Cancer Care fall 2017

care

CANCER

for anyone touched by cancer FALL 2017

They celebrate physical feats page 6

Survivor’s advice: Pay attention, get symptoms checked page 4

Brought to you by the

Understanding the members of your team page 2

Scientist seeks answer: Which tumor will cause trouble? page 12

Future: less surgery for breast cancer page 10

Meet your team

YOUR GUIDE

A TEAM APPROACH to cancer treatment means a patient has more than one doctor taking care of him or her, plus additional medical experts focusing on specialized aspects of care.

Here are some of the typical team members at the Upstate Cancer Center: Medical oncologist – is usually the doctor who coordinates your care. He or she may specialize in a particular type of cancer.

Integrative therapy practitioners – help improve healing through Reiki, yoga, acupuncture and more.

Physical therapist – works with patients who need rehabilitation as part of their cancer care.

Surgeon – removes cancer surgically, before or aer additional treatment, and sometimes instead of additional treatment. Plastic surgeons may become involved to help reducing scarring or reconstruct body tissue.

The multidisciplinary breast cancer team at the Upstate Cancer Center.

Radiation oncologist – prescribes and oversees radiation therapy to shrink or eliminate tumors.

PHOTO BY ROBERT MESCAVAGE

Your primary care doctor – remains an important resource for patients during their cancer treatment.

Psychologists and psychiatrists – treat anxiety and depression during and aer cancer treatment.

Nurses – are part of every aspect of your treatment and are good resources for explaining what to expect and how to manage cancer-related pain and other side effects.

Technicians – assist doctors or nurses in many facets of cancer care.

Social worker – can provide referrals for services patients may need during and aer cancer treatment, including home health care.

He or she can also help with the adjustment aer diagnosis.

Radiologist – uses medical imaging technology – such as X-rays, ultrasounds and magnetic resonance imaging – to help make a diagnosis.

Nuclear medicine physician – is involved in molecular imaging and molecular therapy.

Medical physicist – works with interventional radiologists, nuclear medicine physicians and radiation oncologists.

e Upstate Cancer Center provides multidisciplinary teams for these types of cancer: l

breast

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gynecologic

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head and neck

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liver, gallbladder and pancreas

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neurologic

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prostate

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thyroid

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thoracic

Pathologist – interprets laboratory tests and evaluates cells, tissues and organs to help make a diagnosis.

Geneticist – specializes in cancers that are inherited from a parent. He or she can tell whether someone is at an increased risk for developing certain types of cancers based on his or her personal and family history of cancer.

REQUEST AN APPOINTMENT Reach the Upstate Cancer Center by calling 315-464-4673.

Registered dietitian nutritionist – advises patients about how to eat during treatment.

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upstate.edu/cancer l fall 2017

INSIDE

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8

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12

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Inside this issue CARING FOR PATIENTS

SEARCHING FOR CURES

Alert for kidney cancer symptoms

page 4

A celebration of physical feats

page 7

These women stress the importance of screening mammography

page 8

SHARING EXPERTISE Treating breast cancer with less surgery

page 10

What’s the real risk of incontinence?

page 11

A look at breast imaging

back cover

care

CANCER

for anyone touched by cancer

FALL 2017

CANCER CARE

UPSTATE CANCER CENTER

EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications

DIRECTOR (INTERIM) Jeffrey Bogart, MD

MANAGING EDITOR

Amber Smith 315-464-4822 or smithamb@upstate.edu

WRITERS

Jim Howe Amber Smith

DESIGNER Susan Keeter The Upstate Cancer Center provides the quarterly magazine Cancer Care for anyone touched by cancer. Send subscription requests and suggestions to magazine@upstate.edu and request additional copies by calling 315-464-4836.

Cancer Care offices are located at 250 Harrison St., Syracuse, NY 13202.

fall 2017 l upstate.edu/cancer

DEPUTY DIRECTOR (INTERIM) Gennady Bratslavsky, MD ASSOCIATE DIRECTOR FOR CLINICAL RESEARCH Stephen Graziano, MD ASSOCIATE DIRECTOR FOR BASIC AND TRANSLATIONAL RESEARCH Leszek Kotula, MD, PhD ASSOCIATE DIRECTOR FOR COMMUNITY OUTREACH Leslie J. Kohman, MD ASSOCIATE ADMINISTRATOR Richard J. Kilburg, MBA

He’s learning which tumors will cause trouble

page 12

LIVING WITH CANCER 5 ways to cope with nausea and vomiting

page 14

Recipe: Acorn Squash and Apple Soup

page 14

MAKING A DIFFERENCE She sold her cow to honor her grandfather

page 15

On the cover: Alf Jacques, kidney cancer survivor and legendary lacrosse stick maker.

See story, page 4.

PHOTO BY JOHN BERRY

The Upstate Cancer Center is part of Upstate Medical University in Syracuse, N.Y., one of 64 institutions that make up the State University of New York, the largest comprehensive university system in the United States.

Upstate Medical University is an academic medical center with four colleges, a robust biomedical research enterprise and an extensive clinical health care system that includes Upstate University Hospital’s downtown and Community campuses, the Upstate Golisano Children’s Hospital and many outpatient facilities throughout Central New York — in addition to the Upstate Cancer Center, which is located at 750 E. Adams St., Syracuse, NY 13210.

CANCER CARE

3

CARING FOR PATIENTS

He calls himself lucky Kidney cancer survivor’s advice: Don’t ignore possible symptoms

BY JIM HOWE

Cancer survivor Alf Jacques has a message for people who notice unusual or troubling health symptoms.

“Get tested.”

Cancer survivor Alf Jacques, 68, first began making traditional Iroquois wooden lacrosse sticks at the age of 12. He worked alongside his father, Louis Jacques, who understood the design concept but had never actually crafted sticks himself. Through trial and error, the two learned how to make sticks together.

PHOTOS BY JOHN BERRY

e famed maker of traditional wooden lacrosse sticks noticed blood in his urine in June 2016 and quickly had himself checked out at the Onondaga Nation Health Center.

Tests revealed he had an aggressive form of kidney cancer.

“Getting to my doctor immediately was the most important thing. If I had ignored it and had more symptoms two months later, it would have spread so far, it may not have been worth surgery,” said Jacques, 68, who grew up on the Onondaga Nation territory, south of Syracuse, and creates sticks in his workshop there.

“If you have any symptoms, get checked. at’s why we have health insurance. at’s why we have doctors. at’s why we have laboratories. Get checked. Don’t ignore it,” he advises. “at’s what most people do: ey ignore symptoms. It’s human nature. ey don’t want to accept something that might be a problem.” continued on page 5

IM HOWE

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CANCER CARE

upstate.edu/cancer l fall 2017

CARING FOR PATIENTS

Lucky

continued from page 4

One thing that prompted Jacques to get himself checked was the memory of his grandfather, who ignored an infection that eventually led to his death.

Once Jacques was diagnosed with cancer, he was referred to Upstate urologist Oleg Shapiro, MD, who advised surgery to remove the cancerous kidney as soon as possible.

Shapiro operated in late July 2016, “and pretty much they got everything, which is what you want to do.

Fortunately, it hadn’t spread,” Jacques says, and body scans last year and this summer showed no evidence of cancer. “at’s as good as it gets,” he says, and when he thinks about how he did not need either chemotherapy or radiation treatments, he says, “I’m lucky. I’m really, really lucky.”

Jacques had clear cell renal cell carcinoma, “which is the most common type of kidney cancer,” says Shapiro, an associate professor at Upstate. “It is also one of the most malignant or deadly ones.

Jacques in his workshop on the Onondaga Nation territory, south of Syracuse.

About kidney cancer

“He did absolutely the right thing by checking himself out right aer noticing blood in the urine. Any delay in this situation can have dire consequences,” Shapiro notes.

“Overall, people need to understand that any unusual symptoms must be evaluated by a physician,” says Shapiro.

“If Mr. Jacques did not seek help aer his symptoms appeared, he may not be around today.”

With robotic assistance, Shapiro performed a radical nephrectomy, removing the entire kidney and the fat surrounding it, using small incisions.

Jacques’ cancer had not spread to other areas of his body.

Since his surgery, he joined a clinical trial at Upstate to see whether a drug usually used to treat metastatic kidney cancer can help reduce the risk of the cancer returning in high-risk patients.

Other than the blood in his urine, Jacques says he didn’t notice any specific symptoms that might have pointed to kidney cancer.

He recalls feeling sluggish, but that may have been related to a mild heart attack he had in the spring of 2017 or to being overweight at the time, he said.

e kidneys are a pair of organs whose main job is to filter the blood to remove excess water, salt and waste products, which become urine. People can lead a normal life with just one kidney and can survive on dialysis if they lose both.

Early kidney cancers don’t usually cause any signs or symptoms, but more advanced ones might. e signs and symptoms that may signal kidney cancer more oen are caused by a benign condition, such as an infection. Still, the American Cancer Society says to see a doctor if you develop: blood in the urine, low back pain on one side (not caused by injury), a lump on the side or lower back, fatigue, loss of appetite, weight loss not caused by dieting, persistent fever and/or anemia, a low red blood cell count.

Kidney cancer is among the 10 most common cancers in both men and women. About 64,000 new cases of kidney cancer are expected to be diagnosed in the U.S. in 2017 – about 41,000 in men, and 23,000 in women. e average age at diagnosis is 64. e disease is uncommon in people younger than 45.

e healthy diet he was advised to follow aer the heart attack is similar to what he follows as he functions with just one kidney. He has met several people since his kidney surgery who have also lost a kidney to cancer, and no one would ever guess they were functioning with only one kidney, he notes.

“Every now and then I think, ‘Wow! I’m a cancer survivor.’ It’s just amazing. It’s not like something I wear across my forehead — ‘cancer survivor’ — but every now and then I remind myself,” he says. ● fall 2017 l upstate.edu/cancer

Renal cell carcinoma, or RCC, also known as renal cell cancer or renal cell adenocarcinoma, accounts for about nine out of 10 kidney cancers.

Clear cell carcinoma represents about 70 percent of cases of RCC. Its name comes from the pale, almost clear appearance of the cells under a microscope.

Urologist Oleg Shapiro, MD

— FROM THE AMERICAN CANCER SOCIETY

PHOTO BY ROBERT MESCAVAGE

CANCER CARE

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CARING FOR PATIENTS

Physical feats

Jim Waters, who has stage IV colon cancer, raises his arms in victory after finishing the Downtown Auburn Mile.

PHOTO BY KEVIN RIVOLI/THE AUBURN CITIZEN/AUBURNPUB.COM

Despite cancer, patients focus on accomplishing goals Diagnosis: Colon cancer that has spread to liver.

general manager Jason Smorol she couldn’t come to the baseball games anymore because she had cancer. Smorol connected her with Waters.

Care team: From medical oncology, Adham Jurdi, MD, and Ibrahim abet, NP; surgeon Carl Weiss, MD, PhD; caregiver/wife of 25 years: Linda Waters.

“She wanted to give up so quick,” Walters recalls. He spoke with the woman at length. “She was here a year later with me and a few other cancer survivors throwing out the first pitch.”

Jim Waters, 56, of Auburn

Treatment: Surgery in June 2016, plus chemotherapy.

Goal: Auburn Downtown Mile race, which he walked in a shuffle step on Aug. 25. “I finished 272 out of 313, so there were actually people slower than I was,” he recalls.

Proud moment: A Syracuse Chiefs season ticket holder told

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Walters says helping that woman is one of the most important things he’s done since his diagnosis.

Thought: “What cancer is is an excuse. If you set your mind that you can’t do something, you’ve already lost.”

upstate.edu/cancer l fall 2017

CARING FOR PATIENTS

UPSTATE’S

HealthLink on Air Radio Show Podcast On Demand

89.9 & 90.3 FM WRVO.ORG

William Doney, center, celebrates his 84th birthday by walking through Watertown with community members and the Watertown City School District cross-country teams.

Physical feats

Produced by Upstate Medical University, HealthLink on Air explores health and medical issues of interest to Central New Yorkers.

PHOTO BY AMANDA MORRISON/WATERTOWN DAILY TIMES

continued from page 6

William Doney, 84, of Watertown Diagnosis: Brain cancer.

Treatment: Surgery, then radiation. Now, imaging scans every three months to track tumors.

Care team: Neurosurgeon Walter Hall, MD; radiation oncologist Michael Lacombe, MD; caregiver/wife of 35 years, Debbi Doney.

Now airing on Sundays on WRVO at 6 a.m. & 9 p.m.

Goal: To mark his 84th birthday, Doney was joined by friends, family, the mayor and members of the Watertown High School girls and boys cross-country teams for a nearly three-mile run/walk around the city — including up the Gotham Street hill.

“When he ran, he used to run that hill every day,” says Debbi Doney. She was initially reluctant for him to attempt such a strenuous activity, but his mind was set.

She told the Watertown Daily Times, which covered his birthday outing, that her husband takes daily walks with their three dogs: Delialah, a 12-year-old black Lab; Eloise, a terrier; and Haddie Matilda, a miniature pinscher.

Proud moment: Receiving a purple racing singlet from his alma mater – and the varsity letter that eluded him during high school.

Thought: He’s composing a letter of support to Arizona Sen. John McCain, who was diagnosed with the same kind of brain cancer: glioblastoma.

fall 2017 l upstate.edu/cancer

Listen anytime: HEALTHLINkONAIr.OrG or iTunes (search podcasts for “HealthLink”)

CANCER CARE

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CARING FOR PATIENTS

Catching cancer early

Routine mammogram spotted technician’s breast cancer

Time for your mammogram?

Radiologists and specially trained technologists at Upstate University Hospital offer state-of-the-art breast imaging in two comfortable, private locations with weekday and weekend scheduling: Women’s Imaging l

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Upstate Specialty Services at Harrison Center, 550 Harrison St., Syracuse.

Call 315-464-2588 for an appointment.

Wellspring Breast Care Center at the Community Campus, 4900 Broad Road, Syracuse.

Call 315-492-5702 for an appointment.

kimberly White, a 28-year employee of Upstate, has survived breast cancer. She had surgery in December 2016 and finished radiation treatments in February.

PHOTO BY WILLIAM MUELLER

BY AMBER SMITH

IN 28 YEARS AS A CLINICAL TECHNICIAN at Upstate University Hospital, Kimberly White, 47, has cared for a wide variety of patients, including adults with cancer.

Today she has a new appreciation for the disease, as a survivor.

Her experience helps her relate to patients, especially those who undergo radiation therapy. “I share my story with patients, if the timing is right,” White says.

It was early fall 2016 when she went for her annual mammogram. An appointment that usually takes a half hour stretched to two and a half hours as technicians did additional sonograms. en White underwent a biopsy of her right breast, to get a sample of the tissue that appeared suspicious in the images. Results went to her gynecologist, who called her at about 6:30 p.m. one evening in October 2016. “at’s when I lost it,” she recalls.

White had ductal carcinoma in situ, an early cancer that

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was too small to feel. Only a mammogram would have noticed it.

She had the suspicious area removed in a lumpectomy. Soon aer, she began radiation treatments at the Upstate Cancer Center with radiation oncologist Anna Shapiro. MD. White’s radiation therapy continued Anna Shapiro, MD through mid-February 2017. She returned to work at the end of the month.

Her treatment is complete, but White has follow-up appointments every six months. She feels good now.

Cancer is no longer the first thing she thinks about when she wakes up in the morning.

She has become a mammography advocate, spreading a message of its importance to family members, co-workers, friends and anyone who reads this story: “Don’t be scared,” she says. “Just get it done.” ●

upstate.edu/cancer l fall 2017

‘So worth the drive’

CARING FOR PATIENTS

She makes 73-mile trip for breast care

BY AMBER SMITH

LAURIE GILDEA’S HUSBAND, Kevin, does the research. She goes with her gut.

So when a routine mammogram in May 2017 found a suspicious lesion, and when a subsequent biopsy revealed breast cancer, Gildea suddenly needed a surgeon with breast cancer expertise.

“I have to feel confident with the people I’m with,” she says. As soon as she met Lisa Lai, MD, and Prashant Upadhyaya, MD, and the nurses and staff at the Upstate Cancer Center, Gildea recalls, “I immediately felt the connection.”

Lisa Lai, MD

Prashant Upadhyaya, MD

e Gildeas live in Binghamton. Laurie is a teacher’s aide. Kevin is a systems engineer. e doctors’ credentials and experience impressed Gildea’s husband. Both are board-certified surgeons who frequently work together at Upstate. Lai completed her surgery residency in 2015. Upadhyaya finished his surgery residency in 2010 and then his plastic surgery residency in 2013.

Leslie kohman, MD

e news of cancer that Gildea got aer her mammogram was a surprise. Having survived so many previous medical tribulations — including a lung infection in 2001 that led to a partial lung removal — “I basically thought I’ve gone through enough in my life,” she says.

Gildea’s lung surgeon, Leslie Kohman, MD, helped arrange the biopsy and put her in touch with the two surgeons.

Her breast cancer was considered stage I. It was small and had not spread from the breast. She did not require chemotherapy or radiation treatments. She underwent a mastectomy in early July. Aer her body healed, Upadhyaya inserted Gildea’s new implant. e Gildeas are happy to travel to Syracuse to see the Upstate doctors.

“It’s really not that far,” Gildea says. “And for the care I’m given, it’s so worth the drive.” ●

fall 2017 l upstate.edu/cancer

Laurie Gildea PHOTO BY ROBERT MESCAVAGE

BREAST CANCER STAGES

e stage of a breast cancer helps determine treatment options and a patient’s survival outlook.

Doctors determine the stage based on the size of the tumor, whether lymph nodes are involved and whether cancer has spread elsewhere in the body.

Ductal carcinoma in situ, for instance, is considered stage zero. It is small and contained in the milk ducts of the breast.

Stage I and II are early breast cancers with tumors of various sizes that may involve one or two lymph nodes.

Stage II and III are locally advanced breast cancers, meaning the tumors are larger and/or the cancers may involve up to two lymph nodes.

Stage IV is metastatic breast cancer, which means it has spread to other parts of the body.

CANCER CARE

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To operate, or not?

SHARING EXPERTISE

Treating breast cancer with less surgery

BY AMBER SMITH

PHOTO BY ROBERT MESCAVAGE

Breast surgeon Lisa Lai, MD, in the lobby of the Upstate Cancer Center.

MOST BREAST CANCERS are treated with surgery today, but that may change in the coming years, says breast surgeon Lisa Lai, MD, an assistant professor of surgery and medical director of the breast cancer program at Upstate.

She explains that the trend is to do less surgery whenever possible. In the future, women may be offered procedures to remove breast lumps that don’t even require incisions.

“Nothing excites me more as a breast surgeon than to be able to offer the patient less surgery,” she says.

“We never want to do more than what they need or can have benefit from.”

Forty years ago, women with breast cancer were treated with an operation called a radical mastectomy, in which the breast, muscles and lymph nodes were removed. “at’s an operation that is almost never done these days,” Lai says.

Today, patients have options. Surgeons offer a variety of techniques, including lumpectomies, mastectomies and reconstruction by a plastic surgeon. e focus is on curing the cancer while preserving the cosmetic appearance of the breast.

In some select cases, patients with the earliest stage of breast cancer may forgo surgery by enrolling in a study.

Clinical trial compares surgery to medication

Lai is involved in a national trial that focuses on patients with stage zero breast cancer called ductal carcinoma in situ, or DCIS. e trial compares traditional surgery to remove a breast lump with a newer strategy: medication, plus careful

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surveillance. It’s called the COMET Trial for Low Risk DCIS. COMET stands for Comparison of Operative to Monitoring and Endocrine erapy.

“Our overarching hypothesis is that management of low-risk DCIS using an active surveillance approach does not yield inferior cancer or quality of life outcomes,” researchers say in their description of the trial. Among those leading the COMET Trial are researchers from Duke University, the Dana-Farber Cancer Institute, MD Anderson Cancer Center and New York University. e trial looks at survival time, the number of patients who develop invasive cancer and several other measures, plus coping and quality of life. It began in February and hopes to enroll 1,200 patients before completing data collection in 2021.

To learn more about COMET, contact surgical research coordinator and nurse Linda Ellinwood at 315-464-1852.

Individual treatment plans

As a breast surgeon at the Upstate Cancer Center Lai appreciates working as part of a team — which includes medical oncologists, radiation oncologists, a plastic surgeon, a pathologist, a genetic counselor and others — to come up with an individual treatment plan for each patient.

Lai says she was drawn to the specialty of breast surgery because of the patients she gets to help.

“I love my patients. We really get to know each other well and form a nice bond,” she says. “Nothing delights me more than them being cancer-free and hearing about how life has moved on aer treatment.” ● upstate.edu/cancer l fall 2017

Leaks are a risk

SHARING EXPERTISE

Prostate cancer survivors may face incontinence, national research shows

BY AMBER SMITH

WHEN MEN ARE DIAGNOSED with prostate cancer, their focus becomes treatment of the cancer. e complications of incontinence and erectile dysfunction are considerations, but the priority is usually survival.

Once the cancer is under control, these treatment side effects become more important to men. Urine leakage is a known complication risk for men whose prostate cancer is treated with surgery or radiation.

Incontinence can range from the occasional leakage of drops of urine to complete lack of urinary control. It’s a problem that can cause men to become isolated, for fear of social embarrassment. It can also lead to urinary tract infections, skin breakdown and wound infections.

SURVEY OF U.S. SURVIVORS

136 men who had surgery

125 men who had radiation

75%

57% some leakage

50%

25%

23% significant leakage

42% some leakage

12% significant leakage

0%

A group of urologists at Upstate say the risk is higher than previously believed for a man who opts for the surgical removal of his prostate. Timothy Byler, MD, wrote about a survey of patients they conducted in the journal International Urology and Nephrology. His team included colleagues Gennady Bratslavsky, MD, Michael Daugherty, MD, and Raju Chelluri, MD.

Byler’s data comes from patients who got care from various centers across the nation.

Using a national database constructed by the Center of Disease Control and Prevention, the National Health and Nutrition Examination Survey, Byler queried prostate cancer survivors about urinary incontinence. Men who participated in the survey were interviewed in their homes and then underwent standardized physical exams.

e Upstate urologists looked at both stress and urge incontinence. Stress incontinence is when urine leaks during physical activity. Urge incontinence is when urine leaks before a person can reach the toilet. Byler says both types of leakage may happen aer prostate surgery, but stress incontinence is more common.

Fiy-seven percent of 136 men who underwent surgery for prostate cancer reported some urinary incontinence aerward. Interestingly, 23 percent of these men reported significant incontinence.

Removal of the prostate gland can weaken the sphincter muscle that allows for urinary leakage. For some men, incontinence is temporary, improving as they recover. ose who continue to struggle aer recovery may seek treatment for leakage. Byler says a variety of remedies is available.●

Regarding men who underwent radiation, 42 percent of 125 men experienced leakage, with 12 percent reporting significant leakage.

When men had both surgery and radiation treatments, leakage rates were as high as 80 percent.

Many doctors estimate patient incontinence risk between 10 to 20 percent. at’s based on an average from previous studies, most involving patients at just one center who

PROSTATE CANCER IN 2017…

…will be diagnosed in 161,360 men. …will kill 26,730 men.

reported incontinence aer surgery as low as 6 percent and as high as 69 percent.

Timothy Byler, MD, published a study about urinary leakage after prostate cancer surgery that asks in the title: Are we underestimating the rates of incontinence after prostate cancer treatment?

The answer is probably yes.

PHOTO BY ROBERT MESCAVAGE

FROM CA: A CANCER JOURNAL FOR CLINICIANS, AS CITED IN INTERNATIONAL UROLOGY AND NEPHROLOGY

fall 2017 l upstate.edu/cancer

CANCER CARE

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SEARCHING FOR CURES

Will this tumor cause trouble?

Need treatment?

Researcher seeks answers in the gene he discovered

BY AMBER SMITH

EVER SINCE HE DISCOVERED A GENE that causes prostate cancer 20 years ago, Upstate cancer researcher Leszek Kotula, MD, PhD, has focused on understanding the mysteries of the cancer that, besides skin cancer, is most common in men.

Much of his career is devoted to prostate cancer — because of the numbers.

Each year, 23 million men undergo prostate- specific antigen screening tests. Some 1.2 million men who are found to have high PSA levels undergo a biopsy. Some 240,000 are diagnosed with prostate cancer. e vast majority of those men will have tumors that are noninvasive.

About 3 percent will have an aggressive form of the disease that is difficult to treat. at 3 percent represents some 7,200 husbands, fathers, brothers. ose are the numbers that concern Kotula.

Leszek kotula, MD, PhD

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PHOTO BY WILLIAM MUELLER

He dreams of being able to give men who are diagnosed with prostate cancer more definitive news about their future. He wants to answer whether they have a tumor that will lie quietly within their prostate and cause no trouble, or a tumor that will spread to other organs and require treatment. continued on page 13 upstate.edu/cancer l fall 2017

SEARCHING FOR CURES

Still images from two videos of prostate cell growth. The cluster of cells on the top (in blue) are spherical, indicating healthy cell growth.

The images on the bottom, which have had the gene/ protein ABI1 removed, show cell clusters that are non-spherical and loosely attached, and are trying to migrate out.

FROM THE LAB OF LESZEK KOTULA, MD, PHD

Tumor

continued from page 12

Kotula wants to be able to predict which tumor will remain indolent and which will become invasive.

If he can do that, he can save lives.

Working together, Kotula’s team of biochemists and cell biologists uses a genetic engineering technique to study the disruption of “Abi1,” the gene he discovered in 1998. ey want to learn how the gene interacts with other genes and whether it plays a role in leukemias, breast, ovarian and other cancers.

“If we are successful, then we can make an impact on treatment,” Kotula says.

His discovery of the Abi1 gene set him on this course.

Fast forward two decades, and Kotula is focused on the function of the Abi1 gene. Its presence seems to inhibit prostate cancer, while the loss of function of this gene leads to prostate cancer.

Today his research involves three cell lines, one purchased commercially, one from genetically engineered mice at Upstate, and one from Upstate’s biospecimen bank, where some patients donate tissue from their tumors.

Disharee Das, a doctoral student in biochemistry and molecular biology, puts a cell sample into a liquid nitrogen tank with help from her mentor, Leszek kotula, MD, PhD. PHOTO BY WILLIAM MUELLER

of invasion occurs,” Kotula says, explaining the moment the cancer begins to spread at the cellular level.

Looking under the microscope before the Kotula gene is removed — the scientific term is “gene knockout” — the cells look as if they were melting into one big blob, and that blob spins.

So far, there’s no easy way to tell when that occurs in an individual. Once cells metastasize to the lung or the bone, a patient’s tumors become visible through medical imaging. Before that happens, cellular changes aren’t visible.

e spinning stops when the gene is removed, and the cells are more individual, like a cluster of grapes. Some cells start to move out from the blob. “at’s where the process

But one day, Kotula hopes, doctors may be able to read a man’s genetics and tell him whether he has an aggressive form of cancer, or not. ●

ABOUT PROSTATE CANCER When a man turns 60, his chance of developing prostate cancer soars. The American Cancer Society says three in five men over the age of 65 will develop prostate cancer.

It’s the most common cancer in men, other than skin cancer, and it is the third leading cause of cancer death in men, behind lung cancer and colorectal cancer.

The American Cancer Society projects that almost 27,000 men in the United States will die from prostate cancer this year. fall 2017 l upstate.edu/cancer

CANCER CARE

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LIVING WITH CANCER

Acorn Squash and Apple Soup Ingredients 1 medium acorn or butternut squash (1½ to 2 pounds) 2 tablespoons butter or margarine 1 medium yellow onion, sliced (½ cup) 2 medium tart cooking apples, (such as Granny Smith) peeled and sliced 1 teaspoon dried thyme leaves ¼ teaspoon dried basil leaves 2 14-ounce cans chicken broth (4 cups) ½ cup half-and-half 1 teaspoon ground nutmeg ½ teaspoon salt ¼ teaspoon white or black pepper

Preparation 1. Heat oven to 350 degrees. Cut squash in half; remove seeds and fibers. Place cut sides up in 13-by-9-inch pan.

Pour ¼ inch water into pan. Bake uncovered about 40 minutes or until tender. Cool. Remove pulp from rind and set aside.

2. Meanwhile, in heavy 3-quart saucepan, melt butter over medium heat. Add onion; cook 2 to 3 minutes, stirring occasionally, until crisptender. Stir in apples, thyme and basil.

Cook 2 minutes, stirring constantly.

Stir in broth. Heat to boiling. Reduce heat; simmer uncovered 30 minutes.

3. Remove 1 cup apples with slotted spoon; set aside. Place one-third each of the remaining apple mixture and squash in a blender or food processor.

Cover; blend on medium speed about 1 minute or until smooth, then pour into bowl. Continue to blend in small batches until all soup is pureed.

4. Return blended mixture and 1 cup reserved apples to saucepan. Stir in half-and-half, nutmeg, salt and pepper; cook over low heat until thoroughly heated.

Nutritional information Each 1-cup serving contains:

SOURCE: BETTY CROCKER LIVING WITH CANCER COOKBOOK

190 calories 7 grams fat 20 milligrams cholesterol 670 milligrams sodium 690 milligrams potassium 6 grams fiber 5 grams protein

5 ways to cope with nausea and vomiting l

Eat small, frequent meals.

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Avoid unpleasant odors.

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Avoid hot, spicy, strong-smelling or fried, greasy foods.

Avoid drinking liquids at meals.

Eat dry foods — such as crackers, toast and dry cereals — every two to three hours during the day.

SOURCE: THE UPSTATE CANCER CENTER’S REGISTERED DIETITIAN NUTRITIONIST, MARIA ERDMAN.

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upstate.edu/cancer l fall 2017

MAKING A DIFFERENCE

This cow sold in 2016.

This cow sold in 2017.

Cows for cancer Grateful granddaughter raises livestock to brighten patients’ days THOMAS ELWOOD LIVED HIS WHOLE LIFE on his farm in the village of Walton, in New York’s Southern Tier, with steers, pigs and chickens.

He was retired from Breakstone, the local creamery, where he worked for 45 years. He beamed when his grandchildren — he had seven — showed animals at county fairs. Beef cattle were his favorite.

Recalled his granddaughter, Paige Lee, 11, “Papa would help us wash our cows and get them ready for show, and help us lead them,” Elwood especially enjoyed working with his grandchildren at the Broome County Fair in July in Whitney Point.

When Elwood developed lung cancer, he sought treatment at the Upstate Cancer Center. Rahul Seth, DO, took care of him. Elwood died at the age of 71 at the end of May 2016.

Two months aer her Papa’s funeral, Paige brought one of the steers he helped her raise to the Broome County Fair.

It sold for $2,200.

Some of that money Paige used to buy a pregnant cow, a plan she and her Papa had to help further her herd. e rest, she donated to the cancer center.

She remembered all the times her mother, Anne Lee, took her Papa for chemotherapy in Syracuse.

Paige’s grandfather, Thomas Elwood

Paige decided to help people with cancer because she knows chemotherapy treatments can take a long time. “Having something to do makes it a lot better,” the sixth-grader explains. Her money paid for bags filled with special gis for cancer patients from irty-One Gis. ● To donate to Friends of Upstate Cancer Center, visit www.upstatefoundation.org or contact the Upstate Foundation at 315-464-4416.

ARE YOU GRATEFUL? A gift of gratitude is a meaningful way to both express your appreciation to special caregivers and to help patients during their time of great need. Friend in Deed, Upstate University Hospital’s annual fund, supports a variety of unmet patient needs, such as nutritional supplements for cancer patients, special pediatric needs, communication tools for the hearing impaired, and heart monitors, to name a few.

To donate, visit upstatefoundation.org or contact the Upstate Foundation at 315-464-4416. To share your story, email FND@upstate.edu

Foundation

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Breast imaging radiologist Amina Akhtar, MD, works from a bank of monitors to analyze mammography images at the Wellspring Breast Care Center at Upstate University Hospital’s Community Campus. The center offers routine screening and diagnostic mammograms, ultrasound, tomosynthesis and breast magnetic resonance imaging, and image-guided biopsies provided by a dedicated staff of nurses, technologists, radiologists and surgeons. Hours are 7:30 a.m. to 5 p.m. Monday through Friday, plus some Saturday mornings for screening mammograms. Call 315-492-5702 for appointments. Upstate also offers imaging service at its downtown campus. Call 315-464-2588.

PHOTO BY SUSAN KAHN