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136197_Jonasch_E.jpgIn the 1980s, the American Cancer Society reported that 80% of kidney cancers were diagnosed in the late stages. Today, thanks to better screening methods, only about 40% of cases are discovered at the advanced stage even though patients may not have any kidney cancer symptoms

At MD Anderson, we're continuing to make progress in improving kidney cancer diagnoses and kidney cancer treatment. We spoke with Eric Jonasch, M.D., associate professor in Genitourinary Medical Oncology, to find out more about kidney cancer treatment and research, as well as prevention and diagnosis. Here's what he had to say.  

Who's at risk for kidney cancer? What signs and symptoms should people look for?
Those who have a first-degree relative, like a parent or sibling, who have had kidney cancer are more likely to develop kidney cancer. So are men, as this type of cancer is seen in men twice as often as in women.

In addition, the older we get, the greater our risk becomes. Most kidney cancer patients are over age 60. People who are obese, have high blood pressure or smoke also are more likely to be diagnosed with kidney cancer.

How is kidney cancer diagnosed?
Increasingly, kidney cancer is diagnosed incidentally, when a patient comes in for an unrelated complaint that requires a CT scan and the care team discovers a mass in the kidney.

Kidney cancer symptoms don't often show themselves, but patients whose cancer has progressed to a later stage may experience pain in the stomach or lower back, or blood in their urine.

Patients with kidney cancer also may experience unexplained high hemoglobin levels, unexplained uncontrollable blood pressure or unexplained and persistent weight loss.

Once the cancer is spotted through the CT scan, and there is no sign of spread to other organs, the surgical team may proceed directly to a surgical removal of the tumor. But if the tumor looks abnormal or like it has grown outside of the kidney, they may perform a biopsy to determine if it is a different cancer type.

pathology_group_163_Edited.jpgBy Carol Bryce

It's not unusual for a patient to arrive at MD Anderson with one diagnosis and leave with a different one.

For example, when approximately 2,700 patient cases were reviewed during September 2011, 25% showed discrepancies between the original pathologists' reports and our pathologists' reports. While the changes in diagnosis were minor in 18.7%, in the other 6.2%, the diagnosis change made a major difference.

"In some of those cases, we changed the diagnosis from malignant to benign or vice versa," explains Lavinia Middleton, M.D., professor in Pathology. "That adds up to approximately 2,000 cases per year where we can say that our pathologists' reviews have impacted patients' treatment.

"Changing the diagnosis from malignant to benign is the best call to make. This makes us feel really good."

"Review of outside material is a major component of the work done by our Pathology and Hematopathology departments," adds Stanley Hamilton, M.D., division head in Pathology/Laboratory Medicine. "The correct pathologic diagnosis and stage of each tumor are key to high quality care for patients."

How we make the correct diagnosis
So why do we find things overlooked by other health care institutions?

"Our system here helps us make the right cancer diagnosis. It's based on three things: sub-specialization, volume and redundancy," Middleton explains.

17shah.jpgEach year, about 24,000 people in the United States are diagnosed with multiple myeloma, according to the American Cancer Society. Most are over age 65, but people of all ages are diagnosed with this blood cancer.

Multiple myeloma is marked by the growth of malignant plasma cells found in the bone marrow. These myeloma cells typically make a protein found in blood and urine.

Over the past decade, we've made tremendous strides in treating multiple myeloma, enabling patients to live significantly longer.  

Jatin Shah, M.D., associate professor in Lymphoma/Myeloma, recently spoke with us about how multiple myeloma is diagnosed and treated, as well as new therapies on the horizon.
Here's what he had to say.

How is multiple myeloma diagnosed?
The most common way to diagnose myeloma in its earliest stages before symptoms appear is through routine blood work. If a patient has elevated protein levels, several tests are conducted and their combined results interpreted in order to make a myeloma diagnosis.
What are common myeloma symptoms?

Before they receive a definitive diagnosis, myeloma patients often have problems with anemia, high calcium or renal failure. Or, they may have broken bones or lytic lesions, where sections of bone are basically destroyed.

Peterson_Trackers_140.jpgBy Carol Bryce

Imagine if you could monitor your health between clinic visits and quickly share the details with your care team.

That's the premise of research that's being conducted here.

"We're looking at new ways of data collection that are grounded in real-world challenges," explains Susan Peterson, Ph.D., in Behavioral Science.

This may help address health issues and behaviors that change when you you're not at the hospital or your doctor's office. For example, patients with head and neck cancer usually don't develop swallowing difficulties while they're at their doctors' offices. And former smokers may not struggle with relapse while they're sitting in clinic waiting rooms.

So our researchers are looking at ways to use modern technology to monitor patients' vital signs, side effects, symptoms and treatment adherence between medical appointments.

Research that's based in reality
In their first study, the researchers tested the use of mobile sensors like fitness trackers and other portable devices that enable patients to monitor their health at home. The study was conducted by researchers from MD Anderson, the University of Alabama at Birmingham and the University of California, San Diego.

Researchers created a system that used mobile applications to gather daily data from patients and send the information to their health care teams. The system, called CYCORE (CYberinfrastructure for COmparative effectiveness REsearch), enables patients to directly enter their personal health information into various devices.

"Using CYCORE, we've been able to gather behavioral, environmental and psychological data that's typically not collected in research trials," Peterson says.

A monstrous art project. A groundbreaking lung cancer screening trial. Inspiring stories from our patients and caregivers. Our mission to end cancer. These are just a few of the topics that been popular on MD Anderson's YouTube channel in 2014.

To find out what you missed -- or rediscover some favorites -- check out our top five videos from 2014.

What drives MD Anderson to end cancer

What if we could end cancer? This is the bold idea that guides everything we do here at MD Anderson. Watch our patients, survivors, volunteers and employees describe the hope they feel here and share why they believe MD Anderson is the best place to treat and ultimately end cancer:



experts.jpgNo matter where you are in your cancer journey, you're likely curious about cancer prevention and treatment. Or, maybe you're trying to figure out how to manage an unexpected side effect or whether or not you can exercise during cancer treatment.

Whatever the case, you're sure to find wisdom, guidance and hope in the insight of our doctors and other experts, many of whom shared their expertise here on Cancerwise and in our Cancer Newsline podcast series in 2014.

Below, we've pulled together some of the most helpful insight and advice our doctors and other experts shared this past year. We hope you find something here that helps or inspires you in your cancer journey.

Immunotherapy: Unleashing the immune system to attack cancer
We're making great strides in immunotherapy, a new way of treating cancer that targets the immune system rather than the tumor itself. And, this innovative approach, developed by Jim Allison, Ph.D., professor in Immunology, will open doors for treating all types of cancer. Learn more in this podcast with Allison and Padmanee Sharma, M.D., Ph.D., associate professor in Genitourinary Medical Oncology and Immunology.

Understanding the new HPV vaccine
Recently, the U.S. Food and Drug Administration approved a new vaccine targeting nine types of HPV, including five that haven't been covered by other vaccines. And, for those who get the vaccine, that means even better protection against cervical cancer, oral cancers and other cancers linked to HPV, says Lois Ramondetta, M.D., in Gynecologic Oncology and Reproductive Medicine. Find out what you should know about the new HPV vaccine.

cancer_vaccine_02 var.jpgYesterday, the Food and Drug Administration (FDA) approved a new vaccine targeting nine types of the Human Papillomavirus (HPV), including five types that haven't been covered by other HPV vaccines.

To better understand this new HPV vaccine, known as Gardasil 9 or HPV 9, and what it means for preventing HPV-related cancers, we spoke with Lois Ramondetta, M.D., in Gynecologic Oncology and Reproductive Medicine. Here's what she had to say.

What is the new HPV vaccine, and what does types of HPV does it guard against?

This is the third FDA-approved HPV vaccine. The previous HPV vaccine, known as Gardasil, only protected against four strains of HPV. This one protects against nine different strains of HPV that have been linked to several types of cancer, including cervical cancer, anal cancer, penile cancer, oral cancer and head and neck cancers

This is great news for cervical cancer prevention. Whereas Gardasil was expected to prevent 70% of all cervical cancers, the new HPV vaccine will prevent closer to 90% of cervical cancers.

Keep in mind that these vaccines only work to prevent HPV. So, if you already have HPV, you can't get the vaccine to treat the HPV or to prevent HPV-related cancers.

Conquest Garden photos (1).JPGFrom the gardens to the skybridge to our leading doctors and kind volunteers, there are many things that set MD Anderson apart and help our patients feel at home. 

Whether it's your first appointment or you've become an old pro, you're likely to appreciate these 17 unique features.

1. Our 69 aquariums. The 66 freshwater and three saltwater live coral reef aquariums in our clinics are home to 3,000 fish -- mostly cichlids, angelfish and rainbow fish. The largest freshwater aquarium, by the Pharmacy in the Main Building, holds 850 gallons.

2. The Observation Deck.
Located on the 24th Floor of the Main Building, the Observation Deck offers peace and quiet, as well as a scenic view of Houston. You're also welcome to play the piano up there.

3. Our volunteers. MD Anderson is fortunate to have more than 1,200 volunteers who contributed  193,921 hours of service last year. Stop by our Hospitality Centers for a cup of coffee and to visit with these caring individuals, many of whom are survivors or caregivers themselves.

4. Our pianos. Twenty-five of our volunteers play the piano in The Park and the Mays Clinic between 10 a.m. and 5 p.m. Mondays through Fridays. They also play at the Rotary House each day. If you're lucky, you may hear our harpist or one of our two flautists as well.

5. Room service. Inpatients -- as well as their families, caregivers and friends -- can order whatever they want from room service each day from 6:30 a.m. to 9:30 p.m. Our classically trained senior executive chef comes up with the menu of fresh, cooked-to-order meals.  

lung x ray.jpgLung cancer is the leading cause of cancer deaths, but new advances in prevention, lung cancer screening and research are helping to save more lives. And, here at MD Anderson, we're leading the fight against lung cancer by focusing on prevention, lung cancer screening and personalized lung cancer treatment through our Moon Shots Program, an ambitious program to reduce cancer deaths for several cancers and ultimately find cures for these and other cancers.

We spoke with Ara Vaporciyan, M.D., and Mara Antonoff, M.D., to find out what you need to know about lung cancer. Here's what they had to say about lung cancer screening and early detection, as well as the latest in lung cancer treatment and research.

Who is more likely to develop lung cancer?
Cigarette smoking is estimated to directly cause about 85% of all lung cancers. Smoking cigars or pipes, as well as secondhand smoke exposure, also put you at increased risk of developing lung cancer. 

So does exposure to certain environmental carcinogens, such as asbestos, radon, arsenic, tar, chromium and nickel.

Lung cancer also can run in families, but we have yet to identify exactly the genetic basis for this.

Lung cancer also is becoming more common in women.

IACS_Lab_Shots_492_master.jpgBy Lori Baker

MD Anderson has close to 2,000 doctors. Several hundred never treat patients, yet they are crucial to our mission.

"Our mission is to end cancer, not just provide excellent care," says Helen Piwnica-Worms, Ph.D., vice provost of Science. "We don't yet know enough, so our faculty must include a robust community of researchers who apply their scientific expertise to answer important biological questions."

According to Piwnica-Worms, delivering on our commitment to finding answers sets us apart.
"Discovery is what distinguishes breakthrough institutions," Piwnica- Worms says.

Birthplace of new cancer treatments
Basic research, also referred to as laboratory research and discovery science, is a part of MD Anderson's DNA. Ending cancer requires investments in this type of research, as well as clinical, translational and population sciences research. Many of today's treatments exist because of yesterday's basic research. For example, many patients with advanced pancreatic cancer rely on the drug gemcitabine, which is available to them thanks in large part to basic research conducted by William Plunkett, Ph.D., professor in Experimental Therapeutics.

Plunkett's discoveries of the metabolism, mechanism of action and clinical pharmacology of the drug led to the rationale for fixed-dose-rate infusion. His work complemented trials conducted by our clinical doctors.

As a result, in 1996, gemcitabine was the first drug for pancreatic cancer approved by the Food and Drug Administration (FDA).

clinicaltrialhunt.jpgBy Lori Baker

Bringing patients new and better cancer treatments through clinical trials is what sets MD Anderson apart. It's more than a goal or a point of pride. It's a passion. And we offer more cancer trials than anyplace else. 

Clinical trials are the key to developing new cancer treatment options. Advances only reach patients by going through clinical trials, which are the final step in a long process to find better ways to prevent, diagnose and treat cancer.

"People's health is at stake," says Hagop Kantarjian, M.D., chair of Leukemia. "So trials are conducted only after the procedure or medication has passed many steps that provide confidence it's better than what's available as standard of care. Trials are meticulously designed, reviewed and monitored. Their importance and complexity require expertise and supporting infrastructure, and MD Anderson has no equal in these areas."

Saving lives through clinical trials
Kantarjian personally has conducted 345 clinical trials in his 34 years at MD Anderson. He says he's motivated and inspired by the people he works with, as well as our patients.

"MD Anderson is the best place in the world because of everyone's incredible will to do good by making a difference for so many patients," Kantarjian says.

Jared_Burks_623.jpgBy Jenny Montgomery

After a long day of helping MD Anderson's researchers pursue a cure for cancer, Jared Burks, Ph.D., relaxes by custom crafting his own LEGO minifigures.

For Burks, the biggest problem with LEGOs is the limited selection of minifigures. Where's the Dr. Who collection? How about some zombie-fighting "Walking Dead" characters?

Burks' solution is to custom-craft his own minifigures. In fact, he's created thousands of them.

Life outside the leukemia research lab
An assistant professor in Leukemia and co-director of the Flow Cytometry and Cellular Imaging Core facility, Burks oversees expensive equipment shared by researchers around MD Anderson. These machines allow researchers to see, sort and analyze thousands or even millions of a person's cells very quickly.

But at the end of the day, Burks' idea of relaxing is focusing on something bigger than a cell. Like a light saber the size of a toothpick. Or a pair of goggles smaller than a thumb tack.

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