At United Cancer Center in 2007, a total of 695 cases of new malignancies were diagnosed. As the case in previous years and nationally, the most common cancer that was diagnosed was lung cancer, which was 124 cases or 28% of the total. The second most common cancer diagnosed at United Cancer Center over the past year was breast cancer consisting 26% of cases. Prostate cancer, bladder cancer, and colorectal cancer were the other 3 most common sites diagnosed with 20%, 7%, and 19% of cases respectively.

Over the past year, United Cancer Center has continued to emphasize a three-pronged approach to the care of malignancy in North Central, West Virginia. The primary focus and the one that has the most chance of improving incidence statistics is our emphasis on prevention. In this regard, we supported the action of the Harrison County Health Department in passing smoke-free regulations for indoor public areas. The Cancer Center also provides genetic counseling and testing for patients and family members who have a personal high family risk of developing malignancy so that these patients can be counseled regarding their options if genetic testing does indicate an increased risk. Our second approach to the management of malignancy includes early detection. In this regard, the Cancer center supports annual screening to both men and women each year for screening of skin, breast, cervical, colorectal, prostate, and testicular cancers. In addition, in this year, United Hospital Center Radiology Department is now utilizing digital mammography, which provides a higher quality image to the radiologist with lower radiation exposure for the patient. The addition of this technology will help to enhance early detection of breast cancer.

The third and primary focus of the Cancer Center is the care of malignancy. Each year we find reason for optimism in our battle against malignancy, as the availability of new drugs to treat lymphoma and leukemia such as Treanda become available. The use of Image Guided Radiation Therapy allows us to manage malignancies with radiation with less toxicity. The treatment of these malignances is done in a multidisciplinary fashion through weekly tumor board meetings, which allow multidisciplinary consideration of the newly diagnosed cancer patients and provides ongoing continued medical education to the staff treating malignancies.

A newer but very important focus of the Cancer Center is addressing survivorship issues in cancer patients. Understanding better screening practices, education on impact of lifestyle choices, and newer medical treatments as more successful chemotherapy and radiation treatments, many patients are surviving longer cancer free or are able to live longer periods of time with their cancer as a chronic illness.

These increasing number of cancer survivors have unique issues regarding their ability to function, their on going medical care, and quality of life. We intend to provide care that will enhance the quality of life of cancer survivors as they face these unique issues.

It is an optimistic time to be caring for patients with malignancy since new treatment options become available with each passing year which improve not only survival but quality of life. A major addition to our efforts will be made in 2010 with the opening of the new Cancer Center in the New United Hospital Center which will provide efficient, convenient, and combined modality care to our patients in a much more coordinated fashion, and we look forward with anticipation to be able to provide care in the new environment.

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Long Term Study of Non-Hodgkins Lymphoma ---1997-2007

Non Hodgkin’s lymphomas represent a heterogeneous group of lymphoproliferative disorders comprising over 75% of lymphomas. In the United States there is an estimated 66,120 new cases in 2008 with 19,160 deaths. The incidence of non Hodgkin’s lymphoma increases with age. In our study 136 patients at United Hospital Center were diagnosed with non Hodgkin’s lymphoma between 2000 to 2005. The incidence in male and female are similar with the median age being 68 years (Graph 1), similar to national statistics.

Non Hodgkin’s lymphomas have different patterns of behavior in response to treatment. In general non Hodgkin’s lymphoma can be divided into two prognostic groups- indolent and aggressive. Indolent lymphomas have a long natural history but generally cannot be cured with treatments. In contrast, aggressive lymphomas are rapidly growing and can be fatal without prompt treatment. Over 50 % of patients with aggressive lymphomas can be cured with intensive chemotherapy treatment.

Stage and histological type of non Hodgkin’s lymphoma determine prognosis and treatment. Stage 1 disease represents involvement of a single lymph node region. Stage 2 disease involves two or more lymph node groups with involvement on the same side of the diaphragm. Stage 3 disease is limited to lymph nodes above and below the diaphragm. Stage 4 disease involves one or more extra lymphatic sites including bone marrow, liver, lung, and skin. In our study, over 50% of patients presented with advanced disease (stage 4) which is similar to national experience (Graph 2).

Treatment of non Hodgkin’s lymphoma depends on histology and stage. Stage 1 and 2 indolent and aggressive non Hodgkin’s lymphoma are potentially curable with combined chemotherapy and radiation treatment. In the pie diagram (Graph 3), 10.5 % of patients with early stage disease received combined modality treatment. The majority of the patients in our study presented with stage 3 and 4 disease; these patients were generally treated with chemotherapy alone. Stage 3 and 4 indolent lymphoma patients do not necessarily need immediate therapy if they are asymptomatic and do not have bulky disease. 12.7% of our patients with indolent disease had no initial therapy. Surgery is generally used only for diagnosis; 6.4% of patients had surgery alone. These patients represent advanced indolent lymphoma patients.

Survival depends upon the stage, histological type, age, LDH levels and bulky disease. As seen in graph 4, stage 1 and 2 have 5 year survival of 70%-80%, comparable to national statistics. Stage 3 and 4 patients have 40% 5 year survival which also compares with national statistics.

The addition of Rituxan to standard chemotherapy has made a major impact in response and survival of patients with non Hodgkin’s lymphoma. Patients with indolent non Hodgkin’s lymphoma can survive many years but rarely can be cured while patients with aggressive non Hodgkin’s lymphoma often can be cured with initial treatment.

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Short Term Study of Small Cell Lung Cancer --- 2002-2007

This report is to describe our results and experience at the United Cancer Center for patients with a type of lung cancer called small-cell lung cancer. Small-cell lung cancer is unlike non small-cell lung cancer in that it has a very aggressive clinical course. The median survival for patients with this malignancy who do not receive treatment is only 2 to 4 months. Because it behaves in an aggressive fashion, the majority of patients who present to their doctor with this malignancy already have disease which has metastasized outside the chest. Because patients with this type of malignancy have a tendency to develop distant spread of the cancer early in the course of their disease, treatments such as surgical resection or radiation therapy, which are localized forms of treatment, have not been successful. With the incorporation of chemotherapy in the management of disease, the survival has been unequivocally prolonged with a 4 to 5 times improvement in median years survival compared to patients who get no therapy, and about 10% of all patients with small-cell lung cancer are free of disease at 2 years. The overall survival for all patients at 5 years is 5% to 10%.

Only about 1/3 of patients with small-cell lung cancer will have disease localized to the chest at the time of diagnosis, and this is the group of patients who make up a majority of long-term survivors. Unfortunately, those patients who are fortunate enough to be long-term survivors still remain at risk for other smoking-related malignancies such as new lung cancers or head and neck cancer.

Although, improvements have been made in the diagnosis and care of patients with small-cell lung cancer, the survival benefits have plateaued. At United Hospital Cancer Center, between 2002-2007, we saw 128 cases for small-cell lung cancer. The patients were mostly over the age of 60 and were evenly split between male and female (Graph 5). We did see patients diagnosed as young as in their 20’s and as old as in the 9th decade. In terms of the stage of those 128 patients, only 41 were AJCC (American Joint Committee on Caner) stage I, II, or III which was associated with what is called limited stage disease, i.e., disease confined to the thorax (Graph 6). As noted with national statistics, 75 of these patients had extensive stage disease with evidence of metastasis outside the thorax at the time they were diagnosed. Given the known association with a prior history of cigarette smoking, it is important to note that of these 128 patients, only 4 claimed to have never used cigarettes or tobacco products (Graph 7). Of the 128 patients, 73% received chemotherapy or chemotherapy plus radiation as part of their primary treatment, and 4% received radiation alone (Graph 8). The survival curve by stage seen on graph 9 shows that the majority of patients who enjoyed long-term survival came from the AJCC stage groups I, II, and III with a number of long-term survivors being 10% or less. This is similar to national statistics.

In summary, small-cell lung cancer is a smoking-related malignancy, which is highly responsive to aggressive treatment with chemotherapy or chemotherapy plus radiation in limited-stage patients, but in spite of modern advances in diagnosis, staging, and treatment, this remains a highly lethal malignancy for the majority of patients diagnosed with this illness, and there have been no major advances in the treatment of this disease over the past 5 to 10 years.

The extremely strong association with cigarette smoking and the low cure rate with aggressive treatment emphasizes that one of the primary ways of dealing with this malignancy would be prevention and smoking cessation. In the meantime, clinical trials assessing new drugs and strategies for treatment of this malignancy are in progress and hopefully, will improve the long-term survival of patients, not only with limited stage, but also extensive stage disease.