care
CANCER
for anyone touched by cancer FALL 2014
‘Luckier than anybody I know’ page 3
Breast reconstruction options
5 questions Upstate scientists are answering
E-cigarette dangers
Can your job make you sick?
Pinpointing prostate cancers
A mural that inspires serenity
Brought to you by the
INSIDE
What happens to smoking rates when a workplace bans smoking? In August 2005, Upstate University Hospital became the first hospital in New York State to go smoke-free. That new policy, plus a smoking cessation program, helped encourage Upstate employees who smoked to kick the habit. Smoking rates of 17 percent in 2004 dropped to 12 percent in 2006 – and down to 10 percent by 2010. Upstate offer a smoking cessation program. Call 315-464-8668 for details.
17% 12% 10% 2004 2006 2010
CARING FOR PATIENTS
TEACHING THE COMMUNITY
Unique surgery treats aggressive bladder cancer
page 3
Cancer led him to a career in research page 4
Can your job give you cancer?
page 12
Who needs a hepatitis C test
page 13
SHARING EXPERT ADVICE
What increases your risk for breast cancer
page 5
Why e-cigarettes are dangerous
page 14
Glass mural inspires serenity
page 6
Breast reconstruction options
page 15
Pinpointing prostate cancers
back cover
How to avoid constipation
page 16
On the lookout for bladder cancer
page 17
LIVING WITH CANCER
care
CANCER
for anyone touched by cancer
FALL 2014
CANCER CARE PUBLISHER Wanda Thompson PhD Senior Vice President for Operations
MAKING A DIFFERENCE
Hair care
page 7
One nutrition-packed meal
page 8
Presenting the Upstate Cancer Center page 18
EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications
Rejuvenate with reading
page 9
Supporting a coworker
page 19
MANAGING EDITOR Amber Smith 315-464-4822 or smithamb@upstate.edu
Rallying for breast cancer
page 19
DESIGNER
SEARCHING FOR CURES 5 questions Upstate scientists are answering
page 10
On the cover: Allan Sustare, at the Upstate Cancer Center, is grateful for the care he received from Gennady Bratslavsky, MD. PHOTO BY SUSAN KAHN.
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.
UPSTATE CANCER CENTER
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.
MEDICAL DIRECTOR Leslie J. Kohman, MD ASSOCIATE ADMINISTRATOR Richard J. Kilburg, MBA The Upstate Cancer Center is part of Upstate Medical University in Syracuse, NY, one of 64 institutions that make up the State University of New York, the largest comprehensive university system in the United States. For information on cancer center patient services, call 315-464-HOPE (4673) or visit www.upstate.edu/cancer. The Cancer Center is located at 750 East Adams St., Syracuse, NY 13210.
SUSAN KAHN
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CARING FOR PATIENTS
Building a bladder
Unique surgery treats aggressive cancer
Gennady Bratslavsky, MD, and Allan Sustare share a moment at the window of the new Upstate Cancer Center.
PHOTO BY SUSAN KAHN
BY AMBER SMITH
Allan Sustare celebrates each day. He is grateful to be alive after coming so close to death from advanced bladder cancer. He admits that he had no concept of the severity of his disease. He had no pain, just blood in his urine — once. He wound up undergoing a novel surgery in which a new bladder was fashioned from a portion of his intestine to replace his original bladder, which had to be removed because of cancer. “I count myself luckier than anybody I know,” says Sustare, 63, of DeWitt. “Between Dr. Seth and Dr. Bratslavsky, I don’t know that anybody could have asked for any better care anywhere in this country.” Rahul Seth, MD, is an oncologist, and Gennady Bratslavsky, MD, is chairman of the Department of Urology.
Syracuse University. A professional artist, he has been a jewelry designer, illustrator and maker of collectible pocket knives. At the ribbon-cutting for the Upstate Cancer Center this summer, Sustare shared his story. It was May 2011 when he was diagnosed with bladder cancer. Seth told him his options, which included chemotherapy, radiation and surgery to remove his bladder and replace it with an external bag. Sustare thanked the oncologist. Then he, as he puts it, “ran away.” “I spent most of my inheritance,” he says, describing his time in Houston, in which he pursued alternative treatments. A new tumor had grown by the time he returned to Syracuse. Doctors at the Syracuse VA Medical Center removed what they could of the tumor and then sent Sustare to Bratslavsky.
Cancer Society awards Upstate
Sustare served as a medic in the military before attending
The American Cancer Society Cancer Action Network awarded Upstate Medical University with its signature Gemson Cancer Prevention Public Policy Award for 2014.
The award recognizes prevention-focused policies and practices that reduce the incidence and burden of cancer. “In addition to strong internal practice change regarding tobacco use and employee wellness, Upstate has led policy change in the 64-campus State University of New York and Onondaga County (in partnership with the American Cancer Society),” reads the nomination letter by Leslie Kohman, MD, medical director of the Upstate Cancer
continued on page 17
Center. “In both the clinical mission and the research strategic plan, cancer is the highest priority.”
Three examples: University Hospital, on Upstate’s campus downtown, became the first smoke-free hospital in New York State in 2005. All Upstate employees and dependents receive nicotine replacement therapy and tobacco-cessation counseling at no cost. And, about one-third of the research underway at Upstate is related to cancer. Gregory Eastwood, MD, Upstate’s interim president, received the award Oct. 2 at the society’s Hope Lodge in New York City. ●
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CARING FOR PATIENTS
Cancer survivor develops career in research
Chris Lucchesi’s relationship with cancer began in a high school AP Biology class.
“We started learning about cancer and realizing that it’s nothing really crazy,” says Lucchesi, a graduate student in pharmacology in his fifth year at Upstate. “You have a cell in your body that gets a mutation, and then your own cells start to propagate at an uncontrolled rate and, more or less, learn how to survive better. They are more advanced cells, I guess you could say. “Cancer wasn’t like a virus or some pathogen that you could just target and kill. It was your own body that was going haywire. That intrigued me, that your own body is learning to survive better but ultimately leads to your demise. It was fascinating.” Then it got personal.
PHOTO BY RICHARD WHELSKY
When he takes non-tumorigenic breast tissue cells and makes them express the protein, they survive. If that is not fascinating enough, take it a step further.
Lucchesi was 17 when he was diagnosed with an esthesioneuroblastoma, a cancer that begins in certain very early forms of nerve cells and usually affects children age 5 and younger. His was located in his maxillary sinus, below his right eye. He underwent surgery, chemotherapy and radiation.
Proteins are made up of chains of amino acids. By switching one of the amino acids in the chain with a different amino acid in this particular protein, Lucchesi says, the protein completely changes its actions. It becomes a protein that helps cancer cells grow, also known as an oncogene.
“I’m 10 years out now, and everything seems to be clear,” he says.
Such a complete about-face is meaningful, says Lucchesi, as oncologists strive to customize cancer therapies to individual patients.
Today, Lucchesi is working toward his doctorate in pharmacology. He works in the laboratory of Ying Huang, MD, PhD. (See pages 10 and 11.) Their research focuses on a tumor suppressor protein that was discovered to be down regulated in esophageal cancers. Such proteins can stop a cell’s growth or cause its death. In the petri dishes where Lucchesi grows cancer cells and makes the cells express this particular protein – they all die.
Head & Neck Cancers
4
Graduate student Chris Lucchesi
CANCER CARE
“If you can cut out the tumor from somebody and do pathology on it and realize that it has this mutation,” he says, “well, then you will know what chemotherapies not to use, because they’re not going to be effective for those cancer cells.” ● Listen to this interview at upstate.edu/healthlinkonair by searching for “Lucchesi.”
Sharing experiences helps others A Head and Neck Cancer Support Group meets the third Wednesday of each month, bringing together patients, family and friends before, during and after treatment.
Meetings are held from 5:30 to 6:30 p.m. at the Oasis Learning Center Room, 6333 Route 298 in East Syracuse. Use 6333 Carrier Parkway for navigation systems.
Participation is free, and so is parking. The meetings are led by Upstate speech language pathologist, Jenna Gardner, clinical trials coordinator Dena Martin, and nurses Ann Ray and Robin Salvaterra.
Even though the group is affiliated with Upstate University Hospital, patients are welcome from anywhere. For details, call 315-464-5819. ●
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CARING FOR PATIENTS
Most breast cancers occur in women with no family history Women at increased risk for developing breast cancer have a growing number of options to help prevent the disease — but you may be surprised to learn who is at high risk. Actor Angelina Jolie garnered media attention in May 2013 when she underwent a preventive double mastectomy, revealing a family history of breast cancer and a faulty genetic mutation. “It’s important to keep that in perspective,” says Jayne Charlamb, MD, who directs Upstate’s Breast Cancer High Risk Program. “The vast majority of women who get breast cancer have absolutely no family history.” She says only about 5 to 10 percent of breast cancers are thought to be hereditary, caused by abnormal genes passed from one generation to the next. Other risk factors Women with a mutation in the same gene as Jolie’s, known as BRCA, are at increased risk — but so are many others. As a woman ages, her risk increases. Not having children, or having children later in life puts a woman at higher risk than one who bears children when she is young. “Not breastfeeding puts you at a higher risk,” says Charlamb. Also, a woman with dense breast tissue has an increased risk of developing breast cancer.
reduces risk by about 50 percent during, and sometimes beyond, those five years, Charlamb says. The medications include selective estrogen receptor modifiers, which block the effects of estrogen on breast tissue, and aromatase inhibitors, which stop a key enzyme from changing other hormones into estrogen. Exploring prevention In addition, Charlamb and other breast cancer experts are studying the promise of vitamin D for breast cancer prevention, especially in women with dense breast tissue. Prevention remains important, especially for women with an increased risk. Charlamb tells her patients to exercise regularly and to eat a diet rich with fruits and vegetables that includes a variety of foods and avoids processed foods and red meats. She also discusses alcohol intake. “There is pretty clear evidence now that even very moderate alcohol intake — one drink a day — is enough to significantly increase a woman’s risk of developing breast cancer,” the doctor says. Though it’s impossible to entirely eliminate breast cancer risk in any woman, a healthy lifestyle can bring down a woman’s risk of developing breast cancer, even if that woman is at very high risk due to a genetic mutation.
Some women with a BRCA mutation are opting to have their breasts removed, like Jolie, to reduce their risk of developing breast cancer.
Women interested in the Breast Cancer High Risk Program can call 315-464-8224 to schedule an appointment. ●
Others at high risk for the disease are choosing “chemoprevention,” a 5-year course of medications that
Listen to this interview at upstate.edu/healthlinkonair by searching for “high risk breast cancer.”
GEM CARE
community
EMERGENCY CARE FOR SENIORS AGE 65+
campus
4900 Broad Rd. 315.464.8668 www.upstate.edu/gemcare
fall 2014
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Inspiring serenity
CARING FOR PATIENTS
Pond depicted in glass mural
Marie Luther is an artist who often visits a rambling creek and waterfall near her Syracuse home. “Sometimes I sit near the stream and listen to its melodic whispers and let the soft light that filters between the sugar maples stir my imagination,” she explains on her blog, Light Affects.
While her artistry includes sculpture, bronze casting, pottery building, Luther’s favorite medium is glass, which she describes as “the rigid liquid that melts and flows, yet through all of its manifestations allows colors to blend and light to bend, refract and reflect.”
Visitors to the Upstate Cancer Center catch a glimpse of her tranquility when they see her 5-foot wide glass fused mural, “Window on the Pond.” It is located in the meditation room.
Many poets and artists are attracted to water because it can inspire the soul to find serenity, something Luther says she believed would be fitting in a cancer center.
The mural is one of the many pieces of art, including photographs, paintings and other works, created by 31 artists from Upstate New York that highlight the theme of nature being a refuge during cancer treatment.
She says her mural “is a microscope and a telescope at the same time, allowing our eyes to inspect the finest detail of the view, yet letting our minds wander into far reaches we have yet to explore.” ●
Who was William Waters?
Upstate renamed its Center for Children’s Cancer and Blood Disorders 10 years ago to honor one of its pioneering doctors. Now the center is called the William J. Waters Center for Children’s Cancer and Blood Disorders.
Waters was a 1942 graduate of Upstate’s College of Medicine and one of the first specialists in pediatric hematology-oncology in the Syracuse area. He became known for his compassionate treatment of seriously ill children and their families. He died at age 47 in 1966. Today the center that bears his name serves a 21-country region. Last year, 454 children with cancer and blood disorders were treated, and 617 patients were enrolled in survivor wellness programs at the center, which is housed in both the Upstate Golisano Children’s Hospital and the new Upstate Cancer Center. The director is Richard Sills, MD. The recognition of Waters was made possible by contributions from pediatric orthopedic surgeon Robert Cady, MD, Waters’ son, Peter Waters, MD, an orthopedic specialist at Boston Children’s Hospital, and their families. ●
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CARING FOR PATIENTS
What to do about hair loss Cancer treatment fallout —
Many of the drugs used to fight cancer go after rapidly-growing cancer cells but also wipe out other rapidly-growing cells, which includes hair cells. That means some cancer patients face hair loss ranging from thinning to complete baldness. The amount of hair that falls out depends on the medication you are taking and the dose, and it may not be limited to the hair on your scalp. Some patients experience the loss of eyelash, eyebrow, armpit, pubic and other body hair. Regrowth usually happens within three to 10 months after treatment ends, but many patients have hair of a different color or texture, at least at first. Cancer caregivers encourage patients to plan ahead regarding hair loss and do things that make them feel comfortable before, during and after cancer treatment. This may mean planning for a head covering, whether wigs, scarves or hats. Nothing has been proven to stop hair loss during or after chemotherapy. But a couple of treatments have been considered: ●
and wash your hair only as often as needed, using a gentle shampoo.
Cryotherapy or scalp hypothermia uses ice to lessen the blood flow to your scalp during chemotherapy, so the medications are less likely to have an effect on your scalp.
If you opt to shave your head, be prepared to protect your scalp from the sun and cold air with sunscreen or a head covering.
“Studies of scalp hypothermia have found it works somewhat in the majority of people who have tried it,” the Mayo Clinic reports. “However, the procedure also causes a small risk of cancer recurring in your scalp, as this area doesn’t receive the same dose of chemotherapy as the rest of your body.”
The American Cancer Society says hairpieces that are used due to cancer treatment are tax deductible expenses, which may be at least partly covered by health insurers. The organization advises doctors to write a prescription for a “hair prosthesis” rather than a “wig.”
In addition, patients report headaches and a feeling of uncomfortable cold during cryotherapy. ●
Hair cells are among the rapidly growing cells that many chemotherapy drugs target, which is why hair loss may occur during cancer treatment.
Minoxidil – the drug marketed as Rogaine for pattern baldness – is sometimes used to help speed up hair regrowth. Cancer experts say it does not prevent hair loss.
To minimize the frustration and anxiety that may accompany hair loss, hairdressers suggest a gentle touch. No bleach, colors or perms, which can weaken hair. No blow dryers, curling irons or hot rollers. Use a soft-bristle brush,
The Upstate Cancer Center features a boutique called Dazzle in its lobby where head coverings are sold for children, men and women. Owner Lois Ross says some people seek wigs for everyday wear, and others want something to wear just for special occasions. Some prefer hats. She says one popular item is a cap with hair, which can be put into a ponytail or left long. There are no instructions about whether or how to cover your head during cancer treatment, Ross says. “It’s really whatever makes you feel good.” ●
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LIVING WITH CANCER
Nutritional information, for each of four servings:
Moroccan Shrimp
Nutrition-packed
Calories, 229 Fat, 2 grams Cholesterol, 54 milligrams Sodium, 365 milligrams Carbohydrate, 40 grams Dietary fiber, 7 grams Protein, 15 grams PHOTOS BY WILLIAM MUELLER T.J. HINE PHOTOGRAPHY HINEPHOTO.COM
Epidemiologic studies indicate that people who eat a typical Western diet – high in animal fat, sugar and excess calories – have a higher incidence of many cancers than do people whose diets consist mostly of plant-based foods. That is why many healthy diet recommendations focus less on meat and more on whole grains, vegetables, beans, fruits and dairy products, according to “Cancer Nutrition & Recipes for Dummies.”
This dish includes grains, vegetables and protein, so all you need to meet your nutritional requirements for a meal is the addition of a fruit salad for dessert and low-fat milk or a milk alternative as your beverage. Ingredients
1 teaspoon ground sweet paprika
1 28-ounce can unsalted whole plum tomatoes, drained with ¼ cup of the liquid reserved (For additional flavor, use fire-roasted tomatoes instead)
½ teaspoon ground ginger ½ cup chopped cilantro ¼ cup chopped flat leaf parsley
1 medium onion, peeled, halved and cut lengthwise into ½-inch crescents
¼ teaspoon salt
2 garlic cloves, peeled and chopped
ground black pepper, to taste
1 teaspoon ground cumin
20 large shrimp, peeled, deveined and tails removed (Cod works well in this recipe, too.)
Preparation
1.
Individually remove the tomatoes from the can. Holding each tomato over a deep skillet, crush each tomato by hand, letting the flesh squeeze through your fingers into the pan.
2.
Add the onion, garlic, cumin, paprika and ginger to the pan.
3.
Over medium-high heat, bring the tomatoes to a simmer, stirring to combine all the ingredients.
4.
Mix in the cilantro, parsley, salt and a generous pinch of pepper.
5.
Cover and simmer the sauce over medium-low heat until the tomatoes are soft, about 15 minutes.
6.
Add the shrimp and chickpeas, pushing them into the sauce. If the sauce seems dry, pour ¼ cup of the reserved canned tomato juice into the pan.
7.
Cover and simmer gently until the shrimp are an opaque white and the chickpeas are heated through, about 8 to 10 minutes.
8.
Serve immediately over the couscous.
RECIPE COURTESY OF “CANCER NUTRITION & RECIPES FOR DUMMIES,” BY MAURIE MARKMAN, MD, CAROLYN LAMMERSFELD, RD, AND CHRISTINA TORSTER LOGUIDICE. PUBLISHED IN 2013 BY JOHN WILEY & SONS, INC, THE BOOK IS AVAILABLE AT WWW.DUMMIES.COM
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Q: A:
LIVING WITH CANCER
How much information should I share about my cancer diagnosis with coworkers? It really depends on what your motivation in doing so would be. If it is for emotional support, then realize that not everyone is capable or in tune with their own fears of illness and especially cancer to “really” be there for you.
If you have shared personal information with particular co-workers whom you trust and feel are a positive support, then do so. If you feel that your work will be affected, and you want to warn your co-workers or will need their help, please realize some will be more willing than others. Your cancer diagnosis is YOUR business, and you are not obligated to tell anyone but your boss. And even your boss does not need more details than you are comfortable in giving.–ALIYA HAFEEZ, MD Aliya Hafeez, MD, is an assistant professor of psychiatry and behavioral sciences and a breast cancer survivor. Reach her through Upstate Connect at 315-464-8668. Listen to an interview with Hafeez by visiting upstate.edu/healthlinkonair and searching for “Hafeez.”
Rejuvenate with reading
FROM MARY LAVERTY
Sometimes you need a story that makes you laugh Preschool “Pete the Cat: Pete at the Beach,” by James Dean, (2013) a my-firstreader book. Visiting the beach with his family, groovy Pete the Cat enjoys collecting shells and building a sand castle but resists going into the water or accepting a surfing lesson from Bob, despite the hot weather.
2014 Newbery Medal. It begins, as most superhero stories do, with a tragic accident that has unexpected consequences. The squirrel never saw the vacuum cleaner coming, but cynic Flora Belle does, and she is just the right person to step in and save him. What neither can predict is that Ulysses (the squirrel) has been born anew, with powers of strength, flight, and misspelled poetry.
Youth “Flora & Ulysses,” (2013) by Kate DiCamillo, illustrated by K.G. Campbell. Winner of the
Young adult “Better Nate Than Ever,” (2014) by Tim Federle. Nate has a plan that – with a little luck – will take
him from his bland Pennsylvania town to New York City and land him a role in “E.T.: The Musical.” All ages “Everything I Need to Know I Learned From a Little Golden Book,” (2013) by Diane Muldrow. The author’s humorous yet practical tips for getting the most out of life are drawn from more than 60 stories from the sturdy little books with the shiny cardboard covers and gold foil spines.
Sometimes you need a story that lets you cry Preschool Knock Knock: My Dad’s Dream for Me by Daniel Beaty, illustrated by Bryan Collier. Every morning a boy and his father play a game. “Knock knock,” says Papa, and the boy pretends to be asleep before jumping into his father’s arms. Then one morning Papa doesn’t come anymore, and the boy realizes his father is gone for good. In a rare topic for younger children, Beaty explores the theme of permanent separation from a parent. Youth “Fly Away Home,” (1993) by Eve Bunting, illustrated by
Ronald Himler. This is a story about a homeless boy who lives in an airport with his father, moving from terminal to terminal, trying not to be noticed. Young adult “The Impossible Knife of Memory” by Laurie Halse Anderson. For the past five years, Hayley Kincaid and her father Andy have been on the road, never staying long in one place. He struggles to escape the demons that have tortured him since his return from Iraq. Now they are back in the town where Andy grew up so Hayley can attend school. Perhaps for the first time, Hayley can have a normal life, put aside her
own painful memories, even have a relationship with Finn, a boy who likes her but is hiding secrets of his own. Will being back home help Andy’s PTSD, or will his memories drag him to the edge of hell where drugs push him over? All ages “The Giving Tree” by Shel Silverstein. Once there was a tree and she loved a little boy. Every day the boy would come to the tree to eat her apples, swing from her branches, or slide down her trunk, and the tree was happy. But as the boy grew older he began to want more from the tree, and the tree gave and gave and gave.
Mary Laverty is a librarian in the Family Resource Center of the Upstate Golisano Children’s Hospital. Reach the center at 315-464-4410.
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SEARCHING FOR CURES
A cadre of Upstate researchers focuses on breast cancer
BY AMBER SMITH
Advances in the understanding, diagnosis and treatment of breast cancer begin in laboratories. Here’s a peek into five at Upstate that received grants this year from the Carol M. Baldwin Breast Cancer Research Fund: What is the best way to restrict estrogen? Estrogen is crucial to human life for men and women, but once a woman enters menopause, excess estrogen can lead to breast cancer. Up to 80 percent of the breast cancers detected in women after menopause are triggered and proliferated by estrogen, explains Debashis Ghosh, PhD. Ghosh, a professor of pharmacology, collaborates with Juntao Luo, PhD, assistant professor of pharmacology, about ways to deliver new inhibitors of aromatase, the molecule that makes estrogen, to the tumor sites in animal breast cancer models. Having elucidated the molecular mechanism of how aromatase works, the Ghosh group has designed
Timothy Damron, MD
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Nicholas Deakin, PhD
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novel aromatase inhibitors, which are being tested in his lab. “Some of our compounds have performed better, much better in breast cancer cells than the current drug, which is known as Aromasin or exemestane,” says Ghosh. The next step would be testing the compounds in laboratory animals. Can we better protect bone from radiation therapy? Targeted radiation therapy can be effective in reducing the size of a tumor, but it can leave bones more susceptible to fractures in the years after cancer. Studying stem cells for possible solutions are Megan Oest, PhD, assistant professor of orthopedic surgery, and Timothy Damron, MD, professor of orthopedic surgery, cell and developmental biology and neuroscience and physiology. Stem cells have the ability to develop into many different cell types, depending on the body’s needs.
Debashis Ghosh, PhD.
Ying Huang, MD, PhD
Leszek Kotula, PhD
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SEARCHING FOR CURES
Of the bone cells that are alive at the time of radiation, Oest and Damron have noticed that some die and are never replenished. They are experimenting with chemical or biological methods to prevent damage to these particular cells. Perhaps in the future, patients could receive an injection of a protective substance before undergoing radiotherapy. It’s also possible, Oest theorizes, that patients could undergo something like a stem cell transplant after their therapy. Healthy cells could come from a donor, or from elsewhere in the patient’s body. She and Damron have learned that when radiation is applied to one leg, cells from the opposite leg remain undamaged. “In theory, if it worked, you could actually take cells from the healthy side of the patient and put them into the unhealthy side,” she says.
“We found that the level of expression of paxillin in tumor cells may actually influence the microtubule cytoskeleton and, therefore, may influence how those drugs actually work in individual patients,” Turner says. Nicholas Deakin, PhD, research assistant professor of cell and developmental biology, points out that the deaths of 95 percent of the 40,000 American women who die from breast cancer each year are linked to metastasis. “It’s not the tumor in the breast that really is the problem. It’s the ability of the cells to move away from there,” he explains. “If we can detect the tumors early, and if we can then treat them with a drug or know what drug to go with to stop their spread, then that’s going to greatly influence the survival of these patients.” Which drug will work best in each patient?
How do genes affect drugs that fight cancer? A gene called ECRG2 was recently identified as a tumor suppressor, and preliminary studies at Upstate reveal that it can “strongly inhibit” breast tumor cell growth, says professor of pharmacology, Ying Huang, MD, PhD. She says ECRG2 also appears to play a role in the development of resistance to multiple anticancer drugs commonly used to treat breast cancer. Her project focuses on understanding how this happens. What will stop the spread of breast cancer? The protein paxillin plays an important role in cell movement. What scientists are trying to determine is exactly how paxillin affects the movement of cancer cells away from a primary tumor, into the blood stream and on to colonize distant organs. It’s important to know because “If we can develop ways in which we can limit paxillin’s function, we may be able to block the process of metastasis,” says Christopher Turner, PhD, professor of cell and developmental biology. Many of the drugs used to fight breast cancer tumors target microtubules, the proteins that make up the cytoskeleton that helps cells maintain their shape and internal organization. These drugs create toxic side effects for patients.
A family of molecules known as the Wave Complex interact within our cells. Which molecular family members are present at any given time in the life of a cell determines how that cell will behave: how it gets nutrition, whether and how it moves, whether it remains stationary. This complex appears to play a major role in the invasive types of breast cancer, says Leszek Kotula, PhD, associate professor of urology and biochemistry and molecular biology. Working on the theory that the Wave Complex could be a target for therapy are Kotula and two colleagues, Steve Landas, MD, professor of pathology and urology, and Mira Krendel, PhD, assistant professor of cell and developmental biology. When they increase some specific molecules in the complex, the cancer spreads, Kotula says. He adds that by decreasing certain molecules, “we may actually stop metastasis, or greatly affect it.” The next step will be to test the effects of existing cancer drugs on these molecules. Landas, a diagnostic pathologist for 35 years, sees the potential. “Wouldn’t it be a wonderful thing if we find ourselves in a situation where we can look at certain members of this family of molecules and know with a high degree of certainty which drugs will work and which will not?” ●
Listen to a special episode of Upstate’s talk radio program, “HealthLink on Air” at upstate.edu/healthlinkonair by searching for “breast cancer research.”
Mira Krendel, PhD
Steve Landas, MD
Juntao Luo, PhD,
Megan Oest, PhD,
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Christopher Turner, PhD
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on-the-job
TEACHING THE COMMUNITY
Are you at risk for
cancers?
Asbestos was strong, durable and heat resistant, “so it was used in lots of products,” says mesothelioma lawyer Joseph Belluck. “Every year we learn about more and more products that asbestos was used in.”
Belluck was among the speakers at the recent 10th annual Upstate Cancer Symposium, which focused on occupational cancers. He pointed out that asbestos is still used industrially today, “and there are still many people being exposed to asbestos every day in this country.” Lung cancer, bladder cancer and the aggressive cancer of the lining of the lungs and abdomen called mesothelioma account for the majority of work-related cancers in America. Belluck told symposium attendees that patients diagnosed with mesothelioma in the United States have the cancer because of asbestos. Because mesothelioma has a lengthy latency period, people may not develop symptoms for 10 to 40 or more years after exposure. An estimated 27.5 million people were exposed to asbestos from 1940 to 1979. Early symptoms can be vague: pain in the lower back or side of the chest, shortness of breath, cough, fever, excessive sweating, fatigue, weight loss, trouble swallowing and swelling of the abdomen, face or arms.
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cancercausing chemicals The Occupational Safety and Health Administration regulates the substances listed at right as cancer-causing.
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CANCER CARE
Some 3,000 people from a variety of occupations are diagnosed with mesothelioma each year. Among them are shipworkers, construction workers and people who worked in steel mills and factories, but also school teachers, carpenters and electricians.
Michael Lax, MD, medical director of Upstate’s Occupational Health Clinical Center, says that assessing a person’s exposure to cancer-causing chemicals including asbestos over a lifetime is tricky to do with accuracy. He says at least 24,000 to 60,000 deaths per year are thought to be attributable to occupational carcinogens. “The estimates we have should be considered underestimates,” Lax says, because only 2 percent of chemicals are tested for carcinogenity before they are put into use. He says that makes American workers unwitting participants in a giant experiment to determine which workplace chemicals may lead to disease. While other organizations recognize more than 110 substances as carcinogenic, the federal Occupational Safety and Health Administration regulates only 27 as cancer-causing. Lax and Belluck say it’s important for doctors to recognize if a cancer is work-related so that patients can seek treatments that may be effective and compensation to pay future medical bills. Also, such documentation can help
asbestos
2-Acetylaminofluorene
Ethylene oxide
4-Nitrobiphenyl
4-Dimethylaminoazobenzene
Formaldehyde Methylenedianiline
Methyl chloromethyl ether
N-Nitrosodimethylamine
1,3-Butadiene
Vinyl chloride
Methylene Chloride
3,3'-Dichlorobenzidine (and its salts)
Inorganic arsenic
bis-Chloromethyl ether
Cadmium
beta-Naphthylamine
Benzene
Benzidine
Coke oven emissions
4-Aminodiphenyl Ethyleneimine
1,2-dibromo-3-chloropropane
beta-Propiolactone
Acrylonitrile
alpha-Naphthylamine
fall 2014
Hexavalent chromium
Silica is one example of a substance that is not on the list, despite the World Health Organization and the Centers for Disease Control and Prevention saying it can cause cancer.
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TEACHING THE COMMUNITY
researchers trace cancer causes, and possibly lead to safer workplaces. The first asbestos-related death was documented in 1906, Belluck says, adding that today’s laws regarding workplace safety make companies responsible not just for what they knew, but for what they should have known. The link between asbestos and mesothelioma has been clear since the 1960s, and the link between asbestos and lung cancer since the 1930s, says pathology professor Jerrold Abraham, MD, another speaker at the symposium that attracted cancer specialists and medical students. Patients may be aware of asbestos exposure, and that should make a doctor aware of the risk for developing mesothelioma, which is diagnosed with imaging tests such as X-rays and computerized tomography, and biopsies. Abraham emphasized that occupational exposures may be evident in patients’ biopsy tissues, but may go unnoticed by inexperienced pathologists. Hopefully soon, a blood test will be able to aid in diagnosis. Upstate Cancer Center Medical Director Leslie Kohman, MD introduced a mesothelioma expert at the symposium by saying, “Imaging and history are important, but they will eventually be eclipsed by what we can learn from blood biomarkers.” Harvey Pass, MD, chief of thoracic oncology at New York University Langone Medical Center, spoke of his dream to be able to screen people for asbestos-related diseases such as mesothelioma before they develop symptoms, or to determine which genes make one susceptible to the disease.
Abraham
Lax
Pass
“The earliest we will actually have a validated biomarker is probably within the next four or five years,” Pass told the symposium group. Already, a molecule has been identified that promotes the growth of mesothelioma. A blood test can tell the difference between someone who was exposed to asbestos and someone with mesothelioma. And, 25 percent of patients with the disease have been found to have a particular genetic mutation. So, progress is being made. ● Jerrold Abraham, MD, provided this background image from a paper he co-authored in 2002 in the American Journal of Respiratory and Critical Care Medicine, from a case about someone who died from asbestosis 50 years after a brief exposure in a Vermiculite expansion plant. Listen to this interview at upstate.edu/healthlinkonair by searching for ”asbestos.”
Should you be tested for
hepatitisC? Hepatitis C, the most common blood-borne infection in the United States, is one of the viruses that can cause cancer — and the majority of people who are infected don’t know it.
The Centers for Disease Control and Prevention recommends testing for all Baby Boomers – anyone born from 1945 to 1965. Jain adds that healthcare workers and anyone who believes he or she may have been exposed should also be tested.
The virus causes a chronic liver infection that can exist for decades without symptoms and that can lead to cirrhosis. Up to 7 percent of people with cirrhosis develop liver cancer each year, says Ajay Jain, MD, the associate director of hepatobiliary and pancreas surgery at Upstate. He spoke at the 10th annual Upstate Cancer Symposium in September.
Hepatitis C has become a leading cause of liver cancer. Jain says the disease is treated most successfully with a liver transplant, but surgery or radiofrequency ablation are sometimes recommended. Chemotherapy does not work. ●
No vaccine exists, but treatments can eliminate the virus or prevent its progression. A blood test can reveal hepatitis C antibodies.
Listen to this interview at upstate.edu/healthlinkonair by searching for “hepatitis c.”
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CANCER CARE
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6 reasons to say no to e-cigarettes
SHARING EXPERT ADVICE
ADVICE FROM EXPERTS
Enticed by the flavors and sleek designs of the new electronic cigarettes? Don’t be. That’s the advice of Upstate Cancer Center Medical Director Leslie Kohman, MD, a thoracic surgeon who oversees the Lung Cancer Screening Program. She elaborates: 1. E-cigarettes contain nicotine, the same tobacco product that makes traditional cigarettes so addictive. Kohman says half of the e-cigarettes studied by the FDA also contained cancer-causing chemicals. 2. Glycol, a flavoring, nicotine and “who knows what else” are contained in the devices, which are manufactured without regulation, Kohman says. “E-cigarettes are manufactured in various locations around the world with no manufacturing controls, no safety controls whatsoever.” 3. If the flavor cartridges spill or are left where a child has access, their alluring sweet smell could lead to a toxic exposure or even a lethal ingestion of nicotine for a child. The Upstate New York Poison Center fielded 24 calls about accidental ingestions of e-cigarette chemicals in 2013 and 53 calls in the first three quarters of this year. 4. While the synthetic liquid in most electronic cigarettes, propylene glycol has been recognized as safe for eating by the Food and Drug Administration. “inhaling it is very different,” she says. “The lungs absorb things in a very different way from the intestinal tract.” 5. Though some theories suggest the e-cigarette could serve as an aid to smoking cessation, “there is no evidence that this is more effective in helping people to quit cigarettes.”
6. In communities where smoking restrictions have become the norm, vaping is emerging as a worrisome trend. Big cities (including New York, Boston, Chicago, Los Angeles) are starting to ban e-cigarettes. Kohman says, “we really fear for the public health danger and the social consequences of making it look normal to be walking around with something that looks like a cigarette.” Public health experts worry that e-cigarettes will be a lure for former smokers or a gateway for teens to experiment with traditional cigarettes or other drugs. They also point out that more research on the dangers of e-cigarettes is needed. E-cigarettes are proving more dangerous than some researchers initially believed, Stanton Glantz told Science News earlier this year. He is the director of the Center for Tobacco Control Research and Education at the University of California, San Diego. In a paper in the journal, Circulation, he and his team explained that e-cigarettes deliver high levels of nanoparticles, which have been linked to asthma, stroke, heart disease and diabetes – in case you need a seventh reason to say no to e-cigarettes. ● Listen to an interview with Kohman on this subject at upstate.edu/healthlinkonair by searching “e-cigarette.”
Reducing your risk of esophageal cancer A type of esophageal cancer called adenocarcinoma is on the rise in the United States largely because of the obesity epidemic. People who are overweight may develop reflux, which can damage the esophagus and lead to cancer.
Trouble swallowing is the most common symptom of esophageal cancer. Some people may develop pain or discomfort in the middle of their chest. About half of all patients report they lost weight without trying. Other symptoms can include hoarseness, chronic cough, vomiting, hiccups, pneumonia and bone pain.
Not all esophageal cancers can be prevented, but the American Cancer Society says you can reduce your risk by:
• avoiding tobacco and alcohol, • eating a diet rich in vegetables and fruits, • maintaining a healthy weight, and • seeking treatment for reflux. ● Hear an interview with Upstate thoracic surgeon Vanessa Gibson, MD, at upstate.edu/healthlinkonair by searching “esophageal cancer.” PHOTO BY SUSAN KAHN
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Reconstructing breasts after cancer
SHARING EXPERT ADVICE
Options for women are more plentiful A woman who faces mastectomy also has to consider whether and how to reconstruct the breast that will be removed. Her options have improved in recent years. “Immediate reconstruction, in which the reconstruction is done when the breast is removed, is the gold standard now, and it is done in most of the patients who are reconstructed,” says plastic surgeon Prashant Upadhyaya, MD, an assistant professor of surgery at Upstate. He says no longer is it common for a woman undergoing mastectomy to wake up from surgery with a flat chest. Up to 90 percent of breast reconstructions are “immediate,” but some women have to defer reconstructive surgery for medical reasons, and some want to complete cancer treatment before considering reconstruction.
PHOTO BY SUSAN KAHN
Prashant Upadhyaya, MD, with silicone breast implants that he uses to discuss surgery options with his patients. Breast reconstruction can be done using implants, or it can be “autologous,” meaning the patient’s months later, undergoing another reconstruction. own tissue is used to create a new breast. Either way, most So which surgery provides the best outcome? health insurers are required to pay for reconstruction of both The surgeon says the answer has to be based on each breasts after mastectomy. individual patient’s expectations – and the realization that An autologous reconstruction requires an extensive surgery she may not be happy with any outcome during the postin which tissue is either transplanted from the abdomen to operative period. Healing and recovery is liable to take the chest, or moved from the patient’s back to the chest. This months. ● appeals to patients who do not want implants containing silicone or saline in their bodies, but not every woman is a FACTORS TO CONSIDER candidate for autologous reconstruction, Upadhyaya says.
A woman who opts for implants may also be able to have a surgery that leaves her nipple intact. Newer techniques involve an incision that is made away from the nipple. “It’s actually very well hidden below the breast,” Upadhyaya says. The implants are often inserted through the same incision, and “the patient wakes up with breasts completely intact.” Although sensation won’t be the same, the surgeon says after a woman recovers from the operation, her breast may appear much as it did before. He favors silicone gel implants. “Saline implants do not have the natural feel or the look of silicone gel implants. I offer both to patients. But I think the longevity of the results is better, and the feel of the breast is better with silicone implants.” Implants carry the risk of infection. Upadhyaya says from 5 to 10 percent of patients with implants will face infection, which means having to remove the implants and then,
Decisions about reconstructive surgery depend on many personal factors, including: ●
your overall health
●
the stage of your breast cancer
●
the size of your natural breast
●
the amount of tissue available
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whether you want reconstruction on both breasts
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the type of procedure you are considering
●
the size of the implant or reconstructed breast
●
your desire to match the look of the other breast
Source: American Cancer Society Listen to an interview at upstate.edu/healthlinkonair by searching “breast reconstruction.”
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CANCER CARE
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SHARING EXPERT ADVICE
How to avoid constipation
Since everyone is different, the side effects to cancer treatment vary from person to person. One common problem is constipation. Registered dietitian nutritionist Maria Erdman provides these possible solutions: ● Choose foods that are high in fiber for your meals and snacks. Shoot for 20 to 35 grams of fiber each day. Some suggestions from the Mayo Clinic: ● Introduce fiber into your diet slowly, with a few additional grams every couple days. Otherwise, it may cause stomach upset.
● Stay active with exercise, as you are able. ● Eat at roughly the same times each day. ● Eat breakfast when you start your day, and include both high-fiber foods and coffee, hot tea or hot water with lemon. Hot beverages may act as stimulants.
● Keep hydrated with plenty of liquids, and if you are increasing your fiber intake, increase your fluid intake, too.
High fiber foods FRUITS
LEGUMES, NUTS & SEEDS
1 cup raspberries = 8 grams fiber
1 cup split peas, cooked = 16.3 grams fiber
1 medium pear, with skin = 5.5 grams fiber
1 cup lentils, cooked = 15.6 grams fiber
1 medium apple, with skin = 4.4 grams fiber
1 cup black beans, cooked = 15 grams fiber
1 medium banana or orange = 3.1 grams fiber
1 cup lima beans, cooked = 13.2 grams fiber
1 cup strawberry halves = 3 grams fiber
1 cup baked beans, vegetarian, canned, cooked = 10.4 grams fiber
GRAINS, CEREAL & PASTA 1 cup whole wheat cooked spaghetti = 6.3 grams fiber
VEGETABLES
1 cup pearled barley, cooked = 6 grams fiber
1 medium artichoke, cooked = 10.3 grams fiber
¾ cup bran flakes = 5.3 grams fiber
1 cup green peas, cooked = 8.8 grams fiber
1 medium oat bran muffin = 5.2 grams fiber
1 cup broccoli, boiled = 5.1 grams fiber
1 cup instant cooked oatmeal = 4 grams fiber
1 cup turnip greens, boiled = 5 grams fiber 1 cup Brussels sprouts, cooked = 4.1 grams fiber
STROKE
Stroke Center
upstate.edu/stroke
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www.upstate.edu/cancer
SHARING EXPERT ADVICE
Building a bladder from page 3
They knew of Bratslavsky’s surgical prowess and his extensive experience in urologic oncology from his work at the National Cancer Institute. Sustare’s bladder would need to be removed because the cancer had invaded the muscle. But Sustare was adamantly against replacing it with an external bag or urostomy. Bratslavsky gave Sustare another option. He could create a new bladder out of a portion of Sustare’s intestines. In an operation that would last all day, Bratslavsky and surgeons he is training in the specialty of urology would remove about 60 centimeters of Sustare’s intestine, cut it open lengthwise and configure it into a sphere. It would then be attached to the urethra and kidneys. In addition, the team would remove the bladder, prostate, seminal vesicles, vasa deferentia and 41 lymph nodes. Such a surgery is not an option for everyone with advanced bladder cancer. But Sustare was a good candidate because he was young, healthy and active, as well as conscientious and responsible, Bratslavsky says.
Blood in urine is never normal
The men spoke before the surgery in 2012, with Bratslavsky explaining what could go wrong. “The role of a surgeon is to
Blood in the urine does not necessarily indicate bladder cancer, but it does warrant a visit to a urologist, says Srinivas Vourganti, MD, an assistant professor of urology at Upstate. Bladder cancer occurs mostly in older people. Men are three or four times more likely than women to get bladder cancer during their lifetime, and smokers are three times as likely to be diagnosed as nonsmokers. The usual first symptom: blood in the urine. Patients are evaluated through a combination of X-rays, urine and blood tests and a procedure called cystoscopy that allows a doctor to visualize the inner lining of the bladder. Any abnormal growths are removed and examined to identify cell type, aggressiveness and how deeply the tumor was attached.
About half of bladder cancers are confined to the smooth mucosal lining of the bladder, but the cancers can spread into the deeper layers, or beyond the bladder. “Each depth of invasion is associated with worse outcomes,” Vourganti explains. Treatment varies. The more advanced diseases may require radiation therapy
go closely over all the options, and help patients understand what exactly the potential pitfalls may be,” he says. A patient who chooses this option has to be able to sense if something is not right with his body. He has to realize he may need to use a catheter to empty the new bladder sometimes. And, nighttime urinary incontinence may be an issue. Sustare remembers Bratslavsky’s talk. “He did not sugar coat it.” Sustare underwent chemotherapy first. Then the surgery was done laparoscopically, using the DaVinci robot. His largest incision was no more than an inch. Bladder cancers are prone to recurrence, so Sustare sees Bratslavsky regularly. “It’s only when I get those notices that I have to come in for a CT scan that I even recall that I had cancer,” Sustare says. Between medical appointments, he leads a normal, active life. ● Listen to this interview at upstate.edu/healthlinkonair by searching for “Sustare.”
and/or medications, or the removal of the bladder. Tumors confined to the lining can be removed, but they are like weeds with a tendency to grow back. Vourganti says that is why bladder cancer has the largest economic impact among cancers. “There is an intensive surveillance that has to happen to prevent its progression,” he says.
Cigarette smoking or exposure to industrial chemicals called aromatic amines contributes to many bladder cancers. (Aromatic amines are sometimes used in the dye industry; workers at high-risk for exposure include makers of rubber, leather, textiles or paint products, painters, machinists, printers, hairdressers and diesel truck drivers, according to the American Cancer Society.) With every heartbeat, our kidneys make small amounts of urine, which is stored in our bladder until we void. Since many toxins in our body are filtered out through the urine — including the carcinogens from cigarettes and aromatic amines — the bladder is exposed to these toxins. That makes smokers who work with cancercausing chemicals at especially high risk of developing bladder cancer. ● PHOTO BY ROBERT MESCAVAGE
Listen to this interview at upstate.edu/healthlinkonair by searching for “Vourganti.”
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CANCER CARE
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MAKING A DIFFERENCE
Opening of the Cancer Center
PHOTO BY SUSAN KAHN
Cancer Center opens doors to patients
The community got a sneak peek of the Upstate Cancer Center in July, after the ribbon cutting ceremony. Medical providers cared for the first patients in the center in August. The center encompasses 90,000 square feet and occupies the first three of five floors inside the new building that adjoins Upstate University Hospital. Give Hope a New Home, the fundraising campaign that was launched in 2010 to help support the Upstate Cancer Center, surpassed its $15 million goal by raising $17.4 million for the $74 million facility. The campaign was directed by the Upstate Foundation and the Upstate Cancer Campaign cabinet, led by honorary co-chairs, Syracuse University basketball coach Jim Boeheim and Baldwinsville native and professional hockey player Tim Connolly. The money supports enhanced patient amenities and funds endowments and special programs.
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PHOTOS BY RICHARD WHELSKY AND WILLIAM MUELLER
www.upstate.edu/cancer
MAKING A DIFFERENCE
Breast cancer events raise awareness and money A Run For Their Life (pictured above) raises money for the Carol M. Baldwin Breast Cancer Research Fund, which supports research taking place in the laboratories of Upstate Medical University. The event includes a 15K run, 5K run, 5K walk and a 1.5K victory walk. This year, Upstate fielded the largest team, with 407 participants who raised more than $18,000.
Also Pink Tutus for a Cure held its third annual silent auction Sept. 27 at the Black Olive Mediterranean Restaurant in Armory Square. Black Olive employees Scott Chambers and Danny Espinoza created the effort in honor of a coworker who battled and survived breast cancer. They raised more than $19,000 for breast cancer research at Upstate in the first three years of the auction. Among the items auctioned this year was an autographed Eric Clapton electric guitar, an autographed New York Jets football and autographed Eagles “Hotel California” sheet music.
PHOTO BY SUSAN KEETER
More than a dozen restaurants participated in Baking for Breast Cancer in October, raising “dough” for Positively Pink Packages, a nonprofit organization in Central New York that provides free care packages to newly diagnosed breast cancer patients. Proceeds from the sale of unique desserts at each of the restaurants go to Positively Pink.
Over the last five years, 617 Upstate employees, students, friends and family members have joined hundreds of other Central New Yorkers in the American Cancer Society’s fundraiser, Making Strides Against Breast Cancer. This year’s event was Oct. 19. The noncompetitive walk is seen as a celebration of survivorship, plus an occasion to express hope and a shared determination to make this breast cancer’s last century. ●
How one workplace supported a co-worker with cancer To know the real value of a pink cotton t-shirt, you would have had to see the tears streaming down Stacy Wilson’s face. It was soon after her diagnosis with breast cancer in 2013. She returned to work from a doctor’s appointment. When she walked in, 27 of her coworkers wore bright pink t-shirts with coupons printed on front. “This coupon is worth the support of one friend in your fight against breast cancer. Expiration date: Never,” the shirts said. Wilson was blown away.
See page 10 for a look at some of the research made possible with Baldwin funds.
She works as an application coordinator in information management technology at Upstate. She’s mother to seven children ranging in age from 11 to 19. Her co-workers raised about $200 by selling the tshirts. They also contributed a variety of comfort foods for her family while she was going through treatment. Wilson finished her treatment in July and has a good prognosis. And she remains ever grateful for the support shown by her coworkers. “It was a huge deal, what they did for me.” ● fall 2014
CANCER CARE
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750 East Adams Street l Syracuse, NY 13210
Pinpointing prostate cancers
UPClose
Upstate became the only provider in Central New York (and one of a few sites in the country) to offer breakthrough technology to help pinpoint hard-to-locate prostate cancers when it acquired the UroNav fusion biopsy system.
Traditional biopsies of the prostate gland rely on ultrasound to guide surgeons to areas where cancers tend to form. From there, random samples are taken. The UroNav system uses technology similar to GPS navigation to guide a surgeon to where cancer may be hiding, such as an area within a man’s prostate where the blood supply is abnormal. This allows more accurate samples to be taken and reduces the need for multiple biopsies. Here’s how it works.
14.354 1014 36.750M ELsk
First, the patient undergoes magnetic resonance imaging; those images are analyzed. During the patient’s biopsy, UroNav fuses the MRI images with real-time ultrasound images to guide the surgeon to the precise area within the prostate where cancer might be growing. Tissue samples are then removed for laboratory analysis. Pathologists in the lab determine the extent and aggressiveness of the cancer, so that surgeons can tailor the appropriate treatment.
IMAGES FROM UPSTATE UROLOGY
Above: Screen images from the UnoNav fusion biopsy system. The upper left quadrant shows an ultrasound image of the prostate. The green circle with the red dot is the geometric center of the area where cancer is likely to be hiding; the yellow line is where the urologist removes a tissue sample for biopsy. The lower left quadrant and upper right quadrants are different views from an MRI. The lower right quadrant is a closeup of the prostate. Above, left: Three-dimensional image of the prostate. Blue and lime green colors indicate the areas of interest. Pink lines denote biopsy locations.