Recently in Cancer Treatment Category

Vehbi Koc Foundation (VKF) American Hospital and M. D. Anderson recently announced that they are expanding cancer care services in Istanbul and Turkey through a new radiation treatment center located in the VKF American Hospital.

Using robotic surgery, one of the minimally invasive approaches used at M. D. Anderson, surgeons are able to minimize trauma, to maximize outcomes and enable patients to return to their normal lives more quickly.

Chris Holsinger, M.D., Associate Professor in the Department of Head and Neck Surgery, is applying this technology to the neck and thyroid gland. He was the first ENT surgeon in the United States to perform a robotic thyroidectomy, using Dr. Woong Youn Chung's technique, which allows the removal of tumors from these sites through an incision in the upper arm without carbon dioxide insufflation.

Among those who have benefited from this procedure is cancer survivor Cheryl Michel. In the latest episode of Cancer Newsline, Holsinger highlights the technique and Michel discusses how it helped her.


Listen to Dr. Holsinger and Cheryl Michel

Cancer Newsline is a weekly audio series that features the most current information on cancer research, diagnosis, treatment and prevention. Each episode is available on the M. D. Anderson site or on iTunes.

By Laura Prus, Staff Writer

Kate Saunders noticed several years ago that when it came to her family, a history repeated itself. A history of cancer, that is. Multiple family members had been diagnosed with cancer, several at a young age.

After extensive research, Saunders discovered that her family's cancer history was a result of Lynch syndrome, an inherited tendency to develop colorectal, endometrial and other cancers.

Learning about Lynch syndrome

Saunders recognized something was unusual when she was 13 years old and her mother was diagnosed with ovarian and endometrial cancers.

After college graduation, Saunders began a career in research. During her 10 years working in the Department of Epidemiology at M. D. Anderson, she finally learned what triggered her family's history of cancer.

"I was sitting in a presentation in the Department of Epidemiology at M. D. Anderson and saw a family presented," she says. "It was a Lynch syndrome family, and it looked a lot like mine."

Although shaken, Saunders remained after the presentation to clarify her uncertainty. She left the presentation on a mission to discover whether or not Lynch syndrome ran in her family.

Putting the pieces together

"I started putting together my family's history and tracking down relatives, some of whom I had never met and didn't really know anything about," Saunders says.

It took a while for her to uncover the necessary information. She grilled her grandmother for names of relatives. Saunders also received help from family members who knew of her search.

When a close family member was diagnosed with colon cancer and Saunders was diagnosed with melanoma, she intensified her quest for information.

"I went after my family history more aggressively," Saunders says. "I began to pull death certificates, and it started to come together."

Final test is taken

The last step led Saunders to a genetic counselor. Having worked in family studies, she knew what was needed for the process. "I was unique in that I could provide a well-developed pedigree," Saunders says.

When she constructed her family tree, she recognized that it was a classic depiction of Lynch syndrome. The genetic counselor concurred.

"Although there was no tumor to genotype, it was pretty classic," Saunders says. "My family has one of the more common, but profound, HNPCC mutations."

Questions are answered

The answer was clear. Lynch syndrome, also called hereditary nonpolyposis colorectal cancer syndrome (HNPCC), runs in Saunders' family. This creates a great deal of risk.

The affected gene, which helps prevent colon and endometrial cancers, does not function properly for people with Lynch syndrome. Therefore, Saunders and other affected family members have a 60% to 80% chance of developing colorectal cancer, especially under the age of 50. Female relatives also incur a 40% to 60% lifetime risk of developing endometrial cancer, and both male and female relatives have an increased risk of developing a second primary cancer.

Precautions are crucial

To combat these high percentages, Saunders takes great preventive measures. "I go for fairly aggressive screening," she says. "My family has a lot of different cancers."

Her screening regimen includes an annual colonoscopy, endometrial screening and transvaginal ultrasound to evaluate the ovaries. As a melanoma survivor, she also gets skin exams and is cautious about her sun exposure. "I'm very careful and aware of things that change," Saunders says.

At 41 years old, she also is thinking about larger prevention measures in the future, including a possible hysterectomy.

Breaking the news

To ensure that affected family members begin to take the same precautions as Saunders, she informed them of her findings. "They all know about our 'cancer thing,'" she says. "They just have to come to accept that we, as a family, 'get cancer.' I have tried to explain it and I've encouraged folks to see the genetics services in their local areas, but you can't force people. They have to come to it on their own."

Now, with their knowledge of Lynch syndrome, Saunders and her family are better informed about the precautions they must take to prevent cancer.

Related article:
Q&A: Lynch syndrome

M. D. Anderson resources:
Lynch syndrome

Clinical Cancer Genetics


Additional resources:
NIH Genetics Home Reference - Lynch Syndrome

Representatives from all continents gathered at the Inflammatory Breast Cancer World Alliance meeting, held on Dec. 9 at the CTRC-AACR San Antonio Breast Cancer Symposium. The meeting was chaired by Massimo Cristofanilli, M.D.

Clinical and pre-clinical investigators and advocates from 30 countries have joined forces to find more effective treatment of this most aggressive type of breast cancer. In rare cancers such as IBC, an international collaborative is particularly important to create a large pool of patient data to draw conclusions.

IBC prevalence has been reported in North America, much of Europe and parts of Africa. These studies have contributed to the estimates that IBC makes up 1% to 5% of breast cancers. Published data have indicated that IBC may be more prevalent among women in North Africa (20% of breast cancers) and African-Americans (up to 10% of breast cancers).

Little is known about the prevalence of IBC among other ethnicities. To address this, the alliance has established an international registry trial that links epidemiologic data and patient tissue and blood samples from multiple centers around the globe. Members of the alliance will use the banked patient samples to explore the proteomics, genomics and immunobiology of the disease.

The 2010 inflammatory breast cancer scientific conference will be held on Oct. 5-7 in Marseilles, France, immediately preceding the European Society of Medical Oncology meeting in Milan. Patrice Viens, M.D., Institut Paoli-Calmettes, Marseilles, France, World Alliance member, is the program director. The first call for abstracts will be issued in early 2010.

The Inflammatory Breast Cancer World Alliance is committed to improving outcomes of women worldwide affected by IBC.

For information on joining the Inflammatory Breast Cancer World Alliance or the 2010 conference, contact ibcp@mdanderson.org.
 

By Sharon Giordano, Associate Professor, Department of Breast Medical Oncology

Results from several important studies on adjuvant hormonal therapy for breast cancer were presented Thursday at the CTRC-AACR San Antonio Breast Cancer Symposium.

The TEAM study compared the outcomes of over 9,000 post-menopausal women with hormone receptor positive breast cancer who were randomized to either a) five years of exemestane or b) tamoxifen for 2½-3 years followed by exemestane for a total of five years of treatment. With a follow-up of just over five years, the survival of both groups of women was virtually identical, although side effects were a little different. These results show that either up-front treatment with an aromatase inhibitor or a switching strategy results in equivalent outcomes.

Another study of aromatase inhibitors also was presented Thursday morning. The IES study compared the outcomes of postmenopausal women who were treated with 2-3 years of tamoxifen and then were randomized to either finish a total of five years of tamoxifen or switch to exemestane for the last 2-3 years. In contrast to the previous study, the women who switched to an aromatase inhibitor had superior disease free and overall study. However, this analysis excluded some of the women who were originally enrolled in the study but were later found to have hormone receptor negative breast cancer. Despite this limitation, the study shows that post-menopausal women who start on tamoxifen have better outcomes if they switch to an aromatase inhibitor after 2-3 years. 

A third study of aromatase inhibitors also had some very interesting findings. Dr. Goss presented a sub-analysis of the previously reported MA.17 study. The original study had compared the outcomes of women who were treated with five years of tamoxifen and then were randomized to either letrozole or placebo for five additional years. At the time of randomization, all women were required to be post-menopausal.

The original trial showed improved outcomes for the women who received letrozole. The analysis evaluated whether women who were pre-menopausal at cancer diagnosis but who went through menopause during the years of tamoxifen treatment benefited from letrozole. The findings were striking -- the women who became post-menopausal during treatment with tamoxifen had a large benefit of subsequent treatment with letrozole. These findings are very relevant as many women undergo menopause as a result of cancer treatment, and information about the effectiveness of aromatase inhibitors in this group has been limited. 

Now doctors and patients can feel more confident about the activity of aromatase inhibitors in this population of women. 

 

By Dawn Dorsey, Staff Writer

Cynthia Pettett admits she probably would still be smoking if she hadn't gotten cancer of the larynx (voicebox). After all, she started when she was 15. Even now, when she sits down with her morning coffee, that itch for a cigarette flashes across her mind.

When she was diagnosed in 2002, Pettett made the decision to travel from her home in Kentucky to M. D. Anderson, where she participated in a study that looked at treating larynx cancer with chemotherapy alone, rather than the conventional protocol that combines chemotherapy and radiation.

"When they asked me if I wanted to try to treat the cancer with chemotherapy, I jumped at the chance," she says. "I just felt like I couldn't handle the radiation."

Biopsy confirms cancer

Pettett and her husband are from Illinois, but they retired early to a scenic lake region of Kentucky, where they ran a marina for 20 years before she got cancer and they retired again -- this time for real.

Before she was diagnosed, Pettett didn't feel sick, but she was hoarse and lost a lot of weight. When she got down to 94 pounds, she knew something was seriously wrong. Still, she put off going to the doctor because a new otolaryngologist (ear, nose and throat doctor) was scheduled to come to Murray, Ky., where her primary care doctor is.

The new doctor performed a throat biopsy and told Pettett she had cancer of the larynx. Since their daughter lived in Bryan, Texas, about 90 miles from Houston, Pettett and her husband loaded up the car and drove to M. D. Anderson.

Texas treatment begins

At M. D. Anderson, she had six rounds of chemotherapy, each round lasting three days. The chemo was intense and required frequent blood tests to be sure her kidneys were functioning at the right level.

The treatment required a lot of energy; when it started in the late afternoon it lasted until the early morning hours. The Pettetts stayed at a hotel close to M. D. Anderson and between treatments drove back to Bryan so she could recover.

"A protocol nurse was assigned to me, and that really helped," Pettett says. "I could call her when I had any problems with side effects."

Side effects were bothersome

Although they weren't life threatening, there were several unpleasant side effects. Among them were nausea, helped by a pill before each treatment, and anxiety -- although Pettett says she never was frightened of the treatment.

"I was so restless I would walk the halls of the hospital with my IV pole while I was getting chemo," she remembers. "I was too anxious to sleep at night, but a sleeping pill really helped."

Although the chemo didn't make her hair fall out, Pettett did shave her head.

"The chemo really made my scalp hurt," she says. "That was the worst side effect. One of the nurses told me to have my daughter shave my head. What a relief! It felt so much better after that."

One of the most inconvenient parts of the treatment from her point of view was having to drink 7-8 bottles of water each day.

"I've never been much of a water drinker," she says. "My poor husband had to make me drink the water."

She knew she was improving

At first doctors weren't sure the treatment would be successful.

"But I knew it was working," she says. "I can't explain, but something was different and my voice was stronger. Then they did a biopsy at the next session, and sure enough I was right. It was working."

Treatment pays off

Now cancer free for five years, Pettett returns to M. D. Anderson every year.

"Things are back to normal now, and I'm so glad I had the treatment," she says. "If the cancer comes back, which of course I hope doesn't happen, I can always have another type of treatment later."

Related article:
Q&A: Treating Larynx Cancer With Chemotherapy Alone

In certain cases, cancer of the larynx (voicebox) can be treated successfully with chemotherapy alone, according to a recent study at M. D. Anderson.

Chris Holsinger, M.D., associate professor in the Department of Head and Neck Surgery, was co-author of the study, which is the first of its kind in the United States. He answers questions about this groundbreaking research that may provide hope for some patients.

How has the treatment for larynx cancer evolved over the past few decades?

Thirty years ago, the only option for cancer of the larynx, also called laryngeal cancer was surgical removal of part of the larynx. In the 1970s, treatment moved away from surgery and more toward radiation. Then we began to combine radiation and chemotherapy.

Leaders from M. D. Anderson and Banner Health broke ground today on the M. D. Anderson Banner Cancer Center. An event to mark the occasion took place on the campus of Banner Gateway Medical Center in Gilbert, Ariz.

Targeted to open in fall 2011, the new center will deliver cancer care to patients in Arizona through M. D. Anderson's collaboration with Banner Health, the state's leading nonprofit health care system.

"Banner Health is proud to join forces with M. D. Anderson to fight the battle against cancer," says Peter S. Fine, Banner Health president and CEO. "This groundbreaking marks a major milestone in the vision of our two organizations to provide access to a new level of cancer care in Arizona."

Announced in May, M. D. Anderson Banner Cancer Center will include a 120,000-square-foot, three-story building dedicated to outpatient services including physician clinics, medical imaging, radiation oncology, infusion therapy and many support services. It's this building that began construction today. The center will treat inpatients on two floors inside Banner Gateway Medical Center.



















"Breaking ground on this facility is exciting and real evidence of the commitment that our combined teams have made to those afflicted with cancer in Arizona," says John Mendelsohn, M.D., president of M. D. Anderson. "It's exciting to see our big plans show tangible progress as we prepare for the real work ahead -- reducing the burden of this disease."

















M. D. Anderson Banner Cancer Center will support the multidisciplinary care approach pioneered at M. D. Anderson, which includes individual areas for specific cancers. It also will feature many of the healing environment concepts upon which Banner Gateway Medical Center was built in 2007, along with the most advanced technology and electronic recordkeeping systems.

The center represents a $107 million project funded by nonprofit Banner Health through bonds. In addition, the Banner Health Foundation will engage the community in a fundraising campaign to support this project.


It's a matter of time. I have no doubt about it. The human will, determination and intellect that invented electricity, the phone, the radio, airplanes, the polio vaccine and penicillin, and that put a man on the moon, will definitely find the cure for cancer. Yet, I agree with most, including those who expressed their frustration in the recent New York Times article, that the war on cancer is taking too long to win. It's a war that we have to win. 

According to the American Cancer Society (ACS), 1,479,350 people in the United States will be diagnosed with cancer this year, and it's expected that 562,340 will die from it. In fact, cancer is the second most common cause of death in the U.S., accounting for 23% of all deaths. This means that one of four people living in the U.S. will eventually die of cancer.

A cancer diagnosis can be a shock. But a brain cancer diagnosis is even more challenging. A malignant brain tumor can impact patients' thoughts, speech and communication, and motor skills, and perhaps their ability to financially support themselves or their families.

Brain cancer is a rare disease that originates in the brain, spinal cord or nerves. According to the American Cancer Society, more than 22,000 people will be diagnosed and nearly 13,000 will die from brain cancer in 2009.

Monica Loghin, M.D., assistant professor in the Department of Neuro-Oncology at M. D. Anderson, answers questions on how to deal with a diagnosis and cope with the side effects of both the cancer and its treatment.

What can I expect during my first appointment?
During the first appointment, I always discuss the patient's diagnosis and treatment options. Many patients, however, feel overwhelmed during this appointment and may choose not to discuss details about treatment. In this case, I advise them to take it one step at a time and only gather information that they're able to cope with during their first visit. I suggest having a loved one present during appointments. They can provide emotional support through this process and be an extra pair of ears.

Here are some key questions to ask at a first appointment:
•    Is this a definitive diagnosis?
•    What type of tumor do I have?
•    What are my treatment options?
•    What support services are available to assist during my treatment?

What are the treatment options?
Depending on your diagnosis and type of cancer, a combination of the following treatments could be available:
•    Surgery
•    Radiation
•    Chemotherapy

Each treatment and the associated side effects are discussed with the specialist managing a patient's care.

As a neuro-oncologist, I manage the patient's chemotherapy. We discuss the side effects and concerns the patient or caregivers may have regarding therapy.

The selection of chemotherapy is based on the type of tumor and functional status of the individual diagnosed with the disease. If a patient is physically or mentally impaired, I choose a therapy with low toxicity. In addition, monitoring the individual's health during treatment is very important. When discussing treatment options with the patient, I share my reasons for choosing the chemotherapy, the side effects and any support M. D. Anderson offers.

What are the side effects of chemotherapy?
The usual side effects of therapy are:
•    Nausea
•    Constipation
•    Vomiting

How will treatment impact daily life?
Because chemotherapy impacts each patient differently, it's challenging to anticipate how each one will respond to treatment.

For some patients, chemotherapy may not impact their lives. They can continue working full time and maintain their full neurological functions. This isn't always the case, however. Those receiving treatment may be unable to continue working, which could impact their ability to financially support their families.

My goal is to help patients and family members cope with potential changes in their lives. I explain that treatment can leave patients unable to complete tasks that were once easy for them. They may not be able to think as quickly as before. When psychological effects like these arise, I involve our psychiatry team. The psychiatry team can help those diagnosed and their family members cope with these changes.

At M. D. Anderson, we have an education clinical pharmacologist on staff help monitor  each person's care. Every eight weeks, I evaluate patients' responses to treatment and the impact on their health. These evaluations allow me to make any necessary changes to the treatment schedule. If patients are responding to treatment, we discuss whether or not they can return to work -- or do so on a part-time basis.

What services can patients and caregivers seek to help them adjust and cope?
•    Look for social workers in your community. They can assist with transportation, parking or support at home. If patients exhibit neurological deficits, social workers can evaluate patients' at-home needs through home health support.
•    Sometimes a therapist can help patients and caregivers cope with a cancer diagnosis and the emotional side effects from treatment.
•    Many communities have support groups available to patients and their caregivers. These groups offer support and guidance from others who are facing or have overcome similar challenges.

Related article:
Love and Support Help Gulf Coast Resident Cope With Brain Cancer (November Cancerwise FA1)

M. D. Anderson resources:

Monica Loghin, M.D.

Brain and Spine Center at M. D. Anderson

Additional resources:

Brain Tumors (American Cancer Society)

Brain Tumor

Maurie Markman, M.D., vice president for clinical research at M. D. Anderson, talks about a study in Japan with Paclitaxel and Carboplatin, a standard regimen for the treatment of ovarian cancer.

The study results, published in The Lancet on Sept. 20, indicate that dose-dense weekly Paclitaxel plus Carboplatin improved survival of women with epithelial ovarian cancer and may represent a new treatment option.

Markman says, "Here's an example of where we take an established drug and simply learn how to give it better, and we have an important impact on our patients' lives."




Related Articles

Read the article in The Lancet
New Chemo Regimen May Benefit Ovarian Cancer Patients (U.S. News & World Report)


 

If ever there was a breast cancer in need of increased awareness, it's inflammatory breast cancer. IBC, also known as the silent killer, is a quickly spreading cancer that starts on the skin. Most of the time, there's no lump. This post is short and sweet with one take-home message -- know the signs of IBC.

Why the urgency?
Inflammatory breast cancer is a killer cancer. Caught early, treatment has a better chance. IBC is a "master metastasizer". For many women, IBC has already spread to lymph nodes and beyond by the time of diagnosis.

Signs and symptoms:

• • Increase in breast size, increasing to 2-3 times the size of the normal breast in a matter of a week or two.
• • Redness, rash or blotchiness of the breast. Some women report that it looks like a bug bite.
• • Pain and/or soreness of the breast. 
  
• • Lump, thickening or dimpling of the skin of the breast. 
  
• • Warmth or tenderness of the breast.
• • Lymph node swelling under the arm.
• • Flattening of the nipple or discharge from the nipple.

 

You don't have to have all the symptoms. If you see some of these signs, contact your doctor. If your doctor prescribes a round of antibiotics and the symptoms do not resolve, don't wait. Ask for a referral to a specialist who knows inflammatory breast cancer. Help fight this silent killer by knowing the signs. Knowledge is power.

Resources
Inflammatory Breast Cancer Toolkit (PDF)
Podcast: Inflammatory breast cancer -- Know the symptoms (Mayo Clinic)