Monday , November 29 2021

Oncologist Marek Svoboda: The worst cancer is one that arose unnecessarily



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I deliberately ask. Which cancer is the worst?

I once asked this question to my coach in the United States when I started there. And do you know what he answered me? The worst cancer is yours. It really is. Although a person arrives on time, he also needs happiness to heal. We have patients who come in the first clinical stage, and yet the treatment does not come out well.

But back to your question … I think the worst cancer was wasted. And then what can’t be treated well.

What are they?

They are useless to be created in connection with smoking. Some of them are also difficult to treat. For example, it is pancreatic cancer. Even if detected early and operated on by the pancreas and all surrounding organs, it is very difficult, with only twenty percent of patients living after the diagnosis and more than five years.

Lung cancer is also very dangerous. Many smokers have difficulty coughing, accumulating, and breathing, which is why they ignore these warning signs and come to us late, when the cancer is already metastatic and we can’t cure it.

Advanced tumors of the stomach and bile ducts are difficult to treat. Ovarian tumors belong to a group with an inadequate prognosis, and these are most commonly detected in recent times.

Culture Minister Pavel Dostál was treated in 2005 at your workplace with pancreatic cancer, the first of the most difficult treatments you named.

Yes, amazing person! And the warrior to the end. I have fond memories of her. At the same time, we had a patient who lived alone with his dog. He really wanted someone to bring the dog here from time to time, and I wanted to do it for him, then as a regular doctor. But the dogs were not allowed in the hospital.

I knew Minister Dostál also had a dog. I asked him if he could exchange his views with the department. I assumed they would meet. At first he didn’t want to do it, he said, “Such nonsense, for God’s sake, what do you want from me!” But if it’s for the lady, I’ll do it. ”He really said then about the dog. And I had a discussion: “Minister Dostál can have a dog in the room, this lady can have it here too!” (Laughs) Then they really brought it to him.

Unfortunately, the minister had pancreatic cancer. What are the current options for patients with this diagnosis?

Nine to twelve months of life, often faster. When they are caring for a patient, we are able to achieve a one-year life. If left untreated, it is a few months.

I’ve heard of a new study that can detect in time …

I wouldn’t say it’s new, but you’re basically right. Sonography is endoscopic and its preventive use is already in the case of patients with a genetic predisposition to the development of pancreatic cancer, which can be detected within the prevention programs in our workplace.

Most organs can be made by magnetic resonance imaging. The disadvantage is the duration of the study. Patients are usually given ten minutes in a “tunnel”.

Photo: MOÚ

In the near future we want to start examining the pancreas through endoscopic sonography in healthy people. The advantage is that it only takes a few minutes. Although the study is not entirely pleasant, we need to insert a tube into the patient’s throat, but it is quite accurate. We can see the environment through the stomach wall – including the pancreas. We can detect cancer in the first phase.

Will you completely cure the patient?

Twenty-five percent of 25% of people can be cured by early detection. You might think it’s small. But having a hope of thirty is no better than nothing.

We are researching all the genes currently known to be associated with cancer inheritance

You mentioned the effect of inheritance. What do we know about cancer?

We know more and more about it. The roots go back to the mid-1990s, when the first genes associated with the cancer gene load began to be investigated. These were the BRCA1 and BRCA2 genes. Their mutations can cause breast and ovarian cancer.

A few years ago, the actress Angelina Jolie promoted the possibility of studying these genes, preventing the operation of healthy breasts and ovaries …

Yes, and we are glad that Angelina Jolie has become an ambassador for this approach to prevention. Our institute was one of the first to present a study of these genes in the Czech Republic. Today we examined more than six thousand families. Every year, at our institute, we find about 240 carrier mutations of these genes.

We are currently able to study one or two of these genes, but complete sets of genes, as well as hundreds of genes at once. We are researching all the genes currently known to be associated with cancer inheritance.

Although the number of genes we are researching has increased, it seems that the overall impact of heredity on the development of cancer should reach an average of 10% of people. 90% of the remaining patients develop cancer due to other factors. It’s getting older for the most part. 66% of cancers develop after the age of sixty.

Many people were in a hurry to take Angelina Jolie’s radical move. Can you explain why he made the right decision?

He had two options: to undergo surgery and to remove and remove organs that infect and remove tumors. Or they have a high probability of going to the exam every six months and showing up on time if cancer occurs.

However, even in the case of early detection, subsequent treatment carries a heavy burden. Most genetically based tumors are aggressive and require chemotherapy after surgery. It would last half a year, when you get out of there in the next six months.

Angelina Joli knew she didn’t want to spend a year of her life dealing with the effects of cancer. So he decided to stop. We also offer this opportunity to our patients. Preventive removal of the breast can reduce the risk of cancer by 85 percent to five percent.

Is it possible to quantify the percentage of cases in which cancer deaths can be prevented?

If we avoid it early, we can prevent about 60% of cancer deaths. If people come in at an early clinical stage, we should not use chemotherapy or radiation in many tumors, we will be happy with the operation. For example, in the first phase we cut a colon tumor by surgery without chemotherapy.

The mammogram exam covers insurance companies for all women over the age of 45.

Photo: MOÚ

Patients with cancer are concerned about chemotherapy. It is often associated with unpleasant side effects such as hair loss. Is it true that cancer treatment is still so heavy?

The entire system of chemotherapy and oncological treatment is being developed. Targeted treatment, sometimes called biological treatment or immunotherapy, has been added. Each has its own spectrum of side effects. For example, hair, for example, does not always affect. Therefore, when we have a choice of which medication to use, we discuss it with the patient. We ask him, for example, what he does, what he eats.

I had a patient with breast cancer, a virtuoso piano. One type of chemotherapy, which is usually given after breast cancer surgery, causes bites on the fingertips and loses sensitivity in them. However, it does not cause hair loss. After discussion together, this patient decided on another type of chemotherapy. The side effect of this is hair loss, but it does not affect the sensation of the fingers.

He knew that his hair would grow out in half a year, threatening the profession with endangering the sensitivity of his hands.

Do you come across patients who refuse chemotherapy, for example, to try alternative natural treatments?

Some patients come to us with advanced cancer. For example, they have a large lump that has grown from the breast and with it a place in the hospital has been treated with a healer for a long time. They often say that fear drove them to do so. Or they don’t trust doctors.

Then we have patients who are confident, they make diagnoses for us, they have surgery, but when they have to continue treatment with chemotherapy or radiotherapy, they give up for fear of side effects.

How do you tolerate it as a doctor?

We can’t force people, at the moment we tell them which point of view is best for us. We can agree, for example, that if they decide not to do chemotherapy after surgery, we will monitor them more frequently in the first few years to detect a potential return of the disease over time.

I will remember two patients who refused radiation after breast cancer surgery, both of whom went back to the place where the cancer was given, we both had surgery again. They were then exposed to radiation. Both have been doing well for many years.

Don’t you feel emotion with patients who refuse treatment?

By no means. I don’t want it to be bad, but people have the right to decide what they want. I’m not forgetting anything and I’m sure I’ve given him all the information so I don’t have a problem living it. Also, even though I’m saying it’s based on research on giant patient populations, I can’t stress that my truth is only one percent. I can also understand their arguments.

Does the development of the disease surprise you significantly?

Yes, and it applies in both directions. I remember the case of a patient who was left to die at home, who was finishing treatment, and we could do nothing for him. I met him after a few years and he was fine.

Or another case: a young boy with a kidney tumor, a brain metastasis. The average survival of this diagnosis is a few months, and he was here with us for six and a half years. She got married at the time, she worked brilliantly.

On the other hand, we have patients who caught the disease in time, everything was on the right track, and yet the cancer has returned in two to three years and can no longer be helped.

How to tell patients a serious diagnosis?

There are rules for this that we follow. We try to communicate a diagnosis or inappropriate prognosis about an individual’s situation. Above all, no one should ever have hope. You can use it not only when you have the treatment available to slow down the tumor and revitalize it for years, but also when the treatment doesn’t make sense. Even then, you can give a person decent conditions, such as spending time with his or her family.

Is there a chance that cancer will one day be completely eradicated?

They tell me wrong, but I don’t think so. Through the vaccine, we can remove cancer caused by the actions of the virus, such as cervical cancer. Then we have screening tests. If everyone were to go for a colonoscopy at times, it could theoretically be possible to avoid colon cancer because the polyps before the tumors would be removed in time.

However, the biology of tumor formation is such a natural process, and I cannot imagine that this mechanism could be completely stopped.

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