BLOOMINGTON, Ind. (AP) — It's 7:30 a.m. in IU Health Bloomington Hospital's Medical Staff Conference Room, and about 20 doctors, nurses and specialists are having their weekly cancer conference — a two-hour discussion of how to best treat cancer patients with particularly challenging cases.
The first of six cases to be discussed today involves a 70-year-old woman who had ovarian cancer more than 20 years ago who was treated with chemotherapy and a hysterectomy, and who is now battling breast cancer.
The discussion is peppered with plenty of "doctorspeak," replete with references to such things as "spiculated masses," ''infiltrating ductal adenocarcinoma with lobular features," and "mildly hypermetabolic focus in the breast."
Radiologist Bruce Monson, displaying an ultrasound of the woman's right breast on a large video screen, manipulates a yellow arrow to point to a "highly suspicious" 3-centimeter mass in the breast tissue.
Then pathologist Eric Stevens, the meeting's coordinator, picks up a slide containing a stained slice of that mass and inserts it onto a microscope — which projects an enlarged image of the tissue on a screen.
"As you can see, the tumor has primarily a strandlike growth pattern that is infiltrating through here," Stevens says. "The tumor is showing some positivity for E-cadherin, but it's fairly weak."
Stevens told The Herald-Times (http://bit.ly/XdRElK ) the regular cancer conference is required by the American College of Surgeons Commission on Cancer for any cancer program in the country that wants to be accredited by the organization.
"We get inspected every three years by a trained surveyor from the Commission on Cancer to make sure our program is still meeting all the accreditation requirements," Stevens said. "One of those requirements is that we have regular breast cancer and multidisciplinary conferences. We are also required to submit specific data yearly to the Commission on Cancer as well as the National Cancer Data Base."
Martha Hill, IU Health Bloomington's lead cancer registrar, said the commission also requires accredited cancer programs to maintain a cancer registry with follow up exceeding 80 percent of its overall cases and 90 percent of the last five years of cases, and offer such things as palliative care services and continuing education for its cancer team members.
Hill said IU Health Bloomington also is accredited by the National Accreditation Program for Breast Centers, which has its own standards and guidelines that must be followed. "By having accreditation it shows we have exceeded the standard of care set forth by the governing bodies," Hill said.
Stevens said being an accredited cancer program "lets patients know that we have high quality cancer services at IU Health Bloomington, and that they don't need to travel far from home to get excellent cancer care."
At each conference there must be at least one practitioner of five specialties — surgery, radiation oncology, oncology, radiology and pathology. At this particular meeting there also are a urologist and oncology nurse, plus representatives from the hospital's Women and Children's Services and Cancer Services, IU Health Bloomington's Cancer Registry, IU Health Olcott Center for Cancer Education and IU Health Rehabilitation and Sports Medicine Center.
"The purpose of the conference is to discuss the whole spectrum of cancer care — from diagnosis to treatment to follow-up," Stevens said. "It's a holistic, multidisciplinary approach that allows all the people involved in cancer care to discuss challenging cases and optimize the patient's care."
General surgeon Fadi Haddad said each conference must consist of two separate meetings — a breast cancer conference followed immediately by a multi-disciplinary cancer conference.
"The conferences, at the end of the day, improve patient care," Haddad said. "When I share my opinion with six or seven other colleagues and they share their opinions with me, it opens our eyes to different modalities, resulting in the best possible care for the patient."
During the conference, those in attendance, all sitting at a 25-foot-long wooden table, discuss other cases.
General surgeon Terry Greene says last summer he surgically removed a growing nodule from the cancerous left lung of a 65-year-old male patient, adding that the man continues to smoke.
"I suspect chemo would be helpful, but the amount of help would be relatively limited — maybe reducing the risk of occurrence by 10 percent," says medical oncologist Mark Dayton. "But if he continues to smoke, that would probably offset any benefit he might receive from chemo."
Urologist Dean Lenz talks about a 49-year-old male with bladder cancer who started receiving chemotherapy last summer. Lenz said each day the man smokes two packs of cigarettes and drinks a dozen beers.
"This is one of the more dramatic bladder cancers I've seen in a long time," Lenz says as Monson places a CT scan of the cancer on the video screen. "When I scoped it, I couldn't see any normal bladder mucosa. It was almost all tumor."
Lenz says chemotherapy has helped the patient significantly, but thinks the cancer may have spread to his lymph nodes.
"We took him into surgery last week, and there was no gross, palpable disease around the bladder," he said. "But there was a mass of scarred nodes around the vessels, and I used scissors to cut off the nodes."
Stevens shows a slide of the man's prostate, and points out that some of its ducts are cancerous.
"After he's healed from surgery, I will do follow-up washings of his urethra and maybe scope it periodically," Lenz says. "And unless he has another cycle of chemo I think we should radiate the pelvis for further local control."
Dayton initiates discussion about a 72-year-old female who has a family history of cancer and now has a large cancerous mass in her left breast. He, Monson and Stevens talk about whether it has metastasized, and how she should be treated.
"I don't think we would start out with chemo unless she becomes more toxic appearing," Dayton says. "But if she is HER2 positive, I might change my mind, because that would mean she has a more aggressive disease."
HER2-positive breast cancer indicates the presence of a protein called human epidermal growth factor receptor 2, which promotes the growth of cancer cells. These cancers tend to be more aggressive than other types of breast cancer.
Dayton expresses regret that the woman felt the mass two years ago, but said she ignored it because she was afraid it meant she had breast cancer.
"Instead of telling someone about it when she could potentially be cured, she waited until she had no chance of being cured," he says.
Haddad shakes his head in agreement.
"Some patients are in denial," he says.
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Information from: The Herald Times, http://www.heraldtimesonline.com
