Cancerwise | Cancer blog from M. D. Anderson Cancer Center

Why a Section of Integrated Ethics in Cancer Care?

2010-03-18T17:36:00Z

By François Pouliot, Ph.D., M.D., assistant professor and clinical ethicist, Department of Critical Care

Because M. D. Anderson strives to be the premier cancer center in the world, so too does it endeavor to be the premier leader in cancer ethics. What was known as the Clinical Ethics Service has a new name that fits with its new comprehensive mission: the Section of Integrated Ethics in Cancer Care.

The new program, partially inspired by the U.S. Department of Veterans Affairs' National Center for Ethics in Health Care program, improves the quality of ethics services in cancer care by targeting four areas of ethics through these core activities:

Ethics Consultation
Our clinical ethicists address ethical questions that arise when there's lack of clarity as to what's the right action to proceed with, or when there's disagreement about what's best for a patient. They help patients, families and health care teams identify and resolve specific ethical issues so that individuals responsible for decisions can make good choices.

Organizational Ethics
Integrated Ethics calls on leaders to clarify through their words and actions the priority of ethics, to communicate clear expectations for ethical practices, to practice ethical decision-making and to support their facility's ethics program.

Specific improvement interventions in activities of preventive ethics may include decision support, evaluating organizational performance with respect to ethical practices, and developing policies and protocols that promote ethical practices.

Ethics Education
To support the study of ethics, the section offers a variety of academic opportunities, some providing CME and CEU credits. Areas of study include difficult case reviews, bi-annual Ethics Institutional Grand Rounds and a Psycho-Social Journal Club.

Ethics Research
The faculty of Integrated Ethics is actively conducting research in collaboration with internal and external researchers to advance the field of clinical ethics in cancer care and in the general field of bioethics.

Requests for general information, policy clarification, document review and ethical analysis of a question of an organizational nature or pertaining to research ethics also are part of our activities.

Our faculty also is available to researchers interested in the publication of scientific research, veracity and integrity of research data, animal management and conflict of interest issues.

For pilots at sea or on the inland waterways of cancer care -- patients, relatives or M. D. Anderson employees -- the Section of Integrated Ethics' goal is to aid their navigation.

National Clinical Trial Takes New Approach to Breast Cancer

2010-03-17T13:34:33Z

A major new Phase II clinical trial for women with high-risk, rapidly growing breast cancers will help scientists quickly and efficiently test promising new drugs against the disease.

The Biomarkers Consortium, a public-private alliance that includes the U.S. Food and Drug Administration, the National Institutes of Health and major pharmaceutical companies, announced the start of the I-SPY 2 trial at a news conference this morning at NIH headquarters in Bethesda, Md. The project is led by the Foundation for the National Institutes of Health.

M. D. Anderson will be one of the first of 20 national clinical trial sites to open. The trial combines personalized medicine with an innovative adaptive randomization approach designed to match each woman's tumor with the drug most likely to control her disease.

Study participants will be randomized depending on their biomarker profile - specific biological aspects of their tumors, overexpression of the HER2 protein, for example ¬- and on the basis of the outcomes of treatment for patients with similar profiles. Outcome is pathological complete response, absence of disease, assessed at the time of surgery after receiving chemotherapy.

All study patients will receive either standard presurgical chemotherapy or the standard plus one of many study drugs under development. They will be monitored with a series of MRIs before surgery, which will help indicate whether eventual pathologic complete response is likely.

As the trial progresses, drugs will be dropped from consideration and others will be added. A drug that is working for patients who have a particular biomarker profile will be more likely to be assigned to future patients who have that profile. By the same token, the probability of future assignment decreases for drugs that are not helping patients. This approach allows drugs to more swiftly graduate to Phase III trials or to be dropped from the study.

The study is described in detail by this article in Clinical Pharmacology and Therapeutics, a Nature Publishing Group publication.

I-SPY 2 was designed by Donald Berry, Ph.D., professor and head of M. D. Anderson's Division of Quantitative Sciences, and by Laura Esserman, M.D., professor and director of the Carol Franc Buck Breast Care Center at the University of California, San Francisco, co-principal investigators on the project.

"Between 60% and 70% of all Phase III clinical trials for cancer drugs fail," Berry says. "The main reason is that these trials treat all patients with, say, breast cancer. The problem with that is not all patients respond to any particular therapy. The critical aspect of cancer research is to identify which patients will respond to which therapies."

The goal of I-SPY 2 is to achieve an 85% success rate in Phase III trials by narrowing eligibility in those trials down to groups of patients most likely to respond to the drug based on the biomarkers of their disease.

"Using the I-SPY2 approach will make Phase III trials smaller, and therefore faster, and more successful because the focus will be on the patient population where a drug has been shown to be effective," Berry says.

New Research Sheds Light on the Role of Platelets in Ovarian Cancer

2010-03-17T12:30:13Z

By Laura Sussman, Staff Writer

For more than 100 years, clinicians have observed that thrombocytosis - elevated levels of blood-clotting platelets - occurs in patients with malignant tumors, suggesting that platelets might play a role in the growth and spread of cancer.

This week, Rebecca Lynn Stone, M.D., presented new findings from M. D. Anderson researchers about the clinical correlation between platelet dysfunction and cancer progression in ovarian cancer patients. The presentation was at a focused plenary session on ovarian cancer at the Society of Gynecologic Oncologists 2010 Annual Meeting on Women's Cancer in San Francisco.

Researchers collected and examined data from more than 600 patients across five institutions with a primary diagnosis of ovarian cancer to test associations between platelet count at initial diagnosis, clinical and pathologic factors, and outcome.

Findings showed that thrombocytosis (platelet count >450,000/µL) at initial diagnosis occurred in one in every three women. Further, when compared to patients with normal platelet counts, women with thrombocytosis were significantly more likely to have advanced stage disease, more likely to have their cancer recur and were less likely to survive.

The findings were then replicated in laboratory mouse models. Platelet counts were measured in healthy control and tumor-bearing mice, and data indicated that platelets increased ovarian cancer cell proliferation and that thrombocytosis remained an independent predictor of decreased overall survival. Researchers also examined the effects of platelet depletion on tumor size, proliferation, apoptosis and angiogenesis. Following the adminstration of an antibody to reduce platelet count in mice bearing invasive ovarian tumors, they observed a 50% decrease in ovarian tumor growth.

According to the researchers, the findings offer a new understanding of the biological role platelets play in promoting ovarian cancer growth and suggest that platelet counts may be a good marker for predicting patient outcomes.

"Platelets represent one of the largest storage pools of angiogenic and oncogenic growth factors in the human body. But until now, there hasn't been a concerted effort to examine the clinical and biological significance of platelets in patients with ovarian cancer," says Anil Sood, M.D., professor in the departments of Gynecologic Oncology and Cancer Biology at M. D. Anderson, a senior author on the study whose own clinical observations motivated the effort.

According to Sood, the next step is to examine the potential to block the stimulatory effects of platelets, which could lead to new therapeutic approaches for treating women with ovarian cancer.

What's Your Cancer Risk?

2010-03-16T18:27:37Z

Recommended cancer screening guidelines across a range of disease sites have been revised by several organizations over the last several months, including M. D. Anderson, leaving many confused about when to get screened, or if they even should. The common denominator driving many of the new recommendations is personal cancer risk.

According to the National Cancer Institute (NCI), a risk factor is anything that raises a person's chance for developing a disease. Although science has yet to explicitly define why one person develops cancer and another does not, specific risk factors are known to increase one's chances of developing certain types of cancers.

According to Therese Bevers, M.D., medical director of the Cancer Prevention Center at M. D. Anderson, knowing your cancer risk is important because that information offers guidance about efforts to prevent and detect cancer at its earliest, most treatable stage.

Bevers encourages individuals to talk about their cancer risk with their doctors to determine an appropriate schedule for cancer screening. But how do you uncover your personal cancer risk? The NCI lists four main types of cancer risk factors - some controllable, some not.

Risk Factor #1: Behavioral
Do you smoke? Drink excessively? Eat poorly and never exercise? Lay out in the sun until you have a dark tan? Your cancer risk just increased. There is a reason these risk factors are called "behavioral." By changing these unhealthy behaviors and habits, you can significantly lower your risk for any number of cancers.

Risk Factor #2: Environmental
Believe it or not, where you live and work can affect whether or not you get cancer at some point in your life. If you work in the sun, are usually around secondhand smoke or are frequently exposed to asbestos, radon, pollution or pesticides, your risk of getting cancer increases.

Risk Factor #3: Biological
Biological risk factors are one set of factors that are truly out of an individual's control - they include gender, age, skin complexion and race. Some cancers are gender-specific: only women can get ovarian and cervical cancer, and only men get prostate cancer. In terms of age, cancer risk increases as an individual gets older. Light-skinned individuals are more susceptible to skin cancer than dark-skinned people, and studies have shown that African-American men are at higher risk for prostate cancer than other men.

Risk Factor #4: Genetic
Approximately 5% to 10% of cancer is inherited, which means that changes (or mutations) in specific genes are passed from one blood relative to another. Individuals whose close relatives were diagnosed with cancer have a much higher chance of developing cancer within their lifetime - and at an earlier age. Over the last 15 to 20 years, scientists have made progress in identifying the genes that predispose individuals to breast, colorectal, gynecologic and endocrine tumors. Individuals who have a hereditary predisposition to cancer are recommended to undergo high-risk cancer surveillance - perhaps even including genetic testing - in order to manage their increased cancer risk.

Questions will be answered live on Mar. 23rd

Do you have more questions about your cancer risk? Bevers will be available live on Twitter on Tuesday, March 23, at 1:00 p.m.CT to answer your questions.

Follow @Cancerwise on Twitter and the hashtag #CancerRisk, or join us on tweetchat.

Tobacco Use and HPV Exposure

2010-03-15T18:22:18Z

The two most prevalent causes of head and neck cancers are tobacco use and human papillomavirus exposure. Maurie Markman, M.D., vice president for clinical research at M. D. Anderson, reviews a study reported in Clinical Cancer Research last month on what happens when a patient has HPV exposure and uses tobacco.

The study looked at 124 patients with advanced oropharyngeal cancer, or cancer of the tonsils or the base of the tongue. Of the HPV-positive patients who had never used tobacco, 6% had a recurrence of their cancer. Meanwhile, 19% of former tobacco users and 35% of current tobacco users had a recurrence.

Resources

Tobacco Use Linked to Worse Outcomes in HPV-Positive Head and Neck Cancer (Science Daily)

Head and Neck Cancers (MD Anderson)

Pediatric Patients Celebrate Rodeo Season With Chili Cook-Off

2010-03-10T22:30:05Z

BY Sara Farris, Staff Writer

They may come from all over the world, but recently, pediatric patients and their oncologists from M. D. Anderson fired up their pots of chili, donned their western wear and celebrated Go Texan Day.

Go Texan Day is a long-standing tradition that marks the start of the Houston Livestock Show and Rodeo. People are encouraged to dress in their finest western wear as a means of cultivating the rodeo spirit.

The doctors traded their white coats for pearl snap shirts and competed for the prestigious "best chili" award. The young patients and their families taste-tested the varieties of chili and weighed in on their favorites. Twelve teams from the Children's Cancer Hospital at M. D. Anderson were entered in this year's cook-off.

The Children's Cancer Hospital Chili Cook-Off is another way that the hospital brings fun occasions to the many patients who aren't able to join the crowds due to compromised immune systems from cancer treatment. The cook-off not only distracts the patients from their treatment, but it's a cultural adventure for the many out-of-town patients who are new to our rich Texan culture.

The Soy - Breast Cancer Controversy

2010-03-09T21:10:22Z

By: Richard Lee, M.D., and Lorenzo Cohen, Ph.D.

Cancer patients often take herbs and supplements with the hope of improving their outcomes, and utilization is especially high in women with breast cancer.

One controversial area is the use of soy and soy-related products during and after treatment. Natural soy is known to contain phytoestrogens such as isoflavones, and these compounds in preclinical studies promote estrogen-dependent breast cancer growth. Thus, breast cancer patients are commonly advised to avoid all dietary soy.

Findings from two recent studies are starting to question whether soy may in fact be helpful. A study published at the end of 2009 in The Journal of the American Medical Association by Shu et al., investigated the association between soy food intake and breast cancer survival among a prospective, population-based cohort of 5,042 Chinese women diagnosed with breast cancer between 2002 and 2006. In-person interviews were conducted at baseline, and 12 and 36 months about food consumption, including soy. Soy intake was inversely correlated with breast cancer recurrence and mortality (i.e., higher soy intake was associated with increased survival). The findings remained when comparing estrogen positive/negative and tamoxifen users/non-users subgroups.

Earlier in 2009, results from the Life After Cancer Epidemiology (LACE) study appeared. In this prospective cohort trial involving 1,954 women with breast cancer, those who consumed soy isoflavones at levels comparable to Asian populations actually had a reduced risk of recurrence, especially if they were on concurrent tamoxifen therapy. The authors concluded: "Soy isoflavones consumed at levels comparable to those in Asian populations may reduce the risk of cancer recurrence in women receiving tamoxifen therapy and, moreover, appears not to interfere with tamoxifen efficacy."

These studies provide further information that regular dietary soy as part of a normal diet is probably safe and, in fact, may be beneficial for women with breast cancer. These studies, as well as others, create a growing body of evidence that the current advice that all soy foods should be removed from the diet of a woman diagnosed with breast cancer is probably untrue.

The role of non-dietary soy products such as soy supplements, powders or pills and the use of heavily processed soy items such as soy cheese, soy hot dogs or soy turkey remain unclear and should be avoided.

As the research to date is observational in nature, future randomized trials are needed to verify if a beneficial effect truly exists for the use of dietary soy.

1. Shu XO, et al. Soy and intake and breast cancer survival. JAMA 302(22):2437-2443, 2009.
2. Guha N, et al. Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors: the Life After Cancer Epidemiology study. Breast Cancer Res Treat 118:395-405, 2009.

Is Proton Therapy Right for You?

2010-03-08T20:55:21Z

"Should I get proton therapy?" is a question that my patients often ask me, and you may be thinking about it right now. The short answer is that "it depends." Only you and your oncologist should be making this decision.

Before deciding IF you should receive proton therapy, you need to know WHAT it is. Proton therapy is a form of external beam radiation that uses particles (i.e. protons) instead of photons (i.e. X-rays) to treat tumors. Both forms of radiation can destroy cancer cells by messing up their genetic blueprint (DNA). This makes it difficult for cancer cells to continue to grow and divide, and they ultimately die.

In general, the higher the radiation dose, the better the tumor control will be. However, such high radiation doses can affect normal tissue near the tumor, which is what we all want to avoid.

Photons (x-rays) deposit the majority of their dose within the first inch after they hit the skin, and they continue to deposit dose after they reach the tumor. Hitting a deep tumor with just one or two x-ray beams is hard (that would be like trying to power-wash your driveway with a water pick). We often need to use many different beams to cover the tumor and this can result in more radiation exposure to normal tissues. This is where proton therapy has the edge. Protons deposit most of their dose at the tumor and more importantly stop traveling after they hit the tumor. This reduces the radiation dose beyond the tumor, allows the use fewer beams, and subsequently greater sparing of normal tissue.

Proton treatment requires sophisticated machinery and expert professionals to deliver it. The synchrotron will accelerate protons to almost the speed of light for maximal penetration. Inside the synchrotron they may travel 300,000 miles, which is equivalent to circling the earth 12-13 times. The protons are then fed to the treatment gantry, which is a massive 190-ton device that directs the proton beam before it enters the patient. Despite its large size (over 40 feet in diameter), the gantries have a precision of 1mm. We also have a highly trained, dedicated group of professionals who operate and maintain the Proton Therapy Center to ensure that everything works to its best level.

Proton therapy is currently available in only seven centers in North America. M. D. Anderson has one of the largest and technically advanced centers in the world. We have four treatment rooms, including one of the only centers with spot-scanning (a.k.a. pencil-beam scanning) capabilities.

The first patient was treated with proton therapy at M. D. Anderson on May 4, 2006, and since then we have treated more than 1,700 patients. We have a lot of experience treating patients with lung cancer, esophageal cancer, brain tumors and prostate cancer, as well as various other tumor sites. Also, we're one of the most active centers in the world for treating children with proton therapy.

Since the Proton Therapy Center is part of M. D. Anderson Cancer Center, we can provide our patients not only with outstanding proton therapy but also outstanding cancer therapy.

So, should you receive proton therapy? Please consult with your radiation oncologist or check out our website for more information.

Other Resources

ProtonPals is a support and outreach group for those who choose proton therapy treatment at The University of Texas M. D. Anderson Cancer Center Proton Therapy Center

Prostate Cancer: To Screen or Not to Screen

2010-03-04T23:45:40Z

By Lora Shea, Staff Writer

The debate continues on the value of cancer screening. The latest target: prostate cancer.

The American Cancer Society has issued new prostate cancer screening guidelines that encourage doctors to better communicate the risks and benefits to their patients before testing is pursued. The guidelines question the value of mass prostate screening.

M. D. Anderson urologist John Davis, M.D., says the new guidelines represent "a growing shift from the more simplistic days when doctors told men to go get screened, and we'll deal with the results as needed."

Studies show that more men die with prostate cancer than because of prostate cancer. Screening for prostate cancer may be the right choice for some men, but that decision should be made after careful consideration of a man's personal and family health history, and the risks and benefits of the specific tests. M. D. Anderson's screening guidelines affirm the need for men to discuss testing with their doctor and give specific recommendations based on a man's risk, should he decide to be tested.

The ACS guidelines also call into question the value of community screening events, in which large groups of asymptomatic men are tested. M. D. Anderson has replaced mass screening with education events for the past few years, Davis says. "These events give us the opportunity to talk to men not only about the issues around screening, but also about the variety of treatment and disease management options available to them if they are found to have prostate cancer."

Davis worries that the ACS guidelines "paint a very negative picture of prostate cancer treatment, that harm is inevitable." He says that for those properly evaluated, treatment in the right hands can offer the best outcomes.

"Furthermore, the guidelines are mostly based on two randomized trials. The American trial showed no benefit to screening, but unfortunately has numerous flaws (especially contamination between the treatment arms) and therefore is not conclusive," he says.

"On the other hand, the European study, which did not suffer from as many problems as the American trial, demonstrated a 20% lower risk of dying of prostate cancer as early as nine years from diagnosis. Given the slow natural history of prostate cancer, the percent of men who benefit from screening should go up as these patients are followed to the 15- and 20-year marks."

So who will choose to screen versus not screen? Davis predicts that "for most men who have greater than 10 years of life expectancy and work with their physicians to minimize their cancer AND cardiac disease-related risks, the result will be the well-informed decision to screen."

"Those who are not screened may be due to other more threatening health concerns, or the occasional patient who places a high personal value on avoiding any treatment-related side effects -- even if that means accepting a higher risk of dying of prostate cancer," Davis says.

If you've been screening already, should you stop? According to Davis, "The guidelines provide concise summaries of the relevant data, and it's probably best to let your screening physician talk to you about what age is best to stop."

Integrative Medicine Will Make a Difference in Cancer Care

2010-03-04T16:18:31Z

By: Lorenzo Cohen, Ph.D., and David Servan-Schreiber, M.D., Ph.D.

Integrative medicine aims to enhance cancer care by creating a comprehensive, integrative treatment plan that addresses all dimensions of care: physical, psychological-spiritual and social. It makes use of all appropriate therapeutic approaches, providers and disciplines to improve quality of life, help to manage symptoms, and achieve the best possible treatment results.

Recent research shows that tumors grow and become malignant not only through genetic anomalies in the cancer cells themselves, but also through factors in the cells' microenvironment. These microenvironmental factors include, but are not limited to:

• The ability of the cells to form blood vessels to feed the growing tumor (angiogenesis).
• The propensity for inflammation and stimulating inflammatory pathways, and suppressed cell-mediated immunity.

The tumor microenvironment is the terrain that largely determines whether cancerous cells will grow or not. The body possesses a number of natural defenses that can create a barren, inhospitable terrain for cancer growth. These natural defenses are influenced and strengthened by healthy lifestyle choices such as a proper diet, physical activity, stress management, social connection, and limiting exposure to environmental pollutants.

Modern oncology treatment is focused on destroying cancer cells or blocking cancer-related pathways. This is an essential aspect of therapy. However, it's becoming increasingly clear that truly effective cancer care should simultaneously foster a strong anticancer terrain by strengthening the body's natural defenses.

Existing initial research that follows the tenets of integrative oncology -- making changes in lifestyle and behavior -- shows evidence that this approach can, in fact, strengthen natural defenses, modify the terrain of the body, and have an impact on long-term treatment results.

It's time to provide our patients the education and clinical tools necessary to support an anti-cancer lifestyle to help them remain cancer free and to improve clinical outcomes, quality of life, and symptom control for those with cancer and cancer survivors.

We need to empower people to become active participants in their own health. We need to show them how to best care for themselves; not only because they will feel better if they get involved, but because it's good science and good medicine.

Further Reading:

David Servan-Schreiber: "Anticancer - A new way of life." (Viking)

Andersen, B.L., et al., Psychologic intervention improves survival for breast cancer patients: a randomized clinical trial. Cancer, 2008. 113(12): p. 3450-8.

Ornish, D., et al., Increased telomerase activity and comprehensive lifestyle changes: a pilot study.[see comment][erratum appears in Lancet Oncol. 2008 Dec;9(12):1124]. Lancet Oncology, 2008. 9(11): p. 1048-57.

Ornish, D., et al., Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proceedings of the National Academy of Sciences of the United States of America, 2008. 105(24): p. 8369-74.

Ornish, D., et al., Intensive lifestyle changes may affect the progression of prostate cancer. Journal of Urology, 2005. 174(3): p. 1065-9; discussion 1069-70.

Saxe, G.A., et al., Potential attenuation of disease progression in recurrent prostate cancer with plant-based diet and stress reduction. Integrative Cancer Therapies, 2006. 5(3): p. 206-13.

Saxe, G.A., et al., Biological mediators of effect of diet and stress reduction on prostate cancer. Integrative Cancer Therapies, 2008. 7(3): p. 130-8.

Patient Deals With Ovarian, Then Papillary Thyroid Cancer

2010-03-03T19:54:57Z

In Her Own Words ... by Rebecca Esparza

Thanksgiving Day 2007 couldn't have been more non-traditional: my fiancé Robert Marraro and I spent it in Las Vegas. Ever since my diagnosis of late-stage ovarian cancer at Thanksgiving in 2001, the holiday has never been the same, so we've tried unique and different ways to celebrate over the years.

But there was something special about this trip: It marked my five-year, cancer-free anniversary. We visited the Grand Canyon, stayed at a luxurious suite in a five-star casino and experienced a decadent spa day. On the way home from our week-long trip, we stopped in San Antonio for an extra evening of fun.

That night, I was horribly sick.

The signs are there
Robert later told me it was at that moment, he knew something was seriously wrong with me.

But I was cancer-free. The five-year mark was monumental, especially for an ovarian cancer survivor. For the next five months, I carried on despite being extremely lethargic, gaining weight and losing tremendous amounts of hair. Plus, there were still a host of side effects I was suffering as a result of my chemotherapy, like chronic joint pain, fibromyalgia and neuropathy.

I refused to let my disabilities dampen my spirits for fighting cancer at the grassroots level. The year prior I had been selected as a "Hero of Hope" by the American Cancer Society, which entailed traveling to Relay For Life events across Texas as a survivor spokesperson. I was at a Relay event in Alice, the hometown of my grandmother, Elida Garcia, who had passed away in December 2007 of lung cancer.

As soon as I stepped on the track that night, I could feel her spirit.

An hour later, I tripped and fell, hit my head and passed out. When I awoke, I was in traction and emergency personnel were loading me into an ambulance.

My body demands attention
CT scans of my head and neck revealed no head injuries, but there was something suspicious in my thyroid. The exact verbiage: "Small hypodensity and tiny adjacent calcification within left lobe of thyroid may represent nodule versus cyst."

Despite the fact my doctor at the emergency room was not concerned about it, I decided to take my health in my own hands. I called my gynecologic oncologist at M. D. Anderson, Pamela Soliman, M.D., assistant professor in the Department of Gynecologic Oncology. She advised coming to M. D. Anderson for a fine needle aspiration.

The procedure itself was painful, but the radiologist, nurses and technicians all made sure I was comfortable. The next day I met Camilo Jimenez, M.D., assistant professor in the Department of Endocrine Neoplasia and Hormonal Disorders.

He and I had an instant connection. Looking back on this meeting, I think he sensed the news I had thyroid cancer would be particularly difficult for me.

"Two of the samples came back negative for cancer," he said slowly. "And one ... one came back positive."

I was completely stunned: I had cancer. Again. Two primary cancers and I was only 37.

Dr. Jimenez couldn't have been more caring and sympathetic. He assured me I would receive excellent care, immediately putting my mind at ease. We discussed surgery to remove the thyroid and subsequent radioactive iodine treatment.

In June 2008, Randal Weber, M.D., professor and chair of the Department of Head and Neck Surgery, performed a three-hour surgery to remove my thyroid, one parathyroid and 50 lymph nodes. Seven of those lymph nodes came back positive for cancer and my radioactive iodine treatment was scheduled for November -- around Thanksgiving.

Everything seems to go back to Thanksgiving
After enduring a low-iodine diet for two weeks to ensure proper uptake of the radioactive iodine and undergoing several diagnostic tests to see where the cancer still existed, I was mentally prepared for the treatment.

At this point, I knew Dr. Jimenez was preparing to send me to the hospital for the treatment. He entered the room with the biggest, broadest smile I have ever seen on a physician.

"There is no evidence of cancer. So since there's no cancer, there's nothing to radiate.
This rarely happens, so go home and enjoy your life," he said happily.

I thought I would literally bounce off the walls. And although today I have numerous "reactive" lymph nodes in my neck that are being closely monitored for signs of cancer, I don't spend much time worrying about it.

I like to relish the fact I am a walking miracle that kicked cancer to the curb twice. I'll do it as many times as I need to in the future, but I'll make sure I have my invaluable medical teams at M. D. Anderson by my side every step of the way.

And I believe my grandmother was with me that night in Alice. She gave me a gentle, loving push that would eventually help save my life.

In 2008, Esparza was honored for her networking efforts with other cancer patients by Lance Armstrong when she received the Livestrong Challenge Award.

Related story:
Q&A: Thyroid cancer

M. D. Anderson resources:
Thyroid cancer

Endocrine Care Center

Thyroid cancer survivor (video)

Additional resources:
Thyroid cancer (National Cancer Institute)

Detailed guide: thyroid cancer (American Cancer Society)

Q&A: Thyroid Cancer

2010-03-03T14:50:17Z

Thyroid cancer is a disease in which cancer cells are found in the tissue of the thyroid gland.

Camilo Jimenez, M.D., assistant professor in the Department of Endocrine Neoplasia and Hormonal Disorders at M. D. Anderson, answers questions about this disease.

Are there several types?
Yes, there are four types. The most common is papillary thyroid cancer; the second is follicular thyroid cancer; the third, medullary thyroid cancer; and the rarest, anaplastic thyroid cancer.

In general, papillary thyroid cancer exhibits the best survival rate and prognosis with survival rates up to 100% after five years of initial diagnosis, even in patients with metastatic disease.

Anaplastic thyroid cancer is perhaps the most aggressive cancer that humans may suffer from. Almost 100% of patients survive fewer than three months after its diagnosis. Fortunately it is very rare.

How common is thyroid cancer?
Papillary thyroid cancer is very common. Its incidence has increased during the last decade, and now it's one of the 10 most common cancers in the United States.

What causes it?
In most papillary and follicular thyroid cancer cases, we do not know the cause.
Approximately 3% of papillary thyroid cancer cases have predisposition because other family members have been affected by this disease. Exposure to sublethal radiation, such as that observed in survivors of radiation from Hiroshima, Nagasaki or Chernobyl, is another risk factor for the disease.

In the case of medullary thyroid carcinoma, up to 35% of patients may have a genetic predisposition.

The causes of follicular and anaplastic thyroid carcinomas are unknown.

What are the symptoms?
These tumors are usually found because of the presence of a palpable or visible neck mass. Frequently, they're accidentally found by radiographic studies recommended to evaluate diseases that are not related to thyroid cancer.

In some cases, thyroid cancer is found because of manifestations related to metastatic disease (for example, a fracture due to skeletal metastases).

Papillary, follicular and anaplastic thyroid carcinomas usually do not secrete hormones. Medullary thyroid carcinomas secrete excessive amounts of calcitonin (a hormone produced in the thyroid) making some patients susceptible to flushing and chronic diarrhea.

What are the most common treatments?
Surgery is the most important treatment for thyroid cancer. In a vast majority of papillary and follicular thyroid carcinomas, once surgery is performed, ablation therapy with radioactive iodine is recommended.

Thyroid suppressive therapy with a dosage of thyroid hormone -- enough to suppress the thyroid-stimulating hormone -- is required after ablation therapy in almost every patient. For medullary thyroid cancer, ablation with radioactive iodine and thyroid suppressive therapy are not necessary.

What other information can you share?
We've noticed that both the incidence and aggressiveness of thyroid cancer have increased over the last decade. Some tumors present with metastases that are not possible to remove by surgery.

To attack these tumors, we now have drugs that target molecular pathways important for the tumor development and survival. Many of these drugs are under evaluation in clinical trials, and they include names such as sorafenib, sunitinib, motesanib, XL184, E7080 and others. A new era for thyroid cancer has begun.

Related story:
Patient deals with ovarian, then thyroid cancer

M. D. Anderson resources:
Thyroid cancer

Endocrine Care Center

Thyroid cancer: questions and answers (PDF)

Thyroid cancer survivor (video)

Additional resources:
Thyroid cancer (National Cancer Institute)

Detailed guide: thyroid cancer (American Cancer Society)

Celebrate Colorectal Cancer Awareness Month With a Screening

2010-03-01T19:31:46Z

Although colorectal cancer is often preventable and many are aware of the disease, most people still fail to get screened.

Colorectal cancer remains the fourth most common cancer in the United States. According to the American Cancer Society, more than 148,800 people were diagnosed with the disease in 2008 and 49,960 died because of it.

That's why every March there's a concerted effort to raise awareness of this disease and to encourage people to get screened.

New guidelines for screening
A multidisciplinary panel of M. D. Anderson experts in medical oncology, surgical oncology, radiation oncology, cancer prevention, imaging and other areas have developed new risk categories and related guidelines for colorectal cancer.

For men and women at average risk who are 50 years and older, M. D. Anderson recommends a colonoscopy every 10 years (preferred screening), and either a virtual colonoscopy every five years or a yearly fecal occult blood test (FOBT).

For men and women at increased or high risk, the type and frequency of exams, including colonoscopy and flexible sigmoidoscopy, depend on the following factors:
•   Personal history of precancerous (adenomatous) polyps
•   Personal history of colorectal cancer
•   Family history of colorectal cancer or precancerous (adenomatous) polyps
•   Genetic diagnosis of familial adenomatous polyps
•   Genetic history of hereditary nonpolyposis colorectal cancer, or clinical history suggesting such
•   Inflammatory bowl disease (ulcerative colitis or Crohn's disease)

If you fit these guidelines, celebrate March with a check-up and chat with your primary physician about getting screened for colon cancer.

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

Colorectal Cancer Survivors' Stories Become More Common

M. D. Anderson resources:
Colonoscopy versus Virtual Colonoscopy (podcast)

Colorectal Cancer Treatment and Screening (podcast)

Additional resources:
Colon and Rectal Cancer (National Cancer Institute)

Colon and Rectum Cancer (American Cancer Society)

National Health Observances Toolkit (U.S. Department of Health & Human Services)

Pistachios May Reduce the Risk of Lung Cancer

2010-03-01T16:12:02Z

By Laura Prus, Staff Writer

According to a recent study, adding pistachios to your diet may help lower your risk of lung cancer. However, researchers caution that more research is still needed.

Among the most commonly consumed nuts in the United States, pistachios also are one of the best dietary sources of gamma-tocopherol, a form of vitamin E.

Results of a study aimed at discovering if these nuts have anti-cancer properties was presented in December 2009 at the American Association for Cancer Research's Frontiers in Cancer Prevention Research conference.

Conducting the study
The six-week controlled clinical trial investigated the effect of pistachio consumption on serum levels of gamma-tocopherol. It was divided into three two-week blocks, allowing for a two-week pre-intervention period and a four-week intervention period.

Involved in the study, conducted by researchers at M. D. Anderson and Texas Woman's University, were 36 healthy participants who were randomly assigned to either a normal diet or a diet consisting of 68 grams of pistachio per day. Data for each participant were recorded in a diet diary.

Results show promise
Participants in the pistachio-diet group showed a significant increase in energy-adjusted dietary intake of gamma-tocopherol at weeks three and four. At the end of the study, this group also had a significantly higher value of cholesterol-adjusted serum gamma-tocopherol compared to baseline.

Ladia Hernandez, senior research dietitian in the Department of Epidemiology and the study's first author, says this positive outcome shows promise of the anti-cancer properties of pistachios. "Because pistachios are a good source of gamma-tocopherol then eating them may help to decrease lung cancer risk," she says.

Pistachios are good for you
Although results are encouraging, Hernandez says the chemopreventative effects of pistachio consumption need further clarification. In particular, she says, the effects related to the targeted molecular pathways need to be studied.

However, she does recommend adding gamma-tocopherol to your diet. "Pistachios are one of those 'good-for-you' nuts, and 2 ounces per day could be incorporated into dietary strategies designed to reduce the risk of lung cancer without significant changes in body mass index," she says.

She also states that foods such as peanuts, pecans, walnuts, soybean and corn oils are rich sources of gamma-tocopherol and could prove beneficial for your health as well.

M. D. Anderson resources:

Department of Clinical Nutrition

Additional resources:

Energy Value of Macronutrients From Pistachio Nuts and Mechanisms of Nutrient Action (National Cancer Institute)

Energy Value of Macronutrients From Pistachio Nuts and Mechanisms of Nutrient Action

Pistachios May Reduce Lung Cancer Risk (AACR)
Pistachios May Reduce Lung Cancer Risk (AACR)

The Reason Behind Philanthropic Gifts

2010-02-26T19:43:33Z

By DeDe DeStefano, Staff Writer

Our patients are inspirational, courageous fighters. With each one, I am reminded of the journey I made alongside my mother 11 years ago, as if it were yesterday. Each July we celebrate the end of her treatment as much as we do the day she was born.

On Feb. 18, I had the opportunity to work at an M. D. Anderson event honoring cancer patients everywhere -- celebrating with those who survived their cancer and mourning with family and friends of those who did not. Some of these patients are my colleagues. Some are friends. And some I'd just met. Some told their stories. Others listened and applauded. Everyone cried.

These patients are my heroes. They are why I love my job. Although I am not in direct patient care, I have the honor of telling their stories. Sometimes in the middle of the night I wake up and worry about them, just like I know their care teams do, and I think it's like that with everyone here.

The evening's purpose was to thank the philanthropic donors who have made a difference in the lives of our patients and announce that M. D. Anderson is raising $1 billion to continue that work. Although the celebration thanked donors, the focus was not on the donors themselves, but rather the reason behind the gifts. Testimony after testimony was given -- some planned, others not. From Jeff Wigbels, a non-smoking athlete who learned he had stage IV metastatic lung cancer the day before his son was born, to "America's Got Talent" lymphoma survivor Barbara Padilla, whose operatic voice brought down the house, there was not a dry eye in the room.

In his opening remarks, M. D. Anderson President John Mendelsohn, M.D., paid tribute to Bob Mosbacher, who recently lost his battle with cancer. Mosbacher was the only person to chair M. D. Anderson's Board of Visitors twice. "Bob worked hard to bring national attention and critically needed resources to M. D. Anderson, and did so with the modesty and quiet charm for which he is so admired. He was a great personal friend to Anne and me, and we miss him terribly," he told the audience, which included members of Mr. Mosbacher's family.

Originally slated to serve as master of ceremonies, CNN's Sanjay Gupta, M.D., had to regretfully cancel due to his participation in the earthquake relief efforts in Haiti. Former Miss America Phyllis George stepped in graciously and offered her own personal story with the institution, though we did not know she had one when we asked her to take part. A dear friend was misdiagnosed elsewhere (twice) and ultimately came to M. D. Anderson, where he survived six years. "If he had come to M. D. Anderson first, I have no doubt he'd still be alive today," she said tearfully. She then paid tribute to the patients in the room whose stories were told in the campaign brochure, including Patsy Bodie who struggled with pancreatic cancer for 10 years. The entire room of 600 held a moment of silence for Patsy, who lost her battle with the disease 22 days before the event.

The tribute continued with the spectacular voices of the Houston Five Tenors' performance of "Amazing Grace" joined by St. Thomas' Episcopal School Pipe Band's bagpipes.

Memorial Drive Presbyterian senior pastor Rev. Dave Peterson offered his own testimonial before delivering the invocation. He spoke about his young daughter who, just weeks after getting married, was diagnosed with breast cancer. She came to M. D. Anderson for treatment.

After dinner, Board of Visitors Chair Nancy Loeffler welcomed board and Advance Team members and campaign chair Harry Longwell encouraged guests to spread the word about the need for philanthropic funding for cancer research programs.

After an extraordinary performance of "Ave Maria" by Barbara Padilla, eight patients on eight miniature stages around the room's perimeter gave a moving tribute to cancer patients everywhere as the program's finale. One by one, they were spotlighted, each telling his or her story and each physically striking out the word "cancer" on a screen behind him or her. Barbara Padilla struck hers out on the main ballroom stage and gave a closing rendition of "The Prayer" with one of the five tenors, Ken Gayle.

All in all, it was an evening of hope. Not everyone has survived cancer, but everyone had such an extraordinary story of what this terrible disease does. So many people are fighting cancer, and so many more are fighting with all they have to cure it, whether that means in a lab, in a clinic or with a checkbook.

It was hopeful and moving and quite honestly one of the best evenings I've ever had the privilege to be a part. I think everyone left the event with an understanding of the urgency of the problem of cancer and the compelling desire to do more.

Web site - www.makingcancerhistorycampaign.org
Facebook - The Campaign to Transform Cancer Care

These are the stories of the eight finale participants.

Victoria Johnson

Victoria Johnson is a survivor of more than 11 years of stage IV breast cancer with metastases to all major organs, including her brain. After being extremely conscientious for years about annual mammograms and additional precautionary ultrasounds, Victoria was diagnosed with the late-stage cancer and told that she had approximately 1½ years to live. Searching for hope, Victoria came to M. D. Anderson. She has since had seven brain tumors successfully removed and credits ongoing Herceptin® treatments with enabling her to live a full life. Victoria has repeatedly given her awe-inspiring testimonial to audiences at M. D. Anderson events. Passionate about enjoying each cherished day, she appeared in the CNN video "Taming the Beast," quoting her grandmother: "It's time to use the good china. Enjoy life!"

Nikita Robinson

An M. D. Anderson employee for five years, Nikita is a senior research coordinator in the Department of Health Disparities. She also is a four-year colon cancer survivor and a contributing member of the Employee Cancer Support Group. Nikita says her illness has influenced her perspective of her work, and she is eager to educate others about the institution. Within months of diagnosis, her mother was diagnosed with stomach cancer and her grandfather was diagnosed with pancreatic cancer. Neither survived. Nikita says that her insight gained as a patient and employee enabled her to be a vessel of support for her loved ones through their own cancer battles. Nikita says, "I am a real survivor, and for them -- to honor them -- I have to do this. I feel so honored to represent all the survivors at this institution."

Kenneth Woo

Kenneth is a 17-year Hodgkin's lymphoma survivor, and a 6 /2-year acute myelogenous leukemia and stem cell transplant survivor. Kenneth has many ties with
M. D. Anderson. He is a longtime volunteer with the Anderson Network and routinely supports its members in their time of need. Kenneth chaired the 2009 Anderson Network steering committee and will chair the 2010 Anderson Network Living With, Through and Beyond Cancer Conference. Thoughtfully helping others touched by cancer is a priority in Kenneth's life, and he is quiet but passionate about doing so, helping not only other patients but also their caregivers. Because of Kenneth's cancer experience, he, wife Clara, and daughters Ashley and Kimberly have made the words "be a channel of blessings to others" their family motto.

Janice Duplessis

Janice is a 10-year breast cancer survivor and three-year metastatic cancer survivor. Soft-spoken and serene, she chaired Anderson Network's 2007 annual patient conference of 500 attendees while going through radiation treatments for brain metastasis. She adopted the conference theme, Power of Hope, to describe herself: "We who have cancer must believe in the power of hope. M. D. Anderson has given me hope for the strongest and longest survivorship." Janice volunteers at various conferences, with the Telephone Outreach Program for Breast Cancer and with the American Cancer Society. She and her husband, Rogers, have three sons. Janice credits Rogers, who established the Lean on Me Caregivers Group to support others who care for loved ones facing cancer, with being her strength.

Nadia Jones

Nadia Jones may only be 5 years old, but she's an experienced driver of a pint-sized pink power-wheels Ford Mustang, which she thoroughly enjoys. She is being treated for rhabdomyosarcoma in the Children's Cancer Hospital at M. D. Anderson, and attends kindergarten in Richmond, Texas. Nadia's mother, Brandie, says that despite the numerous obstacles Nadia has encountered since birth, she has always managed to maintain an extremely positive outlook on life.

Jason Connelly

Diagnosed with stage IV melanoma in 2006, Jason has been a survivor for three years. He generously and passionately shares his story of diagnosis, intense treatment and survival, emphasizing the importance of philanthropic funds and their role in advancing the therapy that helped save his life. Jason was one of three cancer patients honored as Person of the Week on "ABC World News" in 2008. The joy of Jason's life is his adorable son, Jacob, 5. "I'm happier now than I have ever been. I'm happier now than I was before I got sick," Jason says.

Jaime Ramirez

Diagnosed in Mexico at age 4, Jaime had osteosarcoma that returned every two years for 17 years. His parents brought him to Houston when he was 7, and after other hospitals could do no more, Jaime, by then a teenager, came to M. D. Anderson. Jaime survived 18 surgeries on his leg, often enduring hospital stays alone while his mother returned home to South Texas to care for his nine brothers and sisters. Jaime has been cancer-free for 22 years, beginning in 1988, when he became an M. D. Anderson employee. "They saved my life, so as long as I'm alive, I will be part of this team's mission to end cancer," he says. Jaime also volunteers on M. D. Anderson's Diversity Council, as an Anderson Network Ambassador and as a caring guide to pediatric patients faced with losing a limb.

Kay Rogers

Kay is a 38-year breast cancer survivor and 21-year colorectal survivor. She has inspired others through 34 years of volunteer service with new volunteers, the Children's Art Project card program and the children's Health Adventures program. She is a motorcyclist and began the Ride for Life for Anderson Network's annual patient conference, served 18 years on the Pediatric Brain Tumor Foundation's Ride for Kids task force and supports the Harley's Angels calendar fundraiser. Kay is retiring soon from her accountant position at Northwest Honda but plans to continue her active lifestyle. Recently, she skydived and hopes to jump again with her husband for her 80th birthday next month. Kay lost her daughter, Patricia Rahl, one year ago to endometrial cancer and today honors her along with all those who did not conquer cancer, yet contributed greatly to the mission to eradicate it.