tests may be shorter if polyps are found or there is reason to suspect HNPCC.After low anterior resection for rectal cancer,exams of the rectum may be done every 3 to 6 months for the first 2 to 3 years to look for signs of recurrence.

Comment Every 5 years.

Same intervals as for those at average risk.

Age to Begin

Recommended Test(s)

Comment

Familial adenomatous polyposis (FAP) diagnosed by genetic testing, or suspected FAP without genetic testing Hereditary non-polyposis colon cancer (HNPCC), or at increased risk of HNPCC based on family history without genetic testing

Age 10 to 12

Yearly flexible sigmoidoscopy to look for signs of FAP; counseling to consider genetic testing if it hasn’t been done Colonoscopy every 1 to 2 years; counseling to consider genetic testing if it hasn’t been done

If genetic test is positive, removal of colon (colectomy) should be considered.

Inflammatory bowel disease:

Cancer risk begins to be significant 8 years after the onset of pancolitis (involvement of entire large intestine), or 12-15 years after the onset of left-sided colitis

-Chronic ulcerative colitis -Crohn’s disease

Age 20 to 25 years, or 10 years before the youngest case in the immediate family

Colonoscopy every 1 to 2 years with biopsies for dysplasia

Genetic testing should be offered to first-degree relatives of people found to have HNPCC mutations by genetic tests. It should also be offered if 1 of the first 3 of the modified Bethesda criteria is met.1 These people are best referred to a center with experience in the surveillance and management of inflammatory bowel disease.

1The Bethesda criteria can be found in the “Can colorectal cancer be prevented?” section of our Colorectal cancer detailed document.

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HELPING CHILDREN UNDERSTAND CANCER

Talk to your Kids About your Diagnosis Your cancer diagnosis has a profound impact on your entire family.There is new information to learn.There are treatment decisions to make. And if you have children, you’re probably also concerned about how much to tell them about your diagnosis and what you are going through.

Here are some tips for communicating with your children: Set the tone. As important as what you say is how you say it. Use a calm, reassuring voice, even if you become sad.This will help your children see how you are trying to cope, and will help them do the same.

Give your children accurate, age-appropriate information about cancer. Don’t be afraid to use the word “cancer.”Tell or show them where the cancer is on your body. Practice your explanation beforehand so you feel more comfortable.

Remember that if you don’t talk to your kids about cancer, they may invent their own explanations, which can be even more frightening than the facts.

Explain the treatment plan and how it will affect their lives.

Prepare your children for any physical changes you might go through during treatment (for instance, hair loss, extreme tiredness, or weight loss). Let your children know that their needs will continue to be taken care of (for example, “Daddy will take you to soccer practice instead of Mom for a while.”)

Answer your children’s questions as accurately as possible.

Take into account their age and prior experience with serious illness in the family. If you do not know the answer to a question, don’t panic. It’s okay to say, “I don’t know. I will try to find out the answer and let you know.”

Reassure your children. Explain to them that no matter how they have been behaving or what they’ve been thinking, they did not do anything to cause the cancer. Let your children know that they cannot “catch” cancer like they can catch a cold.

Let them know they can turn to other members of your support system, too.These people include your spouse or partner, relatives, friends, clergy, teachers, coaches and members of your health care team. Let your children know that they can ask questions of these adults and talk to them

about their feelings.

Allow your children to participate in your care. Give them age-appropriate tasks such as bringing you a glass of water or an extra blanket.

Encourage your children to express their feelings. Share with them that they can express any feelings, even those that are uncomfortable. Let them know, too, that it’s okay to say, “I don’t feel like talking right now,” if that is the case.

Reassure your children that they will be cared for. Let them know that even if you can’t always provide the care directly, their needs are important and will be taken care of.

To the extent possible, make communicating with your children a priority. Cancer treatments may leave you with less energy, but try to make every effort to really listen to your children.This will show them how much you love them, and help them to feel comfortable coming to you with their concerns in the future.

As always, show your children a lot of love and affection. Let them know that although things are different now, your love for them has not changed. When helping your children cope with a cancer diagnosis, it’s almost impossible to be prepared for every situation. Sometimes, you may not know what to say.This is normal and okay. Remember that you are the expert on your children. Cancer can be overwhelming and disruptive, but it doesn’t change the fact that you know your children best.Trust your sense of how to best support them during this difficult time.

Taking great care of cancer patients at Reid and beyond.

Heather Riggs, M.D.

Jeevan Sekhar, M.D.

Derek Serna, M.D.

Tamika Turner, NP

Dr. Heather Riggs, Dr. Derek Serna and Dr. Jeevan Sekhar, physicians with Reid Oncology Associates, and Tamika Turner, Nurse Practitioner, care for patients throughout the region.

Seeing patients in:

Reid Cancer Center

1100 Reid Pkwy., Richmond

(Enter through the Cancer Center entrance, north parking lot)

And at satellite offices in:

Connersville, Eaton & Winchester

Survivorship Program: Living Through Cancer Survivorship care is an important part of your cancer journey.

We are here to provide you with information, support and resources to meet your unique needs as a survivor.

Counseling - psychological, financial & nutrition Cancer risk assessment • Palliative Care • Support groups Ask your physician to call our office to set up an appointment.

(765) 935-8773 • (855) 935-8773 ReidHospital.org/CancerCenter

Quality Cancer Care: Recognizing Excellence