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Cancer Report 2011

2011 Analysis:

Thyroid Cancer Figure 1

Newly Diagnosed Thyroid Cancers 2005-10 60 58 53 48 Number of Cases

43 34

16

0

2005

2006

2007

2008

2009

2010

Years

Figure 2

2010 Thyroid Cancer Cases by Race

Non-White

Dr. Paul Weinberger Assistant Professor Medical College of Georgia Department of Otolaryngology/Head and Neck Surgery Georgia Health Sciences University

African American/Black 33% Asian Indian or Pakistani 2%

35% White

65%

Figure 3

Thyroid Cancer Patient Age at Diagnosis in 2010 400 351 Number of Cases

283

205 136 62

0

62

44

0 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89 Age Range

4 90+

Thyroid cancer arises in the thyroid gland, located in the midline of the neck just under the “Adam’s apple.” The thyroid gland’s primary function is to produce thyroid hormone, which regulates the body’s overall metabolic rate. Thyroid cancer is the most common endocrine cancer (some 44,670 new cases were diagnosed in the United States in 2010, according to the American Cancer Society), with 75 percent of cases occurring in women. The incidence of thyroid carcinoma has more than doubled in the past three decades from 4.85 cases per 100,000 people to 11.03 cases per 100,000 people2, making thyroid cancer the fastest-increasing cancer type in both men and women. The GHS Cancer Center has reflected this trend, treating 252 cases in the past five years (Figure 1). Of the 48 new thyroid cancer patients in 2010, 65 percent were Caucasian, 33 percent African-American and 2 percent another ethnicity (Figure 2). Thyroid cancer affects all ages, with the average age of Georgia Health Sciences Cancer Center patients (51 years) matching national trends (Figure 3). Most cases are diagnosed when a lump in the neck (thyroid nodule) is discovered by the patient or a primary care physician, or by an imaging study such as CT-scan. While 95 percent of thyroid nodules are not cancerous, any new

lump or mass should be evaluated by a physician. Other symptoms can include trouble breathing when lying flat, difficulty swallowing and tightness or pain in the neck or throat. Scientists at GHSU, funded by the American Academy of Otolaryngology, are making great strides toward developing a blood test to diagnose thyroid cancer.

Figure 4

Stages of Thyroid Cancer Diagnosed 2000-2008 100%

Percentage of Cases

The five-year survival rate for thyroid cancer is 97 percent, although, as with many other cancers, the rate varies widely depending on when it is diagnosed. When diagnosed at stage IV, the five-year survival rate is 59 percent nationwide—a dramatic improvement from the approximately 30 percent rate just five years ago (Figure 4). Cancer treatment requires a multidisciplinary approach. The Georgia Health Sciences Thyroid and Parathyroid Center includes endocrinologists specializing in diagnosing and managing thyroid and parathyroid disorders and surgeons specializing in thyroid surgery. Diagnosis usually involves fine-needle aspiration, in which a tiny, ultrasound-guided needle is gently inserted into the thyroid nodule. Cells from the nodule are studied microscopically to determine if they are cancerous.

0

Thyroid cancer remains a daunting adversary, but the GHS Cancer Center and Thyroid/Parathyroid Center provide an ideal partnership to diagnose and treat the disease in a patient- and family-centered environment. Cutting-edge research promises improved diagnosis and treatment.

II

III

IV

NA

UNK

MCG Health

Other

Figure 5

2010 Analytic Cases: Site by Gender Colon

Surgery is the treatment of choice for primary thyroid cancers. Patients worldwide come to Georgia Health Sciences Medical Center to benefit from the worldrenowned expertise of Dr. David Terris, who specializes in minimally invasive thyroid surgery. Surgery is often followed by radioactive iodine treatment to destroy any microscopic remnants of tumor cells. This is usually given as a single, oral medication and requires an overnight stay in the hospital. Since surgery and the iodine remove the functioning thyroid gland, patients require an oral replacement thyroid hormone. The GHS Cancer Center has partnered with the National Cancer Institute to decode the genetic basis for over 20 types of cancer, including thyroid cancer. Institutions including Memorial Sloan Kettering, the Dana Farber Cancer Institute and M.D. Anderson Cancer Center are also participating in the project, called The Cancer Genome Atlas (TCGA)3. This opens the door to a multitude of discoveries concerning the causes and treatments for thyroid cancer.

I

Stage at Diagnosis

Larynx Bronchus & Lung Hematopoietic & Reticuloendo System Breast Corpus Uteri Prostate Gland Bladder Thyroid Gland Lymph Nodes

0

25 Female

1. 2. 3.

50

75

100 Male

125

150

175

283 Transsexual

American Cancer Society Cancer Facts & Figures 2010. Atlanta, GA. Page 20. Davies, L. and H.G. Welch, Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA, 2006. 295(18): p. 2164-7. The Cancer Genome Atlas. cancergenome.nih.gov. Accessed July 1, 2011.

Cancer Registry and Statistical Summary The Cancer Registry collects data and monitors all types of cancer diagnosed and/or treated at Georgia Health Sciences Cancer Center. Its database is a fundamental element of the cancer program, providing the information needed to evaluate and plan cancer services. Cancer data is submitted monthly to the Georgia Comprehensive Cancer Registry and annually to the National Cancer Data Base, both of which pool our data with that of other participating facilities. The resulting statistics illustrate statewide and nationwide trends in cancer incidence, and help clinicians and researchers evaluate treatment efficacy.

Cancer Center in 2010 (589 cases), compared to 48 percent female (557 cases). The top analytic sites are: lung, 15 percent; breast, 13 percent; prostate, 12 percent; blood, 5 percent; thyroid, 4 percent; lymph node, 4 percent; corpus uteri, 4 percent; colon, 3 percent; bladder, 3 percent; and larynx, 3 percent. National top sites are: lung, 15 percent; breast, 13 percent; prostate, 13 percent; colon, 8 percent; and bladder, 5 percent (other sites, 34 percent). The registry staff follows more than 8,000 patients annually to obtain disease status and survival information and maintains a 90 percent follow-up rate.

Nearly 18,000 cases have been added to the registry since its establishment in 1985. In 2010, 1,509 analytic and non-analytic cancer cases were added. 1,147 patients were diagnosed and/or initially treated at GHS Cancer Center, and 362 were treated here for cancer recurrence or progression. Males comprised 52 percent of cancer patients diagnosed and/or treated at Georgia Health Sciences

A Cancer Registry Manager and two Registry Services Specialists staff the Cancer Registry. The registry coordinates the facility’s cancer conferences and quarterly Cancer Committee meetings, helps prepare for the triennial Commission on Cancer accreditation survey, contributes to the Annual Report and reports data to clinicians and administrators.

Figure 5

For more information about the Cancer Registry, call 706-721-1768.

2010 Analytic Cases: Site by Gender

2010 Analytic Cases: Site by Gender Colon Larynx Bronchus & Lung Hematopoietic & Reticuloendo System Breast Corpus Uteri Prostate Gland Bladder Thyroid Gland Lymph Nodes

0

25 Female

50

75

100 Male

125

150

175

283 Transsexual

Reference: Cancer Facts and Figures: 2010, American Cancer Society

Figure 6

2010 Analysis: Geographic Distribution of Patients

Patient Origins at Diagnosis in 2010

Dade

Towns

Fannin

Catoosa

Union Whitfield

White

Lumpkin Gordon

Chattooga

Dawson Floyd

Cherokee

Cobb

Haralson

Clarke

Greene

Morgan

Jasper

Monroe

Upson

Putnam

Hancock

Jefferson

Marion Chattahoochee

Johnson

Screven

Early

Wilcox

Crisp

Lee

Coffee

Tift

Baker Miller

Berrien Mitchell

Jeff Davis

Irwin Worth

Colquitt

Thomas

Brooks

Evans

Toombs

Bryan

Tattnall

Chatham Liberty

Appling

Long

Bacon

Wayne

McIntosh

Pierce

Ware Lanier

Grady

Effingham Bulloch

Atkinson

Cook

Seminole Decatur

Candler

Telfair Ben Hill

Turner Dougherty

Wheeler

o m er y

Dodge

Webster

Calhoun

Treutlen

Mo ntg

Dooly

Sumter

Clay

Laurens

Bleckley

Houston

Pulaski

Schley

Terrell

Emanuel

Peach Macon

Burke

Jenkins

Wilkinson Twiggs

Muscogee

>100 26-99 11-25

Washington

Bibb

Taylor

Richmond

Glascock

Baldwin

Jones

Crawford

Talbot

Columbia

e

Lamar

Meriwether

Randolph

VA

uffi

Pike

Quitman

TX

Taliaferro Warren

Butts

Spalding

Stewart

SC

McD

Newton

Coweta

Harris

PA

Lincoln

Wilkes

Henry

Fayette

Troup

NY

Oglethorpe

le

Clayton

Heard

NC

Elbert

Madison

Oconee

Walton

DeKalb

Fulton

Carroll

LA

k da

Douglas

Barrow

Gwinnett

R oc

Paulding

IN

Hart

Franklin

Banks

Hall

Forsyth

Jackson Polk

IL

Stephens

Pickens

Bartow

FL

Habersham

Gilmer

Murray

Walker

AL Rabun

Brantley

Clinch Charlton

Lowndes Echols

Glynn

Camden

1-10

0

2010 Analysis:

Distribution of Analytic Patients by Cancer Site/Stage Primary Site ORAL CAVITY & PHARYNX Tongue Salivary Glands Floor of Mouth Gum & Other Mouth Nasopharynx Tonsil Oropharynx Hypopharynx Other Oral Cavity & Pharynx Total

Stg 0

Stg I

Stg II

Stg III

Stg IV

NA

Unknown

Total

0 0 0 0 0 0 0 0 0 0

7 0 1 5 0 2 0 0 0 15

5 1 2 2 1 2 1 0 0 14

5 0 0 1 0 4 0 0 0 10

6 4 3 4 0 4 0 1 0 22

0 0 0 0 3 0 0 0 2 5

1 0 1 3 0 1 1 0 0 7

24 5 7 15 4 13 2 1 2 73

DIGESTIVE SYSTEM Esophagus Stomach Small Intestine Colon Excluding Rectum Rectum & Rectosigmoid Anus, Anal Canal & Anorectum Liver & Intrahepatic Bile Duct Gallbladder Other Biliary Pancreas Retroperitoneum Total

0 0 0 0 0 0 0 0 0 0 0 0

2 1 1 6 6 1 5 1 1 3 0 27

3 3 0 10 6 1 1 0 4 7 2 37

4 5 1 9 2 3 2 2 0 10 0 38

2 0 0 11 3 0 0 1 0 7 0 24

0 0 0 1 0 0 2 0 0 0 0 3

0 1 0 0 0 1 0 0 0 0 0 2

11 10 2 37 17 6 10 4 5 27 2 131

RESPIRATORY SYSTEM Nose, Nasal Cavity & Middle Ear Larynx Lung & Bronchus Total

0 0 0 0

2 10 26 38

0 8 13 21

0 3 53 56

2 7 73 82

0 0 0 0

0 2 2 4

4 30 167 201

BONES & JOINTS Bones & Joints Total

0 0

1 1

0 0

0 0

0 0

0 0

0 0

1 1

SOFT TISSUE Soft Tissue (including Heart) Total

0 0

3 3

2 2

4 4

2 2

0 0

2 2

13 13

SKIN EXCLUDING BASAL & SQUAMOUS Melanoma -- Skin Total

7 7

10 10

5 5

2 2

2 2

0 0

0 0

26 26

BREAST Breast Total

27 27

51 51

42 42

23 23

8 8

0 0

0 0

151 151

Primary Site FEMALE GENITAL SYSTEM Cervix Uteri Corpus & Uterus, NOS Ovary Vagina Vulva Other Female Genital Organs Total

Stg 0

Stg I

Stg II

Stg III

Stg IV

NA

Unknown

Total

0 0 0 0 3 0 3

4 18 3 1 0 0 26

5 8 3 0 1 0 17

5 8 6 0 0 2 21

2 3 3 1 0 0 9

0 4 0 1 0 0 5

0 0 0 0 0 0 0

16 41 15 3 4 2 81

MALE GENITAL SYSTEM Prostate Testis Penis Total

0 0 0 0

4 2 2 8

127 1 0 128

2 3 0 5

7 0 2 9

0 0 0 0

0 0 0 0

140 6 4 150

URINARY SYSTEM Urinary Bladder Kidney & Renal Pelvis Ureter Total

3 2 2 7

7 12 0 19

5 2 0 7

7 7 1 15

11 7 0 18

1 3 0 4

1 0 0 1

35 33 3 71

BRAIN & OTHER NERVOUS SYSTEM Brain Cranial Nerves Other Nervous System Total

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

26 29 55

0 0 0

26 29 55

ENDOCRINE SYSTEM Thyroid Total

0 0

29 29

5 5

8 8

6 6

0 0

0 0

48 48

LYMPHOMA Hodgkin Lymphoma Non-Hodgkin Lymphoma Total

0 0 0

3 18 21

4 4 8

2 4 6

2 13 15

0 0 0

0 2 2

11 41 52

MYELOMA Myeloma Total

0 0

0 0

0 0

0 0

0 0

18 18

0 0

18 18

LEUKEMIA Lymphocytic Leukemia Myeloid & Monocytic Leukemia Other Leukemia Total

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

16 37 4 57

0 0 0 0

16 37 4 57

Unknown Site Unknown Site Total

0 0

0 0

0 0

0 0

0 0

19 19

0 0

19 19

Grand Total

44

248

286

188

197

111

18

1,092

2011 Cancer Conferences Conference

Meeting Frequency

Physician Contact

Administrative Contact

Gynecologic Cancer

Weekly

Sharad Ghamande, MD

Interdisciplinary Cancer

Weekly

E. James Kruse, DO

Head and Neck Cancer

Weekly

Lana Jackson, MD

Pediatric Cancer

Monthly

Roger Vega, MD

Hematology/Pathology Cancer Urologic Cancer

Weekly

Kavita Natarajan, MD

Monthly

Ronald Lewis, MD

Thoracic Cancer

Weekly

Zhonglin Hao, MD

Cutaneous Cancer

Monthly

Amanda May, MD

Breast Cancer

Weekly

Thomas Samuel, MD

Brain/Spine Cancer

Monthly

Connie Giller, MD

Luvenia Kelley 706-721-3992 Allison Sabb 706-721-2760 Ellie Pryor, 706-721-6100 Kathleen McCarty 706-721-3626 Helen Smith 706-721-2505 Allison Sabb 706-721-2760 Tiffany Thomas 706-721-6833 Tiffany Thomas 706-721-6833 Nichole Aenchbacher 706-721-4109 Jamey Motley 706-721-7124

Cancer Committee Physicians E. James Kruse, MD Surgical Oncology Cancer Committee Chair * James McLoughlin, MD Surgical Oncology Cancer Liaison James Rawson MD Radiology

Todd Merchen, MD General Surgery Amanda May, MD Medical Oncology* Colleen McDonough, MD Pediatric Oncology/Hematology Catherine L. Ferguson, MD Radiation Oncology*

Paul Biddinger, MD Pathology*

Alison Lauber, MD Palliative Services

Non-Physician Members Nichole Aenchbacher, RN, BSN Breast Health Navigator Lindsay Baker, RD, LD Cancer Center Dietitian

Summer Garrison Judith Giri, PhD Director of Tumor Bank

Steven Black, MBA Cancer Services Administrator*

Jack Evans Community Outreach Coordinator/* Communications & Marketing

Annie Blount, MSW Cancer Center Social Service*

Melissa Jarriel, RHIA, CTR Health Information Managment Services

Pamela Bourbo, RN, BSN, MPH, OCN, CCRC Cancer Clinical Research Unit

Melanie Kumrow, RN Hematology/Oncology CCOP Nurse Manager*

Kim Cheely RN, BSN, OCN Hematology/Oncology Nurse Manager

Tracey Slagle, RN, BSN, OCN, Hematology/Oncology Nurse Manager

Lonnetta Colton, RHIA, CTR Cancer Registry Manager*

Erica Gollett Steed Planning*

Kevin Corbin Pharmacy

Jane Willson Director of Rehabilitation Services

Nettie Engels American Cancer Society Patient Advisor

Committee Activity Coordinators Cancer Conference – Lonnetta Colton Quality Data of Cancer Registry – Jim McLoughlin, MD

Community Outreach – Jack Evans Quality Improvement – Erica Gollett-Steed

* Position required for accreditation by the American College of Surgeons Commission on Cancer


GHS Cancer Center Annual Report 2011