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HealtHy life: CanCer
August 29-30, 2012
By SAUNDRA SORENSON
Pamplin Media Group
In cancer diagnosis and treatment, clin-
ical imaging is an essential, if imperfect,
tool.
Michelle Tilley, clinical imaging manager at
ProvidencePortland, explains thatwhena tumor
is suspected, there are “several modalities” phy-
sicians use in tandemwith biopsies. The type of
imaging tool used depends on the location of the
suspected tumor — certain approaches are use-
less given the kinds of “artifacts,” or potential
interference, might be present in the scan.
For example, any kind of X-ray is useless if
there is bone material, such as skull, that needs
to be penetrated to scan for a tumor. And if a pa-
tient is required to hold his breath during a scan,
she says a computed tomography (or CT) —
which takes an image “within a millisecond” —
is the obvious choice over magnetic resonance
imaging (MRI).
If it’s suspected that the cancermight haveme-
tastasized or spread to the bone, says Tilley, a
bone scan might be recommended along with
nuclear medicine to determine the extent of the
cancer.
“It really is dependent (on the patient). Some-
times it takes multiple modalities,” said Tilley.
“We might do some initial imaging with ultra-
sound, then the patient may be referred for a
CAT scan. All of the modalities partner togeth-
er.”
If a suspicious growth is found, a biopsy will
generally follow.
“No one is ever going to treat for cancer until
there is a cellular diagnosis, or until some type
of biopsy has been done,” said Mary Boros, a
radiologist at Providence Portland.
She adds that some imaging tests are more
accurate than others.
“Screening for breast cancer is one of the
greatest success stories in medicine,” she said.
“We’ve lowered the death rate from breast can-
cer well over 30 percent since we started doing
screening mammography.”
But when a screening calls formodalities that
are known for being less exact, there’s danger of
misdiagnosis.
“There are things that are not cancer that
mimic cancer,” said Boros, “what I like to refer
to as awolf in sheep’s clothing. There are things
on imaging that look very benign but in fact end
up being cancer.” She said that the path a physi-
cian takes when determining the type of imag-
ing to use, and how much to rely on that imag-
ing, is “totally dependent on the modality, how
a patient presents clinically, their symptoms,
whether they have a lump.”
Meanwhile, there are a few cancers — like
skin cancers — where imaging plays no role,
said Boros.
After a patient has been diagnosed and a
proper course of treatment has been decided
on, imaging allows physicians and radiologists
to “assess the efficacy of the treatments all
through the course of care,” said Tilley.
In breast cancer, saidBoros, imaging can play
a more active role.
“A woman will commonly get chemotherapy
before she has her surgery, and we typically do
ultrasounds and MRIs to look at the size of the
tumor and to look for shrinkage while the wom-
an is getting chemotherapy,” she said. “After it’s
shrunk to a certain point, the surgeon can say
that it’s time to go in” to remove the lump.
With most cancers, “Oncologists and sur-
geons use these imaging studies to follow the
response to treatment,” she said. “An oncologist
can use CAT scans and MRIs and PET scans to
watch how patients respond to their chemo
therapy, and to figure out (A) is the chemo ther-
apy working, and (B) howwell is it working?”
This is all in addition to the yearly follow-up
to ensure that a patient’s cancer has not re-
turned.
Boros has been practicing radiology in Ore-
gon for six years after working on the East
Coast. She credits Oregon’s medical profession-
als with beingmore likely to performas a team,
with oncologists, radiation oncologists and sur-
geons working together around each patient in
a system she refers to as a “coordinated care
experience.”
“We have regular conferences where we dis-
cuss patients and their treatment regimens and
what imagery they should be getting,” she said.
“It’s almost likewe’remore likely tomake group
decisions. It’s a very collegiate environment,
and patients feel more watched after. They love
to know that their doctors are communicating
about them behind their back.”
Dr. Stan Cohan
points to
“Dawson’s
Fingers,” actual
MS lesions
shown on an
MRI of a brain.
PMG PHOTO:
JIM CLARK
Screening for a cure
■
When it comes to treatment, imaging plays an important role
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