Why do you see the Oncologist or Hematologist?

1. Why do you see the Oncologist or Hematologist? Dr Kevin Imrie, Hematologist, Odette Cancer Center Cutaneous Lymphoma Educational Forum April 14, 2012

2. Objectives • To provide you a Hematologist/Oncologist’s perspective on skin lymphomas • To understand drug treatment options for skin lymphomas • To understand what comprehensive cancer centers have to offer you

3. Lymphoma • Name given to Cancers of the Immune system • Relatively common, fifth most common cancer • Most commonly presents in the lymph nodes • Skin the third most common area affected • Lymphomas of the skin behave differently

4. What is cancer? • Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues • Cancer cells can spread to other parts of the body through the blood and lymph systems. • Cancer is not just one disease but many diseases. There are more than 100 different types. Most are named for the organ they start in • Not all behave the same www.cancer.gov

5. Loss of normal growth control

6. Lymph Nodes

7. Treatment of lymphomas • Lymphomas can be aggressive or slow growing • Not all require treatment • Many, but not all, can be cured • Surgery not an effective treatment • Most common treatments: • Chemotherapy • Radiation

8. Skin lymphomas

9. Skin Lymphomas • Lymphomas of the skin are different from other lymphomas • Often better-behaved • Treated differently-ie chemotherapy not commonly used • A number of different types • Aggressive or slow growing (indolent) • Primary or secondary • B or T cell

10. Types of skin lymphoma

11. Treatments for skin lymphomas • Observation • Creams (Steroids, others) • Retinoid pills (Accutane, Targretin) • Ultraviolet treatment-Phototherapy • Interferon • Radiation • Chemotherapy • Antibody treatment • Extracorporeal photopheresis • Experimental treatments

12. Retinoids • Drugs related to Vitamin A • Used in a number of skin conditions • Active in skin lymphomas • Isotretinoin (Accutane) and Bexarotene (Targertin) the most commonly used • Often used in combination with other treatments • Side effects include skin dryness, high cholesterol and underactive thyroid • Can cause serious birth defects and precautions must be taken to prevent pregnancy

13. Interferon • Naturally produced substances • Involved in communication in immune system • Active in more advanced skin lymphomas • Given by injection under the skin • Often given with other treatments • Can have side-effects such as fatigue headache, muscle pain • Requires monitoring • Expensive and funding can be difficult

14. Chemotherapy • Chemotherapy is the name given to drugs that kill cancer cells • Most work by damaging dividing cells • Many of the stronger drugs and combinations used in other lymphomas not as useful in skin lymphomas • Gentler oral medications more effective • Chemotherapy drugs used: • Methotrexate, Chlorambucil, Fludarabine, vorinostat

15. Extracorporeal photopheresis (ECP) • Specialized technique used only in advanced skin lymphomas such as Sezary syndrome • Involves removing blood, running it through a machine and exposing it to ultraviolet light • Used very selectively • Offered at Princess Margaret Hospital through Dr David Barth

16. Why you see an Oncologist?

17. Cancer Centers

18. Comprehensive Cancer Centers • Bring services patients with cancer need under one roof • Diagnostic testing • Staging • Surgical, drug and radiation treatment • Supportive services • Nutrition, social work, help with drug funding, etc • Practice in an inter-disciplinary model of care • Teamwork between all health professionals

19. Cancer specialists • Hematologists: • Specialists in diseases of blood and lymphatic system • Medical Oncologists • Specialists in drug treatment of Cancer • Radiation Oncologists • Specialists in treatment of cancers with radiation • Surgical Oncologists • Specialists in surgical treatment of cancer

20. Our team

21. Skin Lymphoma clinic

22. What we can do for you • Confirm the diagnosis • Predict the cancer’s behavior (staging) • Offer a range of treatment options • Multidisciplinary team approach • Get opinions from a panel of experts • Offer supportive care options • Nutrition, psychosocial care, reimbursement experts, wound care, others

23. Patients treated and followed at the cancer center • Those needing chemotherapy, interferon or Extracorporeal photopheresis • Patients with tumor stage disease or lymph nodes or blood affected • Those requiring radiation • Those with rare lymphoma types • Those with higher risk disease • Most others are followed by their dermatologists

24. Conclusions • Skin lymphomas are uncommon • Most can be effectively treated • A variety of treatment approaches is available • A team-based approach with dermatologists and oncologists offers a greatest variety of options

25. Questions We are interested in your feedback