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March 2011 Archives

Cancer of the ear and temporal bone are rare. They also can be difficult to diagnose and challenging to treat. Yet, progress is being made in discovering what drives these diseases and how to approach them more successfully.

Paul Gidley, M.D., associate professor in the departments of Head and Neck Surgery and Neurosurgery at MD Anderson, answers questions about ear and temporal bone cancers. (See related story on ear cancer patient Scott Goodman.)

What are ear and temporal bone cancers?
Cancers of the ear usually begin as skin cancers on the outer ear, ear canal or skin around the outer ear. The most common types are squamous cell carcinoma and basal cell carcinoma. If they are neglected, they may grow into the:

  • Ear canal
  • Middle ear
  • Mastoid or deep into the temporal bone, which houses the ear canal
  • Facial nerve
  • Organs for hearing and balance

bike.jpgFor Scott Goodman, halfway is never enough. His intensity bursts through into everything he does -- his way of speaking, his job, his love of life and family -- even his exercise regimen.

So, when he was diagnosed with squamous cell cancer of the ear canal, Goodman knew he wanted his treatment to be as aggressive as possible.

Squamous cell cancer that begins inside the ear is extremely rare. So rare, in fact, that it's not clear how many cases occur each year. However, Paul Gidley, M.D., associate professor in MD Anderson's departments of Head and Neck Surgery and Neurosurgery, estimates that only some 300 cases are diagnosed every year in the United States.

By Lana Maciel, MD Anderson Staff Writer

soy.jpgSoy milk, tofu and edamame are just a few of the many soy-rich foods touted for helping individuals reduce cholesterol levels and minimize risk of heart disease. But is soy just as beneficial for fighting cancer?

A recent study indicates that it is, but the question of whether tofu and other soy-rich foods can combat tumor growth has yet to be definitively answered.

The effects of soy have been known to produce both positive and negative results in breast cancer patients, particularly because of the chemical makeup of isoflavones in soy. These isoflavones are similar to estrogen in structure. As they bind to estrogen receptors, they can either stimulate or inhibit estrogen-related tissue development, including breast tumors.

By Michelle Moore, Staff Writer

Bill Steele, of Baton Rouge, La., walked 300 miles in 17 days with one mission: to show his son Will Steele, 34, who has cancer, how much he loves him and understands his pain.

"I walked from Baton Rouge to MD Anderson Cancer Center in Houston to inspire my son to take the treatments he needs for his cancer," Bill says.



Around this time last year, Will Steele received a diagnosis of desmoplastic small-round-cell tumor (DSRCT). DSRCT is a form of sarcoma that involves an aggressive and rare, fast-growing tumor. Will is receiving treatment at MD Anderson and this week is set to undergo a 12-hour debulking surgery.

Institutional Review Board (IRB) Is Here to Protect You
By Francois Pouliot, M.D,  PhD., assistant professor, Department of Anesthesiology and Critical Care, MD Anderson

lab1.jpgIf you are a patient at MD Anderson Cancer Center, you might have been invited to be part of a research project. By research we mean a systematic investigation designed to develop or contribute to generalizable knowledge.

As a participant you may be asked to take a new drug, be part of a cognitive intervention to change your behavior, or simply authorize the analysis of blood specimens and medical information.

By Val Marshall

Val Marshall's cancer journey began in May of 2009 when her son Addison was diagnosed with acute lymphocytic leukemia. A visit to the family doctor for what they thought was a simple high school football injury turned out to be so much more.


Inspired by her son's strength and hope, Val strives to be a voice to help connect other parents on this journey.

Addison Marshall Crush Cancer



valmarshalll.jpgLast week I had the privilege of visiting our country's capitol in the role of advocate for pediatric cancer awareness.

As the lone representative from Texas, I had the pleasure of meeting with the health care aides for Sen. Kay Bailey Hutchison and Sen. John Cornyn. I also met personally with Rep. Michael McCaul and Rep. Ron Paul.

A day of training from CureSearch and Children's Oncology Group (COG) prepared us for our day on Capitol Hill. Riding the bus felt like the first day of junior high as everyone rushed to meet with the "popular kids," and the campus police and X-ray machines kept us in line.

I went with the mission of increasing awareness of our medical orphans, the "only" 13,500 children who are diagnosed each year.

On March 16, faculty and staff of MD Anderson and Instituto Nacional de Enfermedades Neoplásicas (INEN), as well as representatives of the government of Peru, met in Lima to formally sign a sister institution (SI) agreement.

Administered by MD Anderson's Global Academic Programs (GAP), SI agreements are a concrete expression of MD Anderson's belief that an institution is a valuable partner in the fight against cancer, as well as a willingness to engage collaboratively to further the aims of helping patients and eradicating cancer. In INEN's case, the development of this partnership has been nearly four decades in the making.

INEN-Dubois-and-Vallejos-252x260 (2).JPG

When talking to major players in cancer care, especially leukemia, there is a name routinely referenced. For baseball fans it would be akin to speaking of Mantle, Ruth or DiMaggio, or to the physics crowd similar to discussing Planck, Feynman or Einstein. 

It takes a few discussions with prominent researchers before one realizes there are certain individuals who have had a comparable impact on the world of oncology. An impact, which throughout the remaining story of man will silently ripple, often imperceptible to those who would learn or benefit from it.

What brings together 100 graduate students, head of the Science and Technology Section for the European Union, science attachés from embassies including the United States', speakers from Massachusetts General Hospital and the École Polytechnique Fédérale de Lausanne, and senior industry leaders from Nestlé and MSD Pharmaceuticals to discuss research, cultural exchange and nascent business plans in biomedical science? The annual symposium of the University of Tokyo's Global Center of Excellence (COE) Center for Medical Systems Innovation (CMSI), that's what.

Global COEs are five-year programs awarded to top Japanese universities by the Japanese Ministry of Education, Culture, Sports, Science and Technology. Similar to U.S. Program Project Grants (PO1s) and Specialized Programs of Research Excellence (SPOREs), the COEs bring together cross-disciplinary research teams to tackle important problems in public health.

Students from MD Anderson's Pediatric Education and Creative Arts Program recently visited the Houston Livestock Show and Rodeo on an educational field trip. One student, Jessica Weller, wrote an essay recapping the day.



On March 10, a group of us from the Children's Cancer Hospital school went on a field trip to the Houston Livestock Show and Rodeo. When we arrived there it was chilly, but luckily the building was not very far to walk to.

When we got inside, we went to the adventure area and looked at all the animals like cows, pigs, sheep, longhorns and chickens. This was right down my alley because I really like livestock and animals in general. We even saw a video of a calf being born. I would never want to be a cow because it sure did look like it hurt!

Gottumukkala S. Raju, M.D., professor in the Department of Gastroenterology, Hepatology and Nutrition at MD Anderson, set aside time to address some misconceptions and answer questions about colonoscopy screening. He reviewed a number of questions from MD Anderson's Facebook fans and recorded six video responses.

The questions

Lynda Ebanks Harrison said, "I know intellectually the why of how important this is, but how do you help the patient not have the "I'd rather stick needles in my eyes than let someone do that to me" kind of fear? And what about the new non-invasive procedure that was recently announced -- is that widely available and comparably priced?"




colonprep.jpgAnticipation. You've been there at some point in your life. As an expectant mother, I worried about labor pains.

The day before my second marathon, I asked myself, "Why am I doing this?" when I heard weather reports about possible thunderstorms.

So here I am the day before my first colonoscopy. Friends and colleagues readily offer their chagrin about the disgusting flavor of the solution offered in the bowel preparation, the necessary step preceding the procedure.

By Winston Huh, M.D., assistant professor, Department of Pediatrics, MD Anderson

child life.jpgI truly believe that cancer is a family diagnosis that not only is physically disruptive, but also exacts a heavy mental and emotional toll for all involved. As families try to adjust their lives and schedules, the rest of the world seems to continue at a frenetic pace. Things such as school work and important social activities can get lost in the shuffle of clinic appointments, radiology scans and hospital admissions.

Thus, the treatment of cancer is much more than simply giving chemotherapy or administering radiation therapy. What good is my therapy if a patient missed so much school that he or she had to drop out? As a pediatric oncologist my goal is to not only cure my patients, but to also do what I can to help the patient and family reintegrate back into life.

By Ritsuko Komaki, M.D.

ritsuko.jpgAs I sat in my sister's house in Nagoya, Japan, last Saturday, I was flooded with déjà vu.  

There was enough hardship with the earthquake and tsunami, but fears about the nuclear power plant touched my early life -- Hiroshima, Nagasaki.

I'm a professor of radiation oncology at The University of Texas MD Anderson Cancer Center because radiation has always been part of my story. I've used it to heal, but I've also experienced its destructive powers. And I prayed never to see its devastation again.

In fact, I never dreamed I would be sitting with family watching in horror the first explosion at the Fukushima Dai-ichi nuclear complex in Okumamachi, northeastern Japan.

On Thursday, March 10, I'd left Houston for Tokyo, where I was to give a talk to radiation oncologists, surgeons and neurosurgeons about a specific kind of radiation for early lung cancer. But ten minutes outside Narita Airport, we were informed that there had been an earthquake, and the airport was closed.

Read the full story here

lucydad.jpgAs an employee in the Communications office at MD Anderson, I spend the majority of my time reading and learning about others' experiences with cancer.

Since March is Colon Cancer Awareness Month, I have been tirelessly researching colon cancer facts and prevention methods.

Last night as I was having dinner with my family I learned my grandmother had colon cancer and her son, my father who is over 50 (sorry dad), has never had a colonoscopy.

"How could you not do this?" I asked, completely shocked and outraged at this information. "How could someone with a history of this devastating disease not get routine checkups?" My mother admitted that she has bugged him on many occasions to get it done. But he, like many people, never visits a doctor unless his arm is falling off.

nicole.jpgASBMT 2011 showcases best treatments and practices, encourages transparency
By Nicole Rosipal, R.N., M.S.N., C.P.N.P.

Close your eyes and imagine the setting - temperatures in the low 80s, clear blue skies and sparkling water.

But I wasn't in Honolulu for the beautiful beaches.

With 2,400 other professionals, I'd come to attend the 2011 Blood and Marrow Transplantation Tandem Meetings last month.

Nurses, physicians, pharmacists, nurse practitioners, physician assistants, statisticians and other health care professionals gathered to learn how to best and most creatively care for our patients.

The first day's focus was on ways to better predict which patients are at risk for developing complications of transplant such as graft-versus-host disease. We also discussed ways to predict who'll have a better response to treatment.

Bradford.jpgBy Leslie Schover, Ph.D., and Andrea Bradford, Ph.D.

According to a recent report from the Livestrong Foundation, 46% of cancer survivors have experienced a problem with their sexual function. Sound familiar? A survey at M D Anderson also found that 49% of men filling out the questionnaire had developed erectile problems since their cancer treatment and 45% of women had a loss of desire for sex and/or pain with sex.

Unfortunately, sexual health is not always "on the radar" in oncology health care, even at MD Anderson. But times are changing. As the number of cancer survivors in the United States approaches 12 million, their long-term health concerns are being recognized.Two clinical psychologists at MD Anderson are launching a series of posts on Cancerwise to share news, tips and important information about sexual health for cancer survivors.

music.jpgBy Alex De Alvarado, Michael Richardson, M.T.-B.C., Ingrid Sevy, M.A., M.T.-B.C., Richard Lee, M.D., and Lorenzo Cohen, Ph.D.

For many people, music connects them to their emotions and is often a way to be socially connected. That is why music can be an effective form of therapy for people with cancer.

The use of music as a therapeutic tool in health and medicine dates back to ancient times.  In modern Western medicine, music therapy started being formally used in the 1950s and is now often incorporated into conventional medical care. Music therapy is a key therapeutic tool used within most integrative medicine programs at large cancer centers around the nation.

When used in conjunction with conventional cancer treatments, music therapy has been found to help reduce pain and discomfort; improve mood and diminish stress; increase quality of life; and allow patients to better communicate their fears, sadness or other feelings.

A type of drug that blocks the binding of cancer-promoting proteins may be suitable for treatment-resistant non-small cell lung cancer (NSCLC), especially if a specific growth factor is activated, according to a case study published today in the Clinical Therapeutics section of The New England Journal of Medicine.

article.jpg

The article, written by a team of researchers while they were fellows at The University of Texas MD Anderson Cancer Center, outlines the available data about use of these drugs, known as oral tyrosine kinase inhibitors, in the treatment of lung cancer patients. 

It is based on the case of a 64-year-old woman with Stage I adenocarcinoma (cancer) of the lung who had a right upper lobectomy, or surgical removal of part of her lung. She had never smoked. A year after treatment, the cancer had spread to the bone and liver. Although she then was treated with carboplatin, paclitaxel and bevacizumab, more bone metastases were found six weeks later.

"NSCLC is a deadly disease that is incurable once it has metastasized," said Don Gibbons, M.D., Ph.D., assistant professor in the Departments of Thoracic/Head and Neck Medical Oncology, and Molecular and Cellular Oncology at MD Anderson. "New approaches like erlotinib and gefitinib have proven benefit in a subset of patients, even with widely metastatic disease, and frequently these are less toxic than cytotoxic chemotherapy."

Erlotinib and gefitinib, known commercially as Tarceva and Iressa, are tyrosine kinase inhibitors, which block the binding of epidermal growth factor (EGF) with the epidermal growth factor receptor (EGFR) to stop cancer growth.

Co-authors were first author Vince D. Cataldo, M.D., Louisiana State University Health Sciences Center; Roman Perez-Soler, M.D., Albert Einstein College of Medicine; and Alfonso Quintas-Cardama, M.D., assistant professor, Department of Leukemia, MD Anderson Cancer Center.

Agents block growth factor binding

According to the American Cancer Society, lung cancer is the leading cause of cancer-related death in the United States, and each year it accounts for more than 157,000 deaths. About 90% of lung cancers are NSCLC. Even with new drugs, such as bevacizumab, the median five-year survival rate is 3.5%.

The dismal outlook for NSCLC has prompted researchers to look for new treatment approaches, including some - like erlotinib and gefitinib - that act on the epidermal growth factor receptor, which is activated in more than half of patients with NSCLC. This is the same protein targeted by the monoclonal antibody cetuximab, that was developed under the pioneering leadership of MD Anderson Cancer Center President John Mendelsohn, M.D.

Binding of epidermal growth factor (EGF) and other EGF-like growth factors to their receptors triggers cancer-promoting  processes such as cell proliferation, protection from cell death, activation of new blood vessel formation and development of metastasis.

Research shows success in certain patients

In clinical trials, these agents have shown some success in NSCLC. Research suggests they may be as effective as standard chemotherapy for second- or third-line treatment in patients with advanced NSCLC. As first-line therapy, tyrosine kinase inhibitors appear to be less effective than standard chemotherapy in general but more effective for some patients, especially those with activating EGFR mutations. Some initial clinical trials have shown that women, patients of East Asian descent, patients who have never smoked and patients with adenocarcinomas who received erlotinib or gefitinib had higher rates of response and overall survival.

Because EGFR tyrosine kinase inhibitors are expensive and have shown relatively low response rates overall, a method is needed to identify the specific patient group that will benefit from them. EGFR mutational status is the most reliable predictor of response and benefit now. However, assessment of all patients with advanced NSCLC and subsequent treatment with an EGFR tyrosine kinase inhibitor for those with EGFR mutations has not shown to have an overall positive effect on survival. However, if a patient is known to have an EGFR mutation, therapy with an EGFR tyrosine kinase inhibitor is advisable.

Erlotinib is recommended in this case

Gibbons says their review of data suggests EGFR tyrosine kinase inhibitors should be considered in this case. Since erlotinib has been shown to be beneficial as second-line therapy in unselected patients, treatment without assessment of the EGFR mutational status is acceptable. Restaging studies should be conducted before therapy begins and six to eight weeks after to evaluate response. Therapy should continue until the cancer progresses.


genetics.jpgIf you suspect that cancer "runs in your family," you may be curious about -- or even considering -- genetic testing.

This testing, which involves having a blood sample taken, can reveal DNA mutations that have been identified as causing certain types of cancer.

For some, the tests provide crucial knowledge. Those who test positive for a known cancer-causing mutation can address the risks head on with increased vigilance and screenings.

But testing is not for everyone, says Banu Arun, M.D., professor in the Department of Breast Medical Oncology and co-director of the Clinical Cancer Genetics Program at MD Anderson.

"Most cancers are not hereditary," she says. "For example, only about 10% of breast cancers are inherited. The rest are "sporadic" -- that is, they occur because of a confluence of factors."

arun.jpgThat's why Arun suggests that before deciding to be tested, you consult a genetic counselor.

Counselors help assess the chances that a person will develop a disease such as cancer. Often, the first step in the process is making a family tree, then looking for such "red flags" as having had many relatives who:

  • contracted cancer before age 50
  • contracted more than one primary cancer, or
  • had the same or a related cancer (for example, breast and ovarian).

She recommends that women who've been diagnosed with breast cancer and suspect it's hereditary get tested before beginning treatment.

"The results might indicate the risk of contralateral breast cancer (second new primary in the opposite breast) and help with surgical decision making, for example, considering bilateral mastectomy," she says.

"Also, new targeted drugs are in development that specifically target hereditary (BRCA-related) breast cancer, and patients might be eligible for these studies."

Read more about genetic testing in the Winter issue of Network.


By Zak Rajput, medical student, MD Anderson Summer Research Program

We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win...

It was nearly 50 years ago that President John F. Kennedy, speaking at nearby Rice Stadium, delivered this historic speech. In it, Kennedy framed the challenge of reaching the moon as a test of the human spirit. Today, his words are as applicable as ever, as we undertake one of the greatest challenges of our generation: the campaign to Make Cancer History. And, echoing the sentiments of his statement, the next wave of future researchers, physicians, and health care professionals are heeding the call to action by investing their time and efforts in cancer research.

Every summer, MD Anderson hosts students ranging from high school through medical school, providing them with firsthand biomedical research experience in the basic or clinical sciences as it relates to cancer.

The majority of this time is spent doing actual hands-on work, ranging from in DNA and protein studies to statistical analysis of chemotherapy outcomes in patients. These experiences provide students with a clear knowledge of what it means to be a biomedical researcher, as well as an understanding of the discipline required.

As a second-year medical student, I had the opportunity to work in the Department of Urologic Oncology last summer, investigating the surgical outcomes of patients with upper urinary tract cancer. I was joined by students from across the country, each with his or her own unique interest in various specialties of cancer medicine.

As a result of our work, many of us have published journal articles and presented our findings at national conferences. Most importantly, by having the opportunity to make a small contribution to the body of cancer science early in our careers, we are more prepared and more motivated than ever to face the unknown challenges in cancer prevention and treatment that await us and our future patients.

By Katrina Burton, MD Anderson Staff Writer

Preparing health scientists and clinicians for leadership roles as research investigators in cancer prevention and control is the number one priority of MD Anderson's Cancer Prevention Research Training Program.

Established almost 20 years ago, the training program follows a comprehensive educational module that captures the trainees' area of specialization and introduces them to other disciplines targeting cancer prevention. Funded by the National Institutes of Health (NIH), the program offers fellowship positions for graduate research assistants, predoctoral and postdoctoral trainees.

"The training program provides opportunities for fellows to launch their careers in externally funded, peer-reviewed research," says Carrie Cameron, Ph.D., instructor and associate director of the training program. "The curriculum offered expands the perspective of the trainees by moving them from their base of strength to training in additional disciplines focused on cancer prevention."



Last summer, with additional funding from the American Recovery and Reinvestment Act       (ARRA), the training program offered new opportunities to undergraduates interested in research careers in cancer prevention.

The Student Research Experiences program allowed students to spend the summer working at MD Anderson. They had access to a research environment that offered extensive epidemiologic, laboratory and clinical facilities. Students were introduced to research in molecular and genetic epidemiology, behavioral science, clinical cancer prevention, health disparities and other prevention-related disciplines.

The additional funding from ARRA has provided opportunities to undergraduates majoring in a variety of disciplines to tailor their careers toward cancer prevention," Cameron says.

A key component of the training program is pairing trainees with mentors -- established faculty members who are considered experts in the trainees' fields of interest. "The relationship between trainees and their mentors is an invaluable and unique part of the program," says Denae King, Ph.D., adjunct associate professor in the Department of Health Disparities Research and mentor for the training program.



King served as mentor to Dee Jordan, an undergraduate selected for the Student Research Experience program. Jordan's research focus on medical geography -- the integration of hardware, software and data for capturing, managing, analyzing and displaying geographically referenced information -- helped her compile and analyze data for a community research project for Galena Park, Texas, residents at an increased cancer risk because of environmental toxins.



Ensuring the medical community is equipped with well-trained experts who can lead the efforts in cancer prevention and control requires continued funding and philanthropic support. The Student Research Experiences summer program is one example of how additional funding is paving the way for future prevention leaders.

Follow the link for more information about the Cancer Prevention Research Training Program or the Center for Research on Minority Health.

By Pamela Schlembach, M.D., MD Anderson Regional Care Center in The Woodlands

She was the proverbial needle in a haystack, but what a find she was.

Breast cancer.jpgLast October, at the Susan G. Komen Race for the Cure in Houston - an annual event that attracts more than 35,000 participants - I met a breast cancer survivor who I will never forget.  


Though I did not treat her or know her before the race, we are connected in so many ways. We met by sheer coincidence but neither Jimmie Sue, the survivor, nor I took the encounter as a fluke.

Here's what happened: After the Houston Race for the Cure, as thousands of runners and walkers cooled down, a survivor randomly asked me to take a photo of her with her family as they celebrated her life after breast cancer. We exchanged pleasantries and then I found out that she was treated at MD Anderson in 1977 for breast cancer.

She told me that she was under the care of Dr. Eleanor Montague, one of MD Anderson's great radiation oncologists, now retired. Not only was Dr. Montague a great physician and accomplished researcher, but she was a true advocate for her patients, breast conservation and someone I work to emulate in my own practice at The Woodlands.

I told Jimmie Sue that, as a radiation oncology resident, I received the Eleanor Montague Distinguished Resident Award from the American Association of Women Radiologists and had interviewed Dr. Montague for a special report on her career. We shared many stories and memories about this remarkable woman.

Jimmie Sue told me that she had been a part of the groundbreaking clinical trial on lumpectomy vs. mastectomy. This was a trial that led to a new standard of care in breast cancer and as a result, millions of women today with early stage breast cancer do not have to lose a breast when they are diagnosed with breast cancer. I thanked Jimmie Sue for having the courage to participate in that trial and how she made a difference for so many patients.
 
As we were saying goodbye, Jimmie Sue and her daughter both mentioned how wonderful and amazing it was that we just happened to meet in a sea of pink that morning. They smiled and said perhaps it was a divine appointment for us all. Perhaps, indeed.

I think a lot about the encounter, about Jimmie Sue and the thousands of women like her who have participated in clinical trials so we can advance our knowledge of breast cancer and other cancers. We owe these ladies a great deal of gratitude and respect for their willingness to consider future generations and ask what they can do to help end this disease through research advancements.

You just never know who you are going to meet and how your paths may cross. Keep your eyes and heart open for such an experience.

By Michelle Patroni, paralegal at Console & Hollawell in Mt. Laurel, N.J.

MichellePatroni.jpgThe curtain opened and in walked the emergency room doctor, nurse and nursing supervisor.

I could tell the news wasn't good.

"You have probable, or possible, uterine leiomyosarcoma," the doctor said.

Then he cautioned, "Don't research this on the Internet."

But the Internet would soon become a tool that helped maintain my sanity.  

The medical team said that my emergency CT scan had revealed a giant (34 cm x 28 cm) uterine mass that had traveled to my lungs.

According to the grim team in front of me, uterine leiomyosarcoma (ULMS) is rare, occurring in less than 1% of the population, and I had less than a 15% chance of survival.

These were terrifying statistics, especially because I didn't feel sick.


Test after test, and a faulty diagnosis
I'd gone to the hospital because of a swollen ankle that had developed and worsened during a long drive from New Jersey to Florida.

Becoming increasingly alarmed, I had looked for remedies along the way at a pharmacy and a hospital off Interstate 95. The pharmacist recommended a diuretic and ibuprofin. The hospital physician ordered blood tests, then concluded I was constipated.

Somehow I managed to make it home, but I knew something was terribly wrong. I went to my family doctor and he ordered blood work and referred me to a cardiologist. The cardiologist did some tests and said, "You have to get to the hospital now. You need a CT scan."  

After I was told I probably had ULMS, I was admitted to the hospital and over the next few days underwent more tests, including a lung biopsy.  

During this time, my sister Kim flew in from Houston.  

When she arrived, we talked through the night and I said to her, "Please promise you'll look after Ryan." The thought of leaving my 28-year-old son was heartbreaking.

The following morning, I was discharged from the hospital, but not before my attending doctor came in with the results of my biopsy: metastatic leiomyosarcoma, stage IV.   

He said, "You have two weeks to get this removed, or it's going to your kidneys next."   

Kim looked at me and said, "You're coming with me to Houston, to MD Anderson."


Finding encouragement, hope online
So off we went. While I waited for my appointment, I spent hours on the Internet researching ULMS.

I learned that it's a deadly and aggressive uterine cancer, and the most effective treatment is surgical removal. If caught early, chances of survival are better.

But my disease was stage IV and my tumor was gigantic.
 
Still, I continued to search for stage IV ULMS survivors. I eventually found and joined an online group of survivors. I read every post. And I began to hope for the first time.

More hope would come from the MD Anderson doctors at my first appointment.

After taking my history, one delivered unbelievable news.

 "We don't think you have cancer," he said. "We believe you have a benign, metastatic myoma."

He said that when the pathologist had examined my original tissue, it didn't meet the criteria for ULMS.

I was told that my treatment would include another CT scan, followed by a hormone blocker.

The CT scan revealed no further metastases, so I began taking the hormone blocker. Then I waited nervously for signs it was working. Within two weeks, I had a steady flow of urine and my ankle swelling had all but disappeared. 

I later learned I had been weeks away from needing dialysis. 

A year has passed since my original diagnosis, and my tumor has shrunk by almost 40%.  Through the worst of it, what sustained me were the stories of women who'd survived ULMS. 

Although I learned I didn't have ULMS, my best source of comfort in those first awful weeks came from reading the stories of other cancer survivors. Hearing of others' experiences encouraged me to seek the best care available. 

I hope my story encourages others and shows that doctors are not infallible.

They should keep hoping, reaching out and searching for the best care -- and for their own Hollywood ending.


By Winston Huh, MD., assistant professor, Department of Pediatrics Patient Care, MD Anderson Cancer Center

dr.huh.jpgAs the treatment of childhood cancer, there has been a growing research interest in the area of cancer survivorship. While many childhood cancer survivors lead normal, healthy lives, we are realizing that other survivors are encountering new problems, like obesity.
 
Research studies have found that certain groups of childhood leukemia and brain tumor survivors are at increased risk of becoming obese. The causes? Well, the answers are not entirely clear and are likely due to several factors, like family genetics, history of radiation treatment to the brain and spine, and diet. While we may not be able to do anything about our family genetic makeup, we can do something to improve our nutrition. 

However, simply changing our diet and eating habits is not necessarily an easy task. We know that changes in taste are a side effect from some chemotherapy medicines, and some children are just picky eaters. Also, when you factor in today's world of mega-advertising for fast food with super-sized portions, it is easy to see why some families get frustrated when trying to eat healthy.

The Children's Cancer Hospital at MD Anderson recently started the ON to Life Program.
The ON to Life Program is a new multidisciplinary program staffed by physicians, registered clinical dietitians, and behavioral health professionals. The goals of the program are to research the role of nutrition in determining outcomes in various childhood cancers, evaluate diet and other health-related behaviors in patients and childhood cancer survivors, and provide an interactive resource to families designed to improve nutrition and promote a healthy lifestyle. The multidisciplinary nature integrating both laboratory and clinical research with patient education truly makes this program unique.

One project that I have taken a personal interest in is the development of a virtual cookbook.
  
The idea behind the virtual cookbook is to have an online repository of recipes that are nutritious, easy to prepare (I love the recipes from the gourmet magazines, but who has time to track down things like Vietnamese cinnamon or fresh Muscovy duck breast), and of course delicious. 

The plan is to collect recipes from families and various culinary experts in Houston. What a wonderful way to foster a relationship with our local community and patient families. Houston has an ethnic and culinary repertoire that is as diverse as any city in the nation.  And who better to know what recipes work than our patient families? I find the potential of the virtual cookbook quite exciting, and it's one of the projects that help make the ON to Life Program truly unique in the nation.  

Here are more details about the ON to Life Program, and look for the virtual cookbook. Bon appétit!

Resources:

Obesity and Outcome in Pediatric Acute Lymphoblastic Leukemia

Longitudinal Changes in Obesity and Body Mass Index Among Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report From the Childhood Cancer Survivor Study



It's a simple fact that bears repeating this Colorectal Cancer Awareness Month: Colorectal cancer screening saves lives. If found early, these diseases, which include colon, rectal and anal cancer, often can be treated successfully.

While traditional colonoscopy has been the method of choice for decades, virtual colonoscopy (VC), also called CT colonography, is a relatively new alternative that offers a less-invasive option for some people.

vining.jpgDavid Vining, M.D., professor in the Department of Diagnostic Radiology at MD Anderson, who invented the procedure in 1993, answers questions about virtual colonoscopy.

What exactly is VC? How is it performed?

In virtual colonoscopy, a CT (computed tomography) scanner is used to examine the abdomen and pelvis. Then the images are analyzed with sophisticated two- and three-dimensional viewing techniques.

We can literally fly inside the computer-generated model of a patient's colon, looking for polyps (growths on the wall of the colon) that are the precursors to cancer.

The process has four steps:

  • Cleansing the bowel with laxatives the day before the procedure
  •  Inserting a small tube into the rectum to inflate the colon with carbon dioxide gas; room air may also be used, but it makes the procedure less comfortable
  • CT scanning of the abdomen and pelvis, which takes less than 10 seconds
  • Image analysis using specialized computers

What are some of the advantages of VC compared to traditional colonoscopy?


No sedation is required for VC, and that is a huge advantage. Another plus is that we can look beyond lesions that might be obstructing the colon or examine a tortuous colon (a longer than normal colon that may become twisted or coiled).

Since VC is less invasive, the risk of bleeding and tearing of the colon is significantly less.

What are some of the disadvantages and criticisms of VC?

The main disadvantage is that, while VC screens for precancerous polyps and cancers, they cannot be removed during the exam. So a follow-up colonoscopy might be required. Some physicians discourage VC on those grounds, saying, "If you get a VC and a polyp is found, you will have to have a colonoscopy. So why not have a colonoscopy in the first place?"

That is partly true, but only 20% of people have significant lesions that warrant biopsy or removal. So, if we screen everyone with colonoscopy, 80% will undergo colonoscopy -- with its inherent risks of bowel perforation and the need for anesthesia -- unnecessarily.

Since the CT scan covers all the organs in the abdomen and pelvis, VC often can detect disease outside the colon. Significant lesions of this type are found in about 10% of cases. This can be a blessing and a curse due to the potential for unnecessary workups of benign lesions. Rather than discarding VC, I think we need better practice management guidelines on what to do with these findings outside the colon.

Another criticism has been that the process gives the patient a low dose of radiation. However, most VCs use ultra-low dose techniques with an extremely small radiation risk.

Who might be a candidate for virtual colonoscopy?


I think average-risk asymptomatic adults age 50 and older should consider VC. It's a good idea to discuss the alternatives with your doctor.

How common is the technology?


Even though VC is endorsed by the American Cancer Society and other national groups, its adoption has been slow for several reasons including:
  • limited insurance coverage,
  • few well-trained providers and 
  • the public's general reluctance to comply with colon cancer screening recommendations
However, as insurance coverage increases, availability should follow.

The best VC exams generally are performed at large academic medical centers. It's a matter of the volume of cases a facility performs and the radiologist's experience in performing and interpreting VC examinations. The technology is available at most medical centers, but the devil is in the details in how to conduct the examinations.

What should people look for in choosing a facility?


Ask how many cases the facility has performed and the radiologist has interpreted. The American College of Radiology and the American Gastroenterological Association recommend that physicians who interpret VC exams have done at least 75, but I suggest that the more the better.

What types of research is MD Anderson doing?


Since bowel preparation is the largest barrier to most people seeking colon cancer screening, my research involves the development of new bowel cleansing approaches. These include solutions to dissolve feces and remove it from below without the need to drink the usual cleansing agents.

MD Anderson resources:

MD Anderson Colorectal Screening Guidelines

Additional resources:
American Cancer Society
American College of Radiology
American College of Gastroenterology


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