Amerika’daki Uluslararası Onkoloji Kongresi’den dönen Dr. Süalp Tansan gelişmelerin umutlandırdığını söylüyor. Süalp Tansan’a göre gen haritasının çözülmesiyle birlikte her tür kanserin tedavisinde çığır açacak ilaçlar yolda
Dr. Süalp Tansan has just returned from a conference held annually in the United States, where innovations in cancer treatment are discussed. We spoke with Tansan about global developments in cancer and common misconceptions about the disease.
* You just returned from a conference on cancer in the United States. What is the significance of this conference?
This is an annual conference held in the United States. It is a very important conference closely followed by doctors working in the field of cancer. This year it was held in Chicago and 25,000 doctors attended. The conference is unique in that it presents the latest innovations and research in the field of cancer each year. This means you have the opportunity to hear about them firsthand, before they are published in the literature.
YUNANLILAR İLERDE
* 25 bin kişiyi nereye sığdırıyorlar?
-They can't fit everyone in. The conference lasted four days, from 8:30 a.m. to 6 p.m. They used twenty large halls. They divide it into days, and you can't even see the speaker; you just watch the proceedings on giant screens. I've been attending the conference for 15 years; in the first year, there were only 5,000 doctors. After this, they might not be able to hold this conference anymore because it's very difficult to bring so many people together.
* Can anyone attend this conference, or is a special invitation required?
-No invitation is necessary. Anyone who is interested can attend, but it is more geared toward doctors, meaning there are technical terms and research involved. If you don't follow the field, it may be difficult to understand.
Is it because the US is the most advanced in cancer research that it is held there?
-Absolutely. There is one thing that is now certain worldwide, and that is that America is very, very far ahead in cancer research. Europeans have made great strides in recent years, but economic power is still very important. For example, the Greeks have also made considerable progress.
ARAŞTIRMA UZUN
* Türkiye araştırmaların neresinde?
As I said, everything is based on finances. Since I'm not in the university environment, it might not be right for me to give you statistics. We're ahead in terms of application, not research. Turkish doctors closely follow global developments and apply them to their patients. For example, there were 80 Turkish doctors at this conference for the first time. I attend every year, but I must say I hadn't seen so many Turks before.
* Cancer research takes a very long time despite all the innovations, doesn't it?
-You bet. Let me give you an example. The first chemotherapy drug was actually discovered in 1977. Its name is Taxol. They found that a substance extracted from a plant on the Pacific coast could cure cancer. However, in order to administer that substance to humans, they first had to dissolve it in water. They succeeded and tested it on mice. The results were positive. When it came to testing it on dogs, they failed and shelved the drug. However, in 1985, a doctor took another look and, by separating the substance used during the dissolution process, was able to achieve the desired result.
BİYOLOJİK HEDEFLER
* Bu ilaç şimdi kullanılıyor mu?
-It was launched in the US in 1991. I think it's been on the market in Turkey for three or four years now. We use it for all major types of cancer. Mainly for breast and lung cancer. It's not a complete solution, but it's one of the important treatments we have. Just think, it only took 15 years to discover it.
* What distinguishes newly released chemotherapy drugs from others?
-Chemotherapy drugs are chemical drugs. We use them to destroy cells that multiply and grow rapidly in the body. Unfortunately, they do not discriminate between cells and kill healthy cells as well.
* Especially hair follicle cells…
-Of course. That's why hair falls out. At the same time, cells in the stomach and intestines are affected, causing vomiting. And most importantly, cells in the bone marrow are damaged, which lowers blood counts. New drugs help normal cells recover, thereby eliminating all side effects.
* Were these drugs also presented at the conference?
-We know we've seen part of it, and we've just learned another part. We learned this at the conference. Every year, these drugs will continue to improve, and side effects will be minimized. America is now working on targeted drugs.
* What innovation at this conference impressed you the most?
-Biological targets. There are two main biological targets. One is angiogenesis. That is, preventing the tumor from forming its own blood vessels when it cannot find blood vessels in the body. The second is to stop the tumor from growing and metastasizing. Twenty biological drugs that block growth factors are currently in the trial phase. One of them significantly increased the effectiveness of chemotherapy in colon cancer.
* How much progress is this?
-For example, if a patient with advanced disease can live for 13 months with chemotherapy, they live for 20 months. This rate is very high with early diagnosis.
YAN ETKİSİ SİVİLCE
* Peki ileri safhada 20 ay yaşayan insanın yaşam kalitesi nasıl?
-Most importantly, quality of life can be maintained at an extremely high level. The revolutionary drug we have been using in Turkey for lung cancer over the past year also significantly inhibits metastasis. It shrinks the disease in 15% of patients, stops it in 65%, and reduces a host of side effects. You take one pill orally per day.
* Are there any side effects?
-Bunu söylerken gülüyorum çünkü yan etkisi sadece sivilce. Bunları gördükçe, yeni araştırmaları izledikçe çok ama çok mutlu oluyorum. Diyebilirim ki ben kanser konusunda bir uzman olarak umutluyum ve yakın gelecekte hastalığın bütün şifreleri çözülecek. Devletin yeni ilaçlar için daha çok bütçe ayırması gerekir, beni bu düşündürüyor.
Sigara içenlere vitamin yok
Dr. Süalp Tansan sigara içenlerin A, B, C, D ve E vitamini kullandıklarında akciğer kanseri olma riskinin yüzde yirmi artacağını söylüyor
* What is the most common type of cancer in Turkey?
Unfortunately, there has been a surge in lung cancer cases. I'm not saying this based on statistics, but rather from observation. Even in my own practice, the number of lung cancer patients has doubled in the last seven years. Lung cancer is a type we fear because early diagnosis is somewhat difficult.
* Isn't it visible on the chest X-ray?
-By the time it becomes visible, it's already too late. Last year, the Japanese published the results of a very important study. A simple spiral lung CT scan can now provide us with early diagnosis. This can significantly reduce the risk of death. Of course, this needs to be made state policy, communicated to the public, and the cost reduced. Still, what I consider more important than these tests is for something to be done as state policy to accelerate smoking cessation.
* Is smoking the cause of lung cancer?
-Absolutely. The worst part is that passive smokers are even more affected because there are more cancer-causing substances in the smoke exhaled by smokers. In fact, we were all passive smokers when we were children.
* Let's say today the entire society suddenly quit smoking. Would lung cancer disappear?
-Even if we all quit today, we'll still suffer from this disease for at least another 15 years before it ends.
* Is there no chance of someone who has never smoked and has never even been in an environment where people smoke developing lung cancer?
-It exists, but it's a very small percentage, a problem caused by pneumonia. Cigarettes are our biggest problem. The moment we eliminate cigarettes from society, this disease could become a thing of the past. The harm of smoking is not limited to the lungs. The smoke starts in the mouth, moves to the throat, and then to the lungs. Then it affects the esophagus, breasts, kidneys, pancreas, and bladder. Can you imagine?
* Most smokers take vitamins as supplements…
-İşte en büyük yanlış. Sigara kullananların kesinlikle A, B, C, D, E vitamini almaması gerekiyor. Bu vitaminler sigarayla birleştiğinde özellikle akciğer kanserine yakalanma oranınız yüzde 20 artıyor. Büyük bir oran bu. Amerika’da vitaminlerin üzerinde “Sigara kullanıyorsanız almayınız” diye yazar.
* Amerika’da sigaraların üzerinde de”Kansere yol açar” diye yazıyor bizde ise sadece “Sağlığa zararlıdır” ibaresi bulunuyor..
-Bizim kongreyi yaptığımız yerdeki salonların kapısında “Otuz metre içerisinde sigara içmemenizi rica ederiz” diye yazıyordu. Bir sürü yerde artık sigara yasak. Amerika çok ilerledi ama kendisi tüketemediği sigaraları gelişmekte olan ülkelere kakalıyor. Bu da bizim kongrenin önemli tartışma konularından bir tanesiydi. Eğer Türkiye olarak bunun önlemini almazsak bu durum maalesef devam edecek.
İyileşmek artık kolay
* Hepimiz biri kanser oldu mu ona öldü gözüyle bakıyoruz. Bu Türklere özgü bir durum mu?
-Absolutely. There's no such thing as "you have cancer, so you're going to die." It is possible to recover completely from cancer. In fact, I can say that cancer is such a disease that you can get better very quickly. You can't recover from high blood pressure or heart disease, but you can recover from cancer. I have many patients who have survived cancer and are completely well. This is not a miracle; it is possible.
* What types of cancer are easier to treat?
-Erken teşhiste lenf bezi kanserleri, meme kanseri, yumurtalık, erkeklerde testis diyebilirim. İyileşmek artık kolay.
Müjde kansere aşı yolda
Genleri kıyaslayarakartık kişiye göre tedavi uygulamak mümkün olacak. Her hastaya göre ilaç kullanımı değişecek
* The human genome has been decoded. How will this achievement impact cancer research?
-This is the most significant development in recent years, exciting and giving hope to all of us, because cancer is a disease of genes. By genes, I don't mean those inherited from parents. I'm referring to the genes located in the cell nucleus that determine how each cell functions.
* Is there a hereditary type of cancer?
-It exists, but it is very rare and 100% hereditary. Cancer occurs due to the effects of the environment, air pollution, smoking, and certain genetic changes that we are not aware of. The human genome has been mapped, but what good is that? Previously, for example, in the case of breast cancer, we could compare gene maps and identify commonalities. This year, we saw its contribution to treatment. There are 74 important genes. If a patient has a high concentration of these genes, we can predict in advance that they will respond to treatment.
* What if those genes aren't there?
-If they are not present, there are another 206 genes. These are the people in the middle group who will benefit from treatment. If these are not present either, it is not possible for that patient to respond to any treatment. At this stage, there is no point in giving the patient medication and exhausting them. We will take tissue from the patient, place it in the device, and a gene map will appear before us. We will then administer treatment according to those genes and administer medication accordingly. For example, we may be able to say that this patient does not need chemotherapy, that biological medication is sufficient. Therefore, the era of patient-oriented treatment, rather than disease-oriented treatment, is beginning. This is a breakthrough.
* All of these studies are focused on people who have cancer. But what about those who are not sick? Can a vaccine for cancer be developed?
-Bundan sonraki kademe o zaten. Kanser olanla olmayan arasındaki değişiklikler inceleniyor. Sağlıklı olanların da gen haritası çıkacak ve karşılaştırılacak. Kıyaslama yoluyla örneğin “Bu kişinin önündeki 50 yılda kanser olma riski var” cümlesini kullanabileceğiz. Hangi kansere meyilli olduğunu bilebileceğiz.
* That's a nasty thing, too. Finding out in advance what kind of cancer you're going to get...
-Yes, but if there are measures against these, it is very important to know and apply them. Vaccines will be developed. For example, vaccines developed against melanoma (related to moles on the skin) and kidney cancer are almost in the final stage.
* So, approximately how many years will it take for these vaccines to become available?
I don't think it will happen in the next 10 years.
YARIN
* Kök hücre ne demektir? Çocukların doğumda göbek bağını saklamak ilerde kanser için işe yarar mı?
* Güneşlenmek kanser yapar mı? Solaryumun etkileri nelerdir? En çok korkulan kanser türü nedir?
* Hangi otu kaynatıp içmek yararlıdır? Yeşil çay ve fındığın kansere etkisi nedir?
