Improving cancer diagnosis and treatment

You probably know fearfully well these grim statistics: Cancer, the country’s leading cause of death, claims 56,000 lives every year. Globally, according to the World Health Organization (WHO), cancer was responsible for 8.8 million deaths in 2015 and this number could escalate to 17 million by 2030. But did you know that between 30 and 50 percent of cancers could be prevented by interventions, such as lifestyle changes and early screening?

Early screening, yes, once more with feeling! Now comes the GE Discovery PET/CT 710 which features high-definition image reconstruction that can actually help doctors recommend the best possible tailor-made regimen for patients while minimizing radiation. Yes, you read that right!

Sadly, cancer symptoms (loss of weight, fever, fatigue, skin changes) are often mistaken for common illnesses that by the time the tumor is diagnosed, it has already spread to other parts of the body.

According to GE Healthcare Philippines country manager Ivan Arota, this is why the availability of advanced healthcare technology matters in improving diagnosis. “Our work as a healthcare solutions provider does not stop with the development of innovative medical equipment. We help build on the diagnostic capacity of healthcare workers pursuant to the recommendations of WHO.”

Here’s more from our interview with Dr. Christine Joy Lee-Gruenberg, medical specialist, Section of Nuclear Medicine, Department of Radiology and Radiotherapy, Veterans Memorial Medical Center and Cardinal Santos Medical Center nuclear medicine consultant (email tingruenberg@gmail.com).

THE PHILIPPINE STAR: What would you say is the No. 1 advantage of this new PET-CT scanner?

DR. CHRISTINE GRUENBERG: The GE Discovery 710 PET/CT is a state-of-the-art system with time-of-flight function that gives exceptional image quality and Q-clear reconstruction that allows more consistent quantitative measurements. PET-CT is mostly used in oncology, but other uses include evaluation of brain abnormalities, such as seizures and Alzheimer’s disease, and evaluation of cardiac abnormalities. 

Will this now eliminate the problem of misdiagnosing?

Positron emission tomography with computed tomography (PET-CT) is a nuclear medicine device that combines two examinations, the PET and the CT, to create a clear whole body hybrid image that depicts cellular function in relation to a specific structure, resulting in a more precise information and accurate diagnosis.

PET-CT is especially useful in cancer care such as disease staging, revealing if and where the cancer has spread, monitoring response to therapy, aiding in radiation treatment planning, and finding out if the cancer has recurred. Because PET-CT is a whole-body examination that combines both anatomic and functional imaging of the body, it complements clinical and pathologic staging, as well as other diagnostic modality, such as an MRI, to give a comprehensive cancer diagnosis valuable to oncologists for appropriate treatment and management.  

What has been your personal experience with this machine?

Cardinal Santos Medical Center recently opened our PET-CT center. Since inception, the patients that are referred to us have varied diagnostic questions. Before cancer treatment can commence, the oncologists need to find out where the primary is, know the stage and re-stage if necessary, and then find out if the cancer has metastasized — or spread to distant organs. These are factors that will dictate management: Will the patient get localized treatment such as surgery or radiation therapy, or will the patient start with a systemic treatment such as chemotherapy? Are we going aggressive in the management of this particular cancer or is this just palliative care? For patients on therapy monitoring, the oncologists need to know if the chemotherapy or the radiation therapy is working. Is the patient on partial remission or is he/she in complete remission? Or did the cancer recur? In order to answer these questions, the oncologists refer to doctors specializing in oncologic imaging. This is where we come in. PET-CT affords this by giving information on the molecular behavior of cancer cells in the whole body, allowing selective therapy most suited to the status of the disease. These sets of information are apparent even before significant structural alterations from cancer occur, hence early response vital to the longevity of the patient can be implemented.

The following are recent cases that we had in our center. We had a patient referred to us for evaluation of rectal carcinoma. The oncologist wanted to know if the disease is localized only in the rectum or if the disease has already spread. The treatment will hinge on what we will find in the scan. We did the PET-CT scan and reported the disease to be localized only in the rectum. Another patient has prostate cancer with increasing PSA after radical prostatectomy. Conventional bone scan showed the patient to have no bone metastasis. He was referred to us for Choline PET-CT.  We reported multiple bone metastases in the rib, along the spine, and in the pelvis, with regional lymph node metastasis in the pelvis.

You have developed a program for cancer patients. Can you tell us more about it?

Based on scientific data spanning almost 20 years, PET-CT is an effective tool in determining the stage of cancer, treatment response, and evaluation of disease recurrence. Unfortunately, without medicare (and PET-CT is not covered by PhilHealth), the cost of a PET-CT scan is prohibitive. Cardinal Santos Medical Center contributes by giving PET-CT service free of charge to two indigent patients per month, allowing them to benefit from a comprehensive cancer care and management. It is our hope that the government will see the necessity of this imaging tool and work towards its inclusion in health care subsidy.      

What has been the most dramatic cancer case you have handled so far?

In our center, we give our patients the support and comfort as they go through with what is possibly the most trying time in their lives. The best case was when we had a patient referred to us for evaluation after a full cycle of chemotherapy for non-Hodgkin’s lymphoma. Conventional CT scan shows significant reduction of the lymph nodes in the mediastinum and in the abdomen. PET-CT scan shows no uptake in said lymph nodes, signifying complete metabolic response to therapy. He is in remission and no further treatment is to be given. We await his follow-up. I think this is the best case because we have shared in the patient’s experience as he battled and survived cancer.