Cancer Conferences 2008

Transcription

1 2009 Annual Report

2 Cancer Registry Report The Cancer Registry collects data on all cancer patients who were diagnosed and/or treated at East Alabama Medical Center. Diagnostic, therapeutic and outcome statistics are collected and evaluated in a database that provides easy access to information. The Cancer Registry is supervised by the Cancer Committee to ensure compliance with the American College of Surgeons Commission on Cancer for the Community Hospital Cancer Center Program. The Cancer Registry participates with the National Cancer Data Base and submits to the Alabama Statewide Cancer Registry for Cancer Statistics. The Cancer Registry continues to provide lifetime follow-up on all cancer patients accessioned into the Registry. The current five-year follow-up rate is percent and Reference Year follow-up rate is 9.89 percent. The information, including disease status, treatment and mortality information, keeps physicians informed on patients status. Cancer Conferences 2008 East Alabama Medical Center Cancer Conferences are multidisciplinary conferences held bimonthly. The conference includes an individual cancer presentation and is open to the entire medical staff and allied healthcare professionals. The medical, surgical, and radiation oncology perspectives of each case are reviewed and correlated with its radiologic and pathologic findings. Cancer Conferences are integral to improving the care of cancer patients by contributing to the patient management process, monitoring outcomes and providing education to physicians and other staff. In 2008, 20 cancer conferences were held. Fifty-three patient case presentations were made. The following table gives a summary of the cases presented. Cancer Conference 2008 Site Total Cases Cases Presented Total for all sites Oral Cavity/Pharynx/Head/Neck/Ophthalmic 24 9 Digestive System 06 2 Respiratory System 94 2 Soft Tissue 0 Breast 03 0 Female Genital System 20 3 Male Genital System 22 7 Urinary System 44 0 Brain/Nervous System 9 2 Endocrine System 7 2 Lymphomas 24 3 Multiple Myeloma 9 2 Leukemias 4 0 Miscellaneous/Unknown Primary 7 2 The Cancer Center of East Alabama 2009 Annual Report

3 Cancer Center of East Alabama 2008 Distribution of Cases The East Alabama Medical Center Cancer Registry accessioned 665 cancer cases for This total includes both analytic and non-analytic cases with analytic cases being 587. A brief overview of the distribution of new cancer cases that were diagnosed and/or treated (analytic cases) at East Alabama Medical Center follows. Of the 587 cases accessioned, 32 (54.68%) were male and 266 (45.32%) were female % of patients reside in Lee County. 46.6% reside in other counties of Alabama. 3.06% reside within Georgia counties. The major sites of cancer seen at this institution were prostate, breast, lung, colon, and bladder. 20 Age at Diagnosis by Gender 00 Shelby Clay Tallapoosa 4 Randolph 30 Chambers 2 Troup Marengo Elmore 7 Montgomery Macon 37 Bullock 2 Lee 294 Russell 7 Muscogee 4 Talbot Male Female Pike Barbour Best AJCC Stage by Gender Out of State - 4 Class of Case Report 2008 Analytic Data Class of Case Report Analytic Data 0.5% Cancer Cases Diagnosed/Treated by Race and Gender 37.4% 62.35% Diagnosis here, all st course treatment elsewhere Diagnosis here, all or part of st course treatment here Diagnosis elsewhere,part or all of st course treatment here Race Male Female Total White Black Korean 0 Asian Indian, Pakistani 0 Samoan 0 Other 0 Total The Cancer Center of East Alabama 2009 Annual Report 3

4 Bladder Cancer Study { Data } by Trevis Hawkins, RN, BSN, MBA Director, Bladder cancer is the fifth most common cancer Outpatient Oncology evaluated at East Alabama Medical Center. Over a five-year period from 2004 to 2008, EAMC analyzed 7 cases of pathology confirmed bladder cancer. What is bladder cancer? What are the symptoms? How is bladder cancer treated? Bladder cancer originates in the lining of the urinary bladder. The urinary bladder acts much like a balloon, expanding and contracting to accommodate a varying volume of urine. The cells that line the bladder can also be found in the lining of ureters and the urethra. These cells are considered transitional cells, or cells that facilitate the changing shape of the bladder. Transitional cell carcinoma is the most common type of bladder cancer in the United States and in the EAMC treatment area. Squamous cell cancer consists of cells that look flat and scaly. Squamous cells occur in the urinary bladder in response to local infection. Squamous cell cancer is not common in the United States, but is more likely to occur in persons with long-term indwelling catheters. Outside of the U.S., squamous cell carcinoma occurs in individuals where a parasitic infection known as schistosomiasis is prevalent. The geographic distribution of schistosomiasis includes parts of South America and the Caribbean, Africa, and the Middle East. Adenocarcinoma consists of cells that occur in mucous secreting glands in the bladder. Adenocarcinoma represents less than two percent of all bladder cancers, is the most aggressive and has an increased likelihood of mortality. Symptoms What are the symptoms of bladder cancer? Fortunately, most bladder cancers are diagnosed at an early stage. Individuals present with an array of symptoms, primarily consisting of one or more of the following. Blood in the urine Painful urination Increased frequency of urination Presence of a urinary tract infection Abdominal pain Lower back pain Many of the symptoms listed mimic other urinary disorders. Individuals experiencing these symptoms should schedule an appointment for evaluation by their primary care physician or urologist. Diagnostic Testing Testing may vary but involves several components. Urine cytology A urine sample is evaluated under a microscope. The bladder may shed cancer cells that may be visible under the microscope. Computerized axial tomography (CT scan) of the pelvis A CT scan is a radiology test performed to visualize the bladder and surrounding tissues in the body. The CT scan may help determine the extent of bladder cancer involvement with other organs in the body. Intravenous pyelogram (IVP) The IVP is a procedure where intravenous injection of a dye is utilized to assist the radiologist in visualizing the urinary system. The visualization includes the bladder, ureters and kidneys. The dye is eventually excreted as waste through the urine. Cystoscopy The physician uses a scope in the form of a long cylindrical tube to visualize the bladder. The bladder is accessed through the urethra under anesthesia. The scope is equipped with a fiber optic lighting system and tiny camera to record images. Biopsy During cystoscopy, the physician may biopsy or take a tissue sample of the bladder. 4 The Cancer Center of East Alabama 2009 Annual Report

5 Figure. The EAMC best stage report for bladder cancer shows the highest percentages in stage followed by stage 2. The national best stage report shows the highest percentages in stage 0 followed by stage. This is performed with a tiny grasping tool that is flexible and easily maneuvered. A biopsy with subsequent pathology review of the sample is the most definitive diagnostic tool for bladder cancer. If bladder cancer is found, an individual may undergo further diagnostic testing in the staging process. Staging Staging involves a pathologist, a physician who specializes in examining tissue and cells for cancer and other diseases, evaluating the cancer cells under a microscope. This process identifies the extent of cancer, whether the cancer is isolated to a particular area of the bladder (local occurrence) or if cancer has metastasized (or spread) throughout the body. In order to appropriately stage, the physician may request additional imaging. CT This test is performed during the diagnostic phase and may possibly be repeated. Magnetic resonance imaging (MRI) of the pelvis This is a more detailed visualization of the bladder and surrounding structures. This imaging may also be utilized later in conjunction with the CT scan for treatment planning in radiation therapy. Bone scan This test is performed to rule out bone metastases. Chest X-ray This test is performed to rule out metastases to the lungs. The information gathered from these tests assist in assigning the following stages: Stage I: Localized to the lining of the urinary bladder. Stage II: The cancer may have penetrated the muscular bladder wall of the bladder, but has not spread outside of the bladder. Stage III: The cancer has metastasized through the bladder wall and spread to the prostate gland in the male and the vaginal wall in the female. Stage IV. There is lymph node involvement and cancer has metastasized to other organs such as the lungs or liver or to the bone. Some bladder cancers are diagnosed as Stage 0. A stage 0 bladder cancer involves a cancer that has been resected. The surgeon may return to the same operative site for a second biopsy to confirm complete removal of the cancer. If the biopsy comes back negative, the site is staged as stage 0. Once the cancer has been staged, then treatment may begin. The Cancer Center of East Alabama 2009 Annual Report 5

6 Figure 2. The national data showed biopsy with surgery as the first course of treatment as well at 73% followed by surgery with chemotherapy at %. The most common first course of treatment for patients at EAMC with bladder cancer was biopsy with surgery at 82% followed by biopsy only at 2%. Treatment Options There are several approaches to bladder cancer treatment. Surgery Surgery is the most prevalent treatment option for bladder cancer. At EAMC, 86 percent of patients received surgery as a stand-alone treatment for bladder cancer. The surgical procedures available are: Surgery for early stage bladder cancer Removal of the bladder tumor through resection Removal of the bladder tumor and a portion of the bladder called a partial cystectomy Surgery for advanced bladder cancer Removal of the entire bladder, also known as a radical cystectomy Creation of an alternative urinary reservoir and outlet Chemotherapy Treatment with chemotherapy involves a systemic approach to treatment. Chemotherapy is introduced intravenously, often through a centralized venous access called a portacath. If the medical oncologist recommends chemotherapy treatment, a combination of Cisplatinum and Gemzar or Carboplatinum and Gemzar is used as a first line of treatment. Immunotherapy This involves the introduction of a natural or synthetic agent through the urethra to the bladder. The natural agent is an immune-stimulating bacterium called Bacille Calmette-Guerin (BCG). The synthetic agent is an immune system protein called Interferon. Immunotherapy is currently available under the guidance of the urologist. Radiation therapy Radiation therapy involves delivery of radiation to a defined target. The focus is narrow, minimizing exposure to non-cancerous tissue. Due to the sensitivity of the bladder to radiation, radiation is rarely used as a treatment option except in cases of metastases. Even though bladder cancer may be diagnosed at an early stage, there is a 60 percent reoccurrence rate of the disease. Survivors living with bladder cancer will undergo follow-up evaluation by their physician. Follow-up evaluation and testing will vary based on the extent of illness and treatment. Risk Factors Perhaps one of the questions that a cancer survivor asks is, What could I have done differently? And, likely, that question may never be satisfactorily answered. There are may be several contributing factors that influence one s 6 The Cancer Center of East Alabama 2009 Annual Report

7 Figure 3. At EAMC, the age at diagnosis of bladder cancer ranges from 20 to 99, with the largest prevalence between 50 and 89 years. The national age range is from 0 to 00+, with the largest age group from 50 to 89 years. Figure 4. Eightynine percent of bladder cancer cases seen at EAMC are Caucasian and % are African American. According to the American Cancer Society, Caucasian Americans are more than twice as likely to develop bladder cancer compared to African American. Gender of EAMC Bladder Cancer Patients, Figure 5. S e v e n t y - n i n e percent of bladder cancer cases seen at EAMC are male and 2% are female. The American Cancer Society reports that in 2008, 66% of all bladder cancer cases in the U.S. were male and 34% were female. The Cancer Center of East Alabama 2009 Annual Report 7

8 risk for bladder cancer. These factors fall into two categories: factors of birth or those factors that cannot be altered, and factors of choice or the environment. Factors of birth Increasing age. Bladder cancer is likely to occur in individuals over 40. Being Caucasian Being male Personal or family history of bladder cancer. If you or an immediate family member has a history of bladder cancer, it is more likely to reoccur. Factors of choice or the environment Smoking The body processes the blood to filter chemicals introduced into the body by smoking. These chemicals may accumulate in the bladder, thus damaging the lining of the bladder wall and increasing the risk of cancer. Chemical exposure Again, the bladder serves as a reservoir for filtered waste from our body s bloodstream. Certain chemicals that reach the bladder are toxic to the bladder, causing damage to the bladder lining. Individuals who work in certain industries, such as the manufacture of dyes, rubber, paint, leather, and textiles also carry an increased risk. (Note: Lee and its surrounding counties have a long history of textile manufacturing.) Previous cancer treatment with Cytoxan Cytoxan is toxic to the bladder and is used in the treatment of many other cancers. Radiation treatment to the pelvis Chronic bladder inflammation This is seen mostly in individuals with chronic or repeat urinary tract infections (UTIs) or chronic cystitis. This would likely lead to squamous cell carcinoma of the bladder. Unfortunately, the incidence of bladder cancer has increased over the past 20 years. However, although the incidence of bladder cancer has increased, the mortality rate of individuals living with bladder cancer continues to decline. Conclusions Early diagnosis and treatment of bladder cancer will contribute to overall survival. Approximately 75 percent of bladder cancer diagnoses are discovered in the early phases of the disease. EAMC is committed to working with your physician in providing high-quality health care. References Centers for Disease Control and Prevention (2009). Parasites and health: Schistosomiasis, Retrieved 200 from dpdx/html/schistosomiasis.htm. Denes, B. (200). Bladder Cancer Prognosis: What does stage 0 bladder cancer mean? Retrieved 200 from interview/bladder-cancer-prognosis-2#what-doesstage-0-bladder-cancer-mean. East Alabama Medical Center, Cancer Registry. Bladder cancer statistical data. Hughes, M.J., Fisher, C., & Sohaib, S.A.A. (2004). Imaging features of primary nonurachal adenocarcinoma of the bladder. American Journal of Roentgenology, 83, Mayo Clinic (200). Bladder cancer. Retrieved 200 from National Cancer Institute (200). SEER stat fact sheets: Urinary bladder. Retrieved 200 from 8 The Cancer Center of East Alabama 2009 Annual Report

9 Primary Site Table Sex Class of Case Stage Distribution - Analytic Cases Only Primary Site Total (%) M F Analy Stg 0 Stg I Stg II Stg III Stg IV 88 Unk Blank/Inv ORAL CAVITY & PHARYNX 24 (4.%) Tongue 6 (.0%) Salivary Glands 2 (0.3%) Gum & Other Mouth 3 (0.5%) Nasopharynx 3 (0.5%) Tonsil 4 (0.7%) Oropharynx 4 (0.7%) Hypopharynx (0.2%) Other Oral Cavity & Pharynx (0.2%) DIGESTIVE SYSTEM 06 (8.%) Esophagus 0 (.7%) Stomach 0 (.7%) Small Intestine 3 (0.5%) Colon Excluding Rectum 53 (9.0%) Cecum Ascending Colon Hepatic Flexure Transverse Colon Sigmoid Colon Large Intestine, NOS Rectum & Rectosigmoid 5 (2.6%) Rectosigmoid Junction Rectum Liver & Intrahepatic Bile Duct 3 (0.5%) Gallbladder 3 (0.5%) Other Biliary (0.2%) Pancreas 8 (.4%) RESPIRATORY SYSTEM 94 (6.0%) Larynx 9 (.5%) Lung & Bronchus 84 (4.3%) Trachea, Mediastinum & Other Respiratory Organs (0.2%) SOFT TISSUE (0.2%) Soft Tissue (including Heart) (0.2%) SKIN EXCLUDING BASAL & SQUAMOUS 3 (0.5%) Melanoma -- Skin 3 (0.5%) BREAST 03 (7.5%) Breast 03 (7.5%) FEMALE GENITAL SYSTEM 20 (3.4%) Cervix Uteri 6 (.0%) Corpus & Uterus, NOS 7 (.2%) Ovary 4 (0.7%) Vulva 3 (0.5%) MALE GENITAL SYSTEM 22 (20.8%) Prostate 6 (9.8%) Testis 4 (0.7%) Penis 2 (0.3%) URINARY SYSTEM 44 (7.5%) Urinary Bladder 24 (4.%) Kidney & Renal Pelvis 20 (3.4%) BRAIN & OTHER NERVOUS SYSTEM 9 (.5%) Brain 8 (.4%) Other Nervous System (0.2%) ENDOCRINE SYSTEM 7 (.2%) Thyroid 7 (.2%) LYMPHOMAS 24 (4.%) Hodgkin Lymphoma 4 (0.7%) Non-Hodgkin Lymphoma 20 (3.4%) NHL - Nodal NHL - Extranodal MULTIPLE MYELOMA 9 (.5%) Multiple Myeloma 9 (.5%) LEUKEMIAS 4 (0.7%) Lymphocytic Leukemia 4 (0.7%) MISCELLANEOUS 7 (2.9%) Miscellaneous Sites 7 (2.9%) Total