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A Place Where Hope is the Norm

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NYT_MindyL.jpgIt'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.

These numbers are even more dreadful when you consider the global impact. The World Health Organization predicts that the number of people worldwide living with cancer will rise from about 28 million today to about 75 million in 2030. The challenge is so big, and those of us on the front lines have no illusion of what we're facing. The New York Times article clearly articulated this challenge.

But to balance these dismal statistics, one has to keep in mind that more and more people survive cancer every year. In 2005, the ACS estimated that more than 11 million cancer survivors were in the United States, and this number continues to increase. 

In my own subspecialty, there are many success stories. For example, over the past decade, the expected survival of patients with indolent lymphoma has increased from an average of eight years to 15 years. For mantle cell lymphoma, it increased from 1.5 years to more than five years, and for Hodgkin's lymphoma the cure rate improved from 30% in 1960 to almost 80% today.  

More broadly, after almost three decades of a stalemate, cancer mortality is starting to slowly decrease. Furthermore, our knowledge of the basic molecular and genetic structure of cancer cells has exploded, identifying new therapeutic targets. A decade ago, only a few drugs were in development for cancer. Today, there are more than 800 drugs, with more coming. So I'm confident that we're on the right track, and it's only a matter of time until we find the cure.

So how do we speed up the process? In my opinion, one of our biggest challenges is the inadequate participation of patients in innovative clinical trials. The public is rightly expressing frustration on the slow progress. But to demand and expect speedy development, they also have to actively participate in clinical trials. With an average of less than 10% of cancer patients participating in clinical trials in the U.S., one shouldn't be surprised that the field is moving forward at a slow pace. 

When I read the New York Times article, I was concerned that, despite the challenges that we all face in the war on cancer, a message of hope may have been unintentionally missed. So I posted the article on my Facebook page and asked my followers, many of whom are patients and cancer survivors, to comment.

To lead the discussion I stated, "While I agree that there is so much work to be done, the article should have provided a more balanced picture of the many patients who are cured of cancer and are living a normal life with their loved ones. I also think that we need to move away from the currently available harsh treatments that are debilitating. We need to develop more gentle targeted therapy that are effective but maintain a good quality of life ..." And here are some of the comments that were posted:

"I can see and understand your point of view, Dr. Younes. At the same time, I'm also glad that the author expressed the gravity of the cancer battle. Too often these days, I think, people who haven't been touched by the disease assume that modern science has evolved to the point that cancer is uniformly curable with one shot. That belittles the gravity of the malady and the fight patients wage each and every day. If this article informs that viewpoint, I'm grateful. That said, I do agree with you that there is great hope, and that's what we must focus on to advance treatment and management of cancer. Thank you, speaking from my heart and as a survivor, for your efforts on that front!"

"I could not agree more Dr. Younes - the article really focuses on the most difficult cases ... but that is why the people with difficult cases come to MD Anderson - b/c MDA will stop at nothing and will always give you hope ..."

"My time at MDA was the best medical experience I've ever had. Ironic, given it was related to the worst diagnosis I've ever had. Thanks for sharing!"

Having worked at M. D. Anderson for the past 16 years, I know that the message of hope prevails on everyone's face and is implanted in everyone's soul. I see it on the faces of everyone who works here, from the president to the cleaning crews. After all, it's this spirit of optimism, dedication and hope that will help us eliminate cancer in Texas, the nation and the world.

Q&A: Coping With a Brain Cancer Diagnosis and Treatment

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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


Ovarian Cancer Drug Research = Improved Survival

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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)

Q&A: Gamma Knife® Radiosurgery for Brain Tumors

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Gamma Knife® is a major advance in the field of stereotactic radiosurgery for certain brain cancer patients. It offers a non-invasive procedure that can be performed in one session and with extreme precision.

Answering questions about this procedure at M. D. Anderson is Eric Chang, M.D., associate professor in the Department of Radiation Oncology.

What is a Gamma Knife?
The Gamma Knife is a 30-ton machine that contains a cylindrical cone made of the world's largest piece of tungsten with lead shielding. The machine has 192 Cobalt-60 radiation sources that are shaped by eight sectors that surround the patient's head.

GammaKnife.jpgThere is a theoretical possibility of choosing from 65,000 combinations of highly focused radiation beams.These can be used to create customized shots that target a particular brain tumor, allowing each shot to be tailored to the shape of the patient's tumor.

In addition, the current Gamma Knife model can treat a larger volume of brain area than previous models, which allows greater cranial reach of tumors located in extreme anatomical locations. It has great accuracy to one-tenth of a millimeter and can reach deep-seated targets.

What is Gamma Knife radiosurgery?
Gamma Knife surgery is actually a form of radiation therapy invented in 1967 by Lars Leksell, a Swedish neurosurgeon. The latest model, Perfexion, has been redesigned and re-engineered, and it is the first fully automated Gamma Knife at M. D. Anderson.

For the one-day procedure, the patient first has a brain MRI with a head frame placed by a neurosurgeon. Then the Gamma Knife team creates a customized treatment plan, which is  delivered to the patient who lies on a sophisticated and highly accurate patient positioning system (PPS). The patient's head is inserted into the cone-shaped tungsten cylinder that delivers highly focused gamma rays around the head.

While the contribution of each ray is relatively small -- allowing for less damage to surrounding healthy cells -- when the multiple rays converge on the tumor, they have great intensity. The Gamma Knife unit also has an audio/visual connection so the patient can be seen and also communicate with the treatment team.

Who is eligible for Gamma Knife radiosurgery?

The brain radiosurgery tumor board is a multidisciplinary team of radiation oncologists, neurosurgeons, neuron-radiologists, a radiation physicist and a nurse. At tumor board meetings, each case is discussed to decide if Gamma Knife radiosurgery is the best option. Radiosurgery is especially important for patients who have no other treatment options, including those not eligible for standard surgical techniques due to illness or advanced age.

The Gamma Knife is considered most effective in the treatment of intracranial tumors (within the cranium and the skull base below the brain) such as:

•    Brain metastases (cancer that has spread to the brain from other parts of the body)
•    Acoustic neuromas
•    Pituitary adenomas
•    Craniopharyngiomas
•    Meningiomas
•    Gilial tumors
•    Skull base tumors
•    Upper cervical spine tumor

What is the process?
Generally an outpatient treatment, the surgery consists of four steps:

1.    Early morning placement of the Leksell stereotactic coordinate frame, which will hold the patient's head in place during imaging and treatment
2.    MRI of the brain, which accurately locates and visualizes the tumor
3.    Planning of treatment using a Gamma Planning Computer  
4.    Treatment, followed by observation in the Post-Anesthesia Care Unit

Depending on the number and complexity of the tumors, the delivery of radiation treatment can take from 15 minutes to several hours. A patient usually can return to a normal routine and activities after 24 hours.  

What are the advantages of Gamma Knife surgery?
Because it is non-invasive and no surgical incision is required, the physical trauma and the majority of risks associated with open neurosurgical procedures are avoided. The procedure is recognized worldwide and supported by more than 2,500 peer-reviewed research articles. In addition, more than 50,000 patients are treated with Gamma Knife every year by the approximately 250 machines in use around the world.

Related article:
Gamma Knife® Radiosurgery Targets Brain Cancer


M. D. Anderson resources:

Brain Cancer

Eric Chang, M.D.

Division of Radiation Oncology


Additional resources:

Detailed Guide: Brain/CNS Tumors in Adults (American Cancer Society)

Brain Tumors (National Cancer Institute)

Gamma Knife

Patient Information - North America (Elekta)


Cancer Newsline... This Month in Cancer News - October 2009

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Diabetes Medicine May Reduce Cancer Risk
Drug May Help Prevent Pancreatic Cancer

Metformin, the most commonly prescribed drug for diabetes, may help protect against pancreatic cancer. Diabetes is a known risk factor for the disease, one of the most dangerous forms of cancer.

According to a study completed by researchers at M. D. Anderson and published in the Aug. 1 issue of Gastroenterology, the anti-diabetic drug reduces the risk of pancreatic cancer by 62%.


Blood Test May Detect Pancreatic Cancer

MicroRNAs Show Promise as Biomarkers

A blood test for molecules that are produced abnormally in pancreatic cancer may provide a promising route to early detection of the disease.

Researchers at M. D. Anderson reported their findings in the September edition of the journal Cancer Prevention Research.


Cancer Newsline Audio Podcast Series

Cancer Pain Management

Dr. Allen Burton, chair of the Department of Pain Medicine at M. D. Anderson, speaks about cancer pain management. About one-third of patients being treated for cancer experience pain and it can take many forms. Whether chronic or acute, pain is unique to each patient and it is vital that each patient's pain treatment plan be tailored to their personal needs.

Traditional Chinese Medicine and Cancer Treatment
Lorenzo Cohen, Ph.D., director of M. D. Anderson's Integrative Medicine Program, and Peiying Yang, Ph.D., assistant professor in the Integrative Medicine program, discuss the in-roads traditional Chinese medicine has made in western medicine and cancer treatment.


Bones May Take a Beating During Cancer, Treatment

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By Bayan Raji, Staff Writer

You may think the skeletal system is pretty stable, supporting the body but not changing much over the years.

Not so. The skeleton always is changing, and it's important, too. The skeleton is the body's source of calcium; without it the brain couldn't function.

"Bone health should be a concern for everyone, especially cancer patients," says Robert Gagel, M.D., professor in the Department of Endocrine Neoplasia and Hormonal Disorders at M. D. Anderson.

Cancer, treatment are culprits
Some cancer treatments may lead to increased bone loss. These include:

•    Breast cancer treatment
•    Targeted therapy treatment
•    Prostate cancer treatment
•    Immunosuppressive agent treatment

Certain cancers, such as multiple myeloma, stimulate bone loss and inhibit formation of new bone.


Early menopause robs bones
Chemotherapy for breast cancer often induces early menopause (the end of a woman's menstrual cycles). Menopause leads to a deficiency in estrogen, which may cause bone loss. Many breast-cancer patients develop bone loss at a younger-than-normal age, which increases their risk of osteoporosis.

"If we don't do something to prevent bone loss at the beginning of treatment, a 45-year-old woman might begin to have bone fractures in 20 years," Gagel says.

Men are affected also
Testosterone in men helps protect bone, much like estrogen does for women. Although
several therapies are available to treat prostate cancer, they all lower testosterone levels.

In most cases, men begin with higher bone density than women, so it takes longer for them to reach levels of bone loss that might lead to fractures. However, the problem should be addressed.

Drugs deliver double punch
Patients who have bone marrow transplants and take immunosuppressive drugs, such as glucocorticoids, face two problems. High doses of these drugs, meant to decrease the risk of the body rejecting the transplant, may:

•    Increase the rate of bone breakdown
•    Decrease the rate of bone formation

Cancer patients often have decreased appetites, and if they receive chemotherapy they may be nauseated as well. As a result, they may not eat well, which may cause a calcium deficiency.

"If we don't take in enough calcium in our diet, our body will withdraw it from the skeleton. If unchecked, this will lead to osteoporosis," Gagel says.

Vitamin D is crucial
Many patients also have vitamin D deficiencies, either because they do not get enough in their diet, or they have liver or kidney failure so their body does not make it.

Vitamin D enables the body to absorb calcium from foods and supplements. While the minimum daily requirement is set at 400 to 600 IUs (international units), many researchers suggest it should be much higher.

Fifty percent of the population in the United States is vitamin D deficient, Gagel says.
This means that, even if they are getting the daily recommended amount of calcium, they are absorbing only about half of it.

Bone up on health
Take your bone health seriously. You may be able to prevent serious problems down the road if you:

•    Add calcium-rich foods to your diet
•    Exercise regularly

Gagel recommends that patients speak to their doctors about any bone health concerns. Ask if you should:

•    Take calcium supplements
•    Check your vitamin D level
•    Have a bone density test

M. D. Anderson resources
Bone Health
Department of Endocrine Neoplasia and Hormonal Disorders


Additional resources
Chemotherapy Causes Bone Loss in Young Women (American Cancer Society)
Calcium (American Cancer Society)

By: Laurence Cooper, M.D., Ph.D., associate professor, Department of Pediatrics

Significant advances have been made in the treatment of pediatric cancer through clinical trials that compare chemotherapy regimens in patients to determine which one works best against a particular cancer. While this strategy has worked for the past three decades to improve the chances of children surviving cancer to 80%, this approach is reaching a point of diminishing returns.

Why is this?
For one, pediatric oncologists rely on chemotherapy drugs that were mostly developed decades ago. For children whose cancer relapses, their options are limited due to the lack of new agents on the market. In addition, relapsed cancers tend to be resistant to chemotherapy.

Secondly, for childhood cancer survivors, the drugs that have cured them also have made a long-term impact on their bodies. According to the Childhood Cancer Survivor Study, nearly 75% of childhood cancer survivors will develop chronic health problems or secondary cancers within 30 years of diagnosis. If a child is diagnosed between the ages of 5 and 10, that means that 35- to 45-year-olds are having major problems. New agents are needed to improve the chances of surviving and reduce the toxicities of treatment.

What are the barriers?
The problem pediatric oncologists face is a lack of new drugs designed for pediatric cancers. The bottom line for biopharmaceutical companies is that they typically cannot recoup the financial cost of developing new therapies for rare cancers, such as those in children. So, pediatric oncologists often rely on medicines that were developed for adults and then project their impact for children. This "hand-me-down" approach has inherent problems as no cancer therapy for adults is invented anticipating greater than a 30-year survival from disease.

What's the solution?
Cell-based therapies can provide an answer to these barriers. Many people think of cell therapy as simply bone marrow transplants, but the world of cell therapy encompasses even more therapeutic approaches to treating cancer.

Cell therapy is an approach being pioneered at a few centers to harness the power of a child's immune system to target their tumor. These therapies can be made specifically to kill cancer cells based on an entirely different principal than disrupting cell division like chemotherapy does. You and I are born with an immune system that has an exquisite ability to separate invading organisms from our own cells. Thus, for most of us, we can fight off an infection without fighting off ourselves.  

Investigators at M. D. Anderson and elsewhere have developed tools to turn immune cells into cancer-fighting cells. Clinical trials within the Children's Cancer Hospital at M. D. Anderson are now establishing the safety and feasibility of this approach. Investigators are infusing two types of immune cells, T cells and NK cells, as an approach to safely attacking tumors that are resistant to chemotherapy. Just as your naturally occurring immune cells provide ongoing surveillance against recurrence of infection, so the expectation is that these cancer-specific immune cells, provided through immunotherapy (a type of cell therapy), will patrol the child's body and be able to respond and possibly prevent recurrence.

We live at the beginning of the golden age of cell therapy. Clinical trials are investigating the promise of this approach.

By: Dean A. Lee, M.D., Ph.D.assistant professor, Department of Pediatrics, Cell Therapy Section

Why all the fuss?
You can hardly be alive and breathing and not be aware of the ethical and political struggles the world has endured over stem cells for the past several years. In a world that's already jaded to the exposure the media gives to new advances in medical science, stem cell research has become the poster child for what the hyperbole of Washington and Hollywood can do to (for?) science. 

Last week, the Washington Post reported the release of new federal rules governing which embryonic stem cells could be used for research, and the week prior U.S. News & World Report ran an article discussing the promise of stem cells. Three weeks ago, My Sister's Keeper was released in theaters, a cinematic adaptation of Jodi Picoult's best-selling novel about the potential legal and ethical conflicts of stem cell donors.

In spite of all the recent discussion on this subject, there's still much confusion about the different kinds of stem cells, the procedures available, and the issues surrounding stem cell therapies.
 
What is a stem cell?
The great majority of cells in our body have one very specialized function: they make hair, or sweat, or they twitch, or they make insulin, or they absorb nutrients, etc. They dutifully perform these tasks until they die. Somewhere in nearly every organ, though, is a cell that makes replacements for these cells that die, and occasionally, also makes a replacement for itself. Something like a beehive, where almost all of the bees on the colony are specialized as drones or workers, but somewhere deep in the hive is a queen making more of them. And, every so often, the queen is able to make another queen. That ability to reproduce itself is the hallmark of a stem cell.

Forward motion
Cells in our body generally become more and more specialized until they become fully functional mature cells. This is a process called differentiation, and this process typically moves in only one direction. That is, once a cell has gained a specific function, it usually can't go back to being a less-specialized cell. This is why embryonic stem cells are usually described as having so much potential -- because they can, under the right circumstances, become anything. They are, coming from an embryo, the least specialized human cell that there is.

The embryonic stem cell eventually gives rise to more specialized stem cells: skin stem cells, liver stem cells, blood vessel stem cells, or blood-forming stem cells (referred to as hematopoietic stem cells or HSC). These cells can't make any cell in the body, but can make many different cells of a particular tissue type. So, the answer to the question in the title of this blog is "no." There are many regulations regarding HSC, but none of them are affected by the regulations for embryonic stem cells.

 
Hematopoietic stem cellsImage from NIH Stem Cell Information

Hematopoietic stem cells
If all you need is blood-forming stem cells, however, the medical research community has a wide variety of well-established sources and procedures -- many that have been in use for more than 30 years. We can obtain these cells from their native source (bone marrow), from the blood of a donor or from a discarded umbilical cord. All of these sources are rich in HSCs and none of them come from an embryo. 

Researchers at M. D. Anderson are investigating ways to grow more cells from cord blood, purify the stem cells from blood, increase the number of stem cells in the blood, change the genes of stem cells, grow special immune cells from stem cells and make the stem cells better at finding their way back to the bone marrow. In addition, we have exciting new research using a new kind of stem cell from the structural part (instead of the blood-forming part) of the bone marrow, called mesenchymal stem cells. Some of these new approaches are already available to patients in clinical trials.

Until a few years ago, only a handful of physicians and nurses -- and an even smaller number of women in the community at large -- had ever heard of a rare but fast-growing type of breast cancer, inflammatory breast cancer (IBC).

The birth of the Internet provided a vehicle for mass communication unparalleled in our history. Perhaps, like me, you were the recipient of the first e-mail alert with a subject line of "the breast cancer without a lump: what every woman should know." That first alert was composed by the mother of a young woman in her 30s who was losing her battle with inflammatory breast cancer.

For decades, women have been lulled into a false sense of security when it comes to breast cancer. That is if you perform monthly self-checks and have an annual mammogram screening after age 40, you'll be able to catch breast cancer in its early stages. These are important guidelines that every woman should heed, but inflammatory breast cancer doesn't play by conventional rules. What about "the breast cancer without a lump"?

Inflammatory Breast CancerIBC is particularly aggressive. The five-year survival rate for IBC is only 40%. (The five-year survival rate for all breast cancers combined is 87%.) It occurs in relatively young women. It's not uncommon to see women in their 30s to 50s in our Inflammatory breast cancer Clinic at M. D. Anderson. The cancer has often spread to the lymph system or beyond at the time of diagnosis. That's why it's so important for every woman to know the signs.

Inflammatory breast cancer appears on the skin of the breast. There's seldom a palpable lump. It may initially look like a bug bite or a breast infection, such as mastitis. The women in our IBC Clinic tell a similar story of noticing a small, red patch that spreads in a matter of days or weeks; a swollen, hot breast with no fever; and skin that is puckered or dimpled. If you notice these signs, don't delay getting to your physician. Your doctor may prescribe a round of antibiotics. If there isn't marked improvement after one course, pursue a referral to an IBC specialist.

So what's the good news here? While breast cancer as a whole will affect one in eight women in their lifetime, IBC is relatively rare. It accounts for about 2% to 6% of breast cancers. Our patients now have clinical trials for IBC that combine standard chemotherapies and targeted therapies like lapatinib. New agents are being tested in pre-clinical settings in our laboratories with more clinical trials set to open soon.

In M. D. Anderson's Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, our motto is "Teach it. Treat it. Beat it." We have assembled a team of clinicians, researchers and advocates who are passionate about raising awareness of inflammatory breast cancer, identifying tools for earlier diagnosis and new treatments that will mean better outcomes for our patients. Help us spread the word.



Q&A: Gestational Trophoblastic Cancer

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Gestational trophoblastic cancer (GTC) is a rare, yet highly treatable, disease. Although it is sometimes referred to as gestational cancer, it usually does not coincide with a successful, long-term pregnancy.

Karen Lu, M.D., professor in the Department of Gynecologic Oncology at M. D. Anderson, answers some questions about this unusual cancer.

What is GTC?

GTC is a rare cancer in which malignant cells grow in the tissues that are formed in a woman's uterus following conception (the joining of sperm and egg). The uterus is the hollow, pear-shaped organ where a fetus grows.

Most frequently, GTC develops after a woman experiences a miscarriage or molar pregnancy.

A molar pregnancy, which occurs in one of 1,000 pregnancies in the United States, is an abnormality of the placenta that leads to a growth of abnormal tissue when an egg is fertilized. A developing embryo is rarely present, but the tissue grows rapidly and appears in grape-like cell clusters.

Rarely, GTC can occur after a live birth. This is called choriocarcinoma.

GTC generally affects women younger than 20 and older than 40.

What are the symptoms of GTC?

The main symptom is abnormal vaginal bleeding, especially after a miscarriage, but also after a molar pregnancy or live birth. Abnormal bleeding would be defined as bleeding between normal menstrual periods or bleeding almost every day instead of having menstrual periods.

If a woman has a molar pregnancy, she usually will be monitored afterward to make sure she doesn't develop GTC.

How is GTC diagnosed?

Most often, a woman notices irregular bleeding and visits her doctor, thinking maybe she's pregnant. The physician may test the patient's level of human chorionic gonadotropin (hCG), which is elevated in pregnancy and in GTC.

If the hCG level is high, the doctor probably will perform an ultrasound to determine if the pregnancy is normal or molar, or if tumors are present.

What is the treatment for GTC?

Once a woman is diagnosed with GTC, CT (computed tomography) scans are performed to determine if the tumor has spread beyond the uterus.

If the tumor has not moved outside the uterus, the patient typically has chemotherapy until hCG levels return to normal. Levels are monitored for about a year to make sure they remain normal.

If GTC has spread beyond the uterus, treatment may include chemotherapy and/or surgery.

What is the prognosis for women diagnosed with GTC?

GTC has a cure rate greater than 90%, depending on the tumor's sensitivity to chemotherapy.

The ability to measure hCG levels has helped increase survival in recent years.

Women with GTC have higher rates of survival when they are referred to specialized centers with experience in treating this rare disease.

Does GTC or its treatment affect a woman's ability to have children?

To treat this cancer, doctors typically don't need to remove the uterus. Many women go on to have children after treatment.

What are some risks associated with the disease?

Because GTC can occur in women over 40, some patients may think they're going through menopause when they experience irregular bleeding and not visit their physicians.

Also, because GTC isn't very common, it's often misdiagnosed. Women of reproductive age can request their physician measure their hCG levels if they're concerned.

What should a woman do if she is diagnosed with GTC?

Once a woman is diagnosed, it's in her best interest to go to a specialized center that frequently sees cases of GTC. Overall, GTC is easier to treat and monitor than other cancers, but certain subtypes can be aggressive and more difficult to treat.



Related article:
New Mom Finds Strength in Cancer Ordeal

M. D. Anderson resources:


Karen Lu, M.D,

Gynecologic Oncology Center

Sources:
What is Gestational Trophoblastic Disease? (American Cancer Society)


Read more Feature Stories from Cancerwise

Tissue Donations Help Advance Research

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By Mary Brolley and Bayan Raji, Staff Writers

When people are diagnosed with lymphoma, they probably aren't thinking of ways to help prevent or treat the disease. However, a tissue donation to M. D. Anderson's Lymphoma Tissue Bank could help researchers do just that.

The purpose of the bank - and others like it - is to collect, process and store tissue samples for research. The samples then are distributed to research teams within M. D. Anderson as well as investigators collaborating with the institution.

Lymphoma is a general term for cancers that develop in the lymphatic system, the tissues and organs that produce, store and carry white blood cells.

Tissue aids research

The more researchers learn about lymphoma, the more they realize that each patient's disease progresses differently.

Researchers hope to advance treatment of the disease and help patients live longer.
Using the donated tissue, they will study how lymphoma develops and try new drugs on tissue samples before testing them in people. This will allow drugs that are likely to have the best chance of success to be moved rapidly from the laboratory to the clinic for the benefit of patients.

Rare lymphomas need investigation

Two types of lymphoma, follicular and diffuse large B-cell, account for about 50% of lymphoma cases diagnosed. The tissue bank is especially important for finding out more about the less common forms of lymphoma.

Researchers hope patients with less prevalent forms of the disease such as Hodgkin's lymphoma, T cell lymphoma, marginal lymphoma, Burkitt's lymphoma or people with AIDS (acquired immune deficiency syndrome) will benefit from increased research on potential treatments.

Patients are informed about process

About 400 people have enrolled in the M. D. Anderson Lymphoma Tissue Bank over the past year, and the numbers continue to grow, says Sattva Neelapu, M.D., assistant professor in the Department of Lymphoma and Myeloma at M. D. Anderson.

Doctors make it a point to inform patients about the bank and its potential value. Established patients are approached when they visit the cancer center for procedures. New patients learn early in their treatment about the bank and how they can contribute.

"We discuss tissue donation with new patients on their first visit," Neelapu says. "They have the option to accept or decline, but the majority are eager to donate their tissue for research."

Process is not inconvenient

Tissue samples for the bank are taken from biopsies performed during the diagnostic process, which means patients are not inconvenienced with special procedures to retrieve samples, Neelapu says.

"We don't stick patients simply to get tissue for the bank," he says. "At no point do we do a procedure just for research purposes."

Typically, only a portion of the tumor or tissue sample is sent to the diagnostics lab, while the remaining parts are discarded. If a patient agrees to donate tissue to the bank, left over specimens are used for research.

Research has wide-ranging effects

The advances made possible because of the Lymphoma Tissue Bank will help patients everywhere with this disease, not just those at M. D. Anderson.

"This bank is beneficial for patients, the institution and research in lymphoma in general because it will help us better understand how lymphoma starts and grows and help us develop new therapies," Neelapu says. "It also will help us develop a larger coalition with other researchers and institutions conducting lymphoma research."

A new informational brochure helps explain the process and purpose of tissue donation to patients. Neelapu hopes it will encourage patients to donate tissue.

"Great strides are being made in the treatment of this difficult disease," he says. "These advances are possible because researchers have been able to conduct research in the lab using lymphoma tissue. The more tissue we have to work with, the more advancements we can make."

M. D. Anderson resources:

Hodgkin's Disease

Non-Hodgkin's Lymphoma

Sattva Neelapu, M.D.

Department of Lymphoma and Myeloma

Lymphoma and Myeloma Center


Other resources:
Overview: Lymphoma, Non-Hodgkin Type (American Cancer Society)

What You Need to Know About Lymphoma (Lymphoma Research Foundation)


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