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CANCER

for anyone touched by cancer SPRING 2017

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How to find a doctor when you are new in town page 4

3 women share their experience with breast cancer page 6

Concentrating on brain tumors page 11

Which childhood cancer is most prevalent? page 17 Why prostate cancer screening recommendations are changing page 19 When a negative is a positive page 20

Better breast biopsies back cover Brought to you by the


YOUR GUIDE

Patients receive medical care – and education

WHEN WE COME TO A MEDICAL APPOINTMENT at the Upstate Cancer Center, we’re ready to have blood drawn, to have our lungs listened to, to report on our symptoms. We are focused on our health.

What we may not realize is that the appointment is also a learning opportunity. “A great deal of what we do as advanced practice clinicians is educate our patients,” says nurse practitioner Travis DeBois, le, who cares for patients with cancer and blood disorders. It’s not unusual for patients to become experts in their particular disease. But we don’t have to do all of our research online or in a library. Our nurse practitioner, for instance, can be a face-to-face resource. Instead of telling him or her about the fatigue we feel, we may want to ask about its underlying cause. We may have questions about a medication we’ve been prescribed. Or we may need help understanding how different blood cells behave. DeBois says he and his colleagues are well equipped and eager to field questions. If they don’t know the answer, they can help find it. ● PHOTO BY ROBERT MESCAVAGE

SINGER/SONGWRITER — and cancer patient – Melissa Clark, 68, of Hamilton is among the musicians who are scheduled to perform in the lobby of the Upstate Cancer Center. She plays a variety of folk songs, including one she wrote called “Heart of a Champion.” A retired postal worker, Clark performs at farmers’ markets, senior residences and restaurants. She was diagnosed with lymphoma in December 2016 and regularly has appointments with medical oncologist Stephen Graziano, MD, or radiation oncologist Paul Aridgides, MD.

PHOTO BY SUSAN KEETER

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upstate.edu/cancer l spring 2017


INSIDE

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Inside this issue CARING FOR PATIENTS

SHARING EXPERTISE

‘A great deal of what we do is educate our patients’

page 2

Team approach to melanoma

page 15

Finding a doctor when you are new in town

Treatment you inhale: pure oxygen

page 16

page 4

9 things to know about brain and spinal cord tumors

page 17

3 women share their experience with breast cancer

page 6

Understanding advances in radiation therapy

page 18

Diagnosis prompts a detour for medical student

page 9

Better breast biopsies

back cover

SEARCHING FOR CURES ‘Brain trust’ collaborates on brain tumor research, treatment

page 11

Research support

page 14

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for anyone touched by cancer

SPRING 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 DESIGNER

Jim Howe, Susan Keeter, Jim McKeever, Amber Smith 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.

spring 2017 l upstate.edu/cancer

DEPUTY DIRECTOR (INTERIM) Gennady Bratslavsky, MD ASSOCIATE DIRECTOR FOR CLINICAL AFFAIRS Ajeet Gajra, 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

When a negative is a positive

page 20

A new body/mind wellness group to join

page 20

Roasted vegetable dip recipe

page 21

MAKING A DIFFERENCE Spreading cheer

page 22

Creating a cancer center

page 23

Climbing mountains

page 23 .

On the cover: Andrea Scheibel. See story, page 4. PHOTO BY SUSAN KAHN

care

CANC ER

for anyone

touched

by cancer

How to doctor find a you arewhen new in town SPRING

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care

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LIVING WITH CANCER

2017

page 4 3 women their experishare with breast ence cancer page 6

Concen on brain trating tumors page 11 Which childho od cancer is most prevale nt? page 18

Why prosta screening te cancer recommenda tions are changi ng page 19 When a negati is a positivve e page 20 Better breast biopsie s page 24 Brought

to you by

the

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. The Cancer Center is located at 750 E. Adams St., Syracuse, NY 13210.

ASSOCIATE ADMINISTRATOR Richard J. Kilburg, MBA

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Settling in

CARING FOR PATIENTS

They found jobs, a home – and a doctor

Andrea Scheibel with her oncologist, Diana Gilligan, MD, PhD.

PHOTO BY SUSAN KAHN

BY AMBER SMITH

WHEN SHE MOVED TO SYRACUSE two summers ago, Andrea Scheibel, 32, had a rare form of anemia that required blood transfusions, sometimes as oen as every week. She got sick in 2014 when her body stopped making red blood cells. She was diagnosed with pure red blood cell aplasia the same week her husband, Will, defended his doctoral dissertation and graduated from Indiana University in Bloomington, where they were living. Scheibel’s doctor always suspected something more was going on with her, beyond the anemia for which she was being treated. Although he cured the pure red blood cell aplasia, her body didn’t reveal cancer until aer she and her husband relocated and she became a patient of Upstate hematologist/oncologist Diana Gilligan, MD, PhD. Scheibel met Gilligan, whom she found with her dad’s help, in August 2015. By then, her body had begun producing red blood cells again. “From the first appointment, I was like, ‘she’s the one,’ ” Scheibel says.

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“She just seems like she’s on top of it — all the time. And I know that she knows what she’s talking about.” Her appointments with Gilligan every month became part of her routine. Scheibel started working in the music resource center at Onondaga Community College. Will Scheibel took a faculty position at Syracuse University’s English department. e couple settled into a home. In November 2016 Scheibel was getting ready to prepare a anksgiving meal for her in-laws, who were visiting Syracuse. She went for her regular blood test that Wednesday. Her red blood cell and platelet counts were both alarmingly low. Gilligan ordered an emergency bone marrow biopsy. Scheibel had undergone two previous such tests, but never when she was so sick. is time, laboratory pathologists looked at her bone marrow and found T-cell large granular lymphocytic leukemia, a chronic leukemia affecting the white blood cells. continued on page 5

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CARING FOR PATIENTS

Settling in

continued from page 4

Robert Hutchison, MD, is an Upstate hematopathologist who specializes in blood analysis. Gilligan says he found the large granular lymphocytes in Scheibel’s blood basically because he was looking for them. Hutchison and colleagues have published several papers about disorders of the blood, including some about the behavior of large granular lymphocytes. With a keen research interest in this type of leukemia, the hematopathology group screens using: l l

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blood film examination, to see abnormalities in red blood cells, white blood cells or platelets;

Robert Hutchison, MD

flow cytometery, in which cells are illuminated as they flow in front of a light source to reveal their size, shape, presence of tumor markers on their surface and other characteristics; and

When you see a stroke act FAST

molecular diagnostics, techniques that analyze biological markers in the patient’s genes and proteins.

“It is quite a common disorder,” Hutchison says of large granular lymphocytic leukemia, “but it is oen overlooked because it is usually indolent, less severe than in this patient.” With the diagnosis of cancer, Scheibel noticed how her thinking changed, and how people spoke to her differently. Still, she was glad to have an actual diagnosis – and a doctor with a plan. Scheibel has an appointment at the Upstate Cancer Center every week. She says Gilligan makes her feel as if she were the only patient she has. “I always feel like she’s doing active research on my situation. She’s always looking ahead to my next treatment or test.” ●

FA C E droops to one side HOW TO FIND A SPECIALTY DOCTOR WHEN YOU ARE NEW IN TOWN

1. Start researching as soon as you know you will be moving, advises Andrea Scheibel’s dad, Bob Verdoorn, who helped her find a doctor in Syracuse. 2. Ask your original doctor if he or she can recommend anyone. 3. Use a search engine to find the names of specialty doctors in the area where you are moving. Verdoorn used Healthgrades.com and searched for hematologists, doctors who specialize in diseases of the blood.

ARM drifts downward

S P E EC H sounds slurred

TIME to call 911 now

4. Look for what you can find about the doctors’ backgrounds and areas of expertise. 5. Run their names through some of the doctor rating websites. Don’t just look for someone whose patients say they’re the greatest doctor ever. Read reviews that give you a sense for the doctor’s professionalism and how they relate with their patients, Verdoorn says. 6. Find out where their offices are, and whether they are taking new patients. Also check on insurance coverage. 7. Scheibel’s diagnosis was complicated, and her doctor suspected something else was going on with her blood. So Verdoorn was looking for a hematologist with experience in oncology. He and his daughter also wanted someone with an interest in research. Doctors who work at academic medical centers, such as Upstate, are likely to be involved in research in addition to caring for patients. 8. Verdoorn knew he wanted a doctor with experience for his daughter. He didn’t want someone who had just finished training, and he didn’t want someone who was close to retirement. That helped him focus his search. 9. Once you’ve narrowed your options, share their professional biographies with your original doctor. He or she may be able to steer you.

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ASK FOR THE EXPERTS. ASK FOR UPSTATE.

10. Make arrangements for your medical records to be transferred, so your new doctor can become familiar with you before your first appointment.

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CANCER CARE

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How breast cancer affected 3 Central New York women

CARING FOR PATIENTS

Surgeons work together to provide mastectomy, reconstruction Breast surgeons Prashant Upadhyaya, MD, and Scott Albert, MD

Paula Malecki, 47, of Cicero Diagnosed: July 3, 2015

Concern: A red spot on her breast seemed to get brighter in the shower. A friend insisted she see a doctor, who sent her for a mammogram and sonogram on a ursday. She returned the next day for a biopsy of an area of concern in one breast. at Monday she learned she had estrogen positive breast cancer. “I felt like my Grandma was looking out for me,” she says. “It was almost like someone gave me a sign to get to the doctor.” History: Breast cancer killed her grandmother. Also, 13 years prior, Malecki underwent a lumpectomy to remove suspicious tissue in one breast. Treatment: Malecki underwent a double mastectomy three days aer her diagnosis, with Scott Albert, MD. “I had to, for my kids. I have twin boys, who were 8 at the time, and I have a daughter who was 18. I had to be strong.” Later she had reconstructive surgery with Prashant Upadhyaya, MD. en she had her ovaries removed, since she was at an increased risk for ovarian cancer. Advice: “If you have dense breast tissue, don’t go without a sonogram. A 3-dimensional mammogram did not show my cancer, but a sonogram did.” Paula Malecki PHOTO BY SUSAN KAHN

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CARING FOR PATIENTS

Crystal Combs, 44, of Syracuse Diagnosed: Feb. 26, 2016 Concern: A routine mammogram revealed two tumors in one breast and three in the other. Five biopsies helped provide Combs with a diagnosis of an aggressive cancer that has required extensive treatment. History: ere has been some cancer in her family. Treatment: Combs underwent a double mastectomy in July 2016, aer several months of chemotherapy. She has had radiation therapy, and is currently being treated with a third type of chemotherapy, which she will be on until March 2018. Combs plans to complete treatment before she considers whether to have reconstructive surgery. “I look at it like I’m fortunate,” she says of her young age and healthy heart, which has allowed her to withstand the rigors of treatment. She also credits her surgeon, Scott Albert, MD, with being compassionate and taking the time to explain her treatments. Combs is grateful that her daughter has been with her every step of the way. Advice: “Talk about it. We owe it to ourselves, our children and grandchildren, and our community to break the silence. It’s okay to say, ‘I have breast cancer. I am here. I’ll get through it.’ It gets hard, but have faith.” Crystal Combs PHOTO BY WILLIAM MUELLER

Elva Greene, 41, of Bernhards Bay Surgery: August 2015

History: Green’s grandmother, mother and two aunts had — and survived — breast cancer. “Aer I divorced and became a single mom, just kind of looming over my head was the fear of potentially having breast cancer.” Action: Considering her family history, and her personal history of benign lumps being discovered and removed, Green’s risk of developing breast cancer was increased. So, she elected to have both breasts surgically removed before cancer could develop. “It was a super-tough decision, but once I made the decision, I have been so happy…just knowing that I have my three kids, and this is not something I will have to worry about.” She says before the surgery and reconstruction, her lifetime risk of developing breast cancer was more than 30 percent. Aerward, her risk dropped to below 1 percent. Treatment: “My doctors did such an amazing job that my scarring is minimal.” Her surgery team included Scott Albert, MD, and Prashant Upadhyaya, MD. Advice: “Join a support group or find someone who has been through the experience. Just finding someone to talk to really takes away the scariness.”

Elva Green PHOTO BY SUSAN KAHN

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CARING FOR PATIENTS

Ora Germany, 79, of Syracuse, holding the pink teddy bear, celebrated her last round of chemotherapy on Feb. 22 by ringing a bell in the Upstate Cancer Center, surrounded by loved ones including her four daughters and several grandchildren. She was diagnosed with stomach cancer in August 2016 and underwent 12 rounds of chemotherapy. She says her tumor got smaller during treatment. The Upstate Cancer Center features a bell on each of three treatment floors. Patients are invited to ring it when they finish treatment or reach a milestone.

Grateful for ‘fantastic job’

PHOTO BY SUSAN COLE

WHEN PATRICK MOHR, managing partner of Eastwood Litho Inc., oversaw the printing of the first issue of Upstate Cancer Care magazine, he did not expect to be featured on its pages. But in December 2015, Mohr was treated for thyroid cancer. His symptoms had started with a lump at the back of his throat, and a biopsy confirmed the presence of cancer. Surgeon Mark Marzouk, MD, removed the thyroid and the cancerous tumor on it, and followed the surgery with internal radiation therapy. rough the placement of radioactive iodine directly on the tumor site, to eliminate any remaining cancer cells, Mohr was able to avoid chemotherapy and further radiation treatments. “Dr. Marzouk did a fantastic job for which I am forever grateful,” Mohr said. “I saw him for my regular checkup in November 2016 and Dr. Marzouk told me the cancer is gone. It doesn’t get much better than that.” ●

Surgeon Mark Marzouk, MD, chats with Patrick Mohr. Prior to becoming Marzouk’s patient, Mohr’s only contact with the Upstate Cancer Center was winning the bid to print its magazine. PHOTO BY SUSAN KAHN

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upstate.edu/cancer l spring 2017


A detour

CARING FOR PATIENTS

Medical student learns about health care as a patient

THIRD-YEAR MEDICAL STUDENT Alex Paley has been in treatment for a brain tumor since Jan. 18, when he was diagnosed and underwent emergency surgery.

He would much rather be a doctor than a patient. Paley has a rare, fast-growing tumor in his brain called a glioblastoma, which made itself known with an excruciating headache and slight facial paralysis. Lawrence Chin, MD, chief of neurosurgery at Upstate Medical University, removed nearly all of the tumor. Doctors at Memorial Sloan Kettering Cancer Center in New York City are overseeing Paley’s radiation therapy and chemotherapy. He ran cross-country at Albany High School and continued running on the track team at the University of Miami, where he majored in engineering. He began medical school at Upstate in 2014. Running continued to be a passion. Aer his diagnosis, his Upstate classmates put together a fundraising run with T-shirts proclaiming “I’m with Alex,” and 814 donors have helped raise $77,604 for Paley’s expenses on YouCaring.com. Paley says he’s grateful for his medical knowledge. It has saved him from having to educate himself during his own medical crisis, and he’s not as scared or overwhelmed as he imagines he would be otherwise. He finds himself explaining a lot to his mother. With the vantage point of a patient, Paley says he sees the importance of explaining everything to patients and of being available to field their concerns. Yes, he would rather be finishing medical school than undergoing chemotherapy. But, Paley is making the best of his situation — and still learning about medicine. He says, “I feel like this is going to help me be a better doctor.” ●

Upstate medical students set up a fundraising run and crowdfunding site for their classmate, Alex Paley, above, who has a brain tumor. Front row: Gabrielle Ritaccio, Kathryn Conway, Victoria Fairchild, Kathleen Donovan and Samantha La Qua. Standing: Peter Congelosi, Daniel Santarsieri, John Lofrese, Mckinzie Neggers, Mary Powers, Emily Kellogg, Caitlin Nicholson, Caroline Shank, Omazonna Amadi, Larissa Assam, Emily Malavenda, Danielle Faivus and Katie Patrick. PHOTO BY SUSAN KEETER

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Diagnosis leads to career KATHERINE FREGA was a high school junior in Westfield, N.J., in May 2010 when she was diagnosed with Hodgkin lymphoma. She transferred her cancer care to Upstate when she became a student at Syracuse University in 2012. Frega graduated from SU with degrees in biology and public policy. In fall 2016 she started medical school at Upstate with the goal of becoming a pediatric oncologist. Two of her former cancer doctors, Jody Sima, MD, and Andrea Dvorak, MD, are among her mentors now, and her history as a cancer patient provides a unique context for her studies. “I took an active approach to my treatment, asking ‘sciency’ questions,” Frega recalls. “It’s really cool now, as a first-year medical student, seeing the chemo drugs I was on in clinical trials now being taught to me.”

Upstate medical student Katherine Frega, right, with her sister, Jennifer. Jennifer donated stem cells as part of Katherine’s treatment for Hodgkin lymphoma.

Frega finds time to volunteer as a leader in Upstate’s “Peds Pals” program, which matches a first- and second-year medical student with a pediatric cancer patient for regular tutoring and companionship. Frega’s “pal” is a teen girl who helps provide Frega with perspective. “I never really wanted to be known as a person who had cancer,” she realizes. “I wanted to be known for what I want to do for others. I’ve been sick, and I’ve been through some terrible things, but I want to make things better for others.” ●

The f irst and only comprehensive stroke center in the region. We offer three levels of specialized neuroscience care for stroke patients.

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Brains against brain tumors

SEARCHING FOR CURES

Experts from several scientific fields join forces to accelerate fight against brain cancer BY JIM HOWE

TO BETTER MEET THE CHALLENGES of treating brain cancer, Upstate’s Precision NeuroOncology Program pools the expertise of the best minds in a variety of scientific fields. e newly formed Brain Tumor Research Group involves neurosurgeons, pathologists and neuroscientists from Upstate Medical University and biomedical scientists from Cornell University to analyze and test brain tumors with the goal of increasing the number of available brain cancer treatments. Working as a multidisciplinary team, the experts store tumor samples in a unique tumor bank, perform molecular profiling and biological assays and work toward predicting the progression of brain cancer and its outcome. In addition, the group works to develop clinical trials that could lead to new cancer treatments and possibly to applications for other diseases as well. is team draws on a special resource — Upstate’s brain tumor cell bank, which has been maintained by the department of neurosurgery for more than 25 years to support its research. Hundreds of tissue samples from brain tumors are carefully stored in a deep freeze at the Neuroscience Research Building. ese samples can be thawed, cultured and studied to help understand how tumors behave. e spirit of collaboration behind this project has already been established. One of Upstate’s newest faculty members, Mariano Viapiano, PhD, came from Harvard University to continue working with Upstate faculty members he had long associated with, including neuroscience professor Russell “Rick” Matthews, PhD, and pathologist Robert Corona, DO, and now neurosurgeon Lawrence Chin, MD. is collaboration integrates the work done at spring 2017 l upstate.edu/cancer

These are some of the experts from different fields who make up the Brain Tumor Research Group. From left are: (front row) Ed Rice, Lawrence Chin, MD, Mariano Viapiano, PhD, and Russell “Rick” Matthews, PhD; (second row) Robert Corona Jr., DO, Charles Danko, PhD; (third row) Malvina Prapa, PhD, Sharon Longo and Nandhu Mohan Sobhana, PhD; (fourth row) Prajna Behera, Lina Barrera Arenas, Ashis Sinha and Geoffrey Eill. Rice and Danko are from Cornell, while the rest are from Upstate Medical University. PHOTO BY ROBERT MESCAVAGE

Upstate’s Neuroscience Research Building with that taking place in the Central New York Biotechnology Accelerator, the Cancer Center, the Cord Blood Bank and Molecular Genetics Laboratory and the laboratory of Charles Danko, PhD, at Cornell University’s Baker Institute. Working together, neurosurgeons can become involved in basic science, neuroscience researchers can pursue topics in oncology, and pathologists can help develop molecular diagnostics. e aim is to create new brain cancer treatments derived from the intensive research and analysis of the tumor samples. e program hopes to become a national reference institution for precision diagnostics and personalized treatment of brain cancer. continued on page 12 CANCER CARE

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Brains against brain tumors

continued from page 11

When a neurosurgeon such as Grahame Gould, MD, removes a brain tumor from a patient, a tiny sample is preserved for study and testing. As more and more tumors are tracked, it is hoped that doctors and researchers will one day be able to predict the likely progress and outcome of a patient’s cancer. PHOTO BY DEBBIE REXINE

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SEARCHING FOR CURES

The brain cancer research group at work

Tumor tissue is invaluable to the study of brain cancer. Upstate is fortunate to have a unique resource, a bank of thousands of tiny vials of frozen cancer tissue samples dating back more than 25 years. These samples, taken from both adults and children, can be used for current and future research. Above, research assistant professor Nandhu Mohan Sobhana, PhD, examines a tray of this preserved tissue – stored in vials about the size of a small pencil.

Frozen samples of brain cancer tumors can be carefully thawed, put in a nourishing medium and placed in a body-temperature incubator to bring them back to life. Above, research specialist Sharon Longo holds a flask in which the cells are placed for this nurturing process. Researchers can study to see, for example, whether the cells will grow a new tumor or how they might react to various chemicals. In addition to frozen tissue, fresh tumor cells can also be studied.

In molecular profiling, a particular patient’s cells are studied for their unique biomarkers, or indicators of the presence or severity of disease. This profiling holds the promise of improving current methods of cancer diagnosis and treatment. Above, postdoctoral research fellow Malvina Prapa, PhD, examines slides of brain cancer cells on a computer screen.

Biological assays, or bioassays, are tests of the effectiveness of a chemical or drug to fight cancer or other diseases by using tissue samples, plants or animals, such as lab mice. Above, from left, research fellow Lina Barrera Arenas and senior research support specialist Prajna Behera work on some samples.

A goal of the program is to bring together various specialists to find better treatments for cancer. Neuroscientists, such as research fellow Lina Barrera Arenas, above, will work with surgeons, oncologists and others to advance the understanding of the disease.

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Uniting the best brainpower available in a spirit of collaboration is the driving principle behind this project. Above are some of the project leaders, from left, Russell “Rick” Matthews, PhD, Lawrence Chin, MD, Charles Danko, PhD, Mariano Viapiano, PhD, and Robert Corona Jr., DO. Matthews, Danko and Viapiano direct research labs, Chin is a neurosurgeon, and Corona directs the pathology department at Upstate. PHOTOS BY ROBERT MESCAVAGE

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SEARCHING FOR CURES

Grant money fuels cancer research Krendel

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MIRA KRENDEL, PHD, associate professor of cell and developmental biology and Juntao Luo, PhD, assistant professor of pharmacology, each received $360,000 grants from New York state to further their research into breast cancer treatments. Krendel is exploring how a particular protein contributes to tumor progression and metastasis in breast cancer. Luo is developing a targeted drug delivery system that relies on nanocarriers. Luo also was the recipient of a $50,000 grant from the Upstate Foundation’s Cancer Center annual fund and its Michael Connolly Endowment for Lung Cancer Research. He and Walter Hall, MD, professor of neurosurgery, are working on a nanocarrier that would be used in the treatment of melanoma and its brain metastasis. Two additional studies underway at Upstate received $50,000 grants. Hong Lu, PhD, assistant professor of pharmacology, is working with Savio John, MD, assistant professor of medicine, on tumor suppressors in liver and/or pancreatic cancer and pre-cancerous liver tissues. Saeed Sheikh, MD, PhD, professor of pharmacology, is paired with Steve Landas, MD, professor of pathology, to identify tumor markers and a target for cancer therapy. ●

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In this kidney cell image from Mira Krendel, PhD, an epithelial cell shows the protein scaffolding that is important for maintaining cell shape and supporting cell migration. The red staining highlights actin filaments that act as struts to support cell shape, while the adhesive plaques attaching the cell to the underlying surface are shown in green.

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SHARING EXPERTISE

Members of the multidisciplinary melanoma team, from left: Surgeon Scott Albert, MD; medical oncologist Adham Jurdi, MD; medical oncologist Abirami Sivapiragasam, MD (known as Abby Siva, MD) and surgical oncologist Ajay Jain, MD PHOTO BY SUSAN KAHN

Team tackles complex skin cancers MELANOMA ACCOUNTS FOR about 1 percent of skin cancers, but it’s the skin cancer most likely to spread and the deadliest. e majority of melanomas are superficial, discovered at an early stage and easily treated with surgery. But some patients have more advanced melanomas that require more complex treatment, says Upstate surgeon Scott Albert, MD. He is part of a multidisciplinary team of doctors at Upstate from surgical oncology, radiation oncology, medical oncology and dermatology who meet monthly to discuss the care of patients with complicated melanoma, “so we can come up with treatment plans for each patient that suits them,” Albert says, explaining that “having a lot of input from other specialties can be very beneficial.” e experts put their heads together to consider surgical options and whether chemotherapy, radiation therapy or other types of treatment are appropriate. ●

REDUCE YOUR RISK OF SKIN CANCER: Limit your exposure to ultraviolet rays. Seek shade, or wear sunscreen, sunglasses, hats and shirts when in the sun. Avoid the use of tanning beds and sun lamps. SOURCE: AMERICAN CANCER SOCIETY

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Upstate students benefit from nationally recognized professors, excellent job placement and SUNY tuition. Open houses are held each fall and spring. DEGREE PROGRAMS Biomedical Sciences (MS, PhD) Cardiovascular Perfusion (BS) Medical Biotechnology (BS) Medical Imaging (BS, BPS) Medical Technology (BS, MS) Medicine (MD, MD/PhD, MD/MPH) Nursing (BS, MS, DNP, post-master’s certificate) Public Health (MPH) Physician Assistant (MS) Physical Therapy (DPT) Radiation Therapy (BS, BPS) Respiratory Therapy (BS)

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Education Care • Research Research Education •Health Healthcare

www.upstate.edu/students

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Treatment you inhale: pure oxygen

SHARING EXPERTISE

BY AMBER SMITH

3 WORDS TO KNOW

Angiogenesis – when new blood vessels form Hyperbaric – increased atmospheric pressure Osteoradionecrosis – bone death caused by radiation

“In conjunction with surgery, hyperoxygenation helps to restore those blood vessels,” says Marvin Heyboer, MD, an associate professor of emergency medicine who serves as medical director of hyperbaric medicine at Upstate. He explains that someone with a delayed radiation injury to the jaw may have 30 one- to two-hour sessions in the hyperbaric chamber before undergoing surgery to have any dead bone removed. en he or she will typically have 10 more hyperbaric sessions. Marvin Heyboer, MD, at the hyperbaric medicine center. PHOTO BY ROBERT MESCAVAGE

ONE OF THE UNFORTUNATE SIDE EFFECTS of radiation therapy for head and neck cancers can be damage to the so tissue and bones of the jaw. No matter how precisely the radiation is directed, small blood vessels and collagen may be damaged. Bone death – called osteoradionecrosis – is less common. For treatment, doctors may recommend surgery plus multiple trips into a pressurized chamber filled with 100 percent oxygen. It’s the same chamber used to treat decompression sickness, carbon monoxide poisoning, arterial gas embolisms and more. e principle is that our lungs can gather more oxygen than normal in a higher-pressure environment. en our blood cells, rich with oxygen, travel the bloodstream stimulating the release of growth factors and stem cells, which promote healing and help fight infection. Inside the chamber, patients nap, read or watch a television screen. ey breathe pure oxygen. eir bodies begin healing.

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Treatment plans are individualized. So, someone being treated for a radiation injury related to cervical cancer or prostate cancer may have more hyperbaric sessions and no surgery. Someone who is treated to help prevent osteoradionecrosis prior to oral surgery may undergo fewer sessions. Hyperbaric oxygen treatment is painless, but it has risks. e middle ear can be damaged due to increased pressure, and a person’s eyeballs can temporarily become more oval in shape, consequently turning vision nearsighted. More serious risks, including seizures related to oxygen toxicity, are rare. Heyboer says patients being treated for osteoradionecrosis report success rates greater than 90 percent. About half of those treated for radiation-injured inflamed bladder or bowel see complete resolution of symptoms, and an additional 30 percent see significant improvement. He has a study underway at Upstate, looking at the benefit of hyperbaric oxygen on certain radiation effects to the head and neck. To learn about participating, reach assistant Christine Hall at 315-464-7608. For more about hyperbaric medicine at Upstate, call 315-464-4910. ●

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SHARING EXPERTISE

Childhood cancer update 9 things to know about brain and spinal cord tumors BY AMBER SMITH

CANCERS OF THE BRAIN AND SPINAL CORD have surpassed leukemia as the largest cause of cancer death in children. It’s not because there are more brain and spinal cord tumors. Rather, progress has been made in treating cancers of the bone marrow and blood cells, so more children are surviving leukemia. Of all cancers, about 1 percent occurs in children, says Melanie Comito, MD, Upstate’s chief of pediatric hematology and oncology. e average age at diagnosis is 6 or 7 years. “Every child you save or cure of childhood cancer lives another 70-plus years,” she explains. “So when you look at years of life lost, more years of life are lost to childhood cancers, compared to adult cancers other than breast cancer.” Comito says each day in America, 46 children are diagnosed with cancer, and seven children die from cancer. Brain and spinal cord tumors account for about one out of four childhood cancers. Each year, more than 4,000 central nervous system tumors are diagnosed in children and teens. Some key things to know about brain and spinal cord tumors: l

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Symptoms vary greatly, based on the age of the child and the size and location of the tumor. Headaches that get progressively worse and morning vomiting episodes may be clues. While adults tend to have brain tumors in the upper part of the brain, many childhood tumors appear more toward the center of the brain or in the back near the cerebellum, the part of the brain that regulates muscular activity. Among the more than 50 types of childhood brain tumors, half are astrocytomas. ese tumors arise from star-shaped brain cells called astrocytes that make up the supportive tissue of the brain. Non-cancerous or benign tumors can be just as lifethreatening as malignant tumors because of where they exist in the brain. “ey’re oen in areas where you can’t just cut them out without causing damage,” Comito explains. She adds that tumors arising in the spinal cord are typically more amenable to surgery. Most tumors can be diagnosed through an imaging scan, but a biopsy is usually required to tell if a tumor is slowor fast-growing. continued on page 18

spring 2017 l upstate.edu/cancer

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Focused beams from many angles

SHARING EXPERTISE

Radiation can be as effective as surgery for some tumor removal NOT LONG AGO, people who were not healthy enough to withstand surgery had few options if a tumor was discovered in their lung or brain.

five treatments, with tighter margins, allowing for less irradiation of normal healthy cells.

Today radiation therapy has evolved into an alternative to traditional surgery that can help these people. In the brain, it’s called stereotactic radiosurgery, even though no scalpel is involved. Outside the brain, it’s commonly known as stereotactic body radiotherapy. Computerized tomography (CT), magnetic resonance (MRI) and other advanced imaging tools are paired with a radiation machine to deliver high-energy X-rays to create a precision treatment.

“If you can picture a number of radiation beams coming at a tumor from many different angles, only the area where all those beams cross would receive the high radiation dose,” Mix explains. Patients typically undergo a fewer number of treatments than they would with traditional radiation therapy. In addition, real-time imaging of the target allows for a better ability to treat as little normal tissue as possible.

Stereotactic radiation can be as effective as traditional surgery in select cases, says Michael Mix, MD, an assistant professor of radiation oncology at Upstate. “is allows us to better focus our radiation treatments and better visualize surrounding structures to make the treatments not only more effective, but safer,” he says. It’s as much an alternative to traditional surgery as to traditional radiation therapy. Traditional radiation therapy – which remains the appropriate treatment for many patients – involves multiple treatments per week over several weeks. Stereotactic radiation is generally given in fewer than

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Mix is impressed with the precision of stereotactic radiosurgery. “We have the ability to actually track a tumor’s motion,” he says. “So, for example, if a lung tumor moves with the patient’s breathing, we’re able to watch that and account for that.” Surgery and conventional radiation therapy remain excellent options for many patients. But a growing number are offered stereotactic radiation. Mix says doctors continue to determine new types of tumors – as well as other noncancerous problems - that can be treated effectively with stereotactic radiosurgery and stereotactic body radiotherapy. ●

continued from page 17

FOLLOW-UP CARE

Depending on a tumor’s location, treatment may include removal by surgery. Because of long-term side effects, radiation therapy is not likely to be recommended. Instead, Comito says many childhood tumors today are treated with chemotherapy. “My treatment goal is to help the child grow up and have the best neurologic outcome that they can have.” e cause of most childhood brain and spinal cord tumors is unknown.

How is stereotactic radiation different?

Continuing medical care is recommended for childhood cancer survivors, who may develop complications known as late effects of treatment. These could include: l

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A patient’s prognosis depends on the type of tumor, its location and grade, speed of growth and treatment options. e child’s age and the extent to which the tumor has affected his or her ability to function is also a factor.

learning disabilities including problems with memory, attention, comprehension and information processing;

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behavioral changes or emotional issues;

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hearing or vision problems;

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seizures or other neurological issues;

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Melanie Comito, MD

physical disabilities such as muscle weakness or diminished coordination;

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hormonal problems including slowed growth, early or late puberty or infertility; damage to internal organs or other body systems; and the possibility of tumor recurrence or the development of a secondary cancer in another part of the body.

SOURCE: AMERICAN BRAIN TUMOR ASSOCIATION

Lifelong follow-up care is recommended for childhood brain tumor survivors. ●

CANCER CARE

upstate.edu/cancer l spring 2017


Screening recommendations change for prostate cancer – here’s why

SHARING EXPERTISE

BY JIM HOWE

Looking at the most recent results from both studies, Chen said it’s clear "there is absolutely a benefit to early screening, and the benefit continues to increase over time.”

WHETHER TO SCREEN a man for prostate cancer should involve a discussion with his doctor and, possibly, a simple blood test, a federal advisory panel says. Dra guidelines released this spring from the influential U.S. Preventive Services Task Force no longer reject the prostate-specific antigen blood test as an unreliable screening tool for men ages 55 to 69.

e benefits show up most dramatically aer 10 years, when those screened for PSA showed a better survival rate than Jeffrey Bogart, MD, and Ronald Chen, MD those not screened, Chen said. Since PHOTO BY JIM HOWE prostate cancer tends to be slow growing, it can take that long for results to show up.

A leading researcher in the field, Ronald Chen, MD, was recently invited to lecture in Syracuse by Upstate Cancer Center interim director Jeffrey Bogart, MD. Chen explained some of the reasons behind this change.

“What this tells us is we don’t have to screen men who have less than 10 years to live, since that’s not likely to benefit, but for men who are healthy and have a long life expectancy, screening can really save lives,” he said.

e blood test for PSA has been in use for more than 20 years. It is a controversial screening tool because it can miss or falsely indicate cancer of the prostate gland, which could lead to overdiagnosis and unnecessary treatments with painful or life-changing side effects, such as sexual dysfunction, urine leakage and bowel problems.

What is unclear is whether annual or less frequent screening is necessary. at should be studied further, he said.

A major reason for the controversy was the conflicting results of European and American studies that started in the 1990s, each designed to compare men who got PSA tests with those who did not. Results published in 2009 showed that men enrolled in the European trial, who had PSA tests every four years, had more cancers diagnosed — but also better survival rates. e men enrolled in the American trial who had annual PSA tests along with digital rectal exams did not see increased survival rates. e studies’ results were one reason the task force recommended, in 2012, against routine PSA screening of otherwise healthy men. But Chen and others re-examined those studies and their regularly updated results and see a different story emerging. “In my mind, these are actually not opposite results,” said Chen, an associate professor in the radiation oncology department at the University of North Carolina at Chapel Hill and an associate director of UNC’s Lineberger Comprehensive Cancer Center. A big reason the studies appear to contradict each other is that about three quarters of the American test subjects who were not supposed to get PSA screening did so anyway, and half had also had a PSA test before joining the trial, Chen said. is meant the American study wasn’t really comparing men who got PSA tests to men who didn’t. spring 2017 l upstate.edu/cancer

Chen called it “unfortunate” that these two trials’ differing results led to recommendations against PSA screening, which led to a huge drop in screening in the U.S., because the American trials were taken at face value and not examined more deeply. “Over time we have realized in prostate cancer not every patient needs to be treated,” he said. So while aggressive cancer must be treated, slow-growing prostate cancer might be better le alone but carefully watched — what is termed “active surveillance” — and only treated if it starts to progress. ● ABOUT PROSTATE CANCER

Other than skin cancer, prostate cancer is the most common cancer in American men. The American Cancer Society estimates about 161,360 new cases of prostate cancer will be diagnosed in the United States in 2017. Risk: About one man in seven will be diagnosed with prostate cancer during his lifetime. The men it strikes: Prostate cancer develops mainly in older men. About six cases in 10 are diagnosed in men aged 65 or older, and it is rare before age 40. The average age at the time of diagnosis is about 66. Death rates: Prostate cancer is the third leading cause of cancer death in American men, behind lung cancer and colorectal cancer. About one man in 39 (or 3 percent) will die of prostate cancer, which means only about one of every six diagnosed prostate cancers will be fatal. Most men diagnosed with prostate cancer do not die from it. SOURCES: AMERICAN CANCER SOCIETY, HARVARD MEDICAL SCHOOL

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Positive is not always a good thing

LIVING WITH CANCER

“THE WORD ‘POSITIVE’ usually means good. We like positive attitudes, positive states of mind, and positive balance sheets. However, in medicine, positive is oen bad,” says Steven Z. Pantilat, MD, director of the Palliative Care Leadership Center at the University of California, San Francisco, in his book, “Life Aer the Diagnosis: Expert Advice on Living Well With Serious Illness for Patients and Caregivers.” Pantilat continues: “A positive lymph node means cancer is in a lymph node and has spread. Positive biopsy margins signify that not all the cancer was removed and some remains in the body. Positive blood cultures mean bacteria are growing in a patient’s blood, which is potentially lifethreatening within hours if not promptly treated. When a skin test for tuberculosis is positive, it means you’ve been exposed to tuberculosis and could harbor that dreaded

disease. A positive CT scan could mean that you have a blood clot in your lung. “ough we think of negative things as being bad, in these examples, negative would be great.” Pantilat says he encourages medical students to communicate more clearly with patients by saying, “We found cancer in the lymph node, which means that the cancer has spread beyond the lung,” or “e biopsy showed that we didn’t get all the cancer; some is le behind and will require another operation.”

Psychosocial care tends to body and mind

His advice for patients: If your doctor says that something is positive, get clarification. Ask, ‘Is it a good positive or a bad positive?’ and then have your doctor explain. ●

PATIENTS ARE USED TO having their pulse, blood pressure, respiration, temperature and pain level recorded in their medical record. Now a “sixth vital sign,” that of emotional distress, is beginning to find its way into patient charts. It’s called distress screening. Patients who have difficulty coping with cancer may be referred for psychosocial care. “is originates from the medical philosophy of focusing on the whole person. In addition to their physical health and well-being, we want to also focus on their psychological and emotional health,” says rehabilitation psychologist Jeffrey Schweitzer, PhD.

He says it’s not uncommon for people who have symptoms suggestive of a cancer diagnosis to report high levels of stress, anxiety and fear. Oen, people who receive a cancer diagnosis grapple with mortality salience, a sudden awareness of their mortality. A person may ponder what death will mean to himself or herself, its impact on loved ones and spiritual implications. Schweitzer says, “Understandably, this brings about significant stress.” Schweitzer and colleague Angelina Rodner, PhD, provide individual psychosocial care to patients of the Upstate Cancer Center. ey also oversee a new Body Mind Wellness Group for anyone with cancer from throughout

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CANCER CARE

Jeffrey Schweitzer, PhD, and Angelina Rodner, PhD PHOTO BY ROBERT MESCAVAGE

the Central New York community. e group will meet regularly, covering nutrition, sleep, stress physiology and other issues important to people facing cancer. Learn more about the Body/Mind Wellness Group by calling Jeffrey Schweitzer, PhD, at 315-464-2378. ●

upstate.edu/cancer l spring 2017


LIVING WITH CANCER

Roasted Vegetable Dip

Healthy dips like this one are good for sharing — and surrounding yourself with friends and family can help li your spirits, says Kris Ghosh, MD, author of the “Betty Crocker Living With Cancer Cookbook.” is particular dip is high in vitamins A and C. Preparation from start to finish is about 45 minutes. is makes seven ¼-cup servings.

Ingredients 1 medium zucchini, sliced (2 cups) 1 medium yellow summer squash, sliced (1½ cups) 1 medium red bell pepper, sliced 1 medium red onion, thinly sliced 2 cloves garlic, peeled cooking spray

½ teaspoon salt ¼ teaspoon ground red pepper (cayenne) dippers (such as baby carrots, cucumber slices, green bell pepper strips, toasted pita bread wedges and/or baked tortilla chips)

PEDIATRIC EMERGENCY DEPARTMENT:

HERE WHEN YOU NEED US Upstate University

Preparation

Hospital has

1. Heat oven to 400 degrees. In a 15x10x1-inch pan, spread zucchini, yellow squash, red pepper, onion and garlic. Spray vegetables with cooking spray. Sprinkle with salt and red pepper. 2. Bake about 30 minutes, turning vegetables once, until vegetables are tender and lightly browned. 3. Place vegetables in blender or food processor. Cover. Blend on high speed about 1 minute — stopping blender occasionally to scrape sides — until smooth. 4. Serve warm. Or, refrigerate at least 2 hours until chilled. Serve with dippers.

the area’s only Pediatric Emergency Department, now in its own newly renovated and expanded space. Only at Upstate will you find physicians and nurses specially trained in pediatric emergency medicine 24/7/365.

Nutritional information One ¼-cup serving contains: 170 milligrams sodium 25 calories 210 milligrams potassium 0 grams total fat 5 grams carbohydrates 0 milligrams cholesterol

1 gram dietary fiber 1 gram protein

Pediatric Emergency Department

SOURCE: BETTY CROCKER LIVING WITH CANCER COOKBOOK

spring 2017 l upstate.edu/cancer

CANCER CARE

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MAKING A DIFFERENCE

Pictures of Cheer Budding photographers aim to brighten days of young patients BY JIM HOWE

“It’s the only spot in the whole exhibit you can get a good shot of her, but I spend a lot of time just waiting for her to get up on that log.”

A RECENT PATIENT and his 8-year-old twin are using their love of animals to spread cheer to other youngsters being treated at the Upstate Cancer Center.

Jordan says she likes to photograph turtles, caimans and iguanas. e twins, who share a camera, plan to keep up their photographic efforts. ●

Ashton Miller, a thirdgrader from Fayetteville, has received drug infusions at the center for childhood nephrotic syndrome, a noncancerous kidney condition. Ashton and Jordan Miller at the zoo. He and his sister, Jordan, PHOTO BY SUSAN KAHN both love to visit the zoo and photograph the animals. ey got the idea to print the pictures as cards to brighten the days of young patients, and they provided a supply earlier this year for the staff to hand out.

Included with the cards is a message: “Hi, I’m Ashton. I like to take photos at the Rosamond Gifford Zoo, and I visit here, too. Here’s a photo to help cheer you up. You can keep it or be very generous and give it to someone else who needs cheering up.” Ashton is in remission and doing well aer his treatments last year, according to his father, Mark Miller, who does research in orthopedic surgery at Upstate. e twins have also done odd jobs and sold some of their photos to family and friends to raise money for the Adopt an Animal program at the zoo. Ashton’s favorite animal to photograph is Natida, the zoo’s female clouded leopard. “Sometimes I’ll wait 15 to 30 minutes for her to go up on this one big log,” he explains. One of the Miller children’s photos taken at the zoo.

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Now airing on Sundays on WRVO AT 6 a.m. & 9 p.m. Listen anytime: HEALTHLINKONAIR.ORG or ITUNES (search by topic)

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CANCER CARE

upstate.edu/cancer l spring 2017


From Elbridge to Ethiopia

MAKING A DIFFERENCE

BY AMBER SMITH

WHAT DOES A PEDIATRIC oncology nurse do for vacation? Brooke Fraser, a 20-year veteran nurse from Elbridge who works in the Upstate Golisano Children’s Hospital, saves her days off for mission trips to countries in need. Last summer she traveled to Ethiopia and spent two weeks helping establish a cancer center for children in the city of Jimma, 220 miles southwest of the capital of Addis Ababa. She has also volunteered in El Salvador, accompanied on each trip by one of her three sons. Fraser began her mission work four years ago when she decided she wanted to step beyond her comfort zone and to understand and appreciate another

culture. She was inspired by the Mahatma Gandhi quote: “e best way to find yourself is to lose yourself in the service of others.” Seeing poverty is difficult, she says, “because you can only make a small difference. You can’t fix everything. You can’t give everybody all the clean water and food and money that you wish you could give them. You can’t eradicate disease.

He sees what’s possible

“But I’m thankful for the small part that I can do.” ●

TIM CONNERS OF FULTON is a blind adventurer who is determined to summit Africa’s Mount Kilimanjaro. He plans to set out May 22, the day aer he graduates from Ithaca College, start climbing May 26 and summit June 2. (Keep track of him at mountimpossible.com)

Conners was a freshman in high school when he was diagnosed with T-cell acute lymphoblastic leukemia. He lost his vision when the cancer spread to his optic nerve. Chemotherapy helped shrink the tumor in his chest that was the size of a football. He also required a bone marrow transplant and dialysis for kidney failure. He was hospitalized for more than 100 days, much of that time at Upstate Golisano Children’s Hospital, which, he says, “ is the reason I am still alive today.” He was grateful to receive care so close to home. “Not having to travel far to receive my treatment, my parents were still able to keep my family together, somehow manage their professional lives, and I was able to be close enough to receive the community support that played such a critical role in my ability to overcome cancer,” he told Oswego County Today.

Tim Conners

One of Conner’s inspirations is American athlete Erik Weihenmayer, the only blind person to reach the summit of Mount Everest. e Make-a-Wish Foundation helped Conners meet Weihenmayer. Conners has a goal of giving back to the children’s hospital and other organizations that helped him. He is raising money to donate through speaking engagements and sales of his book, “It’s Impossible Until You Do It.” ●

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750 East Adams Street l Syracuse, NY 13210

17.1740517 33.285Melsk

A better biopsy

UPClose UPSTATE OFFERS a 3-D guided breast biopsy option for patients whose mammograms reveal something suspicious that requires additional investigation. Using this system, radiologists can easily locate and target regions of interest for what is known as an upright core breast biopsy. e patient, seated in a comfortable chair, is positioned the same way as for a mammogram. Aer images pinpoint the exact location for the biopsy, a small incision is made, and a thin needle is inserted to retrieve tissue samples for analysis. Learn more by contacting Women’s Imaging at 315-464-2582, or the Wellspring Breast Care Center at 315-492-5007.

Cancer Care magazine, spring 2017  

Cancer Care magazine is brought to you by the Upstate Cancer Center, on the campus of Upstate Medical University in Syracuse, NY.

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