Cancer - Nip it in the Bud : THE ANSWERS Part 1

I am so thrilled at the response to this campaign to help raise awareness and promote early detection for cancer in women - there were more questions than the oncologists expected, so they have asked if we could divide them into two segments, the first of which you see today, covering skin cancer and some other types. The next set of questions will be posted next Friday 5/30, so if you don't see your question - bookmark this and come back next week!

I'd like to take just a moment and introduce you to one of the Doctors that will be answering questions so you know who you're dealing with and to thank her for her time. If you live in the Dallas area

Dr. Jessica Hals,D.O. - a medical oncologist with Texas Oncology, specializes in medical oncology with a special interest in colorectal cancers, lung cancers, and head and neck cancers, as well as palliative care and end of life care issues. Dr. Hals is board certified in medical oncology and internal medicine. She received her doctor of osteopathy from Lake Erie College of Osteopathic Medicine in 1999. Dr. Hals completed her internship and residency in internal medicine at Osteopathic Medical Center of Texas in 2002 and her fellowship in medical oncology at Scott & White Memorial Hospital in 2004. (For more information about cancer or to find a physician in your area, visit www.TexasOncology.com or call 1-888-864-I CAN (4226).)

Questions & Answers – Skin Cancer and Other

1. Could the docs identify the different types of screenings available and at what age women should get them?

At Every Age:
• Keep an eye on your skin and check for changes in moles, freckles, and other marks on your skin once a month.
  
• Conduct self breast exams monthly to every three or four months and report any changes to your physician.
  
  20s:
• Begin checking breasts for lumps every month and have a clinical breast exam by a physician every one to three years.
  
• Have a Pap smear to screen for cervical cancer at least once every year beginning at age 21 or approximately three years after first sexual intercourse, whichever comes first.
  
  30s:
  
• Continue having a clinical breast exam and Pap smear every one to three years. After three consecutive normal Pap smears, women may limit screenings to every two or three years.
  
• Discuss MRI screening with your physician if you have an unusually high lifetime risk for breast cancer. You may have a higher risk for breast cancer if you have a strong family history of breast or ovarian cancer, have any first degree male relatives with breast cancer, had a previous abnormal breast biopsy, or have breast cancer in a family member who is younger than age 50.
  
  40s:
  
• Begin having an annual mammogram while continuing your annual clinical breast exam, annual Pap smear, and if recommended by your doctor, a MRI screening.
  
• Begin colorectal cancer screenings if you have an increased risk for the disease.
  
  50s:
  
• Continue your annual clinical breast exam, mammogram, Pap smear and if recommended, MRI screening.
  
• Begin screening for colorectal cancer with one of the options below:
  o Annual fecal occult blood tests (FOBT) or fecal immunochemical tests (FIT),which can detect small amounts of blood in stool samples, along with aflexible sigmoidoscopy every five years.
  o Every five years, a flexible sigmoidoscopy, an internal examination of the rectum and lower colon for polyps.
  o Every five years, a double contrast barium enema; x-rays are then taken of the colon and rectum to detect polyps.
  o Every 10 years, a colonoscopy, the only test that directly examines the entire colon.

For more information from Texas Oncology about screenings, click here

2. Discuss alternative forms of tanning (tanning beds, spray/creme tanners).

I understand that many people like the way a tan looks on their skin. However, I would caution you that sunlamps and tanning beds DO emit UVA radiation which can cause skin damage and, according to the American Academy of Dermatology, has been linked to melanoma (skin cancer). Sprays and lotions are safer options that will give a tanned look to your skin. Any time you are exposed to the sun, you should always apply a sunscreen with a sun protection factor (SPF) of 30 or greater to protect your skin from prolonged exposure to the sun's rays.

3. Discuss cancer risk from USING high SPF sunscreens.

While it is always important to wear sunscreen, the false sense of security that high SPF sunscreen creates may lead to an increased risk of cancer as people may stay in the sun longer. In order to protect your skin from sun damage, you should always apply a sunscreen with a sun protection factor (SPF) of 30 or greater at least 30 minutes before sun exposure. The sunscreen should be reapplied every 1 ½ to 2 hours or when you sweat, are in the water, or towel dry.

4. How about a very specific break down of what we need to watch for on moles. I've gone in before for a mole I was certain was "bad" and been laughed out the door. How do we know?
The most common warning sign of skin cancer is a change in the surface of the skin. The ABCD rule can help guide you when checking your skin.

• A = Asymmetry: One side of the mole does not match the other in size, shape, color or thickness
  
• B = Border: The edge or border of the mole may be irregular
  
• C = Color: The color of the mole is not uniform, various shades of brown and black may be present.
  
• D = Diameter: Skin cancer melanomas are usually larger than 6 millimeters in diameter, but they can be smaller.

It is important to have any mole that has changed checked by a dermatologist.

5. I am fair skinned, blond, blue-eyed. I had several bad sunburns in childhood, teens. Since age 18 I have protected my skin vigilantly. I know I may be high risk for skin cancer. Should I schedule regular screenings of some kind with a dermatologist or just go in when a mole does not appear normal? If I were to have a regular visit, how often should I go and what do I say when I schedule the visit? Is this a normal screening that they do?

Keep an eye on your skin and check your body monthly for changes in moles, freckles, and other marks on your skin. Paying attention to your body for any skin changes is key to preventing skin cancer. I would recommend that high risk individuals, those with significant history of severe sunburns (two degree burns), fair skinned individuals, and those with family histories of melanoma (skin cancer) seek routine, annual skin cancer screenings with a dermatologist. When you call for your appointment, you can request a skin cancer screening. The dermatologist will perform a thorough examination and record information about your skin for review during future appointments.

6. What if a mole has smooth boundaries and overall is smaller than a pencil eraser, but part of it is raised like a skin tag?

Without seeing the mole, it is difficult to say if there is an issue or not. I suggest you see your primary care physician first to determine if you need to see a dermatologist.

7. And are regular skin tags ever problematic?

Skin tags are an outgrowth of normal skin that occur in about 25 percent of adults with the risk of occurrence increasing with age. There is a familial tendency for these to develop. Skin tags usually occur in sites of friction on the body, particularly the armpit, neck, underneath the breasts, and in the groin regions. They become symptomatic when caught on jewelry or rubbed by clothing. Sometimes the skin tag may become twisted on their blood supply and turn red or black. Skin tags can be treated if they are irritating or removed for cosmetic reasons.

8. I also had too many sunburns as a child... now when I get in the sun, even with sunscreen my chest often gets very tiny red dots that are itchy. it only comes with sun exposure. I would like to know if this is something to worry about. I would also like to know more about timelines for skin cancer, for instance if you have an odd mole or freckly how long does it take to be dangerous?

Severe itching or the appearance of a rash after sun exposure may be an allergic reaction. There is no set timeline for moles or freckles to become cancerous, so it is very important to monitor your skin and see a dermatologist if you see any changes.

9. I am very fair and have had more than my fair share of sunburns. Many ending up with water blisters (when I was growing up) I hear that many women don't get enough vitamin D, but I am nervous to be in the sun.

As a person with fair skin, you should be extremely cautious when exposed to the sun. For example, avoid the sun as much as possible between 10 a.m. and 4 p.m., always wear sunscreen above SPF 30, sunglasses that provide 100 percent UV ray protection, and clothing such as a broad-brimmed hat, long-sleeved shirt, and long pants. You can also get Vitamin D from sources other than the sun, for example, fish, milk, eggs with the yolk, and cod liver oil to name a few. Consider taking a Vitamin D supplement as well.

10. My primary care physician has told me that some of my moles look "pre-cancerous", she suggested that I get a second opinion from a dermatologist but said that I could get them looked at on my own time. I assumed this means that they are not dangerous right now and decided to wait to see a dermatologist when my schedule opens up in a few months. Am I being too careless or is it okay to wait?

I don’t think you are being careless, but remember that as a new patient, it can take some time to get an appointment with some dermatologists. For this reason, I recommend researching dermatologists in your area and making an appointment as soon as you can, as it could take a few weeks or even months to see someone.

11. Are you more at risk to get melanoma in a tanning bed rather than the sun?

According to the International Journal of Cancer, tanning beds significantly increase your risk of melanoma (skin cancer) because they emit UVA radiation, which can cause skin damage. If you must tan, consider lotions or spray tans.

12. Colon Cancer: I lost my mother, her brother, their father, and several paternal cousins/aunts etc. Also on my fathers side we've lost my grandmother to CC and have had 2 aunts with breast cancer. I am 38 and have had one colonoscopy. How often should I have them, what else should I do (other screening, blood work up, signs and symptoms) and when? I feel like my life will end with CC - it's my history and my future...is this a valid viewpoint?

Colon cancer generally begins as a polyp, which then progresses through specific changes to evolve into a cancer. These changes typically take several years to occur, but the earlier they are detected, the better chances for catching a polyp before it turns into a cancer. Routine screening with colonoscopy is the best method currently available for early detection. If you have a family history of colorectal cancer, you may be at risk of developing the disease. You should begin annual screenings with one of the options below at age 40, or 10 years before the youngest case in your immediate family, whichever is earlier. While it is a good sign that you had no polyps at age 38, with your family history, you could discuss genetic counseling and screening with your primary care physician. Screening recommendations include:

• Annual fecal occult blood tests (FOBT) or fecal immunochemical tests (FIT),
  which can detect small amounts of blood in stool samples, along with a
  flexible sigmoidoscopy every five years.
  
• Every five years, a flexible sigmoidoscopy, an internal examination of the
  rectum and lower colon for polyps.
  
• Every five years, a double contrast barium enema; x-rays are then taken of the
  colon and rectum to detect polyps.
  
• Every 10 years, a colonoscopy, the only test that directly examines the entire
  colon.

It is recommended to have a colonoscopy every five years after the initial test. When colorectal cancers are detected at an early, localized stage, the five-year survival is 90 percent.

13. My 83 year old, non-smoking grandmother was just diagnosed via a PET scan with lung cancer by her pulmonologist today. I know she has two 'spots' in her upper right lung. Her doctor said it looks like it could have entered into her lymph system. Does my grandmother need an oncologist to take over care or will her pulmonologist treat her? What will her options be? Her doctor told her she could not survive major surgery? I think my grandmother is very strong willed and she wants to do whatever will give her quality life left. What do PET scans show and why doesn't she know for sure what grade the cancer is and whether it has gone into her lymph system for sure?

A diagnosis of cancer can be truly frightening for any family. As with any diagnosis you have been given, you certainly have the right to ask for a second opinion. I would think that your grandmother probably will be referred to an oncologist if she hasn’t been referred to one already and will most likely be treated by a team of doctors who will work together to care for her.

Without being able to review the PET report or films, it is difficult to comment on the stage of your grandmother’s disease. In general, the earlier a lung cancer is caught, the better chances of cure, however, even when caught early, oftentimes it will recur and become fatal.

If a person is very healthy and the remainder of their lungs are healthy and can support normal respiratory function after removal of all or part of a lung, surgery may be an option for very early lung cancers. However, most of the time, the cancer has already spread to other parts of the lung or the lymph nodes, making surgery impossible. Most lung cancer is diagnosed in smokers who have heavily damaged lungs that won’t allow for surgery.

When surgery is not an option or the cancer has spread to the lymph nodes or other parts of the body, treatments options beside surgery are necessary. Sometimes radiation therapy, chemotherapy, or a combination of both is used. The treatment depends upon the overall stage of the disease and the overall health of the patient.

A PET scan, or positron emission tomography, is a medical imaging technique that provides physicians with better knowledge and data about the affected organs. The PET scan along with a computed tomography (CT) scan should provide enough information to determine if the cancer has spread into the lymph nodes. The PET scan looks at metabolic activity, but doesn’t give exact location, just a general location of the cancers – for example in the left lung, upper part – however, a CT scan can give an exact location of the cancers.

Your grandmother’s medical team should be able to provide her with the necessary information and treatment options to make good decisions about her care.


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