Interview with an Oncologist: How Cancer Diagnosis and Treatment Are Evolving

Associate Professor Dr. Irene Kürer is a senior physician at Vienna’s University Hospital (AKH), specializing in general oncology, hematology and internal medicine; she leads the tumor board and co-founded the European Federation for Colorectal Cancer.

How have cancer diagnosis and treatment evolved in recent years, and what major advances have contributed to better outcomes for patients?

Yes, so I think that in just the last few years we have seen a real quantum leap in the treatment of cancers, both in hematologic diseases and in solid tumors, and this has happened mainly because of the introduction of immunotherapyon the one hand, and on the other hand because we now have much better molecular-genetic diagnostics, which allow us to recognize specific markers and develop targeted, personalized therapies for each individual patient, and through this the therapy results have become significantly better.

Are there specific types of cancer that are becoming more or less common today? What factors—genetic, environmental, or lifestyle-related—are driving these trends?

Yes, so that is a very interesting question. The fact is that colorectal cancer in particular is now increasing noticeably in younger people, and that was not the case before. Earlier, this was a disease that usually appeared at the age of 60 to 65, and now we already have affected patients who are 35 years old, and not only when there are family cases. And this development has led to the situation here in Austria where the age for the first colonoscopy—the first examination to see how the bowel looks—has been reduced to 40.

What are the causes? Too little physical activity, a lot of animal fat in the diet, and various genetic factors that are still being researched. But the important point is that young people can also develop colorectal cancer, and what is especially important is that many doctors, both general practitioners and even specialists, often do not think that it could be cancer at all in a young person. They examine for food intolerances, they look for other explanations, and that is why it is very, very important that in any case of intestinal problems at a young age, a colonoscopy should be carried out. That is absolutely clear.

How critical is early detection in improving cancer survival rates, and which screening methods are currently recommended for different age groups or risk categories?

Yes, so early detection is extremely important, and this can be seen very clearly with breast cancer, where regular mammography—especially when started early—allows cases to be recognized sooner, and the cure rate has clearly increased dramatically. But this applies to all examinations.

What can we screen? We can screen the skin, which is very important, because with strong sun exposure the rate of melanoma continues to rise, so the skin should always be checked.
The gastrointestinal tract can be screened with a simple colonoscopy or gastroscopy.
For women, the full range of gynecological examinations is very important.
For men, regular prostate examinations should be performed at specific intervals by the urologist.

These are the most important screening examinations. And one thing still seems very important to me: when someone suddenly has a loss of performance, when they no longer feel the way they did before and there is no explanation for it at all, or when an iron deficiency is found in the laboratory, then a more intensive examination should be carried out and one should not avoid it. That means, for example, doing a chest X-ray, doing a mammography as already mentioned, performing a gastroscopy, a colonoscopy, a gynecological check-up, and also examinations of the breasts or even the bladder, depending on the situation.

What signs or symptoms should prompt patients to consult a specialist, and what is the best way for them to seek specialist care?

The point is that as soon as a cancer diagnosis is made, it is important to visit a specialist even before surgery, unless it is an emergency operation, because with the diagnosis the further course and the future fate of the patient are actually determined. The right therapy, the correct sequence of neoadjuvant chemotherapy, immunotherapy, radiation therapy, or surgery—since we now have so many different options—decides the outcome, meaning the final result for the patient. For example, in end-stage cancer, if the correct sequence is not selected, the crucial chance can be lost, and this also applies to other diseases. So with the diagnosis, a specialist must be involved, someone multidisciplinary, someone connected with other specialties, who can determine which therapy begins and to which therapy the treatment continues.
 

Which preventive measures or lifestyle habits are particularly important today for reducing the overall risk of developing cancer?

So you can say that some cancers are diseases that unfortunately belong to our time, especially because of nutrition, the diet contaminated with animal fats, the low-fiber diet, and alcohol consumption, which has many effects not only on the mouth, pharynx, esophagus, stomach, and pancreas, but really on all these organs that are affected by increased alcohol intake and the higher cancer risk associated with it. And what else can you do preventively? Go to the regular examinations, do laboratory tests, and it must also be said that there are cancer families. That means there is hereditary, inherited cancer, so if someone in the family has cancer, all other family members should also be examined. You can then create a family tree like this, and there are corresponding genetic studies, meaning blood tests, to determine the individual cancer risk.
 

What steps should patients take if they suspect they may need to see a cancer specialist, or if they have already been referred to one?

So it is very, very important when patients now go from one center to another, to have a second opinion or to have therapy performed there, that all findings, even those that at first may seem not at all important, are collected, and ideally also all image material such as computed tomography or X-rays or whatever is available, and that they also know what medication they are taking, because not all patients know that when they come to me, and with this detailed specification of the anamnesis, as we call it, this previous history, you can then ask questions in a very focused way, either online or also in the personal conversation, and with that you save yourself double examinations and come faster to a result.

And the last question, what makes Austria a good place for cancer diagnosis and cancer treatment?

In Austria we have a very broadly established health-care system and also a research system, that is, we have all possibilities to use the latest research results and approved drugs; just as in America they have the FDA, we have the EMA, so the range of approved drugs is very broad, and all examination methods that are currently established worldwide are available here, partly also supported by AI, that is, with artificial intelligence, for example you can evaluate a prostate MRI much more precisely.