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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