- Cancer is the second leading cause of death in the U.S.

Tonight we focus on cancer care, including diagnosis, treatment, and support.

(warm music) (warm music continues) Good evening, and thanks for joining us for WTVP's "Docs on Call."

I'm Mark Welp.

The American Cancer Society estimates there will be 2.1 million new cancer cases this year in the U.S.

Breast cancer in women and prostate cancer and men will be the most common types.

But did you know there are more than 200 distinct types of cancer?

Dr.

Megan Hutchcraft is a gynecologic oncologist with Carle Cancer Institutes in Normal and Urbana.

Doctor, thanks for coming on.

- Thanks for having me.

- We appreciate it.

First, wanna hear a little bit about yourself.

And you've been here at Carle for about two and a half years, correct?

- I have, yep.

So I came to Central Illinois after I graduated from high school, and home has been here ever since.

And it's been really a great honor to be able to care for women in our community who have been diagnosed with or who are at risk for gynecologic cancers.

- Now, that's more specific than just being an oncologist, obviously, you have a specialty.

How common is that for doctors in our area or wherever to have that specific focus, like on gynecology or the brain or things like that?

- Great question.

So, my path is a little bit different than medical oncologists.

So my background, I did a training initially in residency in obstetrics and gynecology and then specialized in gynecologic cancer from there.

So it's not very common to have this kind of subspecialty, but we're really lucky to have this service available for our women here in Central Illinois.

- Well, you must be pretty busy, then, if there aren't too many people like you that have that title in this area, and I'm sure your waiting rooms are full.

- Yep, we are pretty busy.

Hopefully, my job becomes obsolete in the future.

But until then, I'm happy to help take care of everybody.

- Let's talk about cancer care, because with all those different cancers, I'm sure that the treatment and the care, there are a lot of wide varieties of things like that.

You know, where should someone start?

First of all, if they think they may have cancer, should they go to their primary physician first?

- Usually, getting in to see a primary care provider, whether that's their physician or an advanced practice provider, is a really good start.

And making sure that, you know, you advocate for yourself as a patient.

Letting them know you think something is wrong and asking for tests if you feel like you're not, you know, feeling like yourself.

You know, usually, somebody has a good inkling of something is wrong and making sure that you get in to see somebody soon is really important.

- Mm-hmm.

And cancer care is kind of a wide-ranging term.

Why don't we talk about, with your specialty, what it means to care for someone with cancer?

- Absolutely.

- Where do you start?

- Yeah, great question.

So, there's a whole bunch of different types of cancer care.

So it ranges from surgical treatments to medical treatments, like chemotherapy or hormonal therapy, or radiation-directed treatments.

And because of that, we have to have a pretty multidisciplinary team and work collaboratively to care for somebody with cancer.

So usually it starts with a diagnosis, usually get a biopsy, and then once that biopsy comes back, usually get referred to one of the members of the cancer team.

- And would the patient, you know, gynecological cancer, if they have that, do they usually have options as far as treatment, or is it kind of like this is what you have to do to... - It depends on the type of cancer.

So, a lot of the different treatments, it depends on both the stage of disease and how, you know, healthy the patient is to undergo certain different types of treatments.

And a lot of times, we actually use a multimodal type of therapy.

So it's not just chemotherapy or just surgery, but we use both of those together.

Same thing with radiation.

You know, we might not use surgery alone, but we might follow with radiation or something like that.

- So there's no one-size-fits-all treatments?

- Absolutely not.

Yes.

It's very individualized, definitely need to focus on the patient in front of you rather than, you know, just a cookie-cutter approach to cancer care.

- And how do you weigh the pros and the cons when you're thinking about a treatment?

You know, we know there's side effects for radiation, chemotherapy.

How do you look at the pros and cons and say, "Well, this is something that's definitely gonna benefit the patient," or maybe it's not, and we have to go a different direction?

- Yeah, absolutely.

So it kind of first and foremost starts with what are the patient's goals.

You know, so if the patient is someone who is really active and otherwise can tolerate, you know, an aggressive approach for a curative intent treatment, we go for that.

If somebody, you know, maybe is less healthy, maybe already has limited time left from other medical problems, you know, maybe we focus more on a symptom-directed treatment.

So it definitely really depends on the goals of the patient in terms of what's important to them and their future.

- Is it common for someone who gets diagnosed with cancer to have to see more than one doctor?

- [Megan] Absolutely.

- Tell us about that, how that works.

- Absolutely, so, for folks who have, for example, uterine cancer, endometrial cancer's the most common type of cancer that I see, most of the time, what happens is someone comes into their OB-GYN doctor with abnormal bleeding, and then they have a biopsy that shows that they have a cancer of the uterus, so that's doctor number one.

So then they see me, doctor number two, gynecologic oncology, and we usually will perform a surgery to take care of that type of cancer.

And then depending on the results of the pathology from that surgery, they may see another doctor, like a medical oncologist, if they need treatment, like chemotherapy or immunotherapy, or they may see a radiation oncologist, who may prescribe radiation therapy after surgery.

So that's, what, five members of the care team already right there?

- [Mark] That seems complicated.

- Super complicated.

- So how do you help the patient juggle all that?

Like you said, the patient needs to be an advocate for themselves, but there's only so much they can do.

So, as a doctor, how do you communicate with other doctors and make sure everything is happening the way it's supposed to be?

- Yeah, great question.

So, kind of having, usually in most disease types, there's a certain doctor that kinda takes the lead in terms of helping to direct the flow of cancer care.

And in gynecologic cancer, often that's the gynecologic oncologist, like myself.

And we actually meet as a collaborative group of physicians.

At Carle, we have multidisciplinary tumor boards.

We're an accredited cancer center.

We have clinical trials and things like that.

And so we actually meet together as a big cancer care team.

In addition to those, all those doctors we talked about, we also talk to our pathologists, radiologists.

We also talk to folks who specialize in genetics and clinical trials.

All that happens kind of behind the scenes, but we work together in this multidisciplinary team approach, where we have a tumor board that we meet weekly and discuss a patient's cancer treatment and where to go from there.

- Oh, that's good to know.

Well, you know, Carle is in Urbana, Normal, all over the place.

If someone, let's say, in Normal, where you work, is going through cancer or something like this, the different services, the different doctors they see, is, is that all localized, or would they have to go to different hospitals, different offices, things like that?

- Great question.

Yeah, so it's a lot of appointments and things like that.

And so we do wanna try to keep everybody, you know, knowing that it's a lot of appointments, keep everything as easy as possible for the patients.

So in Normal, we have a lot of services that we actually can offer under one roof.

So services like gynecologic oncology, myself and my partner, Dr.

Chang.

We have surgical oncology, we have medical oncology, hematology oncology, radiation oncology.

We can offer all that under one roof, which makes it a really nice ability to have comprehensive cancer care that patients have a one-stop shop where they can get all their treatment.

- Yeah, that's good.

That's one less thing that they have to worry about, and I'm sure their plate is full of worries once- - Absolutely.

- Once they get that diagnosis.

And that brings me to another question.

With all these brilliant doctors doing what they do, they have to be very precise and specific about how they treat the cancer, but there's also the human element.

You know, when the person is diagnosed with cancer, obviously, that's gotta be devastating.

How do you deal with the patient's emotions while still trying to deal with, you know, the medical symptoms?

- Yeah, I think that's a really important part of cancer care.

I think taking care of the person in front of you is more important than taking care of the, you know, the patient in front of you or their diagnosis.

And I think making sure that they feel comfortable with their care team, making sure that they have all of their questions answered, making sure that they have the opportunity to bring friends and family to appointments or listen into phone conversations, because, you know, once you hear the C word, a lot of times everything else is kind of like the ears are closed off, you can't remember anything else.

And getting the opportunity to, you know, have family members to be supportive is important.

We also have social work services as well, so for folks who are having, you know, additional problems, you know, that are other life stressors, you know, in addition to just having a cancer diagnosis, how are they gonna navigate that cancer care system?

How are they gonna pay for things like that?

You know, having an an expert in social services is really important, and fortunately, we do have that service available at our cancer centers.

- Do most patients know to ask for that, or, when you tell them, do they say, "Oh!

Well, that's good.

I need that"?

- I don't know if it's, we probably should do a better job of making sure that we have that service really well-visualized, because it's something that affects everybody.

You know, cancer diagnosis is scary, cancer treatment is scary.

And, you know, I always try to ask about patients, ask patients if they need any of that help, but I think we do a pretty good job of our nurses asking, you know, in terms of screening questions too.

- Sure.

As far as your facilities, I mean, it seems like, in just the medical field in general, technology keeps changing, keeps changing, which seems to be good, seeing those improvements, but is it hard to keep up with all the constant changes in terms of treatments and machines and drugs and things like that?

- I think it could be, but most of us in oncology have specific areas that we specialize in and focus our focus on those specific diseases.

So, I absolutely am not an expert in things like, you know, urologic cancers or breast cancer, but I stay pretty up to date on gynecologic cancers 'cause it's the one area I focus in.

I think most of our oncologists have an area of expertise.

And the other thing is we, you know, try to stay up to date with continuing education, going to meetings to make sure that we are, you know, implementing the latest and greatest research into the cancer care that we provide here locally.

- We said off the top that breast cancer in women is, you know, the most prevalent type of cancer, but when it comes to your specialty in gynecology, tell me about some of the cancers that you see on a routine basis.

- So the most common cancer that I see is endometrial cancer or uterine cancer, it's the lining of the uterus, and that's the most common cancer.

And it's actually one of the few cancers that is actually increasing in prevalence and mortality in the United States, along with colon cancer, you might have heard that in the news as well.

And so we're trying to make sure that we get the word out for that, you know, about what are the signs and symptoms of that.

So abnormal bleeding, bleeding after menopause are kind of the two that come to my mind.

Other cancers that I take care of, cervix cancer.

Obviously, we've got great prevention services for that.

Vaccination, screening with cervical cancer, pap smears, HPV testing.

And then ovary cancer, which doesn't have a great screening test, but knowing if you're at genetic risk can help to kinda decrease that risk in terms of, you know, surgical removal of the ovaries or fallopian tubes after completion of childbearing.

- Sure.

I wanna try and put you out of business here, so let's give folks some tips on how maybe they can prevent getting some of these cancers.

At what age should women start thinking about, you know, gynecological exams and pap smears and all that stuff?

- Great question, so we can start with HPV prevention, which is the cause of most cervical cancers, a lot of vulvar cancers, and several other cancers, like head and neck and anal cancer.

And vaccination can be eligible for kids as young as age nine, and it's a two- to three-shot series, depending on how early that shot series is started.

We don't typically recommend pelvic exams or pap testing until age 21 because it's a virus, and folks who have a healthy immune system, like young people under age 21, usually doesn't show or cause a problem until after that age.

And then from another prevention standpoint, so ovary and fallopian tube cancers, almost a quarter or maybe even over a quarter of those cancers are related to a hereditary cancer problem.

So if somebody in the family has history of ovary cancer or history of breast or pancreatic cancers, all those are genetically linked cancers, so I would encourage folks to ask their primary care doctor if they're eligible for genetic testing.

Or find out, you know, from their gynecologist if they're eligible for genetic testing, 'cause folks who have a gene mutation who have a higher than average risk for those types of cancers can be eligible for more screening.

From a breast cancer standpoint, mammograms, MRI.

And then from a gynecologic cancer, removal of the ovaries and fallopian tubes after childbearing or closer to that natural age of menopause.

- So if someone does have that genetic mutation, and you mentioned talking to your doctor about that, would they maybe be tested earlier than someone who doesn't have that genetic mutation?

- Yeah, so the indications for testing vary.

So sometimes it's based on family history.

If you have a family member who has early onset cancer, you know, asking your doctor if you meet testing criteria, or somebody who has a personal history of a cancer.

So usually cancers that are diagnosed under age 50, those often are a good indicator that there may be a genetic problem present, and those patients may be offered genetic testing.

- Okay.

Is there anything women can do to maybe help prevent some of these types of cancers?

- Yeah, absolutely.

- Any lifestyle changes we can talk about?

- Absolutely.

- So uterine cancer is a cancer that is more prevalent in folks who are overweight or obese, so making sure that you're trying to take care of yourself in terms of healthy diet, exercise, that's really important.

The other thing that can help with uterine cancer's just knowing the symptoms, because most uterine cancers are caught early because they cause symptoms, but knowing those symptoms is really important to catch it early.

So for folks who are still having periods, bleeding that is irregular, not having normal periods, having multiple periods in one month, or skipping several months without a period and then having heavy bleeding.

Those are indications to talk to a gynecologist to get a biopsy.

Or after somebody has gone through menopause and they start bleeding, even, like, light pink spotting, brown discharge, all of that is abnormal in those folks, so definitely get into a gynecologist to get examined.

- Mm-hmm.

Have you noticed any trends in terms of cancer diagnosis when it comes to, you know, the gynecologic area?

Any types of cancers, you mentioned uterine cancers.

Any other cancers, like, on their way up in terms of prevalence, or any on their way down?

- So cervical cancer is on its way down because of really great opportunities to completely actually eradicate cervical cancer with the HPV vaccination.

We've seen several countries in the world that have been able to almost eradicate cervix cancer based on vaccination.

So that's one that's going down.

And then ovary cancer, still, it's probably pretty stable.

But the more we learn about genetic predisposition to ovary cancer, we have an opportunity to decrease that risk too.

- I'm curious why you decided to get into this particular subset.

- Yeah, so I really like connecting with people and getting to know my patients over a long period of time.

So I get, as a oncology provider for gynecologic cancers, I get to be the patient's surgeon, I get to be their surveillance provider, I get to manage them throughout their whole cancer journey.

And you don't really get that with a lot of other medical specialties.

So being able to really get to know somebody and follow them through a time of crisis is really rewarding.

And being able to offer, you know, my expertise to somebody, really, I feel really honored to be able to, that's, you know, a very intimate relationship, I feel very honored to be able to be a part of patient's care in that setting.

- Do you find that Carle has a lot of different specialized teams in terms of, you know, trying to treat these different cancers?

- Yeah, absolutely.

I think most cancers, you know, the way that things are moving forward, we're learning more about best ways to treat and prevent cancers, and it's really a multidisciplinary team approach.

And so I think almost every type of cancer treatment has a team approach and kinda working together as a collaborative team.

And honestly, being able to work with other members from the Carle Cancer Institute and actually across the Carle different facilities, it's been usually pretty seamless in terms of trying to kinda get patients to where they need to go.

- Yeah, we've been pretty lucky here in Central Illinois to have all the different great medical organizations to help us out because even, you know, 20 years ago with some of these things, you'd have to drive to Chicago- - Absolutely.

- For treatment, and boy, that's gotta stink on top of having cancer, having to make that commute and do this and that, but it seems like pretty much anything can be treated here in Central Illinois.

- Yeah, I think that's amazing, 'cause it definitely didn't used to be that way.

And being able to offer these services is incredible because it's stressful enough to have a diagnosis, more stressful to spend a whole bunch of money and gas mileage and a whole day in traffic in Chicago to try to get the cancer care you need.

- Absolutely.

So if a person wanted to see you for gynecological care, what would be the way to go about that best?

- So they should just talk to either their primary care provider or their gynecology care provider if they have concerns about a cancer or risk for cancer and get a referral to gynecologic oncology at Carle.

And we're happy to take care of folks who need our help.

- Doctor, let's talk about the different types of cancer.

Like we said, there are a lot out there.

We know the most prevalent ones, it seems, but there's also subsets of those.

So, what are we seeing at Carle that doctors are treating?

- So one of the ones we talked about before is breast cancer, that's obviously a really common one, prostate cancer.

Colon cancer and lung cancer, I think, are the ones that are probably the most common.

Uterine cancer's up there as well, which is what I take care of.

So because of that, there's a whole bunch of different types of practitioners that take care of those different types of cancers.

So, you know, we briefly talked about, like, medical oncology and radiation oncology.

But for some of those other types of cancers, folks who have been diagnosed with those will see other types of providers as well.

They might see surgeons that operate within the chest, you know, cardiothoracic surgeons from a lung cancer perspective.

They may see colorectal surgeons if they've been diagnosed with a colon or a rectal or anal cancer.

And then of course, you know, if somebody's been diagnosed with a brain tumor, they may see a neurosurgeon, and then we also have neuro-oncology.

Urology can often help with urologic cancers.

There's also urologic oncologists.

There's a whole bunch, obviously.

For folks who are pediatrics, there's pediatric oncology hematology, who specializes in things like leukemia and lymphoma.

And then medical oncology, who usually has different areas of diseases that they specialize in across those different types of, so many different types of cancer.

- Yeah.

We talked about, you know, going maybe to your primary care physician at first if you're worried about something.

If there is a cancer diagnosis or there may be a cancer diagnosis, tell us a little bit about how it works with the, you know, blood work and imaging and things like that.

- Sure, so usually, you know, there's some sort of indication of some concern for cancer.

So maybe it's a symptom that gets worked up with a physical exam.

That usually will start in a primary care doctor's office, maybe a gynecologist's office.

And then following that, often we'll proceed with some imaging.

So that could be ultrasound, it could be a mammogram, it could be a CT scan or a PET scan.

One of the questions that I often get is, "Oh, I have a cancer.

Do I need a PET scan?"

It seems to be a really popular type of imaging, and it really depends on the different type of cancer.

So some cancers, the PET scan works really well in terms of picking up cancer spread outside of the organ where it started.

Sometimes it doesn't.

So I would say that's something that we really individualize with the patients.

Sometimes people will be recommended for additional tests, like MRIs, to see how, you know, where the cancer is located in terms of if it's amenable to have a surgery to remove it or something like that.

But typically we need a biopsy, whether that's performed in the operating room with interventional radiology or in the office, to get that diagnosis before we can really start the ball on treatment discussions.

- Okay.

Any words of wisdom for people out there who may be watching who are fighting cancer as we speak or may be worried that something's not right inside of them?

- Yeah, I'd say just speak up.

Advocate for yourself.

If you're worried about something, make sure that your doctor, your practitioner knows about it.

And if you don't feel like you're heard, find somebody who will listen to you.

I think that's most important, is really just advocating for yourself.

And then don't forget your screening tests, so colon cancer screening, breast cancer screening, cervix cancer.

All of those things are really important because they can decrease the chances that we find a cancer and can prevent cancer altogether.

- All right, Dr.

Megan Hutchcraft, she is a gynecologic oncologist, I think I pronounced all those right, with Carle Cancer Institutes in Normal and Urbana, we appreciate your time, and thanks for all the info.

- [Megan] Yeah, thanks for having me.

- All right.

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