Prendre le pouls - Taking the Pulse
Faites le plein d'inspiration grâce à ces entrevues avec des spécialistes de la santé sur les nouvelles avancées médicales, la recherche révolutionnaire et les transformations dans la prestation des soins aux patients, le tout rendu possible grâce aux généreux donateurs de la Fondation de l'Hôpital général de Montréal. Nous prenons le pouls sur l’innovation en médecine. prendrelepouls.ca
Be inspired by interviews with healthcare specialists about new medical approaches, groundbreaking research and transformative ways of providing patient care, all made possible thanks to the generous donors of the Montreal General Hospital Foundation. We are taking the pulse on what is going on in medical innovation. takingthepulse.ca
Prendre le pouls - Taking the Pulse
Taking the Pulse: What is cancer?
Dr. Robert Turcotte, Orthopedic Surgeon (MGH-MUHC) and Dr. Jonathan Cools-Lartigue, Thoracic Surgeon (MGH-MUHC) explain the basics of this disease, which is the leading cause of death in Canada. What are metastases? Can sarcoma be cured? They answer these and other questions. Learn more about cancer from these two experts.
Dr. Cools-Lartigue is a spokesperson for Together Against Cancer, a unique collaboration between the Cedars Cancer Foundation and the Montreal General Hospital Foundation. Our goal is to raise $100 million to support transformative projects that will improve the experience, quality of life, and outcomes of cancer patients.
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Cet episode de Prendre le pouls est aussi disponible en français.
00:00 Dr. Cools-Lartigue: Intro
00:36 Dr. Cools-Lartigue: What is cancer?
01:09 Dr. Turcotte: What is sarcoma?
01:27 Dr. Turcotte: What are the types of sarcoma?
01:44 Dr. Turcotte: Can sarcomas be cured?
02:06 Dr. Cools-Lartigue: What causes cancer?
03:05 Dr. Turcotte & Dr. Cools-Lartigue: What are the common cancer symptoms?
04:13 Dr. Cools-Lartigue: Why is cancer so difficult to cure?
05:21 Dr. Cools-Lartigue: What is metastasis?
05:49 Dr. Cools-Lartigue: What do the stages of cancer mean?
07:12 Dr. Cools-Lartigue: How do people die of esophageal cancer?
07:43 Dr. Cools-Lartigue: How do you determine the right treatment to follow?
08:52 Dr. Cools-Lartigue: What is chemotherapy?
09:35 Dr. Cools-Lartigue: What is immunotherapy?
10:18 Dr. Cools-Lartigue: Why is it an interesting time in cancer research?
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In my mind. The question is why is your immune system which controls and prevents you from getting cancer? Throughout the course of your life, right? People don't get cancer when they're, for the most part, 20, 30, 40, right? It's a disease of age. So why is it that your immune system at 60 plus years old suddenly cannot control this disease anymore? It's a disease, we call it, of the genes, but it's tissue that grows uncontrollably. And what kills patients is that cancers have a tendency to spread from the first site that you get them to elsewhere in your body, and it's that spread that usually kills people. It's a lot like weeds in your garden, you know, it's a perfectly natural thing, but it's growing in the wrong place at the wrong time and you can't get rid of it, you know? So it's like you get rid of all the weeds, you think everything's fine, and then they pop up somewhere else and you get rid of those and they pop up somewhere else. And cancer is sort of the same thing. It's a disease that we lose control of. And and that's why it's such a problem in our, in our, in the medical field today. Sarcoma is a family of cancer which are different than lung, prostate or breast cancer where the we think the the cancer cell originated from what we call the stem cells, which are the primitive cells we have who can transform in different tissue in our body. Sarcoma is a wide variety of different tumors. There's over more than 50 type of sarcoma. And they involve oftentimes either the bone or the soft tissue at any age and any sex. And the incidence is the same throughout the world. Sarcoma can be cured, especially when they're localized. But when they're spread they're tougher to to cure. So we have good treatment for some of these cancers. Some others are not very responsive to any known agent. Uh, so yes, it's a difficult battle when the cancer progressed, but advanced cancer sometimes can be cured. I think really the global answer is we don't really know, right? We have lots of associations with cancer. So a big one is smoking. That's a common one for for thoracic surgeons who do lung cancer like myself. But there are many risk factors for cancers generally. Most of them are a good proportion of them are lifestyle. So like things like smoking, alcohol, too much food, kind of, you know, gist of the life we live, obesity, stress, all that stuff. Those those are risk factors for cancer. And we can describe cancer, you know, at the clinical level. So you get a lump that causes a problem. We can describe it at the genetic level. So if you look at the genes of certain cancers, they tend to um they tend to give you information on the type of cancer it is. But as a whole, we don't have a great understanding of what this disease really is and why it comes back the way it comes back. So it's sort of like a big mystery that still exists today. And it's it's what my research is focused on is understanding why it comes back. In the extremity cancer, bone and soft tissue cancer, the symptoms are not specific. Usually people will come because they have a bump or they have pain, and these are the main reasons. So rarely people will show up because they're losing weight or coughing and things like that. So these are symptoms for a different cancer. But in limb cancer usually it's a bump or a pain. So the symptoms of cancer are related to where you get the cancer. So probably the most important thing to know is a lot of cancers don't give you symptoms. And that's why it's dangerous. Right. So people don't feel bad until it's relatively advanced. It's one of the reasons why when we talk about lung cancer, for example, most patients aren't candidates for surgery is because most of them have no symptoms. And they present with very advanced disease where they're not able to get surgery. The same is true in esophageal cancer, for example. The symptoms that people can get are specific to the organ that's involved. So if you get a cancer in your colon, for example, you can get blocked and things don't work right. If you get lung cancer, people can have pain, trouble breathing, bleeding, cough, things like that. But again, the most common symptom is nothing. So our treatments of the first presentation of cancer, the first episode of cancer, let's say your lung, for example, is often surgery. We take it out and the problem is solved, right? Cancer is gone. Often your symptoms are better and people can live some quality of life. The problem and what cuts their life short, and what leads to a lot of the suffering and fear that we hear about with cancer. And it's what patients will ask you all the time, right? Is like, did you get it all? And we say, we got it all, but we know that the likelihood that it comes back at certain stages is high, and that's what kills people. So essentially it's the the, the problem with cancer is not so much treating the index presentation, let's say the lung cancer or the esophagus cancer. Is this going to come back. And the answer unfortunately is often yes. And when it comes back is there anything we can do about it. And the answer unfortunately often is not not necessarily. Surgery usually is off the table when things come back because of how they spread and where they spread and the treatments that we have in very advanced disease, although they're getting better, still don't reliably cure your disease, and we cannot reliably prevent the process of metastasis today. Metastasis is the process by which cancer spread from the primary site or the first site that you get them to other parts of your body, be that, you know, lung cancer, for example, which I treat a fair amount of, starts in the lung. But usually what kills patients is spread to bones or brain or liver. And so that process whereby the cancer starts in one place, the lung, for example, and ends up in another, like the brain, for example, that process is termed metastasis. And that is what is killing our patients today. The stages are really a prognostic tool. It's a tool that's used by physicians and surgeons to adjudicate you to a therapeutic course, whether that be surgery, radiation, chemo, immunotherapy or some mix thereof. Right. Generally stages, the more advanced the stage, the more advanced your disease. And generally the more advanced the disease, the worse your prognosis. I don't like to talk about stage with patients beyond adjudication of therapy. Because again, I can't tell you how you're going to do a patient with stage one lung cancer while the majority are cured with surgery alone with very early lung cancers. A good proportion, 10 to 15%, will die of metastasis. Okay. So while the majority are cured, what are we missing in that 15%? And by the same token, patients with stage three and four disease, which used to be a death sentence, is not the case anymore. There are good five year survival for patients who present with lung cancer everywhere. It's about 25% today. That was unheard of a decade ago. So you know, what does your stage mean for you? It means I'm going to recommend different therapies. I think that's really what I think is important for patients to know. The problem is people hear stage three four and they get scared because they think it means they're going to die. It doesn't necessarily mean that. But as a general rule of thumb, the more advanced your stage, the worse your prognosis. What what kills people is, is with esophageal cancer is not necessarily that they can't eat, but it's that their cancer is back. So number one, it's a big burden on your body metabolically. So like a lot of the foods you're eating that would normally keep you going is keeping that cancer going. You know. And so people get very weak. They lose a lot of weight. They get tired. Your immune system doesn't work as well for patients with cancer. So you become susceptible to infection. So what kills most cancer patients with metastasis are infections. And those are often related, like I said, to where that cancer shows up. Generally when we talk about treatment for for cancer there are local treatments. Those include things like surgery and radiation. And by local we just mean can I treat the site. So colon cancer, lung cancer, can I treat the colon? Can I treat the lung. And the answer is often yes. Sometimes we need chemotherapy. So that would be an example of a systemic therapy right. It's not a treatment that acts locally. It acts everywhere in the person in the organism systemically. So things like chemotherapy, immunotherapy and some of the newer targeted agents, you'll hear words like that. Those are systemic therapies. They're divided into lines of treatment. So you'll get like first line treatment. Generally the first line, generally there's a lot of exceptions to everything, but generally the first line treatment is the best, but it doesn't always work. And when first line treatments don't work, that's when we give. You'll hear oncologists talk about second line, third line, and so on and so forth. Generally when you start moving down the line, things are more serious. And that often refers to the the process of metastasis like, oh, your cancer is back. So we'll try your first line therapy, but it's back. So now you need a different therapy because the first one doesn't work anymore. What we talk about when we talk about traditional chemotherapy, these are drugs that kill rapidly dividing cells. So cancers grow quickly. That's the problem. And so chemotherapy traditionally has been used to kill cells, rapidly dividing cells. Generally it kills the cancer a bit more than it does the rest of your cells in your body. But as everybody kind of knows, chemotherapy is quite toxic. I mean, that's the whole point of chemotherapy. More modern therapies or more recent therapies. So things like targeted therapies tend to be targeted to the tumor specifically, so they have less of like a bystander effect. So they'll more effectively kill the tumor cells than they will surrounding cells. They are not without side effects, but generally the side effects are milder. So immunotherapy is a bit newer. It is not aimed directly at killing the tumor like the drug that they give you does not directly kill the tumor. What it does do is it prevents the tumor from telling your immune system to ignore it so your immune system becomes more active, will recognize the cancer as a as something bad, and will attack the cancer itself. So it harnesses the power of your immune system to target the cancer. It seems to be more effective than traditional chemotherapy in certain conditions and certain diseases. It seems to be, in some cases, more durable of a response than than in traditional chemotherapies. And it tends to be a little bit easier on patients than traditional chemotherapy. It is an exciting time to be a researcher right now. And the reason for that is, you know, the two things have sort of changed. Number one is our recognition of the role your immune system plays in cancer. But I guess number two is the emergence of therapies that are actually able to harness the immune system. So we can see what the effects are. We can look at people who get better on immunotherapy. And that can help us understand what kind of immune response your body mounts that's beneficial. And so that's very exciting. That's new. That hasn't been the case throughout the history of the disease. Right. And third, we kind of have the tools to study the immune system today better than we did even recently. I think that, you know, when you find something that works like immunotherapy, usually those things that the concept to me is a valid concept. And as we get farther and understand this better, I think we'll be able to tailor our therapies, our immunotherapies towards more patients and also to understand, like, what do we want to get out of the immune system.
