Download Strategic Plan 2011 Community Executive Meeting

Why do you see the Oncologist or Hematologist?
Dr Kevin Imrie, Hematologist, Odette Cancer Center
Cutaneous Lymphoma Educational Forum
April 14, 2012
Objectives
1. To provide you a Hematologist/Oncologist’s
perspective on skin lymphomas
2. To understand drug treatment options for
skin lymphomas
3. To understand what comprehensive cancer
centers have to offer you
Lymphoma
• Name given to Cancers of the Immune system
• Relatively common, fifth most common cancer
• Most commonly presents in the lymph nodes
• Skin the third most common area affected
• Lymphomas of the skin behave differently
What is cancer?
• Cancer is a term used for diseases in which
abnormal cells divide without control and are
able to invade other tissues
• Cancer cells can spread to other parts of the body
through the blood and lymph systems.
• Cancer is not just one disease but many diseases.
There are more than 100 different types. Most
are named for the organ they start in
• Not all behave the same
www.cancer.gov
Loss of normal growth control
Lymph Nodes
Treatment of lymphomas
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Lymphomas can be aggressive or slow growing
Not all require treatment
Many, but not all, can be cured
Surgery not an effective treatment
Most common treatments:
– Chemotherapy
– Radiation
Skin lymphomas
Skin Lymphomas
• Lymphomas of the skin are different from
other lymphomas
– Often better-behaved
– Treated differently-ie chemotherapy not
commonly used
• A number of different types
– Aggressive or slow growing (indolent)
– Primary or secondary
– B or T cell
Types of skin lymphoma
Treatments for skin lymphomas
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Observation
Creams (Steroids, others)
Retinoid pills (Accutane, Targretin)
Ultraviolet treatment-Phototherapy
Interferon
Radiation
Chemotherapy
Antibody treatment
Extracorporeal photopheresis
Experimental treatments
Retinoids
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Drugs related to Vitamin A
Used in a number of skin conditions
Active in skin lymphomas
Isotretinoin (Accutane) and Bexarotene
(Targertin) the most commonly used
• Often used in combination with other treatments
• Side effects include skin dryness, high cholesterol
and underactive thyroid
• Can cause serious birth defects and precautions
must be taken to prevent pregnancy
Interferon
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Naturally produced substances
Involved in communication in immune system
Active in more advanced skin lymphomas
Given by injection under the skin
Often given with other treatments
Can have side-effects such as fatigue headache,
muscle pain
• Requires monitoring
• Expensive and funding can be difficult
Chemotherapy
• Chemotherapy is the name given to drugs that kill
cancer cells
• Most work by damaging dividing cells
• Many of the stronger drugs and combinations
used in other lymphomas not as useful in skin
lymphomas
• Gentler oral medications more effective
• Chemotherapy drugs used:
– Methotrexate, Chlorambucil, Fludarabine, vorinostat
Extracorporeal photopheresis (ECP)
• Specialized technique used only in advanced
skin lymphomas such as Sezary syndrome
• Involves removing blood, running it through a
machine and exposing it to ultraviolet light
• Used very selectively
• Offered at Princess Margaret Hospital through
Dr David Barth
Why you see an Oncologist?
Cancer Centers
Comprehensive Cancer Centers
• Bring services patients with cancer need
under one roof
– Diagnostic testing
– Staging
– Surgical, drug and radiation treatment
– Supportive services
• Nutrition, social work, help with drug funding, etc
• Practice in an inter-disciplinary model of care
– Teamwork between all health professionals
Cancer specialists
• Hematologists:
– Specialists in diseases of blood and lymphatic
system
• Medical Oncologists
– Specialists in drug treatment of Cancer
• Radiation Oncologists
– Specialists in treatment of cancers with radiation
• Surgical Oncologists
– Specialists in surgical treatment of cancer
Our team
Skin Lymphoma clinic
What we can do for you
• Confirm the diagnosis
• Predict the cancer’s behavior (staging)
• Offer a range of treatment options
– Multidisciplinary team approach
• Get opinions from a panel of experts
• Offer supportive care options
– Nutrition, psychosocial care, reimbursement
experts, wound care, others
Patients treated and followed at the
cancer center
• Those needing chemotherapy, interferon or
Extracorporeal photopheresis
• Patients with tumor stage disease or lymph nodes
or blood affected
• Those requiring radiation
• Those with rare lymphoma types
• Those with higher risk disease
• Most others are followed by their dermatologists
Conclusions
• Skin lymphomas are uncommon
• Most can be effectively treated
• A variety of treatment approaches is available
• A team-based approach with dermatologists and
oncologists offers a greatest variety of options
Questions
We are interested in your feedback