How cancer treatments are assigned

Stuart E. Siegel, MD, explains the number of different factors that now make the type of treatment for cancer a complex decision
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How cancer treatments are assigned

Well, of course, the first thing you need to know is the what the actual diagnosis under the microscope is. What the pathologist tells you is the kind of cancer it is. That's obviously clear. Secondly, you need to know, in a lot of cancers, not all, but in a lot of cancers, how far the cancers is spread. Is it localized? Or is it spread around the body? Because, treatments are different there. But, increasingly the treatment assignments are based on what we call prognostic factors. Which are things that we can determine about that tumor, about that patient, at diagnosis. Which, now we know, tell us whether that child has either a better of worse chance to respond to a given therapy. Whether they need different therapy than we would normally give. These are called prognostic factors. And, in leukemia, for instance, there are things like how high the white count is, the white blood cell count is. Or how old the child is? Or what are the immune characteristics, the proteins on the surface of leukemia cells? What are the genes, the chromosomes in the tumor, in the leukemia look like? In the solid cancers it has to do often with the molecular components of that cancer. We can now take a cancer cell and find out exactly what are the genes that are in there. What are the abnormal genes. And, there are certain patterns or amounts of abnormal genes that can tell us whether a patient needs relatively standard therapy, and will do very well, or whether that patient needs much more intense therapy, or new therapy, or a specific therapy that meets that particular cancers needs for treatment. So, it's really has gotten quite complex to decide how to do this. But, it means that's its very, very important for a family to have their child seen and be treated at a major cancer Center. Because, you have to have all this things available to look at. To examine in the tumor and in the patient. And only the major Centers have this ability to do this. So, that's really one of the critical elements here, in this increasingly complex world where it's not just how far the cancer is spread or what it looks like under the microscope. But, what are this genetic and immunological, and other factors, that can determine how we should treat this, that irradiate the place that can give you those answers. That can do those tests. That can tell the doctor "Okay, here is the pattern. Here is what you need to do to treat that child."

Stuart E. Siegel, MD, explains the number of different factors that now make the type of treatment for cancer a complex decision


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Stuart E. Siegel, MD

Director, Children’s Center for Cancer & Blood Diseases, Children's Hospital Los Angeles

Before recently shifting his focus to international medicine, Stuart Siegel, MD, was Chief of the Division of Hematology/Oncology for 35 years and the founding director of the the Children’s Center for Cancer & Blood Diseases at Children’s Hospital Los Angeles, and Professor and Head of the Division of Hematology-Oncology Department of Pediatrics, Keck School of Medicine of University of Southern California. He remains a leader in supportive care and research in pediatric oncology, with a special focus on neuroblastoma, non-Hodgkin lymphoma, Ewing Sarcoma, acute lymphoblastic leukemia and brain tumors. From developing the first pediatric protective environment in 1971 for children undergoing intensive chemotherapy, to pioneering current efforts to develop academic and clinical care programs nationally and locally for adolescents and young adults with cancer, Dr. Siegel’s contributions have revolutionized the field of pediatric oncology. Dr. Siegel has been honored for his work by the American Cancer Society, Children Foundation, the Cancer Foundation, the Chase Foundation, Padres Contra El Cancer, the Israel Cancer Research Fund and Ronald McDonald House Charities, where he is a member of the National Board, and has consistently been listed among the nation’s top doctors in such publications asAmerica’s Top Doctors and Best Doctors in America. He is a father of one son, Joshua; grandfather of David and Elijah; and lives in Pacific Palisades with his wife of seven years.

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