Every July, the new academic year begins for U.S. medical training programs. It's a time when new interns and fellows join new hospitals to learn and to be educated.

In addition to taking care of new patients on their first day of service, they have to adapt to a new environment, know the nurses and doctors, find their way in new buildings and, sometimes, new cities, and take care of their own personal and family matters: the rent, car insurance, schools for their kids and finding new friends. I remember the first day of my July internship very well. When you're a doctor, it's a day that you never forget.

It was 1986. I had just moved to New York City three days before and was still trying to settle in. I found a studio apartment overlooking the Statue of Liberty and New York bay, bought new furniture and kitchenware, insured my car, got my phone and electricity connected, and got my clothes and medical books out of the boxes. Then came July 1st.

On my first day, I was very excited but nervous. The graduating intern introduced me to my newly assigned patients with a big smirk on his face that made me even more nervous. I bet that also made some of the patients nervous. 

Common genetic variations spread across five genes raise a person's risk of developing the most frequent type of brain tumor, an international research team reports online in Nature Genetics.

"This is a ground-breaking 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. 

The genetic variations identified are the first glioma risk factors of any type identified in a large study.



Read the News Release


Bondy and colleagues expect their findings eventually to help identify people most at risk for the disease and to provide potential targets for treatment or prevention.

For Bondy, the findings are particularly gratifying. "I've been collecting families and case studies since the early 90s," she says. "We have only just begun to understand the causes of brain tumors. Our findings give reasons for hope for those who might be affected and an incentive for a more comprehensive investigation of what has been a mysterious disorder."

Gliomas, deadly tumors that form in the supportive tissue of the brain and spine, account for about 80% of all primary malignant brain tumors, with about 22,000 new cases and 13,000 deaths annually in the United States.

Investigators at the Institute of Cancer Research in the United Kingdom were co-leaders on the study, which also included teams from France, Germany and Sweden.

New research by Ben Smith, M.D., adjunct assistant professor in M. D. Anderson's Department of Radiation Oncology, has proven true Yogi Berra's assertion that, "The future ain't what it used to be!"

Taking into account who's growing old in the United States and how many of us will be old by 2030, Smith projects a 45% increase in cancer diagnosis in general and a 99% increase in cancer incidence among minorities (compared with a 31% increase for non-minorities).

It's very important to note that the researchers aren't saying that anyone's risk for cancer will increase. In fact, their estimates hold the risk to be exactly the same as it is today. Rather, what they're saying is that the number of cancer cases will increase simply because the U.S. population is aging (and older people are more likely to get cancer), and because the proportion of minorities in the U.S. is increasing (so they will make up a bigger percent of the cancer cases in 2030 than they do now).

Among minority groups, expected increases in cancer incidence are:

• 64% for African-Americans
• 76% for American Indian/Alaska natives
• 132% for Asian/Pacific Islanders
• 142% for Hispanics

Currently, although minorities often have higher risk for some cancers, the actual number of minorities who have cancer is low because minorities as a group are younger than the white population and younger people are less likely to get cancer. However, the large group of middle-aged minorities today will make up the group of "old" people in the year 2030. At that time, minority populations will experience the double burden of higher cancer risk and older age. The result will look like an epidemic of cancer in this population. 

Why is this information important for researchers like me and dedicated, caring folks like you? Having a glimpse of the future means that we have time to put into place actions today that can significantly impact the rate of cancer, as well as deaths from cancer, for specific population groups. For example, because minorities are more affected by cancers of infectious origins such as liver cancer and cervical cancer, by implementing effective prevention, education and screening strategies today, we may be able to limit the cancer burden in this group in 2030.

Smith suggests vaccination programs for hepatitis B and human papilloma virus, chemoprevention with tamoxifen and raloxifene, social interventions such as tobacco and alcohol cessation that work for minority groups, and removing pre-cancerous polyps in the colon.

Finally, increasing minorities' participation in cancer clinical trials today will reap even more benefits for care in the future. It will help us to better understand the impact of race on how tissues respond to cancer treatment, the biology of cancer in different groups and effectiveness of cancer therapy for these groups.

Until a few years ago, only a handful of physicians and nurses -- and an even smaller number of women in the community at large -- had ever heard of a rare but fast-growing type of breast cancer, inflammatory breast cancer (IBC).

The birth of the Internet provided a vehicle for mass communication unparalleled in our history. Perhaps, like me, you were the recipient of the first e-mail alert with a subject line of "the breast cancer without a lump: what every woman should know." That first alert was composed by the mother of a young woman in her 30s who was losing her battle with inflammatory breast cancer.

For decades, women have been lulled into a false sense of security when it comes to breast cancer. That is if you perform monthly self-checks and have an annual mammogram screening after age 40, you'll be able to catch breast cancer in its early stages. These are important guidelines that every woman should heed, but inflammatory breast cancer doesn't play by conventional rules. What about "the breast cancer without a lump"?

IBC is particularly aggressive. The five-year survival rate for IBC is only 40%. (The five-year survival rate for all breast cancers combined is 87%.) It occurs in relatively young women. It's not uncommon to see women in their 30s to 50s in our IBC Clinic at M. D. Anderson. The cancer has often spread to the lymph system or beyond at the time of diagnosis. That's why it's so important for every woman to know the signs.

Inflammatory breast cancer appears on the skin of the breast. There's seldom a palpable lump. It may initially look like a bug bite or a breast infection, such as mastitis. The women in our IBC Clinic tell a similar story of noticing a small, red patch that spreads in a matter of days or weeks; a swollen, hot breast with no fever; and skin that is puckered or dimpled. If you notice these signs, don't delay getting to your physician. Your doctor may prescribe a round of antibiotics. If there isn't marked improvement after one course, pursue a referral to an IBC specialist.

So what's the good news here? While breast cancer as a whole will affect one in eight women in their lifetime, IBC is relatively rare. It accounts for about 2% to 6% of breast cancers. Our patients now have clinical trials for IBC that combine standard chemotherapies and targeted therapies like lapatinib. New agents are being tested in pre-clinical settings in our laboratories with more clinical trials set to open soon.

In M. D. Anderson's Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, our motto is "Teach it. Treat it. Beat it." We have assembled a team of clinicians, researchers and advocates who are passionate about raising awareness of inflammatory breast cancer, identifying tools for earlier diagnosis and new treatments that will mean better outcomes for our patients. Help us spread the word.

By Bayan Raji, Staff Writer

Keisha Huse was still adjusting to life as a new mom when she began to notice pains in her stomach. The first time, the pain lasted for an hour and didn't return for several weeks. But by the time her daughter was three months old, Huse was feeling the pains daily.

Her friend had a similar ache after childbirth that ended up being kidney stones, so Huse thought that might be her problem as well. But she hadn't completely stopped bleeding after giving birth, which led her doctor to believe the pain had another source.

"The doctor asked me if there was any way I could be pregnant, and I said it wasn't likely," Huse says. "But, he had me take a pregnancy test, and it came back positive."

Molar pregnancy discovered

Close to her six-week prenatal checkup, the pain worsened. Huse went to the emergency room, thinking something was wrong with her pregnancy. An ultrasound revealed Huse had a molar pregnancy that had to be removed.

In a molar pregnancy, grape-like cysts grow in the uterus after conception. The cysts usually contain tissue from the placenta and occasionally tissue from an embryo that did not develop.   

Molar pregnancies are rare, especially after live, healthy births. They are benign but sometimes develop into malignant tumors. They generally secrete the pregnancy hormone, human chorionic gonadotronin, which is why her doctor thought Huse was pregnant.

Cancer is surprise diagnosis

After the molar pregnancy was removed, Huse thought the ordeal was over. But before she left the hospital, the doctor called her in for a private discussion.

"A routine chest X-ray for admission showed nodules in my lung," Huse says. "I had a rare type of cancer called choriocarcinoma that had spread to my liver and lungs. To go from thinking you were pregnant to being told you have cancer -- with a 3-month-old baby at home -- was a shock."

Because one of her classmates from high school was treated for cancer at M. D. Anderson, Huse, who lives in Wichita Falls, Texas, more than 300 miles from Houston, decided to go there as well.

"I told the doctor I wanted a referral to M. D. Anderson," she says. "This condition is rare, and I wanted to see people who deal with it a lot."

Self-image is clipped

Before she started treatment, Huse faced an emotional struggle. She feared losing her hair, which had been long for years and which she considered one of her best attributes, during chemotherapy.

Knowing she probably faced its loss, she cut it to chin-length before she left home. But even with that pre-emptive move, she felt she was losing her identity when hair fell out. The hospital provided her with a wig, but it took some time to feel comfortable in it.
 
"I was known for my hair," Huse says. "For me, losing it took away my womanhood. I didn't feel pretty, and that was hard to deal with emotionally."

Treatment takes a toll

During the three months Huse was treated at M. D. Anderson, her mother, who also lives in Wichita Falls, stayed with relatives in Louisiana and kept the baby. Huse drove the two hours to visit when she could, but being away from her baby was difficult. 

Her chemotherapy routine alternated each week between once-a-week, three-hour treatments and three-day hospital stays. She got a break only when her white blood cell count was too low to receive chemotherapy.

Although she responded well to treatment, Huse grew tired of being far from home and her family. She requested that her care be transferred closer to Wichita Falls, where she continued to receive chemotherapy for another year. During this time, she came to M. D. Anderson periodically for check-ups. 

"After the transfer, chemotherapy took a different toll on my body," she says. "I was nauseated all three days each time I was in the hospital. I'd get too weak to even move."
 
She feels a new take on motherhood

Now 22, Huse has been cancer-free for more than a year. She believes her take on motherhood is quite different from what it would have been had she not gotten cancer. Her cancer and treatment affected her ability to bond and play with her new baby in the ways she once dreamed.

"I've always wanted a baby, and it was really hard to think that I wouldn't be there for her or watch her grow up," Huse says. "I learned to appreciate her more. I enjoy the smaller things more than I probably would have if I hadn't experienced this."

Experience brings strength

Huse says cancer helped her conquer a phobia of hospitals and doctors. Now, she hopes to be a pediatric nurse one day.

"When I had cancer, I had to be a strong person," she says. "If I showed a sign of weakness, it worried my mom. I didn't want my baby to see me scared either. Now I think I'm much stronger."

Related article:
Q&A: Gestational Trophoblastic Cancer


 Resources:

Choriocarcinoma (Medline Plus)

Gestational trophoblastic tumors treatment (National Cancer Institute)

Gestational trophoblastic disease (M. D. Anderson)

Department of Gynecologic Oncology (M. D. Anderson )

Read more Feature Stories from Cancerwise
 

Gestational trophoblastic cancer (GTC) is a rare, yet highly treatable, disease. Although it is sometimes referred to as gestational cancer, it usually does not coincide with a successful, long-term pregnancy.

Karen Lu, M.D., professor in the Department of Gynecologic Oncology at M. D. Anderson, answers some questions about this unusual cancer.

What is GTC?

GTC is a rare cancer in which malignant cells grow in the tissues that are formed in a woman's uterus following conception (the joining of sperm and egg). The uterus is the hollow, pear-shaped organ where a fetus grows.

Most frequently, GTC develops after a woman experiences a miscarriage or molar pregnancy.

A molar pregnancy, which occurs in one of 1,000 pregnancies in the United States, is an abnormality of the placenta that leads to a growth of abnormal tissue when an egg is fertilized. A developing embryo is rarely present, but the tissue grows rapidly and appears in grape-like cell clusters.

Rarely, GTC can occur after a live birth. This is called choriocarcinoma.

GTC generally affects women younger than 20 and older than 40.

What are the symptoms of GTC?

The main symptom is abnormal vaginal bleeding, especially after a miscarriage, but also after a molar pregnancy or live birth. Abnormal bleeding would be defined as bleeding between normal menstrual periods or bleeding almost every day instead of having menstrual periods.

If a woman has a molar pregnancy, she usually will be monitored afterward to make sure she doesn't develop GTC.

How is GTC diagnosed?

Most often, a woman notices irregular bleeding and visits her doctor, thinking maybe she's pregnant. The physician may test the patient's level of human chorionic gonadotropin (hCG), which is elevated in pregnancy and in GTC.

If the hCG level is high, the doctor probably will perform an ultrasound to determine if the pregnancy is normal or molar, or if tumors are present.

What is the treatment for GTC?

Once a woman is diagnosed with GTC, CT (computed tomography) scans are performed to determine if the tumor has spread beyond the uterus.

If the tumor has not moved outside the uterus, the patient typically has chemotherapy until hCG levels return to normal. Levels are monitored for about a year to make sure they remain normal.

If GTC has spread beyond the uterus, treatment may include chemotherapy and/or surgery.

What is the prognosis for women diagnosed with GTC?

GTC has a cure rate greater than 90%, depending on the tumor's sensitivity to chemotherapy.

The ability to measure hCG levels has helped increase survival in recent years.

Women with GTC have higher rates of survival when they are referred to specialized centers with experience in treating this rare disease.

Does GTC or its treatment affect a woman's ability to have children?

To treat this cancer, doctors typically don't need to remove the uterus. Many women go on to have children after treatment.

What are some risks associated with the disease?

Because GTC can occur in women over 40, some patients may think they're going through menopause when they experience irregular bleeding and not visit their physicians.

Also, because GTC isn't very common, it's often misdiagnosed. Women of reproductive age can request their physician measure their hCG levels if they're concerned.

What should a woman do if she is diagnosed with GTC?

Once a woman is diagnosed, it's in her best interest to go to a specialized center that frequently sees cases of GTC. Overall, GTC is easier to treat and monitor than other cancers, but certain subtypes can be aggressive and more difficult to treat.



Related article:
New Mom Finds Strength in Cancer Ordeal

M. D. Anderson resources:

Karen Lu, M.D,

Gynecologic Oncology Center

Sources:
What is Gestational Trophoblastic Disease? (American Cancer Society)


Read more Feature Stories from Cancerwise

By Mary Brolley and Bayan Raji, Staff Writers

When people are diagnosed with lymphoma, they probably aren't thinking of ways to help prevent or treat the disease. However, a tissue donation to M. D. Anderson's Lymphoma Tissue Bank could help researchers do just that.

The purpose of the bank - and others like it - is to collect, process and store tissue samples for research. The samples then are distributed to research teams within M. D. Anderson as well as investigators collaborating with the institution.

Lymphoma is a general term for cancers that develop in the lymphatic system, the tissues and organs that produce, store and carry white blood cells.

Tissue aids research

The more researchers learn about lymphoma, the more they realize that each patient's disease progresses differently.

Researchers hope to advance treatment of the disease and help patients live longer.
Using the donated tissue, they will study how lymphoma develops and try new drugs on tissue samples before testing them in people. This will allow drugs that are likely to have the best chance of success to be moved rapidly from the laboratory to the clinic for the benefit of patients.

Rare lymphomas need investigation

Two types of lymphoma, follicular and diffuse large B-cell, account for about 50% of lymphoma cases diagnosed. The tissue bank is especially important for finding out more about the less common forms of lymphoma.

Researchers hope patients with less prevalent forms of the disease such as Hodgkin's lymphoma, T cell lymphoma, marginal lymphoma, Burkitt's lymphoma or people with AIDS (acquired immune deficiency syndrome) will benefit from increased research on potential treatments.

Patients are informed about process

About 400 people have enrolled in the M. D. Anderson Lymphoma Tissue Bank over the past year, and the numbers continue to grow, says Sattva Neelapu, M.D., assistant professor in the Department of Lymphoma and Myeloma at M. D. Anderson.

Doctors make it a point to inform patients about the bank and its potential value. Established patients are approached when they visit the cancer center for procedures. New patients learn early in their treatment about the bank and how they can contribute.

"We discuss tissue donation with new patients on their first visit," Neelapu says. "They have the option to accept or decline, but the majority are eager to donate their tissue for research."

Process is not inconvenient

Tissue samples for the bank are taken from biopsies performed during the diagnostic process, which means patients are not inconvenienced with special procedures to retrieve samples, Neelapu says.

"We don't stick patients simply to get tissue for the bank," he says. "At no point do we do a procedure just for research purposes."

Typically, only a portion of the tumor or tissue sample is sent to the diagnostics lab, while the remaining parts are discarded. If a patient agrees to donate tissue to the bank, left over specimens are used for research.

Research has wide-ranging effects

The advances made possible because of the Lymphoma Tissue Bank will help patients everywhere with this disease, not just those at M. D. Anderson.

"This bank is beneficial for patients, the institution and research in lymphoma in general because it will help us better understand how lymphoma starts and grows and help us develop new therapies," Neelapu says. "It also will help us develop a larger coalition with other researchers and institutions conducting lymphoma research."

A new informational brochure helps explain the process and purpose of tissue donation to patients. Neelapu hopes it will encourage patients to donate tissue.

"Great strides are being made in the treatment of this difficult disease," he says. "These advances are possible because researchers have been able to conduct research in the lab using lymphoma tissue. The more tissue we have to work with, the more advancements we can make."

M. D. Anderson resources:

Hodgkin's Disease

Non-Hodgkin's Lymphoma

Sattva Neelapu, M.D.

Department of Lymphoma and Myeloma

Lymphoma and Myeloma Center


Other resources:
Overview: Lymphoma, Non-Hodgkin Type (American Cancer Society)

What You Need to Know About Lymphoma (Lymphoma Research Foundation)

By Bayan Raji, Staff Writer

The eyes have been called the windows to the soul, but the hands and feet are often the first parts of the body to experience something, perhaps the softness of a blanket or hot sand on a beach.

 The importance of hands and feet make them the focal point of reflexology, a healing art historians believe was used first in China more than 5,000 years ago. It focuses on pressure points of the hands and feet and can be used by anyone, but it may be especially beneficial to cancer patients.

 
Pressure applied to hands, feet
Reflexology may help relieve symptoms often related to cancer treatment such as nausea, insomnia and stress. The technique also is believed to have a generally beneficial effect on a person's health and well-being.

Reflexology therapists use their hands - usually their thumbs or forefingers - to apply pressure to areas of the hands and feet that they believe are connected to specific zones of the body. Stretching and movement techniques also may be used. They may open or close the session with a gentle hand or foot rub.


Symptoms may be helped
Margaret Harle, a registered nurse, holistic health consultant and reflexologist, teaches classes about reflexology to patients and caregivers at M. D. Anderson's Place ... of wellness. She answers questions about the technique and demonstrates reflexology for those who are interested in using it at home.

Harle says that during private sessions reflexologists generally work on the hands or feet for 30 to 45 minutes. Most patients find the sessions relaxing, and many experience temporary symptom relief.

 Some patients notice mild temporary, uncomfortable after-effects, including:

    * Nausea
    * Fatigue
    * Need to urinate more often

 
Check with your doctor first
Reflexology should be part of a comprehensive health care plan, Harle says. Some people with certain side effects of cancer or cancer treatment, including lymphedema and neuropathy, should avoid reflexology. Be sure to check with your health care provider.

 Reflexology should not be considered an alternative to medical treatment.

 
M. D. Anderson resources:
Integrative Medicine Program


Other resouces:
Manipulative and Body-Based Practices: An Overview (National Center for Complementary and Alternative Medicine)

By Mary Brolley, Staff Writer

A cancer diagnosis may feel like a one-way ticket to a strange country. No passport, no map, no directions. And, at first, patients don't even speak the language.

Once treatment is complete, survivors may feel relieved, but they frequently are drained and uncertain as well. They may have questions about what's next, and it's likely they are more determined than ever to be conscious of their health and emotional state.

To help them -- and their caregivers -- navigate the physical, emotional and practical challenges of life after cancer treatment, the Patient Education Office at M. D. Anderson has developed a comprehensive booklet that's now available online.

Access roadmap for survival

"Survivorship: Living With, Through and Beyond Cancer," offers an overview of life after a cancer diagnosis and treatment. Whether patients have questions about how to keep themselves as healthy as possible, want to know how to deal with treatment side effects or how best to weather the financial strains cancer treatment may bring, this information points them in the right direction.

A list of survivorship resources helps patients find answers to questions or concerns about the physical, psychosocial, emotional or spiritual impacts of a cancer diagnosis and treatment. This section also indicates whether patients need referrals to seek these services.

"Because survivors may be overwhelmed with options and questions, we wanted to make it easier for them to find the information and resources they need," says Julie Bradford, program manager for communications in the Patient Education Office.

Online content expands audience

Although this booklet is available at M. D. Anderson, Bradford says making it available online ensures that patients everywhere have access to it.

"The Internet has broadened survivors' research options -- and our reach -- incredibly," she says. "We're so happy this information is accessible to people all over the world."

 Download and print the survivorship booklet. (PDF)

M. D. Anderson resources:

Cancer Survivorship

Patient Education Office

Other resources:

Living With and Beyond Cancer (U.S.News and World Report)

Survivors After Treatment (American Cancer Society)

The Cancer Survival Toolbox (National Coalition for Cancer Survivorship)


Read more Feature Stories from Cancerwise

Metastatic Colon Cancer Survival Jumps Dramatically
Almost a Third of Patients May Live Five Years

Novel chemotherapy and biological agents, combined with advances in liver surgery, have increased five-year survival rates for metastatic colorectal cancer from 8% to 30% in the past 20 years.


Acupuncture Eases Radiation-Induced Dry Mouth
Ancient Technique Shows Promise
 
The traditional Chinese medical technique of acupuncture may safely help patients whose radiation treatments cause extreme dry mouth, or xerostomia.

"The quality of life in patients with radiation-induced xerostomia is impaired profoundly," says Mark Chambers, D.M.D., professor in the Department of Dental Oncology and the study's senior author. "Conventional treatments have been less than optimal, providing short-term response at best."


Genetic Variants Predict Bladder Cancer Recurrence, Survival
SNPs Play Roles After Standard Treatment

Variations in genes that modulate inflammation in the body can influence survival rates and recurrence in patients with non-muscle invasive bladder cancer (NMIBC) who are treated with one of the most common therapies for this disease.

In this study of 596 patients at M. D. Anderson, Yang and his colleagues evaluated 59 gene variations called single nucleotide polymorphisms (SNPs) in 35 major inflammation genes to try to find the roles they might play in preventing or facilitating recurrence.


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