October 15, 2024 • 11 mins
Dr. Robert Turcotte, Orthopedic Surgeon (MGH-MUHC) and Dr. Jonathan Cools-Lartigue, Thoracic Surgeon (MGH-MUHC) explain the basics of this disease, which is the leading cause of death in Canada. What are metastases? Can sarcoma be cured? They answer these and other questions. Learn more about cancer from these two experts.
Dr. Cools-Lartigue is a spokesperson for Together Against Cancer, a unique collaboration between the Cedars Cancer Foundation and the Montreal General Hospital Foundation. Our goal is to raise $100 million to support transformative projects that will improve the experience, quality of life, and outcomes of cancer patients.
Join us and give the best you can.
Togetheragainstcancer.ca
Cet episode de Prendre le pouls est aussi disponible en français.
00:00 Dr. Cools-Lartigue: Intro
00:36 Dr. Cools-Lartigue: What is cancer?
01:09 Dr. Turcotte: What is sarcoma?
01:27 Dr. Turcotte: What are the types of sarcoma?
01:44 Dr. Turcotte: Can sarcomas be cured?
02:06 Dr. Cools-Lartigue: What causes cancer?
03:05 Dr. Turcotte & Dr. Cools-Lartigue: What are the common cancer symptoms?
04:13 Dr. Cools-Lartigue: Why is cancer so difficult to cure?
05:21 Dr. Cools-Lartigue: What is metastasis?
05:49 Dr. Cools-Lartigue: What do the stages of cancer mean?
07:12 Dr. Cools-Lartigue: How do people die of esophageal cancer?
07:43 Dr. Cools-Lartigue: How do you determine the right treatment to follow?
08:52 Dr. Cools-Lartigue: What is chemotherapy?
09:35 Dr. Cools-Lartigue: What is immunotherapy?
10:18 Dr. Cools-Lartigue: Why is it an interesting time in cancer research?
Si vous avez aimé cet épisode de Prendre le pouls, partagez-le avec vos amitiés! Envoyer vos commentaires à communications@fondationhgm.com
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Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
In my mind.
The question is why is yourimmune system which controls and
prevents you from gettingcancer? Throughout the course of
your life, right?
People don't get cancer whenthey're, for the most part, 20,
30, 40, right?
It's a disease of age.
So why is it that your immunesystem at 60 plus years old
suddenly cannot control thisdisease anymore?
(00:36):
It's a disease, we call it, ofthe genes, but it's tissue that
grows uncontrollably.
And what kills patients is thatcancers have a tendency to
spread from the first site thatyou get them to elsewhere in
your body, and it's that spreadthat usually kills people.
It's a lot like weeds in yourgarden, you know, it's a
perfectly natural thing, butit's growing in the wrong place
at the wrong time and you can'tget rid of it, you know?
(00:57):
So it's like you get rid of allthe weeds, you think
everything's fine, and thenthey pop up somewhere else and
you get rid of those and theypop up somewhere else.
And cancer is sort of the samething.
It's a disease that we losecontrol of.
And and that's why it's such aproblem in our, in our, in the
medical field today.
Sarcoma is a family of cancerwhich are different than lung,
prostate or breast cancer wherethe we think the the cancer cell
(01:19):
originated from what we callthe stem cells, which are the
primitive cells we have who cantransform in different tissue in
our body. Sarcoma is a widevariety of different tumors.
There's over more than 50 typeof sarcoma.
And they involve oftentimeseither the bone or the soft
tissue at any age and any sex.
(01:41):
And the incidence is the samethroughout the world.
Sarcoma can be cured, especiallywhen they're localized.
But when they're spread they'retougher to to cure.
So we have good treatment forsome of these cancers.
Some others are not veryresponsive to any known agent.
Uh, so yes, it's a difficultbattle when the cancer
(02:03):
progressed, but advanced cancersometimes can be cured.
I think really the global answeris we don't really know, right?
We have lots of associationswith cancer.
So a big one is smoking.
That's a common one for forthoracic surgeons who do lung
cancer like myself. But thereare many risk factors for
cancers generally.
Most of them are a goodproportion of them are
(02:25):
lifestyle. So like things likesmoking, alcohol, too much food,
kind of, you know, gist of thelife we live, obesity, stress,
all that stuff. Those those arerisk factors for cancer.
And we can describe cancer, youknow, at the clinical level.
So you get a lump that causes aproblem.
We can describe it at thegenetic level.
So if you look at the genes ofcertain cancers, they tend to um
(02:47):
they tend to give youinformation on the type of
cancer it is. But as a whole,we don't have a great
understanding of what thisdisease really is and why it
comes back the way it comesback.
So it's sort of like a bigmystery that still exists today.
And it's it's what my researchis focused on is understanding
why it comes back.
In the extremity cancer, boneand soft tissue cancer, the
(03:09):
symptoms are not specific.
Usually people will comebecause they have a bump or they
have pain, and these are themain reasons.
So rarely people will show upbecause they're losing weight or
coughing and things like that.
So these are symptoms for adifferent cancer.
But in limb cancer usually it'sa bump or a pain.
So the symptoms of cancer arerelated to where you get the
(03:30):
cancer. So probably the mostimportant thing to know is a lot
of cancers don't give yousymptoms.
And that's why it's dangerous.
Right. So people don't feel baduntil it's relatively advanced.
It's one of the reasons whywhen we talk about lung cancer,
for example, most patientsaren't candidates for surgery is
because most of them have nosymptoms.
And they present with veryadvanced disease where they're
(03:51):
not able to get surgery.
The same is true in esophagealcancer, for example.
The symptoms that people canget are specific to the organ
that's involved. So if you geta cancer in your colon, for
example, you can get blockedand things don't work right.
If you get lung cancer, peoplecan have pain, trouble
breathing, bleeding, cough,things like that.
But again, the most commonsymptom is nothing.
(04:13):
So our treatments of the firstpresentation of cancer, the
first episode of cancer, let'ssay your lung, for example, is
often surgery. We take it outand the problem is solved,
right? Cancer is gone.
Often your symptoms are betterand people can live some quality
of life. The problem and whatcuts their life short, and what
leads to a lot of the sufferingand fear that we hear about with
cancer. And it's what patientswill ask you all the time,
(04:35):
right? Is like, did you get itall? And we say, we got it all,
but we know that the likelihoodthat it comes back at certain
stages is high, and that's whatkills people.
So essentially it's the the, theproblem with cancer is not so
much treating the indexpresentation, let's say the lung
cancer or the esophagus cancer.
Is this going to come back.
(04:55):
And the answer unfortunately isoften yes.
And when it comes back is thereanything we can do about it.
And the answer unfortunatelyoften is not not necessarily.
Surgery usually is off thetable when things come back
because of how they spread andwhere they spread and the
treatments that we have in veryadvanced disease, although
they're getting better, stilldon't reliably cure your
(05:16):
disease, and we cannot reliablyprevent the process of
metastasis today.
Metastasis is the process bywhich cancer spread from the
primary site or the first sitethat you get them to other parts
of your body, be that, youknow, lung cancer, for example,
which I treat a fair amount of,starts in the lung.
But usually what kills patientsis spread to bones or brain or
(05:38):
liver. And so that processwhereby the cancer starts in one
place, the lung, for example,and ends up in another, like the
brain, for example, thatprocess is termed metastasis.
And that is what is killing ourpatients today.
The stages are really aprognostic tool.
It's a tool that's used byphysicians and surgeons to
adjudicate you to a therapeuticcourse, whether that be surgery,
(05:59):
radiation, chemo, immunotherapyor some mix thereof.
Right. Generally stages, themore advanced the stage, the
more advanced your disease.
And generally the more advancedthe disease, the worse your
prognosis. I don't like to talkabout stage with patients beyond
adjudication of therapy.
Because again, I can't tell youhow you're going to do a patient
(06:21):
with stage one lung cancerwhile the majority are cured
with surgery alone with veryearly lung cancers.
A good proportion, 10 to 15%,will die of metastasis.
Okay. So while the majority arecured, what are we missing in
that 15%? And by the sametoken, patients with stage three
and four disease, which used tobe a death sentence, is not the
case anymore. There are goodfive year survival for patients
(06:42):
who present with lung cancereverywhere.
It's about 25% today.
That was unheard of a decadeago.
So you know, what does yourstage mean for you?
It means I'm going to recommenddifferent therapies.
I think that's really what Ithink is important for patients
to know. The problem is peoplehear stage three four and they
(07:04):
get scared because they thinkit means they're going to die.
It doesn't necessarily meanthat.
But as a general rule of thumb,the more advanced your stage,
the worse your prognosis.
What what kills people is, iswith esophageal cancer is not
necessarily that they can'teat, but it's that their cancer
is back. So number one, it's abig burden on your body
metabolically. So like a lot ofthe foods you're eating that
(07:24):
would normally keep you goingis keeping that cancer going.
You know. And so people getvery weak.
They lose a lot of weight.
They get tired.
Your immune system doesn't workas well for patients with
cancer. So you becomesusceptible to infection.
So what kills most cancerpatients with metastasis are
infections. And those are oftenrelated, like I said, to where
that cancer shows up.
Generally when we talk abouttreatment for for cancer there
(07:46):
are local treatments.
Those include things likesurgery and radiation.
And by local we just mean can Itreat the site.
So colon cancer, lung cancer,can I treat the colon?
Can I treat the lung.
And the answer is often yes.
Sometimes we need chemotherapy.
So that would be an example ofa systemic therapy right.
It's not a treatment that actslocally. It acts everywhere in
the person in the organismsystemically.
(08:07):
So things like chemotherapy,immunotherapy and some of the
newer targeted agents, you'llhear words like that.
Those are systemic therapies.
They're divided into lines oftreatment.
So you'll get like first linetreatment.
Generally the first line,generally there's a lot of
exceptions to everything, butgenerally the first line
treatment is the best, but itdoesn't always work.
(08:29):
And when first line treatmentsdon't work, that's when we give.
You'll hear oncologists talkabout second line, third line,
and so on and so forth.
Generally when you start movingdown the line, things are more
serious. And that often refersto the the process of metastasis
like, oh, your cancer is back.
So we'll try your first linetherapy, but it's back.
So now you need a differenttherapy because the first one
(08:51):
doesn't work anymore.
What we talk about when we talkabout traditional chemotherapy,
these are drugs that killrapidly dividing cells.
So cancers grow quickly.
That's the problem. And sochemotherapy traditionally has
been used to kill cells,rapidly dividing cells.
Generally it kills the cancer abit more than it does the rest
of your cells in your body. Butas everybody kind of knows,
(09:13):
chemotherapy is quite toxic.
I mean, that's the whole pointof chemotherapy.
More modern therapies or morerecent therapies.
So things like targetedtherapies tend to be targeted to
the tumor specifically, so theyhave less of like a bystander
effect. So they'll moreeffectively kill the tumor cells
than they will surroundingcells.
They are not without sideeffects, but generally the side
(09:34):
effects are milder. Soimmunotherapy is a bit newer.
It is not aimed directly atkilling the tumor like the drug
that they give you does notdirectly kill the tumor.
What it does do is it preventsthe tumor from telling your
immune system to ignore it soyour immune system becomes more
active, will recognize thecancer as a as something bad,
(09:55):
and will attack the canceritself.
So it harnesses the power ofyour immune system to target the
cancer. It seems to be moreeffective than traditional
chemotherapy in certainconditions and certain diseases.
It seems to be, in some cases,more durable of a response than
than in traditionalchemotherapies.
And it tends to be a little biteasier on patients than
(10:16):
traditional chemotherapy.
It is an exciting time to be aresearcher right now.
And the reason for that is, youknow, the two things have sort
of changed. Number one is ourrecognition of the role your
immune system plays in cancer.
But I guess number two is theemergence of therapies that are
(10:37):
actually able to harness theimmune system.
So we can see what the effectsare.
We can look at people who getbetter on immunotherapy.
And that can help us understandwhat kind of immune response
your body mounts that'sbeneficial. And so that's very
exciting. That's new.
That hasn't been the casethroughout the history of the
disease. Right.
And third, we kind of have thetools to study the immune system
today better than we did evenrecently.
(10:59):
I think that, you know, whenyou find something that works
like immunotherapy, usuallythose things that the concept to
me is a valid concept.
And as we get farther andunderstand this better, I think
we'll be able to tailor ourtherapies, our immunotherapies
towards more patients and alsoto understand, like, what do we
want to get out of the immunesystem.
In my mind.
The question is why is yourimmune system which controls and
prevents you from gettingcancer? Throughout the course of
your life, right?
People don't get cancer whenthey're, for the most part, 20,
30, 40, right?
It's a disease of age.
So why is it that your immunesystem at 60 plus years old
suddenly cannot control thisdisease anymore?
(00:36):
It's a disease, we call it, ofthe genes, but it's tissue that
grows uncontrollably.
And what kills patients is thatcancers have a tendency to
spread from the first site thatyou get them to elsewhere in
your body, and it's that spreadthat usually kills people.
It's a lot like weeds in yourgarden, you know, it's a
perfectly natural thing, butit's growing in the wrong place
at the wrong time and you can'tget rid of it, you know?
(00:57):
So it's like you get rid of allthe weeds, you think
everything's fine, and thenthey pop up somewhere else and
you get rid of those and theypop up somewhere else.
And cancer is sort of the samething.
It's a disease that we losecontrol of.
And and that's why it's such aproblem in our, in our, in the
medical field today.
Sarcoma is a family of cancerwhich are different than lung,
prostate or breast cancer wherethe we think the the cancer cell
(01:19):
originated from what we callthe stem cells, which are the
primitive cells we have who cantransform in different tissue in
our body. Sarcoma is a widevariety of different tumors.
There's over more than 50 typeof sarcoma.
And they involve oftentimeseither the bone or the soft
tissue at any age and any sex.
(01:41):
And the incidence is the samethroughout the world.
Sarcoma can be cured, especiallywhen they're localized.
But when they're spread they'retougher to to cure.
So we have good treatment forsome of these cancers.
Some others are not veryresponsive to any known agent.
Uh, so yes, it's a difficultbattle when the cancer
(02:03):
progressed, but advanced cancersometimes can be cured.
I think really the global answeris we don't really know, right?
We have lots of associationswith cancer.
So a big one is smoking.
That's a common one for forthoracic surgeons who do lung
cancer like myself. But thereare many risk factors for
cancers generally.
Most of them are a goodproportion of them are
(02:25):
lifestyle. So like things likesmoking, alcohol, too much food,
kind of, you know, gist of thelife we live, obesity, stress,
all that stuff. Those those arerisk factors for cancer.
And we can describe cancer, youknow, at the clinical level.
So you get a lump that causes aproblem.
We can describe it at thegenetic level.
So if you look at the genes ofcertain cancers, they tend to um
(02:47):
they tend to give youinformation on the type of
cancer it is. But as a whole,we don't have a great
understanding of what thisdisease really is and why it
comes back the way it comesback.
So it's sort of like a bigmystery that still exists today.
And it's it's what my researchis focused on is understanding
why it comes back.
In the extremity cancer, boneand soft tissue cancer, the
(03:09):
symptoms are not specific.
Usually people will comebecause they have a bump or they
have pain, and these are themain reasons.
So rarely people will show upbecause they're losing weight or
coughing and things like that.
So these are symptoms for adifferent cancer.
But in limb cancer usually it'sa bump or a pain.
So the symptoms of cancer arerelated to where you get the
(03:30):
cancer. So probably the mostimportant thing to know is a lot
of cancers don't give yousymptoms.
And that's why it's dangerous.
Right. So people don't feel baduntil it's relatively advanced.
It's one of the reasons whywhen we talk about lung cancer,
for example, most patientsaren't candidates for surgery is
because most of them have nosymptoms.
And they present with veryadvanced disease where they're
(03:51):
not able to get surgery.
The same is true in esophagealcancer, for example.
The symptoms that people canget are specific to the organ
that's involved. So if you geta cancer in your colon, for
example, you can get blockedand things don't work right.
If you get lung cancer, peoplecan have pain, trouble
breathing, bleeding, cough,things like that.
But again, the most commonsymptom is nothing.
(04:13):
So our treatments of the firstpresentation of cancer, the
first episode of cancer, let'ssay your lung, for example, is
often surgery. We take it outand the problem is solved,
right? Cancer is gone.
Often your symptoms are betterand people can live some quality
of life. The problem and whatcuts their life short, and what
leads to a lot of the sufferingand fear that we hear about with
cancer. And it's what patientswill ask you all the time,
(04:35):
right? Is like, did you get itall? And we say, we got it all,
but we know that the likelihoodthat it comes back at certain
stages is high, and that's whatkills people.
So essentially it's the the, theproblem with cancer is not so
much treating the indexpresentation, let's say the lung
cancer or the esophagus cancer.
Is this going to come back.
(04:55):
And the answer unfortunately isoften yes.
And when it comes back is thereanything we can do about it.
And the answer unfortunatelyoften is not not necessarily.
Surgery usually is off thetable when things come back
because of how they spread andwhere they spread and the
treatments that we have in veryadvanced disease, although
they're getting better, stilldon't reliably cure your
(05:16):
disease, and we cannot reliablyprevent the process of
metastasis today.
Metastasis is the process bywhich cancer spread from the
primary site or the first sitethat you get them to other parts
of your body, be that, youknow, lung cancer, for example,
which I treat a fair amount of,starts in the lung.
But usually what kills patientsis spread to bones or brain or
(05:38):
liver. And so that processwhereby the cancer starts in one
place, the lung, for example,and ends up in another, like the
brain, for example, thatprocess is termed metastasis.
And that is what is killing ourpatients today.
The stages are really aprognostic tool.
It's a tool that's used byphysicians and surgeons to
adjudicate you to a therapeuticcourse, whether that be surgery,
(05:59):
radiation, chemo, immunotherapyor some mix thereof.
Right. Generally stages, themore advanced the stage, the
more advanced your disease.
And generally the more advancedthe disease, the worse your
prognosis. I don't like to talkabout stage with patients beyond
adjudication of therapy.
Because again, I can't tell youhow you're going to do a patient
(06:21):
with stage one lung cancerwhile the majority are cured
with surgery alone with veryearly lung cancers.
A good proportion, 10 to 15%,will die of metastasis.
Okay. So while the majority arecured, what are we missing in
that 15%? And by the sametoken, patients with stage three
and four disease, which used tobe a death sentence, is not the
case anymore. There are goodfive year survival for patients
(06:42):
who present with lung cancereverywhere.
It's about 25% today.
That was unheard of a decadeago.
So you know, what does yourstage mean for you?
It means I'm going to recommenddifferent therapies.
I think that's really what Ithink is important for patients
to know. The problem is peoplehear stage three four and they
(07:04):
get scared because they thinkit means they're going to die.
It doesn't necessarily meanthat.
But as a general rule of thumb,the more advanced your stage,
the worse your prognosis.
What what kills people is, iswith esophageal cancer is not
necessarily that they can'teat, but it's that their cancer
is back. So number one, it's abig burden on your body
metabolically. So like a lot ofthe foods you're eating that
(07:24):
would normally keep you goingis keeping that cancer going.
You know. And so people getvery weak.
They lose a lot of weight.
They get tired.
Your immune system doesn't workas well for patients with
cancer. So you becomesusceptible to infection.
So what kills most cancerpatients with metastasis are
infections. And those are oftenrelated, like I said, to where
that cancer shows up.
Generally when we talk abouttreatment for for cancer there
(07:46):
are local treatments.
Those include things likesurgery and radiation.
And by local we just mean can Itreat the site.
So colon cancer, lung cancer,can I treat the colon?
Can I treat the lung.
And the answer is often yes.
Sometimes we need chemotherapy.
So that would be an example ofa systemic therapy right.
It's not a treatment that actslocally. It acts everywhere in
the person in the organismsystemically.
(08:07):
So things like chemotherapy,immunotherapy and some of the
newer targeted agents, you'llhear words like that.
Those are systemic therapies.
They're divided into lines oftreatment.
So you'll get like first linetreatment.
Generally the first line,generally there's a lot of
exceptions to everything, butgenerally the first line
treatment is the best, but itdoesn't always work.
(08:29):
And when first line treatmentsdon't work, that's when we give.
You'll hear oncologists talkabout second line, third line,
and so on and so forth.
Generally when you start movingdown the line, things are more
serious. And that often refersto the the process of metastasis
like, oh, your cancer is back.
So we'll try your first linetherapy, but it's back.
So now you need a differenttherapy because the first one
(08:51):
doesn't work anymore.
What we talk about when we talkabout traditional chemotherapy,
these are drugs that killrapidly dividing cells.
So cancers grow quickly.
That's the problem. And sochemotherapy traditionally has
been used to kill cells,rapidly dividing cells.
Generally it kills the cancer abit more than it does the rest
of your cells in your body. Butas everybody kind of knows,
(09:13):
chemotherapy is quite toxic.
I mean, that's the whole pointof chemotherapy.
More modern therapies or morerecent therapies.
So things like targetedtherapies tend to be targeted to
the tumor specifically, so theyhave less of like a bystander
effect. So they'll moreeffectively kill the tumor cells
than they will surroundingcells.
They are not without sideeffects, but generally the side
(09:34):
effects are milder. Soimmunotherapy is a bit newer.
It is not aimed directly atkilling the tumor like the drug
that they give you does notdirectly kill the tumor.
What it does do is it preventsthe tumor from telling your
immune system to ignore it soyour immune system becomes more
active, will recognize thecancer as a as something bad,
(09:55):
and will attack the canceritself.
So it harnesses the power ofyour immune system to target the
cancer. It seems to be moreeffective than traditional
chemotherapy in certainconditions and certain diseases.
It seems to be, in some cases,more durable of a response than
than in traditionalchemotherapies.
And it tends to be a little biteasier on patients than
(10:16):
traditional chemotherapy.
It is an exciting time to be aresearcher right now.
And the reason for that is, youknow, the two things have sort
of changed. Number one is ourrecognition of the role your
immune system plays in cancer.
But I guess number two is theemergence of therapies that are
(10:37):
actually able to harness theimmune system.
So we can see what the effectsare.
We can look at people who getbetter on immunotherapy.
And that can help us understandwhat kind of immune response
your body mounts that'sbeneficial. And so that's very
exciting. That's new.
That hasn't been the casethroughout the history of the
disease. Right.
And third, we kind of have thetools to study the immune system
today better than we did evenrecently.
(10:59):
I think that, you know, whenyou find something that works
like immunotherapy, usuallythose things that the concept to
me is a valid concept.
And as we get farther andunderstand this better, I think
we'll be able to tailor ourtherapies, our immunotherapies
towards more patients and alsoto understand, like, what do we
want to get out of the immunesystem.
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