 Hello, and welcome to this episode of Quality of Life. I'm your host, Dave Augustine. Today we're gonna talk about oncology and how quality of life can be improved through treatments and advances they've made now in cancer research. Joining us today is Dr. Mark Batag, oncologist at Matthews Oncology. Thank you, welcome. And Tammany Augustine, a cancer survivor. Welcome. Thank you. Also joining us for the first time, we have a studio audience today from Lakeland College. They're a television history class who's here to observe, so welcome also. So I guess let's get into it. Dr. Mark, can you tell us what is cancer and why is it so hard to find a cure to it? Well, those are two separate questions. So I'm gonna start with the first one. So cancer is a single cell that was once a normal cell. So you weren't born with it. You had it all, it was a normal cell all your life and something flipped the switch and made that cell start to grow and grow and grow. So it's like a light switch has flipped and that cell is turned on. So if I cut my arm, those skin cells will heal up that cut but as soon as that cut is healed both cells stop dividing. Cancer cells have lost the ability to stop their biting, they're turned on. So you could have a cancer cell in your brain, your breast, your lung, it can start anywhere. So that's the definition of cancer. The second part that is as far as trying to find cancer and why is it so hard to treat. So finding cancer can be difficult depending on where it starts. So the symptoms for cancer differ depending on where it starts. So if you have a spot in your lung, you may have a cough, you may be coughing up blood, you may have pain, whereas if you have a spot somewhere else, for example, a colon cancer, you don't always get abdominal pain, you may have bleeding from the stool or something along those lines. Okay. You kind of touched it on already but how many different forms of cancer are there that we know of today? That's in a nutshell. So as many different cells as you have, that's how many different types you have. For example, the most common cancer in women is breast cancer. Even in breast cancer, there are multiple different types of breast cancer. There's multiple different types of lung cancer. So there's literally hundreds of different types of cancer. And we treat cancer differently depending on where it starts. So not all lung cancers are treated the same. And so when people come in and they think they may get chemotherapy for a particular type of tumor, there's not a generic chemo. Things are targeted specifically for whatever type they have. Okay. Correct me if I'm wrong, but just one observation that I've made is in the past, because we haven't done a lot of research or a lot of the cancers treated the same. So it was kind of a hit or miss because we didn't know of all the different types. And now through our research, we're actually getting ahead of the game. So that's a great question. So if we go back, I came out of my training in 1995, almost all the drugs I use now today are different than the drugs that were available then. We just had a handful of drugs then. So we recycled a lot of the same chemo drugs at that time. Things have kind of exploded. In fact, the field of oncology has probably changed the most of any field in medicine over the last 20 years. And we can get into some of the different treatments and why they're so different now than in years gone by. But right now the big focus is on targeted therapy. We're looking at molecular changes in the cancer cells and even the genes of the cancer and targeting specific agents to those genes. So for example, years ago we would treat all lung cancers the same and everybody would get cisplatinum and VP16 or something along those lines. Now when somebody comes in with lung cancer, we check for specific genes, RRM1. We also check for ERCC1 and a whole bunch of other genes. So if you have this gene, you cannot get this treatment because it won't work. But if you have this gene, you can. And with the old treatments, the likelihood that we would have a response in lung cancer was about 15%. In fact, they had debates over whether it was even ethical to treat people for lung cancer because the response rate was so low. Now with the targeted therapy, it's probably close to 70% response rates. That's excellent progress. It's a couple of long way. Okay. Tammany, you are a cancer survivor. Could you tell a little bit about the types of cancers that you've encountered? Okay. I was first diagnosed with breast cancer in January of 2006. It was a very aggressive cancer. It was found in less than two months after I found a lump in my breast. It had grown to stage 3B, which is a very serious stage. While I was in treatment for breast cancer, I found out I had colorectal cancer the following January. So I've basically been in treatment for just the breast cancer. They were able to get the colon cancer with just surgery. So I was fortunate there. And I completed my treatment with Dr. Mark probably about four, five years ago. Still see him on a routine basis, but I outlived my life expectancy. I wasn't expect to make it, but maybe five years. So I say I'm officially three years old because I made it three years past my expiration date. Ex expiration date, okay. Did you encounter any pre-symptoms or was it detectable or did it just pop right out? Well, for me, I still do regular breast exam. I do them every month on the date of my birthday, which is the 12th. I'd had a mammogram done the last week in November. There was no thing there. I did my breast exam on the 12th of December and detected something about the size of a pinhead. By the end of December, what had been the size of a pinhead was probably about the size of a quarter. So if you think from the 12th of December to the end of December, he had grown that much. By the time I had my biopsy the first week in January, it was in to see Dr. Mark on the second week in January, third week in January rather, it had already almost become a visible appendage on my breast. It almost looked like I had a third breast growing. So mine was very aggressive and it came out of nowhere. Okay, Dr. Mark, when you first saw Tammany, what was your initial reaction or response to get treatment started or diagnosis? Well, the first thing we like to do when people come in is we have to stage and find out how far as the cancer spread. So for most cancers, we stage in the four stages. Stage one is usually local. Stage two is a little bit bigger. Stage three often goes to lymph nodes and stage four spreads to other parts of the body. And so the staging tells us how far it is spread and then based on that, we need to do a biopsy and then we plan our treatment accordingly. So because Sam's was growing so fast, we wanted to get moving extra quickly. If I remember correctly, you told me you could literally feel it growing day by day. Oh, you could. You could watch it. You could see it. So we started right away. I mean, there wasn't much time between when I initially saw you and when... It was a week, one week exactly from my date that I saw you until my first treatment. Yeah, I had my PET scan. I had a port implanted and had my treatment all within one week. That is aggressive and you're still here today. So this is a positive turnout. Oh yeah, it was a tough road. I will admit that, but I am happy to say that so far we're doing very well. Excellent. You've already been talking about treatments of cancer. What are the basic ways to treat cancer? I mean, there's radiation, there's chemo, there's surgical, I guess. How do you know which one to use or go after or how does each of those types or others affect cancer? That's a good question. So in the old days you'd go to school for a long time and you'd have experience rotating through all the different subspecialties. And nowadays things are a little bit easier. There's something called NCCN guidelines and anybody can go on the guidelines and look up the particular guidelines for a particular cancer. And there are experts that get together multiple times a year, go through all the world's literature for that particular cancer, and they come up with specific guidelines for stage one, two, three, four, whatever the cancer is. The guidelines can't possibly encompass every single clinical scenario that comes up. And so we use our knowledge our ability to see and judge what the clinical behavior of the tumor is and then we pick a treatment. So often surgery is employed depending on where it is. If you can remove a tumor, that's the best. And then sometimes chemotherapy is given either before the surgery to try to shrink it down to make the surgery easier or after the surgery in case there's microscopic disease. So you may know people who've had lung cancer, prostate cancer, breast cancer, they have surgery and the cancer comes back a year to later, why? Before the surgeon ever takes a scalpel to cut some of those tumor cells can grow into a blood vessel and start floating around in the blood. And since we don't have a blood test or a CAT scan, MRI PET scan that can detect microscopic disease, depending on the risk factors for recurrence will often give chemo. And that's why in Sam's instance because of the size of the tumor and how fast it was growing, we did the chemotherapy. Okay. With, you had mentioned about the different diagnostic types to detect. I mean, like you had mentioned there's MRI, PET scan, CT scans, X-rays, I guess do all those types of diagnostic tools detect cancer or is there a certain one that does or doesn't? Yeah, that's kind of a complicated question. So the best way to detect breast cancer believe it or not is MRI, but MRIs are expensive. And if you were to do MRIs on everybody in the United States you're gonna spend a lot of money. So the cheapest way to screen mass amounts of population is with mammograms, which are a good screening tool. They're not perfect. They miss about 10% of breast cancers. Physical exams are cheap. They cost nothing. So every woman should do a physical exam. So why do we use MRIs? Why do we use CAT scans? So CAT scans are really good from the chin to the knees looking for intraabdominal spread of cancer. So if we know somebody has a cancer we'll often do a CAT scan to see how far as it's spread. MRIs are really good for a brain. You can see the inside of the brain far better with an MRI than you can with a CAT scan. You can see the spine better and you can image joints fairly well. The newest modality is actually a PET scan. A PET scan is a sugar-based dye and since cancer cells grow faster than normal cells they take up the dye more readily than normal cells. And there's a radioactive tag on the glucose. So wherever that glucose congregates lights up bright on the scan. So oftentimes when people are first diagnosed today they often will get a PET scan. And then sometimes we'll do an MRI of the brain to scan and see if the cancer is there depending on symptoms. Okay. Thanks for clarifying that. I've always wondered about that. Yeah. Thank you. Now to more methods of improvements or of the treatments over the years. Could you basically go into the research that's been done and how cancer treatment has improved over the years? Sure. So some of the first treatments that we had were mustard or nitrogen mustard and World War I they had nitrogen mustard that they threw in the trenches. So that was kind of some of the first chemicals that we had. One of the first big breakthroughs was a drug called cisplatinum. And that was the drug that Lance Armstrong got that cured him of his testicular cancer. Now today there's probably 10 to 15 drugs approved every year for cancer medicine. There was just one approved in February for chronic lymphocytic leukemia that will probably be a game changer for that particular disease. So the older chemo drugs from the 1970s and 80s affected the DNA of the cancer cell. So there's the double helix and as it pulls apart there are little ribosomes that zip along the side and make another strand and it affects the replicating of the cell. Some of the newer ways that cancer treatments are going, they're going after the blood supply to the tumor. And some of the most recent ones are going after particular enzymes in the cancer cell. So a lot of different research, even radiation is different. They're looking at different modalities to treat with really focused beams. The typical way we used to treat with radiation is they get radiation every day, Monday through Friday for several weeks. Now they're looking at focused treatments, high doses with a very few treatments. So even that's changing. Okay. You also went through radiation. Yes, I did. And I did as well. So quite a bit of extensive ozip for like 30 days straight. 33 sessions of radiation. I went at least three days a week, some weeks I went four days a week. Yeah. Now one of your treatments that was used was Herceptin afterwards. Yes. And that was at the time kind of state of the art. Is that still used or is that pretty much obsolete and been replaced already? No, that's still used a lot. About a third of women with breast cancer have a protein on their surface called Hertunu. And if you have that, you have a more aggressive breast cancer. The good thing about it, such as in Sam's case, is there's this molecule or this drug that specifically targets that protein. And people who get that drug have a much improved cure rate over those that don't get that drug that have that protein. So there are some newer drugs now that have been added on top of Herceptin so that if you were diagnosed today, it may be changed just a little bit. Sure. Yeah. Excellent. With the whole subject of cancer, it is definitely a different type of medical condition than I have got a cold or a broken arm because this can be on a life terminating event. Excuse me. So I would imagine to maintain quality of life or to help with that, there's other types of treatments or services that oncologists have to go through because there's probably a mental as well as physical health that can contribute to anything. Could you go through like some of those different types that you go through? So we have a cancer liaison physician or a physician at our office and it's a person who's been through cancer and he leads support groups. But I think one of the biggest things that help people get through is their mental attitude and their friends. And I have to take a break here and just say, Sam did not have an easy time going through. And right when she was going through, she had a double whammy with the colon cancer. And then she's had several ups and downs that were not cancer related even afterwards. I have to say, you have probably had the hardest time of just about anybody I've had in the last 10 to 15 years. But you know what? Despite all the ups and downs, she's always been positive and I wish I could take your spirit and infuse it to some of my other patients. And I mean that sincerely because that willing spirit and that drive to not give up is huge. I'm always amazed at two groups. The groups that should do well that don't and they just give up, but they're Sam's group. The group that shouldn't do well that does. And I'm a firm believer that that mental attitude is everything. You have a lot to teach a lot of people. But, and I think you only get some of that toughness when you go through some tough times in your life. So you probably you nails for breakfast. Well, I'm a breakfast for supper person so I don't do it in the morning. But yes, but I will admit that I did have a tough row of it and I did spend over a year seeing a psychologist. I mean, I had to have help. Well, that's not unusual. You know, when you go through and you confront death and you're wondering, am I gonna be here? You know, a lot of people need help. Some need antipressants just for a small period of time to get through. Some people see counselors. A lot of people find relief and exercise, you know just a release of some sort to get some of the energy and anxiety out. And so everybody finds their way differently. The support groups are huge for some people. They are life changing. So whatever works. Sam, could you go in a little bit more detail as far as what your ups and downs were? I know you had a rough time the last few years of what you were all experienced. Well, it was, mine has been rather complicated. I've had a number of complications from it. Not only did I have the breast cancer then I was diagnosed with the colon cancer. Once my treatments were completed I developed some heart issues and I've had not one but two open heart surgeries all within the same year. There was an issue with my first open heart surgery where they had to go in and repeat the same procedure less than five months later. Then the following year when I was well enough to go ahead and I was of the mental state where I felt like I could have my breast reconstruction done during that surgery I had a complication where I had a stroke during my surgery that wasn't discovered until virtually two days later. So I've had to deal with that. I didn't have typical symptoms with the stroke. I've been left with a pain syndrome because of the area of my brain that was damaged where basically you can draw a line down my body down the center and on the right side of my body I have pain 24-7. It never goes away. I do wear a narcotic pain patch to eliminate some of the pain. With that I'm able to get it from a 10 down to about a seven. I use medication techniques to deal with that as well as there are days when I'll admit I just pray. No, the other thing that you may have left out that a lot of people struggle with is in the midst of all of this people are dealing with insurance issues and I know at one time we were having problems with your insurance company and the last thing that people wanna do is have money problems when they're going through and wondering how am I gonna buy groceries? How am I gonna do all this? And that's becoming more and more of a problem now than it ever has and that causes a great deal of anxiety. It's traumatic, it really is cause not only are you fighting for your life you're fighting for your spouse, your children and everybody else for their future if you're gone. Because if you're gone you don't want them to be left with all of the bills and everything from where you were sick. Right, but your other point too is I think prayer is a huge component. I mean I think sometimes spirituality and prayer will give a calmness in your life and a settering about what's truly important in life and sometimes we get so wrapped up in our day to day lives and we forget and something like this suddenly crystallizes what's really important in life. So I think that's huge. It is, it is and I know that I had people praying for me all over the country. I had family members that put me on their prayer lists at their church and when I would get a letter from that church saying that they had prayed for me on Sunday it was invigorating, it made me feel better. Sometimes I don't think you realize how many lives you touch until something like this happens. Can you realize how many people care about you and come out of the woodwork to help? Oh sure, you know and people tell me all the time that they hope that they have the grace to accept an illness the way that I did because I never gave up. Because I remember when you told me I had colon cancer I was comforting you. Yeah that was not a good time. That follows right into my next question. How does the patient-doctor relationship differ in these cases versus you know like a regular MD where I'll take two aspirin and call me in the morning so to speak. How does this relationship differ? My brother's an ear, nose, and throat doc in the Appleton and I tease him a lot but you know he sees people he takes their tonsils out and away they go. We kinda have a long journey that cancer docs and we get to know people really well we get to know their families and it's sometimes it's a happy ending like Sam's but sometimes it's not a happy ending and so you get to know them quite well and you see them that they're ups and they're downs so you get to be very close to them. I tell people it's like going into battle and you know you feel exhausted at the end of the fight but I have the greatest job in the world. I get to help people every day. I get to see the human spirit and the triumph of the human spirit over some of the worst that life can throw at them. Sam is a cancer survivor. Do you declare her cancer free or does anyone ever declare cancer free once they have it? So for most patients ask me when they're diagnosed when am I cured and so there's a word cure and then there's a word remission. So for many cancers we believe that they're cured when they're alive five years after they've been diagnosed colon cancer lung cancer a lot of cancers. There are some cancers that can recur even 10 or 15 years later. So breast cancer is a cancer that can recur even 12, 15, 17 years later. I had one lady that recurred 40 years after her original surgery and we know it was the same tumor because it's staying the same as her original. That's unusual. Melanoma, skin cancer can recur a long time later. I have a lady right now with kidney cancer who it's recurred well over two decades after the original tumor. But for most other cancers we consider five years and you're cured. What about between zero and five? We consider you in remission if there's no evidence. So I tell people it's like putting together pieces in a puzzle. Your symptoms are important, your blood work is important and the scans are important. If there's no evidence of cancer then we consider you in remission. Basically it's about time to wrap up. Is there any other comments that either of you would like to make before we do? I just know for anybody who gets cancer if you have that fighting spirit, don't give up. There's always hope. Dr. Mark? I think Sam said it well and I think if you have a wonderful family and support and faith, I think that can see you through most anything. Don't ever be afraid to get another opinion. Thank you both for being on the show. On behalf of Quality of Life, I'd like to thank Dr. Mark Teg from Matthews and College, Tammy Augustine, cancer survivor. And yes, there is no coincidence that we have the last name that we are husband and wife, so as far as that goes. And I'd like to thank our studio audience from Lakeland College. If there's any questions you have or other episodes you'd like to see, you can contact us through our WSCS website, which is www.wscsscheboygan.com. Again, for Quality of Life, I'm Dave Augustine. Thank you for watching.