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Memorial Cancer Institute Regional Centers of Excellence inspired medicine inspired medicine 2008 Annual Report With Statistical Data for 2007 inspired medicine Table of Contents Chairman’s Letter—Dr. Sanford Sharp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Cancer Committee Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Cancer Registry Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Tumor Registry Statistics: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Distribution by Site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Top Five Cancer Sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Geographic Distribution by County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Five-year Graph of Patient Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2007 Cases by Age at Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2007 Cases by Stage at Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2007 Cases by Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2007 Cases by Race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Head & Neck Cancers—Dr. Peter Hunt What is Head & Neck Cancer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Thyroid Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Thyroid Histology-2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Thyroid Histology-2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Thyroid Treatments-2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Thyroid Treatments-2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Thyroid Cancer Survival Rates MHCS versus NCDB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2 Memorial Health Care System 2008 Cancer Annual Report inspired medicine The 2008 Annual Report of the cancer activities of the Memorial Health Care System The Memorial Health Care System Cancer Institute is accredited by the American College of Surgeons’ Commission on Cancer accreditation program as a Community Hospital Comprehensive Cancer Program. We provide patients, their families, and physicians in our community with a fully integrated, state-of-the-science, multidisciplinary approach to the prevention, early intervention, diagnosis, and treatment of cancer. During 2007, the Cancer Committee provided professional guidance in a number of cancer related activities, including: ● ● ● ● An option to enroll in three Memorial clinical trials for promising prevention and treatment research. Dr. Sanford Sharp, Serving our cancer patient population, their families, and the community: Pathologist Cancer Committee Sponsoring the Komen Chattanooga Race for the Cure Chairman ● Participating in the annual American Cancer Society 24-hour Relay for Life ● Sponsorship of the annual Memorial “We Care Weekend,” a retreat for cancer survivors ● Sponsorship of the American Cancer Society’s annual Cancer Survivors’ Day in June ● Continuing the many Health Fairs and “Hats Off for Health” Breast Health Programs held throughout the community, North Georgia, and Northeast Alabama. Tumor Conferences have been expanded and improved to allow for each session to be more sitespecific. ● A Breast Tumor Conference is held every week on Thursday morning ● A Chest Conference and a Head & Neck Conference is held on the 1st and 3rd Fridays of each month ● A Colorectal Conference and a Genitourinary Conference is held on the 2nd and 4th Fridays of each month ● A Gynecologic Tumor Conference is held on the second Monday of each month ● A general Tumor Conference time is available each Friday as needed to discuss any cases not presented at the site-specific conferences Frequency, case presentation, and attendance are monitored weekly for all tumor conferences and required physician disciplines are present to contribute virtually 100% of the time. ● The Breast Cancer Risk Evaluation Program provided support and counseling to individuals concerned about their risk of developing breast cancer due to an inherited gene mutation. The program facilitated genetic testing and disclosure as appropriate. ● Memorial Health Care System committed to a healthier community by becoming a smoke-free campus at both facilities—Memorial Glenwood campus and Memorial North Park campus in Hixson. The Cancer Committee continues to oversee the overall cancer program in the Memorial Health Care System through coordination and facilitation of all programs and services. The Committee sets annual goals, reviews, and revises them, as needed, to improve the care of all our patients. It focuses on identifying patient needs and developing strategies to meet those needs. Patients have the assurance of access to hospital-associated resources, as well as community resources for treatment, rehabilitation, support, and education about their specific disease. We continue to provide comprehensive care with state-of-the-science technology. We also recognize the importance of caring for the whole person through the efforts of dedicated staff and physicians. ● Memorial Health Care System 2008 Cancer Annual Report 3 inspired medicine 2008 Cancer Committee Members Physician Members Dr. Sanford Sharp, Cancer Committee Chairman, Pathology Dr. Edward R. Arrowsmith, Cancer Committee Co-Chairman, Medical Oncology Dr. Mark Brzezienski, Plastic Surgery Dr. Gale Fellows , VP, Medical Affairs & Chief Medical Officer Dr. James R. Headrick, Thoracic Surgery Dr. Peter Hunt, Performance Improvement Chairman, Otolaryngology Dr. Terry Melvin, Family Practice/Hospice Dr. Don Mills, Diagnostic Radiologist Dr. Charles A. Portera, Jr., Surgical Oncology Dr. Maurice Rawlings, Jr., Surgical Oncology Dr. David W. Rice, Radiation Oncology Dr. Eric Schubert, CME Committee Chairman, Pathology Dr. William Young, Cancer Liaison Physician, Urology Non-Physician Members Penny Andrews, RN, Oncology Quality Coordinator Bud Baker, Oncology Business Director Bill Bunnell, Executive Director, Imaging Services Lisa Casey, RN, BS, MSN, Nursing Coordinator/Educator, Breast Services Angie Colbert, Community Outreach Coordinator Crysty Cornett, CTR, Coordinator, Oncology Data Management Kathy Dittmar, RT (R) (M), Director, Breast Services Mary Dupree, RN, Public Member of Community Served Debbie Dyer, RN, Coordinator, Clinical Trials Rhonda Edwards, MSW, LCSW, Social Worker/Case Manager Renee Epps, RT (T) ROCC, Radiation Oncology Coordinator Cathy Fiacco, RN, MS, Colorectal Program Coordinator Sharon Hopper, RD, Clinical Oncology Dietician Kathy Igou, RN, OCN, Cancer Risk Counseling Jackie Jackson, RN, BSN, MSN, V.P. of Service Line Administration Betsy Kammerdiener, M. Div., BCC, Pastoral Care A. Nasser Khalifeh, Ph. D., Director, Medical Physics Marty Laird, D.Ph., Pharmacy Mary McArthur, RN, Performance Improvement Tanya Parker, RN, Coordinator, Oncology Nursing Laurel Rhyne, MSN, Med, APRN-BC, Nurse Practitioner, Thoracic Program Melissa Roden, RN, Executive Director, Quality & Utilization Kim Shank, RN, OCN, Oncology Educator/Cancer Risk Counseling Carla Sanderlin, BA, Marketing Communications Representative Ashley Tanis, American Cancer Society Lorraine Tilstra, RN, Director, Oncology Support Services 4 Memorial Health Care System 2008 Cancer Annual Report inspired medicine The Cancer Registry Report The Cancer Registry utilizes a data system designed for the collection, management, analysis, and reporting of information on persons with cancer who have been diagnosed and/or treated in the Memorial Health Care System (MHCS). The registry reports to the State of Tennessee Central Registry, the National Cancer Database, and the IMPAC/Medical Registry Service National Data Set. The Cancer Registry at Memorial has been in existence since January 1990 and has almost 28,000 cases entered into the database. The data maintained in the Registry is available for use by the medical staff and other healthcare professionals for special studies, reports, and research. The data is used for treatment planning and evaluation, outcome measurement, clinical research, and cancer program strategic planning. The American Joint Commission on Cancer TNM staging system is used for all applicable cancer sites. A TNM staging form is used in the medical record to ensure compliance and accuracy of staging. The Registry serves as staff support to the Cancer Committee and Oncology Conferences and coordinates the implementation of the ACoS (American College of Surgeons) guidelines. Each patient is provided with an annual lifetime follow-up that serves to continuously monitor for diagnostic and treatment results. Follow-up procedures serve as automatic reminders to both physicians and patients to schedule regular physical exams. The Cancer Registry follows over 13,000 patients annually throughout the United States and has a successful follow-up rate of over 90% of these cases. The staff includes a Certified Tumor Registrar (CTR), two registrars in training, a data assistant, and four other CTRs that assist on an ‘as needed’ basis. Staff members are active in the National Cancer Registrar’s Association and the Tennessee Tumor Registrars Association. They attend national, state and regional meetings to stay abreast of the latest changes in the cancer registry field. As our physician staff, site specific cancer programs, and the team of health care professionals have grown, so has the caseload reviewed and abstracted in the Registry. Follow-up letters returned to the Registry from patients are highly complimentary of the quality of care they received and of the caring and compassionate manner in which their health care was delivered at Memorial. A Ministry of Healing At Memorial, we understand that cancer affects not just the body, but also the mind and spirit. We care for the complete person and their family throughout their cancer journey by combining state-of-the-science medicine with emotional and spiritual support. This comprehensive approach provides patients with extensive resources to fight their disease and enjoy the blessings of life. Caring for the body, mind and spirit Memorial Health Care System 2008 Cancer Annual Report 5 inspired medicine Distribution of Cancer by Site - 2007 Cases All Sites Breast Respiratory System Bronchus/Lungs Larynx Nose/Nasal Cavity Male Genital System Prostate Testis/Penis/Other Male Genital Digestive System Colon Rectosigmoid/Rectum Anus/Anal Canal Pancreas Stomach Liver Small Intestine Esophagus Gallbladder/ Other Digestive Skin Melanoma Other Skin (Excludes Basal & Squamous Cell) Urinary System Bladder Kidney/Renal Pelvis Ureter Other Urinary Lymph Nodes (Lymphoma) Female Genital System Cervix Uteri Corpus Uteri/ Uterus Ovary Vulva/Vagina/ Other Female Endocrine System Thyroid Other Endocrine Hematopoietic/ Reticuloendothelial Bones/ Soft Tissue Head and Neck Lip/Gum/ Floor of Mouth Tongue Nasopharynx Pyriform Sinus/ Hypopharynx Tonsil Salivary Glands Eye/ Adnexa Brain/Central Nervous System Other/Unknown Primary 6 Total Cases 2122 338 305 278 24 3 338 331 7 334 145 56 10 38 29 5 11 25 15 227 220 7 149 90 55 2 2 88 74 10 34 21 9 61 47 14 48 19 45 14 10 3 1 12 5 0 39 57 Memorial Health Care System 2008 Cancer Annual Report Analytic 2091 336 300 273 24 3 329 322 7 332 144 56 10 37 29 5 11 25 15 225 218 7 148 90 54 2 2 86 69 8 32 20 9 61 47 14 47 19 45 14 10 3 1 12 5 0 39 55 Non-analytic 31 2 5 5 0 0 9 9 0 2 1 0 0 1 0 0 0 0 0 2 2 0 1 0 1 0 0 2 5 2 2 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 2 Male 1080 2 179 155 22 2 338 331 7 171 63 30 3 17 17 4 8 21 8 110 109 1 112 74 35 2 1 45 0 0 0 0 0 14 9 5 26 10 30 8 7 1 1 9 4 0 16 27 Female 1042 336 126 123 2 1 0 0 0 163 82 26 7 21 12 1 3 4 7 117 111 6 37 16 20 0 1 43 74 10 34 21 9 47 38 9 22 9 15 6 3 2 0 3 1 0 23 30 inspired medicine 2007 Top Five Cancer Sites The top five cancer sites in the Chattanooga service area have not changed significantly for the past ten years except for the increasing prevalence of skin cancer possibly due to more sun exposure and increased tanning bed use. Below is a chart showing the last ten years of major site groupings. Site Lung Breast Colorectal Prostate Skin Head & Neck Lymphoma/Leukemia Corpus Uteri Bladder Cervix Uteri Other Total 1998 194 280 147 209 70 46 74 24 48 15 287 1394 All Others (735) 35.2% 1999 255 350 176 246 48 35 82 41 65 24 300 1622 2000 258 342 166 245 72 33 78 29 64 10 257 1554 2001 278 369 137 232 77 31 61 37 69 11 254 1556 2002 271 316 177 269 110 32 85 30 57 13 283 1643 2003 290 299 169 289 133 35 73 49 66 14 306 1723 2004 311 319 156 240 148 31 82 32 73 5 294 1691 2005 245 328 172 219 194 40 62 32 78 10 299 1679 2006 293 315 170 253 247 52 80 42 87 13 323 1875 2007 273 336 200 322 225 45 86 32 90 8 474 2091 Breast (336) 16.1% Lung (273) 13.1% Prostate (322) 15.4% Skin (Melanoma) (225) 10.8% Colorectal (200) 9.6% Memorial Health Care System 2008 Cancer Annual Report 7 inspired medicine 2007 Geographic Distribution Residence by County at Time of Diagnosis County/State Hamilton Walker, GA Catoosa, GA Bradley Whitfield, GA Rhea Marion Dade, GA Jackson, AL Sequatchie Meigs Murray, GA Polk 8 Cases 1262 192 117 117 77 76 58 56 29 29 26 22 17 County/State Bledsoe McMinn Chattooga, GA Grundy Fannin, GA Franklin DeKalb, AL Union, GA Gordon, GA Cherokee, NC Monroe Putnam Van Buren Memorial Health Care System 2008 Cancer Annual Report Cases 11 10 7 7 6 6 5 5 4 3 3 2 2 County/State Cherokee, AL Morgan, AL Duval, FL Hillsborough, FL Manatee, FL Cherokee, GA Clinch, GA Emanuel, GA Gilmer, GA Du Page, IL Macomb, MI Clay, NC Cumberland Cases 1 1 1 1 1 1 1 1 1 1 1 1 1 County/State Davidson Hawkins Knox Macon Roane Weakley Bexar Washington, VA Cases 1 1 1 1 1 1 1 1 inspired medicine 2007 Cancer Incidence As the rate of cancer grows within the overall population, so does the growth of patients being treated at Memorial. That growth has exceeded 26% since 2003. Most of those patients (60.2%) are from Hamilton County in Tennessee with Walker, Catoosa, Whitfield, and Dade counties in Georgia adding another 21% from that state. Overall, 75% of the patients came from Tennessee, 23% from Georgia, and 2% from Alabama and other states. Five-Year Patient Growth 2400 2200 2000 Patients 1800 2092 1935 1671 1652 1753 1600 1400 1200 1000 Analytic Patients Non-Analytic Patients 800 600 400 200 0 2003 2004 Year 2005 2006 2007 The graph below reflects the age of the cancer patients at the time they were diagnosed. This is a typical distribution that shows almost 29% of the patients diagnosed between the ages of 60 and 69. Another 40% of patients are diagnosed after the age of 70, further verifying the fact that one of the biggest risk factors for cancer is age. Total 2007 Analytic Cases By Age at Diagnosis Number of Analytic Cases 700 601 600 541 500 398 400 300 264 162 200 100 27 69 30 0 0-29 30-39 40-49 50-59 60-69 70-79 80-89 90 + Age at Diagnosis Memorial Health Care System 2008 Cancer Annual Report 9 inspired medicine 2007 Cancer Incidence The earlier that a cancer can be detected, the better the probability of curing that disease. In the graph below it shows that over 37% of the cancer cases at Memorial are diagnosed in the early stages of '0' and '1'. Categories of 99 and 88 indicate that the stage is unknown or the cancer is not one that is staged (such as brain). Number of Analytic Cases 2007 Analytic Cases by Stage at Diagnosis 35.0% 27.5% 30.0% 25.2% 25.0% 20.0% 15.0% 10.0% 13.4% 12.4% 9.6% 8.5% 3.4% 5.0% 0.0% 0 1 2 3 Stage at Diagnosis 4 % of 2007 Analytic Cases by Gender Male 51% Female 49% % of 2007 Analytic Cases by Race White 92% Other 1% 10 Memorial Health Care System 2008 Cancer Annual Report African American 7% 99 88 inspired medicine What is head and neck cancer? Head & Neck Cancer refers to several types of cancers including, but not limited to, cancer of the tongue, gums, oral cavity, nasal cavity, voice box, and back of the throat. Men have a higher incidence of head and neck cancer than women, although incidence in women has been increasing significantly throughout the world. What Kinds of Cancers are Considered Cancers of the Head & Neck? Most head and neck cancers begin in the squamous cells that line the structures found in the head and neck. Because of this, head and neck cancers are often referred to as squamous cell carcinomas. They are further defined by the area in which they begin: Dr. Peter Hunt, Otolaryngologist Oral Cavity—lip, front 2/3 of the tongue, gums, lining inside the cheeks and lips, floor of the mouth, bony top of mouth, area behind wisdom teeth Salivary Glands—located several places in head & neck region Paranasal sinuses and nasal cavity—hollow spaces in the bones surrounding the nose and hollow space inside the nose Pharynx—the hollow tube that starts behind the nose and goes to the esophagus and trachea Larynx—the voice box Lymph nodes—in the upper part of the neck Cancers of the brain, eye, thyroid, scalp, skin, muscles, and bones are not usually included in the head and neck category of cancers. Epidemiology Head and neck carcinoma accounts for approximately 5%-6% of all new cancers. There will be approximately 40,000 Americans diagnosed this year with cancer of the head and neck. Nearly 13,000 Americans will die this year from this disease. Gender—Head and neck cancer is more common in men; 66%–95% of cases occur in men. The incidence by gender varies with anatomic location and has been changing as the number of female smokers has increased. The gender ratio is 5:1 male to female Age—The incidence of head and neck cancer increases with age, especially after 50 years of age. Although most patients are between 50 and 70 years old, head and neck cancer does occur in younger patients. Race—The incidence of laryngeal cancer is higher in African Americans relative to the white, Asian, and Hispanic populations. Additionally, in African Americans, head and neck cancer is associated with lower survival for similar tumor stages. The overall 5-year survival rate is 56% in whites and 34% in African Americans. Geography—In the United States, the high incidence among urban males is thought to reflect exposure to tobacco and alcohol. Among rural women, there is an increased risk of oral cancer related to the use of smokeless tobacco (snuff). Memorial Health Care System 2008 Cancer Annual Report 11 inspired medicine Causes/ High Risk Factors As many as 90% of the head & neck cancers occur after prolonged exposure to tobacco use (cigarettes, cigars, chewing tobacco, or snuff) or excessive consumption of alcohol. Use of both of these products can increase the overall cancer risk factor by more than 30 times. In adults who neither use tobacco products nor drink alcohol, cancer of the mouth and throat are nearly nonexistent. Symptoms Fortunately, most head and neck cancers produce early symptoms. Knowing and recognizing these symptoms can save lives. Symptoms include, but are not limited to: ● A lump or thickening anywhere in the mouth or neck ● A sore throat that does not go away ● Difficulty swallowing or chewing ● A change or hoarseness in the voice ● A red or white patch in the mouth that does not go away ● Unusual bleeding or pain in the mouth that does not go away ● Pain that does not go away in the face, chin, jaw, or neck With head and neck cancers (as with all cancers), be aware of your own body and if there are changes that persist, see your physician. His/her physical examination is the best means for detecting lesions of the “upper aerodigestive tract” and for indicating the severity and chronicity of the disease. Staging Tumor stage is of primary importance in determining treatment options and the prognosis of head and neck carcinoma. It is important to note that once regional lymph node involvement occurs, the survival rate drops by 50 percent. The TNM system is used. T = tumor size N = status of the neck lymph nodes M = presence or absence of distant metastatic disease Perineural invasion at the tumor site has been associated with more extensive local and regional disease and, therefore, a worse prognosis. Vascular invasion is an important step in the development of metastasis. Although most circulating tumor cells do not develop into metastasis, the greater the number released into the vascular system, the higher the likelihood. 12 Memorial Health Care System 2008 Cancer Annual Report inspired medicine Treatment and survival ● Surgery ● Radiotherapy ● Chemotherapy Combined therapy Two major methods are currently employed in the treatment of squamous cell carcinoma of the head and neck—surgery and radiation therapy. Chemotherapy has been utilized as induction therapy or combined with mixed results. More promising results are being obtained with combined chemotherapy and radiation therapy. ● Surgery Surgery alone is generally reserved for early tumors in regions where significant functional and cosmetic deficits will not result from this treatment. Radiotherapy Radiation therapy may be used alone in early tumors, most notable in early laryngeal cancer in order to preserve laryngeal function. It also may be used alone for unresectable tumors. In this instance, it may be considered a palliative treatment and not intended as a cure. Chemotherapy Although good initial responses have been obtained with induction chemotherapy, the long-term outcomes are unclear. In general, it is not recommended to use chemotherapy as a sole treatment with curative intent for head and neck squamous cell carcinoma. Combined therapy Surgery and radiation are often used together in more advanced lesions. As combined treatment has evolved, surgery with postoperative radiation therapy is most often employed. Recent advances in reconstructive surgery have further improved functional and cosmetic outcomes. In select instances, promising results are being obtained with combined chemotherapy and radiation therapy in an effort to avoid surgical resection. The Future of Head and Neck Cancers The decrease in the incidence of head and neck cancers over the past 20 years is largely due to a decrease in smoking. Although approximately 90% of head and neck cancers are the result of tobacco use and excessive consumption of alcohol, an increasing number of Head & Neck cancers are the result of Thyroid cancers or Melanoma. Memorial Health Care System 2008 Cancer Annual Report 13 inspired medicine Thyroid Cancer Thyroid cancer is one of the more prevalent ‘head and neck cancers’. It is estimated that 37,340 men and women (8,930 men and 28,410 women) will be diagnosed with thyroid cancer in 2008. Approximately 1,600 men and women will succumb to this disease in 2008. Thyroid cancer is a cancer that starts in the thyroid gland which is a butterfly-shaped gland in your neck, just above your collarbone. In order to understand thyroid cancer, it helps to know about the normal structure and function of that gland. The thyroid gland makes hormones that help control heart rate, blood pressure, body temperature, weight, and the amount of calcium in the blood. The picture to the right shows the thyroid gland’s placement in the neck: What Causes Thyroid Cancer? No one knows the exact cause of thyroid cancer. Doctors can seldom explain why one person will get thyroid cancer and another person will not. Thyroid cancer research has shown that people with certain risk factors are more likely than others to develop thyroid cancer, but it is important to note that risk factors do not cause thyroid cancer. However, several thyroid cancer risk factors may act together to increase a person’s probability of having thyroid cancer. Risk Factors ● ● Being exposed to high levels of radiation Having a family history of medullary thyroid cancer or certain other medical conditions (such as goiters) ● Being female ● Being over 40 years of age ● Being caucasian ● Not getting enough iodine in one’s diet Symptoms Early thyroid cancer often does not have symptoms; but as the cancer grows, symptoms may include: 14 ● A lump in the front of the neck ● Hoarseness or voice changes Memorial Health Care System 2008 Cancer Annual Report inspired medicine ● Swollen lymph nodes in the neck ● Trouble swallowing or breathing Pain in the throat or neck that does not go away Most often, these symptoms are not due to cancer. An infection, a benign goiter, or another health problem is usually the cause of these symptoms. Anyone with symptoms that do not go away in a couple of weeks should see a doctor to be diagnosed and treated as early as possible. ● You should see a doctor if you have a lump or swelling in your neck. Your doctor can order tests to see if you have cancer and, if so, which type. Treatment depends on the type and how far the cancer has spread. They include surgery, radioactive iodine, hormone treatment, radiation therapy or chemotherapy. Some patients receive a combination of treatments. Types of Thyroid Cancer There are four main types of thyroid cancer: ● Papillary ● Follicular ● Medullary, and ● Anaplastic Treatments Surgery is the most common form of treatment for thyroid cancer that has not spread to distant parts of the body. The surgeon usually removes part, or all, of the thyroid and any other affected tissue, such as lymph nodes. (If the patient has a surgical biopsy, the biopsy and the removal of the thyroid may be done in the same operation). Patients with localized papillary or follicular thyroid cancer also may receive treatment with I-131 (a radioactive iodine isotope). The patient swallows the iodine, which collects in any thyroid cancer cells that remain in the body after surgery. By damaging such cancer cells, the radioactive iodine helps prevent the disease from recurring. The patient must remain in the hospital for a few days while the radiation is most active. The treatment may be repeated, if necessary, at a later time. Hormones usually are given to patients who have had surgery to remove the thyroid and/or treatment with radioactive iodine. The hormones replace those that are normally produced by the thyroid. This treatment also slows down the growth of any remaining thyroid cancer cells. The doctor may need to do follow-up tests to determine whether the patient is receiving the proper amount of the necessary hormones. Surgery may not be recommended when a patient is found to have thyroid cancer that has spread. Treatment usually includes some form of systemic therapy (treatment that can kill or slow the growth of thyroid cancer cells throughout the body), such as chemotherapy, radioactive iodine therapy, and/or hormone therapy. Regular follow-up is very important after treatment for thyroid cancer. Follow-up care may include periodic complete physician exams, x-rays, scans, and blood tests. Patients should work with their doctor to develop a treatment plan that meets their medical needs and personal values. Choosing the most appropriate thyroid cancer treatment is a decision that ideally involves the patient, the family, and the healthcare team. Memorial Health Care System 2008 Cancer Annual Report 15 inspired medicine 2002 vs. 2007 Thyroid Histology Thyroid Histology 2002 (Number and % of total) Other (2) 11% Carcinoma (1) 5% Adenocarcinoma (1) 5% Follicular Variant of Papillary Carcinoma (10) 53% Follicular Adenocarcinoma (3) 16% Medullary Carcinoma (2) 10% MHCS thyroid histology in both 2002 and 2007 reflects percentages reported throughout the thyroid cancer literature. The most common thyroid malignancy is Papillary (65-85%), followed by Follicular (1022%), and Medullary (6-12%). Thyroid Histology 2007 (Number and % of total) Other (1) 2% Follicular Variant of Papillary Carcinoma (35) 75% Squamous (1) 2% Follicular Adenocarcinoma (7) 15% Medullary Carcinoma (3) 6% 16 Memorial Health Care System 2008 Cancer Annual Report inspired medicine 2002 vs. 2007 Thyroid Treatments Thyroid Treatments 2002 (Number and % of total) Thyroidectomy NOS (1) - 5% No Surgery (1) 5% Lobectomy (6) 32% Total Thyroidectomy (7) - 37% Lobectomy w/isthmus (1) - 5% Subtotal Thyroidectomy (2) 11%) Partial Lobectomy (1) 5% The thyroid cancer treatment graphs show an increase in total thyroidectomy procedures from 2002 to 2007, reflecting an increase from 37% to 66% during this five-year time period. This is a favorable trend as total thyroidectomy procedures are now recognized as the standard of care for the majority of thyroid malignancies. Thyroid Treatments 2007 (Number and % of total) No Surgery (1) - 2% Total Thyroidectomy (31) 66% Lobectomy (8) - 17% Lobectomy w/isthmus (2) - 5% Partial Lobectomy (1) - 2% Removal Part of Lobe and part of contralateral lobe (2) - 4% Subtotal Thyroidectomy (2) -4%) Memorial Health Care System 2008 Cancer Annual Report 17 inspired medicine Thyroid Comparison Graphs Thyroid Cancer NCDB 1998-2001 Survival Rates by Stage 100.0% Percent Survival 90.0% 80.0% Stage 1 70.0% Stage 2 Stage 3 60.0% Stage 4 50.0% 40.0% 30.0% 20.0% Diagnosis 12 Months 24 Months 36 Months 48 Months 60 Months Years MHCS performed very favorably when compared to the National Cancer Data Base (shown above) for stages 1, 2, and 3. Stages 1 and 2 performed better than the national averages, while stage 3 performed on par with the NCDB. For stage 4 diagnoses though, there was only one patient in the MHCS data base for this time period, not giving us a good statistical analysis, and that individual did not survive for 24 months. Thyroid Cancer MHCS 1998-2001 Survival Rates by Stage 100.0% Percent Survival 90.0% 80.0% 70.0% Stage 1 60.0% Stage 2 Stage 3 50.0% Stage 4 40.0% 30.0% 20.0% 10.0% 0.0% Diagnosis 18 12 Months 24 Months Memorial Health Care System 2008 Cancer Annual Report Years 36 Months 48 Months 60 Months inspired medicine Glossary Accession Cases that are entered into the Memorial Tumor Registry database ACoS American College of Surgeons ACS American Cancer Society AJCC American Joint Committee on Cancer Analytic Cases that were diagnosed and/or received their first course of treatment at Memorial Health Care System Basal Cells Round cells under the squamous cells of the skin CTR Certified Tumor Registrar Histology Study of the microscopic anatomy of cells and tissues H&N Head and Neck Lobectomy A surgical excision of a lobe. This may refer to a lobe of the lung, a lobe of the thyroid or a lobe of the brain Lymph Nodes Tiny, bean-shaped glands, located in many different areas of the body. The main locations are the neck, under the arms, and in the groin MHCS Memorial Health Care System NCDB National Cancer Data Base Reference Date Starting date after which all eligible cases must be included in the Tumor Registry, established January 1, 1990 Squamous Cells Thin, flat cells that form the top layer of the epidermis TNM (T) tumor size (N) nodal involvement (M) metastatic status Memorial Health Care System 2008 Cancer Annual Report 19 inspired medicine Memorial Health Care System has proudly served the Chattanooga community since 1952. It's Cancer Program has consistently received three-year approvals with commendation in the CoC category of “Comprehensive Community Cancer Program”. Memorial’s Comprehensive Cancer Program Includes: ● The Area’s only Mobile Mammography Coach ● Breast Center of Excellence ● Colorectal Center of Excellence ● Thoracic Center of Excellence ● Comprehensive Radiation Oncology Center ● Clinical Trials and Research ● Genetic Testing and Counseling ● Dedicated 20-Bed Inpatient Oncology Unit ● Weekly Breast and General Cancer Conferences ● Bi-monthly Lung, Head &Neck, Genitourinary and Colorectal Conferences ● Monthly Gynecologic Conference ● Cancer Tumor Registry ● Comprehensive Community Outreach Programs For more information contact: Memorial Hospital 2525 de Sales Avenue Chattanooga, TN 37404-3322 Tel: 423.495.7778 ● Fax: 423.495.6192 www.memorial .org Memorial North Park Hospital 2051 Hamill Road Hixson, TN 37343-4026 Tel: 423.495.7100 ● Fax 423.495.7388 Memorial Cancer Institute Regional Centers of Excellence inspired medicine Memorial Hospital 2525 de Sales Ave. Chattanooga, TN 37404 www.memorial.org Memorial North Park Hospital 2051 Hamill Road Hixson, TN 37343 20 Memorial Health Care System 2008 Cancer Annual Report