Ask The Oncologist

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By Andres Bhatia, MD

Dr. Bhatia went to Medical School at UCCEM in Puerto Rico and did his residency and fellowship at Cleveland Clinic. He has been in private practice in Gainesville since 1993, and he joined Florida Cancer Specialists in 2010.

Aside from genetics, what other cancer risk factors should I look out for? Should I think about undergoing genetic testing?

By far the most common risk factor for developing cancer is smoking. Smoking not only increases your risk of developing lung cancer, but it also can increase your risk of bladder, pancreatic, head and neck cancer. Other risk factors include obesity, high-fat diets and alcohol. More recently, Human papillomavirus (HPV) has proven to increase the risk of cervical cancer and oropharyngeal cancer. Other risk factors include exposure to Agent Orange as well as radiation exposure.

Genetic testing could be considered if you have a strong family history of cancer diagnosed at a young age. Ideally, the family member who has the cancer should be the person tested. If the results are positive for a genetic mutation, then other family members should consider testing.

What are the most common treatments for cancer? Do you ever recommend taking part in a clinical trial?

There are many different treatments for cancer depending on the type and staging of the cancer, as well as the performance status of the patient. Surgical intervention is the initial treatment for many cancers, and removal of the tumor is often the only treatment necessary. Surgery involves removing the tumor and surrounding lymphatics. This is important for staging, which often determines whether further treatment will be recommended. After surgery has been performed and the patient has recovered, the oncologist will review the pathology of the mass and lymphatics as well as any scans to determine if further treatment is required. Other modalities include chemotherapy, which is systemic treatment, and radiation therapy, which is localized treatment. There are also now many targeted therapies as well as vaccines as treatment options. Many practices offer clinical trials, which not only help the current patient, but also patients receiving treatment in the future.

What are the different stages of cancer and what does each stage mean?

Cancer staging is different for each tumor type. Basically, there are four stages of cancer for solid tumors, beginning with Early Stage Disease/Stage 1. This is when a cancer is small in size with no local spread of disease and no lymph node involvement. The stages increase from Stage 1 to Stage 2 and Stage 3 with increasing size of the tumor, lymph node involvement, and increasing aggressive pathologic features. Stage 4 generally means that the disease has spread to distant organs such as lung, liver, bone and/or brain.

Is there anything I can do to prevent myself from developing any form of cancer?

The best way for you to prevent yourself from developing cancer is to live a healthy lifestyle: no smoking, limiting alcohol consumption, avoiding fatty foods and avoiding obesity. Early detection is very important as you can diagnose cancer in its early stages when it is much easier to treat and there is a better chance for cure. Early detection studies include skin exams, a yearly mammogram beginning at 40, colonoscopy at 50, pap smear every one to three years for women, and Prostate-specific antigen (PSA) and rectal exams for men.

If I am diagnosed with cancer, will I end up losing my hair?

Many cancers do not require chemotherapy, and many chemotherapies do not cause hair loss. Therefore if you are diagnosed with cancer, you won’t necessarily lose your hair. Some patients receiving chemotherapy that may cause hair loss have benefitted from cooling caps/scalp hypothermia, which can prevent hair loss from occurring. However, this treatment can be expensive and not covered by insurance, and some patients do not tolerate the cooling cap.

Can you get lung cancer even if you do not smoke?

Unfortunately, being a nonsmoker does not protect you 100 percent from developing lung cancer. There are some types of lung cancers that occur in nonsmokers, however, this is an exception.