While routine visits to the doctor sometimes may seen unnecessary, they may reveal life-saving information. For Angela Hawkins, a 2004 check-up changed the course of her life.
For about six months, Hawkins had struggled with pain in her side, thinking it was an injured rib. But a yearly well-woman exam revealed she had an enlarged liver.
The gynecologist's concern prompted Hawkins to see a gastroenterologist, who performed a CT (computed tomography) scan and several biopsies, only to reveal inconclusive results. He referred her to M. D. Anderson, where Hawkins discovered her adrenal gland, not her liver, was the problem. She was diagnosed with stage IV adrenocortical carcinoma.
"As soon as you're diagnosed, you want something you can be working toward," Hawkins says. "The doctors at M. D. Anderson laid out a strategy plan, listing ways we could try to fight this."
Rare cancer requires intense treatment
Adrenocortical carcinoma is a malignant tumor that occurs in the outer layer of the adrenal gland. It is a rare cancer, affecting only about 300 to 500 people annually in the United States. Age is believed to be the biggest risk factor. Most cases occur in adults between the ages of 40 and 50, although it is known to strike children under 5 years old. Symptoms of adrenocortical carcinoma vary widely, depending on the hormones produced by the tumor.
Hawkins' doctor, Jean-Nicolas Vauthey, M.D., a professor in the Department of Surgical Oncology at M. D. Anderson, told her the cancer was inoperable as it was, so she received eight months of chemotherapy to shrink the tumor.
Workplace provides strength
During chemotherapy, Hawkins lost her hair and 35 pounds, but she says she was lucky to have a supportive work environment. Co-workers even helped raise money to offset her medical expenses. They never made her feel guilty for missing work, she says, even when she had to take a month off after surgery.
"They were very supportive the whole time, and I did everything I could to work," she says. "You can't take advantage of a situation like that."
New procedure removes tumor
After chemotherapy, Hawkins went back to Vauthey for surgery. He removed the tumor, one kidney and half of her liver using a procedure that placed the liver in a type of "sling."
The sling procedure ensures a more accurate surgery, dramatically reduces the chance of damaging the vena cava, a major vein that runs through the liver, and also reduces the likelihood of rupturing the tumor.
The technique can be used to remove large tumors in the right upper abdomen area and has been used in patients with adrenal, liver or colorectal cancer, stromal tumors and renal cell carcinoma.
The journey is the adventure
Nearly four years later, the lessons Hawkins learned remain fresh in her mind. She says family and time are too precious to lose track of.
"I think cancer helps you realize there are certain things in your life that you better enjoy," she says. "You can't get caught up in the day-to-day struggle. You have to enjoy the journey."
Family bond grows stronger
Science may have cured Hawkins, but it was the support from her extended family, which includes parents, a brother, a son and daughter, 11 aunts and uncles, and countless cousins, that carried her through.
"My family is huge and was very supportive. They are what got me through this," Hawkins says. "I think it was critical to my survival."
A brush with cancer also has brought her family closer together. Instead of putting off time together until "some day," a time that may never come, her family marks the small milestones like birthdays and anniversaries. They also recently took a trip to Italy and can't stop talking about it, she says.
During a period of uncertainty, Hawkins also found comfort in the dedication of her medical team.
"The doctors gave me some hope to hold on to," she says. "That's all we really have every day anyway."
Read more Feature Stories from Cancerwise
Q&A: Liver-Hanging Surgery
April 2009 Archives
By Dawn Dorsey, Staff Writer
Surgical removal of a tumor close to or connected to the liver creates risks that the patient will have severe blood loss or the tumor will spill into other areas.
A surgical procedure in which the liver is placed in a sling, also called a liver-hanging procedure, is performed at M. D. Anderson. This approach, specifically designed for removal of large tumors in the upper right abdomen, reduces these risks.
Jean-Nicolas Vauthey, M.D., professor of surgery and chief of the Liver Service in the Department of Surgical Oncology at M. D. Anderson, developed the procedure and answers questions about this surgical approach.
What is the liver-hanging procedure?
Using a blunt instrument designed for pediatric surgery, we can safely develop a space between the major vein of the body, the vena cava, and the back of the liver. Then the instrument can be safely advanced behind the liver, and a sling can be passed through the space. The sling is used as a guide to cut the liver safely with minimal bleeding. This can be accomplished while the major vein is protected.
For which types of tumors is this procedure used?
The liver-hanging maneuver can be used for large tumors in the upper right abdomen of the body, specifically tumors attached to the liver. A person does not have to have liver cancer to have the surgery.
We have used this surgery with:
• Liver cancer
• Adrenal cancer
• Colorectal cancer
• Renal cell carcinoma
• Large stromal tumors
What is the benefit of the liver sling?
With this procedure, we have seen a reduction in bleeding and occurrences of tumor rupture. Fewer patients have had tumor recurrences.
In patients who had the liver-sling surgery:
None had tumor rupture during surgery. Without the sling, 12% of tumors rupture.
The cancer returned in 38% of cases. It returned in 69% of patients who had other surgeries.
Less blood loss occurred.
How is this procedure different from the regular surgical approach?
Before, large incisions had to be made in the chest for adrenal carcinoma and some other types of cancer. This procedure doesn't involve cutting the diaphragm, which is a huge advantage.
What is the history of the procedure?
Doctors in France and China have used similar procedures, and I modified their approaches to focus on large tumors in this area.
The first liver-hanging surgery was performed at M. D. Anderson in 2003, and since then about 40 patients have benefited from it.
Why isn't it used with small tumors?
Because small tumors don't stick to the liver, they pose less risk than larger ones.
Read more Feature Stories from Cancerwise
Innovative Surgery Treats Adrenocortical Cancer
Thanks to public awareness, earlier detection and improved cancer treatments, the National Cancer Institute (NCI) reports that nearly 12 million cancer survivors are living in the United States today. This number is estimated to increase to 19 million by the year 2020 as baby boomers enter their cancer-prone years.
According to the U.S. Centers for Disease Control and Prevention and the NCI, 64% of adults diagnosed with cancer today can expect to be alive in five years. For children, survival rates range between 70% and 92%, depending on the type of cancer.
Who are cancer survivors? A cancer survivor is commonly defined as anyone who has been diagnosed with cancer, from the time of diagnosis and treatment through the remaining years of life. The definition has been expanded to include people who have been affected by the diagnosis, such as family members and caregivers.
Within this definition are stages or phases of survivorship:
- Living with cancer refers to the experience of receiving a cancer diagnosis and any treatment that may follow
- Living through cancer is the period following treatment in which the risk of cancer recurring is relatively high
- Living beyond cancer refers to post-treatment and long-term survivorship
Why is this important? As many survivors have learned, recovery is not always the end of the cancer experience. Even years after successful treatment, cancer recurrence is a possibility. Cancer therapies can leave health issues that require lifelong surveillance. Finally, recovering from the emotional, social, and economical trauma of cancer can take longer than recuperating from treatment.
To address the needs of our survivors, M. D. Anderson is developing survivorship as a distinct phase of cancer care. Providing the framework for the survivorship effort is our multidisciplinary, patient-centered care model, in which every patient benefits from a diverse team of cancer specialists participating in cancer treatment planning. We're using this platform for cancer care to lead, develop and implement an integrated, multidisciplinary survivorship program, easing the transition from illness to wellness.
As a cancer survivor, what are your biggest concerns or questions? Please take a few minutes to post your comments and I'll do my best to address them.
Young women with cervical cancer interested in future fertility often face a difficult dilemma. A radical hysterectomy has been the standard approach for many years. Fortunately, this is no longer the case.
Now patients can be treated for their cervical cancer and still maintain fertility. The procedure is called a radical trachelectomy. In this procedure, the cervix is removed but, unlike radical hysterectomy where the uterus is removed along with the cervix, the uterus is kept intact and it's reattached to the vagina so that women can get pregnant afterwards.
Frequently, many women will ask if by undergoing this procedure they're exposed to a higher risk of recurrence or death from this disease. Fortunately, this isn't the case. The recurrence rate and survival is the same or better than for women undergoing radical hysterectomy.
Most women who try to get pregnant after having this procedure will be able to do so spontaneously. Some women will need assisted reproductive technology to become pregnant. The majority of patients who eventually get pregnant also will reach the third trimester and be able to deliver at term.
All women who undergo this procedure require a cerclage placed either at the time of surgery or early in their pregnancy. A cerclage is a suture that's placed in the lower uterus to hold the pregnancy in place. Another important fact is that all women who undergo a radical trachelectomy must deliver by Cesarean section. A number of patients have been able to get pregnant and deliver healthy babies multiple times after undergoing this procedure.
Some problems may arise after having this procedure such as irregular or lack of menstrual cycles, abnormal Pap smears, vaginal discharge or infertility. Fortunately, these are rare complications.
Women should ask their doctors whether they're candidates for this procedure and should seek a consultation with a gynecologic oncologist who's skilled in performing this procedure.
Resources from M. D. Anderson
Listen to Dr. Ramirez talk about the radical trachelectomy procedure
Mindful living and mindfulness meditation are practices that can help reduce stress and anxiety. They involve residing in the moment by acknowledging emotions and thoughts as they come.
"Through living mindfully, we inhabit our lives," says Micki Fine, who teaches Mindful Living at M. D. Anderson's Place ... of wellness. "When we notice the details, our lives matter more to us."
Mindful living consists of:
• Paying intentional attention to the moment
• Realizing attitudes toward others, self
• Letting go of judgment
One of the most common obstacles to mindful living is stress. It prevents you from thinking about the present because you worry about what might happen in the future or what happened in the past.
We create opinions all the time, but typically we don't realize it. Living mindfully, people can become aware of thoughts and learn to recognize when they pass judgments and why. When we understand the reasons behind negative attitudes, we are more likely to let them go.
Meditate through breathing
Mindfulness meditation, the more structured method of being mindful, can be done anywhere. To practice mindfulness meditation:
• Sit with your back straight, but relaxed
• Place your feet on the floor if you are in a chair
• Cross your legs if you are sitting on the floor
• Breathe normally
• Pay close attention to the breath as it exits and enters the body
• Don't try to control your thoughts
• If your mind wanders, gently bring it back to the breath
Make room to value the little things
Life with cancer can be extremely difficult to cope with, Fine says, but the illness may present opportunities to which others are blind.
"Those of us who aren't living with cancer often don't have the sense of how precious life is," she says.
Any moment in the day can be turned into a form of meditation and appreciation, Fine says. To do so, focus on the situation at hand.
For example, while you're in the shower don't worry about work or school. Instead, pay attention to the warmth of the water and how it feels against your skin. Smell the body wash or shampoo. Focus on the movements of your limbs.
Fine says, "The way you pay attention to something changes your experience."
Read more Feature Stories from Cancerwise
By Mary Brolley, Staff Writer
A new booklet from the Patient Education Office at M. D. Anderson answers some of the questions patients have about sexuality and how cancer affects it.
In straightforward language, Sexuality and Cancer acknowledges sex is an issue when patients are facing a health crisis.
Targeted to patients and their partners, topics include treatment effects, emotional effects, fertility issues, relationships and resources within and beyond M. D. Anderson.
Concerns are common
"Half of cancer survivors have sexual problems," says Leslie Schover, Ph.D., professor in the Department of Behavioral Science. "This booklet lets them know it's legitimate for them to have -- and to ask -- questions about how cancer or treatment might affect sexual function."
Survivors of four of the most common types of cancer may well find their sex lives are affected by cancer or its treatment.
"Treatment for prostate, breast, colorectal and gynecological cancers is likely to have an effect on sexual function, body image or fertility," Schover says.
Go ahead and ask
Many patients are reluctant to raise the subject when making treatment decisions. It's often an issue of time.
"Physicians are busy, and appointments go quickly," she says. "We want patients to know that these are legitimate questions to ask."
Schover is a national expert on the impact of cancer treatment on sexual function and relationships, fertility and attitudes to childbearing. She has developed an interactive educational CD-ROM, "Banking on Fatherhood," to make physicians and patients aware of the option to bank sperm in advance of cancer treatment.
"There's a narrow window of time for young patients to consider their fertility options," she says.
Research and progress continue
Schover has written extensively on the subject for the American Cancer Society and in several books.
With funding from the ACS and additional pilot funding from the M. D. Anderson Prostate Cancer Research Program, she has developed a Web-based intervention to improve sexual rehabilitation after treatment for localized prostate cancer.
Read more Feature Stories from Cancerwise
M. D. Anderson Resources:
Q&A: Sexual Relationships and Cancer
Audio Podcast - Sexuality and the Cancer Patient
Professor of Experimental Therapeutics Kapil Mehta earned one of four pilot grants awarded this year by the Pancreatic Cancer Action Network (PANCAN) and the American Association for Cancer Research.
The $195,870 two-year grant supports Mehta's ongoing inquiry into how overexpression of tissue transglutaminase (TG2) promotes pancreatic cancer drug resistance and metastasis.
He and other awardees were honored Tuesday night at the AACR Research Grants Dinner at its annual meeting in Denver.
Mehta has connected overexpression of the gene to treatment resistance and metastasis in pancreatic and breast cancer and melanoma. Mehta and colleagues have shown that expression of TG2 can be shut down with a targeted small-interfering RNA (siRNA).
Young scientists from M. D. Anderson earned eleven Scholar-in-Training Awards at the American Association for Cancer Research 100th Annual Meeting 2009, the most of any institution at the session in Denver.
About 17,000 scientists from 90 countries are attending. The highly competitive travel grants go to postdoctoral fellows and graduate students judged to have submitted meritorious abstracts for the AACR meeting. Overall, 200 were awarded.
Three of M. D. Anderson's winners came from the lab of XifengWu in the Department of Epidemiology - two postdocs and one graduate student.
M. D. Anderson honorees are:
Ahmed A. Ahmed of Experimental Therapeutics
Ugur Akar, Breast Medical Oncology
Chandra Bartholomeusz, Breast Medical Oncology
Tina Cascone, Thoracic Head and Neck Medical Oncology
Meng Chen, Epidemiology, and a graduate student in The University of Texas Graduate School of Biomedical Sciences.
Puja Gaur, Surgical Oncology.
Longfei Huo, Molecular and Cellular Oncology
Xia Pu, Epidemiology
Manish Shanker, Thoracic and Cardiovascular Surgery
Jingmin Shu, Leukemia
Hushan Yang, Epidemiology.
National Cancer Institute Director John Niederhuber, M.D., described the institute's plans and priorities for the $1.3 billion it will receive over two years from President Obama's stimulus plan and for a 3 percent increase in its baseline budget. He addressed the American Association for Cancer Research 100th Annual Meeting 2009. A text copy is available.
Higher RO1 Grant Payline
Using the budget increase for FY 2009, the payline for RO1 grants will rise from last year's 12th percentile (grant must score in top 12 percent to be funded) to the 16th percentile. Coordinated but separate use of stimulus and budget funds will raise it to the 25th percentile.
The payline for young investigators will rise concurrently.
NCI is planning to fund early stage start-up packages to help young faculty members establish their labs. Physician-scientists and Ph.D.s who are committed to translational research will receive the grants.
Three Signature Initiatives
Niederhuber discussed three central projects: expansion of The Cancer Genome Atlas, establishment of a personalized cancer care platform to better move "from data, to function, to target, to therapy," and start up of a network of Physical Sciences-Oncology Centers to explore new approaches by better connecting physical sciences to cancer biology.
A webcast of speech will be posted around 2 p.m. CDT (after the speech).
Are you caring for a loved one with cancer? Feeling overwhelmed? You're not alone.
When I was a cancer caregiver, it would have been so helpful to have resources to help me and my family through a very difficult time in life. I'm hoping that this blog may now provide you with information and support as you go about your day as a caregiver.
My series on caregivers will reflect the observations of other caregivers who have been part of a similar journey. It's intended to serve as a practical guide and an emotional survival kit to help you take care of yourself while taking care of someone else.
A caregiver has special needs, which often are quite different from those of a patient. As you probably know, caregiving brings a sudden set of new responsibilities that demand an enormous amount of time and energy. While the caregiving experience may provide opportunities for growth with positive experiences, it also can take an emotional and physical toll, at times leaving you frightened, lonely, burdened and drained.
Many people travel from near and far to receive the world-class treatment that M. D. Anderson offers. While this carries distinct medical advantages, the adjustments that are needed can bring unique challenges. There are many new things to learn, including navigating a large and unfamiliar setting; gaining understanding of medical terminology; building trust with a new staff; managing medications, side effects and schedules; keeping the home fires burning from a distance ... well, the list goes on and on.
Over the next several months, we'll cover many topics, including thoughts, feelings and actions that caregivers experience. I'll share with you how others have faced these challenges and the methods they used to help them get through this stressful time. I hope the guidance provided here will strengthen, soothe and energize you -- the caregiver -- a pivotal member of the treatment team.
Watch for my next post, which will address the responsibilities and feelings of caregivers. A bit later, we'll talk about identifying your strengths and ways to take care of yourself.
In the meantime, I'd like to hear about your experiences as a caregiver or questions you may have on the topic. Post your comments and I'll do my best to address them.
Caregiver Support at M. D. Anderson
The American Association for Cancer Research 100th Annual Meeting 2009 officially started this morning. Even so, senior M. D. Anderson researchers were heavily involved Saturday in the customary meeting eve educational sessions.
Saturday's sessions were divided into four general areas - educational programs, methods workshops, basic science-clinical interface sessions and professional advancement.
Xifeng Wu of Epidemiology presented "Use of biomarkers in case-control studies of etiology and prognosis: Functional Assays" in a workshop on development of biomarkers for epidemiological studies.
Chun Li of Experimental Diagnostic Imaging discussed "Multifunctional, multimodality cancer imaging based on biodegradable water-soluble synthetic polymers" at a session on nanotechnology platforms for cancer imaging.
J. Jack Lee of Biostatistics co-chaired two sessions on clinical trials design, one on early phase I trials and discovery and one on late phase trials and validation. In the first session, he presented "Adaptive designs for speeding up drug discovery."
Chris Amos of Epidemiology discussed "Copy number variation and cancer risk" at a workshop on new tools for molecular epidemiology.
Professional Advancement Sessions
Elizabeth Travis, associate vice president of women faculty programs, participated on a panel titled "Principles of negotiations: Building dynamic and reciprocal partnerships in your world," the Fourth Women in Cancer Research Leadership Development Workshop.
James Abbruzzese, chair of Gastrointestinal Medical Oncology, and Mien-Chie Hung, chair of Molecular and Cellular Oncology served as mentors in the 12th Annual Grant Writing Workshop.
Basic Science-Clinical Interface Sessions
Gordon Mills, chair of Systems Biology presented "mTOR pathway components as therapeutic targets: Preclinical and recent clinical experience," in a session on targeting mTOR to inhibit cancer cell growth and cell cycle.
Dihua Yu of Breast Medical Oncology chaired a session on HER-2 targeting therapies, resistance and counteracting strategies.
George Calin of Experimental Therapeutics co-chaired a session on cross-talk between epigenetic modifications and non-coding RNAs in cancer. He also discussed "Non-coding RNA paradigms in medical practice."
Jean-Pierre Issa of Leukemia discussed "In vivo epigenetic modulation after DNA hypomethylation therapy" during a session on epigenetic therapies to overcome resistance.
Exploring the intricacies of T cells, Chen Dong uncovered an unexpected new molecular route in the adaptive immune system. Blocking the path might prevent autoimmune diseases such as rheumatoid arthritis and multiple sclerosis. Following the path could direct a powerful immune response against cancer.
Dong, a professor in M. D. Anderson's Department of Immunology, will be honored by his peers for his role defining this pivotal molecular cascade and his contributions to understanding T cells -- white blood cells that guide adaptive immune system attacks against invading microbes and parasites. The American Association of Immunologists will bestow its AAI-BD Biosciences Investigator Award at Immunology 2009, the AAI's annual meeting May 8-12.
T cells, or T lymphocytes, bind to antigens, an act that converts the T cell to a T helper cell which secretes signaling molecules to launch an appropriate immune response. Normally, T cells are tolerant of their fellow cells, Dong notes. When they decide that self-tissues are the enemy, autoimmune disease results.
In a Nature Immunology paper, Dong and colleagues reported T helper cell 17 (Th 17) produces the inflammatory molecule interleukin-17, which they also showed is the key culprit in autoimmune and inflammatory disease. Before Dong's team and another based in Alabama independently discovered Th 17, scientists believed there were only two types of T helper cells, Th 1 and Th 2.
Connecting the dots between IL-17 and the new Th 17 opened up one of the hottest fields in biological research, presenting a new target for novel drugs. Since then, Dong and colleagues have published a series of articles further defining the Th 17 pathway. Clinical trials for rheumatoid arthritis and psoriasis are under way based on Dong's work. The Nature Immunology paper has been cited more than 540 times by scientists in the field.
Dong's lab also is exploring ways to turn IL-17 autoimmunity against tumors. Early data from mouse model experiments has been encouraging. Dong also directs his department's new Center for Inflammation and Cancer. "The idea is to improve good inflammatory responses against cancer and dampen the chronic 'bad' inflammation associated with many tumors," he notes.
In my role in the Communications Office at M. D. Anderson, I don't often get to see and talk to patients and their families. However, I do have the privilege of speaking with the physicians, nurses and support staff who work on the front lines every day. I love to hear first hand their stories of hope, survival, caring and discovery. The stories are amazing and indicative of what makes M. D. Anderson special.
It all boils down to caring, integrity and discovery. These aren't just words to the 18,000-plus employees and volunteers here at M. D. Anderson. These ideas are the core of our personal value system. If you were to walk through any one of the buildings that make up M. D. Anderson today, you would most likely witness the true caring, undeniable integrity or passionate discovery in action that I see in the halls every day.
Our hope with this blog is to share stories of our core values in action and to open the lines of communication between you and this institution of cancer treatment, research, education and prevention. In other words, this is your chance to learn more about what we do, ask questions, respond to our ideas or let us know what you think. We're open to honest feedback and we'll post and answer every comment that we can.
A type of meditation that originated in Tibet may help alleviate the pain and discomfort of cancer and cancer treatment, allowing some patients to decrease their medication.
Alejandro Chaoul, Ph.D., adjunct assistant professor in the Integrative Medicine Program at M. D. Anderson, teaches Tibetan meditation at M. D. Anderson's Place ... of wellness .
"Medication and meditation aren't an odd couple," he says. "Actually, they go very well together. Often, the more you meditate, the less medication you might need."
Make a connection
The main objective of Tibetan meditation is to connect to the "heart mind," using breathing and vocalization of simple sounds, Chaoul says.
The heart mind is not the restless mind that jumps from thought to thought. It is the calm, centered mind, also called "home."
Goal is to clear the mind
"In Tibetan meditation, body, energy and mind are thought of as the three doors to the main castle that is home," Chaoul says.
As the mind settles, obstacles are swept away, leaving the mind clear. The goal is to bring the clarity achieved through meditation into everyday life.
Read more Feature Stories from Cancerwise
Related articles: Tibetan Meditation Helps Patients Handle Life's Challenges
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- Innovative Surgery Treats Adrenocortical Cancer
- Q&A: Liver-Hanging Surgical Procedure
- Survivorship: a distinct phase of cancer care
- Fertility Preservation in Cervical Cancer
- Be Mindful of The Moment
- New Booklet Answers Questions About Sex and Cancer
- Mehta wins AACR-PANCAN grant for pancreatic cancer research
- 11 from M. D. Anderson earn AACR Scholar-in-Training Awards
- NCI Director outlines plans for increased funding
- Caring for the caregiver
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