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Diagnosis of a tumor no longer means early death

Diagnosis of a tumor no longer means early death

For many of us, until recently, a malignant tumor was a synonym for a likely death sentence. Nowadays, however, this diagnosis no longer means inevitable early death.

 

In recent years, diagnosis and treatment of both malignant and benign tumors has developed very rapidly around the world, and modern methods of treatment have become more efficient and accessible.

What methods of cancer diagnosis and treatment are available in the world and in Latvia?

It is needless to say that a malignant tumor is a serious illness, but nowadays it is no longer completely incurable. More than half of newly diagnosed cancer patients in the world are cured using a variety of advanced methods of treatment and technologies. Every year, hundreds and thousands of patients return to their normal rhythm of life. According to the American Cancer Association data, less than half of the patients who were diagnosed with cancer survived in the 1970s, while during the period from 2004 to 2010 the five-year survival rate reached two-thirds or 68% of all cases. It should be noted that the survival rate of patients with certain forms of cancer is extremely high at 99%.

It is important to keep in mind that there are a great many types of benign and malignant tumors, including those that are very hard to treat. However, due to the rapid development of the methods of cancer diagnosis and treatment, it is possible to diagnose and treat promptly such forms of malignant tumors that used to result in early death. These diagnoses include, for example, various types of leukemia, Hodgkin’s lymphoma, melanoma, breast cancer and testicular cancer. Thanks to early detection of these forms of cancer, patients’ five-year survival rate has reached almost 85% of all cases.

Dr.med. Kaspars Auslands, neurosurgeon at Riga East Clinical University Hospital and Chairman of the Board at the Latvian Society of Neurosurgeons, who also deals with neuro-oncology patients on a daily basis, explains the fact that the diagnosis of a malignant brain tumor or brain metastases from cancer in other organs does not mean early and certain death anymore. Even in cases where it has not been possible to fully cure the tumor, its manifestations have been controlled for a long period of time with success: “Although no method has yet been found to completely cure primary brain cancer or brain metastases from cancer in other organs, the adequate and proper treatment used in the modern world, including Latvia, has a good potential to ensure sufficiently long survival of neuro-oncology patients and help them maintain their quality of life. Conversely, if no treatment is used, the estimated survival rate for these patients is a matter of a few months.”

Without doubt, cases of malignant tumors or metastases in the brain are not too optimistic in comparison with other forms of cancer, however, according to the American Cancer Association data, the median survival of such patients has increased as much as twofold or even threefold in the last decade.

What methods of tumor diagnosis are available in Latvia?

Latvian medical key opinion leaders stress the importance of the earliest diagnosis as a prerequisite for the radical treatment of tumors: the earlier a tumor is detected and the smaller it is in size, the more radically it can be treated. The modern methods of diagnosis and treatment that are used these days around the world have now been introduced in Latvia, leading to a significant improvement in the situation with the treatment of oncological diseases in the last decade. For example, we have succeeded in introducing concurrent chemoradiotherapy for treating head and neck squamous cell tumors, provided that the patient has indications for the therapy. Eight years ago, tumors with this localization were treated only surgically and/or with radiation therapy.

The incidence of malignant diseases in Latvia remained consistently high in 2014. According to the data of the Center for Disease Prevention and Control, there were 11,412 new cases diagnosed that year (compared to 11,567 in 2013). The total number of registered oncological patients across Latvia was 77,822 in 2014.

Dace Saukuma, Chairperson of the Board at the Latvian Therapeutic Radiology Association and Chief Radiosurgery Physician of the Oncology Center of Latvia, explains the crucial importance of diagnostic tests for cancer: “Speaking of diagnostic tests, their role in oncology cannot be emphasized enough. Diagnostic capabilities are very good in Latvia – the equipment is of high quality, easily accessible and in sufficient quantity, but the main obstacle is the waiting time, which depends on state funding and quotas. In order to treat a patient properly and with success, relatively fresh diagnostic tests are required. For example, examination results should preferably be not older than a month when referring a patient to radiosurgery or stereotactic treatment. Elsewhere in the world, results of the magnetic resonance imaging carried out within the last week are recognized. Speaking of Latvia, if the patient can afford paid diagnostic tests, the process runs smoothly and the treatment starts immediately.”

The only method of tumor diagnosis that is not yet available in Latvia is positron emission tomography (PET). While computed tomography and magnetic resonance imaging are used to diagnose the anatomical size of the tumor and its localization, PET makes it possible to obtain information on the functional nature of the cell formation – whether the cells are active, inactive, living or dead. “This is a way to diagnose a disease at a much earlier stage than when carrying out the classical diagnostic tests, such as X-ray, computed tomography, and even magnetic resonance imaging. There have been cases when magnetic resonance imaging failed to detect anything in a particular area, whereas positron emission tomography showed that the diseased cells were accumulating the radioactive material used in the examination. This helps determine the activity of the diseased cells. PET provides a possibility of detecting tumors much earlier, before the changes can be seen, for example, during MRI,” D.Saukuma says.

The good news in the field of oncology is that starting from 2016 PET diagnostic examination will also be available to patients in Latvia. The Nuclear Medicine Center, which is due to open at the beginning of 2016, will be the most state-of-the-art center for diagnosis and clinical research of its kind in the Baltic States. “The aim of the NMC is to ensure diagnosis of oncological diseases in Latvia on the same quality level as in developed European and world countries, as well as to produce material necessary for diagnosis and export it to medical centers in other countries,” Vitālijs Skrīvelis, Chairman of the Board at the Nuclear Medicine Center, explains.

The NMC will mainly specialize in precise diagnosis of cancer and heart disease at early stages, using short-lived radionuclides. The availability of this method of diagnosis in Latvia will definitely be a significant addition to radical treatment of cancer, because while the traditional ways of diagnosis provide information about a specific part of the body, PET examination helps obtain data on developments and changes throughout the body, allowing for starting treatment at a very early stage.

The latest and most advanced cancer treatment methods are now available in Latvia

The methods for treating benign and malignant tumors that have now become available in Latvia are comparable with the medical capabilities in the European Union, the United States and other developed countries. The capital Riga is positioned the best in this respect, as it can offer access to a wider range of treatment options, including surgery, chemotherapy and radiation therapy, although tumors are also treated in regional hospitals, for example, in Liepaja and Daugavpils.

Explaining the differences, especially those in radiation therapy, Dr. Dace Saukuma says that they mainly lie in the available equipment: “Radiation therapy in Latvia is available in four hospitals. The Oncology Center of Latvia in Riga is fitted with the most advanced equipment, which was installed in 2009, and more extensive options. The situation in other hospitals is different, and modern technology, such as stereotactic radiotherapy or radiosurgery, is not yet available in regional hospitals. However, treatment can also be performed in regional cities like Liepaja and Daugavpils, although it depends on the competence of the doctors and on how medical physicists and technicians can manage to adjust radiation plans to the equipment at their disposal. Opportunities definitely exist.”

Although radiation therapy dates back to the last century, it is still considered to be a high-potential cancer treatment method. It helps radically fight tumors in hard-to-reach areas which, unfortunately, cannot be accessed surgically. “The best treatment results are observed in cases where the primary brain tumor or metastasis can be removed completely, without causing post-surgery neurological damage, such as speech or cognitive problems, movement disorders and other symptoms. Unfortunately, this is not always possible, as formations are often found in deep, surgically hard-to-reach places or functionally important areas.

Moreover, a patient may have multiple metastases, and all the metastatic nodes cannot be removed during surgery: a part of them remains in the body and can start growing with time, causing symptoms. In such cases, radiosurgery is a way to effectively control a tumor without surgery. Therefore, before any intervention it is very important to carry out adequate planning and make provisions for using different methods of treatment aiming to achieve the best outcome, while maintaining the patient’s quality of life. Usually it is the case consultation committee composed of doctors of various disciplines that determines the best tactic in any particular case,” neurosurgeon Kaspars Auslands explains.

New developments in Latvia are also expected in the field of radiation therapy or radiosurgery: the end of this year will see the opening of Stereotactic Radiosurgery Center Sigulda (SRC Sigulda) in Sigulda Hospital. SRC Sigulda will offer treatment of oncological and non-oncological (benign) tumors with the most advanced stereotactic radiosurgery technology CyberKnife®. This is noninvasive treatment aimed at patients who cannot undergo surgical treatment due to concomitant diseases or anatomical localization of the formation. The advantage of the CyberKnife® method is that the treatment requires just a few sessions and there is no need for the patient to stay in hospital, as the therapy is administered in outpatient settings. Moreover, significantly fewer complications are usually observed after such treatment, and the quality-of-life indicators are much higher compared to those after a surgical procedure.

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