Healthy Living: Your Experts
Oncology Associates of West Kentucky is specifically designed to treat oncology and hematology patients. With over 50 years of combined experience, our physicians offer the latest in cancer fighting treatments. Hematology patients are treated for blood disorders, both benign and malignant.
Dr. Luis Concepcion completed his medical training at the College of Physicians and Surgeons of Columbia University. His training in medical oncology was completed at the University of Texas Medical Branch in 2000.
Dr. Winston Chua completed his residency at the Lutheran Medical Center in Brooklyn, NY. His training in medical oncology was completed at the University of Texas Medical Branch in 1999.
Dr. James Gould completed his residency at the University of Texas Health Sciences Center in Houston, TX before serving as Chief Medical Resident for that institution in 1984. His training in medical oncology was completed at the MD Anderson Cancer Hospital in Houston in 1987.
Our office staff is specially trained in the care of oncology patients. Our nurses have all chosen to be in the field of oncology and are specialized in this area.
We strive to enhance quality of life for cancer patients with compassion for all aspects of their disease. We strive to keep patients pain-free, using all means available. We also strive to keep patient convenience at the forefront.
Through innovative treatments and special expertise, Dr. Luis Concepcion, Dr. Winston Chua, and Dr. James Gould are able to offer patients with cancer and blood disorders the most advanced treatments.
Our physicians see patients by appointment only, but offer a variety of options for your convenience. We have satellite offices to help avoid long travel times for physician visits. Our satellite offices are located in Benton, KY, Mayfield, KY, Princeton, KY and Harrisburg, IL. Although we may ask you to make an occasional trip to Paducah, KY, the satellite office will be used to maximize convenience for each patient’s visit.
Frequently Asked Questions
- How do I know if I have cancer?
- Unfortunately, the symptoms which are associated with cancer are also the symptoms associated with multiple other common illnesses: Pneumonia, acid reflux, arthritis, etc. It is good practice on the part of the patient to report any symptoms which last more than 2 to 3 weeks. These should be reported to your primary care physician. Of course, the 7 danger signs of cancer include: Change in bowel habits, blood in the stool, unexplained weight loss, unexplained lump or bump in an area which is new, and change in the size or character of a spot on your skin.
If your Primary Physician feels that your symptoms are suggestive of cancer, additional studies -- or a referral to a specialist -- will be undertaken.
- How many different types of cancer are there?
- Currently, there are over 100 different specific types of cancer described. These include variations on the common cancer types which include breast cancer, lung cancer, colon cancer, prostate cancer, and skin cancer. There are also many types of cancer which are less common, and require special attention. Your cancer care physician has many resources to help establish the correct diagnosis and outline a treatment plan for cancer.
- Exactly how is cancer treated?
- There are at least several types (modalities) of cancer treatment. These include surgery, radiation therapy, hormonal therapy, chemotherapy, blood vessel growth inhibitors (angiogenesis inhibitors) monoclonal anti-bodies, and targeted therapies. Immunotherapy (to stimulate a patient's immune function) is also available.
Among the therapies, surgery is considered to be the only curative therapy for most cancers. The use of surgery depends on cancer stage.
Radiation therapy is used to fight cancer and a localized site, i.e., the breast, the bone, or a small area of the bowel.
Hormonal therapy is reserved for those patients who have breast, prostate, or ovarian cancers.
Chemotherapy is the classic cancer therapy. This involves primarily the administration of cancer fighting drugs through an IV, sometimes through a port. There are nearly 130 different types of cancer chemotherapy available; some of these drugs have been available for 75 years. Many drugs are used in combination with one another.
Blood vessel growth inhibitors (angiogenesis inhibitors) are also administered intravenously. The side effect profile is minimal and quite different from chemotherapy side effects. Angiogenesis inhibitors are used in a select few malignancies.
Monoclonal antibodies are used primarily for malignancies of the blood and lymphatic system. Again, these are delivered intravenously. For the most part, the side effect profile is minimal
Targeted therapies are the drugs of the future. The drugs are usually given by mouth and are called "targeted" because they target a specific intracellular pathway. Targeting the pathway stops the growth of the target cell.
In most instances, a variety of therapies are required. The cancer care team (medical oncology, radiation therapy, surgical oncology, pathology, and radiology) work together to provide a recommendation which is most appropriate for the individual patient.
- What does cancer Stage mean?
- "Stage" is shorthand for how advanced a cancer is. In order to more effectively use the treatment tools described above, the Stage of the cancer must be determined. For the most part, cancers are staged from 0 through IV; with stage 0 being minimal presence of cancer and Stage IV meaning the cancer has spread to more than one organ. Obviously, the less the stage (smaller the disease process) the easier it is treat. For a cancer which has spread to more than one organ, more broad-based therapies might be required, i.e., chemotherapy, antibody therapy, or targeted therapies.
- What is the Tumor Board?
- A. Tumor Board (or tumor conference) is a group of health-care providers who meet on a regular basis to discuss the specifics of an individual's cancer care. In a university setting, each subspecialty has its own conference. For instance, the lung cancer specialists would meet as a group to decide how best to treat a lung cancer patient. Or the lymphatic group would get together to help standardize treatment for a specific lymphoma. In the community, i.e., Paducah, the tumor board meets once a week (as it has for 25 years) to discuss the best treatment for complicated or unusual cancer-related problems.
The types of physicians involved in the tumor conference include medical oncology, surgical oncology, radiation therapy, pathology, and radiology. Having so many doctors meet on a regular basis helps each of us to recognize the nuances associated with a particular individual's malignancy.
- What is a clinical trial?
- A clinical trial is an investigational study sponsored by a treatment facility and often a pharmaceutical agency. The purpose of a clinical trial is to introduce to practice therapies which may be promising for future generations of patients. Clinical trials are available primarily in the university setting. In order to be referred to a clinical trial, you must meet certain basic healthcare qualifications, and, have a malignancy specific to the trial. You cannot be a participant in a clinical trial without signing a consent form. Signature on the form is only undertaken after the trial has been well explained to you in a face-to-face setting by a member of the research team. It is important to know that when a drug is deemed useful on a clinical trial, it is introduced to general practice worldwide. That is, those medications which are found to be successful are considered for general use.
- What is hematology?
- Hematology is the study of blood and blood disorders. This includes the study and treatment of blood disorders (anemia, red blood cell access, and the platelet disorders) as well as the study and treatment of malignant disorders (leukemia's, lymphomas, and precancerous bone marrow disorders).
Most patients who have blood disorders are seen first by their primary care doctor. It is the responsibility of the hematologist to assess further the nature of the blood disorder to find out whether it is malignant or benign. The hematologist usually requires special blood testing, and if the blood testing is not helpful, the specialist may require a bone marrow biopsy. Usually within a visit or two, the answer to the problem will be found. However, some more difficult disorders require several weeks or months to sort out, in addition to the basic blood work.
Examples of non-cancerous blood disorders are blood loss anemia, vitamin B12 deficiency, and iron deficiency.
Examples of malignant or cancerous blood disorders are chronic lymphocytic leukemia, chronic myelogenous leukemia, hairy cell leukemia, and the acute leukemias. Hematologists also take care of such malignant disorders as multiple myeloma, Hodgkin's disease, and non-Hodgkin's lymphoma.
- What is a bone marrow biopsy?
- A bone marrow biopsy is functionally a biopsy of the blood forming organ, the bone marrow! As everybody knows, when a lady has a lump in her breast, biopsy of the breast is in order. Likewise, when a mole begins to look like a skin cancer, the skin doctor does a biopsy. Likewise, when the blood doctor feels that something is not right in the bone marrow, the only way to get more information is to do a bone marrow biopsy.
The marrow of the bone is contained within the hard outer casing of the bones of the body. When you look at a pork bone in cross-section, the center of the bone is kind of rough and honeycombed. That central area is where the bone marrow is located. Thus, to do a bone marrow biopsy, a biopsy device needs to be drilled through the outer bone into the marrow cavity in order to sample the marrow tissue.
When the patient is scheduled for a bone marrow biopsy, the procedure can be done either in the office or under anesthesia in the hospital. It's kind of like pulling a tooth: The area is numbed up, the procedure is undertaken, and a sample is procured. Just like in dentistry, some patients prefer general anesthetic before the drilling of the bone.
Most bone marrow biopsies are undertaken from the big bone of the back of the hip. The skin is numbed too. Then the outer covering of the bone, known as the periosteum, is numbed with lidocaine. Next, a small incision is made in the skin following which a needle is placed into the now-asleep bone. The needle is drilled through the numb spot on the bone, into the bone marrow cavity, following which a little fluid and a core biopsy are taken.
The procedure only takes about 15 minutes in most circumstances. If it looks like the biopsy will be difficult, the radiologists can slide the needle under x-ray guidance.
The information to be obtained from the biopsy are the content of the bone marrow, the presence of abnormal cells (cancer cells), scarring of the marrow, overgrowth of the marrow, or undergrowth of the marrow. Additional information is obtained about the genetic complement of the blood cells as well as whether a clone of malignant cells is growing in the bone marrow.
Precautions to be taken after the bone marrow are to keep the small incision clean and dry. A report is usually ready within 7 to 10 days.
- What is anemia?
- Anemia is the medical term for having too little blood.
An individual may develop the problem of too little blood in many ways. Sometimes it is a sudden problem, and other times it takes a while to develop. Some forms of anemia are treatable; others are not.
Unfortunately, the symptoms of anemia are not precise. That is, a person may have symptoms which suggest anemia (poor energy, breathlessness, and pale skin) but not have low blood. On the other hand, some people with low blood have no symptoms at all!
The most common cause of anemia is blood loss anemia. This can develop quickly (in the instance of a bleeding ulcer) or slowly, over several years (for instance, the bleeding which a woman experiences on a monthly basis as she grows older). In the either instance, the bottom line is that out with the blood (bleeding) goes the iron. And when a person is short on iron, blood can no longer be produced.
Other common causes for anemia include deficiencies of vitamin B12 and of folic acid. Vitamin B12 deficiency is usually a result of genetics and of growing older. It is a disease easy to recognize and is easy to treat. On the other hand, folic acid deficiency is very uncommon in the United States and the westernized world. The reason for this is that we are privileged to have foodstuffs fortified with vitamins. Thus, most of us get what we need.
A very common cause for anemia is the anemia (low blood) associated with chronic kidney disease. Chronic kidney disease (under functioning kidneys) can occur in the absence of symptoms. This problem is picked up on routine laboratory at the doctor's office. Treatment of the anemia associated with kidney disease requires replacement injections, in a manner similar to treating diabetes with insulin.
Other causes for anemia include cancers of the bone, of the bone marrow, chronic illnesses (cancer), leukemias, and bone marrow failure.
- What is iron deficiency?
- Iron deficiency is the term for having too little iron in the body. Iron deficiency usually results in anemia.
The diagnosis of iron deficiency involves the suspicion of your doctor and some simple blood tests. The blood tests show that the iron level is low.
Interestingly, when people develop iron deficiency, the very last thing that happens is that they become anemic. The development of iron deficiency anemia is like the "low fuel" light going on in your automobile: Anemia is the red flag that means something needs to be done!
Iron deficiency comes from iron loss. A common source of iron loss in women is the loss of iron that accompanies the blood loss associated with monthly periods. The body is set up such that it absorbs only a certain amount of iron every day; when a person bleeds to excess on a regular basis or donates too much blood to the Red Cross, the loss of iron exceeds the body's ability to absorb it; thus, deficiency and anemia.
In those individuals who do not lose blood via donation or monthly periods, other causes for iron loss must be sought. The most common cause is blood loss through the bowels. This can occur in people who have untreated stomach ulcers, bleeding polyps, or elderly blood vessels which leak a little blood all the time.
Although iron deficiency is easy to treat, the important item is to find out the cause for the iron leak. If the patient is unable to report a history of frequent blood donations, or, pinpoint a source of bleeding, the patient usually requires an inspection of the gastrointestinal (GI) tract to look for a source of blood loss. This investigation can be undertaken as an outpatient.
Treatment of iron deficiency is usually very easy. It involves the administration of iron pills, or, in many patients, the infusion of an iron preparation through the vein. Because the body is set up to absorb only a small amount of iron daily, bypassing the body's uptake methods by giving the iron intravenously oftentimes speeds the process of treating the iron deficiency.
No matter how quickly the iron deficiency is treated, whether by vein or by pill, 3 to 4 months may pass before the anemia actually goes away. And in any patient once treated for iron deficiency, the rediscovery of iron deficiency later in life should lead to a brand-new investigation.