Docs On Call - Follow-up
Topic: Radiation Oncology
During the Docs on Call broadcast on April, 4, 2011 on WEEK-TV there were questions that were not aired due to time constraints. Below Dr. James Knost of the Illinois Cancer Center answers the remainder of the questions.
To view the show click on the Docs on Call preview graphic below.
Caller - Jenny: I had a lumpectomy procedure 5 years ago. Is it normal to be sore under the arm with activity?
- Dr. James Knost: This could be secondary to scar tissue from where the lymph nodes were sampled at the time of the lumpectomy. I would see your physician and have it examined in the event that it represents an enlarged lymph node or local recurrence.
Caller - Janet: My sister has invasive ductal carcinoma – stage unknown. She’s having a lumpectomy. How serious is the type of cancer and what is the cure rate?
- Dr. James Knost: To answer your question I would have to know the size of the cancer, number of lymph nodes involved, grade of the cancer, Estrogen, Progesterone and HER2 status, your sisters age and any medical problems your sister has. In general we use the nomogram composed by Dr. Peter Ravdin or if the cancer is node negative and estrogen receptor positive we use the OncotypeDX assay.
Caller - Dana: Why can you not operate on small cell cancer?
- Dr. James Knost: I assume you are talking about small cell lung cancer. The British Lung Study Group tried this in the 60’s and it did not have an effect on survival. This cancer spread widely long before the patient goes to see the doctor. The approach even for patients with Stage I and II disease is chemotherapy and radiation, not surgery because the outcome is the same as surgery followed by chemotherapy.
- Small cell at other sites are treated with surgery i.e. Primary small cell cancer of the bladder.
Caller - Anonymous: Patient diagnosed with cancer two years ago. Had upper lobectomy, no chemotherapy or radiation. Scans have been clear every six months. Should he be concerned about recurrence? Should he have a full body PET scan as opposed to just the chest?
- Dr. James Knost: I would need to know more about the cancer i.e. stage, cell type. The patient will have to wait five year before he/she can consider that cancer gone and cured. Patients that have lung cancer and are cured still face a 50% lifetime risk of a second lung cancer. PET scans have not been shown to be a good way to follow lung cancer patients.
Caller - Geri: Younger and younger women are being diagnosed with breast cancer. Are there reasons why younger women might be diagnosed earlier now compared to the past?
- Dr. James Knost: It is more dramatic when someone young has any cancer, but the incidence of breast cancer in women under 40 is not going up. 50% of breast cancer occurs in women over 65, 70% in women over 50, and 93% in women over 40. Breast cancer is a disease of aging, there are exceptions to this rule; families with a history of breast or ovarian cancer, women exposed to radiation as a child or young adult, or a list of rare genetic disorders. Screening young women is difficult because they have dense breast tissue for which mammograms and ultrasounds don’t have the sensitivity that they have in older women whose breast are mostly fatty tissue. In high risk groups, those that have a lifetime risk of 20% or more yearly MRI’s (Magnetic Resonance Imaging) is indicated.