By Lana Maciel, MD Anderson Staff Writer
Dennis Parker is a warrior.
Since his first diagnosis of metastatic colon cancer, he's been in a hard-fought, four-year battle with the disease, which made its way through his body, spreading to his liver and lungs. And if that weren't enough, he also developed two cases of superficial skin cancers on his face, both of which were successfully removed through Mohs surgery.
It's an experience that has brought the 59-year-old into MD Anderson as a patient in various departments. And it's one that has left him grateful to the doctors who joined him in each of his battles against cancer.
Parker's long journey began in January 2007, when a biopsy returned positive for colon cancer that had metastasized to his liver. After having a tumor removed, he began chemotherapy treatments at MD Anderson.
"When they did the initial scan and I saw four spots on my liver, I thought I was in bad shape," he says. "I just had this feeling that this was it. I felt lost, and I didn't have a lot of faith that I would make it. But when I came to MD Anderson and they said they could treat it, I was encouraged."
Surgeons removed the entire right lobe of Parker's liver. Then, just when he began to recover, another type of cancer developed, this time in the form of basal cell carcinoma, a likely development from years of sun exposure and unrelated to the metastatic colon cancer.
Because the carcinoma presented a different, more superficial form of cancer, he opted for a different kind of surgery. Under the care of Deborah Mac Farlane, M.D., professor in the Department of Dermatology, Parker had the carcinoma removed from his nose with Mohs micrographic surgery.
A fifth occurrence
Typically, the Mohs procedure is used to treat primary or recurrent basal and squamous cell carcinomas that appear on areas of the body where tissue conservation is especially important. Using a local anesthetic, this highly accurate outpatient procedure ensures that the entire tumor is removed with minimal removal of healthy tissue. And, as in Parker's case, Mohs surgery often leaves little sign of scars.
Told he was cancer-free for the third time, Parker celebrated the beginning of 2008, but a CT scan in February indicated what appeared to be scar tissue on his right lung. On first glance, it was harmless, until a closer look revealed it wasn't scar tissue, but a further spread of cancer -- his fourth cancer occurrence.
"What they initially thought was scar tissue on my right lung started growing," Parker says. "So at that point, they knew it wasn't scar tissue. It was pretty surprising to find out that what we thought was one thing actually turned out to be cancer that spread to my lung."
Parker again had surgery on his lungs, but in 2009, yet another cancer surfaced. When his wife Cindy began noticing that a mole he had on the side of his cheek was getting darker in color, Parker paid another visit to Mac Farlane at the Mohs Unit. Test results confirmed it was an isolated case of melanoma in situ, which he again had removed through Mohs surgery.
"The melanoma had gone pretty deep on my cheek, so they cut out a good-sized area. But I was amazed at just how well it healed," Parker says. "The scar from the Mohs surgery is barely even noticeable."
Conquering 'the beast'
By the spring of 2010, another CT scan revealed that the cancer was growing back on Parker's lungs. As he approaches the four-year mark of his diagnosis in January 2011, the semi-retired resident of Schertz, Texas, hopes to finally win his war against cancer when he undergoes surgery to remove the last of the disease.
"Hopefully once I have the lung surgery, this will be the end of the cancer, and I can declare this beast killed."
Looking back at his lengthy cancer journey, complete with all of its highs and lows, the grandfather of three -- with another on the way -- says he and his wife have learned to appreciate every day as a gift.
"The longer I live, the more inspired I become because I look back at where I was in the beginning and where I am now, and I'm so thankful to be here. At this point, I'm getting better, not worse, and it makes me value life a lot more."
Specialized Treatments in Skin Cancer Therapy
Mohs surgery for more superficial skin cancers ensures maximum preservation of healthy tissue and complete removal of cancerous cells.
MD Anderson resources:
Basal cell carcinoma
Mohs and Dermasurgery Unit
Deborah Mac Farlane, M.D.
Sun Protection: Cancer Trends Progress Report (National Cancer Institute)
Skin cancer facts (American Cancer Society)
December 2010 Archives
By Lana Maciel, MD Anderson Staff Writer
By Lana Maciel, MD Anderson Staff Writer
As the most common type of cancer in the United States, skin cancer will affect an estimated 50% of Americans at least once by the time they reach age 65, according to the National Cancer Institute. It's an alarming statistic, but not terribly surprising, considering the amount of time many Americans might spend exposed and unprotected to the sun's harmful ultraviolet rays.
This overexposure to the sun is often the most common cause of skin cancers, including basal cell carcinoma, squamous cell carcinoma and melanoma. In some cases, patients develop these cancers on exposed areas of the skin where tissue conservation is important, such as on the face.
This can make surgery a scary endeavor for patients who fear the surgery might leave disfiguring scars. Fortunately, through a procedure called Mohs micrographic surgery, surgeons are able to accurately remove the cancerous tissue while leaving healthy tissue intact and reducing the possibility of scarring.
Rather than use a standard surgical procedure that removes tumors and the entire surrounding area, the Mohs procedure maps and tracks the tumor stage by stage, testing 100% of the margins until it is clear. This method ensures maximum preservation of healthy tissue and complete removal of cancerous cells.
The fall issue of Conquest, MD Anderson's external magazine, introduced readers to the Mohs and Dermasurgery Unit, a small but integral part of the institution's Department of Dermatology. Patients in the Mohs Unit receive highly specialized therapy for skin cancers, lesions and sun-damaged skin with a treatment plan that optimizes recovery and overall health.
Read more about this procedure and the Mohs and Dermasurgery Unit, in Conquest.
Patient Finds Hope After Battling Three Forms of Cancer
While battling metastatic colon cancer, Dennis Parker developed two cases of superficial skin cancer on his face, both of which were successfully removed through Mohs surgery, leaving no scars. Read more about Dennis Parker
MD Anderson resources:
MD Anderson Mohs and Dermasurgery Unit
Deborah Mac Farlane, M.D.
Department of Dermatology
Sun Protection: Cancer Trends Progress Report (National Cancer Institute)
Skin cancer facts (American Cancer Society)
By Lana Maciel, MD Anderson Staff Writer
The best forms of healing don't always come in a bottle, a pill or any kind of external medicine. Sometimes, internal healing works best to promote overall health, and, for some people, it can be achieved through the practice of tai chi.
An ancient Chinese martial art, tai chi was first used as a form of self-defense, but research has shown that this practice of meditation can actually be an effective form of medication for cancer patients.
Tai chi is a "moving meditation" in which participants perform a series of slow, graceful motions that often resemble movements in nature. Individuals concentrate on deep breathing and precise posture, which helps to relax the mind and strengthen the body.
Recent studies have indicated that tai chi enhances the immune system and relieves pain, anxiety and stress in cancer patients and survivors. Lorenzo Cohen, Ph.D., professor in the departments of Behavioral Science and General Oncology and director of the Integrative Medicine Program at MD Anderson, says he often recommends tai chi to patients because of its overall health benefits.
"In terms of the evidence that's out there and the scientific literature, practices such as tai chi have been found to help improve patients' quality of life," Cohen says. "There are some studies showing that these types of mind-body practices can also have an impact on physiological functioning, improving aspects of immune function and decreasing stress hormones."
Internal balance for a healthy body
As a form of complementary medicine, tai chi is believed to create a positive energy force by balancing the concepts of yin and yang, the opposing internal forces within the body. This healthy balance aids in the flow of qi (chi), which in ancient Chinese beliefs is a vital energy of the body.
Additional health benefits of tai chi include:
• Improved balance and reduced risk of falls, especially in the elderly
• Improved coordination, flexibility and overall wellness
• Decreased blood pressure
• Decreased pain and stiffness
• Lower risk for depression
Doctors and researchers are continuing to study the effects of tai chi on cancer, including the incorporation of such meditation practices into cancer treatment plans. Cohen is currently conducting an National Cancer Institute-funded study examining the benefits of tai chi incorporated into the treatment plan for people with prostate or rectal/anal cancer undergoing radiation therapy.
MD Anderson resources:
MD Anderson Integrative Medicine Program
Tai Chi (Video)
Tai chi: An introduction (National Center for Complementary and Alternative Medicine)
Office of Cancer Complementary and Alternative Medicine (National Cancer Institute)
Tai chi (American Cancer Society)
MD Anderson now offers some patients with newly diagnosed, early breast cancer a new treatment option at two of its regional care centers.
Accelerated partial breast irradiation (APBI) is available at MD Anderson Regional Care Center in Bay Area and MD Anderson Radiation Treatment Center in Bellaire. Also known as brachytherapy, the technique may be an alternative to the current standard of care, which is four to six weeks of daily external beam radiation after lumpectomy.
APBI directly treats the area in the breast at highest risk for recurrence, while minimizing the dose to the healthy breast tissue. It reduces the number of radiation treatments dramatically, from four to six weeks of daily treatments to approximately five days of
With APBI, the breast surgeon inserts a small tube or balloon-like device into the lumpectomy cavity and inflates it to fill the small, hollowed out area of the breast where the tumor once was. Richard Ehlers, M.D., a breast surgeon who cares for patients at MD Anderson Regional Care Centers in Sugar Land and Katy, says the devices come in a wide variety of shapes and sizes to suit the needs of each patient. He adds that coordination of care between the surgeon, radiation oncologist and patient is vital.
Once the patient recovers from surgery, she will see her radiation oncologist for planning and treatment, which will take eight to 10 days. Elizabeth Bloom, M.D., who brought the technique to MD Anderson Radiation Treatment Center in Bellaire in 2008, says a tube or catheter carries the radioactive pellet or seed into the implanted device in the breast cavity. The seeds are left in place for five to 10 minutes -- about the length of a typical radiation treatment -- and then removed when the patient leaves the center. The patient returns twice a day for treatment for five days.
Matthew Ballo, M.D., a radiation oncologist at MD Anderson Regional Care Center in Bay Area, has been treating women with APBI since August. He says that, while the treatment rapidly is becoming a standard of care, it is not suitable for every patient. Ballo says the best candidate for the technique is a woman more than 50 years old, who has a relatively small tumor and has disease that is confined to the breast.
The facilities in Bellaire and Bay Area participate in research studying recurrence, survival, side effects and how the treatment compares to the traditional form of radiation. MD Anderson's Proton Therapy Center on the main campus also has a new protocol open using proton therapy to deliver partial breast irradiation.
To learn more about APBI, listen to the audio interview on the topic with Ehlers and Bloom. This podcast is one of a large and growing library of educational interviews from MD Anderson that also is available for downloading at no charge on iTunesU.
The two-day event in mid-December was the first of its kind hosted by MD Anderson's Global Academic Programs. The summit was organized to launch the Sister Institution Network Fund (SINF) and the Collexis Research Profiles tool, both intended to accelerate and enable collaborative research between faculty at MD Anderson and the SIs.
Together, the two resources are the newest programs from the Center for Global Oncology and underline the dedication of MD Anderson to energize our network of collaborating institutions to reach beyond meetings, symposiums and conferences, which have been the historic bedrock of SI relationships.
SIs with lengthy affiliations attended the summit, as well as representatives from GAP's newest sister institutions -- Instituto Nacional de Enfermedades Neoplasicas (INEN) of Lima, Peru, and King Hussein Cancer Center of Amman, Jordan -- and possible future sister institution, Barretos Cancer Hospital of Barretos, Brazil.
To Mahmoud Sarhan, M.D., CEO and general director of the King Hussein Cancer Center (KHCC), the summit was an important opportunity to meet with members of MD Anderson and the sister institutions while gaining a better understanding of the changing emphasis of GAP toward one of active research collaboration.
"We (KHCC) have a wonderful cancer treatment program, but there are two areas we hope to improve by working with MD Anderson: our integrative medicine and personalized cancer care." Sarhan adds, "We will definitely be applying to the Sister Institution Network Fund and already have the matching funds to begin research."
Carlos Vallejos, M.D., director of Peru's INEN, also expressed his enthusiasm for participating in the SI network and promised to bring his center's strength in clinical trials to the group. Vallejos went on to convey his desire to collaborate on research involving understudied U.S. cancers that are also important public health problems in Peru.
Many at the summit echoed similar objectives, although most recognized the infancy of the program and the inevitable unforeseen kinks to work through over the next year as the SINF assesses and supports its first research programs.
"We are planning on funding at least 10 research projects in the first year," explains Oliver Bogler, Ph.D., vice president for Global Academic Programs. "But if we receive additional high quality applications, we will try to fund more."
Perhaps the most productive portion of the summit occurred in the closing hour when John Mendelsohn, M.D., president of MD Anderson, and Raymond DuBois, M.D., Ph.D., provost and executive vice president, joined Bogler and the summit participants for wrap-up discussions focused on the big picture.
By Will Fitzgerald, MD Anderson Staff Writer
With the season of giving already upon us, a Haitian boy, who was trapped beneath his home's rubble following last January's earthquake, may have received the most important gift of all from MD Anderson's Proton Therapy Center.
Karim Apollon, 8, was on the second story of his home when the fateful earthquake hit. The shock caused the floor to disintegrate, destroying the Apollon family home and sending young Karim into a twisted pile of debris. After being rescued hours later, he was airlifted to Miami for emergency treatment.
Physicians quickly ordered CT scans, which revealed a skull fracture and a larger, more unusual mass inside Karim's brain. At the time, this mass was thought to be a blood clot, resulting from serious head trauma. After recuperating for three months, Karim was excited to return home.
It wasn't long until a sudden phone call changed everything. Just when a sliver of normalcy began to return to Karim's world, physicians from Miami called with serious concern and asked that Karim return immediately for an MRI. The mass in Karim's brain was not a blood clot, rather a pineal germ cell tumor, a cancer located in the middle of his brain. Karim would need surgery, followed by chemotherapy and radiation.
The news was heartbreaking. Karim's mother, Tania, recalls telling her son what would have to be done. Karim, an energetic and effervescent youngster, responded as those who know him best might say he would. He shrugged his shoulders and said, "No problem."
Doctors in Miami performed the surgery, where Karim also underwent chemotherapy. His physicians then recommended proton therapy, a highly advanced form of treatment that deposits radiation with such precision that it spares surrounding tissue. For young patients, proton therapy is especially effective because its accuracy greatly limits radiation exposure, an important factor for developing bodies. Tania chose MD Anderson after learning about its successful track record of administering proton therapy, especially to children with cancer.
For five weeks, Karim dazzled his therapists and doctors with his witty charm and funny stories, as well as his fancy footwork, often breakdancing or moonwalking into Gantry Room 3. In between daily proton therapy treatments, he found time to attend his first concert and a Houston Texans football game, and said when he returns to Haiti he wants to ride a motorcycle.
On Dec. 20, surrounded by his family and MD Anderson staff, Karim rang the celebratory gong signaling his 25th and last proton therapy session. With a wide smile, he ended a heroic journey that ironically began with an event that could have ended his life, not saved it.
Karim will return home with a good prognosis and just in time to celebrate the holidays. He said he can't wait to hug his brother.
People with higher levels of folate in their red blood cells were more likely to have two cancer-preventing genes shut down by methylation -- a chemical off switch for genes, researchers report this week in the December issue of Cancer Prevention Research.
DNA hypermethylation, notes co-author Jean-Pierre Issa, M.D., professor in MD Anderson's Department of Leukemia, is found in a variety of cancers and diseases of aging. Methyl groups attach to genes, protruding like tags, preventing gene expression.
"Our new finding is that having high levels of folate in the blood as observed in a sensitive measure of red blood cell (RBC) folate is related to higher levels of DNA methylation," Issa says.
Folate is a natural B vitamin that plays a role in DNA creation, repair and function, as well as red blood cell production. Pregnant women who have a folate deficiency are at elevated risk of having a child with neural tube defects, which occur when the spinal cord or brain fail to fully close.
Folate's found in leafy vegetables, fruits, dried beans and peas. Since 1998 its synthetic version, folic acid, has been added to breads, cereals, flours, pastas, rice and other grain products under order from the U.S. Food and Drug Administration, reducing the rate of neural tube defects in the United States.
The recommended daily requirement is 400 micrograms for adult men and women from a balanced diet and an additional 400 for women capable of becoming pregnant. Folate also is taken as a dietary supplement.
Folate's effect on cancer, once thought to be mainly preventive, has become less clear in recent years, with scientists finding cancer-promoting aspects of folate intake in colorectal and other cancers.
The research team analyzed the association between folate blood levels and dietary and lifestyle factors on DNA methylation in normal colorectal tissue. They enrolled 781 patients from a parent clinical trial that compared folate to aspirin in the prevention of precancerous colorectal polyps.
The genes, ERα and SFRP1, are expressed in normal colorectal tissue but silenced by methylation in colon cancer. They also have been found to be methylated in breast, prostate and lung tumors.
Age was strongly associated with increased methylation -- a finding that confirmed longstanding research. Neither folate nor aspirin treatment had a significant effect. However, RBC folate was associated with methylation of both genes with significant differences emerging between the top quarter of patients with the highest RBC folate count and the bottom quarter with the lowest. RBC folate levels closely reflect long-term folate intake.
"These differences were not trivial. They were the equivalent of 10 years of extra aging for those with high RBC folate counts," Issa says.
"Today, it's worrisome that taking extra folate over the long term might lead to more DNA methylation, which then might lead to extra diseases including potentially an increased chance of developing cancer and other diseases of aging," Issa says.
By Lynn Waldmann, L.C.S.W., and Carmella Wygant, L.C.S.W., Department of Social Work
H. A. L. T.
Hungry, Angry, Lonely and Tired. Now, there's a combination for combustion! The holiday season can sometimes be an especially hard time for people with cancer and these four holiday Scrooges can make it even more stressful. So, to avoid that disturbing concoction, here are some simple suggestions:
- Try to keep a daily goal of sitting down for three healthful meals. What is a healthful meal? Non-processed foods, whole grains, fruits and vegetables, and protein.
- This month can have us out of the house running more errands than normal. Carry a snack if you will be out for more than three hours. Fruit or a can of V8 is an easy and healthful option.
- Remember to take time to taste the food. Make eating a pleasurable moment no matter what it is you're eating. Cook, if you like to cook, or ask others to cook and make suggestions for the menu.
- Lower your expectations of those around you, realizing that we are all human and have our limitations. It's amazing how quickly the joy factor will rise.
- Make the choice to enjoy your holidays and encourage your friends and family to enjoy them with you. Your loved ones know your cancer is there. They are thinking about it just like you. The secret is to make the choice to enjoy the season in spite of the cancer.
- Share all of the feelings, even the tough ones. Tears, laughter and touch can be powerful gifts during the season. And remember, when tears come, they do stop.
- Celebrate the joy of the holidays. Cancer changes things in everyone's life. If necessary, create new traditions. And remember to put loved ones first.
- Friends and family often want to help but so seldom know how. Use your voice and ask specific people for specific ways they can help.
- Remember to line up AT LEAST three or four people as your holiday buddies. People who you enjoy that can be your "go-to" people when you're feeling isolated. While their schedules are most likely busier this time of the year, if you know there are several people on your buddy list, you're not likely to be disappointed if someone cannot be in touch. In addition, you can enjoy reconnecting with others when making these "outreach" calls.
- Help someone else during the holidays. Some easy, low-stress ways to do this are: Send a card. Tell someone that you love them. Thank friends for the good times. Tell a joke. Sing a song.
- Rest up and sit down WHENEVER you can. With cancer, energy conservation takes on a whole new meaning.
- When out running errands, let friends and family drop you off at the door. Skip the busy stores and shop online or ask others to shop for you. Sometimes the process of making homemade gifts can be a stress reliever in itself. Or instead of gift giving, is there some other way to show someone you care during the holidays?
- When out in stores shopping, use the motorized carts if they're available; it can benefit everyone with you.
- Plan to leave the house after you have been resting. Also, stay on schedule and return home when planned, even if you're having a wonderful time. Just the excitement of the day and riding in the car can burn more calories than we realize. If you get too tired, it may deplete your energy source not just for the day, but the next few days as well.
Remember the best things in life are free, so keep it simple and enjoy your holidays. The Department of Social Work at MD Anderson is here to help patients, families and friends cope with their disease no matter what season it is.
If you are feeling stressed out, talk to one of our licensed, master's-trained social work counselors. You can contact the Department of Social Work at 713-792-6195.
We all give gifts and remembrances at holiday time because we want to share the spirit of giving and caring.
This time of year, the MD Anderson Blood Bank is asking for a very personal gift, one that doesn't cost anything but is so vital to the lives of hundreds of MD Anderson patients.
The need for blood or platelets remains tremendous every day at MD Anderson, regardless of the holidays. Each day, patients require about 150 units of red blood cells and 500 units of platelets; MD Anderson is the largest blood transfusion center in the nation. A donation of either blood or platelets can keep patients' blood counts on track so they can continue lifesaving treatment, recover from stem cell transplants or have innovative surgery.
MD Anderson's Blood Bank on Holly Hall near Almeda, about a mile south of the Texas Medical Center, offers free parking in front of the building, easy access and a comfortable location to give blood or platelets. It's open Monday through Friday, from 10 a.m. - 7 p.m., or weekends from 10 a.m. - 5 p.m. The last appointment for platelet donation is one hour before closing. There also is a donation center that is open during the week on second floor of MD Anderson's Mays Ambulatory Clinic Building at 1220 Holcombe.
Please call 713/792-7777 to make an appointment to donate platelets or ask questions about giving blood or sponsoring a blood drive. You need not call to schedule an appointment for blood donation, but one is recommended for platelet donation because it can take up to two hours. Please click on the link above for directions, eligibility requirements, donating in the name of a patient and other information.
A donation of blood or platelets can touch the lives of three MD Anderson patients.
By: William Fitzgerald, MD Anderson Staff Writer
MD Anderson faculty members are known for their commitment to education, but some have recently made their way into a special Houston classroom full of sixth-graders. It's their way of giving back to the community and sharing their knowledge housed inside the nation's largest cancer center.
On Tuesday evenings for the last 10 weeks, Jennifer Litton, M.D., assistant professor in the Department of Breast Medical Oncology, cruises over to Jane Long Middle School in Sharpstown, a suburb of Houston, to teach a group of 20 students about genetics and the importance of education.
Her volunteer efforts are through Citizen Schools, a nationwide program that mobilizes at-risk communities and schools by placing local professionals in classrooms after the standard school day ends. From 4:00 to 5:30 p.m., students have extended time to learn new concepts and develop new skills, which pave the way toward future success.
Working with members of MD Anderson's Clinical Genetics Program, Litton and colleagues designed a genetics apprenticeship. The program teaches kids about DNA through interactive methods, such as using Twizzlers and Gummi Bears to build a genetic model. In addition, students learned about tracking family disease and how genes translate to specific characteristics.
The students are excelling, learning things they never imagined and dreaming of careers once thought unattainable. Of course, every class has a test, right? The test for this group, and their new-found wealth of knowledge, is a presentation called Citywide. Last evening, the students joined other Citizen School apprenticeships from across Houston in the areas of science, technology, engineering and math (STEM), to present their genetics project.
For Litton, and the team from MD Anderson, the end goal is to inspire kids and change lives.
"We have so many resources at MD Anderson, including some of the best research and collaboration, and I think we have so much to offer these kids," Litton says.
For any patient or family faced with a cancer diagnosis, daily activities or interactions that were once routine and taken for granted can become monumental gifts. For Aidan Immroth, art was his gift. It was a gift that got him through years of cancer treatment, and it was a gift he shared with thousands through his artistic creations.
Aidan was diagnosed with brain cancer as a toddler. Despite several relapses over the years, he didn't let cancer define him. Aidan was an active student in the Pediatric Education and Creative Arts Program at MD Anderson Children's Cancer Hospital and contributed several designs featured on Children's Art Project gift items. He even founded his own organization, Angels in Disguise Are Always Near (AIDAAN.org), which helps pediatric cancer patients cope with waiting at the hospital by providing iPods loaded with customized playlists.
In 2009, Aidan met Ian Cion through a summer art collaboration with Children's Cancer Hospital patients called Collidescapes. When Cion returned to the Children's Cancer Hospital in 2010 to launch their Arts in Medicine Program, Aidan was one of his first students. The two began meeting regularly during Aidan's hospital visits, and elephants soon became a focus for the young man's drawings.
"We were able to celebrate Aidan's passion for art through the Children's Art Project and through Ian and the Arts In Medicine Program. They allowed our family to focus on positive activities versus a singular focus on battling cancer," says Aidan's mother, Hallie Immroth.
When Aidan heard of another MD Anderson patient who had painted a design on her own horse, he and Cion discussed the possibility of painting a live elephant. Cion was sharing Aidan's desire with a group of patients when a nurse, overhearing the conversation, said she knew of a person who might be able to help make Aidan's dream a reality. Soon she provided Cion with the phone number of elephant owner and trainer Bill Swain.
On the day of painting, Aidan was joined by his parents, brother, grandparents, cousins, aunt, uncles and friends, who came together from around the country to assist Aidan with painting his masterpiece.
"It was amazing how everyone just knew what to do. I wasn't even aware of all the little things that were done to help until after the painting was done," Hallie recalls. "For instance, we had brought about 60 pounds of carrots and apples, and someone was there feeding Krissy the elephant and keeping her happy while we painted."
For 13-year-old Aidan, it was a momentous event that he wanted to go off without a hitch. He even visited the Houston Zoo a couple of times to study their elephants and get a feel for the texture of their skin.
"I knew they had wrinkly skin with a rough texture, but I didn't anticipate how large their wrinkles are," Aidan said. "We had to make sure we got lots of paint in the cracks between the wrinkles. Krissy was amazing through it all."
For Aidan and his family, the entire day was a wish fulfilled.
"Not only was it neat to be able to do it with my family and to do any project with your family, but it wasn't like you were scrapbooking, you were painting an elephant. That's something you're never going to get to do again," Aidan said. "It was really cool to be able to have that experience and to be able to include so many people I love and who are meaningful in my life."
A month after he painted the elephant, Aidan passed away on Nov. 19 surrounded by his family at home. His art lives on through the memories he left his family and friends and the many designs he contributed through the Arts In Medicine Program and the Children's Art Project.
by Laura Nathan-Garner, MD Anderson Staff Writer
Lose weight. Exercise more. Quit smoking. Many of us want to make healthy changes like these in the New Year.
But by mid-January, many of us have returned to our old ways. That's because most of us try to make a change before we're really ready.
Everyone moves through five stages before making a successful behavior change. Here's the good news: If you know you need to make a change, you've already gone through the first stage. And, knowing what stage you're in -- and how to move forward -- may help make this the year you succeed.
Find tips for making successful New Year's resolutions in this month's issue of Focused on Health.
You'll get expert tips to help you make healthy changes, like quitting smoking, that reduce your risk of cancer and other diseases. You'll also learn which alcoholic drinks -- and serving sizes -- to avoid and get recipes for festive alternatives to alcohol that you can serve at your next gathering. And you'll find some important reminders from our most-read stories of 2010, so you can ring in a healthier 2011.
For more tips on how to enjoy a healthier holiday season, follow us on Twitter and join our conversations on Facebook.
Much-anticipated and highly-disappointing results were presented today at the 33rd Annual CTRC-AACR San Antonio Breast Cancer Symposium. In an international trial of 3,360 women, the bone-building drug Zometa failed to prevent breast cancer recurrence and found no disease-free survival benefit among the majority of women with stage II/III disease.
Zometa did offer benefit to one subset of women: in those who were five years or more post-menopausal, there was a 29% improvement in overall survival.
Bisphosphonates' role in the treatment of breast cancer has been an active area of research focus, as previous clinical trials had shown that the class of drugs may have anti-cancer activity.
Sharon Giordano, M.D., associate professor in MD Anderson's Department of Breast Medical Oncology, was a commentator on today's press program where the findings were presented. In this video she shares her perspective.
After a long and successful career in broadcast journalism in
Houston, North Texas and Oklahoma, Judy Overton joined MD Anderson in
2008 as a senior communications specialist. Her husband, Tom, was treated
at MD Anderson for renal cancer. He died in April 2007. Judy's
occasional posts will cover aspects of the cancer experience from the
Read more posts in this series
On our first visit to MD Anderson, Tom stayed busy signing what seemed like an endless number of consent forms. There was one for pharmacy, another for X-rays and still another to diagnose and treat, with no promise for success.
After those were done, we maneuvered our way through a number of doctor, scan and X-ray appointments. One of them was with a clinical specialist, where we learned that removing a kidney brings a good chance of survival.
Good news there.
We then saw Tom's oncologist, Eric Jonasch, M.D., a soft-spoken man, who described the possible course of action: Interleukin-2 (IL2). It's an immunotherapy, FDA approved and normally prescribed for melanoma patients. "Avastin," Jonasch added, "promises to be a viable drug for renal cell carcinoma. Unfortunately, it's not yet FDA approved for this type of cancer."
"A final strategy will be announced a week from today once all the results are analyzed." We then moved on to the litany of tests and scans.
At some point later in the afternoon, I left Tom so I could tend to some personal business.
This was a mistake.
Several hours later, I'm comfortably at home and Tom hasn't returned yet from MD Anderson. Even though we had cell phones, I wasn't able to reach him. He apparently was involved with a scan or test and wasn't able to communicate outside the hospital.
By the time I finally reached him, he was exceptionally frustrated. Tom said it would be well after 10:00 p.m. before he was through for the evening. He was expected back at MD Anderson the next day around 7:00 a.m. Since we live almost an hour away from the Texas Medical Center, I told him I would call long-time friends, Lisa and Alan, to see if he could stay overnight with them. They were glad to take him in.
As luck would have it, the results were going to be released when I was scheduled to be out of town on a consulting job, but Tom and I agreed we would be better off financially if I continued with the assignment.
So, his sister Joy and her husband accompanied him to hear the results. The appointment was scheduled for 11:00 a.m. As soon as I had a break in my schedule, I contacted Joy by cell phone. What in the world did people do before this technology? The tension and anticipation of the unknown was bad enough, but to not find out for hours must have been excruciating.
Joy shared the news, which wasn't exactly surprising, but still unsettling. Jonasch confirmed Tom had clear cell renal carcinoma. There apparently are 32,000 cases of renal cancer diagnosed per year in the United States. Eighty percent are clear cell carcinoma, stage IV and very aggressive. Joy jotted down in the journal, "D-Day Plan."
Currently, it's a lung metastases only, the doctor told them. So, Tom will receive a high dose of IL2 therapy, which will be administered by the melanoma group. The response rate is about 20%, Jonasch said. He added, "It's not a desperate situation. We have the luxury of time."
So what did that mean? How long did Tom really have?
Truthfully, the only time we seriously faced his possible demise was almost two winters later on the eve of his second back surgery, which was also the eve of his 53rd birthday.
Collapsing in each others' arms, we sobbed at the thought that Tom might not be physically present when our sons got married or when our grandchildren were born.
But we allowed this to happen for only a special, fleeting moment in time, only one short moment. No rest for the weary. We had a battle on our hands.
As cozy as it looks, the scene pictured here is one that oncologists prefer to break up. The purple cells are chronic lymphocytic leukemia cells and they are being nourished by the green cell, appropriately called a nurse-like cell.
Jan Burger, M.D., assistant professor in Leukemia at MD Anderson, discovered nurse-like cells as a post-doctoral fellow. Now he, graduate student Julia Hoellenriegel and colleagues have shown that an experimental drug called CAL-101 interferes with this connection and also directly attacks the abnormal B cells that cause CLL.
(B cells are white blood cells that fight infection. CLL is the most common form of leukemia.)
The drug works by jamming chemical signals -- chemokines and cytokines -- produced by B cells, including those that communicate with nurse-like cells. The nurse-like cells are part of CLL's microenvironment -- external factors that support cancer and need to be suppressed. In this case, external signaling is transmitted by PI3Kδ, part of a signaling pathway often involved in cancer development, and the drug's target.
CAL-101, developed by Calistoga Pharmaceuticals, also kills malignant cells by forcing them to commit suicide -- a process called apoptosis.
"We've identified a central mechanism of action of this drug," Burger says. "It blocks B cell antigen receptor signaling and BCR-derived survival signals."
Hoellenriegel presented their findings at the 52nd American Society of Hematology Meeting in Orlando Sunday evening. Only involved in this field for a year, Hoellenriegel held her own in a room full of CLL experts.
In a series of lab experiments, the researchers found that the drug reduced CLL cell viability and steeply cut the production of a number of important chemokines. They then treated CLL cell cultures with either CAL-101, the chemotherapy drug bendamustine, or a combination of both. By itself, CA-101 produced a 20% reduction in cells compared to untreated controls. Bendamustine alone cut the cells by 30%. Together, they pushed the cell count down by more than 40%.
Separately, plasma samples from 14 patients treated with the drug also showed sharp reductions in cytokine levels. For example, one of these, CCL3, fell from 186 picograms per milliliter to 29 pg/mL 28 days after treatment.
Burger is co-principal investigator on a soon-to-open Phase II study at MD Anderson of CAL-101 and rituximab in elderly patients with no previous treatment. "We will further explore the drug's activity in CLL patients," Burger says.
Today MD Anderson President John Mendelsohn, M.D., announced his plans to return to a role in clinical and translational research once a new president is recruited and in place.
"I've had the best job imaginable, working with amazing faculty, administrators and all employees, along with our many volunteers and supporters in the community. I am grateful for the opportunity I've had to serve as their leader at MD Anderson," says Mendelsohn, who has been president for nearly 15 years. "So much has been accomplished, but much more remains to be done. I am confident MD Anderson will continue to lead that worldwide effort."
He will stay on as a member of the MD Anderson faculty and as co-director of the new Institute for Personalized Cancer Therapy (IPCT) with Gordon Mills, M.D., Ph.D., who chairs the Department of Systems Biology. The IPCT is designed to bring together laboratory researchers, clinicians and investigators from many disciplines to test cancer therapies that target the abnormal genes and gene products detected in each individual patient's cancer.
"Helping to launch the IPCT builds on my career experiences in developing the field of targeted cancer treatment," Mendelsohn says. "This position will allow me to continue to work at MD Anderson with people I admire, doing things for which I have great passion."
When Mendelsohn joined MD Anderson in 1996, he came with an international reputation for his research on how the binding of growth factor receptors on the surface of cells regulates cell functions. Upon his arrival, his focus quickly shifted from laboratory research and clinical trials to the intricacies of leading an intuition that now employs nearly 18,000 people and serves 100,000 patients yearly.
But the numbers don't begin to describe what has developed at MD Anderson under Mendelsohn's leadership. During his tenure MD Anderson has:
• Expanded clinical care activities by opening the Lowry and Peggy Mays Clinic, the Faculty Center, the T. Boone Pickens Academic Tower, Proton Therapy Center and a 320-bed expansion of the Alkek Hospital.
• Created the Duncan Family Institute for Cancer Prevention and Risk Assessment
• Increased the cancer center's operating budget, private philanthropy and earned more competitive research grant dollars from NCI than any other U.S. cancer center or university.
• Built a world-wide collaborative network of more than 20 sister institutions, and opened clinical programs bearing the MD Anderson name across greater Houston, in Orlando, Madrid, Istanbul, Albuquerque and soon in Phoenix.
See a full list of accomplishments
"John Mendelsohn is the epitome of a visionary leader. Not only did he lead The University of Texas MD Anderson Cancer Center to be the nation's -- and arguably the world's -- greatest cancer center, he also brought out the best in the entire MD Anderson community. That is why patients, their families and all those whose paths cross MD Anderson will always be grateful to John Mendelsohn. He is an inspiration to The University of Texas System, and we are fortunate that he will continue to make cancer history," says UT System Chancellor Fransisco Cigarroa, M.D.
Hodgkin's lymphoma is one of the more curable cancers. About 75% of patients are cured by initial therapy.
However, for those failed by chemotherapy, there is no standard therapy. New drugs moving through clinical trials at MD Anderson appear to provide an answer for resistant or relapsed Hodgkin's lymphoma.
Two MD Anderson patients and two oncologists from the Department of Lymphoma/Myeloma talk about the latest developments at Patient Power
Breakthroughs in Lymphoma from Patient Power® on Vimeo.
Follow Dr. Younes on Twitter
Targeted therapy for chronic myeloid leukemia is one of the great success stories of cancer treatment.
CML is driven by an abnormal chromosome that creates a hybrid gene called bcr-abl that produces a protein which causes and fuels the disease. This abnormality is called the Philadelphia chromosome because it was discovered by scientists in that city.
Only half of CML patients survived to the five-year mark. Imatinib, known as Gleevec, changed all of that. Scientists at the Oregon Health Sciences University discovered the drug's effect on CML and worked with Novartis, the drug's owner, to develop Gleevec. Clinical trials were conducted largely at MD Anderson.
The result: 90% of patients survive to five years. However, some patients have their disease grow resistant to the drug. And for those with a mutation called T315I, the drug does not work. This held true for second-generation drugs -- nilotinib (Tasigna) from Novartis and dasatinib (Sprycel) from Bristol-Myers Squibb.
A new, experimental drug called ponatinib appears to hit all versions of CML. Jorge Cortes, M.D., professor in the Department of Leukemia at MD Anderson, presented Phase I results Monday morning at the American Society of Hematology Annual Meeting in Orlando.
Developed by ARIAD Pharmaceuticals, ponatinib cleared CML cells from the blood in 30 of 32 patients in the chronic, early stage of the disease. All 11 chronic phase patients with T315I had that hematological response. Eight had complete cytogenetic response, which means absence of malignant cells in the bone marrow.
"Ponatinib seems to be filling the gap we had for patients who right now have no good treatments left," Cortes says. "We are very encouraged by such strong results in the Phase I setting and have begun a pivotal Phase II clinical trial."
For more detail on results please see the abstract
American Society of Hematology 2010 Meeting and Expo
Recent results, just published last week in the Journal of the National Cancer Institute, indicate that treatment with the selective COX-2 inhibitor celecoxib resulted in a 62% reduction in non-melanoma skin cancers, the most common cancers.
After adjusting for age, sex, Fitzpatrick skin type, history of actinic keratosis at randomization, non-melanoma skin cancer history and patient time on study, the number of non-melanoma skin cancers was lower in the celecoxib arm than in the placebo arm (RR = 0.41, 95% CI = 0.23 to 0.72, P = .002) as were the number of basal cell carcinomas (RR = 0.40, 95% CI = 0.18 to 0.93, P = .032) and squamous cell carcinomas (RR = 0.42, 95% CI = 0.19 to 0.93, P = .032).
Importantly, there was no significant difference between the number and extent of cardiovascular side effects between the placebo and treated group. This is an interesting study and offers some hope for the development of a chemopreventive approach for non-melanoma skin cancer.
The reduction in skin cancer incidence in this study was much greater than that seen with the use of sunscreen. One of the investigators (Pentland) had already shown that COX-2 appears to play a role in sunlight-induced skin cancers.
We have known for a couple of decades that non-steroidal, anti-inflammatory drugs (like aspirin and other NSAIDs) reduce the risk for colorectal cancer and possibly other cancers. Recent evidence supports the reduction in risk for colorectal cancer in long-term NSAID users as well.
Celecoxib is a drug that is widely used for treatment of symptoms associated with arthritis and has been studied extensively in several pre-clinical cancer models. It is effective in reducing tumor burden.
Results from this recent skin study are exciting and I wonder if it means that future sunscreen lotions could be developed that might contain COX-2 inhibitors?
By: Mary Brolley, MD Anderson Staff Writer
He had no symptoms. But he fit the profile.
Jerry Reidy of Aurora, Colo., went in for a routine cholesterol check in late summer 2008. When the results came back, his family doctor gave him a call.
"He said it looked like I was anemic, but he wanted to do more tests."
After the tests -- again with suspicious results -- the doctor sent Reidy to an oncologist, who did a bone marrow biopsy. The biopsy indicated that Reidy had myelodysplastic syndrome, one of a diverse collection of blood disorders formerly called pre-leukemia.
MDS diagnoses increasing
Myelodysplastic syndromes share a single, defining trait: the bone marrow is damaged and doesn't produce enough blood cells. Incidence of this condition is on the rise, perhaps due to physicians' growing awareness of the disease and improved diagnostic procedures.
The National Hematologic Diseases Information Service estimates that 7,000 to 12,000 people, mostly older adults, develop MDS every year. In about 30% of cases, MDS turns into leukemia. Even when it doesn't, the syndromes pose serious threats to health.
To worry or not to worry?
"At first I wasn't too worried," Reidy says. "I didn't have any symptoms, so I thought it was like being anemic. Then I started reading about it. I thought, 'This is kind of serious.'
I asked my local oncologist what we should do about it. He said we'd wait and watch, and do transfusions if and when I needed them. But I wasn't comfortable with that."
Reidy's brother was aware of MD Anderson, one of the largest referral centers for MDS in the United States. Reidy soon had an appointment with Guillermo Garcia-Manero, M.D., professor and chief of the Section of Myelodysplastic Syndromes in the Department of Leukemia.
Clinical trial offers hope
"At my first appointment, Dr. Manero showed me the tables that said I had about 22 months to live. But then he said, 'There's a protocol I think you should try. It could extend your life by five years.'"
"I'm not as dumb as I look. I said, 'I'll try that.' "
He went home, got some clothes, then came back and lived in an apartment in Houston for a two-month treatment process. His wife and family visited him as often as they could.
He had a combination of injections and a liquid form of Vidaza®,a hypomethylating agent.
Hypomethylating agents cause rapidly dividing cells to die while leaving non-proliferating cells alone. These agents and others, like lenalidomide, are among the most promising drugs available to treat MDS.
Other options, risks
Another option for certain patients is a stem cell transplant, a treatment in which chemotherapy is followed by the replacement of blood-forming cells from a matched donor. For more information on these therapies, see the link to the related story below.
Garcia-Manero says the typical patient diagnosed with MDS is an older male with exposure to chemicals. Cancer survivors treated with chemotherapy or radiation are also at risk.
Smoking seems to increase the risk of developing the disease.
Reidy's history tracks well with this description. "I smoked for 20 years, though I quit 40 years ago," he says. "And because I ran a metal refinishing business, I had my hands in lacquer thinners for 40 years."
'The poster boy for MDS'
Over the months of treatment in the Leukemia Center, Reidy developed a friendly rivalry with an MDS patient from Arkansas.
"I met him in the waiting room. He was shooting off his mouth," Reidy jokes. "I told him I would be the poster boy for beating MDS."
"This guy said 'no,' he would be. We went back and forth."
"So I made a big poster of me playing in a softball tournament. The headline said, "Ha, ha, take that, MDS!'"
Because he's still in the Phase I clinical trial, Reidy returns to MD Anderson monthly for tests and a visit with Garcia-Manero and his staff. If his blood levels are acceptable, he then goes home to begin another cycle of taking Vidaza® in pill form for seven days, then is off for 21 days.
His side effects have been mild -- a sporadic rash and occasional constipation or diarrhea after taking the pills -- and he hasn't needed a transfusion since diagnosis.
Wiry and energetic, Reidy still works in the family metal refinishing business, plays softball frequently and exercises with a trainer twice a week. He is grateful that the clinical trial is going so well.
"The last time I went in for a check-up, Dr. Manero looked at my chart and said, 'How are you feeling?'
"Then he looked at me and said, 'Why do I ask? You look like a million bucks.'"
Q&A: Focus on Myelodysplastic Syndromes
A growing incidence of myelodysplastic syndromes, mostly in older adults, has sent researchers and clinicians scrambling for answers to the biology and treatment of this group of serious blood disorders.
MD Anderson resources:
Treatment advances in myelodysplastic syndromes (Leukemia Insights)
Leukemia Center at MD Anderson
Guillermo Garcia-Manero, M.D.
Myelodysplastic syndromes treatment (ACS)
Is it cancer, or a precursor to cancer?
A growing incidence of myelodysplastic syndromes (MDS), mostly in older adults, has sent researchers and clinicians scrambling for answers to the biology and treatment of this group of serious blood disorders.
Guillermo Garcia-Manero, M.D., professor and chief of the Section of Myelodysplastic Syndromes in MD Anderson's Department of Leukemia, answers questions about MDS. Also see the related story on Jerry Reidy, an MDS patient enrolled in a Phase I clinical trial.
What is MDS?
It's a very complex group of hematological disorders characterized by progressive peripheral blood cytopenias, conditions in which there's a lower than normal number of blood cells. There's an eventual need for transfusion and a tendency for it to transform into acute myelogenous leukemia (AML).
A fraction of patients have a "smoldering" course that resembles more the clinical history of other bone marrow failure syndromes, whereas other patients' symptoms are more like those of AML. We're starting to understand the molecular basis of the disease; recent data indicates that different mutations occur in a small subset of patients. This adds significant complexity to the known karyotypic -- chromosomal characteristics -- of these patients' disease.
What are the symptoms of MDS?
There are no specific symptoms. Most patients are diagnosed incidentally when having a routine blood analysis. In early cases, symptoms may include anything from fatigue and decreased physical resistance to evidence of bleeding or even transformation to leukemia (fever, infections, weight loss) in more advanced cases.
How is it diagnosed?
Initially, a complete blood count will point towards the diagnosis. This should be confirmed by a bone marrow aspiration and biopsy. The diagnosis is still morphological -- made by studying the form or shape of the organisms. There are no molecular markers for the disease diagnosis. Cytogenetic (chromosomal) analysis is needed for prognosis and may also help when morphological diagnosis is ambiguous.
Are some people at higher risk for this disease? If so, who?
Yes, older males have a significantly higher tendency to develop this disease. There's also a clear association between prior exposures to chemicals and MDS. Patients treated with chemotherapy or radiation therapy are also at risk for MDS. In this setting, we refer to these cases as "therapy-related." Overall prognosis is poor for this subset. There are also some associations between smoking and MDS.
What are the main treatments for MDS?
It depends on the risk level of the patient. Usually patients are divided into a lower-risk group and a higher-risk one. Options for lower-risk patients include observation, growth factor support and lenalidomide or hypomethylating agents (which help the bone marrow function more normally). For those at high risk, patients can be treated with hypomethylating agents, intensive chemotherapy or allogeneic stem cell transplantation (from a related or matched donor). Recently, a Phase III study has shown improvement in survival with a hypomethylating agent compared to other interventions. In my opinion, all MDS patients should be treated in a clinical trial.
What factors might affect a patient's prognosis and/or treatment options?
Age, comorbidities (the presence of more than one disorder or health condition, such as diabetes or heart problems) and presence of cytogenetic (chromosomal) alterations are fundamental when assessing patients with MDS. I think over the next few months we're going to start seeing results of some large molecular studies performed at several centers, including MD Anderson. The clinical data together with the models mentioned earlier allow us to personalize therapy for patients with MDS.
What research is being conducted at MD Anderson in regard to this disease?
This is an important area of research in the Department of Leukemia. Our clinic is probably the largest referral center for patients with MDS in the United States, maybe worldwide. We have clinical trials for nearly every possible clinical situation a patient with MDS might experience.
We also have a program in allogeneic (from a related or matched donor) stem cell transplantation with our colleagues in the Department of Stem Cell Transplantation and Cellular Therapy. At the basic and translational level, we have active programs in the study of epigenetic alterations of this disease -- something that affects a cell without directly affecting its DNA -- and drug development. Also, we have active collaborations with other centers performing large-scale genetic analyses. My laboratory is now focused on the analysis of innate immune responses in patients with MDS.
MDS Patient 'Looks Like a Million Bucks'
Jerry Reidy of Aurora, Colorado, went in for a routine cholesterol check in late summer 2008. When the results came back, his family doctor gave him a call. Read more about Jerry Reidy and MDS
MD Anderson resources:
Treatment advances in myelodysplastic syndromes (Leukemia Insights)
Leukemia Center at MD Anderson
Myelodysplastic syndromes treatment (ACS)
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