30th Anniversary Celebration: XXX-Out Cancer
Oncologist Coty Ho, M.D.
Not too many years ago, many patients regarded a diagnosis of cancer as a death sentence. Cancer treatments were few and ineffective and most had debilitating side effects such as nausea, anemia, and pain. Unfortunately, these misperceptions persist. But cancer treatment today is very different from that offered a decade ago, says Dr. Coty Ho, chief of medical oncology and associate professor of oncology at UT Health Northeast. Cancers that used to quickly kill patients now can be controlled and sometimes go into remission for years. Painful, nauseating chemotherapy has been replaced with targeted treatments that kill cancer cells and minimize incapacitating side effects. And it’s research into how cancer works that has led to these tremendous advances, Dr. Ho says.
"Cancer originates from our own bodies. It’s a part of us that has gone wrong, gone awry. It doesn’t respond to normal growth control," he says. "It becomes an immortal cell and has the potential to grow much faster than normal cells. These cells continue to replicate without any restraint, and the final products are very bad, abnormal cells," Dr. Ho adds. "Unlike their counterparts, the normal cells, these cancer cells do not function correctly," he says. At this stage, the cancer interferes with crucial bodily functions and becomes life threatening. Within the past 10 or 15 years, researchers have gained a much better understanding of some of the many biological pathways that cancer uses to grow. Once researchers understand a pathway, they can design a therapy to block it. But that’s not the end of the story.
"You block cancer one way and it takes an escape pathway, a new detour around the block," Dr. Ho says. "It’s very hard to block all the pathways. That’s why there’s not a cure yet." Fellow oncologist Dr. Thomas Gregory says patients need hope. "I explain to them that there have been a lot of advances in treatment. While many malignancies are incurable, almost all are treatable. We cannot predict exactly how an individual patient is going to respond to treatment, but there’s always a chance that a patient will respond well," Dr. Gregory says. One new cancer therapy involves genetically engineered monoclonal antibodies, which are designed to keep cancer cells from growing. Because these antibodies block a specific growth pathway of cancer cells, they don’t affect normal cells as much and so do not cause traditional chemotherapy’s side effects – hair loss, nausea, and anemia.
More and more cancer drugs now are taken orally, as pills, rather than being administered via an intravenous drip into a patient’s vein. "The key for you, as a cancer patient, is to find out as much as possible – with the guidance of your physician – about your cancer. It’s important to have guidance, because some information on the Web, for example, isn’t reliable," Dr. Ho says. Well-understood, effective therapies are available to treat many cancers. It makes sense to try these first. If the standard therapies don’t work or stop working, then go on to more experimental treatments, he says. "The patient can really help his or her overall medical treatment by being part of the team. You should never be afraid to ask your physician any question. You should make clear how aggressive you want treatment to be, so that your physician and your family understand what you want," Dr. Ho says.
Armed with information, you can evaluate treatment options. That’s the best way to direct your own treatment and also ensure the best possible outcome. "For physicians, the key to talking to patients is compassion. You have to show the patient and the family the reality of the diagnosis, and also show them that we have treatments, we have something to offer them," he says.