Results tagged “Cancerwise Feature Story”

By Tomise Martin, Staff Writer

When Patrick Williams was diagnosed with an aggressive form of brain cancer called glioblastoma multiforme, the three constants he'd always cherished -- family, laughter and colleagues -- helped him cope.

A 27-year veteran of the fire department in Ocean Spring, Miss., he recalls feeling lightheaded and unable to find his balance one day after a staff meeting.

"I couldn't focus, and I needed to brace against a wall for support," Williams recalls. "All I wanted was to go home and take a nap."

Luckily a friend and colleague, trained as a registered nurse, noticed Williams' difficulty and quickly reacted.

"Initially, he and I joked about me slowing everyone down," Williams says. "The banter turned to concern once he heard my symptoms."

As the colleague was taking him to a local hospital, Williams had a seizure. Tests showed he had a brain tumor and would need surgery. It was unknown whether the tumor was cancerous or non-cancerous.

"When anyone mentions cancer, my family thinks of M. D. Anderson," Williams says. "There was no question about my next step."

His first appointment
Days later, surrounded by a group of friends and family, Williams arrived for his first M. D. Anderson appointment.

His surgeon, Sujit Prabhu, M.D., associate professor in the Department of Neurosurgery, told him the tumor was stage IV glioblastoma multiforme, the most common form of brain cancer, and was located in his right parietal lobe. Prabhu explained that the side effects from surgery could include blurry vision, impaired spatial orientation and headaches.

Three days later, Williams emerged from surgery unable to see images to the far left.

"If a board read 'nurse manager,' I would only see 'n rs  m nager,'" Williams says.

Although Prabhu described the possible side effects very clearly, Williams felt unprepared for the outcome. He still considers the experience unreal.  

Multidisciplinary care
With a team of brain cancer experts, including a neurosurgeon, neuro-oncologist and a radiation oncologist, Williams benefited from M. D. Anderson's multidisciplinary approach to cancer care.

After surgery, he met with Monica Loghin, M.D., assistant professor in the Department of Neuro-Oncology. She checked his neurological functions and discussed the remaining treatment options -- chemotherapy, radiation and clinical trials.

"With chemotherapy and radiation still available, I had no desire to try the third option," Williams says.

Loghin prescribed Temodar® (temozolomide), an oral therapy found to be effective for some patients with glioblastoma multiforme, and referred Williams to Anita Mahajan, M.D., associate professor in the Department of Radiation Oncoloy, for radiation therapy.

To complete his radiation treatments, Williams moved to Houston. While the side effects of treatment were hair loss and nausea, his spirits stayed high with frequent family outings and dining at his favorite restaurants.

Try, try again
During a follow-up appointment with Loghin about six weeks later, Williams learned that the brain cancer had not responded to chemotherapy. As a result, he chose to join a Phase II clinical trial studying the effectiveness of XL184, an investigational drug, on glioblastoma multiforme.

In January 2009, he received the good news that some tumors had disappeared or stopped growing.

Life as a brain cancer survivor
Life has changed. Williams has retired as fire chief of the Ocean Springs fire department and his energy level has dropped. But his vision has cleared enough so he's able to drive again on a limited basis.

"I plan activities with their needed recovery time," Williams says. "One day of fishing is followed by two days of rest."

But he doesn't let these new details hamper life. He's usually cracking jokes or surrounded by his friends and family. A brother-in-law always accompanies him to follow-up appointments, which are every four weeks.

"I'm fortunate to have the love and support of my family," Williams says. "Life is what you make of it. I choose to live mine filled with laughter and surrounded by my loved ones."

Related article:
Q&A: Coping With a Brain Cancer Diagnosis and Treatment

M. D. Anderson resource:

Brain and Spine Center

Additional resources:
Brain Tumors (American Cancer Society)

Brain Tumor (NCI)

A cancer diagnosis can be a shock. But a brain cancer diagnosis is even more challenging. A malignant brain tumor can impact patients' thoughts, speech and communication, and motor skills, and perhaps their ability to financially support themselves or their families.

Brain cancer is a rare disease that originates in the brain, spinal cord or nerves. According to the American Cancer Society, more than 22,000 people will be diagnosed and nearly 13,000 will die from brain cancer in 2009.

Monica Loghin, M.D., assistant professor in the Department of Neuro-Oncology at M. D. Anderson, answers questions on how to deal with a diagnosis and cope with the side effects of both the cancer and its treatment.

What can I expect during my first appointment?
During the first appointment, I always discuss the patient's diagnosis and treatment options. Many patients, however, feel overwhelmed during this appointment and may choose not to discuss details about treatment. In this case, I advise them to take it one step at a time and only gather information that they're able to cope with during their first visit. I suggest having a loved one present during appointments. They can provide emotional support through this process and be an extra pair of ears.

Here are some key questions to ask at a first appointment:
•    Is this a definitive diagnosis?
•    What type of tumor do I have?
•    What are my treatment options?
•    What support services are available to assist during my treatment?

What are the treatment options?
Depending on your diagnosis and type of cancer, a combination of the following treatments could be available:
•    Surgery
•    Radiation
•    Chemotherapy

Each treatment and the associated side effects are discussed with the specialist managing a patient's care.

As a neuro-oncologist, I manage the patient's chemotherapy. We discuss the side effects and concerns the patient or caregivers may have regarding therapy.

The selection of chemotherapy is based on the type of tumor and functional status of the individual diagnosed with the disease. If a patient is physically or mentally impaired, I choose a therapy with low toxicity. In addition, monitoring the individual's health during treatment is very important. When discussing treatment options with the patient, I share my reasons for choosing the chemotherapy, the side effects and any support M. D. Anderson offers.

What are the side effects of chemotherapy?
The usual side effects of therapy are:
•    Nausea
•    Constipation
•    Vomiting

How will treatment impact daily life?
Because chemotherapy impacts each patient differently, it's challenging to anticipate how each one will respond to treatment.

For some patients, chemotherapy may not impact their lives. They can continue working full time and maintain their full neurological functions. This isn't always the case, however. Those receiving treatment may be unable to continue working, which could impact their ability to financially support their families.

My goal is to help patients and family members cope with potential changes in their lives. I explain that treatment can leave patients unable to complete tasks that were once easy for them. They may not be able to think as quickly as before. When psychological effects like these arise, I involve our psychiatry team. The psychiatry team can help those diagnosed and their family members cope with these changes.

At M. D. Anderson, we have an education clinical pharmacologist on staff help monitor  each person's care. Every eight weeks, I evaluate patients' responses to treatment and the impact on their health. These evaluations allow me to make any necessary changes to the treatment schedule. If patients are responding to treatment, we discuss whether or not they can return to work -- or do so on a part-time basis.

What services can patients and caregivers seek to help them adjust and cope?
•    Look for social workers in your community. They can assist with transportation, parking or support at home. If patients exhibit neurological deficits, social workers can evaluate patients' at-home needs through home health support.
•    Sometimes a therapist can help patients and caregivers cope with a cancer diagnosis and the emotional side effects from treatment.
•    Many communities have support groups available to patients and their caregivers. These groups offer support and guidance from others who are facing or have overcome similar challenges.

Related article:
Love and Support Help Gulf Coast Resident Cope With Brain Cancer (November Cancerwise FA1)

M. D. Anderson resources:

Monica Loghin, M.D.

Brain and Spine Center at M. D. Anderson

Additional resources:

Brain Tumors (American Cancer Society)

Brain Tumor

By Bayan Raji, Staff Writer

For some cancer patients, reactions to certain medications and treatments create tingling sensations -- similar to when you sit on your foot too long -- that don't go away.

This tingling, known as neuropathy, typically begins on the palms of the hands or the soles of the feet. Eventually, it may become painful and debilitating.

About half of cancer patients who receive chemotherapy drugs experience neuropathy. In about one-eighth of patients, the pain may become chronic.

Drugs may play a role

Neuropathy can be caused by radiation, surgery or chemotherapy drugs, including taxanes, platinum, Oncovin® (vincristine) and Thalomid® (thalidomide). It often is irreversible and even may worsen over time.



Common symptoms of neuropathy include:
•    Numbness
•    Tingling
•    Prickling
•    Burning, shooting or pinching pain
•    Cramping

Patrick Dougherty, Ph.D., professor in the Department of Anesthesia and Pain Medicine at M. D. Anderson, says patients should bring these symptoms to the attention of their doctors.  

Cause may be elusive

Some doctors believe neuropathy is caused when the interaction between nerve endings and the surrounding tissue is affected during chemotherapy. However, no concrete evidence exists to explain the origins of the neuropathy some cancer patients experience.

"The cause may be difficult to determine because these drugs are very different from one another, and they work differently to kill the cancer cells," Dougherty says.

Trial and error may be necessary

Allen Burton, M.D., chair of the Department of Pain Medicine, says doctors may try several methods to reduce neuropathy symptoms.

"When the symptoms are acute, and the patient is receiving, or has recently finished, chemotherapy, the oncologist may lower the dose or extend the time between doses of the drug that are suspected of causing neuropathy," Burton says. "Often, the problem drug is a component of a combination chemotherapy regimen."

Drugs used to treat severe or chronic neuropathy cases include:
•    Opioids (pain medications)
•    Anticonvulsants such as Neurontin® (gabapentin) and Lyrica® (pregabalin)
•    Antidepressants such as Cymbalta® (duloxetine) or Elavil (amitriptyline)

These medications, in conjunction with physical therapy, often help reduce pain and restore the patient's ability to function, Burton says. Occupational therapy may be useful if the patient's hands are affected by neuropathy.

Alternative therapies may help

In addition to medication, doctors may advise patients to try integrative medicine approaches. These may include:

•    Physical therapy
•    Acupuncture
•    Aromatherapy
•    Heat therapy

Dougherty recommends patients work down the list to find therapies that work for them. The most helpful place to access information to these and other alternative therapies is a multidisciplinary pain center, he says.

"It's important to note that certain methods may work really well for some patients but make the pain worse for others," Dougherty says.

Risk isn't clear

Doctors aren't able to determine fully who is at risk for neuropathy. Dougherty says his general impression is that younger patients are more likely to experience it than older patients, but no real explanation exists.

Clinicians at M. D. Anderson are working to develop a pain level chart to better categorize the sensations of neuropathy.

In addition, researchers are conducting several clinical trials for patients with or at risk for neuropathy. Contact askMDAnderson at 1-877-MDA-6789 for information.

Related articles:

Bridging the Divide (Conquest)

Cancer and Neuropathy (Patient Power webcast)


M. D. Anderson resources:
Peripheral Neuropathy

Department of Pain Medicine


Additional resource:
Peripheral Neuropathy Caused by Chemotherapy (American Cancer Society)

By Dawn Dorsey, Staff Writer

Getting a good night's sleep when you have cancer can be a challenge. In addition to treatment side effects and anxiety, a condition known as restless leg syndrome (RLS) gives some sleepers fits.

As many as one-tenth of adults are affected by RLS, according to the American Academy of Sleep Medicine. It's likely that figure is even higher among cancer patients.

What is RLS?

RLS, which happens most frequently at night when a person is at rest, causes a strong, undeniable urge to move the legs. Many people with RLS also have paresthesia,  uncomfortable feelings deep in the legs that often are described as burning, tingling or prickling.

Many people with RLS also have periodic limb movements, in which muscles tighten, twitch or flex when they are resting. These movements may wake them or another person sleeping nearby.

RLS and its accompanying conditions are roadblocks to sleep quality and quantity, which is so important to the health of cancer patients. Among other dangers, sleep disruption may affect the immune system and endocrine (hormonal) function, since hormones are produced during certain levels of sleep.

Triggers are varied

RLS causes may include:

•    Iron deficiency
•    Medications including:
•    Nonprescription allergy and cold medicine like Benadryl®
•    Antidepressants like Elavil® and Prozac®
•    Major tranquilizers like Haldol®, Mellaril®, Thorazine®
•    Family history of RLS

Solutions depend on severity

For mild cases of RLS, try:

•    Establishing a regular daytime exercise program
•    Taking hot baths
•    Getting leg massages
•    Using a heating pad
•    Avoiding alcohol
•    Doing stretching exercises like yoga or Pilates late in the day

If your iron levels are low, talk to your doctor about oral or intravenous iron treatments.
More severe RLS may be treated with drugs including:

•    Requip® (ropinirole) or other dopaminergic agents
•    Benzodiazepines, such as Valium® or Xanax®
•    Opiates, such as Vicodin®

If you experience RLS symptoms, tell your doctor or health care provider.

Related article:

Cancer Patients Need to Treat Sleep Disorders

By Dawn Dorsey, Staff Writer

Cancer has been playing hide-and-seek with Patsy Lofton for 17 years, traveling from her breast to her lung, spine and brain.

Over the years she's tried many treatments, some more successful than others. Now, she's hoping a recent Gamma Knife radiosurgery procedure at M. D. Anderson will help slow the growth of the cancer in her brain.

Breast cancer began the saga
In 1992, Lofton, who lives in central Mississippi, was diagnosed with stage 1 breast cancer. She had a lumpectomy (surgical removal of the tumor and some of the surrounding tissue), radiation and chemotherapy and felt lucky she had caught the cancer before it spread.

But three years later, she began to have a pain in her back, just under her shoulder blade.

"I had a feeling the cancer was back," Lofton says. "But after you've had cancer, you think every little pain is cancer."

Cancer reappears in lung, spine
Unfortunately she was right; the cancer had reappeared in her lung. The tumor was surgically removed, and Lofton had two bone marrow transplants.

For nine years, she was free of cancer. Then it reared its head again, this time in her spine. Her radiologist referred her to M. D. Anderson.

"Since I was 50, still young the doctor said, he thought we might be able to just remove the two vertebrae where the cancer was," she says. "But to do that, we first had to treat the spine with radiation."

Surgeries take their toll
After the radiation, surgeons removed T3 and T4, two vertebrae in the middle of her back.

"It's been a pretty tough adjustment, and it still affects me," says Lofton, who's now 55. "I can't do very much, and my shoulders hurt a lot. Everything below and above the vertebrae that were removed has to work extra hard to compensate."

Before she was completely healed from the surgery, Lofton slipped and fell as she was leaving a restaurant. She broke her ankle and heel and was in a wheelchair for four months, requiring two surgeries.

Procedure hones in on tumor
Last year, a PET (positron emission tomography) scan revealed several small spots on Lofton's brain and lung. Doctors treated the spots on her brain with radiation, but 10 months later another PET scan revealed two new spots. That's when they decided to try Gamma Knife.

A Gamma Knife procedure is neither a knife nor surgery. It's a type of radiation treatment that delivers highly focused, high-intensity rays to a tumor with little damage to healthy tissue.

Gamma Knife causes little pain
Although the procedure might sound scary, Lofton explains it calmly. She says she felt only minor discomfort.

"They drilled two little holes in my skull: two in front and two in back," she explains. "Then they fitted a metal, locking mechanism called a halo on my head to keep it straight and still during the procedure. First they did an MRI, then the procedure, which lasted about 40 minutes."

Lofton was awake during the procedure, but she was lightly sedated.

"After they removed the halo, I had to sit for about an hour, and then I was dismissed," she says. "They asked me to stay in town overnight, and I went home the next day."

"The only side effect has been a little discomfort and two small knots where they drilled the holes to fit the halo."

Treatment continues for lung cancer
Lofton returns to M. D. Anderson every three months for MRIs of her brain, and the tumors seem to have stopped growing. She still receives chemotherapy for lung cancer, but she's able to do that at a facility about two hours from her home.

Recently, a small spot appeared on her liver.

"The doctor says that's the least of my worries," Lofton says. "But we're keeping an eye on it."

Battle influences her attitude
How does Lofton keep going? She attributes it in large part to family, including her husband of 30 years and a grandchild who lives a little over an hour away.

After fighting a formidable enemy for so many years, Lofton has developed a fairly easygoing attitude.

"I ask a lot of questions and learn what I can," she says. "But, in the end, the cancer's either going to come back or it's not."

Related articles:
Q&A: Gamma Knife® Radiosurgery for Brain Tumors

M. D. Anderson resources:

Breast cancer

Lung cancer

Brain cancer

Division of Radiation Oncology


Additional resources:

Detailed Guide: Brain/CNS Tumors in Adults (American Cancer Society)

Brain Tumor (National Cancer Institute)

Patient Information - North America (Elekta)

Gamma Knife® is a major advance in the field of stereotactic radiosurgery for certain brain cancer patients. It offers a non-invasive procedure that can be performed in one session and with extreme precision.

Answering questions about this procedure at M. D. Anderson is Eric Chang, M.D., associate professor in the Department of Radiation Oncology.

What is a Gamma Knife?
The Gamma Knife is a 30-ton machine that contains a cylindrical cone made of the world's largest piece of tungsten with lead shielding. The machine has 192 Cobalt-60 radiation sources that are shaped by eight sectors that surround the patient's head.

There is a theoretical possibility of choosing from 65,000 combinations of highly focused radiation beams.These can be used to create customized shots that target a particular brain tumor, allowing each shot to be tailored to the shape of the patient's tumor.

In addition, the current Gamma Knife model can treat a larger volume of brain area than previous models, which allows greater cranial reach of tumors located in extreme anatomical locations. It has great accuracy to one-tenth of a millimeter and can reach deep-seated targets.

What is Gamma Knife radiosurgery?
Gamma Knife surgery is actually a form of radiation therapy invented in 1967 by Lars Leksell, a Swedish neurosurgeon. The latest model, Perfexion, has been redesigned and re-engineered, and it is the first fully automated Gamma Knife at M. D. Anderson.

For the one-day procedure, the patient first has a brain MRI with a head frame placed by a neurosurgeon. Then the Gamma Knife team creates a customized treatment plan, which is  delivered to the patient who lies on a sophisticated and highly accurate patient positioning system (PPS). The patient's head is inserted into the cone-shaped tungsten cylinder that delivers highly focused gamma rays around the head.

While the contribution of each ray is relatively small -- allowing for less damage to surrounding healthy cells -- when the multiple rays converge on the tumor, they have great intensity. The Gamma Knife unit also has an audio/visual connection so the patient can be seen and also communicate with the treatment team.

Who is eligible for Gamma Knife radiosurgery?
The brain radiosurgery tumor board is a multidisciplinary team of radiation oncologists, neurosurgeons, neuron-radiologists, a radiation physicist and a nurse. At tumor board meetings, each case is discussed to decide if Gamma Knife radiosurgery is the best option. Radiosurgery is especially important for patients who have no other treatment options, including those not eligible for standard surgical techniques due to illness or advanced age.

The Gamma Knife is considered most effective in the treatment of intracranial tumors (within the cranium and the skull base below the brain) such as:

•    Brain metastases (cancer that has spread to the brain from other parts of the body)
•    Acoustic neuromas
•    Pituitary adenomas
•    Craniopharyngiomas
•    Meningiomas
•    Gilial tumors
•    Skull base tumors
•    Upper cervical spine tumor

What is the process?
Generally an outpatient treatment, the surgery consists of four steps:

1.    Early morning placement of the Leksell stereotactic coordinate frame, which will hold the patient's head in place during imaging and treatment
2.    MRI of the brain, which accurately locates and visualizes the tumor
3.    Planning of treatment using a Gamma Planning Computer  
4.    Treatment, followed by observation in the Post-Anesthesia Care Unit

Depending on the number and complexity of the tumors, the delivery of radiation treatment can take from 15 minutes to several hours. A patient usually can return to a normal routine and activities after 24 hours.  

What are the advantages of Gamma Knife surgery?
Because it is non-invasive and no surgical incision is required, the physical trauma and the majority of risks associated with open neurosurgical procedures are avoided. The procedure is recognized worldwide and supported by more than 2,500 peer-reviewed research articles. In addition, more than 50,000 patients are treated with Gamma Knife every year by the approximately 250 machines in use around the world.

Related article:
Gamma Knife® Radiosurgery Targets Brain Cancer


M. D. Anderson resources:

Brain Cancer

Eric Chang, M.D.

Division of Radiation Oncology


Additional resources:

Detailed Guide: Brain/CNS Tumors in Adults (American Cancer Society)

Brain Tumors (National Cancer Institute)

Gamma Knife

Patient Information - North America (Elekta)

Diabetes Medicine May Reduce Cancer Risk
Drug May Help Prevent Pancreatic Cancer

Metformin, the most commonly prescribed drug for diabetes, may help protect against pancreatic cancer. Diabetes is a known risk factor for the disease, one of the most dangerous forms of cancer.

According to a study completed by researchers at M. D. Anderson and published in the Aug. 1 issue of Gastroenterology, the anti-diabetic drug reduces the risk of pancreatic cancer by 62%.


Blood Test May Detect Pancreatic Cancer
MicroRNAs Show Promise as Biomarkers

A blood test for molecules that are produced abnormally in pancreatic cancer may provide a promising route to early detection of the disease.

Researchers at M. D. Anderson reported their findings in the September edition of the journal Cancer Prevention Research.


Cancer Newsline Audio Podcast Series

Cancer Pain Management
Dr. Allen Burton, chair of the Department of Pain Medicine at M. D. Anderson, speaks about cancer pain management. About one-third of patients being treated for cancer experience pain and it can take many forms. Whether chronic or acute, pain is unique to each patient and it is vital that each patient's pain treatment plan be tailored to their personal needs.

Traditional Chinese Medicine and Cancer Treatment
Lorenzo Cohen, Ph.D., director of M. D. Anderson's Integrative Medicine Program, and Peiying Yang, Ph.D., assistant professor in the Integrative Medicine program, discuss the in-roads traditional Chinese medicine has made in western medicine and cancer treatment.

By Bayan Raji, Staff Writer

You may think the skeletal system is pretty stable, supporting the body but not changing much over the years.

Not so. The skeleton always is changing, and it's important, too. The skeleton is the body's source of calcium; without it the brain couldn't function.

"Bone health should be a concern for everyone, especially cancer patients," says Robert Gagel, M.D., professor in the Department of Endocrine Neoplasia and Hormonal Disorders at M. D. Anderson.

Cancer, treatment are culprits
Some cancer treatments may lead to increased bone loss. These include:

•    Breast cancer treatment
•    Targeted therapy treatment
•    Prostate cancer treatment
•    Immunosuppressive agent treatment

Certain cancers, such as multiple myeloma, stimulate bone loss and inhibit formation of new bone.


Early menopause robs bones
Chemotherapy for breast cancer often induces early menopause (the end of a woman's menstrual cycles). Menopause leads to a deficiency in estrogen, which may cause bone loss. Many breast-cancer patients develop bone loss at a younger-than-normal age, which increases their risk of osteoporosis.

"If we don't do something to prevent bone loss at the beginning of treatment, a 45-year-old woman might begin to have bone fractures in 20 years," Gagel says.

Men are affected also
Testosterone in men helps protect bone, much like estrogen does for women. Although
several therapies are available to treat prostate cancer, they all lower testosterone levels.

In most cases, men begin with higher bone density than women, so it takes longer for them to reach levels of bone loss that might lead to fractures. However, the problem should be addressed.

Drugs deliver double punch
Patients who have bone marrow transplants and take immunosuppressive drugs, such as glucocorticoids, face two problems. High doses of these drugs, meant to decrease the risk of the body rejecting the transplant, may:

•    Increase the rate of bone breakdown
•    Decrease the rate of bone formation

Cancer patients often have decreased appetites, and if they receive chemotherapy they may be nauseated as well. As a result, they may not eat well, which may cause a calcium deficiency.

"If we don't take in enough calcium in our diet, our body will withdraw it from the skeleton. If unchecked, this will lead to osteoporosis," Gagel says.

Vitamin D is crucial
Many patients also have vitamin D deficiencies, either because they do not get enough in their diet, or they have liver or kidney failure so their body does not make it.

Vitamin D enables the body to absorb calcium from foods and supplements. While the minimum daily requirement is set at 400 to 600 IUs (international units), many researchers suggest it should be much higher.

Fifty percent of the population in the United States is vitamin D deficient, Gagel says.
This means that, even if they are getting the daily recommended amount of calcium, they are absorbing only about half of it.

Bone up on health
Take your bone health seriously. You may be able to prevent serious problems down the road if you:

•    Add calcium-rich foods to your diet
•    Exercise regularly

Gagel recommends that patients speak to their doctors about any bone health concerns. Ask if you should:

•    Take calcium supplements
•    Check your vitamin D level
•    Have a bone density test

M. D. Anderson resources
Bone Health
Department of Endocrine Neoplasia and Hormonal Disorders


Additional resources
Chemotherapy Causes Bone Loss in Young Women (American Cancer Society)
Calcium (American Cancer Society)

By Bayan Raji, Staff Writer

Continuing their quests for that bronze "summer" look into the fall and winter, many people walk away from the beaches and into indoor tanning salons when sweater weather rolls around.
    
While tanning beds may seem like a no-risk alternative to the sun, they carry many similar dangers.

UV rays are harmful   
Tanning beds do their job with ultraviolet (UV) radiation. While these rays may not cause sunburn, they can thin the skin and make it less able to heal. This may increase previous skin damage caused by the sun.

"Tanning beds are dangerous," says Carol Drucker, M.D., associate professor in the Department of Dermatology at M. D. Anderson. "Advertising may make them seem like a safe alternative to tanning, but they're not."

Beds increase cancer risk
Skin cancer is the most common type of cancer in the United States, according to the American Cancer Society (ACS), and melanoma is the most dangerous form of skin cancer. More than 59,000 people in this country are diagnosed with melanoma each year, and 7,000 people die because of it.

The ACS found women who use tanning beds more than once a month are:

•    55% more likely to develop malignant melanoma
•    75% more likely to develop melanoma if they use tanning beds before age 35

Occasional use of tanning beds almost tripled the risk of developing melanoma.

Don't buy vitamin D claims
Some tanning salons try to counteract negative views of tanning beds by saying the UV rays can help increase the body's production of vitamin D. Vitamin D is necessary for strong bones and a healthy immune system.

"While it may be true that you get vitamin D from the UV rays in tanning beds, the danger far outweighs the positive aspects," Drucker says. "It's preferable not to get your vitamin D through a carcinogen. You can get vitamin D from much safer sources, including fortified milk, orange juice or cereals, or oral supplements."

Self-tanning products can give you the same look, without the negative effects. But, remember, most of them do not include sun protection. Be sure to wear sunscreen when you are outside. 

M. D. Anderson resources:

Melanoma

Department of Dermatology


Additional resources:

Tanning Beds Cause Serious Cancer Risk, Agency Says (American Cancer Society)

How Do I Protect Myself from UV? (American Cancer Society)

Can Melanoma Be Prevented?(American Cancer Society)

Melanoma (National Cancer Institute)

 

By Dawn Dorsey, Staff Writer

Cancer affects every member of the family. Children whose parents or other relatives have cancer may face emotional upheaval, doubt and anxiety.

At M. D. Anderson, the CLIMB® (Children's Lives Include Moments of Bravery) program helps children identify and express their emotions when a parent has cancer.

Marisa Minor, a social worker in the Department of Social Work and one of the program's facilitators, says children experience stressful situations differently than adults.

Tips help parents communicate
"In most cases, children aren't yet equipped with the coping tools to help them verbalize questions and seek help when they are worried or scared about what is happening to their parent and to their family," she says.

To help cancer patients guide children through the tough times, Minor recommends these tips:
•    Use the three "C's"
     o    It's called Cancer
     o    The patient or child did not Cause the cancer
     o    Children cannot Catch cancer like a cold or flu
•    Be honest but don't overshare; use age-appropriate information
•    Reassure them there's a plan for their welfare and you will keep them informed
•    Check in frequently; they may have questions even if they don't ask
•    Ask the medical team or social worker for advice about talking to your children
•    Look for resources, such as books, to help children cope

Children can develop tools
Minor says learning age-appropriate and healthy ways to cope with a parent's cancer early in the process can prepare children to:

•    Normalize their feelings
•    Communicate their concerns
•    Identify personal strengths

"Working together as a family helps children become better equipped to express and manage their feelings," she says. "They can develop tools to help them cope with other life challenges that may come their way."

Program brings children together
Through guided conversations and art, CLIMB meetings allow children to bond with other children who are having similar experiences. They find ways to cope with and express sadness and anger. A concurrent parent support group also takes place.
CLIMB was developed by The Children's Treehouse Foundation, a nonprofit organization dedicated to the emotional support of children whose parents have cancer.

Partial funding support for CLIMB is provided by M. D. Anderson's Volunteer Endowment for Patient Support and the Department of Social Work.For more information about the program, contact Minor at 713-792-6826.

M. D. Anderson resources:
CLIMB Support Program

CLIMB Program Helps Children Whose Relatives Have Cancer (M. D. Anderson News Release)


Additional resources:
Children's Treehouse Foundation

Helping Children When A Family Member Has Cancer: Dealing With A Parent's Terminal Illness (American Cancer Society)

When Your Parent Has Cancer: A Guide for Teens

By Tomise Martin and Dawn Dorsey, Staff Writers

Growing up in Louisiana, Roger Giles ate plenty of farm-fresh vegetables. But, true to Southern cooking traditions, they often were fried in bacon grease and served with high-fat foods like buttered cornbread and biscuits.

"When I graduated from high school, I was athletic and weighed 195 pounds," Giles says. "But, as I entered my early adult years, I started having 'yo-yo' weight gain. By my mid-50s, my weight had ballooned to the 270-plus range."

Pain was the first sign
Last year, Giles had two attacks of acute pancreatitis, a sudden inflammation of the pancreas that frequently is painful. When he felt the symptoms returning in October, he went back to the doctor, hoping for some answers.

"We did a lot of tests, but none of them were conclusive," he says. "They couldn't find the problem, and I really wanted to know what was going on. We suspected cancer, so I went to
M. D. Anderson." Giles was admitted to M. D. Anderson on Dec. 15, and two weeks later he was diagnosed with adenocarcinoma, the most common form of pancreatic cancer.

Diagnosis was not a shock
"To be quite honest, I wasn't the least bit surprised," he says. "I recognized I had some kind of serious problem internally; I just didn't know what it was."

To treat the cancer, Giles had eight weekly treatments of chemotherapy, followed by six weeks of daily radiation treatment.

"From the beginning, my sole goal has been to attack this disease with the most aggressive treatment available," he says.

Weight, cancer are linked
In addition, Giles participated in a study at M. D. Anderson that showed a relationship between high body mass index (BMI) and pancreatic cancer.

According to the American Cancer Society, pancreatic cancer is the fourth leading cause of cancer death in the United States. More than 42,400 people will be diagnosed with this disease, and more than 35,400 will die from it this year.

He's found the right weight
When the pancreatitis hit last fall, Giles weighed 272 pounds. Within a week, he started losing weight at an alarming rate.

"I was losing a pound a day; within four weeks I lost more than 20 pounds," he says. "I couldn't eat solid foods because the pain was excruciating, and I put myself on Ensure to maintain nutrition."

Now, after losing even more weight during treatment, Giles' weight has leveled off at 185 pounds, and he says he feels comfortable there.

"My diet has changed drastically," he says. "I've lost 90 pounds. I'm at a healthy weight, and I understand the importance of staying fit."

It's time to change
Giles has always enjoyed gardening, and now it serves as more than just a favorite pastime that occupies his thoughts during and between treatments. It contributes to his diet and is a reminder to be healthy.

These days, he sticks to a low-fat diet built on fresh vegetables from his garden and stays active. He's also on somewhat of a one-man mission to convince people of the importance of healthful eating.

"Statistics say more than half the people in our country are overweight," he says. "It's time we awakened to that fact. As a nation, we all need to change the way we eat, especially fast food, and high-fat and high-calorie diets. It's an ongoing struggle."

Related article:
Q&A: Pancreatic Cancer and Obesity

M. D. Anderson resources

Pancreatic Cancer

Gastrointestinal Cancer Center


Additional resources
Pancreatic cancer (National Cancer Institute)

Recent research at M. D. Anderson shows that obesity is a risk factor for pancreatic cancer, and being overweight may play a role in the outcomes of people who develop the disease.

Donghui Li, Ph.D., professor in M. D. Anderson's Department of Gastrointestinal Medical Oncology and the study's senior author, answers questions about this landmark investigation.

What inspired you to do this study?
We know obesity is a risk factor for pancreatic cancer, but few studies have looked at body mass index (BMI) throughout a patient's lifetime rather than just when they are adults or the year they are diagnosed. We wanted to show the relationship between BMI and the risk of developing pancreatic cancer across a patient's life span and determine if being overweight in a specific time period raised that risk.

Also, we were curious about the links among BMI, cancer occurrence and overall survival.
Why is this study important?

Pancreatic cancer is one of the most dangerous types of cancer. It's the fourth leading cause of cancer death in men and women in this country. Median survival is less than 10 months, and the five-year survival rate is less than 5%.

Obesity and smoking are known risk factors for the disease, and while smoking is on the decline, obesity is increasing.

This study helps us understand the cause-and-effect relationship between obesity and pancreatic cancer, and we hope it will help identify high-risk people and specific ways to prevent them from getting the disease.

What were the research methods?
First, we enrolled 1,595 people:
•    841 pancreatic cancer patients treated at M. D. Anderson from 2004 to 2008
•    754 cancer-free people

We interviewed each person about his or her:
•    Smoking history
•    Family cancer history
•    Alcohol use
•    Medical history

Participants were asked to recall their height and body weights at 14 and 19 years old; in their 20s, 30s, 40s, 50s, 60s and 70s; and the year prior to their pancreatic cancer diagnoses or enrollment in the study.

We then calculated each person's BMI during each decade and compared the healthy patients with the pancreatic cancer patients.

Among the cancer patients, we also looked at the average age of diagnosis and the overall survival time, then compared those to their BMIs.



What were the results?
As we suspected, the research confirmed an association between obesity and pancreatic cancer.

People who were obese when they were young had a higher risk of developing pancreatic cancer than those who became overweight later in life.
For example, people who became overweight:
•    Between 14 and 19 years old had 100% increased risk
•    In their 20s had 65% increased risk
•    In their 30 had 27% increased risk

The risk of developing the disease diminished for those who gained excess weight in their 40s and later in life.

Also, we found an association between excess weight and earlier onset of pancreatic cancer. Median age at diagnosis was 64 for those at normal weight, compared to 61 and 59 for overweight and obese patients respectively.

Obesity later in life, especially within a year before a patient's cancer diagnosis, reduced overall survival time.

Did these results surprise you?
It was surprising that overweight and obese pancreatic cancer patients were diagnosed at a younger age. This underscores the impact of obesity on loss of life, especially in productive years.

What do these results mean for pancreatic cancer?
Obesity is a risk factor that can be controlled. This study shows that we should try hard to help people control their weight at an early age to reduce the risk of pancreatic cancer.

What's next?
We need to further investigate the links among obesity, pancreatic cancer and poor outcome, looking at insulin resistance as a possible mechanism.

We also will research factors, such as heredity, diet and others, that might affect the relationship between excess body weight and the disease. One day, we hope to develop ways to prevent this dangerous cancer and detect it earlier.

Related article:
After Pancreatic Cancer, 'Southern Style' Gets A Healthy Makeover

M. D. Anderson resources:

Pancreatic Cancer (M. D. Anderson)

M. D. Anderson Study Finds Even Stronger Relationship Between High Body Mass Index,
Pancreatic Cancer (M. D. Anderson News Release)

By Bayan Raji, Staff Writer

Fourteen years ago, Julie Gomez had surgery to remove a gastrointestinal carcinoid tumor, her gallbladder, and parts of her liver and small intestine. Since then she's been living with this rare and chronic cancer that is controlled -- but not cured.

Illness affects immunity

Although Gomez, a volunteer in M. D. Anderson's Hospitality Center*, has checkups every six months, there isn't much she or doctors can do to get rid of her cancer or to prevent the tumors from growing.

As with any other chronic illness, Gomez says she's learned to deal with side effects and lifestyle changes. In 2002, she contracted Still's disease, a form of rheumatoid arthritis.

"I went from being perfectly fine to immobile in a matter of weeks," she says. "That experience completely humbled me as far as my immune system goes and made me realize I have to be careful."

Symptoms are life-changing

Fatigue is a constant. Gomez, who spends each Wednesday talking to fellow patients and caregivers at the Hospitality Center, doesn't schedule any outings or appointments for Thursday because she knows she won't have the strength.

"You only have so much energy," she says. "It's important to listen to your body, or you'll end up getting sick."

Everyone needs an outlet

Gomez says it's important to talk about her cancer, and the conversations in the Hospitality Center tend to be uplifting and positive.

"I volunteer once a week and talk about my experience with cancer, and it's almost like therapy," she says. "I think everyone needs to connect with people who've had similar experiences."



Mantra helps her make it

Life with an incurable cancer isn't all doom and gloom, but when a bad day strikes Gomez has a motto to get through it.

"I know there will be a bad day, but there won't be a bad week or month," she says.

*The Hospitality Center, a program of Anderson Network, are on-campus oases hosted by cancer survivors and caregivers where patients and caregivers can relax and enjoy refreshments.

M. D. Anderson resources:

People Profile: From Workaholism to Penguins and Volcanoes

Prevention: Patient Profile

Anderson Network


Additional resources:

Gastrointestinal Carcinoid Tumor (National Cancer Institute)

What Is a Gastrointestinal Carcinoid Tumor? (ACS)

By Tomise Martin, Staff Writer

Once a radio station owner, talk show host and Texas senator, colorectal cancer survivor Mike Richards looks forward to a future enjoying life with his wife, children and eight grandchildren.

At 72, Richards has no physical restrictions and plenty of energy.

"I'm fortunate to enjoy my favorite pastimes still," Richards says. "I walk outside or on a treadmill about five times a week, and my wife and I recently celebrated our 50th wedding anniversary with an Alaskan cruise. And I just returned from a month in Colorado."

Cancer comes calling

Healthy most of his life, Richards became concerned when he found himself short of breath from climbing just a few stairs and had abdominal pain.

When doctors found a tumor during a colonoscopy, Richards was referred to M. D. Anderson, where he was diagnosed with stage II colorectal cancer and scheduled for surgery. The tumor was removed in January 2006, and no additional therapy was needed. His surgeon was Lee Ellis, M.D., professor in M. D. Anderson's Department of Surgical Oncology.

About a year later, however, the cancer had metastasized (spread) to his liver. In March 2007, Richards had surgery to remove tumors from his liver, followed by a six-month regimen of chemotherapy.

More people live to tell the tale

Survivors of metastatic colorectal cancer (colorectal cancer that has spread to other parts of the body) are becoming more common.

To better understand this increase, investigators decided to study databases of metastatic colorectal patients, says Scott Kopetz, M.D., assistant professor in the Department of Gastrointestinal Medical Oncology at M. D. Anderson and the study's senior author.

In the study, which was published in the Journal of Clinical Oncology, Kopetz and his team found the overall survival rates for metastatic colorectal cancer patients like Richards had tripled since two distinct occurrences in treating the disease:

•    Increased use of liver resection (surgery to remove part of the liver)
•    Advancements in chemotherapy

Large patient sample examined

Researchers analyzed data from tumor registries at two institutions. These included:

•    1,614 patients at M. D. Anderson
•    856 patients at Mayo Clinic

Patients were diagnosed between 1990 and 2006 with follow-up through 2008.

As a comparison, 45,459 metastatic colorectal cancer patients from the National Cancer Institute Surveillance Epidemiology and End Results (SEER) database were evaluated. These patients were diagnosed between 1990 and 2005.

Data show good news

Prior to 1990, when the combination of two drugs, 5-FU and leucovorin, was the sole therapy, overall survival for metastatic colorectal cancer patients was eight to 12 months.

Survival for patients diagnosed in 1990 through 1997 increased to 14.2 months.

Since then, survival has continued to increase. It was:

•    18 months in 1998 through 2000
•    18.6 months in 2001 through 2003
•    29.3 months in 2004 through 2006

Better treatments, surgery make a difference

Overall five-year survival showed a similar increase. It was:

•    9.1% for patients diagnosed from 1990 through 1997
•    13% for patients diagnosed from 1998 through 2000
•    19.2% for patients diagnosed from 2001 through 2003

The five-year survival rate is not available yet for people diagnosed after 2003, but Kopetz projects it will be approximately 30%.

"This is a dramatic change in survival that can compare to the success story for breast cancer 10 years ago," Kopetz says. "The efforts to develop and use better chemotherapies, as well as better identify patients for liver surgery, contribute to these findings."

Cancer worry decreases

Since completing chemotherapy in September 2007, Richards has been free of cancer.

"I feel great," he says. "My cancer diagnosis doesn't cross my mind until I have my follow-up every six months. I've done everything I could to beat this disease. Without my faith and the great team at M. D. Anderson, I wouldn't be here today."


M. D. Anderson resources:

Advances in the Treatment of Colon Cancer

Colon cancer

Department of Gastrointestinal Medical Oncology


Additional resources:

Journal of Clinical Oncology


Colon and Rectal Cancer  (National Cancer Institute)

Four New Targets Found for Breast Cancer
Protein Receptors, Enzyme Often Over-Produced

 Three protein receptors and an enzyme that often are over-produced in several types of cancer also play roles in breast cancer.

A team of researchers, led by scientists at M. D. Anderson, reported its findings on lysophosphatidic acid (LPA) receptors (LPA1, LPA2, and LPA3) and the LPA-producing enzyme, autotaxin, in the June edition of Cancer Cell.

"Lysophosphatidic acid is the single most potent cellular survival factor," says
Gordon Mills, M.D., Ph.D., professor and chair of M. D. Anderson's Department of Systems Biology and senior author on the paper.


Variation in Gene May Increase Risk of Bladder Cancer
Prostate Stem Cell Antigen (PSCA) Is a Factor

Researchers have pinpointed a specific gene variation that causes increased risk of urinary bladder cancer.

In the future, scientists hope the results of this large, multicenter international study may help determine who is at high risk for this deadly cancer, which may lead to improved screening and targeted chemopreventive interventions.

"With this research, we found a novel specific gene and a functional variation that are independent of the previous suspects," says Xifeng Wu, M.D., Ph.D., professor in M. D. Anderson's Department of Epidemiology, the lead and corresponding author.


Five Gene Variations Raise Risk for Brain Tumors
Study Is First to Discover Glioma Risk Factors

Variations in five genes may raise a person's risk of developing glioma, the most prevalent type of brain tumor.

This study, the first to suggest risk factors for any type for glioma, was the largest to date of a rare cancer. The international research team, led by scientists at M. D. Anderson and the Institute of Cancer Research in the United Kingdom, reported its findings online in Nature Genetics.

"This is a groundbreaking study because it's the first time we've had a large enough sample to understand the genetic risk factors related to glioma, which opens the door to understanding a possible cause of these brain tumors," says co-senior author Melissa Bondy, Ph.D., professor in M. D. Anderson's Department of Epidemiology.
Video - Genetic Variants Linked to Brain Tumor Risk


Cancer Newsline Audio Podcast Series

Anal Cancer
Cathy Eng, M. D., associate professor in the department of gastrointestinal medical oncology explains risk factors and treatment options for anal cancer.

Treatment Options for Lymphedema Patients
David Chang, M.D., explains what lymphedema is and discusses treatment options including lymphaticovenular bypass surgery.

By Bayan Raji, Staff Writer

Questions about treatment options and resources often accompany a cancer diagnosis, and many people look for answers on the Internet.

While it is home to numerous reliable, informative sites, the Internet also contains misleading or unreliable sources. Sometimes it's difficult to know where to turn for accurate answers to difficult questions.

Service provides reliable information

AskMDAnderson puts the front door of M. D. Anderson only an e-mail or a phone call away. This reliable source of information has helped more than 700,000 people since it was established in 1995.

AskMDAnderson can help prospective patients:

•    Find accurate cancer information
•    Make an appointment
•    Understand treatment options
•    Learn about research studies
•    Navigate M. D. Anderson's Internet site
•    Learn about and use patient resources
•    Locate community cancer resources

Accurate info is key

AskMDAnderson representatives are trained by an oncology educator, and they take part in regular training to keep up to date on treatment options and clinical trials.

"Patients are much more informed when they go into their first appointment than they were 10 or 15 years ago," says Jennifer Kennedy-Stovall, associate director in the Public Education Office at M. D. Anderson and head of askMDAnderson. "We help educate people by being a trustworthy source of information about potential treatments and options."

Answers ease treatment

Kennedy-Stovall says the most common question askMDAnderson specialists hear is, "How do I become a patient at M. D. Anderson?"

"It's important for people to contact us in the very beginning because we can make sure they get to the next step in a timely manner," she says. "We can get them to the right place and answer questions they have along the way. If we don't know the answer to something, then we'll find out."

Prospective patients can call askMDAnderson at 1-877-MDA-6789, Monday through Friday, from 8 a.m. to 5 p.m. Central Standard Time (CST). Questions also can be submitted online and are answered in a timely manner.


M. D. Anderson resources:

askMDAnderson

Frequently Asked Questions

Gateways to Care (Conquest magazine)

By Mary Brolley, Staff Writer

"Getting back on the horse" during and after cancer treatment was never a question for Dawna Harwell. A professional horse trainer for 25 years, the Collinsville, Texas, resident is often on the road, competing with one or more of the six horses she trains for their owners.

Just after she returned from a horse show last summer, Harwell went to her doctor with what she thought was a urinary tract infection. She was told she had kidney stones, and a CT (computed tomography) scan and ultrasound were ordered.

Diagnosis is elusive

That's when everything started to get complicated.

 "They told me they could see 'extra stuff' on the tests -- something that shouldn't be there," she remembers.

So started Harwell's long search for a definitive diagnosis, which led her from a gynecologist to a gynecologic oncologist to a lymphoma specialist.

Doctors suspect lymphoma

Eventually she decided to come to M. D. Anderson. After a few more weeks of diagnostic tests, she met Kathleen Schmeler, M.D., assistant professor in the Department of Gynecologic Oncology, and Fredrick Hagemeister, M.D., professor in the Department of Lymphoma and Myeloma.

"They were 90% sure it was lymphoma, and they were right," she says. "It turned out to be follicular lymphoma."

Disease often has no symptoms

In many ways, Harwell's is a textbook case of follicular lymphoma, one of the most common types of B-cell lymphomas in the United States.

She had no symptoms, even though she was diagnosed with stage IV disease. A definitive diagnosis took many tests, three needle biopsies, abdominal surgery and countless trips to specialists over the course of many weeks.

According to the Leukemia and Lymphoma Society, non-Hodgkin's lymphomas are the seventh most common cancer in the United States. An estimated 65,000 Americans will be diagnosed with some type of this disease in 2009.

Nearly a quarter of them will have one of the follicular types of lymphoma, so called because of the appearance of the cells and the pattern of the rounded shape of the malignant lymphocytes. Follicular lymphomas generally are indolent (slow-growing). Most arise in the lymph nodes, commonly in the neck, chest, abdomen, tonsils and skin.

Recovery put her in the eye of the storm

Before Harwell could begin chemotherapy, she needed surgery. So on Sept. 12, 2008, Schmeler removed a mass from Harwell's ovaries, cervix and uterus.

It was a big day for Mother Nature, too. Harwell's surgery was the last performed at M. D. Anderson before Hurricane Ike hit Houston.

Harwell laughs about being "locked down" in the hospital to recover after surgery.

"It really wasn't bad," she says. "We never lost water or electricity. The only thing I noticed was we didn't get menus -- they just served the food they had."

Treatment caused uncomfortable side effects

After recuperating for six weeks, Harwell started a chemotherapy regimen called R-CHOP, which includes Rituxan® (rituximab), Cytoxan® (cyclophosphamide), Adriamycin® (hydroxyodoxorubicin), Oncovin® (vincristine) and prednisolone (a steroid).  

The treatment caused a serious reaction during her first treatment, which took 8½ hours.

"I had terrible itching and hives and welts all over my body, and my throat swelled shut," she says. "I'm so glad I was in the hospital."

After eight 21-day cycles of R-CHOP, followed by a course of Neulasta® (pegfilgrastim) to boost her white blood cell count, Harwell began maintenance therapy this spring. For two years, she'll be treated with Rituxan® every three months.

Horses help her stay focused

Harwell says she feels well and has managed to continue her active life throughout the elusive diagnosis and intense treatment.

She missed only one horse show during her treatment. Once she recovered from surgery, she resumed work and traveling, and she believes this has helped her recovery.

"It gave me something to focus on," she says. "Horses have always been part of my life."

Tissue donation helps progress

Harwell happily donated some of her biopsied tissue to M. D. Anderson's Lymphoma Tissue Bank, which provides tumor samples for researchers at the institution and other cancer centers.

"I was delighted to help in any way I could," she says.

Related articles:

Q&A: Follicular Lymphoma
Tissue Donations Help Advance Research

M. D. Anderson resources
Non-Hodgkin's Lymphoma
Lymphoma and Myeloma Center

The hallmark of follicular lymphoma is its slowly progressive nature. Few patients have symptoms until they visit their doctors with swollen lymph nodes.

Though it usually is slow-growing, the disease can be tricky, finding ways to recur again and again. Fortunately, new drugs and targeted agents offer hope to patients.

Answering questions about follicular lymphoma is Fredrick Hagemeister, M.D., professor in the Department of Lymphoma and Myeloma at M. D. Anderson.

What is follicular lymphoma?

Lymphoma is a cancer of the body's lymphocytes, a type of white blood cell. After the cells become malignant (cancerous), they can become tumor masses that invade other organs.

Lymphomas are divided into two general types:

•    T cell lymphomas are relatively uncommon in the United States. They are more common in Asia.
•    B-cell lymphomas are relatively common in the United States and Europe. They can occur in the young and the old, and, depending on their genetic makeup, can be fast- or slow-growing.

Follicular lymphoma:

•    Is a slow-growing B-cell lymphoma
•    Accounts for 22% of lymphomas in the United States

What are the causes of follicular lymphoma?  

The reasons they develop are not clear. Possible causes include:

•    Genetic disposition
•    Environmental factors
•    Viruses

Is there a "typical" follicular lymphoma patient?

It's more common in older people, possibly because as people age and they are on the planet longer, they are exposed to more environmental toxins and stresses.

Most patients have no symptoms until they develop swollen lymph nodes in the neck, underarm or groin.

What are the stages of follicular lymphoma?

Determining the stage of this disease is crucial.

Stage I: One lymph node is affected.
Stage II: More than one lymph node on the same side (above or below) of the diaphragm is affected.
Stage III: Lymph nodes on both sides of the diaphragm are affected.
Stage IV: The disease has spread to another organ.

Because the disease usually has no symptoms in the early stages, the majority of patients have stage III or IV disease.



What are the advantages of being treated for this disease at a major cancer center?

I believe an expert hematopathologist (type of physician that specializes in analyzing cells of lymphomas and leukemias) should review the pathologic slides of each lymphoma patient. There are 24 types of T cell lymphomas alone, and determining the exact diagnosis is crucial and may make a difference in the patient's outcome.

Here at M. D. Anderson and at other major cancer centers, patients have opportunities to participate in clinical trials that may give us information about the disease and its treatment.

You seem to speak of the management, rather than the cure, of the disease.

We are determined to find a cure for lymphoma.

The good news is we are developing new agents and drugs to treat relapses. An example is Rituxan® (retuximab), a drug that delays recurrence and improves survival.

But in most cases, chemotherapy alone can't cure lymphoma. In the majority of patients, follicular lymphoma will progress and recur. Many follicular lymphoma patients are treated four or five times.

Eventually, lymphoma may become resistant to treatment. Many patients ultimately get bone marrow transplants.

Why do you have a sense of urgency when you speak about lymphoma diagnosis and treatment?

I've always been interested in educating both patients and physicians. There's so much happening -- so many new drugs, cellular and molecular discoveries -- that many people (even physicians) are unable to keep up with the lymphoma literature. The number of clinical trials has expanded rapidly and broadly, for one thing. It's an exciting time to be a lymphoma specialist.


What is the future of lymphoma treatment?

One promising area is in the development of targeted therapies like proteasome inhibitors, which work without damaging a person's DNA. Instead, they block the proteins that DNA produces. Proteasome inhibitors change the surroundings of the malignant cells, so they die, but healthy cells are not as affected.

Other new drugs, like monoclonal antibodies and immunomodulatory agents, also have great potential to improve the lives of lymphoma patients.

Our Lymphoma Tissue Bank is something else we're excited about. Lymphoma patients have the option to donate part of their biopsies to the bank, which is housed at M. D. Anderson. It's been in operation about a year and a half, and it's really growing.

Tissue samples from the bank are a rich resource for researchers at this institution and at others as well. We hope this will help us find out more about how lymphomas develop and which targeted therapies work best for each patient.

Related articles:
Elusive Diagnosis Leads Horse Trainer to Lymphoma Treatment
Tissue Donations Help Advance Research


M. D. Anderson resources:
Non-Hodgkin's Lymphoma
Lymphoma and Myeloma Center


Additional resources:
Treatment of Specific Lymphomas (American Cancer Society)
Non-Hodgkin Lymphoma (NCI)

By Bayan Raji, Staff Writer

Cancer among elderly people and minority groups is expected to increase dramatically over the next 30 years, precipitating a need for increased research in two groups that often are under-represented in clinical trials.

The study by researchers at M. D. Anderson, published in the June issue of Journal of Clinical Oncology, predicts cancer diagnoses over the next 30 years.

Population, cancer cases will grow

To conduct their research, the team looked at U.S. Census Bureau statistics, updated in 2008 to project population growth through 2050, and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database.

They found:
•    The U.S. population is expected to grow from 305 million in 2010 to 365 million in 2030
•    The total number of cancer diagnoses per year will increase from 1.6 million in 2010 to 2.3 million in 2030
•    In 2030, 70% of cancers will be diagnosed in the elderly
•    In 2030, 28% of cancers will be diagnosed in minorities

The study highlighted three important issues:
•    Clinical trial participation
•    Increasing cost of cancer care
•    Expected shortage of oncologists

Groups face challenges

From 2010 to 2030, the rate of cancer is predicted to increase:

•    65% in elderly people
•    100% percent in non-white people

These groups are under-represented in clinical studies and are vulnerable to sub-optimal cancer treatment.

"The fact that these two groups have been under-represented in clinical research participation, combined with the groups' rapid growth in cancer diagnoses, reflects the need for clinical trials of new therapies to be more inclusive and to address issues that are relevant to both populations," says Ben Smith, M.D., adjunct assistant professor in M. D. Anderson's Department of Radiation Oncology and the study's senior author.

Screening, prevention crucial

Cancer rates will increase by:

•    31% in whites
•    64% in blacks
•    76% in American Indian-Alaska Natives
•    101% in multi-racial people
•    132% in Asian-Pacific Islanders
•    142% in Hispanics

Screening and prevention will become essential tools to help prevent a similar growth in cancer deaths. However, no easy answer exists, according to Smith.
"There's no doubt the increasing incidence of cancer is a very important societal issue," Smith says. "There will not be one solution to this problem, but many different issues that must be addressed to prepare for these changes."
Changes take toll on system

The cost of cancer care continues to grow at a rate that's not sustainable for patients.

"As we design clinical trials, we need to seek not only the treatment that will prolong survival, but prolong survival at a reasonable cost to patients," Smith says. "These are two issues that oncologists need to be much more concerned about and attuned to."

A shortage of medical oncologists will have an impact on the health care system by 2020, according to the American Society for Clinical Oncology (ASCO).  

Smith says ASCO and other professional medical organizations beyond oncology are aware of the problem and are trying to increase the number of physicians, nurse practitioners and physician assistants.

More research needed

Unless specific prevention and treatment strategies are discovered, cancer death rates will increase dramatically, according to Smith.

"It's alarming that a number of the types of cancers expected to increase, such as liver, stomach and pancreas, still have tremendously high mortality rates," he says.

M. D. Anderson resources

Audio Interview with Dr. Smith about Cancer Rate Growth (Cancer Newsline)

Cancer Incidence Rates Among Minorities Expected to Increase (David Wetter, Ph.D)

Division of Radiation Oncology


Other resources

Cancer Health Disparities (National Cancer Institute)

How Common Is Use of Off-Label Drugs in Breast Cancer?
Many Patients Receive Legal But Non-Approved Drugs

 More than one-third of breast cancer patients receive chemotherapy drugs that, while approved by the U.S. Food and Drug Administration (FDA), have not been vetted specifically to treat the disease.

The use of drugs for conditions other than those for which they were approved is legal, and, according to a study by M. D. Anderson researchers, prevalent in breast cancer treatment. The study was presented at the American Society of Clinical Oncology's (ASCO) annual meeting in May.

Vaccine Gives Hope Against Advanced Melanoma
First-of-Its-Kind Study Shows Benefit

Patients with advanced melanoma, one of the most dangerous cancers, showed improved response to treatment and length of progression-free survival when a vaccine was added to their treatment with the immunotherapy drug interleukin-2 (IL-2).

Results from the Phase III clinical trial - the first of its kind in melanoma and one of the first in any type of cancer - were presented by M. D. Anderson researchers at the American Society of Clinical Oncology (ASCO) annual meeting in May.

Two-drug Combo Shows Benefit in Lung Cancer
Targeted Agent, Chemotherapy Slow Cancer Growth

When combined with the standard chemotherapy drug Taxotere® (docetaxel), the oral targeted therapy Zactima® (vandetanib) improves progression-free survival for patients with advanced non-small cell lung cancer.

Researchers from M. D. Anderson presented the findings of the first-of-its-kind, international Phase III trial at the American Society of Clinical Oncology's (ASCO) annual meeting in May.

Cancer Newsline Audio Podcast Series

Hodgkin's Lymphoma Treatment Anas Younes, M.D., Professor of the Department of Lymphoma/Myeloma discusses frontline, pre-transplant, and post-transplant treatment options for Hodgkin's lymphoma.

Ways You Can Help Without Giving Money: Donate Blood
Andrea Johnson, Community Representative for the University of Texas M. D. Anderson Blood Bank, discusses the challenges blood banks face when getting blood and platelets for their patients and explains how you can help.