Management of acute spinal cord compression in multiple myeloma

Cancer Diagnosis

Cancer diagnosis frequently requires imaging studies that in many cases use small amounts of radiation. Procedures such as X-rays; computed tomography (CT); magnetic resonance imaging (MRI); positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are important in clinical decision-making, including therapy and follow-up.  

Imaging tests – taking pictures of the inside of the body – are of pivotal importance in the diagnosis and management of cancer patients. The use of diagnostic imaging is one of the first steps in the clinical management of cancer. Diagnostic radiology and nuclear medicine studies play an important role in the screening, staging (finding out the extent of the cancer, such as how large the tumour is, and if it has spread beyond the primary site), follow-up, therapy planning, evaluation of therapy response and the long-term surveillance of patients.

A reliable diagnosis is necessary to identify the site of the primary tumour, and to assess its size and dissemination to surrounding tissues and to other organs and structures in the body. An appropriate diagnosis is of paramount importance in deciding the therapeutic approach to take and establishing the prognosis.

Early diagnosis

The chance of cure for a cancer patient strongly depends on the stage of the disease at the time of diagnosis.  When it is diagnosed at an early stage – before it is too large or has spread – a tumour is more likely to be successfully treated. The early detection of cancer hinges on many factors: the screening of at-risk population; the ability of patients and health professionals to recognise warning signs; and the use of diagnostic methods to differentiate between cancer and other processes, as well as to precisely determine the location and the extension of the tumour. Modern diagnostic imaging technologies provide the ability to discriminate tissues down to a millimetre, using magnetic resonance imaging (MRI) and X-ray computed tomography (CT), while the range of positron emission tomography (PET) and single photon emission tomography (SPECT) are a few millimetres.

Anatomy versus function

Diagnostic imaging can be divided into two broad categories: those methods that define very precisely anatomical details and those that produce functional or molecular images.

The first method (using CT and MRI) can provide exquisite details on lesion location, size, morphology and structural changes to surrounding tissues, but only delivers limited information as to the tumour's functioning.

The second method (using PET and SPECT) can give insight into the tumour physiology down to the molecular level, but cannot provide anatomical details.

Combining these two methods enables the integration of anatomy and function in a single approach. The introduction of such "hybrid" imaging has allowed for the characterization of tumours in all stages.

Role of nuclear techniques

The use of different diagnostic imaging techniques that employ various forms of radiation such as X-rays (CT and radiography) and gamma rays (PET and SPECT) has revolutionized the management of cancer patients. Technologies such as positron emission tomography (PET) that rely on the use of radiopharmaceuticals represent a breakthrough in the medical practice due to their capability to decipher, without opening the human body, what is happening at molecular level in a certain cell or tissue. The information obtained from these techniques has enabled significant improvements in patient management and the proper distribution of healthcare resources.

HIFU For Treatment Of Prostate Cancer

Prostate cancer poses a significant health concern in India, with 33,000-42,000 new cases annually. A recent Lancet report has warned of a sharp surge in cases in India by 2040, with many men being diagnosed in advanced stages, leading to fatal outcomes. Dr. Sudhir Kumar Rawal, a leading oncologist from RGCIRC, Delhi discusses advancements in treatment like HIFU therapy, with ARCHANA JYOTI

Dr Rawal, kindly provide us an overview of prostate cancer and its prevalence in India vis-à-vis the world.

Prostate cancer is the second most commonly diagnosed cancer in men. As per the GLOBOCON report on prostate cancer, an estimated 1.4 million diagnoses and 375,000 deaths worldwide in 2020. The incidence is low in Eastern and South-Central Asia but rising.  In India, the projected number of cases for 2020 was 51,979and the numbers are only increasing. It is pertinent to note that there is an underestimation of incidence in India due to a lack of a population-based cancer registry, underreporting, and social stigma of cancer detection among others.

The prevalence rate of prostate cancer is higher in certain geographies within the country. As per the latest ICMR data Delhi-NCR reported the highest incidence rate of over 11.8 cases/million adults registered followed by Kamrup region of Assam with 10 cases/million adults and Thiruvananthapuram with 9 cases/million adults.

Unfortunately, there is no conclusive data that could support specific preventive or dietary measures that reduce the risk of developing prostate cancer. In such circumstances, individuals should immediately reach out to a urologist in case of any urinary problem and those above 50 years of age should regularly undertake Blood Prostate Specific Antigen (PSA) Test.

What are some of the key risk factors associated with prostate cancer, particularly in the context of India?

Prostate cancer is directly linked with genetic mutation. So, it can be hereditary as well as familial. In different studies association of different environmental and dietary factors have been found with prostate cancer. Hypertension, obesity, and hypercholesterolemia factors have increased risk. Dietary factors like high alcohol intake, coffee, fried fatty food, red meat as well as processed meat have been linked with increased association of prostate cancer. However, no conclusive data exist that could support specific preventive or dietary measures that can reduce the risk of developing prostate cancer.

How do you approach the diagnosis and staging of prostate cancer in your practice?

Prostate cancer is usually suspected when a patient presents with urinary symptoms and has raised PSA (Prostate-specific antigen) or abnormal digital rectal examination. With increasing awareness, many asymptomatic people regularly do blood PSA testing as part of routine health checkups. Prostate cancer diagnosis requires prostate biopsy. We have the facility of the latest prostate biopsy techniques including the most precise MRI fusion transperineal biopsy (Artemis System). For local staging we do biparametric/multiparametric MRI. Metastatic staging requires a PSMA PET CT scan.

What treatment options are available for patients with prostate cancer, and how do you decide on the most appropriate approach for individual patients?

We have all possible treatment options for various stages of prostate cancer. We offer robotic radical prostatectomy/ High intensity-focused ultrasound ablation/ Hormonal therapy + radiotherapy for localized prostate cancer. For metastatic prostate cancer, treatment is hormonal therapy along with novel antiandrogens chemotherapy or radionuclide therapy. We are currently running a few trials for metastatic prostate cancer. The appropriate approach is individualistic for each patient. It depends on the patient's age, physical performance status, associated comorbid conditions, and disease stage. We always make shared decisions with patients after discussing the merits and demerits of each therapy option suitable for them.

Are there any emerging trends or advancements in prostate cancer treatment that you find particularly promising?

With the evolution of medical sciences, there are rapid advancements in prostate cancer treatment in India. There are advancements in the incorporation of genetic testing and related therapy, robotic technologies, more targeted radiation therapy, non-invasive treatment like HIFU, availability of newer antiandrogens, oral hormonal agents, and gene-directedradionuclide therapy. I am hopeful for new gene-directed therapy that can increase the survival of patients with metastatic disease.

Can you provide an overview of what HIFU (High-Intensity Focused Ultrasound) treatment entails and how it works as a treatment option for prostate cancer?

HIFU works by treating only the portion of the organ affected by cancer with a safe margin while sparing the remaining normal healthy tissue. It precisely delivers ultrasound waves inside the prostate. Ultrasound energy gets converted into thermal energy inside the prostate. Thus, cancer cells get killed by heat. HIFU is typically used as a treatment option for localized prostate cancer. It is also used as a palliative therapy option after the failure of hormonal therapy and radiation therapy

What are the typical eligibility criteria for patients considering HIFU treatment for prostate cancer?

HIFU is a treatment option for a select group of prostate cancer patients. Although there are no strict criteria, it is best suited for low-risk and intermediate-risk prostate cancer patients. Typically, it is done for patients whose PSA is less than 20 ng/ml, Gleason score £ 7, disease has not spread outside the outline of the prostate.

What are the potential benefits of HIFU compared to traditional treatment options such as surgery or radiation therapy?

HIFU therapy has various advantages over surgery and radiation therapy:

Usually done as a daycare procedure

Does not require any skin cuts /incisions

Relatively painless procedure

Recovery is usually quick and most men return to their normal activities within two-three weeks .

Treats the small cancer areas with little damage to nearby tissue , nerves and muscles .Consequently the rates of urinary leakage and erectile dysfunction are significantly lower than radical treatments

Even after recurrence , the patient remains eligible for repeat sessions of focal therapy or other options (surgery/radiation)

What are the potential risks and side effects associated with it?

HIFU is a relatively safe procedure and has no significant risks associated with it. Long-term cancer survival data(after 10 years ) is not yet available for focal therapy. About 20-30% of patients may need a second session of focal therapy for recurrent cancer. Less than 1 % ofpatients may develop a hole between the rectum and the urinary passage (termed a rectourethral fistula). This may need urethral catheter placement for a few months or surgical repair in case it does not heal on its own.

Can HIFU be used as a primary treatment for localized prostate cancer, or is it typically recommended as a salvage therapy after other treatments have failed?

HIFU is typically used as treatment for localised prostate cancer. It is also used as salvage therapy after the failure of hormonal and radiation therapy.

Are there any long-term considerations or follow-up care that patients should be aware of after undergoing HIFU treatment?

Follow-up is very important after HIFU like any other intervention. After HIFU, the patient's PSA level is expected to fall and then remain low. PSA testing is performed at 3-6 monthly intervals for the first few years after the procedure. The Urologist may perform imaging in the form of mpMRI at frequent intervals to track the response of the lesion to treatment, and the development of new lesions in the treated area or elsewhere in the prostate. A rising PSA may indicate that the prostate cancer has returned.

Finally, what advice would you offer to men regarding prostate cancer prevention and early detection?

If you feel any urinary problems, immediately visit a urologist to get evaluated. Start blood PSA screening from 50 years of age.

Coping In The Aftermath Of A Cancer Diagnosis

Receiving a cancer diagnosis can be one of the most stressful, pivotal moments in an individual's life. During my over decade-long career as a social psychologist and health communication researcher, I have been told repeatedly that the words "you have cancer" often create immensely negative emotions such as overwhelm, fear, anger, stress or even depression.

These emotional reactions are normal and part of most patients' experience—but there are ways to find support. With May being Mental Health Awareness Month, it is critical to raise awareness for patients and those supporting them.

One major challenge is that patients' experiences of these negative emotions can make it hard to process all the information their oncologist presents to them. Prior research shows that when cancer patients' difficult emotions (such as fear, anxiety and worry) are too high, it can hinder their ability to engage in cancer treatment decision-making. This is problematic because this is occurring at the beginning of treatment when rapid-fire decision making must occur to determine next steps in treatment.

So, how do you cope with the aftermath of a cancer diagnosis? Read on to learn how to find support and allow yourself to engage in treatment decision-making in an informed way.

Coping with a recent cancer diagnosis

Due to the overwhelming stress and strain—emotionally, mentally and physically—of receiving a cancer diagnosis and undergoing treatment, it is so important to be sure that you are provided with support. Below are some tips on ways to begin dealing with the reality of a cancer diagnosis and seek out the support you might need:

Express how you are truly feeling. An essential part of coping with challenging emotions is to first label and acknowledge them. If you find yourself feeling fearful, anxious, sad and/or depressed, begin to label those emotions. Often, in the face of a cancer diagnosis, patients feel the need to be brave and put on a strong face for those around them. But this may not be in line with the reality of how you feel. Find safe spaces and places (support groups, counselor, spiritual leader) to express how you are truly feeling.

Find the right people to support you. Walking through a cancer diagnosis and treatment often requires a lot of support—both practical and emotional. If you are able, begin to make a list of the people in your life who can provide practical support, such as getting you to and from the hospital, assisting with meals or watching your kids or pets. Then think of who you turn to for emotional support. Reach out to these people for help. To make it less overwhelming, you can also designate one person in each category to reach out on your behalf to others in order to get you the practical and emotional support that you need without you doing all of the delegation work. If you do not have a source of support, there are many people on your oncology team ready to support you such as psychologists, chaplains and social workers. These individuals are focused on ensuring you, the patient, feel supported with all of your practical, emotional and mental health needs.

Get help (if needed) in communicating your cancer diagnosis. A common challenge recently diagnosed cancer patients face is the immense exhaustion and burden of communicating their diagnosis with friends and family. First, remember that you are not obligated to communicate your diagnosis to anyone. But, for those with whom you do want to communicate, consider asking some of your close friends or family to lift that burden off you and communicate it on your behalf. This way, everyone is informed and can provide support (encouraging notes, meals for you, etc.) without you having to go through the draining process of telling everyone yourself.

Find something that you love (and are able) to do during treatment. Many patients report that something that helps them get through their cancer treatment is engaging in something very simple that they are realistically able to do. This could be watching your favorite shows, reading a poem a day or having your pet come in for a daily cuddle (when at home). The key is to pick something that soothes you and brings you joy but that is manageable while undergoing various treatments such as radiation or chemotherapy, or recovering from surgery. And remember that being flexible and taking days off when the side effects are too severe is crucial!

Take each day one step at a time. Feelings of overwhelm are very commonly reported by cancer patients, especially when they are first diagnosed. There are often a lot of decisions to make, a lot of treatments to undergo, and all of this is happening while you are processing that you have cancer. If things feel like they are a blur to you, know that is normal and it's OK to take one step forward at a time and not think too far into the future. Center yourself each morning on what appointments or choices you have to make that day rather than zooming too far ahead. This can help reduce the amount of overwhelm and allow you to focus on each step of treatment as it comes.

Tips for appointments and decision-making in early stages of cancer treatment

Experiencing challenging emotions is not only difficult, it can interfere with your treatment decision-making and your communication with your oncologist. Good communication with your oncologist is so important that it's linked to both being satisfied with your communication with your oncologist and your psychological outcomes (such as anxiety and depression). Below are some tips for how to optimize your appointments with your oncologist in the early stages of treatment decision-making:

If possible, bring someone with you to your appointments. As mentioned, recall of information can be poor if your challenging emotions like fear or anxiety are too high. That's why, if possible, it is very helpful to bring someone like a friend or family member to your appointments. This way, you have another person present to both hear and recall information as well as to ask questions. If that person lives out of town, ask your oncologist if you can use FaceTime or another phone-based technology to virtually bring the person to your appointment. It is often good to pick someone who you feel will be an advocate for you during those appointments. Another key tip to remember is that if English is not your preferred language, you can always request a medical interpreter. Even if you speak English but feel more comfortable in another language, you can request this service to ensure you feel confident in understanding what your oncologist is saying to you.

Write out your questions ahead of your appointment. Patients' minds are often swimming with questions and concerns, but these can be forgotten or overlooked at the actual appointment. By bringing a list of questions, either written down on paper or typed into your phone, you can ensure that your oncologist looks at your questions and helps you prioritize what should be addressed during your appointment that day.

Let your oncologist know if and where you are researching information. My prior research has shown that often, patients are looking up information about their cancer (treatment, prognosis, etc.) but failing to tell their oncologist where they got that information from fear of embarrassment. However, it is best to be honest with your oncologist about where you are seeking and finding information. This builds trust between you and your oncologist and helps them inform you more clearly about that information. In most cases, oncologists respond very positively to patients sharing this information and can best help guide and inform you to the details of your specific cancer diagnosis in a way that information online may not be able. Use this as an opportunity to gain from your oncologist's expertise to help guide you through the information you are finding.

Ask about any procedures or decisions that should (or can) be made before starting cancer treatment. A common issue that can negatively affect a patient's future is overlooking important procedures, such as fertility preservation, that can only happen prior to starting cancer treatment. Although most oncologists discuss fertility loss as a side effect of cancer treatment, research shows that few provide information to their patients about preserving their fertility. This means that patients lose the chance to engage in fertility preservation. If you are of childbearing age and this is of priority to you, you may want to inquire about this possibility with your oncologist. If you are a Fred Hutch patient, ask about the Oncoreproduction Clinic. Additionally, ask your oncologist if there are any other medical procedures you should know about or consider prior to starting treatment.

Ask your oncologist to outline (if possible) a roadmap of your treatment plan and/or get patient navigation support. Something newly diagnosed cancer patients commonly report is how overwhelming and confusing the cancer treatment ahead of them is. There can be multiple steps in your cancer treatment and care which include surgery, radiation and chemotherapy but very little clear guidance. Ask your oncologist or someone on your care team to create a roadmap for you of what lies ahead if you find that beneficial. You can also request to be connected with a patient navigator if the clinic where you are being treated has one. Patients report that patient navigation is extremely beneficial. It has been shown to help provide emotional support and assistance with information needs, problem-solving and the logistical aspects of coordinating their cancer care.

The aftermath of dealing with a cancer diagnosis can be an emotional time, full of uncertainty and a long, winding confusing path. But there are resources to help you every step of the way, and finding and seeking out good support and having clear communication with your oncologist can help you, just as they have helped many other patients in your shoes.

Provided by Fred Hutchinson Cancer Center

Citation: Coping in the aftermath of a cancer diagnosis (2024, May 3) retrieved 6 May 2024 from https://sciencex.Com/wire-news/476198579/coping-in-the-aftermath-of-a-cancer-diagnosis.Html

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