Cancer doesn t care but we do Cancer Annual Report

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1 Cancer doesn t care but we do Cancer Annual Report

2 The Cancer Committee of CHRISTUS St. Patrick Hospital is proud to present its 2010 Annual Report. The Community Hospital Comprehensive Cancer Program of CHRISTUS St. Patrick Hospital is currently accredited by the American College of Surgeons Commission on Cancer. At CHRISTUS St. Patrick Hospital, the experienced physicians and staff are committed to providing the most advanced treatment options to oncology patients throughout Southwest Louisiana. The best of diagnostic, treatment, follow-up, and support services necessary for oncology patients are available right here at CHRISTUS St. Patrick Hospital. The Cancer Committee continues to promote cancer awareness, prevention and early detection in our community with education on lifestyles and our environment. We continue to provide annual screenings for skin and prostate cancer to the community. CHRISTUS St. Patrick Hospital hosts all of the American Cancer Society sponsored support groups for Southwest Louisiana: the Man-to-Man Prostate Cancer Support Group and the Bosom Buddies Breast Cancer Support Group. We are excited to have such a great cancer program for the local community, and we are dedicated to continually improving the services that we offer. The Regional Cancer Center continues to provide the most advanced radiation therapy treatment to cancer patients with Intensity Modulated Radiation Therapy (IMRT), which treats tumors within close margins while minimizing side effects. At the Women s Health Center, we have the latest digital mammography units that provide computer enhanced images, which allow the radiologist to receive the images faster and manipulate the images for better viewing and timely results. We continue to provide robotic technology that offers minimally invasive procedures for both prostatectomies and hysterectomies. In addition, our oncology services continue to provide the highest levels of patient satisfaction. We look forward to continued success in the upcoming year as we broaden and improve our cancer services. The physicians and staff of CHRISTUS St. Patrick Hospital are committed to providing quality, compassionate cancer care for our community and continuing our mission to extend the healing ministry of Jesus Christ. Stephanie Richard, M.D. Cancer Committee Chairman Larry Hauskins, M.D. Cancer Liaison

3 Prostate Cancer The male reproductive system contains an organ called the prostate which is located in front of the rectum and under the bladder. The prostate is a gland that makes part of the seminal fluid which helps carry sperm out of the man s body as part of semen. The prostate is a very small organ a healthy prostate is only about the size of a walnut. It surrounds the urethra, which is the tube through which urine flows. Male hormones called androgens make the prostate grow. The testicles are the main source of the male hormones, including testosterone. The adrenal gland also makes testosterone, but in small amounts. If the prostate gland grows too large, it begins to squeeze the urethra which in turn may slow or even stop the flow of urine from the bladder to the penis. The definition of prostate cancer is the formation of extra cells in tissues of the prostate. Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die and new cells take their place. Sometimes this process goes wrong and the new cells form when the body doesn t need them, and old or damaged cells don t die as they should. The build-up of extra cells often forms a mass of tissue called a growth or tumor. Growths or tumors can sometimes be benign (not cancerous) and sometimes malignant (cancerous). Benign tumors such as Benign Prostate Hyperplasia (BPH) are not as harmful as malignant tumors. They are rarely a threat to life, they can be removed with little worry of recurrence, they do not invade other tissues around them, and they don t spread to other parts of the body. On the other hand, malignant tumors can be a threat to life. They can often be removed, but sometimes do grow back. Malignant tumors can invade and even damage nearby tissues and organs. They can even spread to other parts of the body when the cancer cells break away from the tumor and enter into the blood vessels or lymph vessels which branch into all of the body. These cells attach to other tissues and organs and grow to form new tumors. This spread of cancer is called metastasis. Risk Factors for Prostate Cancer When someone has been diagnosed with prostate cancer, it is natural to wonder what may have caused the disease. No one knows exactly what causes prostate cancer. Doctors are unable to explain why prostate cancer develops in one man, but not in another. However, recent research has shown that men with certain risk factors are more likely to develop prostate cancer. By definition, a risk factor is something that increases the chance of getting a disease such as prostate cancer. The risk factors for prostate cancer include the following: Age: The chance of getting prostate cancer increases as a man gets older. Age is the main risk factor for prostate cancer; in the United States, most men with prostate cancer are over the age of 65. It is very rare for men under the age of 45 to be diagnosed with this type of cancer. Family History: The risk of being diagnosed with prostate cancer increases if your father, brother or son has had prostate cancer. Race: Studies have shown that prostate cancer is more common in black men than white or Hispanic/Latino men. It is also less common among Asian/Pacific Islander and American Indian/Alaska Native men. Certain Prostate Changes: Some men with cells called high-grade prostatic intraepithelial neoplasia (PIN) may be at an increased risk of prostate cancer. These abnormal prostate cells are visible under a microscope. Certain Genome Changes: Research has found certain areas on certain chromosomes that are also linked to a higher risk of prostate cancer. According to the studies, if a man has a genetic change in one or more of these areas, the risk of prostate cancer could increase. The risk increases more with the number of genetic changes that are actually found. Other studies have shown that the risk also increases among men with changes in certain genes such as changes in the human genes BRAC1 and BRAC2. LA white black other white black other white black other Distribution by Race The majority of men diagnosed with prostate cancer are white. LA Distribution by Age The largest numbers of men diagnosed with prostate cancer are between the ages of 60 and 69.

4 Many other possible risk factors are currently under study. For example, researchers are now studying whether vasectomy surgeries pose a risk. Most of these studies have found no increased risk thus far. Although researchers are continuing to study all possible risk factors, most studies have shown that the chances of getting prostate cancer are not increased by BPH, sexually transmitted diseases, obesity, lack of exercise, or diets high in animal fat or meat. In addition, the use of tobacco and alcohol has not been linked to the development of prostate cancer, but it has been proven to be a dominant factor in the growth of more aggressive prostate cancers. It is important to understand that just having a risk factor does not necessarily mean that you will develop prostate cancer. Most men who have these risk factors never develop the disease. Researchers are also in the process of studying how prostate cancer can be prevented. Some studies are looking at the possible benefits of certain drugs such as vitamin E, selenium, green tea extract, and many others. These ongoing studies are being performed with men who have not yet developed prostate cancer. Signs and Symptoms of Prostate Cancer Many men with prostate cancer do not have symptoms at all, but for men who do have symptoms, the most common are the following: Urinary Problems: described as not being able to pass urine, having a hard time starting and stopping the flow of urine, needing to urinate often and especially at night, weak flow of urine, urine flow that starts and stops, and pain or burning while urinating. Other symptoms include: difficulty having an erection, blood in the urine or semen and frequent pain in the lower back, hips or upper thighs. Oftentimes these symptoms are not due to prostate cancer. BPH, infection and other health problems may cause the same symptoms. If you have any of these symptoms, you should contact your doctor. LA I II III IV Unknown I II III IV Unknown I II III IV Unknown Distribution by Stage at Diagnosis Correlating with the national and state averages, most men are diagnosed with prostate cancer in Stage II.

5 Early Detection, Screening and Diagnosis Doctors can actually check for prostate cancer before men exhibit any symptoms. During a regular office visit, a doctor might ask about personal and family medical history, then they would perform a physical exam and possibly a Digital Rectal Exam, a Prostate Specific Antigen (PSA) Blood Test or both. These tests are also being studied in clinical trials to learn whether finding prostate cancer early can lower the number of deaths caused from the disease. While digital rectal exams and PSA tests can detect a problem, they cannot show whether the problem is cancer or a less serious condition. If an abnormal test result is shown, the doctor may then suggest other tests that will provide a more definite diagnosis such as a Transrectal Ultrasound or a Transrectal Biopsy. If cancer cells are not found in the biopsy, the doctor may recommend more frequent follow-up exams so that the problem can be followed closely. If cancer cells are found, the pathologist will study the tissue samples from the prostate to report the grade of the tumor. The doctor will use the tumor grade in conjunction with the man s age and other factors to suggest treatment options. The tumor grade also tells how the tumor tissue differs from normal prostate tissue, and it may suggest how fast the tumor is likely to grow. Tumors with higher grade cells tend to grow at an increased rate in comparison to those classified at a lower grade, and they are more likely to spread to other parts of the body. The most common grading system used by pathologists is called the Gleason Score. Year of Diagnosis has been averaging about 46 cases of prostate cancer per year since Staging Once doctors have determined that a man does in fact have prostate cancer, the next step will be to learn the extent of the disease in order to choose a treatment plan. This process is called staging. Staging is described as a thorough attempt to find out whether or not the cancer has invaded other tissues of the body and if so, where the invasion has occurred. When cancer spreads, it is often found in nearby lymph nodes. If cancer does happen to reach these nearby lymph nodes, there is also a chance that it has spread to other more distant lymph nodes, the bones and possibly other organs. Some of the tests doctors may use to evaluate the spread and/or stage of cancer include a Bone Scan, CT Scan or an MRI. These are the four stages of Prostate Cancer: Stage I: The cancer or tumor cannot be felt during a digital rectal exam, nor seen on a sonogram. This is when the cancer is found by chance, which is referred to as an incidental finding, when surgery is being performed for other reasons, such as BPH. The cancer is confined to the prostate, and the grade is G1, or the Gleason Score is no higher than 4. Stage II: This is a more advanced or higher grade tumor, usually higher than Stage I. Although the tumor is still confined to the prostate, it may be felt during a digital rectal exam, and it is more likely to be seen on a sonogram. Stage III: The tumor extends beyond the prostate and has invaded the seminal vesicles, but not to the lymph nodes. Stage IV: The tumor extends beyond the seminal vesicles to invade the bladder, rectum or other nearby structures. In this stage, it is also possible that the cancer has spread to lymph nodes, bones or other distant organs which include the lungs and the liver. Treatment Here VS Treatment Elsewhere Diagnosis Here & Treatment Elsewhere Diagnosis Elsewhere & Treatment Here A large number of men who were diagnosed with prostate cancer at another facility chose to have treatment here at, while even a larger number of men were actually diagnosed at. Treatment Options There are many options for men who have been diagnosed with prostate cancer. These options include Active Surveillance (also called Watchful Waiting), surgery, radiation therapy, hormone therapy, and sometimes chemotherapy. Some doctors may even recommend a combination of treatments, but it is important to remember that the treatments that are best for one man may not necessarily be best for another. Doctors are able to determine the best treatment plan for each individual man by evaluating factors such as age, the grade of the tumor (Gleason Score), the number of biopsy tissue samples that contained cancer cells, the stage of the cancer, symptoms, and the general health of the patient. LA Surgery Other No Treatment Surgery Other No Treatment Surgery Other No Treatment Treatment Modality The treatment of choice for prostate cancer varies. While some men may choose surgical treatment, others may choose radiation therapy and/or hormone therapy, or even a combination of both. YEARS ALL STAGES YEARS ALL STAGES Observed Survival For Prostate Cancer maintains a slightly higher five-year observed survival rate for prostate cancer than the national average.

6 Cancer Registry The Cancer Registry is a data retrieval system for the collection, management and analysis of demographic, diagnostic, staging, and treatment information on all cancer patients seen at CHRISTUS St. Patrick Hospital, for both outpatient and inpatient services. In the year 2009, 490 cases were accessioned into the registry. Of those cases, 480 (98) were analytic cases and 10 (2) were non-analytic cases. The reference date for the registry is January 1, There are a total of 12,360 cases in the database. The registry is currently obtaining follow-up information on 2,075 cancer registry patients with a 90 follow-up rate. The Cancer Registry is an integral part of the cancer program at CHRISTUS St. Patrick Hospital. Information gathered by the registry is used by the Cancer Committee to track referral patterns, plan community education programs, propose advertising strategies, and outline yearly goals for the cancer program. TUMOR BOARD The Tumor Board of CHRISTUS St. Patrick Hospital meets weekly to review cases of newly diagnosed cancer patients. These conferences compose all of the major cancer sites that are diagnosed at the hospital during the year. Physicians in attendance focus on pretreatment evaluation, treatment strategies, cancer staging, and rehabilitation of patients. A comprehensive treatment plan for each patient is then developed based on protocols and recommendations made by the team of physicians. Representatives from relevant disciplines are encouraged to attend and discuss the care of each patient CASES PRESENTED AT TUMOR BOARD Prospective Retrospective... 2 Follow Up SITES DISCUSSED AT TUMOR BOARD Central Nervous System... 2 Head & Neck... 5 Colon Lung Breast Female Genital... 3 Prostate Male Genital... 1 Liver... 1 Hematopoietic... 3 Lymphoma... 8 Urinary... 5 Rectum/Anus... 6 Kidney Bone Marrow... 4 Appendix... 1 Pancreas... 4 Thyroid... 8 Thymus... 1 Stomach... 5 Unknown Primary Site... 9 Support Groups The Cancer Program at CHRISTUS St. Patrick Hospital assists patients and their families in coping with the physical and emotional impact of cancer. This is accomplished by providing multiple American Cancer Society sponsored support groups and various services or referrals that might be needed, such as counseling, nutritional education, spiritual care, homecare, palliative care, hospice, and pain management. Support Groups and Educational Programs Hosted by CHRISTUS St. Patrick Hospital Call for meeting dates and locations. Bosom Buddies Breast Cancer support group Meets 2 nd Tuesday of each month Man-to-Man Prostate Cancer support group Meets 3 rd Tuesday of each month Reach to Recovery (as referred by physician) Regional Cancer Services Radiation Oncology Inpatient Oncology Ambulatory Treatment Center Cancer Registry Cancer Information/Resources American Cancer Society National Cancer Institute CANCER CHRISTUS St. Patrick Hospital

7 Breast Cancer Screening Mammography screenings are available year-round at the Women s Health Center at CHRISTUS St. Patrick Hospital. Mammography is a tool used for early detection of breast cancer. It is recommended that women at the age of 40 start having an annual mammogram and clinical breast exam by a healthcare professional. The use of mammograms has led to an increase in the early detection of breast cancer for many women and therefore has led to increased rates of survival due to the early detection. It is also recommended that women in their 20s start performing monthly breast self-exams. Skin Cancer Screening Skin cancer screenings are available at CHRISTUS St. Patrick Hospital each year in the month of May. Hundreds of patients have been receiving free skin cancer screenings each year, and this screening is open for the entire community. Physicians detect skin cancer by simply observing new skin growths and changes in appearances. Suspicious lesions will be recommended for follow-up evaluations. Prostate Cancer Screening Prostate cancer screenings are available at CHRISTUS St. Patrick Hospital each year in the month of September. A blood test, Prostate Specific Antigen (PSA), is done as well as a digital rectal examination in order to detect prostate cancer. Beginning at the age of 40, men should have a baseline PSA and examination, and beginning at the age of 45 should start having these done annually. Colorectal Cancer Screening Colorectal cancer screenings are available through your primary physician. It is recommended that men and women at the age of 50 begin annual colorectal screening by taking a fecal occult blood test, the sampling of stool from multiple bowel movements to detect the presence of blood, or having a flexible sigmoidoscopy (insertion of a scope to visualize the colon) every five years. Ambulatory Treatment Center (ATC) A comfortable outpatient area for patients to receive chemotherapy, blood product transfusions, antibiotics, IV fluids, and other medications or procedures. Recliners and beds are available. Care is provided by an oncology nurse with chemotherapy certification. ATC provides care for patients having special radiology procedures. Inpatient Oncology A medical oncology unit that provides patients with a multidisciplinary team of certified chemotherapy and oncology nurses and support staff. Patients may be admitted to this unit for their cancer treatment, complications related to their cancer, pain management or palliative care. Radiation Oncology An open, accessible environment for inpatients and outpatients undergoing radiation therapy located in the Regional Cancer Center. Under the consultation of a radiation oncologist, treatment is provided by a team of board certified and licensed dosimetrists, radiation therapists, oncology nurses, and a Ph.D. physicist. Intensity Modulated Radiotherapy (IMRT) offers patients with prostate, spine, head and neck cancer a more focused treatment that provides a reduction in side effects.

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