July 13, 2025 • 42 mins
Sarcoma is deadliest cancer among children and young people, accounting for nearly one third of deaths among the 15-24 age group.
Despite this, research funding remains low compared to more common cancers, and feeds back into low survival rates.
It's also reportedly misdiagnosed a third of the time, highlighting the urgent need for better early detection.
What do we do if we feel like our doctors misdiagnosed us? What signs should we look out for?
How can we balance cancer-research to address the common ones and the deadliest ones?
Orthopaedic Surgeon Andrew Johnston joins Tim Beveridge for the Health Hub...
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Speaker 1 (00:05):
You're listening to the Weekend Collective podcast from News Talks EDB.
Speaker 2 (00:17):
Hi Hi, Yes, and welcome back to the Weekend Collective
on this July thirteenth, twenty twenty five.
Speaker 3 (00:37):
I'm Tim Beverage. By the way, if you missed any
Politics Central go to our podcast. You can check it
out on news talksb dot Curda NZ but also on iHeartRadio.
Just look for the Weekend Collective and we get it
loaded pretty quickly after each hour is up. Now we've
got a new guest today and a new focus for
the Health Hub because it is currently I think it's
(00:59):
called Sarcoma Awareness Month, but anyway, Sarcoma is the deadliest
cancer among children and young people. It's responsible for nearly
one third of deaths among the fifteen to twenty four
age group, and despite this, research funding remains low compared
to more common cancers. We can all think of the
cancers that I've got, the ones that are more an
(01:21):
easier self for instance. I mean, we can look at
the difference between prostate cancer and breast cancer and what
gets the most coverage. But of course, you know, there
are lots of diseases that struggle to the people who
are looking into cures and getting better diagnosis. There's constantly
struggling for funding. And it's also that ssacoma is reportedly
(01:41):
misdiagnosed a third of the time, which highlights the urgent
need for better early detention detection. So in saying that,
what do we do if we feel like a doctor,
how do we go about working out if we've been
correctly diagnosing in the right diagnosis. And there's a whole
lot of issues around this. Anyway, I'm going to stop
talking because well I will continue, of course, but we
(02:04):
are joined by Andy Johnston. He's an orthopedic oncologist and
he's with us now. Actually I might just get you, Andy,
to pull the microphone just closer to sort of just
there we go, Andy, good, I, how you going good afternoon?
Speaker 4 (02:16):
Thanks very much for having me.
Speaker 3 (02:17):
On orthopedic oncologist.
Speaker 4 (02:21):
I get that right, Yeah, that's that's spot on. So
that's just a descriptor of an orthopedic surgeon who deals
with cancer as part of their sub specialty.
Speaker 3 (02:30):
And how long is it? How did you become an
orthopedic on coologist And tell us about the journey. We'll
learn a little bit about you before we get into
the substance of what we're here to talk about.
Speaker 4 (02:40):
I became an orthopedic on collegist because when I came
to New Zealand and started working as an orthopedy junior
register of Auckland Hospital, I worked with the then Tacoma
surgeon there, Mike Hanlon, and then I left his run
and worked with Mike Flint and Gary Friendship Counties.
Speaker 3 (02:59):
How do you get directed into that sort of area
of medicine.
Speaker 4 (03:01):
I guess you have to have an enjoyment and a
love for that particular thing. It's it's a kification. You
enjoy some part of what you're being e supposed to
and you think, well, I can see myself doing this.
Speaker 3 (03:15):
Because oncologists traditionally sort of that's a medical side of things,
and you you also have a surgical side as well,
and I guess they go hand in hand to that.
Speaker 4 (03:23):
We work very closely with medical oncology, redition oncology, pathology,
and our specialist team, so a big old team looking
after psarcoma for example.
Speaker 3 (03:32):
So is it Sarcomer Awareness Month? Isn't it?
Speaker 4 (03:36):
It is July every year?
Speaker 3 (03:37):
Yeah, So can you give us some context for what
this disease is how how dangerous it is and the
challenges that faces in terms of.
Speaker 4 (03:45):
Finding I mean absolutely, I think probably a good way
to start is I mean, you were seeing about cancers
and the more common ones, and the more common ones
are carcinomas, and carcinomas are cancers that develop from lining cells,
so breast, bow, prostate, lung, they're all lining cell cancers,
and lining cell turnover much more common, much more frequently,
(04:09):
and and so there's much more chance for something.
Speaker 3 (04:11):
To go wrong carcino. I'm taking that because I just
sort of.
Speaker 4 (04:18):
Feel Sarcomas are cancers of connective tissue and what we
call amusing chymal origin, So they are things like bone,
near fat, muscle, okay, blood, vessel walls, and and cartilage,
and they are much more stable things, and they don't
turn over very often and so less chance for something
(04:38):
to go wrong.
Speaker 3 (04:39):
That actually just the lip out of me here is
that the casinamus turn over more often. Does that mean
that because they're turning out of some reason my brain
tells me that they would be easier to detect or not.
Speaker 4 (04:52):
Well, they're just more common, and there are things like
blood tests for some cancers and there are screening programs
for some cancers. We don't have that luxury. It's it's
it's one of the oldest own cancers. There is found
in a hominid, which is how one of human's early
ancestors at one point seven million years ago. And there's
(05:13):
even osteosarcoma, which is one of the bones Sarcoma's identified
in dinosaurs. So this has cancer that's been around forever.
It's not becoming more common. It's we're seeing more of
it as we there are more of us. Is that
we are living longer.
Speaker 3 (05:29):
The better. Are we more effective at diagnosing it? No? No, no,
why not?
Speaker 4 (05:37):
It's it's diagnosis is done through pathology, and that the
critical part of our team is our pathologists and for
the audience who don't know, that's people who are specialized
in looking at cells down microscopes and giving a diagnosis
on what those cells look like. And that's that's getting
more and more sub specialized and more and more accurate
(06:02):
with the with the advances and genetic labeling of things.
So that's definitely getting better. Our major hurdle is not
once they hit our service, is getting them into our service.
What you alluded to earlier on about delay and diagnosis
and people not being aware of sarcoma existing.
Speaker 3 (06:21):
And how much of the awareness is Oh okay, I'll
keep on thinking. I'm trying to avoid becoming political or
saying and controversial, but how much of the lack of
awareness around sarcomas is just public awareness versus political awareness
versus actually awareness within the medical profession.
Speaker 4 (06:41):
I mean, all our problems, I don't think any one
of those is worse than the other. I guess a
lot of your listeners may have never heard the term before,
which is again a very common problem. It's estimated that
a family doctor, a general partitioner will see one case
of sarcoma and their entire working career. So okay, for them,
(07:02):
it's a small it's a small part of what they
are dealing with, and they'll see umptyen breast cancers a year,
humpty in bell cancer, cervical cancers a year.
Speaker 3 (07:12):
So did you say one in their career year.
Speaker 4 (07:16):
Is the average?
Speaker 5 (07:17):
Yeah?
Speaker 4 (07:17):
That's the often stated figure.
Speaker 3 (07:19):
Is that? I mean, intuitively, that sounds like part of
the battle around awarenesses because it's just not prominent enough
for people to think, oh, well, this is it picks
a few people.
Speaker 4 (07:28):
It's absolutely right, and that's part of the reason. Why
is it sarcoma clinicians have to go about but you know,
rattling the drum making sure that people are aware that
this problem exists.
Speaker 3 (07:41):
So the Sarcoma Awareness Month, what is what do you
want to see? What are the people who work with
this disease? Diseases? Is that the right world? I don't
even know if it is. What do you want to
achieve from Sacoma Awareness Month?
Speaker 4 (07:55):
Is just trying to bring the awareness that this disease
is out there, what to look for, when to go
to your doctor, and what and what things to say
to your doctor. And because this will drift out of
people's memories not long after this podcast, after this radio program,
and it's about doing the same thing every now and
again and raising it in people's minds to say, well,
(08:16):
actually that that could be a sarcoma and maybe I
should go and get that checked out.
Speaker 3 (08:22):
So what what would what are some of the symptoms
that people might want to be aware of.
Speaker 4 (08:26):
Well, again, this is something that doesn't help the cause
because there are it can affect any age, so the
infants and babies can get it. And ninety year olds
can get it, and the way it presents is different
along those age groups. Soft tissue sarcoma is much more
common in older people and there are one hundred different subtypes. Okay,
(08:53):
so very very very confusing for people. And some of
those subtypes signovial sarcoma lyo myyer sarcoma can behave in
a very indolent, reassuring thing. So, oh, doctor, I've had
this lump for two years. I think it's getting a
bit bigger. Oh right, well it's probably nothing.
Speaker 3 (09:12):
Okay, Well you've got you've got a lump, and that
is something that everyone can recognize, isn't it. Absolutely What
sort of lumps are we talking about?
Speaker 6 (09:18):
Are they?
Speaker 3 (09:19):
Because you mentioned that they're you know, attaches to bone.
Obviously you're an orthopedic, yeah on college. Just so you're
concerned with psychomasm, bone.
Speaker 4 (09:27):
Borne and soft tissue and soft tissues.
Speaker 3 (09:29):
So that would be what cartilage and.
Speaker 4 (09:31):
Connected cattliage comes under bone, so muscles, fat nerves, Okay, yeah,
all of that.
Speaker 3 (09:37):
So looking further out, are there other expertises who deal
with psychoma or is that all your.
Speaker 4 (09:44):
So we do the orthopedic on colleges do most of it,
and there's another group called general surgical on colleges and
in particularly rich per to neal sarcoma, which happens in
the abdomen and the rich peraitiniums the area right back
where your kidneys are, and that's even rarer. So in
the North Island we see you about twenty to twenty
five cases.
Speaker 3 (10:05):
Year, Okay, And I mean I don't like to dig
into those things, but you've mentioned that's what we're here for.
Of course, it's the deadliest cancer among children and young people.
Is that because well, I guess it's a deadly cancer anyway.
Is it a higher risk to everyone? And children? Cancer
can be particularly aggressive? What where we at with that?
Speaker 4 (10:26):
Well, that's right, so it happens. It's bone cancers that
are much more common in young people, although those two
that I mentioned, the synovial sarcoma and the Lyo Mayer
can also happen in young people. And it happens in
younger people because of what we mentioned with carcinoma, so
the rapid turnover of cells and more chance for something
to go wrong. So classically it happens around the knee,
(10:48):
although it can happen anywhere. And that's because your thigh
bone grows from the knee side and your shin bone
grows from the knee side. So all that cell growth
and turnover is happening at the end of your thigh bone.
Much more chance for a cell to go wrong there
and become cancerous.
Speaker 3 (11:04):
Do we know what causes cells to go wrong?
Speaker 7 (11:06):
No?
Speaker 4 (11:07):
Well, there we know in a biological way that the
celle has to have a genetic mutation, and the sales
defense systems that normally pick up those genetic mutations and
cause the sale to commit suicide have failed, and so
a cancer grows.
Speaker 3 (11:23):
You know, you mentioned that how many million years ago?
It goes back to.
Speaker 4 (11:27):
One point seven in hominids and a toe bone I believe,
and a bone and a dinosaur. So however, many hundreds
of millions of.
Speaker 3 (11:37):
Years a go, and I mean just from the do
do you learn things from the fact that it's been
such an old cancer or anything?
Speaker 4 (11:45):
Or is it not really? I guess it just what
the point of illustrating that is to say that this
has been around forever and it's not becoming more common.
And one of the questions patients will often ask when
you're breaking the bad news that I'm terribly sorry you've
got a sarcoma? Is how why have I got this?
(12:05):
And you know the reason is random bad luck?
Speaker 3 (12:09):
So generally, how do people end up? As you say,
the problem is diagnosis? It's so rare and a GP
might see one in their career. How on earth did
they ever make their way to you? Because it sounds
to me that it's so far off the radar for
people in general. How does the case make its way
to you?
Speaker 4 (12:27):
A variety of ways. Children, it's often a limp and
a persistent limp, and then somebody gets an x ray
and that actually shows the sures, the changes in the
board and keeping with sarcoma, and then they get they
get put down the right pathway. With adults with soft
tissue lumps and bumps, it can be a much more
prolonged process because it's human nature to think, I've got
(12:51):
a bit of a bump there, How did that happen?
I'll bump my leg on the cheer seven weeks ago.
That must be why I've got that bump there. And
then they go to their family doctor and say, well,
a lump of my leg, I banged it and the
doctor says, well, it's probably just a little bit of
a you know, it's just all makes sense, And so
that's what you get to. The thing where people have
sought multiple opinions before they finally get referred.
Speaker 3 (13:16):
So how important is is time in getting early detection
and how much of a difference does it make?
Speaker 4 (13:24):
Yeah, it makes a massive difference. So the quicker you
can get it, the smaller it is, the less chances
had to spread, and also the less of the effect
of the surgery that we have to perform to get
rid of it. So if you've got a massive tumor
involving half the palvis and we've got to cut out
half your palvise, then that's got a much more impact
(13:47):
on your life. And if we can get it smaller,
we only have to cut something smaller. So size matters
from a recovery and from an effect on your long
term quality of life.
Speaker 3 (13:59):
Is excision removing it the only way to deal with no.
Speaker 4 (14:03):
There are lots of different treat slightly different treatments of
the different subtypes of sarcoma, the bone sarcomas. The common
ones are osteosarcoma, the one we've mentioned that was a
dinosaur and then one called ewing sarcoma, and they are
generally treated with something called neoagefic chemotherapy, which just means
they get some chemotherapy for about three months, then they
(14:26):
get surgery to remove the tumor and reconstruction if reconstruction
as possible, and then they finish consolidation chemotherapy. So the
whole journey takes nine months to a year.
Speaker 3 (14:36):
So it doesn't sound like so even though you are
doing oncology I'm sorry, chemotherapy and other treatments, you still
have to remember.
Speaker 4 (14:45):
You still have to remove the primary tumor. Ewing sarcoma
in some cases can be treated with radiation therapy to
control the local the primary tumor. But in the main
surgeries and what we do and then that the chondrosarcoma,
there is nothing else. There is only surgery. Nothing is
effective against it.
Speaker 3 (15:02):
So just how what is the pace of So if
somebody has a cell that goes I don't know what
the word is for it, but it goes wrong, goes wrong,
what's the journey in terms of for it to become obvious, well,
to become yeah, to become obvious and then to become
I mean, how quickly does a tumor grow, so you
(15:23):
might let's let's talk about your knee. You've got a
cell that's gone walking in your knee. What's the journey
in terms of time until from a surgical point of view,
it's like we have to do something really major here.
Speaker 4 (15:33):
I mean many many months in reality to possibly longer,
and some subjects before that tumor even becomes big enough
for you to be aware of it, and then you know,
the surgery will depend on how big it's got by
that stage. And it's very difficult to see how long
someone's had something when they when they pitch up, you
(15:54):
can make an estimate that that's been there for a
long time. What you can often tease out from someone's
history is that, oh, yeah, I noticed that, but I
didn't think it was that important, and that was four
months ago.
Speaker 3 (16:05):
That sounds like the lesson you'd want people to take
away from this, wouldn't you be if you have you've
got some I mean, is it the pain that someone
would get let's say it's an osteosarcoma we're talking about
the bone, is when would someone start feeling something was
wrong because obviously one cell going. You're not feeling anything.
Speaker 4 (16:25):
Yeah, you start to feel something wrong in an osteosarcoma
or ing sarcoma, when either the boone becomes weakened to
the point that it's structural and integrity is threatened, that's
when you start to get the limb or it's pushing
on something else. So ewing sarcoma can push, can have
a massive soft tissue comportent and can push against an
air or some things like that.
Speaker 3 (16:44):
How do you and what do you mean when we're
talking about this on on a nationwide radio sort of thing.
And one of the things that's a bit like when
you google. If you google your symptoms the layperson does,
you can become quite catastrophic about you can. Where do
we so? What's the what's the media in the happy medium?
(17:06):
In terms of where you'd want people to be the
awareness you'd want to have people to have of something.
Is it almost if someone listens and they've got a
friend or a relative or something you're saying, I've had
this pain for such and such for seven or eight weeks,
then somebody might go or you might want to get
that looked at.
Speaker 4 (17:20):
What do you want yeah, I think that's right. I
think the first thing you want to do is go
to your family doctor and say, look, I've had this,
you know, can you can you have a look at it?
What do you think? And the first step, hopefully is
the GP says, yeah, that is a concerning thing. We're
going to get an ultrasound and if that's worrying, we'll
refer you, or we're going to get an X ray
if it's a bony thing. Part of the problem with
the soft tissue sarcomas is they are not painful. They
(17:43):
are not sore until they become massive. So most people
present with a penless lump.
Speaker 3 (17:50):
And when you say soft tissue, that's not cartilage because
that's inclined.
Speaker 4 (17:53):
And that's concluded in bone, so muscle, nerves, fat. Some
of them are so poorly differentiated and we've lost their
original cell line.
Speaker 3 (18:03):
If I had a sarcoma and mathyle something would would
I would you could could someone feel it? Yeah? Okay,
so you would feel a lump. Yeah, and that's not
necessarily the pain. You'd go call they've got a strange
lump in the file. So unless it's involving in there,
and in terms of parts of the body. Are there
parts that it's more.
Speaker 4 (18:22):
Common in the born ones, Yes, so those areas of
high growth around the knee, top of the armborne and
in soft tissue. It can be anywhere. It can be
in front of the savaka spain, it can be in
your neck, it can be in your chest and on
your ribs and sege your lung, can be anywhere.
Speaker 3 (18:41):
Well, uh, we're going to continue the chatting just a moment.
There's lots of lots for us to talk about and
talk about with this disease. Where with Andy Johnston, he's
an orthopedic oncologist. If you'd like to join the conversation,
we've got any questions for Andy about about something, then
give us a call on topic. By the way, when
I say orthopedic oncologist, we're not going to be taking
(19:02):
calls about whether you need your hip redone. But if
you've got some questions for Andy about this on eight
hundred and eighty ten eighty text on nine two nine
two as well. This is the health Hub on News
Talk set B. It's come out to twenty four past four.
Every one else got lambe yes, guess.
Speaker 7 (19:33):
You don't know your yes?
Speaker 6 (19:37):
Welcome back.
Speaker 3 (19:38):
Sir, the Weekend Collective, I'm Tim Beverage. This is the
Health Ub. By the way, if you're wondering why on
earth I'm playing one direction, it's actually because we offer
our guests the chance to play a song of their choosing.
And my guest, Andy Johnston, it's not a song of
his choosing, but this is that's sort of a son
who's about to perform it an a talent quest. So
so that's that's for you. Andy's son. My guest is
(19:58):
Andy Johnston. He is an orthopedic oncologist, and we're talking
about the challenges of COMBA because it's a psarcoma awareness month.
Speaker 1 (20:07):
Now.
Speaker 3 (20:08):
I gave a stat which we discussed. The stat Andy
mentioned that maybe a GP might only encounter one case
in their whole career, which makes it sound in my
mind I filed away just handful of cases. But Andy,
this is something like between two hundred and three hundred
cases per year. I think you deal with the North
Islanders around two hundred cases per year, would that be right?
Speaker 4 (20:29):
Yeah, so about two hundred new diagnosis per year for
the Northaland, including kids and adults.
Speaker 3 (20:33):
And what's the prognosis when it comes to survivability on
two hundred people.
Speaker 4 (20:38):
Very much depends on their subtape and when they present
and whether it's spread where the tame they arrived. But
the overall survival average for all sarcomas is fifty percent
and ten years.
Speaker 3 (20:49):
And the treatment, the chemo for it is pretty hard.
Speaker 4 (20:53):
Work, isn't It's incredibly toxic. So chemo therapy for rostio
sarcoma and ewing sarcoma is some of the most toxic
chemotherapy given, so it really hits.
Speaker 3 (21:03):
Why is is that just? That's as far as we've
gotten in terms of the chemotherapy is. Of course, it
used to be the It used to be the case
with early chemotherapy that the cure was almost worse than
the cause sometimes, but the chemo didn't kill you.
Speaker 4 (21:18):
Now that's right, we haven't got any of them. You
may have heard of melanoma and some other cancers having
immune therapy. That's if ficacious breast cancer's got horrmone treatments,
that effic is prosty. We don't have any of that,
and so it's all fashioned sight of toxics. In other words,
cell killing chemotherapy.
Speaker 3 (21:37):
Gosh, we're taking your cause. By the way, if you've
got any questions for Andy, give us a call on
our one ten and eighty Bruce. Hello, Bruce, are you there?
Hang on a second, let's just check that you are there,
just Asaiah. Have we got everything turned up there that
we should be able to hear? Bruce?
Speaker 7 (21:54):
I'm here?
Speaker 3 (21:55):
Oh there you go?
Speaker 7 (21:56):
Where you good? Okay? Yes, let's say cancerous disease that
I've never heard of. But I go to a skin
wanted a better term, the skin specialist where I get
fun cancerous growths from being out in the sun too
long cut out, And I pointed out this little pie
(22:19):
sized lump up from my big toe or the second
tie in, and they had the same clinic. They did
an ultra sound on it and referred to it as
a as a foreign body. But it's a lump of
a pea and it's been like the same for the
(22:39):
last two years. So I might be overly worried about it,
but it's just it's not painful. It's just annoying when
I'm exercising flat on a tummy and I can just
feel it's pressing.
Speaker 3 (22:53):
Has our conversation made you think you would like to
ask the question?
Speaker 7 (22:58):
Yeah? Is it something to be concerned about.
Speaker 3 (23:02):
Well, Andy, this is the sort of thing where people
are going, am I catestraph? But from the conversation I
can say, well, Bruce would be like, yeah, I.
Speaker 4 (23:09):
Mean it's it's very difficult and that in Bruce's case,
and thanks for your question. Bruce just quite nicely highlights
highlights the issue. So some of some of those peace
sized lumps will get bigger and become and become more
obviously nasty. In Bruce's case, someone's done the right thing.
They've done an ultrasound investigation, and an altra sound is
very good screening tool. It's by no means gold standard
(23:31):
for us, and we don't look at them in our
m d T. But it will point you in a direction.
This is a benign looking, not very worrying, doesn't have
any blood supply, and with Bruce's quite reassuring history, that's
that's pretty good. So I wouldn't worry about it, and
in particular unless it was causing you issues, which it
sounds like it might be, and then you can always
(23:53):
have it removed.
Speaker 7 (23:54):
In a minor way. And it hasn't been larged over
two years, I don't think. Yeah, just annoying. The lump
the peace size or slightly bigger.
Speaker 3 (24:05):
I'm surprised they haven't cut it out actually, but then
again sometimes.
Speaker 7 (24:08):
Well actually, actually the chap that does have done some
work on my other parts of my potty for some
some cancerous grass, and I pointed out to him. Any
city will remove it, So that's going to happen in August.
Speaker 3 (24:28):
Okay, well that's good, that's good, Bruce. Well, I mean
they'll probably they'll probably send them. Do they send when
they do remove things, they send them away for a test,
And yes, absolutely, so we can reassure Bruce, don't panic.
You're getting it removed, and it will be what's the
word biopsied.
Speaker 4 (24:41):
Or biopsy is they'll send off to the pathologists who
will look at it in the microscope and tell them
what it is.
Speaker 3 (24:47):
So what do you you mentioned ultrasound? What are the
diagnosis tools that lead you to a diagnosis of like, okay,
we've got something serious here.
Speaker 4 (24:55):
So ultrasin is a very effective tool that our general
practitioners can use if it's a superficial light puma, which
is a benane tumor, and an ultrasain is usually good
at pecking that up and reassuring or assist, but we'll
also show something that's a bit more worrying, and at
that point the GP usually would refer into the hospital.
If it is in Gisbon, it'll be on a two
(25:16):
week wait cancer pathway into the local hospital and then
an MRI would be done at that point. If it
was in your leg, for example, the local orthopedic surgeon
would usually refer it straight to the North Aland Sarcoma
MDM and then it would go on our weekly MDM meeting.
Speaker 3 (25:34):
How much of what you do is on the Oh god,
I've got some crude analogies here, but I just mean,
you know, from a cliche point of view, it is
on the smell of an oily rag. In terms of
the funding that you would like versus how you cope
with it as a medical profession, well.
Speaker 4 (25:48):
I mean a very good question. I guess funding is
always an issue where, always everywhere, everywhere, and in every subspecialty,
and most places around the world we're always struggling for funding.
I guess we're incredibly grateful that Auckland District Healthperler Auckland
City Hospital essentially shoulders costs for sarcoma surgery and diagnostic
(26:08):
MDM for the North Island. So there is no central
funding for sarcoma care for the and so.
Speaker 3 (26:14):
How does that affect money that the DHB would be
spending on other things? I mean, do you need specific funding?
Speaker 7 (26:20):
Do you?
Speaker 3 (26:20):
And how much more do you unit? Do you think?
Speaker 6 (26:21):
Well?
Speaker 4 (26:22):
I mean absolutely because essentially me and my colleagues Mike
and Shineal and Andy Graden operating on big tumor cases
in the thigh or Carla and Isaac and Mike operating
in the abdomen. Those are big cases. They take all
day and that displaces Aucklanders in our catchment zone getting
knee replacements, at replacements, goll bladder surgery. So it's the
shortage in people, it's the shortage in I guess it's
(26:46):
the shortage in centralized funding that allows us to displace
other work in a safe way. So people are waiting
longer for their normal operations because we're doing these big
cases from Gisbon. But from a safety point of view
and from an international standard of care, that's the way
sarcoma needs to be managed by high volume specialty centers.
(27:09):
That's an unarguable evidence.
Speaker 3 (27:12):
And how much, I mean, what results how much would
we need to address the challenge for you.
Speaker 4 (27:19):
I mean, I guess it's very difficult, and I wouldn't
be able to throw your figure. I know we cost
the DHB, you know, I think it's seven thousand if
you think of a patient's treatment pathway and funding and expenditure,
I think the average is seven thousand dollars lost to
the DHB per patient that we treat surgically at Auckin Hospital.
(27:41):
So if you think about that, some patients the DHB
will inverticomers make money on So you take out a
small lump that doesn't take long and they go home
the next day, that's money making exercise. And if they
have a big sacral so that's the bottom of your
spine in the pelvis, and they're in the hospital for
three months and go back to these are three times,
(28:01):
that's a massive loss of money.
Speaker 3 (28:05):
What difference would early detection make in terms of the resources?
Speaker 4 (28:08):
And early detection is critical because if you get it earlier,
get it smaller, and you have to do less catastrophic surgery.
Speaker 5 (28:16):
And so is.
Speaker 3 (28:19):
There an an obvious answer in terms of the earlier
detection because we've you know, we've touched on very briefly,
you know just how challenging it is to work out
that you've got a problem.
Speaker 4 (28:29):
Yeah, not really. Our problem is in people not knowing
they've got a problem.
Speaker 7 (28:34):
I am.
Speaker 4 (28:34):
And then I was doing things like coming on and
top to you, tim and raising awareness so that people think,
hold on a minute, I've got one of those lumps.
Maybe I should go and see my daughter. I'm putting
it all.
Speaker 3 (28:43):
See what because I'll walk away as a layperson, having
spent an hour in studio with you, and I'll be
thinking if a loved run or a friend has been like, God,
I've had this persistent lump for a few weeks and
it doesn't seem to be going away, whether it's sore
or not, then at least I would be like, mate,
you need to go and get that app go and
get that looked at. And even if it's the most
(29:04):
benign thing world, which.
Speaker 4 (29:05):
Likely is exactly right.
Speaker 3 (29:07):
If it's not, you'll be glad you did.
Speaker 7 (29:09):
Yeah.
Speaker 4 (29:09):
I mean, that's the certainly right, and the likelihood is
it is benign because the balance of probability is that way.
Speaker 3 (29:15):
Somebody's I'm just trying to find this text here. It
says Andy would the lump, be soft or hard. AG
on your hand between the top of your thumb where
it joints that. Obviously this person's thinking of something specific.
Ag on the on your hand between the top of
your thumb where it joins your hand and the next
finger bones. Some people fob those sort of things off
as sort of swollen joints, arthritists, et cetera.
Speaker 4 (29:36):
They're usually firm. They're usually firm, often deep, but not
always and the problem again, this is a great text,
and thanks for your question. There there are so many
benign lumps and bumps in the hand, and way more
common things are to have a little gangly insist on
attending or a little nodule of what's called Jupatron's contracture.
(29:57):
All of those things are much more common than sarcoma.
So it's about being suspicious, just to recognize the thing
that's worrying, I might get cheer.
Speaker 3 (30:06):
Well, look at something. In the next break, I'm gonna
read this one about says from James. It's just this,
where would we be without reassuring and articulate angels like
Andy and the health system? So I thought we're just
going to appeal laying James, thank you now, well let's
go to some more calls, shall we knowl Hello.
Speaker 6 (30:24):
Hello, my name's Nol. I'm from Napier eighty seven. I've
had the melanie had taking off my shoulder and they've
got two four spots on my lane. Now they're going
to give me another CP scan as they mentioned EMO therapy. Now,
(30:49):
I'm not sure at my age whether EMO theopy has
got side effects? Would they affect an older person?
Speaker 3 (30:58):
Okay, and it's a really good question.
Speaker 4 (31:01):
I mean, you're slightly out with my super subspecialized and
usually immunose therapy have less side effects from a more
toxic point of view than chemotherapy. And for the listeners
who don't know what immunotherapy is, it's a way of
turning your body's defenses against the cancer cell rather than
killing it directly with the drug. So usually they are
(31:24):
better tolerated.
Speaker 3 (31:26):
Okay, hey, thanks for your call. Now, actually, is there
a future of I mean, is there a future of
treatment do you think with when it comes to at
the moment you're talking about it uses a very toxic chemotherapy.
And you said to me in the break that's for instance,
if I had a sarchoimer and you traded me with
the sort of dice that you can give a child,
I'd probably be killed, whereas the children can deal with more.
Speaker 4 (31:46):
Yeah, that's right, So a child can take a much
more toxic dose. The way forward for all cancer management
is turning your body's own defenses onto the cancer. So
the problem is if you get an osteosarcoma, it's going
wildly wrong and multiplying and trying to spread, but it's
still holding up and I'm tim flag yeah, and your
body recognizes it is still part of you, so it's
(32:08):
not attacking it.
Speaker 3 (32:09):
So what does that mean in terms of ammuniotherapy potential?
Speaker 4 (32:13):
If you can turn the body's defenses against the cancer,
which is what the idea of immune therapy is, and
things that you've heard about like car te cells.
Speaker 3 (32:22):
And so there was something on the news just the
other day about more.
Speaker 4 (32:25):
The idea of that is that you get the body
to work for you.
Speaker 3 (32:28):
All Right, we're going to take another break, but back
in just to tick. Give us a call if you like.
We with Andy Johnston, he's an orthopedic oncologist. It is
Psychoma Awareness Month and we're having a chat about that.
If you've got any questions. Then we'd love to hear
from your eight hundred and eighty ten and eighty lots
for Andy and I to talk about in the meantime. Anyway, Now,
should I say it's nineteen and a half minutes to
five news Talk, said B, this is the health of
(32:48):
my guest is Andy Johnston formerly Andrew, of course, but
he didn't remind us it was Andy. He's an orthopedic
oncologist and we're talking about psychoma just before we go
to our next call. Andy. In terms of just information
people can get hold of or connecting or finding out
more about the disease, you guys even have you guys,
but there is an Instagram, Facebook sort of presence for
(33:11):
this condition, isn't it?
Speaker 7 (33:13):
Ah?
Speaker 4 (33:13):
Yes, So there's it's always best to go to some
site that's been set up specifically for patient information. In
New Zealand, we have the Sarcoma Foundation, which is a
charity we set up a couple of years ago specifically
to have a home based information site for our patients
to support patients and families going through a sarcoma or
other amusing chemical tumor diagnosis and journey. And then there's
(33:38):
the Australian Usual Sarcoma Association, which slightly different entity and
it's more research driven. So there are both of those
things we've got. We're very lucky we've got one of
our ambassadors is Cam Suafoa, who's a Blues Oakland blues
player who's been in the middle of a very difficult
journey but also raising awareness for sarcoma every opportunity.
Speaker 3 (34:02):
It's been amazing that that is quite something, isn't because
you've got your own journey? Yeah, Actually, what's I mean?
You probably I can't really discuss a part from what
he's put out there publicly, but when someone is going
through that journey, how is the general sounds side dumb
asking this question, but how is the general well being
in terms of day to day functioning and all that
(34:22):
sort of thing?
Speaker 4 (34:23):
Again ugely varial, but but there are different stages of
all of these journeys. So there's the initial shock and
all diagnosis, and then there's you know, going through the treatment,
whether that be chemo and surgery or radiation therapy and surgery.
Then there's the early recovery and then for the younger
children or for people who their surgery or the tumor
(34:43):
has changed what they can and can't do. There's the
grieving process even in survivors who you know, have had
big tumor process put in, for example, and you can't
play football, you can't go and ride their bike. You know,
there's a grieving process for what could have been.
Speaker 3 (34:59):
Yeah, so you know it is.
Speaker 4 (35:02):
There are many stages and that we've got we have
psychological support services and and things like that that can help.
Speaker 3 (35:10):
So and it's not always it's not always fatal, of course,
you can sometimes treatment will work in excision or removal
of the bones. And is it a fast traveling cancer
in terms of what people would understand to be fast
or slow moving?
Speaker 4 (35:25):
Yeah, it can be fairly aggressive and fairly fast.
Speaker 3 (35:28):
Okay, let's take some more calls.
Speaker 6 (35:31):
Chris, hellopping guys, How are you good?
Speaker 3 (35:35):
Thank thank you.
Speaker 6 (35:37):
Just a very quick question. How reliable are pit skins?
Speaker 4 (35:44):
Wow, that's a very good question. So PET scans are
incredibly sensitive.
Speaker 3 (35:49):
What are they?
Speaker 7 (35:49):
So?
Speaker 4 (35:50):
A PET scan is a fancy CT scan using positrons.
So you probably heard of matter and anti matter. Well,
you know, positron is the opposite of an electron, and
essentially it labels a sugar and anything that's very active
takes up of sugar, and the CT scan picks up
the increase in activity around the tumor. I don't want
(36:14):
to get people going on about not having sugar if
they've got cancer, because if you see a PET scan,
you can see the thing that is glowing the hottest
on the PET scan is your brain because it is
the biggest user of sugar in your body, and your
body will confer anything you eat to sugar. But PET
scans are very sensitive, not super specific, but they are
very useful in some cancers. So for example, in our bones,
(36:35):
sarcoma's particularly ewings, it's made a big difference to how
we look at them, but it is no use for
some cancers. So some of our cancers we use different
kinds of whole body imaging. So it very much depends
on the type of cancer you're talking about how we
use PET scans, but they are a very useful tool
in our armory.
Speaker 3 (36:55):
He thanks for you, Cole. We'll be back into a moment.
Actually we've got some more caals lined up, but I
think we'll quickly take the break and be back in
a tick. It's twelve minutes to five. News toxid bit Yes,
news stalks heid be that's the hell with Andy Johnston.
He's an orthopedic surgeon. We're talking about psychoma's sarcoma Awareness
Month and we've got time for one quick more call.
I hate to say quick call, but that's the way
in the name of the game. Lucy, Hello, Oh hi doctor.
Speaker 5 (37:18):
Two or three bumps on my cheek, which I don't
think I've seen before. Just wondering whether they should be
looked at as the cantress.
Speaker 3 (37:28):
I guess does it come in multitude of bumps with it?
Andy on there we go.
Speaker 4 (37:34):
Yes, usually they come in solitary lumps, and sarcoma does.
But I think if you've got a new bomb, you know,
and it's not going away, then you should go and
see your family doctor about that and ask them to
have a look at it.
Speaker 3 (37:50):
Have you seen anyone, Lucy, No, I haven't.
Speaker 5 (37:53):
I just wanted to see it because they've only just
come up in the last two or three weeks. I
wanted to see whether you know, whether they change shape,
or they're going to be paying for or what.
Speaker 3 (38:05):
Yeah, well, I would say it's basic to get along
to a doctor. I think that's what Andy is saying,
but in terms of reassurance, usually if you have got
something that's serious, solitary, solid slog ah. So for people
who do have what do you want just to reiter right,
what would you want people to take away from the
(38:26):
check that we've had this afternoon?
Speaker 4 (38:28):
I mean, I guess And what we want people to
take away is so that they know of sarcoma. They've
heard of it, they know it can affect any age
in any part of the body and it's bone in
soft tissue. That if they are worried about something or
they know somebody who's got something like this, they should
say to them, please go along and see your family doctor.
And also, you know there's the website, So the Sarcoma
Foundation New Zealand and the Australian New Zealand Sarcoma Association
(38:52):
go onto their websites. There's information there about diagnosis and
what to be concerned about, and then they're fantastic resources.
Speaker 3 (39:02):
Just a few takes here just to pass on. One
says Hi, my dad was diagnosed with psycoma on his
back about five years ago, his late sixties. GP sent
him away so many times over several years and told
him it was a lipoma. Lipomer took him sending a
photo of it to the Eden hospital get it identified.
He at a massive op to remove it along with
some ribs. My message would be to keep pushing if
(39:24):
your GP isn't proactive, and we don't want to crack
at GPS.
Speaker 4 (39:27):
But this is a that's very common sarcomastory and unfortunately
lapumas are super common, and I lipe with psycomas, which
is what this gentleman sounds like he had, are rare,
but also they are a very serious cancer.
Speaker 3 (39:41):
And another one says, thank you for the very informative interview.
My husband has a rab dough MYO sarcoma rap Did
I get that right? It me? Anyway, he did started
in his thigh, manifested when he played squash and he
thought he'd pulled a muscle. How long would it have
been there? Do you think? Unfortunately he was in the
(40:03):
unlucky fifty percent. He had three years of fabulous support
from Michael Flint.
Speaker 4 (40:08):
Yeah, Mike's I love the guy, a very good surgeon.
It would have been there for a number of months,
if not up to a year before he was aware
of it. And his story is very very common that
I must have enjured it playing soccer and it's again
a common question is this is because of acc Absolutely isn't.
It's human nature. We had it in London as well.
(40:31):
I've bumped my leg hardly playing football. I've got a bump.
It must be a little tour muscle. I'll keep an
eye on it.
Speaker 3 (40:37):
Are all your cases We've got about just a couple
of minutes to go. But are all your cases that
you deal with? Are you exclusively dealing on psychomas or
it's a range of things. As an ooth paid controcologist.
Speaker 4 (40:49):
So mainly sarcoma, that's my main job, so people refer
to me at that. But we do have a role
in metastatic bone disease, which is a major increasing issue
for health services around the world because our medical oncology
colleagues are getting much much better at curing common cancers
like melanoma, breast cancer, and so people with metastatic bone
(41:11):
disease are living much longer and we have to do
bigger operations that allow them to continue having a good
quality of life.
Speaker 3 (41:17):
Who do you need the voice of to get more
funding for these issues? Is it a matter of getting
on Simeon Brownsie or someone at Health New zeand or what.
Speaker 4 (41:24):
Well, yeah, I mean we're always always open to having
more funding and but you know, just getting some research
trials open in New Zealand. We don't have any formal
research offices. The research stuff that we do is all
done in early morning before we start working in the
evening instead of watching the TV.
Speaker 3 (41:42):
What chance do you think that there will be immunotherapy
will kick in instead of this highly toxic sort of chema.
Speaker 4 (41:48):
Absolutely, eventually that's what we will end up getting. And
there is research. There are big international trials going on
for these rare and ulter rear cancers. International collaboration is
the way to go.
Speaker 3 (41:59):
Excellent, Hi Andy, I really appreciate your time coming in
and good luck with all the work you do. Really
appreciate it. If anyone who has listened to this and
you'd like to go back and get the lowdown on
a few of the issues around psychomists, then please do
go and check out our podcast. We load the hour
pretty quickly after each our confluences. But that wraps the
Health Hub. We'll be back with Smart Money with Hanna
(42:20):
McQueen is next. It's three minutes to five News Talks
EDB
Speaker 1 (42:26):
Great listen Zy For more from the weekend collective, Listen
live to News Talks EDB weekends from three pm, or
follow the podcast on iHeartRadio.
You're listening to the Weekend Collective podcast from News Talks EDB.
Speaker 2 (00:17):
Hi Hi, Yes, and welcome back to the Weekend Collective
on this July thirteenth, twenty twenty five.
Speaker 3 (00:37):
I'm Tim Beverage. By the way, if you missed any
Politics Central go to our podcast. You can check it
out on news talksb dot Curda NZ but also on iHeartRadio.
Just look for the Weekend Collective and we get it
loaded pretty quickly after each hour is up. Now we've
got a new guest today and a new focus for
the Health Hub because it is currently I think it's
(00:59):
called Sarcoma Awareness Month, but anyway, Sarcoma is the deadliest
cancer among children and young people. It's responsible for nearly
one third of deaths among the fifteen to twenty four
age group, and despite this, research funding remains low compared
to more common cancers. We can all think of the
cancers that I've got, the ones that are more an
(01:21):
easier self for instance. I mean, we can look at
the difference between prostate cancer and breast cancer and what
gets the most coverage. But of course, you know, there
are lots of diseases that struggle to the people who
are looking into cures and getting better diagnosis. There's constantly
struggling for funding. And it's also that ssacoma is reportedly
(01:41):
misdiagnosed a third of the time, which highlights the urgent
need for better early detention detection. So in saying that,
what do we do if we feel like a doctor,
how do we go about working out if we've been
correctly diagnosing in the right diagnosis. And there's a whole
lot of issues around this. Anyway, I'm going to stop
talking because well I will continue, of course, but we
(02:04):
are joined by Andy Johnston. He's an orthopedic oncologist and
he's with us now. Actually I might just get you, Andy,
to pull the microphone just closer to sort of just
there we go, Andy, good, I, how you going good afternoon?
Speaker 4 (02:16):
Thanks very much for having me.
Speaker 3 (02:17):
On orthopedic oncologist.
Speaker 4 (02:21):
I get that right, Yeah, that's that's spot on. So
that's just a descriptor of an orthopedic surgeon who deals
with cancer as part of their sub specialty.
Speaker 3 (02:30):
And how long is it? How did you become an
orthopedic on coologist And tell us about the journey. We'll
learn a little bit about you before we get into
the substance of what we're here to talk about.
Speaker 4 (02:40):
I became an orthopedic on collegist because when I came
to New Zealand and started working as an orthopedy junior
register of Auckland Hospital, I worked with the then Tacoma
surgeon there, Mike Hanlon, and then I left his run
and worked with Mike Flint and Gary Friendship Counties.
Speaker 3 (02:59):
How do you get directed into that sort of area
of medicine.
Speaker 4 (03:01):
I guess you have to have an enjoyment and a
love for that particular thing. It's it's a kification. You
enjoy some part of what you're being e supposed to
and you think, well, I can see myself doing this.
Speaker 3 (03:15):
Because oncologists traditionally sort of that's a medical side of things,
and you you also have a surgical side as well,
and I guess they go hand in hand to that.
Speaker 4 (03:23):
We work very closely with medical oncology, redition oncology, pathology,
and our specialist team, so a big old team looking
after psarcoma for example.
Speaker 3 (03:32):
So is it Sarcomer Awareness Month? Isn't it?
Speaker 4 (03:36):
It is July every year?
Speaker 3 (03:37):
Yeah, So can you give us some context for what
this disease is how how dangerous it is and the
challenges that faces in terms of.
Speaker 4 (03:45):
Finding I mean absolutely, I think probably a good way
to start is I mean, you were seeing about cancers
and the more common ones, and the more common ones
are carcinomas, and carcinomas are cancers that develop from lining cells,
so breast, bow, prostate, lung, they're all lining cell cancers,
and lining cell turnover much more common, much more frequently,
(04:09):
and and so there's much more chance for something.
Speaker 3 (04:11):
To go wrong carcino. I'm taking that because I just
sort of.
Speaker 4 (04:18):
Feel Sarcomas are cancers of connective tissue and what we
call amusing chymal origin, So they are things like bone,
near fat, muscle, okay, blood, vessel walls, and and cartilage,
and they are much more stable things, and they don't
turn over very often and so less chance for something
(04:38):
to go wrong.
Speaker 3 (04:39):
That actually just the lip out of me here is
that the casinamus turn over more often. Does that mean
that because they're turning out of some reason my brain
tells me that they would be easier to detect or not.
Speaker 4 (04:52):
Well, they're just more common, and there are things like
blood tests for some cancers and there are screening programs
for some cancers. We don't have that luxury. It's it's
it's one of the oldest own cancers. There is found
in a hominid, which is how one of human's early
ancestors at one point seven million years ago. And there's
(05:13):
even osteosarcoma, which is one of the bones Sarcoma's identified
in dinosaurs. So this has cancer that's been around forever.
It's not becoming more common. It's we're seeing more of
it as we there are more of us. Is that
we are living longer.
Speaker 3 (05:29):
The better. Are we more effective at diagnosing it? No? No, no,
why not?
Speaker 4 (05:37):
It's it's diagnosis is done through pathology, and that the
critical part of our team is our pathologists and for
the audience who don't know, that's people who are specialized
in looking at cells down microscopes and giving a diagnosis
on what those cells look like. And that's that's getting
more and more sub specialized and more and more accurate
(06:02):
with the with the advances and genetic labeling of things.
So that's definitely getting better. Our major hurdle is not
once they hit our service, is getting them into our service.
What you alluded to earlier on about delay and diagnosis
and people not being aware of sarcoma existing.
Speaker 3 (06:21):
And how much of the awareness is Oh okay, I'll
keep on thinking. I'm trying to avoid becoming political or
saying and controversial, but how much of the lack of
awareness around sarcomas is just public awareness versus political awareness
versus actually awareness within the medical profession.
Speaker 4 (06:41):
I mean, all our problems, I don't think any one
of those is worse than the other. I guess a
lot of your listeners may have never heard the term before,
which is again a very common problem. It's estimated that
a family doctor, a general partitioner will see one case
of sarcoma and their entire working career. So okay, for them,
(07:02):
it's a small it's a small part of what they
are dealing with, and they'll see umptyen breast cancers a year,
humpty in bell cancer, cervical cancers a year.
Speaker 3 (07:12):
So did you say one in their career year.
Speaker 4 (07:16):
Is the average?
Speaker 5 (07:17):
Yeah?
Speaker 4 (07:17):
That's the often stated figure.
Speaker 3 (07:19):
Is that? I mean, intuitively, that sounds like part of
the battle around awarenesses because it's just not prominent enough
for people to think, oh, well, this is it picks
a few people.
Speaker 4 (07:28):
It's absolutely right, and that's part of the reason. Why
is it sarcoma clinicians have to go about but you know,
rattling the drum making sure that people are aware that
this problem exists.
Speaker 3 (07:41):
So the Sarcoma Awareness Month, what is what do you
want to see? What are the people who work with
this disease? Diseases? Is that the right world? I don't
even know if it is. What do you want to
achieve from Sacoma Awareness Month?
Speaker 4 (07:55):
Is just trying to bring the awareness that this disease
is out there, what to look for, when to go
to your doctor, and what and what things to say
to your doctor. And because this will drift out of
people's memories not long after this podcast, after this radio program,
and it's about doing the same thing every now and
again and raising it in people's minds to say, well,
(08:16):
actually that that could be a sarcoma and maybe I
should go and get that checked out.
Speaker 3 (08:22):
So what what would what are some of the symptoms
that people might want to be aware of.
Speaker 4 (08:26):
Well, again, this is something that doesn't help the cause
because there are it can affect any age, so the
infants and babies can get it. And ninety year olds
can get it, and the way it presents is different
along those age groups. Soft tissue sarcoma is much more
common in older people and there are one hundred different subtypes. Okay,
(08:53):
so very very very confusing for people. And some of
those subtypes signovial sarcoma lyo myyer sarcoma can behave in
a very indolent, reassuring thing. So, oh, doctor, I've had
this lump for two years. I think it's getting a
bit bigger. Oh right, well it's probably nothing.
Speaker 3 (09:12):
Okay, Well you've got you've got a lump, and that
is something that everyone can recognize, isn't it. Absolutely What
sort of lumps are we talking about?
Speaker 6 (09:18):
Are they?
Speaker 3 (09:19):
Because you mentioned that they're you know, attaches to bone.
Obviously you're an orthopedic, yeah on college. Just so you're
concerned with psychomasm, bone.
Speaker 4 (09:27):
Borne and soft tissue and soft tissues.
Speaker 3 (09:29):
So that would be what cartilage and.
Speaker 4 (09:31):
Connected cattliage comes under bone, so muscles, fat nerves, Okay, yeah,
all of that.
Speaker 3 (09:37):
So looking further out, are there other expertises who deal
with psychoma or is that all your.
Speaker 4 (09:44):
So we do the orthopedic on colleges do most of it,
and there's another group called general surgical on colleges and
in particularly rich per to neal sarcoma, which happens in
the abdomen and the rich peraitiniums the area right back
where your kidneys are, and that's even rarer. So in
the North Island we see you about twenty to twenty
five cases.
Speaker 3 (10:05):
Year, Okay, And I mean I don't like to dig
into those things, but you've mentioned that's what we're here for.
Of course, it's the deadliest cancer among children and young people.
Is that because well, I guess it's a deadly cancer anyway.
Is it a higher risk to everyone? And children? Cancer
can be particularly aggressive? What where we at with that?
Speaker 4 (10:26):
Well, that's right, so it happens. It's bone cancers that
are much more common in young people, although those two
that I mentioned, the synovial sarcoma and the Lyo Mayer
can also happen in young people. And it happens in
younger people because of what we mentioned with carcinoma, so
the rapid turnover of cells and more chance for something
to go wrong. So classically it happens around the knee,
(10:48):
although it can happen anywhere. And that's because your thigh
bone grows from the knee side and your shin bone
grows from the knee side. So all that cell growth
and turnover is happening at the end of your thigh bone.
Much more chance for a cell to go wrong there
and become cancerous.
Speaker 3 (11:04):
Do we know what causes cells to go wrong?
Speaker 7 (11:06):
No?
Speaker 4 (11:07):
Well, there we know in a biological way that the
celle has to have a genetic mutation, and the sales
defense systems that normally pick up those genetic mutations and
cause the sale to commit suicide have failed, and so
a cancer grows.
Speaker 3 (11:23):
You know, you mentioned that how many million years ago?
It goes back to.
Speaker 4 (11:27):
One point seven in hominids and a toe bone I believe,
and a bone and a dinosaur. So however, many hundreds
of millions of.
Speaker 3 (11:37):
Years a go, and I mean just from the do
do you learn things from the fact that it's been
such an old cancer or anything?
Speaker 4 (11:45):
Or is it not really? I guess it just what
the point of illustrating that is to say that this
has been around forever and it's not becoming more common.
And one of the questions patients will often ask when
you're breaking the bad news that I'm terribly sorry you've
got a sarcoma? Is how why have I got this?
(12:05):
And you know the reason is random bad luck?
Speaker 3 (12:09):
So generally, how do people end up? As you say,
the problem is diagnosis? It's so rare and a GP
might see one in their career. How on earth did
they ever make their way to you? Because it sounds
to me that it's so far off the radar for
people in general. How does the case make its way
to you?
Speaker 4 (12:27):
A variety of ways. Children, it's often a limp and
a persistent limp, and then somebody gets an x ray
and that actually shows the sures, the changes in the
board and keeping with sarcoma, and then they get they
get put down the right pathway. With adults with soft
tissue lumps and bumps, it can be a much more
prolonged process because it's human nature to think, I've got
(12:51):
a bit of a bump there, How did that happen?
I'll bump my leg on the cheer seven weeks ago.
That must be why I've got that bump there. And
then they go to their family doctor and say, well,
a lump of my leg, I banged it and the
doctor says, well, it's probably just a little bit of
a you know, it's just all makes sense, And so
that's what you get to. The thing where people have
sought multiple opinions before they finally get referred.
Speaker 3 (13:16):
So how important is is time in getting early detection
and how much of a difference does it make?
Speaker 4 (13:24):
Yeah, it makes a massive difference. So the quicker you
can get it, the smaller it is, the less chances
had to spread, and also the less of the effect
of the surgery that we have to perform to get
rid of it. So if you've got a massive tumor
involving half the palvis and we've got to cut out
half your palvise, then that's got a much more impact
(13:47):
on your life. And if we can get it smaller,
we only have to cut something smaller. So size matters
from a recovery and from an effect on your long
term quality of life.
Speaker 3 (13:59):
Is excision removing it the only way to deal with no.
Speaker 4 (14:03):
There are lots of different treat slightly different treatments of
the different subtypes of sarcoma, the bone sarcomas. The common
ones are osteosarcoma, the one we've mentioned that was a
dinosaur and then one called ewing sarcoma, and they are
generally treated with something called neoagefic chemotherapy, which just means
they get some chemotherapy for about three months, then they
(14:26):
get surgery to remove the tumor and reconstruction if reconstruction
as possible, and then they finish consolidation chemotherapy. So the
whole journey takes nine months to a year.
Speaker 3 (14:36):
So it doesn't sound like so even though you are
doing oncology I'm sorry, chemotherapy and other treatments, you still
have to remember.
Speaker 4 (14:45):
You still have to remove the primary tumor. Ewing sarcoma
in some cases can be treated with radiation therapy to
control the local the primary tumor. But in the main
surgeries and what we do and then that the chondrosarcoma,
there is nothing else. There is only surgery. Nothing is
effective against it.
Speaker 3 (15:02):
So just how what is the pace of So if
somebody has a cell that goes I don't know what
the word is for it, but it goes wrong, goes wrong,
what's the journey in terms of for it to become obvious, well,
to become yeah, to become obvious and then to become
I mean, how quickly does a tumor grow, so you
(15:23):
might let's let's talk about your knee. You've got a
cell that's gone walking in your knee. What's the journey
in terms of time until from a surgical point of view,
it's like we have to do something really major here.
Speaker 4 (15:33):
I mean many many months in reality to possibly longer,
and some subjects before that tumor even becomes big enough
for you to be aware of it, and then you know,
the surgery will depend on how big it's got by
that stage. And it's very difficult to see how long
someone's had something when they when they pitch up, you
(15:54):
can make an estimate that that's been there for a
long time. What you can often tease out from someone's
history is that, oh, yeah, I noticed that, but I
didn't think it was that important, and that was four
months ago.
Speaker 3 (16:05):
That sounds like the lesson you'd want people to take
away from this, wouldn't you be if you have you've
got some I mean, is it the pain that someone
would get let's say it's an osteosarcoma we're talking about
the bone, is when would someone start feeling something was
wrong because obviously one cell going. You're not feeling anything.
Speaker 4 (16:25):
Yeah, you start to feel something wrong in an osteosarcoma
or ing sarcoma, when either the boone becomes weakened to
the point that it's structural and integrity is threatened, that's
when you start to get the limb or it's pushing
on something else. So ewing sarcoma can push, can have
a massive soft tissue comportent and can push against an
air or some things like that.
Speaker 3 (16:44):
How do you and what do you mean when we're
talking about this on on a nationwide radio sort of thing.
And one of the things that's a bit like when
you google. If you google your symptoms the layperson does,
you can become quite catastrophic about you can. Where do
we so? What's the what's the media in the happy medium?
(17:06):
In terms of where you'd want people to be the
awareness you'd want to have people to have of something.
Is it almost if someone listens and they've got a
friend or a relative or something you're saying, I've had
this pain for such and such for seven or eight weeks,
then somebody might go or you might want to get
that looked at.
Speaker 4 (17:20):
What do you want yeah, I think that's right. I
think the first thing you want to do is go
to your family doctor and say, look, I've had this,
you know, can you can you have a look at it?
What do you think? And the first step, hopefully is
the GP says, yeah, that is a concerning thing. We're
going to get an ultrasound and if that's worrying, we'll
refer you, or we're going to get an X ray
if it's a bony thing. Part of the problem with
the soft tissue sarcomas is they are not painful. They
(17:43):
are not sore until they become massive. So most people
present with a penless lump.
Speaker 3 (17:50):
And when you say soft tissue, that's not cartilage because
that's inclined.
Speaker 4 (17:53):
And that's concluded in bone, so muscle, nerves, fat. Some
of them are so poorly differentiated and we've lost their
original cell line.
Speaker 3 (18:03):
If I had a sarcoma and mathyle something would would
I would you could could someone feel it? Yeah? Okay,
so you would feel a lump. Yeah, and that's not
necessarily the pain. You'd go call they've got a strange
lump in the file. So unless it's involving in there,
and in terms of parts of the body. Are there
parts that it's more.
Speaker 4 (18:22):
Common in the born ones, Yes, so those areas of
high growth around the knee, top of the armborne and
in soft tissue. It can be anywhere. It can be
in front of the savaka spain, it can be in
your neck, it can be in your chest and on
your ribs and sege your lung, can be anywhere.
Speaker 3 (18:41):
Well, uh, we're going to continue the chatting just a moment.
There's lots of lots for us to talk about and
talk about with this disease. Where with Andy Johnston, he's
an orthopedic oncologist. If you'd like to join the conversation,
we've got any questions for Andy about about something, then
give us a call on topic. By the way, when
I say orthopedic oncologist, we're not going to be taking
(19:02):
calls about whether you need your hip redone. But if
you've got some questions for Andy about this on eight
hundred and eighty ten eighty text on nine two nine
two as well. This is the health Hub on News
Talk set B. It's come out to twenty four past four.
Every one else got lambe yes, guess.
Speaker 7 (19:33):
You don't know your yes?
Speaker 6 (19:37):
Welcome back.
Speaker 3 (19:38):
Sir, the Weekend Collective, I'm Tim Beverage. This is the
Health Ub. By the way, if you're wondering why on
earth I'm playing one direction, it's actually because we offer
our guests the chance to play a song of their choosing.
And my guest, Andy Johnston, it's not a song of
his choosing, but this is that's sort of a son
who's about to perform it an a talent quest. So
so that's that's for you. Andy's son. My guest is
(19:58):
Andy Johnston. He is an orthopedic oncologist, and we're talking
about the challenges of COMBA because it's a psarcoma awareness month.
Speaker 1 (20:07):
Now.
Speaker 3 (20:08):
I gave a stat which we discussed. The stat Andy
mentioned that maybe a GP might only encounter one case
in their whole career, which makes it sound in my
mind I filed away just handful of cases. But Andy,
this is something like between two hundred and three hundred
cases per year. I think you deal with the North
Islanders around two hundred cases per year, would that be right?
Speaker 4 (20:29):
Yeah, so about two hundred new diagnosis per year for
the Northaland, including kids and adults.
Speaker 3 (20:33):
And what's the prognosis when it comes to survivability on
two hundred people.
Speaker 4 (20:38):
Very much depends on their subtape and when they present
and whether it's spread where the tame they arrived. But
the overall survival average for all sarcomas is fifty percent
and ten years.
Speaker 3 (20:49):
And the treatment, the chemo for it is pretty hard.
Speaker 4 (20:53):
Work, isn't It's incredibly toxic. So chemo therapy for rostio
sarcoma and ewing sarcoma is some of the most toxic
chemotherapy given, so it really hits.
Speaker 3 (21:03):
Why is is that just? That's as far as we've
gotten in terms of the chemotherapy is. Of course, it
used to be the It used to be the case
with early chemotherapy that the cure was almost worse than
the cause sometimes, but the chemo didn't kill you.
Speaker 4 (21:18):
Now that's right, we haven't got any of them. You
may have heard of melanoma and some other cancers having
immune therapy. That's if ficacious breast cancer's got horrmone treatments,
that effic is prosty. We don't have any of that,
and so it's all fashioned sight of toxics. In other words,
cell killing chemotherapy.
Speaker 3 (21:37):
Gosh, we're taking your cause. By the way, if you've
got any questions for Andy, give us a call on
our one ten and eighty Bruce. Hello, Bruce, are you there?
Hang on a second, let's just check that you are there,
just Asaiah. Have we got everything turned up there that
we should be able to hear? Bruce?
Speaker 7 (21:54):
I'm here?
Speaker 3 (21:55):
Oh there you go?
Speaker 7 (21:56):
Where you good? Okay? Yes, let's say cancerous disease that
I've never heard of. But I go to a skin
wanted a better term, the skin specialist where I get
fun cancerous growths from being out in the sun too
long cut out, And I pointed out this little pie
(22:19):
sized lump up from my big toe or the second
tie in, and they had the same clinic. They did
an ultra sound on it and referred to it as
a as a foreign body. But it's a lump of
a pea and it's been like the same for the
(22:39):
last two years. So I might be overly worried about it,
but it's just it's not painful. It's just annoying when
I'm exercising flat on a tummy and I can just
feel it's pressing.
Speaker 3 (22:53):
Has our conversation made you think you would like to
ask the question?
Speaker 7 (22:58):
Yeah? Is it something to be concerned about.
Speaker 3 (23:02):
Well, Andy, this is the sort of thing where people
are going, am I catestraph? But from the conversation I
can say, well, Bruce would be like, yeah, I.
Speaker 4 (23:09):
Mean it's it's very difficult and that in Bruce's case,
and thanks for your question. Bruce just quite nicely highlights
highlights the issue. So some of some of those peace
sized lumps will get bigger and become and become more
obviously nasty. In Bruce's case, someone's done the right thing.
They've done an ultrasound investigation, and an altra sound is
very good screening tool. It's by no means gold standard
(23:31):
for us, and we don't look at them in our
m d T. But it will point you in a direction.
This is a benign looking, not very worrying, doesn't have
any blood supply, and with Bruce's quite reassuring history, that's
that's pretty good. So I wouldn't worry about it, and
in particular unless it was causing you issues, which it
sounds like it might be, and then you can always
(23:53):
have it removed.
Speaker 7 (23:54):
In a minor way. And it hasn't been larged over
two years, I don't think. Yeah, just annoying. The lump
the peace size or slightly bigger.
Speaker 3 (24:05):
I'm surprised they haven't cut it out actually, but then
again sometimes.
Speaker 7 (24:08):
Well actually, actually the chap that does have done some
work on my other parts of my potty for some
some cancerous grass, and I pointed out to him. Any
city will remove it, So that's going to happen in August.
Speaker 3 (24:28):
Okay, well that's good, that's good, Bruce. Well, I mean
they'll probably they'll probably send them. Do they send when
they do remove things, they send them away for a test,
And yes, absolutely, so we can reassure Bruce, don't panic.
You're getting it removed, and it will be what's the
word biopsied.
Speaker 4 (24:41):
Or biopsy is they'll send off to the pathologists who
will look at it in the microscope and tell them
what it is.
Speaker 3 (24:47):
So what do you you mentioned ultrasound? What are the
diagnosis tools that lead you to a diagnosis of like, okay,
we've got something serious here.
Speaker 4 (24:55):
So ultrasin is a very effective tool that our general
practitioners can use if it's a superficial light puma, which
is a benane tumor, and an ultrasain is usually good
at pecking that up and reassuring or assist, but we'll
also show something that's a bit more worrying, and at
that point the GP usually would refer into the hospital.
If it is in Gisbon, it'll be on a two
(25:16):
week wait cancer pathway into the local hospital and then
an MRI would be done at that point. If it
was in your leg, for example, the local orthopedic surgeon
would usually refer it straight to the North Aland Sarcoma
MDM and then it would go on our weekly MDM meeting.
Speaker 3 (25:34):
How much of what you do is on the Oh god,
I've got some crude analogies here, but I just mean,
you know, from a cliche point of view, it is
on the smell of an oily rag. In terms of
the funding that you would like versus how you cope
with it as a medical profession, well.
Speaker 4 (25:48):
I mean a very good question. I guess funding is
always an issue where, always everywhere, everywhere, and in every subspecialty,
and most places around the world we're always struggling for funding.
I guess we're incredibly grateful that Auckland District Healthperler Auckland
City Hospital essentially shoulders costs for sarcoma surgery and diagnostic
(26:08):
MDM for the North Island. So there is no central
funding for sarcoma care for the and so.
Speaker 3 (26:14):
How does that affect money that the DHB would be
spending on other things? I mean, do you need specific funding?
Speaker 7 (26:20):
Do you?
Speaker 3 (26:20):
And how much more do you unit? Do you think?
Speaker 6 (26:21):
Well?
Speaker 4 (26:22):
I mean absolutely because essentially me and my colleagues Mike
and Shineal and Andy Graden operating on big tumor cases
in the thigh or Carla and Isaac and Mike operating
in the abdomen. Those are big cases. They take all
day and that displaces Aucklanders in our catchment zone getting
knee replacements, at replacements, goll bladder surgery. So it's the
shortage in people, it's the shortage in I guess it's
(26:46):
the shortage in centralized funding that allows us to displace
other work in a safe way. So people are waiting
longer for their normal operations because we're doing these big
cases from Gisbon. But from a safety point of view
and from an international standard of care, that's the way
sarcoma needs to be managed by high volume specialty centers.
(27:09):
That's an unarguable evidence.
Speaker 3 (27:12):
And how much, I mean, what results how much would
we need to address the challenge for you.
Speaker 4 (27:19):
I mean, I guess it's very difficult, and I wouldn't
be able to throw your figure. I know we cost
the DHB, you know, I think it's seven thousand if
you think of a patient's treatment pathway and funding and expenditure,
I think the average is seven thousand dollars lost to
the DHB per patient that we treat surgically at Auckin Hospital.
(27:41):
So if you think about that, some patients the DHB
will inverticomers make money on So you take out a
small lump that doesn't take long and they go home
the next day, that's money making exercise. And if they
have a big sacral so that's the bottom of your
spine in the pelvis, and they're in the hospital for
three months and go back to these are three times,
(28:01):
that's a massive loss of money.
Speaker 3 (28:05):
What difference would early detection make in terms of the resources?
Speaker 4 (28:08):
And early detection is critical because if you get it earlier,
get it smaller, and you have to do less catastrophic surgery.
Speaker 5 (28:16):
And so is.
Speaker 3 (28:19):
There an an obvious answer in terms of the earlier
detection because we've you know, we've touched on very briefly,
you know just how challenging it is to work out
that you've got a problem.
Speaker 4 (28:29):
Yeah, not really. Our problem is in people not knowing
they've got a problem.
Speaker 7 (28:34):
I am.
Speaker 4 (28:34):
And then I was doing things like coming on and
top to you, tim and raising awareness so that people think,
hold on a minute, I've got one of those lumps.
Maybe I should go and see my daughter. I'm putting
it all.
Speaker 3 (28:43):
See what because I'll walk away as a layperson, having
spent an hour in studio with you, and I'll be
thinking if a loved run or a friend has been like, God,
I've had this persistent lump for a few weeks and
it doesn't seem to be going away, whether it's sore
or not, then at least I would be like, mate,
you need to go and get that app go and
get that looked at. And even if it's the most
(29:04):
benign thing world, which.
Speaker 4 (29:05):
Likely is exactly right.
Speaker 3 (29:07):
If it's not, you'll be glad you did.
Speaker 7 (29:09):
Yeah.
Speaker 4 (29:09):
I mean, that's the certainly right, and the likelihood is
it is benign because the balance of probability is that way.
Speaker 3 (29:15):
Somebody's I'm just trying to find this text here. It
says Andy would the lump, be soft or hard. AG
on your hand between the top of your thumb where
it joints that. Obviously this person's thinking of something specific.
Ag on the on your hand between the top of
your thumb where it joins your hand and the next
finger bones. Some people fob those sort of things off
as sort of swollen joints, arthritists, et cetera.
Speaker 4 (29:36):
They're usually firm. They're usually firm, often deep, but not
always and the problem again, this is a great text,
and thanks for your question. There there are so many
benign lumps and bumps in the hand, and way more
common things are to have a little gangly insist on
attending or a little nodule of what's called Jupatron's contracture.
(29:57):
All of those things are much more common than sarcoma.
So it's about being suspicious, just to recognize the thing
that's worrying, I might get cheer.
Speaker 3 (30:06):
Well, look at something. In the next break, I'm gonna
read this one about says from James. It's just this,
where would we be without reassuring and articulate angels like
Andy and the health system? So I thought we're just
going to appeal laying James, thank you now, well let's
go to some more calls, shall we knowl Hello.
Speaker 6 (30:24):
Hello, my name's Nol. I'm from Napier eighty seven. I've
had the melanie had taking off my shoulder and they've
got two four spots on my lane. Now they're going
to give me another CP scan as they mentioned EMO therapy. Now,
(30:49):
I'm not sure at my age whether EMO theopy has
got side effects? Would they affect an older person?
Speaker 3 (30:58):
Okay, and it's a really good question.
Speaker 4 (31:01):
I mean, you're slightly out with my super subspecialized and
usually immunose therapy have less side effects from a more
toxic point of view than chemotherapy. And for the listeners
who don't know what immunotherapy is, it's a way of
turning your body's defenses against the cancer cell rather than
killing it directly with the drug. So usually they are
(31:24):
better tolerated.
Speaker 3 (31:26):
Okay, hey, thanks for your call. Now, actually, is there
a future of I mean, is there a future of
treatment do you think with when it comes to at
the moment you're talking about it uses a very toxic chemotherapy.
And you said to me in the break that's for instance,
if I had a sarchoimer and you traded me with
the sort of dice that you can give a child,
I'd probably be killed, whereas the children can deal with more.
Speaker 4 (31:46):
Yeah, that's right, So a child can take a much
more toxic dose. The way forward for all cancer management
is turning your body's own defenses onto the cancer. So
the problem is if you get an osteosarcoma, it's going
wildly wrong and multiplying and trying to spread, but it's
still holding up and I'm tim flag yeah, and your
body recognizes it is still part of you, so it's
(32:08):
not attacking it.
Speaker 3 (32:09):
So what does that mean in terms of ammuniotherapy potential?
Speaker 4 (32:13):
If you can turn the body's defenses against the cancer,
which is what the idea of immune therapy is, and
things that you've heard about like car te cells.
Speaker 3 (32:22):
And so there was something on the news just the
other day about more.
Speaker 4 (32:25):
The idea of that is that you get the body
to work for you.
Speaker 3 (32:28):
All Right, we're going to take another break, but back
in just to tick. Give us a call if you like.
We with Andy Johnston, he's an orthopedic oncologist. It is
Psychoma Awareness Month and we're having a chat about that.
If you've got any questions. Then we'd love to hear
from your eight hundred and eighty ten and eighty lots
for Andy and I to talk about in the meantime. Anyway, Now,
should I say it's nineteen and a half minutes to
five news Talk, said B, this is the health of
(32:48):
my guest is Andy Johnston formerly Andrew, of course, but
he didn't remind us it was Andy. He's an orthopedic
oncologist and we're talking about psychoma just before we go
to our next call. Andy. In terms of just information
people can get hold of or connecting or finding out
more about the disease, you guys even have you guys,
but there is an Instagram, Facebook sort of presence for
(33:11):
this condition, isn't it?
Speaker 7 (33:13):
Ah?
Speaker 4 (33:13):
Yes, So there's it's always best to go to some
site that's been set up specifically for patient information. In
New Zealand, we have the Sarcoma Foundation, which is a
charity we set up a couple of years ago specifically
to have a home based information site for our patients
to support patients and families going through a sarcoma or
other amusing chemical tumor diagnosis and journey. And then there's
(33:38):
the Australian Usual Sarcoma Association, which slightly different entity and
it's more research driven. So there are both of those
things we've got. We're very lucky we've got one of
our ambassadors is Cam Suafoa, who's a Blues Oakland blues
player who's been in the middle of a very difficult
journey but also raising awareness for sarcoma every opportunity.
Speaker 3 (34:02):
It's been amazing that that is quite something, isn't because
you've got your own journey? Yeah, Actually, what's I mean?
You probably I can't really discuss a part from what
he's put out there publicly, but when someone is going
through that journey, how is the general sounds side dumb
asking this question, but how is the general well being
in terms of day to day functioning and all that
(34:22):
sort of thing?
Speaker 4 (34:23):
Again ugely varial, but but there are different stages of
all of these journeys. So there's the initial shock and
all diagnosis, and then there's you know, going through the treatment,
whether that be chemo and surgery or radiation therapy and surgery.
Then there's the early recovery and then for the younger
children or for people who their surgery or the tumor
(34:43):
has changed what they can and can't do. There's the
grieving process even in survivors who you know, have had
big tumor process put in, for example, and you can't
play football, you can't go and ride their bike. You know,
there's a grieving process for what could have been.
Speaker 3 (34:59):
Yeah, so you know it is.
Speaker 4 (35:02):
There are many stages and that we've got we have
psychological support services and and things like that that can help.
Speaker 3 (35:10):
So and it's not always it's not always fatal, of course,
you can sometimes treatment will work in excision or removal
of the bones. And is it a fast traveling cancer
in terms of what people would understand to be fast
or slow moving?
Speaker 4 (35:25):
Yeah, it can be fairly aggressive and fairly fast.
Speaker 3 (35:28):
Okay, let's take some more calls.
Speaker 6 (35:31):
Chris, hellopping guys, How are you good?
Speaker 3 (35:35):
Thank thank you.
Speaker 6 (35:37):
Just a very quick question. How reliable are pit skins?
Speaker 4 (35:44):
Wow, that's a very good question. So PET scans are
incredibly sensitive.
Speaker 3 (35:49):
What are they?
Speaker 7 (35:49):
So?
Speaker 4 (35:50):
A PET scan is a fancy CT scan using positrons.
So you probably heard of matter and anti matter. Well,
you know, positron is the opposite of an electron, and
essentially it labels a sugar and anything that's very active
takes up of sugar, and the CT scan picks up
the increase in activity around the tumor. I don't want
(36:14):
to get people going on about not having sugar if
they've got cancer, because if you see a PET scan,
you can see the thing that is glowing the hottest
on the PET scan is your brain because it is
the biggest user of sugar in your body, and your
body will confer anything you eat to sugar. But PET
scans are very sensitive, not super specific, but they are
very useful in some cancers. So for example, in our bones,
(36:35):
sarcoma's particularly ewings, it's made a big difference to how
we look at them, but it is no use for
some cancers. So some of our cancers we use different
kinds of whole body imaging. So it very much depends
on the type of cancer you're talking about how we
use PET scans, but they are a very useful tool
in our armory.
Speaker 3 (36:55):
He thanks for you, Cole. We'll be back into a moment.
Actually we've got some more caals lined up, but I
think we'll quickly take the break and be back in
a tick. It's twelve minutes to five. News toxid bit Yes,
news stalks heid be that's the hell with Andy Johnston.
He's an orthopedic surgeon. We're talking about psychoma's sarcoma Awareness
Month and we've got time for one quick more call.
I hate to say quick call, but that's the way
in the name of the game. Lucy, Hello, Oh hi doctor.
Speaker 5 (37:18):
Two or three bumps on my cheek, which I don't
think I've seen before. Just wondering whether they should be
looked at as the cantress.
Speaker 3 (37:28):
I guess does it come in multitude of bumps with it?
Andy on there we go.
Speaker 4 (37:34):
Yes, usually they come in solitary lumps, and sarcoma does.
But I think if you've got a new bomb, you know,
and it's not going away, then you should go and
see your family doctor about that and ask them to
have a look at it.
Speaker 3 (37:50):
Have you seen anyone, Lucy, No, I haven't.
Speaker 5 (37:53):
I just wanted to see it because they've only just
come up in the last two or three weeks. I
wanted to see whether you know, whether they change shape,
or they're going to be paying for or what.
Speaker 3 (38:05):
Yeah, well, I would say it's basic to get along
to a doctor. I think that's what Andy is saying,
but in terms of reassurance, usually if you have got
something that's serious, solitary, solid slog ah. So for people
who do have what do you want just to reiter right,
what would you want people to take away from the
(38:26):
check that we've had this afternoon?
Speaker 4 (38:28):
I mean, I guess And what we want people to
take away is so that they know of sarcoma. They've
heard of it, they know it can affect any age
in any part of the body and it's bone in
soft tissue. That if they are worried about something or
they know somebody who's got something like this, they should
say to them, please go along and see your family doctor.
And also, you know there's the website, So the Sarcoma
Foundation New Zealand and the Australian New Zealand Sarcoma Association
(38:52):
go onto their websites. There's information there about diagnosis and
what to be concerned about, and then they're fantastic resources.
Speaker 3 (39:02):
Just a few takes here just to pass on. One
says Hi, my dad was diagnosed with psycoma on his
back about five years ago, his late sixties. GP sent
him away so many times over several years and told
him it was a lipoma. Lipomer took him sending a
photo of it to the Eden hospital get it identified.
He at a massive op to remove it along with
some ribs. My message would be to keep pushing if
(39:24):
your GP isn't proactive, and we don't want to crack
at GPS.
Speaker 4 (39:27):
But this is a that's very common sarcomastory and unfortunately
lapumas are super common, and I lipe with psycomas, which
is what this gentleman sounds like he had, are rare,
but also they are a very serious cancer.
Speaker 3 (39:41):
And another one says, thank you for the very informative interview.
My husband has a rab dough MYO sarcoma rap Did
I get that right? It me? Anyway, he did started
in his thigh, manifested when he played squash and he
thought he'd pulled a muscle. How long would it have
been there? Do you think? Unfortunately he was in the
(40:03):
unlucky fifty percent. He had three years of fabulous support
from Michael Flint.
Speaker 4 (40:08):
Yeah, Mike's I love the guy, a very good surgeon.
It would have been there for a number of months,
if not up to a year before he was aware
of it. And his story is very very common that
I must have enjured it playing soccer and it's again
a common question is this is because of acc Absolutely isn't.
It's human nature. We had it in London as well.
(40:31):
I've bumped my leg hardly playing football. I've got a bump.
It must be a little tour muscle. I'll keep an
eye on it.
Speaker 3 (40:37):
Are all your cases We've got about just a couple
of minutes to go. But are all your cases that
you deal with? Are you exclusively dealing on psychomas or
it's a range of things. As an ooth paid controcologist.
Speaker 4 (40:49):
So mainly sarcoma, that's my main job, so people refer
to me at that. But we do have a role
in metastatic bone disease, which is a major increasing issue
for health services around the world because our medical oncology
colleagues are getting much much better at curing common cancers
like melanoma, breast cancer, and so people with metastatic bone
(41:11):
disease are living much longer and we have to do
bigger operations that allow them to continue having a good
quality of life.
Speaker 3 (41:17):
Who do you need the voice of to get more
funding for these issues? Is it a matter of getting
on Simeon Brownsie or someone at Health New zeand or what.
Speaker 4 (41:24):
Well, yeah, I mean we're always always open to having
more funding and but you know, just getting some research
trials open in New Zealand. We don't have any formal
research offices. The research stuff that we do is all
done in early morning before we start working in the
evening instead of watching the TV.
Speaker 3 (41:42):
What chance do you think that there will be immunotherapy
will kick in instead of this highly toxic sort of chema.
Speaker 4 (41:48):
Absolutely, eventually that's what we will end up getting. And
there is research. There are big international trials going on
for these rare and ulter rear cancers. International collaboration is
the way to go.
Speaker 3 (41:59):
Excellent, Hi Andy, I really appreciate your time coming in
and good luck with all the work you do. Really
appreciate it. If anyone who has listened to this and
you'd like to go back and get the lowdown on
a few of the issues around psychomists, then please do
go and check out our podcast. We load the hour
pretty quickly after each our confluences. But that wraps the
Health Hub. We'll be back with Smart Money with Hanna
(42:20):
McQueen is next. It's three minutes to five News Talks
EDB
Speaker 1 (42:26):
Great listen Zy For more from the weekend collective, Listen
live to News Talks EDB weekends from three pm, or
follow the podcast on iHeartRadio.
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