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The Revolution In Cancer Care
What’s New in Cancer Care
By Elyse Notarianni

When we think of cancer treatments, we often picture long chemotherapy appointments with harsh side effects. But today, a cancer diagnosis comes with many more treatment options. With science advancing every day, doctors have found new, innovative ways to diagnose, treat and even send cancer into remission – and fortunately for us, those treatments at the forefront of medicine can be found right here in South Jersey.

Image-Guided Radiation Therapy

The technology used in radiation therapy has advanced significantly over the years, says Anthony Dragun, MD, chair of the department of radiation oncology at Cooper University Health Care. One of the most recent is called Image-Guided Radiation Therapy or IGRT.

“The idea is that you want to be able to look at what you’re treating as you’re treating it,” says Dragun. “That’s not something we’ve been able to do before now.”

Previously, patients would receive a low-radiation CT scan to get an image of the tumor before the therapy, but doctors couldn’t see the tumor while treating it. The problem, Dragun says, is that tumors move and change shape during treatment, which means the patient’s organs can also move. This increases the risk of exposing normal tissue and vital organs to harmful radiation.

“It’s like having scales removed from your eyes…We’re seeing things we’ve never been able to see before.”

Anthony Dragun, MD

“We were going off coordinates. It was like driving a car using your GPS but not being able to see out the windshield,” says Dragun. “But technology grinds forward, and they figured it out.”

The new device has been particularly useful for people who have tumors deep in their abdomen and pelvis like pancreatic cancer, prostate cancer and gynecologic malignancies that may be otherwise difficult to see and treat, Dragun says.

“It’s like having scales removed from your eyes,” he says. “We’re seeing things we’ve never been able to see before.”

Endoscopic Ultrasounds

Sometimes, the most cutting-edge technology is not necessarily new, says Punitha Shivaprasad, DO, a gastroenterologist at Virtua Health.

When diagnosing patients with pancreatic and bile duct cancers, Shivaprasad often uses practices that go back to the 1960s, but their significance today is anything but outdated, she says.

“Technology is constantly improving, and when you’re working with an organ as vital as the pancreas, you need to be as precise as possible with diagnosis and treatment,” she says.

Punitha Shivaprasad, DO

The pancreas lies behind the stomach, which makes it very difficult to diagnose cancers in their earlier stages. Shivaprasad uses a combination of techniques. One – called ERCP – uses an extremely small scope to examine the bile duct to identify tumors. Another is an endoscopic ultrasound, which combines a small, minimally-invasive scope and high frequency ultrasound to examine the bile duct and take biopsies that help diagnose the patient’s cancer early.

ERCP has been around since 1968 and endoscopic ultrasounds since the 1980s, but back then they were only used to diagnose patients, she says. Then, a surgeon would have to perform an extremely extensive exploratory surgery to identify and remove the tumor.

“But now,” says Shivaprasad, “we can use the same technology to do the therapeutic process, get cell samples, make the diagnosis and determine if the patient needs chemotherapy, surgery or both without the initial exploratory surgery.”

Over the decades, both of these techniques have become more and more precise, and while that’s brought huge advancements in diagnosing and treating GI cancers, it also means they’re more difficult to perform. The biggest concern with GI cancers is that they easily and quickly spread through the body, but these methods can help detect cancers long before they spread. This early diagnosis, she says, is often the difference between life and death.

“Each year 40,000 pancreatic cancers are diagnosed in the US, and 8,000 bile duct cancers are diagnosed,” says Shivaprasad. “These are deadly, deadly cancers, and often early diagnosis is the only chance for survival for many of these patients.”

Immunotherapy

Doctors aren’t just relying on drugs to kill cancer cells, says James Lee, MD, an oncology and internal medicine specialist at Regional Cancer Care Associates in Moorestown. They want to train the body to heal itself.

James Lee, MD

“Immunotherapy really is a revolution in cancer treatment,” says Lee. “There’s a whole range of new drugs that have come out in the last 3 or 4 years that stimulate the immune system and train our own white blood cells to recognize and fight cancer.”

When doctors first started using immunotherapy in the late ’80s, it was targeted to rare cancers that had few treatment options. Now, it’s not considered innovative because it’s specific and specialized, he says, but because it can be used effectively on many cancers.

“Every month, if not every week, the FDA approves a new immunotherapy drug for different cancers,” says Lee. “When we combine that with new advancements in hyper-targeted treatments, doctors have even more precision in attacking only the cancerous cells.”

While immunotherapy is not a cure for everyone – nor is it even an option for every patient – there are also situations where it can be used to keep the disease under control and extend the patient’s life, Lee says.

“I’ve personally had at least a dozen patients who 10 years ago would have been incurable,” says Lee. “Now they are completely cured with these treatments.”

Another benefit, he notes, is that immunotherapy comes with minimal side effects compared to other treatments.

“Common cancer treatments like chemotherapy effectively poison the cancer cells,” adds Lee. “But since cancer cells are 99% the same as our normal cells, the drugs damage our healthy cells too, and that’s why patients get side effects like nausea, vomiting, hair loss and infections. But with immunotherapy, we’re stimulating the healthy cells to attack the cancer, so you don’t get all the side effects.”

July 2021
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