She went to her family doctor, followed by x-rays, and a bronchoscopy to look inside her airways. By January 2022, Karen was formally diagnosed with grade 2 neuroendocrine cancer.

While neuroendocrine tumours can occur anywhere in the body, in Karen’s case, hers were in her lymph nodes and gastrointestinal tract.

“I hadn’t had any symptoms, I didn’t even know,” says Karen, who was 48 years old at the time; a sports mom with two teenagers in the house. “I was shocked, I didn’t experience anything, and still haven’t (besides that chest cold discomfort feeling). It never crossed my mind that I may have cancer.”

A clinical trial testing radioligand therapy (RLT)

Upon speaking to her radiation oncologist, Dr. Sten Myrehaug, Karen signed up for a clinical trial to receive radioligand therapy (RLT) as the first course of treatment.

Although neuroendocrine cancer is uncommon, its incidence is rising rapidly and few treatments exist for these patients as this kind of cancer is resistant to most therapies; making it challenging to treat.

RLT involves injecting radioactive isotopes through an IV – in this case, with the drug Lutathera – in order to target specific cancer cell receptors, and deliver more targeted and precise radiation to kill cancer cells while preserving healthy tissue.

While RLT has been used in the treatment of some other cancers in later stages of a patient’s care path, this study evaluated for the first time the use of RLT earlier as a first-line (or “up front”) treatment for patients newly diagnosed with grade 2 or 3 advanced gastrointestinal neuroendocrine tumours.

Karen started off on the “standard arm” of the trial with two intramuscular injections – one in each hip – of high-dose long-acting release (LAR) octreotide.  This is used to in order to stop or slow down the progression of tumours.

When one of her tumours started to grow in size, she was then switched to the treatment arm of the trial that offered infusions of the radioactive medication Lutathera.

Treatment took up to 30 minutes, with an IV in each arm, with the rest of the day with anti-nausea medications.

“Besides the nausea, I didn’t have any other side effects, except having to be isolated from my family for a week. I locked myself in my bedroom with my own bathroom. I had my own dishes, everything had to be washed separately, I equipped myself with my laptop and some trash magazines for the week.”

The nausea got better after each treatment and she continued working full time in healthcare administration right through without any symptoms. She finally took six months off last year to “concentrate on me” and has been back to work since October.

Asked if anything has changed for her, Karen says: “I try to walk more than I did in the past, to keep up with healthy living, getting better. Other than that, nothing has changed.”

The results: a game changer in the practice of cancer treatment

Since the multi-site trial closed, the researchers assessed the data and the results were recently published in the journal The Lancet: the RLT that Karen and other participants received showed a reduction of the risk of advanced neuroendocrine tumour progression by 72 per cent.

Karen’s response upon hearing these results? “I couldn’t be happier.”

“The results confirm the clinical benefit of earlier use of RLT for newly-diagnosed patients with these types of aggressive and life-threatening tumours,” says Dr. Simron Singh, global principal investigator of the trial, and medical oncologist and cofounder of the Susan Leslie Clinic for Neuroendocrine Tumours at Sunnybrook’s Odette Cancer Centre.

“Cancer care has traditionally been treated by surgery, drugs or radiation; RLT is a game changer in the practice of cancer treatment. While it’s technically radiation, it is given via a chemotherapy route through the blood until it reaches the precise location of the tumour. This is the next step in personalized targeted cancer therapy for patients, focused on more effectively killing cancer cells, while limiting the damage to surrounding healthy tissues.”

This past March, once she knew it was safe to do so, Karen decided to get a tattoo of boxing gloves with a zebra pattern. The zebra is the awareness symbol for uncommon or rare diseases including neuroendocrine cancers.

“This was about me fighting my cancer. It symbolized for me my strength and just knowing I’m going to beat this and fight through this. It gives me strength.”

Photo credit: Kevin Van Paassen/Sunnybrook

The post The growing fight against rare but challenging cancers appeared first on Your Health Matters.

Sunnybrook Health Sciences Centre is home to the Odette Cancer Centre, the second largest cancer centre in Canada. The centre is leading the way in innovative cancer care that is designed to meet the unique needs of individual patients living with cancer.

At the latest Sunnybrook Speaker Series, experts from the centre shared their insights about personalized cancer care and how it is evolving.

Dr. Calvin Law, chief of the centre, described the transformative future of personalized cancer care as the health-care system moves away from a “one-size-fits-all approach” and instead focuses on each individual’s experience and treatment needs in order to achieve the best possible outcomes.

“At the end of the day, it is the individual patient who we are serving,” said Dr. Law. “The personalized care we provide needs to get better every day.”

How do Genes Play a Role in Personalized Cancer Care?

Tracy Graham, genetic counsellor and manager with the Odette Cancer Centre Genetics Program, shared her insights on how a person’s genes can play a role in the personalized cancer care they receive – something many patients might not be aware of.

“All cancer is genetic because there has to be genetic mutations occurring within the cells of our body for cancer to occur,” explained Graham. “But only five to ten percent of cancer is hereditary.”

Genetic testing can be done for both hereditary cancers (germline mutations) and those which are acquired throughout a person’s lifetime (somatic mutations) to help determine the most effective treatment options.

Often conducted with a simple blood or saliva test, genetic testing can also provide patients with a sense of closure by answering the question, Why was I diagnosed with cancer?, said Graham.

“For example, for a patient who is diagnosed with colorectal cancer in their 20s – which is a young age – finding out there is a hereditary genetic reason behind it sometimes gives them that explanation they are looking for.”

Genetic testing and counselling can also help guide screening and early detection for other types of cancer a person could be at risk of developing, as well as for their family members.

The Future of Precision Oncology

Dr. Eileen Rakovitch, program research director with the Odette Cancer Centre, explained that experts are trying to better understand why standardized cancer treatments are more effective for some patients than others.

A key goal for the future of cancer care is to shift towards personalized treatment for each individual, as opposed to the same approach being used for all patients with the same type of cancer.

Thanks to breakthrough scientific technologies, cancer researchers can now pinpoint the molecular profile of cancers in order to recommend optimal personalized treatment plans.

“With molecular profiling, we now can see this individual with breast cancer, for example, has a different molecular profile than others,” explained Dr. Rakovitch. “Once you do that, you can match and individualize the best drug or radiation treatment for that specific individual.”

Added Dr. Rakovitch: “This is going to enable us to direct better and more effective treatments to patients and help them avoid side effects of treatments that are ultimately not going to be effective. This is the future of cancer treatment.”

Targeting Cancer with Personalized Radiotherapy

Dr. Deepak Dinakaran, a radiation oncologist with the Odette Cancer Centre and scientist with the Sunnybrook Research Institute, discussed how advances in radiation treatment are also contributing to personalized cancer care.

Radiation therapy, also called radiotherapy, uses high energy X-rays targeted at the cancer site to damage cancer cells in the hopes of stopping the future growth and spread of the disease.

“Thanks to technological advances over the past 10 to 20 years, radiation oncology has evolved to better target the site of cancer and significantly reduce how much radiation is going to the rest of the body,” said Dr. Dinakaran. “This precision radiotherapy has allowed us to evolve what we can do clinically to help patients.”

The next frontier of radiation treatment, he said, is adaptive radiotherapy. This aims to adjust a patient’s treatment plan on any given day based on sudden changes within the body. In simple terms: If the tumour or cancer site requiring treatment has suddenly moved, instead of directing radiation where it may no longer be needed, a more accurate site of the body can be focused on.

“Currently it is very hard to adapt to those kinds of internal shifts, but that is what adaptive radiotherapy aims to do by leveraging leading-edge equipment and artificial intelligence for image analysis,” explained Dr. Dinakaran.

“All of this happens within minutes while the patient is still on the bed. It is still new and evolving, but it will really open up new opportunities in how to use radiotherapy.”

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Oral cancer is a form of head and neck cancer, affecting more than 5,000 Canadians per year. Progression of the disease can drastically affect the way an individual eats and speaks. Dr. Jesse Chao, scientist in the Odette Cancer Research Program and Canada Research Chair in Precision Cancer Diagnostics and Artificial Intelligence, is developing new AI software to better detect cancerous cells in the mouth and lymph nodes which will support early detection, staging, and prognosis, leading to improved patient outcomes.

Timely diagnosis plays a critical role in the treatment and recovery of cancer patients. The earlier tumours are detected and diagnosed, the more responsive cancerous cells are likely to be to treatments like surgery, chemotherapy and radiation. Unfortunately, the diagnosis of oral cancer and nodal disease can often be a difficult and time-consuming process. Dr. Chao’s research is aiming to close this gap.

“Our team has developed an AI model that examines tissue samples at various magnification levels, imitating the workflow of a pathologist,” explains Dr. Chao. “This significantly decreases the computational load and complexity of integrating tissue and cellular data for precise tumour detection.”

Using samples from over 500 patients with oral cancer, Dr. Chao and his team are training AI software to automate the image analysis of microscopy data. The software first identifies regions in the tissue and pinpoints areas likely to contain tumours, it then confirms the presence of cancerous cells.

Pathologists often have to go through numerous slides and use many different dyes and stains to determine an oral cancer diagnosis. “Automating this process enhances diagnostic quality, advances early detection, supports personalized treatments and ultimately improved patient outcomes,” adds Dr. Chao.

The software can be used by pathologists to help analyze a sample or provide a second opinion. The software also has the opportunity to serve communities outside of urban centres that lack access to quality cancer care and resources, as it can be accessed remotely by physicians and serve as a potential preliminary diagnosis.

Currently Dr. Chao and his lab are applying this model to detect instances of oral cancer, however, with further research Dr. Chao hopes the software will play a role in the diagnosis of other forms of cancer.

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Going through cancer treatment during the holidays can make it difficult to embrace what has typically been one of the happier times of the year. Patients and families may struggle with how they can celebrate when they or someone close to them is coping with cancer. Patients wonder if they will feel well enough to enjoy the holidays when they going through radiation treatment, receiving chemotherapy or recovering from surgery. There are questions about whether they will have the energy to participate in family celebrations and worries about what the coming year will bring. While everyone else is moving ahead with holiday preparations and celebrations, many of our patients are facing a very uncertain future. They may feel pressured (by themselves or others) to carry on with the traditional holiday rituals, even though they may not have the physical or emotional energy to do so.

As the holiday season gets into full swing, here are some tips for families affected by cancer.

Focus on your own well-being

Whether you are a patient or a caregiver, first and foremost you have to focus on your own wellbeing. Eat well, ensure that you get your rest — including naps — and stay hydrated. Do not abandon your regular routines to accommodate the hectic holidays as these routines are what have helped you cope so far. Allow yourself to do less than you are accustomed to doing during this season and allow yourself to ask for help, whether that is with picking up gifts or bringing in food or helping with decorating and cleaning. Try to limit your visits and visitors to friends and family that share or respect your approach to COVID precautions.

It’s OK to say no

Remember that it is OK to say no. You do not have to accept every invitation or accommodate every request. Most importantly, be flexible. Make plans with the understanding that you may have to reschedule or change plans depending on how you or your loved one is feeling that day – and let people know that when you accept or offer an invitation. Cancer and its treatments weaken your immune system, making it harder to fight off viruses and making you more vulnerable to COVID. With this in mind, limiting your outings and contacts becomes even more reasonable from both an energy-conservation perspective but also from a health-related perspective.

Plan ahead

Clinic closures may be a source of stress for you or your loved one. It is important to know what dates your Cancer Centre is closed over the holidays and who to contact in the off hours if you run into difficulty. Ensure that you have enough of all your prescription medication to last through the holidays.

Prepare for questions

The family and friends you see over the holidays may ask questions about your diagnosis and how you are doing. Allow people the benefit of the doubt that their questions are expressions of concern. But know also that you do not need to explain your medical situation or provide any information beyond what you are comfortable disclosing. It may be helpful to coordinate an exit plan with one of your caregivers if you feel their questions or inquiries are becoming overwhelming.

Remember things may be different – but try not to focus on those differences

This season may not be like holidays from the past so try not to pressure yourself to make it so. The past two years of COVID have prepared many people to expect different or less over the holiday season. Give yourself permission to do what feels safe and comfortable to you. You may come away with new traditions while still being able to participate — instead of making the whole Christmas dinner, offer to host a potluck. Or hand the tradition to a sibling or child. Try not to focus on what might be missing, on what tradition wasn’t kept, or on what might be different about this year’s holiday season from those in the past. Rather, try to focus on the moment and enjoy your celebration in whatever form it takes. Remember what the holidays are truly about – a time for being thankful and sharing with others.

If you have concerns about how to cope with the stress of the holidays, talk to your health care provider and let them know how you are feeling.  Support is available through the Patient and Family Support Program at the Odette Cancer Centre. Wellspring also has various support programs available.

This blog has been updated from a previous version.

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“Rightfully a lot of attention is paid at the time of diagnosis and active treatment,” Dr. Al-Khaifi said. “Many breast cancer survivors have told me that while they felt they had a lot of information and support during their active treatment, once treatment stopped, they lost the continuity of care with the physician.”

It means patients are often left wondering what to expect, what to watch out for with respect to cancer recurrence, and what to do about ongoing side effects of treatment.

“After treatment ends, it’s very common for side effects to continue,” Dr. Al-Khaifi said. “It’s not just a ‘return to normal life.’ Pain. Lymphedema. Anxiety. Depression. Self-image changes. Sexual dysfunction. Menopausal symptoms that are caused by cancer treatment. And the fear of the cancer coming back. All of these contribute to the patient’s quality of life.”

Long-term survival rates after the diagnosis of breast cancer are improving, with a 5-year survival rate in Canada of 90 per cent.

“The continuing improvement in survival rate, coupled with an aging population, contribute to an increase in survival population. As a result, follow-up care with a focus on quality of care is increasingly important,” Dr. Al-Khaifi said. “Research shows that a quarter of breast cancer survivors report anxiety, depression and fears around recurrence, and anecdotally based on my experience with breast cancer patients, I believe the rate is much higher.”

Dr. Al-Khaifi wanted to improve the lives of breast cancer survivors and that’s why she developed and proposed the Sunnybrook Breast Cancer Survivorship Care Clinic. Currently she is the physician lead of the survivorship program at the Louise Temerty Breast Centre.

“I met a patient who had completed treatment and had a good prognosis. She was so acutely anxious of cancer recurrence and her self-image was so low after her body changes that she told me she didn’t leave the house. As a healthcare team, we have to support the whole person. We have to provide women like this with more support and resources after their active treatments like chemotherapy and radiation end.”

Dr. Al-Khaifi works with patients to create an action plan and address their side effects and concerns, and promote a healthy lifestyle to help reduce the risk of recurrence. She also works closely with family doctors to assist in the transition of care back to the community physician.

“Research shows family physician-led survivorship care is as good as specialist care with no difference in recurrence-related serious clinical events. Patients are generally more pleased with their care because it’s closer to home and more comprehensive, and their quality of life improves.“

The care is also individualized, she adds.

“Everyone is different, and everyone responds and reacts to cancer treatment differently. We use a practice-based, evidence-based and personalized approach to help support the whole person through their cancer journey.”

The approach can also have an impact on the healthcare system, she adds, by helping open up cancer physicians’ caseloads for active treatment patients.

“Plus, educating patients on what’s ahead and providing follow-up plans can help reduce fears, which reduces the demand for unplanned care and the amount of imaging, and the costs associated with that.

“So, this approach can be cost effective and beneficial for the healthcare system as well as patients. Further, this may support better coordination between cancer teams and family physicians through treatment summaries and survivorship care plans.”

The post Dr. Muna Al-Khaifi on closing the gap in breast cancer treatment appeared first on Your Health Matters.

Rates of lung cancer are decreasing, and strategies such as enhanced screening and detection methods can lead to an earlier diagnosis, which can result in better patient outcomes. Recognizing these improvements (in addition to decreased incidence of cigarette smoking), enhanced treatments, and the latest forms of radiation technologies, Sunnybrook experts recently reiterated the White Ribbon Project’s message that it is indeed “time to change the lung cancer story.”

The White Ribbon Project’s advocacy is based on promoting lung cancer awareness, in addition to altering the public perception of the disease rooted in years of misleading campaigns. At the last Sunnybrook Speaker Series event, guest presenters Surgical Oncologist Dr. Calvin Law (Chief of the Odette Cancer Centre), Radiation Oncologist Dr. Alexander Louie, Respirologist Dr. Harvey Wong, and Thoracic Surgeon Dr. Negar Ahmadi highlighted the advances in treating lung problems and malignancies that have contributed to a significant improvement in outcomes over the past few decades.

Innovations in Lung Cancer Treatments

Innovations in cancer treatment include various new trials taking place at Sunnybrook that involve SBRT (Stereotactic Ablative Body Radiotherapy). New surgical approaches for treating early cancers are also available, and becoming more minimally invasive, including robotic surgery, and removing smaller portions of diseased lung (i.e., segmentectomy rather than lobectomy).

At Sunnybrook, outpatient Interventional Pulmonology programs such as LDAP (Lung Diagnostic Assessment Program), are helping to expedite the work of patients with suspicious findings for lung cancer. This in turn results in quicker cancer treatments for patients, resulting in better patient outcomes. Minimally invasive methods are now available to confirm the diagnosis of lung cancer (i.e., scopes with ultrasound capabilities, in conjunction with navigation software, result in a painless and incisionless tissue sampling). While these innovations are currently in use, there are also newer technologies (i.e., Robotic Bronchoscopy) that are not yet available in Canada, but are being actively investigated and explored internationally.

Minimally invasive interventions are also available to manage complications related to lung cancer such as airway dilatation and the debulking of tumors from central airways. Another outpatient Interventional Pulmonology program, the EPIC (Effusion Procedural Interprofessional Clinic), inserts indwelling catheters so patients can have the fluid that forms around the lung drained in the comfort of their own home, rather than requiring frequent visits to the hospital.

Positive Outcomes from New Lung Cancer Innovations

• Enhanced treatment for patients
• Improved patient support and home care collaboration
• Faster treatment of cancer complications
• Increase in minimally invasive removals
• Enriched patient experience

Early Screening Saves Lives

Those between the ages of 55 and 74, with a current or former history of smoking (or who have quit smoking within last 15 years), are advised to talk to their primary care physician to see if they quality for lung cancer screening via CT scan. Lung cancer screening saves lives, and Sunnybrook continues to ensure that patients have the latest and most successful options.

Recommended Readings from our Experts

Offering perspectives from lung cancer patients, physicians, and on navigating the Canadian health care system.

• “The Emperor of All Maladies” by Siddhartha Mukherjee
• “When Breath Becomes Air” by Dr. Paul Kalanithi
• “Taking Charge of Cancer” by Dr. David Palma

The post Advances in Lung Cancer Treatment: Changing the Lung Cancer Story appeared first on Your Health Matters.

What is complex malignant hematology (CMH)?

Complex malignant hematology includes a variety of disorders and cancers of the blood. These conditions start in the bone marrow or in the cells of the immune system.

What are the types of blood cancers?

Complex malignant hematology is divided into two main types: lymphoid and myeloid.

Lymphoid cancers affect the lymphocytes – part of the immune system. It may originate in the bone marrow or the lymph nodes.

Myeloid cancers start in the bone marrow. Bone marrow is a spongy tissue inside some of our bones that contains stem cells. Stem cells are immature cells that can develop into blood cells.

The conditions are further classified as “acute” or “chronic”. Acute conditions mean that the cancer cells are splitting and growing quickly, and affecting the immature cells. Chronic conditions mean the cells are reproducing more slowly, and typically involve more mature cells. Sometimes chronic conditions can transform into acute conditions.

Acute conditions may be life threatening left untreated and generally require the treatments to start within 1 week.

To better understand blood cancers, it is helpful to visualize how they are classified. While not an exhaustive list, the starred conditions would fall under the jurisdiction of Complex Malignant Hematology.

The goal of therapy in most CMH conditions is cure.

Lymphoid Conditions

Acute:
Acute lymphoblastic leukaemia (ALL)*
Lymphoblastic lymphoma (LL)*

Chronic:
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma – many types, including:

• Burkitts lymphomas*
• High grade B-cell lymphomas double hit*
• Primary CNS Lymphomas*

Myeloid Conditions

Acute:
Acute Myeloid Leukemia (AML)*
Granulocytic sarcoma*

Chronic:
Myelodysplastic syndromes (MDS)
Myeloproliferative neoplasms (MPN)
Aplastic Anemia (AA)*
Paroxysmal Nocturnal Hemoglobinuria (PNH)*

What are the symptoms of blood cancers?

The symptoms of blood cancers or conditions can be different because of all the different types of condition.

Some of common symptoms of blood cancer, according to the Canadian Cancer Society, are:

• Unexplained weight loss
• Fatigue
• Shortness of breath
• Easy bruisability or bleeding
• Enlarged lymph nodes in the neck, underarm, groin or above the collarbone
• Swollen stomach or abdominal discomfort
• Frequent and repeated infections
• Fever/night sweats

Why do these conditions require such specialized care?

As a general rule, these conditions require management in specialized cancer centres. Many people require chemotherapy and or immunotherapy, and some may only be cured by a bone marrow transplant. The transplant can come either from ones own stem cells (autologous) or from an external donor’s (allogeneic). These treatments essentially wipe out the immune system, putting patients at risk for infection and at higher risk for needing blood transfusions. So, a very specialized care team and treatment space is needed to deliver the best and safest care.

More resources: 

Lymphoma Canada

Leukemia and Lymphoma Society of Canada

Learn more about Sunnybrook’s facility for treating complex malignant hematology.

This post was reviewed and updated Sept. 15, 2021.

The post What is blood cancer? appeared first on Your Health Matters.

The reason that so many people die from lung cancer is that by the time it is usually diagnosed, the cancer has spread to other parts of the body or is too big. When the cancer has spread or is too big, treatment has less of a chance of working.

The good news is that Ontario now has an effective and evidence-based way to check, or screen, people who are at high risk of getting lung cancer. According to Dr. Lisa Del Giudice, Regional Primary Care Lead – Cancer Screening, Toronto Central Regional Cancer Program, this means that some lung cancers can be found early, when treatment has a better chance of working.

The new Ontario Lung Screening Program (OLSP) is an organized lung cancer screening program that is currently available at four hospitals in Ontario.

Who can qualify for lung cancer screening?

People may qualify to get screened for lung cancer if they:

• Are 55 to 74 years old, and
• Have smoked cigarettes every day for at least 20 years in total (it does not have to be 20 years in a row, which means there could be times when someone did not smoke).

To find out if you qualify for lung cancer screening, Dr. Del Giudice recommends speaking with your health-care provider or contacting an OLSP site hospital. To find a hospital that offers lung cancer screening through the OLSP, call 1-866-662-9233 or visit the OLSP website for a list of locations.

If you qualify for lung cancer screening and you do not have a health-care provider, the hospital will help find you one so that you can get screened.

What is the screening test for lung cancer?

People who qualify to get screened will be offered a special type of computed tomography (CT) scan that uses a small amount of radiation. This test is called a “low-dose CT scan.” Getting screened with a low-dose CT scan is the best way to find lung cancer early when it may be easier to treat.

Lung cancer screening is not for everyone. Dr. Del Giudice says that “people who are not at high risk of getting lung cancer should not get screened because there may be more risks than benefits for them.”

For more information about lung cancer screening, please visit Cancer Care Ontario. If you think you have any signs or symptoms of lung cancer, speak with your health-care provider.

There are several things you can do to lower your risk of lung cancer:

• Do not smoke and avoid second-hand smoke;
• Protect yourself from cancer-causing substances;
• Eat a healthy diet;
• Know your personal risks.

Learn more about your lung cancer risk and how to reduce your risk at My CancerIQ.

Blog Authors:

Toronto Central Regional Cancer Program, Cancer Screening

Dr. Lisa Del Giudice, Regional Primary Care Lead – Cancer Screening, Toronto Central Regional Cancer Program Family Physician, Sunnybrook Health Sciences Centre Academic Family Health Team

¹Cancer Care Ontario [Internet]. Toronto (ON): Lung Cancer. Available from: cancercareontario.ca/en/types-of-cancer/lung 

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Q: I saw a Colorectal Cancer Awareness poster that said to look out for blood in my stools. What exactly am I looking for?

A: A person’s stool (poop) is a window into their health and a precious warning sign of a problem, so look at it before you flush it. Keeping an eye on your stools is an important step in being aware of colorectal cancer and identifying early signs of the disease.

The topic of what one’s stool says about their health is very extensive and I won’t get into it all here, but let’s talk about seeing blood.

Firstly, blood in your poop is not normal. All blood passed in the stool, around the stool or after the stool is abnormal and represents a problem of varying severity.

So to answer the question, you are just looking for blood. And if you see it, you need to report it to your family physician for investigation. It’s just that simple. Having said that, there are certainly more worrisome characteristics of the blood in one’s stool and certain features that you should be aware of in order to report them to your physician. To understand these characteristics, one must imagine where this blood is coming from.

Colorectal cancer is a disease of the cells of the inner lining of the colon or rectum. The cells begin to grow out of control, first forming a cluster of cells called a polyp and eventually becoming a cancer as the cells burrow deeper into the wall. Because these polyps and eventual cancers are growing on the inner lining of the bowel, they ooze or bleed into the bowel and that blood then becomes incorporated with the stool as it passes through.

With that background, one can begin to imagine just how blood in the stool might look if it is coming from a colorectal cancer. If the cancer is in the right side of the colon (the beginning of the colon and furthest from the anus) then the blood might be undetectable by the eye by the time it reaches the toilet. If there is lots of blood coming from a cancer in the right colon, it may no longer look like red blood by the time it reaches the toilet but rather like black tar mixed in with the stool.

If the cancer is further along in the colon or even in the rectum, the blood will still be red smeared along the stool as it hits the toilet or the blood will be mixed in with the stool but still bright red in appearance.

Finally, if the cancer that is bleeding is in the rectum, just before the exit, you might see only blood coming into the toilet either prior to or after the stool as it is bleeding directly out of the anus rather than mixing with stool.

So by understanding how blood in the stool could be a warning sign of a cancer, it also becomes clearer why we use a fecal immunochemical test (FIT) to look at the stool microscopically (and why it’s so important!) This test checks for occult (hidden) blood in the stool as a screening test for colorectal cancer — it can find blood that isn’t visible to the eye when you look in the toilet.

The test isn’t specific — many other things can lead to hidden blood in the stool and the test can’t tell which it is causing the blood. But it is very sensitive, which means that almost all colorectal cancer patients would be positive if the test was done. That means very few false negatives, which is ideal for a screening test.

It is obviously very important to understand that many different colorectal problems can lead to blood in the stools, not just cancer. But do remember that regardless of the cause, blood in your poop it is not normal and needs discussion and investigation by your primary care physician. The characteristics of the blood will offer clues but by no means will it make a diagnosis and almost certainly the next step will be a colonoscopy to definitively sort out what’s going on.

In very simple terms, please do this for me: Turn and look at your stool before flushing. It could save your life.

(This post was updated in August 2020 to reflect a change in Ontario’s colorectal screening test from the fecal occult blood test to the FIT)

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Treating cervical and other gynecological cancers used to require an uncomfortable procedure and overnight stay at the hospital. Now, with the help of an innovative imaging and operating suite at Sunnybrook, some patients can receive treatment in hours rather than days – all with minimal discomfort.

Sunnybrook’s specialized MRI-Brachytherapy Suite combines the power of magnetic resonance imaging (MRI) with an operating room and radiation bunker. In this space, doctors can pinpoint tumours and place a radiation source directly into cancerous tissue, while using MRI to observe the treatment “in real time,” says Sunnybrook radiation oncologist Dr. Eric Leung.

The entire procedure, known as gynecological interstitial brachytherapy, can be performed in adjoining rooms, rather than transporting a patient between imaging and operating suites across the hospital. This has turned a lengthy treatment, which previously took up to 48 hours, into an outpatient procedure that is quicker and less painful.

During a gynecological interstitial brachytherapy, MRI is used to guide the placement of a tube-shaped applicator and around 20 thin needles that deliver large doses of radiation to the vagina, cervix or uterus while avoiding healthy, sensitive tissue.

Prior to the suite, patients would have to wait for a few hours – awake – with the applicator inserted, which many people found uncomfortable or painful. They were also awake for the applicator removal.

“Importantly, the treatment can now be done while a patient is under anesthesia,” Dr. Leung says.

Sunnybrook’s efforts to improve the treatment haven’t stopped there. Ananth Ravi, PhD, lead brachytherapy medical physicist, is testing new electromagnet technology to guide needle placement and increase precision during the procedure.

“Our brachytherapy team is excited by this leap forward in the evolution of our program,” Ravi says. “The efforts of our team and the introduction of innovative technologies enable us to deliver not just effective, but [also] truly compassionate, patient-centred care.”

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