Orlando Health Choose Health - Cancer Edition (2021)

WINTER 2021

Triumph Over Cancer

Food to Fight Cancer Debunking Myths
Avoid These Patient Mistakes of HPV and
Lessons from Celebrity Cancers
Cancer Signs – Top to Bottom Rectal Exams

OrlandoHealth.com/ChooseHealth

CANCER INSTITUTE SPECIAL EDITION

WELCOME

Welcome to the cancer
edition of Orlando Health
Choose Health magazine. 
In this issue, the experts
at Orlando Health Cancer
Institute share tips and advice,
including ways to improve
your health through your
grocery list, symptoms not to
ignore, and exciting new tools
to boost the immune system
and find cancer earlier.
We also reveal common
patient mistakes, as well as
myths about HPV.

INSIDE THIS ISSUE

Food to Myths About HPV
Fight Cancer
16 – 17
6–7
Avoid These What Mail-Away
Patient Mistakes Cancer Signs DNA Tests Miss
Top to Bottom
8–9 20 – 21
10 – 11
Shining Light on Lung Cancer:
Celebrity Cancers America’s Deadliest

14 – 15 22 – 23

Firing Up the By Tim Barker, Editorial Contributor
Immune System

24 – 25

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BACK ROW LEFTTO RIGHT Jennifer K. Logan, MD MIDDLE ROW LEFTTO RIGHT Joseph K Meunier, DO,
Rajesh M. Nair, MD James Mayo, MD Georges A. Hobeika, MD FACOOG
Nicholas G. Avgeropoulos, MD Danielle Henry, MD Prajwol Pathak, MD Sajeve Thomas, MD
Said M. Baidas, MD Michael Kahky, MD Sabrina N. Pavri, MD Ana E Cuesta-Fernandez, MD
Surabhi Ranjan, MD Mickey Liao, MD Julio Hajdenburg, MD Susan Constantino, MD
Ashley A. Muehlberger, MD Matthew Johnston, MD Akash Nanda, MD, PhD Tirrell Johnson, MD
Daniel Anscher, MD Chad D. Kollas, MD Veronica L Schimp, DO Lorna Brudie, DO
Jose E. Sarriera, MD Cameron Swanick, MD Richard Klein, MD, MPH Tomas Dvorak, MD
Omar Kayaleh, MD Kenneth Lee, MD Emilio Alonso, MD Luis J Herrera, MD
Daniel Buchholz, MD

FRONT ROW LEFT TO RIGHT Juan Escalon, MD NOT PICTURED
Daniel A Landau, MD Yasser Khaled, MD Kavita Pattani, MD
Rafael Mañon, MD Elizabeth Feldman, DMD Naren R. Ramakrishna, MD, PhD
Ahmad El-Far, MD Inoel Rivera, MD, FACS Justin Rineer, MD
Alka Arora, MD Nikita C. Shah, MD Regan Rostofer, MD
Patrick Kelly, MD, PhD Terry P. Mamounas, MD, MPH Eric L Saunders, MD
Asad A Sheihk, MD Robin L. Rahm, MD Jeffery Smith, MD
Sreerem Maddipatla, MD, MPH Omar E. Beidas, MD Rafael O. Toro-Serra, MD
Rebecca Moroose, MD Catherine E. Mercado, MD Jennifer Tseng, MD
Kaitlin Christopherson, MD

OrlandoHealthCancer.com

Lifestyle By Julie Vargo, Editorial Contributor
ChTahnagtes
PrCYooatuenct Cutting your risk of cancer by half may sound
too good to be true, but it’s actually possible.
Research suggests that up to 50 percent of
cancer cases and deaths are preventable.

“While there are no guarantees to preventing
a cancer diagnosis, there are certainly some
steps we can take to reduce the possibility,”
says Kathleen Goff, a nurse practitioner at
Orlando Health Cancer Institute’s Cancer
Genetics and High Risk Care Center.

In 2020, nearly 1.8 million Americans were
diagnosed with cancer and more than
one-third of them died, according to the
National Cancer Institute.

Some risks, like genetics and exposure to environmental toxins, For those interested in more ways to lower their risk
can’t be controlled. But understanding family medical histories and of cancer, Goff suggests that you:
recognizing cancer’s symptoms are things we can do.
Exercise your options.
Making Changes
Daily exercise can help reduce the risk of colorectal,
Adopting healthy lifestyle behaviors also can make a difference. breast, lung, pancreatic and potentially even
“Even small changes can make a big impact,” says Goff. “For reproductive cancers. Strive for at least 30 minutes
example, obesity increases the chance of developing many forms of of physical activity each day for maximum benefit.
cancer. Learning to choose the right foods for a nutritious diet and Mix it up, combining moderate and vigorous activity.
working to maintain a healthy weight can have lifelong benefits.”

4ChooseHealth OrlandoHealth.com/ChooseHealth

June 2021

Become sun savvy. Plan proactive
prevention.
Skin cancer is one of the most common and
preventable types of cancer. Sunlight’s damaging Catching cancer early — and when it’s most treatable —
ultraviolet (UV) radiation can increase the risk of is essential. The best way to do this is to schedule cancer
melanomas and other skin cancers. Protect yourself screenings like mammograms, skin exams and colonoscopies
from frying in the sizzling Florida sun by slathering on at regular intervals. These are key to early diagnosis, so work
sunscreen, covering exposed areas, wearing sunglasses and avoiding the with your doctor to make sure they are on the calendar.
day’s strongest rays between 10:00 am and 4:00 pm. Be sure to reapply
throughout your time in the sun, especially after being in the water. Up your vitamin D.

Practice safe sex. Vitamin D supports the immune
system and may help reduce the risk
The more sexual partners you have of prostate and colon cancers. Talk
in your lifetime, the more likely to your provider about having your
you are to contract a sexually level checked. Some studies show
transmitted infection like HPV vitamin D levels in the mid-range
and HIV/AIDS. HPV is spread through may decrease your cancer risk.
skin-to- skin contact during sex. HIV
also is sexually transmitted and Mention menopause.
can set the stage for AIDS-related
cancers of the anus, liver and lung as well Combination menopausal therapies of estrogen
and progesterone have been associated with an
as cervical cancer in women. To lower your increased breast cancer risk. Women considering
risk, limit your sexual partners and practice safe sex. hormone therapy should discuss potential risks with
their doctors.
Lower your infection rate.
Take a smoking break.
Certain viruses like hepatitis and the human papillomavirus
(HPV) have been linked to cancer. Hepatitis viruses account Better yet, avoid all forms of tobacco –
for the majority of liver cancer cases in the nation. HPV, a cigarettes, cigars, chewing tobacco and
sexually transmitted virus, can lead to several types of cancer, including snuff. Tobacco use has been linked to a
cervical and anal cancers. variety of cancers — including cancer of
the lung, mouth, throat, larynx, pancreas,
Fortunately, hepatitis and HPV can be bladder, cervix and kidney. Even if
prevented through vaccination. Talk to you don’t use tobacco, exposure to
your doctor about whether these vaccines secondhand smoke can increase
are an option for you and your family, then your risk of lung cancer.

follow all recommendations.

For more wellness insights, visit OrlandoHealth.com/ContentHub.

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What to Eat

to Lower Your Risk

By Julie Vargo, Editorial Contributor

Searching for ways to
reduce your cancer risk?
Nutritionists suggest
stocking your pantry
with foods favored for
fighting cancer.

While being a savvy grocery shopper
doesn’t guarantee you won’t get cancer,
it may lower your risk. “No single food
can protect you against cancer by itself,”
says Hollie Zammit, a registered dietitian
at Orlando Health Cancer Institute.
“But research shows eating a variety of
vegetables, fruits, whole grains, beans and
other plant foods can lower the threat for
many of these diseases.”

Eating a wide range of plant foods
appears to provide the most protection.
Special plant nutrients, called
phytochemicals, reduce cancer risk by:

• Supporting the immune system

• Protecting cells from damage that
could lead to cancer

• Slowing the growth rate of some
cancer cells

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Beans and whole grains contain dietary fiber and all-natural chemical Selection Process
compounds that help fight infection and lower cancer risk. Beans and
lentils also are great sources of protein, dietary fiber, iron, potassium Deciding to eat healthy is just the first
and other necessary nutrients. Tofu and tempeh provide more step to lowering cancer risks. How
nutrient-dense, plant-based proteins. you select, prepare and cook those
ingredients also matter.
Knowing the foods to avoid is important too. Studies show overeating
saturated fat and red meat ups the possibility of colon and prostate Go Exploring: “When you head out
cancers. Processed meat like bacon, hotdogs and cold cuts helps to shop, be sure to look beyond the
boost the chances for stomach and colorectal cancer. And regularly outer edges of the grocery store,” says
drinking too much alcohol increases the risk of breast, colon, lung, Zammit. “Shopping just the perimeter of
kidney and liver cancers. a store may cause you to overlook some
nutrient-dense food items, such as whole
What to Buy grains, beans, lentils, nuts and seeds.”

To help keep cancer at bay, Zammit suggests adding these to your Washed Up: Be sure to wash your
supermarket shopping list: produce with water prior to eating or
cooking. This will help get rid of any dirt,
Veggie Tales: Leafy green vegetables have vitamin A, noted for debris and pesticide residue. Using a
helping slow cancer growth. Cruciferous vegetables like broccoli, kale vegetable scrubber is recommended for
and cauliflower help to boost the body’s protective enzymes and produce with harder surfaces.
eliminate cancer-causing chemicals.
Shop Local: If you’re worried about
Berry Good: Mounting evidence from the Centers for Disease Control pesticides, buy organic or shop
and Prevention (CDC) shows consuming berries offers a variety local farmer’s markets. “Locally
of benefits that help ward off several types of cancer. Blueberries grown produce is less likely to
have shown potential in reducing risk of breast cancer. Strawberries have been treated with chemicals
appear to protect against oral cavity, breast, lung and esophageal to prevent spoilage,” says Zammit.
cancers. Cranberries boast vitamin C and dietary fiber as well as a
concentrated amount of antioxidant phytochemicals that lower risks Whole Deal: To get the best
for several cancers. cancer-fighting benefits from your
produce, Zammit suggests eating them
Something Fishy: For a non-plant protein, choose a fatty fish. in their whole natural form, rather than
Salmon, halibut, cod and mackerel are packed with anti-inflammatory juicing. “Whole fruits and vegetables
Omega-3 fatty acids. tend to have the most vitamins and
minerals, particularly in fiber,” she says.
Spice It Up: Sprinkling food with spices may lower cancer risk and
affect tumor behavior thanks to antioxidant, antimicrobial and anti- Get Steamed: When you do choose
inflammatory properties. CDC research showcases caraway, cinnamon, to cook veggies, follow a less-is-more
clove, turmeric, ginger, garlic, saffron and thyme among the spices approach to preserve more vitamins
with potential cancer-fighting nutrients. and minerals. Try steaming vegetables
until just tender. If you do opt to boil
Go Green: Guzzling green tea also can help reduce your cancer risk. your produce, save the vitamin-laced
Powerful antioxidants known as polyphenols enable green tea to deliver cooking water for use in future soups,
multiple health benefits. Drink daily to reap its healthy rewards. casseroles or gravy.

For more nutritional advice, go to OrlandoHealth.com/ContentHub.

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tMPBMhaigeaitsgiketeeanskttess
By Wendy Bacigalupi-Bednarz, Editorial Contributor

Mistakes come in all shapes and sizes. Maybe you set your alarm
clock for 6:00 pm instead of 6:00 am, put your shirt on inside out at
the gym or made a wrong turn on the way to work. These mistakes
are easy to fix. Other mistakes are not so easy — especially when it
comes to safeguarding your health. Four doctors reveal the biggest
mistakes they see patients make and how you can avoid them to get
and stay well.

8ChooseHealth OrlandoHealth.com/ChooseHealth

Being Uninformed Rushing Through the Process

The transition from passive patient to active healthcare consumer If you become ill, invest the time to make the
is underway. Ignorance is no longer bliss but a liability that can best decisions for your long-term health along
put your health at greater risk. Dr. Nikita Shah, a board-certified the way. These are some of the ways patients
oncologist at Orlando Health Cancer Institute, notes these mistakes: undermine their health by moving too fast,
says Dr. Omar E. Beidas, a board-certified
Researching health information on the internet and plastic and reconstructive surgeon with
assuming it is true, scientific and applies to your individual Orlando Health Aesthetic and Reconstructive Surgery Institute.
situation. It’s important to know and trust where your information
comes from. Your doctor is the best place to start. Rushing to choose a doctor. Take your time when choosing a
doctor skilled in your specific disease or illness.
Not recognizing
symptoms of the most Not considering all treatment options. Ask critical questions
common health issues assessing whether surgery or other alternatives can be considered.
affecting Americans,
including cancer, heart Speeding through healing. This is a big no-no that can result in
attack, stroke and diabetes. increased risk for a new injury or complication.

Not asking your doctor questions about your condition, Avoiding Commitment
concerns and issues. Try making a checklist of questions to bring to
your appointment and review it with your doctor. Once you start to feel better, what do you do? Returning to old habits
instead of committing to a new normal can doom your recovery and
Making Assumptions send you back to the doctor — or worse. Dr. Kiran Mogali, a board-
certified cardiologist at Orlando Health Heart & Vascular Institute,
Assuming everything is fine — or maybe just a little off — can affect says these behaviors can put you at risk for recurring problems:
wellness and increase risks for more serious and chronic conditions.
According to Dr. Hector Ramirez, a board-certified OB-GYN with Stopping medications once
Orlando Health Physician Associates, some assumptions to avoid you start to feel better. It’s
include: important to talk to your doctor
before stopping or changing
Skipping routine exams because you “feel fine” can prevent the medications.
early detection and treatment of problems.
Skipping out on follow-up
Expecting that no news is good news. If you don’t get a call care such as a rehabilitation
back from the doctor’s office about test results, don’t assume the program or physical
results are normal. When in doubt, call your doctor. therapy. Spend time choosing the right setting and provider for your
prescribed follow-up care, and then go to your sessions.
Thinking that bleeding, tingling, pain or a lump is no big
deal. If constant or recurring, these can be warning signs of looming Not adopting a healthier lifestyle. Many diseases have lifestyle-
issues that need to be evaluated by your doctor. related links, including smoking, poor nutrition, insufficient exercise
and alcohol consumption. Talk to your doctor to make lasting
lifestyle changes you can stick with.

Do you have questions for a healthcare provider?
Find an expert who can help at OrlandoHealth.com/Physician-Finder.

9ChooseHealth OrlandoHealth.com/ChooseHealth

From Top to Bottom: From the Top
SCWIGAFANNOTSCRCETHRO
It’s true that Brain cancers can initially present
different By Tim Barker, Editorial Contributor with a severe headache. There may
be changes in mental status or signs
cancers of dementia. Other symptoms include
seizures, severe vomiting, blurred
have their unique vision and partial vision loss.

symptoms, depending Pituitary tumors (also in the brain)
can cause a person’s facial appearance
on which organs or to change. Hands and fingers may be
enlarged. You also may experience a
body parts they attack. hormonal imbalance, obesity or sexual
dysfunction.
One of the keys to
Head cancers may cause one of your
getting an early jump tonsils to appear enlarged. Swallowing
may be uncomfortable, but not
on treatment is recognizing necessarily painful. An ulcer on your
tongue could show as white spots that
the many ways cancer signals won’t go away.

its presence, says Neck cancers often include swelling
of the lymph nodes. You may notice
Dr. Musaddeque Ahmad, multiple enlarged lymph nodes in
your neck – a definite red flag. In
a board-certified internal children, this could indicate leukemia
or lymphoma.
medicine physician with
Thyroid cancer may be indicated if you
Orlando Health Medical Group. have difficulty swallowing. You may
have a goiter or a hard nodule in the
thyroid gland, which can be felt with
the finger.

Throat cancer can start with problems
eating or difficulty swallowing. It also
could be cancer of the esophagus,
back of the throat or stomach.

ChooseHealth 10 OrlandoHealth.com/ChooseHealth

In Your Middle All the Rest

Breast cancer may present as a lump in the breast or Bone cancer may begin with bone swelling, bone pain
bleeding from the nipple. You may have eczema on your or a bone fracture (without trauma). Regular fractures
nipples or feel pain in the lymph nodes, armpits or neck. are often the result of trauma, whether it’s a fall or car
accident. In pathological fractures, however, the hip or
Lung cancer may include a chronic cough. You may lower/upper extremity may fracture without any obvious
suddenly lose weight, notice chest pain or experience cause. You could, for example, break an arm while lifting
shortness of breath. something weighing less than 10 pounds.

Abdominal cancers can present with pain or swelling. Blood cancer may reveal itself as severe fatigue,
You may feel a lump, discover you have a peptic ulcer or diarrhea, loss of appetite, weight loss, multiple enlarged
feel pain in the upper abdomen. There may be weight non-painful lymph nodes, bruises, bleeding gums, a
loss, gastrointestinal bleeding, decreased appetite, bloody nose, fever, frequent infections, or severe back or
vomiting (sometimes with blood), yellowed skin and/or rib pain.
eyes, or a black, tarry stool.
Skin cancer can show initially as a brown or dark
Colon cancer’s early symptoms include weight loss, pigment on the surface of the skin, usually with no hair.
abdominal pain, constipation and diarrhea. This is a A full skin examination is advised annually, especially
common cancer, especially for Americans over 50 years when areas like the back, neck and buttocks cannot be
old or with a family history of the disease. seen without assistance.

Bladder cancer symptoms include blood in the urine and If you have one or more of these symptoms,
abdominal pain. visit your primary care doctor. To find one,
go to OrlandoHealth.com/PrimaryCare.
Kidney cancer can start with blood in the urine. You may
feel swelling in the kidney area.

Uterine cancer may include vaginal bleeding as well as
an irregular period. Often, tumors in the uterus may be
an indication of cancer elsewhere. And for young women
who notice bleeding after intercourse, cervical cancer is
a possibility.

Prostate cancer can be indicated by difficulty urinating,
the need to go more often or the presence of blood in
your urine.

Testicular cancer may cause pain, a mass or swelling in
the scrotum.

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LesUsonnesxpFercotmedaDPeaartehnt’s

By Julie Vargo, Editorial Contributor

12ChooseHealth OrlandoHealth.com/ChooseHealth

Zach Hoover is an outlier. While more than half the Hoover dismisses these excuses. “You make
men in America find excuses to avoid the doctor’s time for things that are a priority,” he says.

office, this Central Floridian religiously shows up to Fear the doctor will uncover something
his annual physicals and routine screenings. seriously wrong is the excuse 21 percent
of men surveyed use to circumvent

Hoover wasn’t always this health-conscious. smokers are at least three times more likely checkups. “You know what’s worse than
Elevating his own wellness to priority status to get bladder cancer than nonsmokers. being frightened you might have cancer?”
occurred only after unexpectedly losing his Caught early, bladder cancer is highly says Hoover. “Finding out you have
father to bladder cancer three years ago. treatable. But even with twice-yearly blood stage 4 cancer and it’s too late to do
work and primary care visits, Dick’s cancer something about it because you put
“I was always terrified of doctors and remained hidden until it was too late. off going to the doctor.”
bloodwork,” says the 39-year-old, who’s
on the government affairs team at Orlando “Dad was a ‘we don’t need to worry anyone Embarrassment and
Health. “But my father’s death taught me about this’ kind of guy,” says Hoover. “So, uncomfortable exams keep

a man’s health impacts everyone around I wonder if he had painful symptoms and 18 percent of men away from
him, and that getting regular checkups is did not investigate, or took comfort in good the doctor’s office. “Being
important.” blood work results as an excuse not to.”
embarrassed or uncomfortable
In 2017, Hoover His father’s passing pitched Hoover into
flew to Georgia with what he calls an early-onset midlife crisis. is a small price to pay for an
his wife and two Fresh from the funeral, he quit his job and increased chance of survival,”
young children to moved his family from Philadelphia to says Hoover. “Being alive is

enjoy Easter with his Central Florida to be closer to his widowed more important than being
parents, Dick and mother. His own health and wellness embarrassed.”
Jayne. “After dinner that night, Dad shared became paramount.

popsicles on the deck with my three-year- “We had all these plans,” says Hoover. “We Family Matters
old son, which was their tradition,” he says. were talking about adventures we would
“Everything seemed normal.” have traveling together with the kids. I just When deciding if they should see a doctor,
took for granted my dad would be around.” Hoover suggests men imagine what choice
Following an Easter egg hunt the next their family would make for them. Then
day, the situation shifted. Exhausted, Dick Excuses, Excuses simply do that.
climbed into bed mid-afternoon. “That was
so unlike him,” says his son. “But what we According to a 2016 survey commissioned “There was a richness
didn’t realize is it was the beginning of the by Orlando Health, most men avoid to the way my dad
end. Dad never really got out of bed again.” seeing a doctor, especially for annual lived his life that my
checkups. Common excuses include children will never
Nagged to see a doctor, his father was being busy, fear something may be wrong, experience,” says
diagnosed with late-stage bladder cancer. and embarrassment and discomfort with Hoover. “Dad had a
Less than three months later, he was gone. certain exams like prostate checks. Yearly way of lighting up a
A lifelong smoker until his sixties, the physicals often catch issues like high room. I’m heartbroken my kids will miss
74-year-old was otherwise in good health. cholesterol, elevated blood sugar or other out on knowing him.

Lingering Questions concerns early, before they become big “And I will always wonder whether he had
health problems later. Yet 22 percent of been suffering and, if so, why he didn’t see
His family still wonders why the elder the men surveyed said they were too busy a doctor sooner.”
Hoover didn’t see a doctor sooner. for annual checkups.
According to the American Cancer Society,

For more patient stories, go to OrlandoHealth.com/Stories.

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WHAT WE CAN LEARN FROM

By Julie Vargo, Editorial Contributor

As celebrities know, fame and fortune Oral Cavity & Lung Cancers

provide little protection against a When Eddie Van Halen died last year at age
devastating cancer diagnosis. Whether 65, few fans realized the rock star had wrestled

they choose to be public about their with oral cavity and lung cancers for two
cancer, like Jeopardy! host Alex decades.

Trebek, or more private, like actor Initially diagnosed with tongue cancer in 2000, the
Chadwick Boseman, famous folks legendary guitarist also suffered from throat cancer. Oral
face the same challenges as other cavity cancers like these affected about 53,000 people in
2020, according to the American Cancer Society. Symptoms

patients. Through their battles, can include a persistent sore throat; trouble swallowing,
though, they can shine a light fully opening your mouth or moving your tongue; and a
on little-known aspects of this lump in the back of the mouth, throat or neck.

deadly disease. “The most common risk factors for oral cavity cancers are
long-term tobacco use, alcohol consumption and being

infected with the HPV,” says Dr. Jennifer R. Christenson, a

head and neck surgeon with Orlando Health Cancer Institute.

“Many don’t realize that HPV, a common sexually transmitted

disease, can result in cancers of the tongue, tonsils and throat.”

Smoking also is a risk factor for lung cancer, which Van Halen
struggled with over the last 10 years of his life.

To reduce your risk: Avoid using alcohol and tobacco
products, and get the HPV vaccine, if possible.

14ChooseHealth OrlandoHealth.com/ChooseHealth

lebrity Cases

Colon Cancer in Young Adults Pancreatic Cancer

As Black Panther in several Marvel movies, actor Chadwick Grammy Award-winner Aretha Franklin and game-show
Boseman was a superhero. When the 43-year-old lost his battle host Alex Trebek both battled pancreatic cancer but took
with colon cancer in August 2020, his fans were shocked. different approaches. For the Queen of Soul, who died in Fall
2018 at age 76, it was a very private matter that surprised millions
Boseman’s untimely death is not as uncommon as you might of fans. Trebek, on the other hand, went public with his stage 4
think. “In recent years, rates of colon and rectal cancer have been pancreatic cancer diagnosis as soon as he found out in March 2019.
increasing in those under 50,” says Dr. Sreeram Maddipatla, a Despite initially responding well to treatment, he died in November
board-certified oncologist at Orlando Heath Cancer Institute. “But 2020 at age 80.
young people are not regularly screened, so the disease is detected
at later stages.” Pancreatic cancer makes up 3 percent of all cancers diagnosed each
year, but accounts for 7 percent of cancer deaths, according to the
Boseman was diagnosed with stage 3 colon cancer in 2016, while American Cancer Society. If caught early, cancer is treatable in the
still in his 30s. Because of his age, the actor wouldn’t have met any pancreas, the organ that helps your body digest food and regulate
of the current colonoscopy guidelines, which advise Americans to blood sugar. But the disease is difficult to detect. Symptoms such as
begin regular screenings at age 45. abdominal or back pain, unexplained blood clots, weight loss, lack
of appetite, and nausea and diarrhea mimic many illnesses, making
Survival rates for colorectal cancer depend on early diagnosis. it challenging to narrow the cause down to the pancreas.
Symptoms for colon cancer develop slowly and some, like diarrhea,
constipation, abdominal pain and changes in bowel habits, can be “Most cases aren’t diagnosed until it’s too late, in large part because
misdiagnosed as other gastrointestinal issues. no reliable early screening test exists,” says Dr. Emilio Alonso, a
fellowship-trained surgical oncologist at Orlando Health Cancer
To reduce your risk: Pay close attention to changes in your Institute.
bowel habits. Get screened as early as age 35 or 40 if you
have ongoing symptoms, a family history of colon cancer The majority of patients are over age 45, and men are more likely to
or blood in your stool. develop pancreatic cancer than women.

To reduce your risk: Avoid smoking, exposure to
workplace chemicals and obesity.

15ChooseHealth OrlandoHealth.com/ChooseHealth

By Tim Barker, Editorial Contributor

Few things are more devastating
than watching someone in their
30s prepare to die from cervical
cancer, knowing it could have
been prevented. Unfortunately,
misconceptions about the
disease and HPV vaccine
are putting women at risk –
sometimes until it’s too late.

“It doesn’t have to be that way,” says
Dr. Veronica L. Schimp, chief of gynecologic
oncology at Orlando Health Cancer Institute.
“Vaccinations offer protection, while
screening can help us find precancerous
cells before they become invasive.”

Cervical cancer occurs in the cells of the cervix
— the lower part of the uterus that connects to
the vagina. The vast majority (95 percent) of these
cancers are caused by HPV — a group of more
than 100 viruses that spread through skin-to-skin
contact. The number one gynecological cancer
is of the uterus or womb, with 54,000 women
expected to be diagnosed annually with this type
of cancer.

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The effects of an HPV infection may not develop for years. Without treatment, cancerous cells in the cervix can spread to other
parts of the vagina or pelvic walls and travel to the bladder, rectum, kidney, lymph nodes or other areas of the body.

These viruses are most often acquired in our late teens and twenties as we become sexually active. That’s why Pap tests are
strongly recommended between the ages of 21 and 30. After that, an HPV infection may not be detected until the ages of 45 to 55,
when cervical cancer is typically diagnosed.

These are some of the most common misconceptions about HPV.

Myth #1: You’ll know if you’re infected. HPV is called a silent infection Myth #4: Vaccines are dangerous.

because there are no symptoms. The only way for a woman to know she has it The vaccine protects against nine types of
is through testing (as in a Pap test), which looks for proteins associated with the HPV — the seven that cause most HPV-related
virus. If HPV is detected, the lab will determine the genotype, indicating whether cancers and the two that cause most genital
it’s a version that leads to genital warts or one that can cause cervical cancer. warts. The vaccine is recommended for girls
and boys at age 11 or 12, ideally before they’re
Myth #2: Infections are uncommon. HPV infections are incredibly exposed to the virus. The most common side
effects are fever, headache and pain or redness
common. Eighty million people are infected and another 14 million will be in the arm at the site of the shot. There have
diagnosed this year. Not every case leads to cervical cancer, as the immune system been no deaths related to the vaccine.
often defeats the virus before it causes substantial damage. Persistent infections
may require aggressive treatment. Myth #5: If you get the vaccine, you

Myth #3: Only women can get it. Men and women both can become no longer need a Pap test. The vaccine offers
protection against cancer-causing HPV. But
infected. In fact, men are three times more likely to have HPV than women. there are other causes of cervical cancer that
Unfortunately, there is no test for men. But as with women, there are no symptoms, have nothing to do with this family of viruses.
and infections usually go away on their own. If not, cancers of the penis, anus and That’s why it’s still important to have Pap tests
throat can develop. Condoms and the HPV vaccine can reduce infection risk. to look for cell abnormalities.

Cervical cancer is avoidable and, when found early, is treatable.

Talk with your doctor if something is causing pain. And if your doctor recommends a
treatment or screening option, ask for more details. Learning more about what’s going to
happen to you (before it happens) can take some of the stress out of the experience.

To learn more, visit OrlandoHealth.com/ContentHub.

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NWofehaeydRYetoocutBaDel EoAxnfa’rtamid

By Tim Barker, Editorial Contributor

Mention “rectal exam” and many people
will cringe, then start looking for excuses
to avoid a trip to the doctor. But what

exactly does a digital rectal exam
entail, and who needs one?

Doctors use them to look for tumors or cancers, assess the
functioning of the anal sphincter, examine for hemorrhoids
or determine other causes of pain or bleeding. While these
exams are sometimes performed on women, they’re more
frequently recommended for men because of the increased
risk of prostate cancer that comes with age.

About one in nine American men will be diagnosed with
prostate cancer in their lifetime, and the average age at
diagnosis is 66, according to the Prostate Cancer Foundation.

“The exam takes just a few seconds,” says Dr. Jamin
Brahmbhatt, a board-certified urologic surgeon with the
Orlando Health Medical Group Urology PUR Clinic. “Despite
this, many men are reluctant to get one, because they’re
worried about what we might find or because of the test
itself.”

Why a Rectal Exam

You may wonder why there aren’t less-invasive options. There are, but there’s
no substitute for this simple exam, which also helps the doctor evaluate other
issues, including an enlarged prostate and urination problems. To get to the
prostate, doctors must go through the rectum.

ChooseHealth 18 OrlandoHealth.com/ChooseHealth

When to Discuss Screening With Your Doctor These recommendations may seem confusing. At a
minimum, you should start asking your doctor about
Prostate cancer is the second-most common cancer in prostate cancer screening by the age of 40. Based on
men (after skin cancer) and can be treated when caught your diagnosis and medical history, your doctor can
early. Your family history and demographic offer a guide guide you from there.
for when you should start screening. The American Cancer
Society recommends: What Happens on Exam Day?

• Age 50 for men who are at average risk of It’s your doctor’s job to make sure you have a
prostate cancer comfortable experience, so ask questions. Remember,
this exam is the equivalent of your doctor checking
• Age 45 for men at high risk, including African your heart with a stethoscope or looking into your
Americans and men who have a father or brother ears with an otoscope. The most important thing you
diagnosed with prostate cancer before 65 can do is just show up.

• Age 40 for men at even higher risk, including those Patients may sometimes say, “Wait, but my PSA is
with more than one close relative who had prostate fine, I’m peeing fine, I don’t have cancer.” But often,
cancer before 65 prostate cancer is found in small parts of your prostate
and won’t show up in lab work. You may not feel it
when urinating or notice any other issues, but doctors
can detect it just based on that nodule. It’s similar to
how women sometimes miss breast irregularities that
are discovered by their doctors.

During the exam, the doctor wears gloves and gently
inserts one finger, using ample lubrication. Your doctor
will feel for lumps, bumps and nodules – looking for
irregularities on the prostate. Don’t be surprised if
it feels like you need to go to the bathroom. That
happens because your urethra goes through your
prostate. But because the exam is quick, that feeling
should pass quickly. Otherwise, you shouldn’t feel any
aftereffects from the exam unless you have prostatitis,
a common condition.

It’s natural for patients to feel self-conscious before
the exam. It doesn’t matter — your doctor won’t judge!
All they care about is protecting your health.

Other Advice

Remember, your primary care physician can perform
this exam — you don’t need to see a urologist.
And although you won’t necessarily need one every
year, be sure to visit your doctor annually for a
wellness check.

Need to schedule your annual exam or wellness visit?
Talk to your primary care physician or find one at OrlandoHealth.com/Physician-Finder.

ChooseHealth 19 OrlandoHealth.com/ChooseHealth

What Mail-Away

By Tim Barker, Editorial Contributor

When you want to learn about your heritage,
mail-away DNA tests can be fascinating and
fun. But medical experts become concerned
when there’s a danger of those tests
influencing our healthcare choices.

Such is the case with 23andMe’s consumer test for BRCA1/BRCA2, the
first such option available to the public without a prescription.
The test looks for three BRCA gene mutations found most
commonly in people of Ashkenazi Jewish descent, and
that are associated with elevated risk of breast, ovarian
and prostate cancers.

“Simply spitting into a cup and sending it off to a
testing company, with no medical support before or after,
seems reckless,” says Dr. Rebecca Moroose, a board-certified
medical oncologist and the director of cancer research and
genetics at Orlando Health Cancer Institute. “I worry women will
say ‘I tested negative for breast cancer risk’ based on the results of
these three variants and stop getting mammograms. Or test positive
and become paralyzed by fear.”

Indeed, the announcement of these new consumer tests — approved
by the FDA in 2018 — was greeted with a mixture of excitement
and trepidation. On one hand, it’s encouraging to see people take a
greater interest in their own DNA, says Ryan Bisson, a cancer genetic

counselor with Orlando Health Cancer Institute. On the other hand,
the results can be tricky and lead to misunderstandings.

“This information may be helpful if you follow up with a healthcare
provider,” Bisson says.

ChooseHealth 20 OrlandoHealth.com/ChooseHealth

DNA Tests Can’t Tell You

Missing Pieces A Fuller Picture

Breast cancer is a scary topic. It’s the second-most deadly cancer Understand that testing positive or
afflicting American women. The American Cancer Society says negative for certain variants is merely
260,000 women and a few men will be diagnosed with the disease one of several factors impacting cancer
this year, and nearly 41,000 will die. But genetics will play a role risk. Family history, ancestry, lifestyle and
in only about 5 percent of those cases. And the potential for environment all play roles. It’s the job of
misplaced attention, emphasizing genetics over other factors, a genetic counselor to help people better
is concerning to genetic counselors. understand the interplay of these factors.

Dr. Moroose also worries about limitations in testing for only And that’s a key component missing
three of the thousands of BRCA1/BRCA2 variants — offering when consumers deal directly with
an incomplete risk picture. Consider that breast cancer has no a genetic testing company. Indeed,
identifiable genetic mutation in 95 percent of cases. And Jewish whenever test results come back to the
women can have other genetic mutations or cancer risks not Cancer Genetics and High Risk Care
covered by these tests. Center at Orlando Health Cancer Institute,
medical professionals go over them in
“Just because someone tests positively or negatively does not detail with patients.
mean they will or will not get the cancer linked to the gene
mutation,” says Dr. Moroose. “When it comes to cancer risk and “A genetic counselor has an in-depth,
diagnosis, genetic testing is just a piece of the whole puzzle.” one- to two-hour conversation with
patients in a supportive environment about
23andMe promotes its tests as a way for people to gain their results,” says Dr. Moroose. “We look
personalized health information without working through a at all the medical options, offer proactive
genetics expert. But does that shortcut increase the risk of tests advice and try to empower our patients
being misinterpreted by people with little or no understanding so they can make the best healthcare
of the field? choices possible.”

The FDA certainly considered that a possibility when it issued To make an appointment with a genetic
a warning along with its approval: “Consumers and health care counselor, contact the Orlando Health
professionals should not use the test results to determine any Cancer Institute’s Cancer Genetics and
treatments, including anti-hormone therapies and prophylactic High Risk Care Center at (321) 841-GENE.
removal of the breasts or ovaries. Such decisions require
confirmatory testing and genetic counseling.”

21ChooseHealth OrlandoHealth.com/ChooseHealth

PREVENTING & DETECTING

America’s Deadliest Cancer

By Tim Barker, Editorial Contributor

For Americans, lung cancer is the leading cause

of cancer deaths for both men and women. In fact,
more people die from this disease than from
colon, breast and prostate cancers combined,

according to the American Cancer Society.
The disease develops when cells in the lungs change,

generally due to breathing dangerous substances,
says Dr. Matthew Johnston, a

fellowship-trained thoracic surgeon
with Orlando Health Cancer Institute.
“And it’s important to know that these

cell changes can happen even years
after exposure.”

ChooseHealth 22 OrlandoHealth.com/ChooseHealth

While smoking is the obvious culprit, there are a range of factors that can play a role.

Risk Factors Prevention

Smoking: This is the single greatest risk factor, causing 90 percent While there’s no guarantee you won’t develop lung cancer, you can
of cases and 80 percent of cancer deaths. The risk increases the take steps to reduce your risk.
longer you smoke. Cigars and pipes increase the risk nearly as much
as cigarettes. Menthol and low-tar cigarettes also are dangerous. And The most important one is not to smoke. If you don’t smoke, don’t
it’s not just risky for the person doing the smoking. Being around start. And if you do smoke, quit. Also, avoid secondhand smoke.
smokers can increase your risk through secondhand smoke.
Consider testing your home for radon. You can have this done
Radon: This odorless, colorless, radioactive gas is the second- professionally or with a do-it-yourself kit available at many
leading cause of the disease. The gas exists naturally in soil and hardware stores. If necessary, you can hire a mitigation service to
enters buildings through structural gaps. In Florida, one in five reduce emissions to safe levels.
residences has radon levels above the EPA action level, according
to the state’s Department of Health. By comparison, the national Know your risk factors and talk with your doctor to see if you
figure is one in every 15 homes. Radon exposure combined with should be screened for lung cancer.
cigarette smoking is a particularly potent combination.
Early Detection
Other hazardous chemicals: Exposure to chemicals such as
asbestos, arsenic and uranium increases your risk. Most early-stage lung cancers show no symptoms and are frequently
found by accident during an unrelated chest X-ray or CT scan. When
Air pollution: Small particles – exhaust smoke, for example – can people do have symptoms, the most common are a cough, coughing
enter your lungs as you breathe. up blood, shortness of breath, fatigue and weight loss.

Other health issues: Conditions such as pulmonary fibrosis and As with all cancers, the earlier lung cancer is caught, the greater the
HIV infection can increase your risk. treatment options available and the better the outcome. But since
early-stage lung cancer has no symptoms, getting screened if you
Family history: Genetics also may play a role here, so if someone are at high risk is your best option.
in your family has lung cancer, you may have a higher risk.

Expanded Guidelines for Screening

If you are a current or former smoker, “For some people, this could be the The former guidelines started at age 55 and
you may be wondering when you most important cancer test you can get.” defined heavy smoking as 30 pack-years.
should be screened for lung cancer.
Even if you quit smoking up to 15 years ago, What Is a Pack-Year?
The pool of Americans who could benefit you should be screened annually, according The term pack-year measures how much
from early detection recently was expanded to the U.S. Preventive Services Task Force, a person has smoked over a long period
by U.S. health officials. “The goal is to if you: of time, according to the National Cancer
improve survival odds by catching the Institute. To calculate pack-years, multiply
disease as early as possible,” says Dr. Luis J. Are between the ages of 50 and 80 the number of packs smoked per day by the
Herrera, a board-certified thoracic surgeon number of years of smoking. For example,
at Orlando Heath Cancer Institute. Have a history of heavy smoking 20 pack-years is equivalent to smoking a
(now defined as 20 pack-years) pack a day for 20 years or two packs a day
for 10 years.

To schedule a lung cancer screening, call (321) 8HEALTH (843-2584) or visit OrlandoHealth.com/Lung.

ChooseHealth 23 OrlandoHealth.com/ChooseHealth

By Tim Barker, Editorial Contributor

Using Our Benefits of
Immunotherapy
CIFmmIAGunNeHSyCsTteEmsRto
By Tim Barker, Editorial Contributor One reason cancer
cells keep growing
Our immune system is best at recognizing threats and spreading is that
originating from outside the body rather than those they’re able to hide from
from within. That’s one of the reasons our natural your immune system.
defenses don’t typically detect cancers. Even worse, A key benefit of some
some cancer cells give off substances that essentially immunotherapy treatments
shield them from detection and destruction. is how they “mark” cancer
cells, making it easier for
To counter this, immunotherapy treatments are designed to “wake up” our the immune system to find
immune systems. “We do this by stimulating the patient’s natural defenses,” and destroy them. Other
says Dr. Daniel A. Landau, a board-certified oncologist at Orlando Heath immunotherapies boost the
Cancer Institute. “This helps the body find and fight cancers it wouldn’t be immune system to better
able to otherwise.” mobilize against cancer.

Immunotherapy is different from other cancer treatments in that it doesn’t These treatments often
directly destroy cancer cells. “Instead, it does one of two things,” says have fewer side effects
Dr. Jennifer Tseng, associate director of clinical research for medical oncology than older cancer
at Orlando Health Cancer Institute. “It enables the immune system to trigger treatments: no hair loss
a cancer-fighting response, or it counters agents in the body that prevent and less fatigue. The most
an anti-cancer immune response.” common side effects are
skin reactions at the needle
site, if given intravenously.
There also could be flu-like
symptoms, though severe
reactions are rare.

ChooseHealth 24 OrlandoHealth.com/ChooseHealth

Immunotherapy vs. Traditional Treatments Advice for
Cancer
Immunotherapy isn’t used as often as other cancer treatments like surgery, Patients
chemotherapy and radiation. The optimal treatment depends on the type of cancer
you have and its stage, or how far it has spread. Other factors include your age and Recently, these
other health problems. The Centers for Disease Control and Prevention (CDC) offers treatments have taken
a list of cancer treatments, including surgery, chemotherapy, radiation therapy, on a larger role in
hormone therapy and stem cell (bone marrow) transplant, as well as immunotherapy. treating certain cancers.
Sometimes immunotherapy is favored over chemotherapy, and other times the New treatments are
treatments are used together. being tested and
approved, and new
Immunotherapy may be delivered by IV, pills or skin cream. It may be given on a daily, ways of working with
weekly or monthly basis, or in cycles. Again, it depends on your cancer, how advanced the immune system
it is, the type of immunotherapy you get and how well it is working. are rapidly being
discovered. Talk to your
Types of Immunotherapy physician about your
options. Keep in mind
There are four types of immunotherapy treatment. Here’s an overview of the options: that immunotherapy
doesn’t work for every
1 Checkpoint inhibitors target immune checkpoint pathways that aid the cancer, and some
development and growth of tumor cells. These inhibitors reactivate the body’s patients may not be
T cells, helping them identify and attack cancer cells. These drugs work by making good candidates,
it difficult for cancer cells to use immune checkpoint pathways to reduce the including those who
body’s immune response. take certain medications
or have autoimmune
2 Monoclonal antibodies target a specific antigen, marker or foreign substance conditions.
found on tumor cells and then block the signaling pathways that help tumors grow.
They also stimulate an immune response. Some of these are manmade and mimic To schedule a consultation
antibodies the body naturally produces, working to activate cancer-fighting T cells. with a cancer expert, go to
OrlandoHealthCancer.com.
3 Therapeutic cancer vaccines trigger an immune response that targets antigens on
tumor cells. Some of these antigens are found in nearly 50 percent of lung cancers.
Clinical trials are seeking to determine whether these vaccines can prevent or delay
lung cancer recurrence in high-risk patients.

4 Adoptive cell therapy removes a patient’s T cells and genetically modifies them
to strengthen their ability to kill cancer cells. The cells are then returned to the
patient’s body. Clinical trials have shown this technique may be effective against
lung cancer, leukemia and lymphoma.

ChooseHealth 25 OrlandoHealth.com/ChooseHealth

NewETaorolyl HDeeltpesctIimonprove

By Julie Vargo, Editorial Contributor

Skin cancer might grab more attention in sun-drenched Florida, The Ion™ Platform is part
but lung cancer actually causes more deaths annually, according to of a comprehensive cancer
the American Cancer Society. care program at Orlando
Health Cancer Institute that

“Lung cancer is a deadly “It may take years for access to small nodules deep includes robotic surgery,

disease,” says Dr. Luis lung cancer to grow,” says within the lung. Physicians use advanced radiation therapy,

Herrera, a board-certified Dr. Herrera. “By the time computer-assisted navigation proton therapy and an

thoracic surgeon at Orlando symptoms appear, cancer based on three-dimensional interdisciplinary assembly of

Health Cancer Institute. “It often has spread to other parts models of the patient’s own cancer experts.

accounts for more than 25 of the body. The sooner lung lung for the most direct path

percent of all cancer deaths cancer is detected, the to the nodule.

in this country, and early more successfully it can be “For patients, Ion delivers
diagnosis can be difficult.” treated. Ion makes it possible more successful biopsies on
to safely access hard-to-reach even the smallest nodules,”
To help increase early parts of the lungs to biopsy says Dr. Herrera. “There
detection, Orlando Health nodules and diagnose cancer are no incisions, and the
recently added the Ion™ earlier.” procedure has a lower risk of
Platform to its high-

tech arsenal of advanced A minimally invasive, robotic- complications for patients. It

diagnostic tools. This assisted bronchoscopy offers a quicker diagnosis and

innovative lung biopsy system procedure, Ion utilizes faster recovery times.”

helps oncologists diagnose ultra-thin, fully maneuverable

the disease earlier and robotics; small cameras

improve survival rates. with real-time vision; and To learn more or to schedule a consultation, visit
sophisticated tools that allow OrlandoHealthCancer.com.

ChooseHealth 26 OrlandoHealth.com/ChooseHealth

A team of award-winning cancer experts, the latest care and
advancements, and a huge dose of understanding and compassion.

All of this working in harmony to guide your
personal triumph through cancer.

OrlandoHealthCancer.com

Cancer Institute

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COrHlanOdoOHeSalEth

At the Orlando Health Cancer Institute, our guiding purpose is to provide
advanced, specialized care that is conveniently accessible and personalized to
meet the needs of our patients — through diagnosis, treatment and recovery.
As one of the largest cancer care providers in Florida, we have developed a
collaborative approach to patient care, with highly trained specialists providing
expert, multidisciplinary care while compassionately treating each patient as a
unique individual.

• Next-day appointments • Proton therapy
• Virtual appointments
• Second opinions • Clinical trials
• Nurse Navigators
• Patient Resource Guides • Highly sub-specialized physicians
in each cancer type

• Cancer Support Community

The Orlando Health Cancer Institute is pleased to offer cancer care in the following communities:
Clermont | Downtown Orlando | Dr. Phillips | East Orlando | Kissimmee | Lake Mary | Ocoee | Winter Park

To make an appointment call (321) 841-1869 or visit OrlandoHealthCancer.com.