Expertise & Accreditations
Both of our surgeons participate in nationally accredited cancer programs on campus at Coliseum Cancer Centers. Dr. Martin is the chairman of the Cancer Program at Coliseum Medical Centers and he is also the medical director of the Breast Cancer Program. The Commission on Cancer (COC), which is part of the American College of Surgeons, is an organization recognized worldwide for its excellence in Cancer Care. We meet standards set by this organization for the treatment of cancer.
For breast cancer, we are accredited by the NAPBC, the National Accreditation Program for Breast Centers, which is also a part of the American College of Surgeons. A similar set of standards are set by this organization that must be met to participate. Guidelines set up by the NCCN, the National Comprehensive Cancer Network, are routinely followed by our doctors and others that participate in the treatment of cancer at our hospital. This ensures that our patients receive state-of-the-art care and only the best treatments available for their cancer.
What is Cancer?
Cancer may also be referred to as carcinoma, neoplasm, malignancy, tumor(s), growth(s) or mass(es). All cancers have the ability to spread to surrounding tissues or to other places in the body. Some neoplasms are benign (not cancerous). The same holds true for some tumors, growths or masses. Not all are malignant or have the ability to spread.
If a cancer spreads to other parts of the body or into adjacent organs or tissue it is metastatic. A metastasis is a tumor deposit that is present outside of the location of the primary source of the cancer. An example of a metastasis would be breast cancer that has spread to the lungs. It is cancer in the lung tissue but is not lung cancer because it originated in the breast. The term primary is often used to describe the original site, tissue or organ where the cancer started.
It is difficult to explain what cancer is but a simplistic approach is to understand that all cells in the body have a programmed life cycle. When cells become damaged or die, they are usually replaced by healthy cells. However, if a cell that reproduces has damaged DNA, it may produce cells that have lost their programmed time to die. This leads to an overproduction of cells that eventually will crowd out normal tissue or spread to other organs so they eventually crowd out the normal cells in that organ. This can lead to damage and eventually death. The actual process can vary widely according to the cancer. The rate of growth of a cancer is referred to as its grade. The grade usually ranges from 1-3, with grade 1 being slow growing and grade 3 being fast growing. The stage of cancer is different from grade. The best way to think about cancer stages is to look at how the cancer is contained. Stage 1 or 2 usually means the cancer is contained in the site where it originated or has spread to nearby lymph nodes. Stage 3 or 4 refers to more advanced cancer that has spread to other parts of the body. Stage 4 is the highest stage.
Causes, Risk Factors & Prevention
Cancer has many causes: genetic, environmental, dietary, hormonal and pharmacological (drug related). Some families may carry a gene that can increase the risk of developing a cancer. One well-known gene is the BRCA 1 and 2, which increase the risk for breast and ovarian cancers. We are able to test for many different genes that can cause cancer, and your physician can determine if you are a candidate for genetic testing.
Environmental risks include substances and elements in the environment that increase the risk of cancer when you are exposed to them. Some examples of this include radiation exposure from the sun that increases the risk of skin cancer or smoking and smokeless tobacco which increases the risk of mouth, lung and esophageal cancers.
Dietary risks include alcohol intake, ingestion of large quantities of smoked foods or overeating that leads to obesity. These risks can be direct or indirect. Alcohol can damage tissues on contact or can lead to diseases such as cirrhosis of the liver, which can increase the risk of liver cancer. Obesity can lead to an increased production of hormones by tissues that can increase the risk of breast, ovarian and endometrial cancers. Other hormonal risk factors include supplemental hormone replacement that in men can increase the risk of prostate cancer and, in women, breast, ovarian and endometrial cancers.
Pharmacological risk factors include any drug or chemical that could be ingested that could increase the risk of cancer. Such a substance or agent is called a carcinogen. Any drug that is known to increase the risk of cancer is usually labelled as a risk factor for cancer on the label. All patients should be well informed about the drugs they take on a daily basis so they are aware of these risks.
There are many ways to prevent cancer. Maintaining a healthy weight, exercising regularly, eating a healthy diet, limiting the amount of processed foods, limiting alcohol intake, avoiding too much sun exposure and being aware of your family history are some of the ways to prevent or reduce the risk of cancer. Chest X-rays, mammograms, screening colonoscopies and routine blood work are done routinely at annual visits or physicals as part of cancer detection. Your physician can help you with other risk-management strategies.
Detection, Testing & Imaging
Some cancers are detected by symptoms. Examples of this include a palpable mass or lump, blood in the stool, blood in sputum, localized pain and skin wounds that won’t heal. Some cancers can be detected during a physical exam. Masses in the breast, skin cancers and soft tissue cancers are some examples of cancers that can be detected during a physical exam by you or your physician.
Some cancers are detected by blood tests. An example would be the PSA test (prostate specific antigen) for prostate cancer and low red blood count that can indicate blood loss from a cancer in the intestinal tract, such as colon cancer. Some cancers have tumor markers associated with their presence that can assist physicians with making a diagnosis. An example of this is CA-125 (cancer antigen 125) test used to help diagnose ovarian cancer.
Some cancers are detected by more invasive types of examinations. Good examples of this are an endoscopy and a colonoscopy, where a flexible scope is used to inspect the lining of the intestinal tract. Bronchoscopy is a similar type of scope used to inspect the lining of the bronchial tubes and trachea. During a laparoscopy, a scope is inserted at the navel under general anesthesia to inspect the abdominal and pelvic tissues for abnormalities.
Effective radiologic techniques for detecting cancer include chest X-rays, CT or CAT scans, MRIs and nuclear imaging like a bone scan. PET scans are specialized scans used for detecting cancer that is usually combined with a CAT scan to help localize any metastases from a primary cancer. This test is not done as a screening tool. Chest X-rays and now CAT scans are used as screening tools for lung cancer, especially in patients that are high risk. Patients with a high risk for breast cancer often have an MRI of the breast in addition to 3D mammograms.
Some cancers are treated primarily by surgery and some primarily by medications. Most skin, soft tissue, breast, colon, lung, thyroid and solid organ cancers are treated by surgical removal. Sometimes a cancer is best treated by chemotherapy that can either be given by mouth or intravenously. Some cancers are treated with radiation, which can be delivered a number of different ways. Most cancers are treated with a combination of all three types of treatment.
A good way to frame cancer treatment is that surgery and radiation are needed to control or treat the cancer locally and chemotherapy is for the entire body when there is concern that a cancer has spread. Your physician will determine which type of treatment is best if you are diagnosed with cancer. Most cancers are treated by a multidisciplinary team that includes surgeons, medical oncologists and radiation therapists. Both of our surgeons participate routinely in cancer conferences where multidisciplinary teams discuss the care of patients proactively prior to treatment. This will often save time and money and give patients the additional opinions they may seek in determining the treatment for their cancer.