Director's Report

United Cancer Center is recognized as a regional leader in comprehensive cancer care. Our commitment to excellence is evident by the exceptional quality and dedication of our doctors and medical staff, as well as our specialty programs especially designed for our community.

Patient education is of paramount importance to our program. We recently developed an education video/dvd addressing the complexities of living with cancer. A step-by-step approach, dealing with cancer from diagnosis to treatment is detailed. Available treatment programs at United Cancer Center are explained in full by the medical doctors overseeing the specific departments. Medical, nursing, and support staffs are shown using equipment and technology to minimize fear and increase patient awareness and involvement.

Support groups are very important in helping patients and families deal with the diagnosis of cancer. In addition to “Reach to Recovery”, “Special Touch”, “Hope Support”, “Look Good, Feel Better”, “Man to Man”, and “I Can Cope” – online, we have added “Let’s Talk About Cancer With Kids”. This helps children understand the illnesses of their siblings, parents, and grandparents and provides a coping strategy to help them deal with the stresses associated with the diagnosis of this disease.

Clinical trials are extremely important in advancing cancer knowledge and offering patients state of the art treatments and cancer drugs. In addition to the National Surgical Adjuvant Breast & Bowel Project and the Southwest Oncology Group, United Cancer Center has recently joined the American College of Surgeons Oncology Group. This latest clinical trial group allows our cancer surgeons to participate in clinical trials that further advance surgical options and techniques in cancer operations.

It is an exciting time to be involved in medical oncology. Newer targeted therapies that have fewer side effects than standard chemotherapy are being used alone or in combination with standard chemotherapy. These innovative therapies improve survival in difficult to treat cancers such as kidney and liver cancer and common cancers such as lung, colon, and lymphoma. Our medical staff is proud to be able to offer these innovative treatments to our communities, neighbors, friends, and families.

Through the cooperation of the medical and radiation oncologists and surgeons, and in conjunction with the nursing, dietary, and diagnostic x-ray departments, United Cancer Center is providing the very best cancer care to West Virginia.

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Long Term Study of Esophageal Cancer – 1996-2006

Carcinoma of the esophagus is a major health problem around the world and in the United States. Each year in this country we will have 15,000 new cases and 13,900 deaths. In West Virginia, the incidence of esophageal cancer is about 9 per 100,000 men and 2 per 100,000 women. Esophageal cancers are classified as either squamous cell cancers or adenocarcinomas. Both types are increased in risk by cigarette smoking. Adenocarcinomas seem to be increasing in incidence and are associated not only with cigarette smoking but with chronic gastroesophageal reflux disease (GERD).

In West Virginia, through the period of 1999 to 2003, cancer of the esophagus was the 7th leading cause of cancer related mortality against West Virginia men. At United Hospital Center, in a 10-year period from 1996 to 2006, we saw 80 cases of carcinoma of the esophagus. Most of these cases occurred in patients over the age of 50 with a predominantly 4 to 1 male to female incidence (Graph 1).

In West Virginia, according to statistics from the American Cancer Society, more than half of all cancers of the esophagus recently diagnosed had spread regionally or distantly at the time of diagnosis.

At United Hospital Center, over the 10-year period of our review, of the 80 patients seen, 58 had Stage II, III, or IV disease (Graph 2). Of these 80 patients, the vast majority i.e. 63% had the location of their cancer in the lower third of the esophagus. 6% presented with disease in the upper third, 4% in the cervical esophagus and 4% in the thoracic esophagus and the remainder in other sites (Graph 3). The patients were treated with a variety of modalities. 37% received radiation/chemotherapy, which was the most common modality used while 10% received chemotherapy alone and 9% received radiation alone, 15% were treated with surgery and 19% of patients were too ill or their disease too advanced to receive therapy (Graph 4).

The results of therapy of these 80 patients is outlined on the survival curve on (Graph 5). This indicates that our patients with Stage I disease, had the best chance of survival, with a 5 year overall survival of approximately 28%. All other groups had much lower 5-year survival rates.

The survival rates of patients with cancer of the esophagus diagnosed throughout West Virginia were similar to national survival rates and most patients had distant disease or locally advanced disease at the time of diagnosis.

This malignancy continues to be a major challenge for physicians who treat this disorder. Various combinations of chemotherapy and radiation therapy in conjunction with surgery are still being studied in order to improve the results of initial therapy. Improved staging techniques using positron emission tomography (PET) scan will hopefully not only lead to better outcomes but allow us to improve a selection of patients who will benefit most from aggressive approaches.

Coupled with advances in staging, treatment, and prevention (including emphasis on smoking cessation, treatment of gastroesophageal reflux disease and surveillance of patients with Barrett's esophagus) we hopefully can prevent esophageal cancers or lead to earlier detection so that these malignancies can be removed when they are in a more curable stage.

We anxiously await results of future randomized studies, which are evaluating new surgical and chemo/radiotherapeutic approaches of esophageal cancer since it remains a highly lethal neoplasm.

 

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Short Term Study of Ovarian Cancer – 2001-2006

Epithelial ovarian cancer comprises 90% of all ovarian cancers and is the fifth most common cause of cancer mortality in women. In 2006, there were approximately 22,000 new cases and 15,000 deaths due to this disease in the United States. The incidence of ovarian cancer increases with age with a median age of 65 and is most prevalent in the eighth decade.

In our study of 32 patients with epithelial ovarian cancer at United Hospital Cancer Center between 2001 and 2006, we found the median age of diagnosis at 70, with the greatest prevalence in the seventh decade of life (Graph 6).

Risk factors for ovarian cancer include family history involving genotype for DNA markers BRCA-1 and BRCA-2, and either no children, or first birth over age 35. Conversely, birth control use and first child at age less than 25 decrease the risk of ovarian cancer.

Ovarian cancer spreads by shedding of cancer cells from the ovary into the pelvis, beyond the abdomen, to the lung pleura. Ovarian cancer very rarely spreads through the blood stream. Stage of disease reflects the spread of this cancer. Stage I is cancer confined to the ovaries, stage II represents spread into the pelvis, stage III consists of disease spread into the abdominal cavity, and stage IV is spread beyond the abdomen, especially into the pleural space of the lung.

Common symptoms of ovarian cancer include abdominal or pelvic pain and abdominal swelling. These tend to be non-specific and when symptoms occur and patients seek medical attention, the disease is often advanced. In fact, over 70% of patients in the United States have stage III or IV disease at presentation. In our study, 21 out of 27 (78%) patients had stage III or IV disease (Graph 7).

Treatment of ovarian cancer depends on the stage. Initial surgery is important regardless of stage and can be curative in patients with stage I disease. In stage III and IV disease, optimal debulking surgery to remove all cancer to less than 1 centimeter can significantly improve overall outcome and survival. Chemotherapy is important for stage II, III, and IV disease and also high risk subsets of patients with stage I disease (positive peritoneal cytology and grade III).

In our study, (Graph 8), 13% of patients received surgery alone, representing stage I patients. 40% of patients received both surgery and chemotherapy representing those patients with stage II, III, and IV disease. 19% of patients received chemotherapy alone, representing those patients with advanced disease (stage III and IV), who could not be operated on due to age, underlying medical problems or severity of disease. 25% of patients received no treatment, which might reflect an elderly population with advanced disease where palliative care was the only option.

Survival of patients with ovarian cancer depends on stage and age at diagnosis. Women younger than age 65 generally survive twice as long as similarly staged older women greater than 65 years of age. In our study (Graph 9), patients with stage I disease (3 patients) did well until 39 months, when they appeared to experience recurrence and died. In the literature, typical five year survival for stage I patients is 93%. Stage II patients in our study (3 patients) had a 67% 4.5 year survival, but all recurred and died by five years. Stage III patients (10 patients) experienced 50% three year survival, but all had died by four years. Stage IV patients (11 patients) had a 40% three year survival, but all had died before four years. In the general literature, five-year survival for stage II patients is 69% and decreases to 30% for stage III and IV patients. Unfortunately, the patients in our retrospective study faired worse than the national average, due in part to our patients more advanced age, comorbid conditions, and smaller patient numbers analyzed than national study, affecting percentage outcomes.

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2006 SITE DISTRIBUTION

Code	Site	# Accessioned
C01	BASE OF TONGUE	1
C02	OTHER PARTS OF TONGUE	2
C05	PALATE	1
C06	OTH PARTS OF MOUTH	3
C07	PAROTID GLAND	2
C09	TONSIL	5
C11	NASOPHARYNX	3
C15	ESOPHAGUS	4
C16	STOMACH	4
C17	SMALL INTESTINE	1
C18	COLON	63
C19	RECTOSIGMOID JUNCTION	11
C20	RECTUM	20
C21	ANUS AND ANAL CANAL	4
C22	LIVER-INTRAHEP BILE DUCTS	3
C23	GALLBLADDER	3
C24	OTHER PARTS OF BILIARY TRACT	1
C25	PANCREAS	8
C30	NASAL CAVITY/MIDDLE EAR	2
C32	LARYNX	6
C34	BRONCHUS AND LUNG	112
C38	HEART, MEDIASTINUM, AND PLEURA	2
C42	HEMATOPOIETIC/RETICULOENDOTHELIAL	40
C44	SKIN	19
C49	CONNECTIVE, SUBCUTANEOUS, AND OTHER SOFT TISSUE	9
C50	BREAST	106
C51	VULVA	3
C52	VAGINA	2
C53	CERVIX UTERI	8
C54	CORPUS UTERI	21
C55	UTERUS, NOS	1
C56	OVARY	8
C61	PROSTATE GLAND	73
C62	TESTIS	3
C64	KIDNEY	8
C65	RENAL PELVIS	2
C66	URETER	2
C67	BLADDER	21
C68	OTHER URINARY ORGANS	1
C71	BRAIN	3
C73	THYROID GLAND	7
C74	ADRENAL GLAND	1
C77	LYMPH NODES	28
C80	UNKNOWN PRIMARY SITE	7
	TOTAL	634

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Cancer Committee 2006

Paul M. Brager, MD, Co-Chair Medical Oncology Gaspar Barcinas, MD General Surgery Craig J. Coonley, MD, Co-Chair Medical Oncology Chinmay Datta, MD Pathology James Demarco, MD Nephrology Jack Faroun, MD Medical Oncology Carl Fischer, III, MD, Cancer Liaison General Surgery Raymond Hinerman, MD ENT Joseph Kassis, MD Urology Thomas Kennedy, MD Plastic Surgery Saad Mossallati, MD Thoracic Surgery Roger K. Pons, MD Colorectal Surgery Ali Rahimian, MD Gynecology Michael A. Stewart, MD Radiation Oncology W. Park Thrush, MD Radiology Marc Valley, MD Pain Management

Gary Ammons Behavioral Medicine Mary Jo Arbogast, RN, OCN Infusion Center Coordinator Lisa Ashcraft-Carr Dietician Linda Carte, RN, MSN, AOCN Director Oncology Services Paul Carter, RN Director Surgical Services Nancy Dye, RN, OCN Oncology Program Coordinator Vickie Hall, RN, OCN Nurse Manager, Oncology Lorry Hamrick, RHIT, CTR Cancer Registrar Butch Heflin, MSW Social Worker Cathy Libert Supervisor, Radiation Oncology Mary Lough American Cancer Society Julie Mitchell, RN, MSN Manager, Hospice James Morley Chaplain John Pulice, PT Manager, Rehabilitation Services Todd Rohrbough, RPH Pharmacist Anna Shreves, RN Director, Quality Improvement Michael Tillman VP Patient Services, Chief Operating Officer