Cancer Care Fall 2019

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for anyone touched by cancer

Team care = better care

Lung cancer often curable when caught early

Are you a candidate for screening?

Rick quit smoking; you can, too Brought to you by the

Fall 2019

your g ui de

Noah’s famous he kids and the doctors you see on Upstate


Medical University banners and billboards are real kids and real doctors.

Meet Noah Axtell, who is now 7.

Maybe you saw him on a billboard, or on a banner hanging inside Destiny USA mall. He’s grinning, next to Irene Cherrick, MD, the pediatric oncologist who takes care of him. Noah is a second-grader who lives near Sylvan Beach with his mom, Tonia; dad, Jesse; and older sister, Xenia. When he was 3 years old, Noah began saying his neck hurt. His stomach was becoming distended. Tonia Axtell says she knew something wasn’t right. At Upstate’s pediatric emergency department, she says doctors discovered a rare kind of kidney cancer called a Wilms tumor growing on his kidney. Noah underwent chemotherapy at the Upstate Cancer Center to help shrink the tumor before having surgery to remove the tumor and one of his kidneys. Afterward, he underwent radiation and more chemotherapy. Axtell says her son is healthy now. He still sees Cherrick every six months. It was after a visit to see her that Axtell stopped with Noah at the Syracuse mall before returning home. A friend told her about the banner, and Axtell wanted to show Noah. Looking at the photo she took of him in front of his banner, she says, “He very much thinks he’s famous.” CC

lung cancer

special section. See pages 10-19.

“We don’t completely understand the biology of this, but we know there are distinct differences in the biology of lung cancer in women versus men,” says Leslie Kohman, MD, left, medical director for the lung cancer screening program. Lung cancer in men is probably present for about four years before it will show up on a scan; for women, it’s about six years. 2

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care C o n T e n T S CANCER

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. It is located at 750 E. Adams St., Syracuse, NY 13210.

on The Cover With help from Upstate, cancer survivor Rick Shattell quit after more than 50 years of smoking. See story, pages 14-15.

Caring for paTienTS Immunotherapy put him in remission Radiation – mixed with kindness

page 4 page 7

Why getting care from a team is better for patients page 10 A cure is possible — if lung cancer is caught early page 12 Do you qualify for lung cancer screening?

These quitters succeeded

page 13

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CanCer Care

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

Exploring a protein’s role in lung cancer

page 16

Finding clues to the cause of lung adenocarcinoma

page 18

What if your prostate cancer is the hereditary type? page 20 back cover

Noah is a real kid, now famous

Amber Smith 315-464-4822 or

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Sharing experTiSe

Living wiTh CanCer



Ovarian cancer symptoms tend to be subtle

Maximizing data



Fall 2019

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Researching lung cancer Recipes

pages 16, 18 page 21

Jim Howe Amber Smith Susan Keeter


Jeffrey Bogart, MD



ASSOCIATE DIRECTOR FOR COMMUNITY OUTREACH Leslie J. Kohman, MD ASSOCIATE ADMINISTRATOR Richard J. Kilburg, MBA The Upstate Cancer Center provides the quarterly magazine Cancer Care for anyone touched by cancer. Send subscription requests and suggestions to and request additional copies by calling 315-4644836. Cancer Care offices are located at 250 Harrison St., Syracuse, NY 13202.

Upstate’s Cancer Care magazine has received a 2019 Clarion Award, a national honor from the Association for Women in Communications. Cancer Care was named “Best Overall External Magazine” in the small circulation category. The large circulation winner was The Oprah Magazine.

Reason to celebrate, on her 7th birthday

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Caring for paTienTS

Living his life He worked treatment for non-Hodgkin lymphoma into his college schedule BY AMBER SMITH

ohn Hrbac is a junior at George Washington


University. He travels the East Coast with the

school’s debate team. Over the summer he visited

Europe. He’s studying for the law school admission test. At 21, the young man from Manlius is living the kind of life he envisioned. “He’s happy, and healthy,” says his mom, Maha Hrbac, before adding, “I hope.” Once a month Hrbac sits for an infusion of an immunotherapy medication to help his body’s immune system fight non-Hodgkin lymphoma. Hrbac was diagnosed between his freshman and sophomore year of college. He had surgery, chemotherapy and radiation therapy. When tests showed that some cancer remained, his doctor proposed the immunotherapy drug, pembrolizumab, sold under the trade name Keytruda. His mother says it seems to be working. “It’s slowly deteriorating the cancer.” Hrbac feels fine. He’s going on about his life. Every three months he returns to Upstate for a checkup and scans to monitor the drug’s success.

how it started Hrbac’s medical crisis began with general fatigue around Thanksgiving 2017. Being his first semester of college, he thought it was normal to feel so tired. Then, starting in December, every once in a while he’d feel a pinch on his heart. Intense shoulder pains began in January, but Hrbac thought he’d pulled a muscle or slept wrong.

John Hrbac



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He went skiing with friends during spring break in 2018 and wound up at an urgent care clinic with chest tightness and shortness of breath. “They told me that my muscles were inflamed and to just take painkillers. That was around the time my night sweats started,” Hrbac says.

Cari ng for paTi enTS

By early May Hrbac started coughing up blood. Something wasn’t right, he knew. But because he didn’t have a doctor in Washington, D.C., he decided to wait and see his doctor as soon as he got home after finals. “At first they thought it was either pneumonia or a blood clot. They did X-rays. They immediately called me and said I had to come and get a computerized tomography scan. When they called me for the CT, I knew it was something bad,” Hrbac recalls. His primary doctor called him with the results. A tumor the size of a misshapen orange was growing in his chest.

diagnosis and treatment Hrbac underwent additional scans and a biopsy to get the diagnosis of non-Hodgkin lymphoma, a cancer that starts in the white blood cells. Specifically, he had mediastinal large diffuse B-cell lymphoma, an aggressive form that would need prompt treatment. Upstate pediatric oncologist Jody Sima, MD, became his doctor. “She saved my son,” Maha Hrbac says emphatically. “John’s tumor was so large that it had stuck to the side of his left lung. It was pushing on his lung, airway and heart. It was constricting his main arteries, and the blood flow and his airway,” she recalls. “His health was deteriorating, to the point that he couldn’t walk down the hallway. He could only sleep sitting up at about 55 degrees. If he lay down, he couldn’t breathe because of the tumor.” Sima admitted Hrbac to the Upstate Golisano Children’s Hospital, on the 11th floor, cared for by nurses and technicians his mother describes as angels. Surgeon Tamer Ahmed, MD, installed a port for the administration

What is immunotherapy? One reason cancer cells thrive is because they have the ability to hide from the body’s immune system. The medication John Hrbac takes, pembrolizumab (Keytruda), is an immune checkpoint inhibitor designed to prevent cancer cells from hiding from the immune system’s T cells. This allows the T cells to recognize and attack the cancer cells. Some immunotherapies boost the body’s immune system in a general way. Others help train the immune system to attack cancer cells specifically. Some types of immune therapies are made using the patient’s own immune cells. Different immunotherapies work on some types of cancers better than on others. Some are used alone, and some work best when paired with another therapy. The goal is generally to stop or slow the growth of cancer cells or to stop cancer from spreading to other parts of the body. SOURCE: AMERICAN CANCER SOCIETY

of chemotherapy medications, and Hrbac underwent five days of continuous chemotherapy before going home. Every two and a half weeks, he would return for five additional rounds of chemotherapy. During her son’s first hospitalization, Maha Hrbac was a wreck. She stayed by his side. In the middle of the night, she stirred when a nurse came in to check Hrbac’s vital signs while he slept. The nurse then adjusted his blanket to tuck him in. That gesture meant so much to Maha Hrbac. She hurried to the hallway to hug the nurse and thank her for taking such care with her son. The treatment was not fun, but Hrbac told his mom, “A little part of me was always happy to come back to the floor because I knew I would get to see everyone.” The six rounds of chemo continued over the summer and into the start of his sophomore year at George Washington, where professors were understanding. At the conclusion, he returned to Upstate for follow-up scans. Sima had to tell him the bad news that the cancer wasn’t gone.

what next Hrbac underwent 20 days of radiation during winter break — which also didn’t get rid of all the cancer. Sima investigated options. Many patients in his position undergo high-dose chemotherapy and a bone marrow transplant. “That is the traditional therapy,” Sima says, “however, it’s not very effective.” As it turned out, Hrbac’s tumor contained some specific markers indicating that a new type of immunotherapy might work. Sima met with Hrbac and his family. She said Keytruda was working well for some patients with lung cancer. It was still early, but success was also being seen in some patients with nonHodgkin lymphoma who were taking the immunotherapy drug. It might be worth trying. “We were like, ‘What have we got to lose?’” Maha Hrbac remembers. So, for the spring of her son’s sophomore year, every three weeks she would drive six hours to pick him up from

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Caring for paTienTS

Living his life

continued from page 5

school after classes on Thursday. He had no classes on Friday, so that’s when he would get his Keytruda infusion at Upstate. Then they would drive back to Washington, D.C., so he could be in class Monday. She would, of course, do it all over again if she had to.

Keeping things normal Sima knew how important it was to Hrbac to be able to keep living his life. “I didn’t want it to stop me from living a normal life. I tried my hardest to keep life going,” he says. “Everyone told me to take this semester off, but I didn’t want to. It took a lot of strength, obviously. There were a lot of days I didn’t want to. But I didn’t want to put everything on hold for four months.” Hrbac’s advice to anyone in a similar situation: Try to keep things normal. “Just keep going with it. That’s how I got through it. At the end of the day, the mental aspect was the hardest part.” Now, Maha Hrbac’s son is a junior in college. He’s technically cancer free. But he undergoes the immunotherapy John Hrbac, center, with his pediatric oncologist, Jodi Sima, MD, left, and his surgeon, Tamer Ahmed, MD, right. infusions once a month. The medication PHOTOS BY SUSAN KAHN comes in a plastic bag about the size of a coin purse. It infuses into his arm through an intravenous line slowly. “In an hour, he’s done,” she says, “and he goes on his merry way.” CC


EXPERTS Older adults are more likely to sustain injury from falls. The Upstate Concussion Center provides comprehensive evaluation and treatment services for concussion, including sports concussion. 6

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Caring for paTienTS

Warmth, kindness andradiation, too BY AMBER SMITH


t had been a rough 2019 for Joan Gorton of Hamilton.

Starting early in the year, the 83-year-old woman had a series of medical issues — a lingering cough, then a suspicious lump on her leg that had to be removed. She described feeling as if she were sitting on a brick, so doctors conducted an exam and a Pap smear. When the results came back, Gorton received a phone call. She had a rare cancer of the vulva. She required surgery, followed by chemotherapy and radiation. Just when she thought she was done with her last radiation treatment, her radiation oncologist Paul Aridgides, MD, broke the news. He told Gorton she was going to need an additional week of radiation treatments. He hugged her. That hug meant everything to Gorton. In April, her surgeon had removed the affected tissue, along with 18 lymph nodes. Cancer was detected in one of the lymph nodes, Gorton’s daughter, Linda Gorton, explained. That’s why the surgeon was recommending chemo and radiation. “That’s how we got to know the incredible Dr. Paul,” Gorton says, using the physician’s nickname.

“If you’re having a bad day, they really help with the emotional side, too,” Gorton says. “What amazing, loving, caring people.” She remembers one day when the power went out due to a storm. “They just handled it. They were very much at ease, maintaining a calmness for those patients who are already a little bit on edge.” The kindness, the hugs and the weare-going-to-help-get-you-through-this attitude really helped her mother through a difficult time. She says Joan Gorton has since turned 84, and her recuperation continues. CC Radiation oncologist Paul Aridgides, MD, with Joan Gorton of Hamilton. PHOTO BY ROBERT MESCAVAGE

Her mother would need chemo every week and radiation every weekday for six weeks, in an effort to make sure the cancer was gone. They considered traveling from Hamilton to the Upstate Cancer Center. Then they learned of the Upstate Cancer Center satellite in Oneida. “That’s a half hour closer than going to Syracuse.” Gorton says she and her mom were impressed with how Aridgides and the rest of the staff got to know her mother. Her treatment in Oneida began the week after the Fourth of July. Her seat was always waiting for her, with the warmed blanket she requested, the television tuned to HGTV, and a reassuring attitude from the technicians and staff. l fall 2019 l C A N C E R C A R E


Caring for paTienTS

Subtle symptoms Her ovarian cancer required surgery and chemotherapy BY AMBER SMITH

A two-year survivor of stage 3 ovarian cancer, Aimee Derbyshire is thankful for her family and friends, her Eastwood neighborhood and the care she received from Mary Cunningham, MD, and her staff. PHOTO BY ROBERT MESCAVAGE

he’s 52 and still alive, so Aimee


with belly pain so severe that she went to the hospital. Hours later, a doctor gave her the news: On her ovary was a growth the size of a tennis ball. She left with an appointment to see Cunningham.

aunt and sister to various cancers, each

“Everything moved very quickly,” she recalls. Surgery to remove the tumor was Aug. 9. A few weeks later she began chemotherapy, which ended on Jan. 3, 2018.

Derbyshire feels as if she had survived a family curse. She lost

a great-grandmother, grandmother, mother, “Bald is beautiful” was Derbyshire’s response to tempoDerbyshire and another sister are survivors. rary hair loss caused She credits gynecologic oncologist Mary Cunningham, MD. by chemotherapy.

before they turned 50.

This January, Derbyshire will mark two years of remission from ovarian cancer. It was the end of July 2017 when Derbyshire was struck 8

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Today she follows up with Cunningham every four months. “I’m just grateful to be alive,” Derbyshire says. “She’s a wonderful doctor. She cured me.” CC

Caring for paTienTS Fallopian tubes


ovary with cancer Uterine cavity

Mary Cunningham, MD

Ovarian cancer facts Overview Ovarian cancer starts in a woman’s reproductive glands, known as the ovaries. Most ovarian cancers are made up of epithelial cells, which cover the outer surface of the ovary, but some originate from germ cells or structural tissue cells. Some ovarian tumors are benign. Those that are malignant may spread (metastasize) to other parts of the body. Ovarian cancer is rare in women younger than 40. About half of the women who are diagnosed with ovarian cancer are 63 years or older. About 20 percent of ovarian cancers are found at an early, more treatable stage, but most ovarian tumors are difficult or impossible to feel during a medical exam. Symptoms The most common symptoms are bloating; pelvic or abdominal pain; trouble eating or feeling full quickly; and feeling as if you need urinate frequently or urgently. See your medical care provider if you have these symptoms almost daily for more than a few weeks. Symptoms may also include fatigue, upset stomach, back pain, pain during sex, constipation, heavy or irregular menstruation and abdominal swelling with weight loss. Risk factors Factors that may increase a woman’s risk for developing ovarian cancer: a personal history of breast cancer; a family history of ovarian, breast or

colorectal cancer; being overweight or obese; having a first child after age 35 or never carrying a pregnancy to term; taking estrogen therapy after menopause; and – potentially – using fertility treatment with in vitro fertilization. Factors that appear to lower a woman’s risk for ovarian cancer: each full-term pregnancy; carrying a baby to term before age 26; breastfeeding; the use of oral contraceptives; tubal ligation or short use of intrauterine devices; and a hysterectomy, a surgical procedure to remove the uterus. Diagnosis A variety of tests may be recommended in order to diagnose ovarian cancer. An ultrasound uses sound waves to produce a picture of the ovaries. Computerized tomography scans or X-rays take pictures of the ovaries or other parts of the body. Laparoscopy allows a doctor to look at the ovaries and other nearby body parts. Blood tests can also be used as tumor markers. A biopsy of ovarian tissue — usually done when the tumor is removed during surgery — is the only way to confirm cancer. Treatment Surgery is the main treatment, but depending on the type and stage of ovarian cancer, some women may need other treatments before or after surgery, or both. That usually includes chemotherapy. CC SOURCE: AMERICAN CANCER SOCIETY

Douglas Bunn, MD

GYN Oncology of CNY joins Upstate Mary Cunningham, MD, and Douglas Bunn, MD, of GYN Oncology of CNY joined Upstate’s department of obstetrics and gynecology and offer services through the Upstate Cancer Center. The practice is the area’s leading provider of comprehensive care for women with gynecologic cancers. Bunn and Cunningham will see patients at the Madison Irving Medical Center, 475 Irving Ave., Syracuse. “Patients will have access to more clinical trials and additional support services, says Cunningham. They offer a range of diagnostic and therapeutic options for women with ovarian, uterine, cervical and other gynecologic cancers, including radical surgery, radiation, chemotherapy and newer treatments such as immunotherapy and robotic sentinel node dissection. Nutritional and psychological counseling and genetic testing are also available. Upstate participates in the National Cancer Institute’s cooperative trial group, NRG Oncology, providing patients with local access to the latest developments in therapy and access to national clinical trials. With this move, Cunningham and Bunn join Rinki Agarwal, MD, as physicians in Upstate’s Division of Gynecologic Oncology. CC

To request an appointment, call 315-464-hope (4673). l fall 2019 l C A N C E R C A R E


lung cancer

special section

The TOP (lung cancer) team includes, from left: Jeffrey Bogart, MD, radiation oncology; Terri Harrington, RN; Carolyn Walczyk, tobacco treatment counselor; Ernest Scalzetti, MD, radiology; Michael Archer, DO, thoracic surgery; Manju Paul, MD, pulmonology; Stephen Graziano, MD, oncology; Erin Bingham, clinical research associate; Jason Wallen, MD, thoracic surgery; Mark Crye, MD, thoracic surgery; Leslie Kohman, MD, director emerita; Michael Mix, MD, radiation oncology; Heather Smith, RN; and Ginger Cowan, NP. PHOTO BY SUSAN KAHN AND WILLIAM MUELLER


For 20 years, multidisciplinary approach boosts survival rates BY AMBER SMITH

pstate debuted its Thoracic Oncology Program


20 years ago. It’s defined by a multidisciplinary team approach — which other

medical providers at the Upstate Cancer Center have since adopted — and which has been shown to significantly boost a patient’s survival.

A multidisciplinary team is comprised of specialists from multiple disciplines who collaborate on the care of individual thoracic oncology patients. Team 10

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members include medical, surgical and radiation oncologists, pathologists, imaging specialists, pulmonary specialists, nurse practitioners with specialized training, nutritionists, social workers and patient navigators. Yes, it’s a big team. But they’ve got a big table in a big conference room where they gather every week. Typically the team discusses care for six or eight new patients, along with up to 20 brief updates on established patients. Continued on page 11

special section

lung cancer

Teamwork Care comparison continued from page 10

Contrast the team approach with “traditional care,” which is serial and not so coordinated: A primary care doctor whose patient has an abnormal chest X-ray may refer that patient to a pulmonologist, who may then send him or her to a surgeon or to an oncologist. Each specialist may not know (or agree with) what the other recommends.

Team (multidisciplinary) care l


Patient care is expedited because it’s coordinated, saving patients time from scheduling multiple appointments.

Traditional care l paTienT

Multiple specialists collaborate on a streamlined plan of care for the patient.


Care may be duplicated, omitted or provided out of order as patient moves from doctor to doctor. paTienT

Treatment decisions may be made without input from all the specialists who eventually will care for the patient.

l A patient navigator helps track care. l Patients track their own care. “Most of us feel that Stage 1 lung cancer Stage 1 lung cancer Stage 1 lung cancer complicated decisions on one-year survival five-year survival 10-year survival cancer care should not be made by a single doctor,” Multidisciplinary team: 92% Multidisciplinary team: 53% Multidisciplinary team: 24% says Jason Wallen, MD, Traditional care: 79% Traditional care: 33% Traditional care: 10% the medical director for SOURCE: STONY BROOK CANCER CENTER the Thoracic Oncology leading cancer institutes: Dana Farber receiving multidisciplinary care and Program. The team approach means and Brigham and Women’s in Boston, half receiving traditional care. every patient has every option open and the University of North Carolina. They found the team approach has for discussion. “It’s kind of like getting “Not only does it save patients time, a 30% survival advantage over eight or 10 second opinions all but almost all cancer patients today — standard care. at once.” and even beginning back then — need “There is near universal interest in For doctors, the team meetings more than one modality. Very few deploying multidisciplinary structures “ensure that we’re always learning,” patients are treated with just surgery, of care to improve outcomes in lung Wallen says. or just chemotherapy or just radiacancer, but to date implementation of With the rapid pace and volume of tion,” Kohman says. “To have experts such models has been slow because of medical research, it can be difficult for from all those disciplines discuss the lack of supporting data,” says one doctor to keep up on every detail. treatment up front is very beneficial Thomas Bilfinger, MD, director of Regular collaboration among such a to the patient.”CC Stony Brook’s Lung Cancer Evaluation large group of experts means everyone Center. “Our findings show that outshares information from their own comes are improved with a multidiscifield, Wallen says. “So we all grow, and The Upstate Cancer Center is part plinary care and communications I think that allows us to provide even of an academic medical center, where model and should be considered as a better care to patients as time goes on.” medical providers are accustomed to ‘best practice’ guideline for treating all Such team care is natural at an acacollaborating on patient care. These lung cancer patients. demic medical center, where doctors groups have formalized that process Leslie Kohman, MD, championed the and caregivers are encouraged to seek with multidisciplinary care teams: team concept at Upstate 20 years ago input from one another. l Breast 315.464.3510 “because it gives better care to the The Stony Brook Cancer Center patient, and it saves the patients a l Gastric & esophageal (including follows a multidisciplinary approach tremendous amount of time getting liver, pancreas and gallbladder) with its lung cancer patients, too — around to all of those different 315.464.6295 and officials there have found that appointments,” she says. l Head and neck (including ear, nose patients live longer because of it. What was named the Thoracic and throat) 315.464.3510 Examining data from 2002 to 2016, Oncology Program, or TOP, at l Lung 315.464.3509 Stony Brook officials compared the Upstate was modeled after programs at care of 4,000 patients, about half l pediatrics 315.464.5294

Cancer teams at Upstate l fall 2019 l C A N C E R C A R E


lung cancer

special section

Catch it early through screening to reduce lung cancer deaths


ung cancer screening saves lives — and could save more, if more

people submitted to the testing.

Of the lung cancers that are discovered through a lung cancer screening program, 80% are at an early stage — and most of those can be cured with surgery. Compare that with the general population of people who discover they have lung cancer when they develop symptoms or have a chest X-ray for some other reason. Of those lung cancers, only about 15 percent are at an early, curable stage. “We can save tens of thousands of lives, provided they get the screening and continue to get the screening,” says Leslie Kohman, MD, the medical director for the lung cancer screening program at Upstate. She says studies have proven how well screening works, using low-dose computed tomography, or CT scans. Men whose cancers were discovered through screening had a 26% lower mortality rate than men who were not screened. The mortality rate for women is even better. The ability to screen people for lung cancer has been available for about 10 years, and today the American Cancer Society recommends screenings for certain smokers and former smokers at high risk for lung cancer. Just 2% of those eligible for lung cancer screening undergo the test, Kohman says. That’s two people out of 100. And that’s the big reason more lung cancers aren’t caught early, she says. Those other 98 people are either unaware of screening, or they’re afraid — of radiation exposure, of the cost, of what happens if cancer is found.

Do you have symptoms? Lung cancer screening is for people at high risk for developing lung cancer who do not have symptoms. Someone who has symptoms – including persistent cough, hoarseness, shortness of breath, coughing up blood, unexplained weight loss, or chest pain that worsens when you take a deep breath – may need a diagnostic scan, which is similar. Leslie Kohman, MD, urges people to bring symptoms to the attention of their primary care doctor.


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Kohman addresses those fears: • The lung cancer screening scans use lower doses of radiation than are used for standard CT scans. “It’s like the amount of radiation you would get from the atmosphere if you flew in an airplane across the country,” she says. • Lung cancer screening requires a referral from a physician, but for eligible patients, it’s paid for by most health insurers, including Medicaid and Medicare. • If the radiologist detects something unusual in the lung scan, a biopsy may be required. Kohman explains that an experienced lung cancer screening program, such as Upstate’s, has a strong record of only recommending biopsies when they are necessary. Upstate is a certified center of excellence for lung cancer screening and has offered the test for the last decade. CC

special section

lung cancer

Should you be screened? ARE YOU 55 OR OLDER?

Annual screening for lung cancer is not recommended for people younger than 55, but smoking cessation is. Contact us for help quitting.



You may be eligible, depending on how many years you have smoked. Contact us.



You are probably eligible, depending on how many years you smoked. Contact us. You may be eligible, depending on how many cigarettes you smoke. Contact us. You are at high risk and eligible for screening. We can also help you quit smoking. Contact us.

By not smoking, you eliminated a primary risk factor. Yay!

If you quit more than 15 years ago, your lung cancer risk has dropped, and you are not eligible for screening.

You may be eligible, depending on how many years you smoked. Contact us.

Contact us To reach the Lung Cancer Screening program, call 315-464-7460 To reach the Smoking Cessation Program, call 315-464-3519 l fall 2019 l C A N C E R C A R E


lung cancer

special section

Making a change She succeeded in quitting after a cancer diagnosis

After more than 30 years as a smoker, Peggy Strong quit. November 2019 marks her second year as a non-smoker. PHOTOS BY SUSAN KAHN

hen Peggy Strong, 47, of Liverpool was


diagnosed with breast cancer in 2015, “my first reaction was to have a cigarette.”

She had smoked since the age of 14. Her radiation oncologist brought up the idea of smoking cessation. Even though she had long wanted to quit, Strong says quitting wasn’t an option for her then because of the added stress of her cancer treatment. Then her mother was hospitalized. She was under the influence of pain medications when Strong visited. “She doesn’t remember saying this to me, but she said, ‘Of all people, I can’t believe you continue to smoke — after having cancer.’ It struck a nerve. It was like, I have to make a change.” Strong contacted Upstate’s Smoking Cessation Program and quit in November 2017. Strong met with Theresa Hankin, a respiratory therapist and tobacco treatment specialist. She used a nicotine replacement patch for a while, and she had lozenges and a nicotine inhaler that she used a few times. She’s also got Hankin’s phone number in case she ever feels as if she’s going to slip.

“I don’t know how or why, but I have no desire to pick up a cigarette again,” Strong says. She took up crocheting because she didn’t know what to do with her cigarette-free hands. “I made the world’s longest blanket,” she describes, and gave it to her oldest son. He’s a smoker, and she hopes that he will decide to quit someday. She underwent a low-dose computerized tomography scan that showed no abnormality in her lungs. She had no signs of lung cancer, she says. She takes a medication to help prevent recurrence of the breast cancer, which was discovered early and successfully treated. CC

did you know?

80% of the lung cancers discovered through screening are early stage and mostly curable. 14

2% of people eligible for lung cancer screening undergo the test.

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lung cancer

They quit smoking too

Sheila devaney, 56, of Baldwinsville

rick Shattell, 69, of redfield

Started smoking: at age 11.

Started smoking: at age 16.

What prompted her to quit: The surgeon who removed her gallbladder last spring introduced her to Theresa Hankin, a respiratory therapist and tobacco treatment specialist for Upstate’s Smoking Cessation Program. “I wasn’t ready then,” says Devaney. “But when I was ready, I called this woman. From the moment I met her, not once did I feel like a jerk for smoking.”

What prompted him to quit: During treatment for prostate cancer, Shattell had to undergo regular phlebotomies, an uncomfortable procedure in which a needle makes an incision in a vein. “Dr. (Rahul) Seth told me, ‘if you quit smoking, we won’t have to do this anymore.’ That was huge for me.”

How she’s doing: Hankin offered encouragement, and the Upstate Foundation helped pay for Devaney’s medication, varenicline. “I’m still trying to figure out a way to thank her. Without her, and the foundation, I would still be smoking.”

How he’s doing: Sometimes he still craves a cigarette, but he’s learned how to shift his thinking to something else. “It’s very hard to do in the beginning,” he admits.

Terry Tourot, 62, of Lafayette richard neufang, 59, of Syracuse Started smoking: at age 30. What prompted him to quit: “I wanted to increase my chances of living longer” after a diagnosis of pancreatic cancer. “And, I knew I would feel better. I always thought it was stupid that I started smoking in the first place. I despised it all my life.” How he’s doing: “The last cigarette I had was March 17, last year.”

Started smoking: at age 13. “I’ve been trying to quit forever, since I got pregnant with my son, and he’s 33 years old.” What prompted her to quit: Her lung cancer screening included a connection with the Smoking Cessation Program, where she received counseling and the medication bupropion. How she’s doing: “I’ve been struggling with my health, but this is one thing I’ve done right. I feel so much better now. I can sing a whole song now, and I don’t lose my breath.”CC

To reach the Smoking Cessation program, call 315-464-3519 or email l fall 2019 l C A N C E R C A R E


lung cancer

special section

Grateful for an expert team After months of intensive chemotherapy and radiation, Louis Musa rang the bell in the Upstate Cancer Center, signaling, “My cancer treatment is over!” Musa said that he was “grateful for the care and compassion of everyone at Upstate.” Musa never imagined that his world would be rocked with a diagnosis of a cancerous tumor on his lung. At the Upstate Cancer Center, a multidisciplinary team of surgeon Louis Musa, lung Mark Crye, MD, cancer survivor oncologist Adham Jurdi, MD, and radiation oncologist Jeffrey Bogart, MD, determined the most effective treatment. “This team saved my life,” Musa said. “I was initially headed for surgery, but a CAT scan revealed the cancer had spread. Chemotherapy followed by radiation became the best treatment option. The doctors made me feel at ease, and I was confident in their recommendations. If it weren’t for them, I wouldn’t be alive today. I’m thrilled to report I am in remission.” By ringing the bell, Musa also signaled that he was ready and able to give back as a grateful patient. To donate to Friends of the Upstate Cancer Center, visit or contact the Upstate Foundation at 315-464-4416. Your gift supports research and clinical advances so that patients, like Louis Musa, can thrive. CC 16

C A N C E R C A R E l fall 2019 l

Exploring a protein’s role in lung cancer BY AMBER SMITH

Some lung cancer cells are addicted to glutamine, the body’s most abundant amino acid.

ork underway at Upstate is focused on a


novel protein in lung cancer that could, potentially, help stimulate lung cancer cell

death. It’s taking place in the lab of professor M. Saeed Sheikh, MD, PhD, thanks to a grant from the Michael E. Connolly Endowment for Lung Cancer Research, through the Upstate Foundation.

Mansi Babbar, PhD, completed her dissertation research in Sheikh’s lab, characterizing a protein called Coiled-coil Helix Tumor and Metabolism-1, which is abbreviated to CHTM1. She earned her doctorate at Upstate and is now a postdoctoral fellow at the National Institutes of Health.

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lung cancer

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So, what’s important to know about CHTM1? Sheikh’s team — which also included Ying Huang, MD, PhD, and Christopher Curtiss, MD — examined tissue samples from more than 230 patients with lung, breast or colon cancer and found elevated levels of this protein in the majority of samples. In a series of additional experiments, they established a role for CHTM1 in cancer cell metabolism. “It is known that certain cancer cells, including some lung cancer cells, are addicted to glucose and glutamine,” Sheikh says, describing glutamine as the body’s most abundant amino acid, needed for various building blocks, which cancer cells rely on as a nutrient for proliferation. “Deprivation of these nutrients leads to a type of stress known as metabolic stress.”

“We think CHTM1 is one such marker. It appears to help cancer cells grow during the early stages of development, when blood supply is not fully established and nutrients are scarce.” Take away CHTM1, he says, “and we can increase lung cancer cell death during metabolic stress.” A paper written by Babbar, Huang, Curtiss and Sheikh this year in the Journal of Experimental & Clinical Cancer Research describes their approach and results for disabling this protein. The Upstate team also notes that a deficiency of CHTM1 made lung cancer cells more sensitive to anticancer effects of metformin, a drug that helps people with diabetes control their blood sugar.

The researchers also discovered that a deficiency of CHTM1 makes lung cancer cells more sensitive to being killed by metabolic stress.

Researchers around the world became intrigued by metformin after doctors noticed that people who have taken the drug long term seem to have a lower incidence of cancer. Studies are underway to determine the cancerfighting properties of metformin. “There is a lot of enthusiasm about this drug,” Sheikh says. He believes that with the CHTM1 protein disabled, metformin — or other, similar drugs — may prove to be more effective in fighting cancer. CC

answers lead to new, intriguing questions • Higher levels of the protein CHTM1 are present in some lung cancers, as well as some breast cancers and colon cancers. Could this fact lead the way to the development of a biomarker, or biological indicator of disease? • Cancer cells become sensitized when levels of the protein CHTM1 are diminished. Would that help an anticancer drug become more effective?

“Cancers are metabolically flexible,” Sheikh says, explaining that “in the absence of important nutrients, they appear to utilize markers to survive the metabolic stress induced by nutrient deprivation. M. Saeed Sheikh, MD, PhD PHOTO BY RICHARD WHELSKY

• The protein CHTM1 helps lung cancer cells grow during the early stages of development. Depriving fully developed lung cancer cells of certain nutrients creates metabolic stress, and they are more sensitive to death by metabolic stress when they lose CHTM1. If scientists induce metabolic stress and block CHTM1 at the same time, would that be a novel approach to kill lung cancer cells?

To donate to the Michael e. Connolly endowment for Lung Cancer research at upstate, contact the upstate foundation at 315-464-4416, l fall 2019 l C A N C E R C A R E


lung cancer

special section

Putting the brakes on lung cancer Finding clues to the cause of lung adenocarcinoma BY AMBER SMITH


cientists have long searched for the cause of lung


cancer, particularly lung adenocarcinoma, the type that commonly occurs in nonsmokers. Ying

Huang, MD, PhD, believes a gene she’s been studying for more than two decades may provide some answers. Huang, a professor in the department of pharmacology at Upstate, works in collaboration with M. Saeed Sheikh, MD, PhD, also a professor in the department of pharmacology . They have independently identified a gene called monoglyceride lipase, abbreviated to MGL, which may be important in how lung adenocarcinoma develops. Comparing tissue samples from more than 340 patients, they found normal levels of MGL in healthy lung tissue but significantly reduced levels in a big 18

C A N C E R C A R E l fall 2019 l

portion of the cancerous lung tissue. In the case of lung cancer, the research team found more than 65% of lung cancer showed reduced MGL levels. Huang suspected MGL to be a tumor suppressor, a gene whose presence prevents cancer from growing, but whose absence allows it to grow. To determine whether MGL is a tumor suppressor, the researchers introduced a copy of the MGL gene into lung and colon cancer cells and found that MGL suppressed cancer cell growth. Then, to further assess MGL’s role in cancer development in animals, they continued on page 19

special section


lung cancer

continued from page 18

deleted the MGL gene from laboratory mice. Initially they found no tumors developing in the animals up to 6 months of age. But when the mice reached 10 months, lung cancers — specifically lung adenocarcinomas — became apparent in a significant portion of the animals. “These results indicate that this gene is important in preventing lung cancer,” Huang says. She described the research in the journal Cell Death and Disease. “Our studies, using animals as a model, demonstrate for the first time that MGL deficiency is an important contributing factor in the development of lung adenocarcinomas,” she wrote. The mice also developed cancer in the spleen, liver and lymphoid tissues, but “lung neoplasms were the most common,” said Huang. Pathologists Christopher Curtiss, MD, Steve Landas, MD and Rong Rong, MD, PhD, collaborated on these studies by evaluating animal tissues. Doctoral students Renyan Liu and Xin Wang also participated in the project. Liu is now a research fellow at the Harvard School of Dental Medicine. Wang continues her thesis research in Huang’s lab. Huang hopes that her work contributes to the understanding of how lung cancer develops. She wants to explore MGL’s potential as a lung cancer treatment, too. Her MGL studies have been funded by grants from the National Institutes of Health and the Michael E. Connolly Endowment for Lung Cancer Research. Her lab is seeking additional funding for further research.

To donate to the Michael e. Connolly endowment for Lung Cancer research at upstate, contact the upstate foundation at 315-464-4416,

The role of genes in cancer Oncogenes Proto-oncogenes are genes that normally help cells grow. When a proto-oncogene mutates, or changes, or there are too many copies of it, it becomes a “bad” gene that can become permanently turned on or activated when it is not supposed to be. When this happens, the cell grows out of control, which can lead to cancer. That bad gene is called an oncogene. Think of a cell as a car. For it to work properly, there need to be ways to control how fast it goes. A proto-oncogene normally functions like a gas pedal. It helps the cell grow and divide. An oncogene could be compared with a gas pedal that is stuck down, causing the cell to divide out of control.

UNDERGRADUATE PROGRAMS Medical Imaging Sciences, Radiography (X-Ray), BS CT, BPS MRI, BPS Ultrasound, BS, BPS Medical Biotechnology, BS Medical Technology, BS Nursing, BS Radiation Therapy, BS, BPS Respiratory Therapy, BS GRADUATE PROGRAMS

Tumor suppressor genes

Behavior Analysis, MS

These are normal genes that slow cell division, repair DNA mistakes, or tell cells when to die (a process known as apoptosis or programmed cell death). When tumor suppressor genes don't work properly, cells can grow out of control, which can lead to cancer.

Biomedical Sciences, MS, PhD Programs in Biochemistry & Molecular Biology, Cell & Developmental Biology, Microbiology & Immunology, Neuroscience, Pharmacology, Physiology

A tumor suppressor gene is like the brake pedal on a car. It normally keeps the cell from dividing too quickly, just as a brake keeps a car from going too fast. When something goes wrong with the gene, such as a mutation, cell division can get out of control. An important difference between oncogenes and tumor suppressor genes is that oncogenes result from the activation (turning on) of proto-oncogenes, but tumor suppressor genes cause cancer when they are inactivated (turned off).

Clinical Perfusion, MS Medical Preparation, MS Medical Technology, MS Medicine, MD, MD/PhD, MD/MPH Nursing, MS, Post Master’s Certificate Nursing, DNP Physical Therapy, DPT Physician Assistant, MS Public Health, MPH, Certificate



Sharing experTiSe

The ripple effect What to know when your prostate cancer is hereditary edical oncologist Gloria Morris, MD, PhD, who specializes in cancer risk


assessment and genetic testing for hereditary cancers, answers six important


1. What percentage of prostate cancers are hereditary? “Only a very small percentage of all cancers are hereditary.

“Even though prostate cancer is among the most commonly diagnosed cancers in men — analogous to breast cancer being the most common in women — only 10 percent of men with aggressive forms of prostate cancer may have a hereditary component. That is, they may have inherited the predisposition to develop prostate cancer by inheriting a gene mutation, which can also overlap to cause a predisposition for breast cancer.” Since the genetic connection between breast and prostate cancers became evident in recent years, genetic counselors now look at the cancer risk for both male and female family members of men with hereditary prostate cancer. She says, “when I see women with hereditary breast cancers, I always look around for its ripple effect. There could be other women or men in her family who could benefit from genetic testing.”

breast cancer developing in a woman with that gene is much higher, anywhere from 40% to 80% over one’s lifetime.”

4. Who should consider genetic testing? “A man who has several family members with prostate cancer or multiple family members with other possibly associated cancers — colon, ovarian and breast cancers all overlap to possibly elevate a prostate cancer risk. “Through blood testing and/or saliva testing, we can send for DNA sequencing of the known hereditary prostate cancer genes.” Morris says commercially available genetic test kits may only test for portions of genes and may not target the ones most relevant to an individual. Instead, she recommends seeking care at an established clinical genetics program. The program at the Upstate Cancer Center accepts referrals directly from patients or from primary care providers.

5. are mutations passed on to children? 2. if you have a specific gene mutation, does that mean you will develop cancer? “It does not mean that a person is doomed to develop prostate cancer or breast cancer,” Morris says.


“In our numbered pairs of chromosomes, we inherit — usually — one copy that is normal from one parent, and one copy that might be mutated. When those chromosomes split, when we pass on half our genes to each child, there is a random 50/50 chance of passing on that mutation.”

Instead, she says someone who learns of a genetic mutation may need earlier and more frequent screening to stay ahead of any possible cancer development, especially if the person has a family history of cancer.

The parents, children and siblings of a person with a hereditary form of prostate cancer are recommended to be tested for that mutation.

3. How many genes are we talking about?

6. at what point should children be tested?

“Eight to 10 breast cancer genes are known to increase the risk of prostate cancer if that same mutation is passed on.

“For the gene mutations that could cause adult-onset cancers, we recommend testing anytime over the age of 21. There are a lot of psychological impacts of carrying a gene mutation. However, understanding the ramifications is a good idea.” CC

“The genes that have been identified in men who have aggressive prostate cancers actually are breast cancer genes,” she says. “BRCA2, for example, imposes up to a 7% lifetime chance of developing prostate cancer in men. The risk for C A N C E R C A R E l fall 2019 l

Livi ng wi Th C anCer


Pumpkin Kale, Spice Butternut Squash and Overnight Pomegranate Salad Oats ingredients

1 large butternut squash (about 3 pounds), peeled, cut into 3/4-inch cubes

1/4 cup olive oil, divided

5 cloves garlic

1/2 teaspoon turmeric

1/4 teaspoon salt

Freshly ground black pepper

1/2 cup chopped walnuts (can also use pumpkin seeds or sliced almonds)

2 large bunches (about 2 pounds total) Tuscan kale, stemmed and thinly sliced

1/4 cup fresh lemon juice (from 1 large lemon), divided

Sea salt

1 tablespoon apple cider vinegar

1 teaspoon pure maple syrup

1 tablespoon Dijon mustard 1 shallot, finely chopped

1 cup pomegranate seeds (from 1 large pomegranate)

nutritional information per Serving: 200 calories

11 grams total fat

23 grams carbohydrates

5 grams protein

4 grams fiber


preparation Preheat oven to 400 degrees. Place cubed butternut squash on baking sheet; drizzle 1 teaspoon olive oil over the top. Add whole garlic cloves, turmeric, and salt and pepper. Toss to evenly coat the butternut squash with oil and spices. Spread butternut cubes evenly around pan and roast for 30 to 40 minutes, until squash is fork tender. While the squash is roasting, heat 1 teaspoon olive oil in a small skillet over medium-high heat. Add walnuts and cook, stirring occasionally, until they are just golden brown, 2 to 3 minutes. Set aside. Prepare the kale by slicing it into thin strips. Add the 2 tablespoons lemon juice and a pinch of sea salt and massage into kale to wilt. Set aside. (Note: if you are prepping the day ahead, only add the lemon and massage the kale the day it’s served.)


1/2 cup rolled oats

1/2 cup unsweetened almond milk

1/3 cup plain Greek yogurt

1 tablespoon ground flaxseed

2 tablespoons pumpkin puree

1 tablespoon maple syrup

1/2 teaspoon vanilla extract

1/2 teaspoon ground cinnamon 1/4 teaspoon ground ginger

1/4 teaspoon ground nutmeg

Pinch of salt

preparation Stir together all ingredients in a medium-sized bowl. Add to a mason jar with a fitted lid. Refrigerate and store overnight. Makes one serving.

nutritional information 330 calories 7 grams fat

50 grams carbohydrates 17 grams protein

8 grams dietary fiber


When the squash and garlic are done roasting, remove the garlic pieces and add them to a medium bowl or food processor. Add the remaining olive oil, lemon juice, apple cider vinegar, maple syrup, Dijon mustard and shallot; whisk or pulse until smooth. In a large mixing bowl, combine kale with about 3/4 of the dressing and toss until kale is lightly coated. Add more dressing to taste and reserve any leftover for another use. Add roasted squash and pomegranate seeds to the kale; toss to combine. Transfer to a serving bowl and top with toasted walnuts. Serves eight. l fall 2019 l C A N C E R C A R E


Living wiTh CanC er


Kaylee in a ball pit in February 2019, celebrating her seventh birthday. It was a happy occasion, unlike her sixth birthday, when she was diagnosed with cancer.

aylee Marshfield of Lakeland received


unforgettable news on Feb. 1, 2018. It was her sixth birthday: She had cancer.

A strange lump led to tests that detected a Wilms tumor on her left kidney. It was the most aggressive subtype of this childhood cancer, and it would mean removal of the kidney, chemotherapy, radiation treatment and lots of hospital stays at Upstate. During her treatment, Kaylee and her family volunteered for the Cans for Cancer drive at the New York State Fair and caught the eye of Maranie Staab. Staab, who is studying photography at Syracuse University, struck up a friendship with them and began taking pictures of Kaylee navigating life with cancer. Kaylee completed her treatment in October 2018, and since then, she has shown no evidence of cancer, says her pediatric oncologist at Upstate, Irene Cherrick, MD. As a second-grader this fall, Kaylee has resumed her old life and activities. Her hair has grown back, too. “Kaylee is a special little human. I’m a bit biased, but I mean that. She is outspoken, intuitive, introspective and only 7 years old. It’s been a privilege to observe and get to know her,” Staab says. 22

C A N C E R C A R E l fall 2019 l

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Kaylee at the 2018 State Fair, which she could not visit as often as she would have liked while on treatment.

Living wiTh C anCer

Glimpses of a girl who fought cancer — and won

continued from page 22

Returning to karate training in spring 2019 at Karate John‘s Martial Arts Center in Cicero, which held a fundraiser for Kaylee while she was absent for cancer treatment and created a special pink belt for her.

With her mother, Kristina Crosley-Marshfield, on one of their many visits to Upstate for treatments or hospital stays in 2018. “She liked playing with Barbies and Legos. We had a whole soap opera with the Barbies,” her mother recalled. In general, Kaylee tolerated her cancer treatment well.

Clowning at lunchtime at St. Rose of Lima School in North Syracuse, where art is her favorite subject. “When she first meets you, she can strike you as being quiet, but she’s not,” said Irene Cherrick, MD, her cancer specialist. Staab added, “Kaylee is so full of life and personality, and her face is very expressive. I find her to be very mature and sophisticated for such a young age.” ADDITIONAL PHOTOS AND A VIDEO OF KAYLEE CAN BE FOUND AT WWW.MARANIERAE.COM

A family photo of pre-cancer Kaylee. “It was shocking to see the difference between the little girl I had just met (in mid-2018) and the healthy one she had been just a few months before,” said Maranie Staab, her photographer.

For Halloween 2018, shortly after a successful end to her treatment, Kaylee dressed as Pinkie Pie, a “My Little Pony” character. l fall 2019 l C A N C E R C A R E


Non Profit Org. US Postage

PAID 750 East Adams Street l Syracuse, NY 13210

Permit No 110 Syracuse, NY

UPClose $1.1 million grant from the


National Institutes of Health helped Upstate Medical University

purchase one of the most advanced ultra-high performance mass spectrometers available today. The new machine allows researchers to make further advances in the fields of structural and quantitative proteomics and metabolomics and drug discovery.

Close-up of the mass spectrometer’s nanospray ionization source, where molecules are converted into ions — a critical step in their detection. PHOTO BY WILLIAM MUELLER

Mass spectrometers are used to make chemical analyses by producing charged particles, also known as ions, from chemical substances. It then uses electric fields to measure the weight of the charged particles, which researchers say is important in helping to identify and distinguish the ions or molecules from other molecules. A key feature of Upstate’s new mass spectrometer is its versatility and speed. This model has a faster scanning speed than previous models, allowing for more in-depth analysis of a sample, thereby maximizing the data obtained for a single sample and the number of samples that can be analyzed in a given amount of time. “This is a game-changer for us on the research front, as it will also allow us to train future generations of research technicians and introduce postdoctoral fellows and graduate students to the latest biomedical mass spectrometry applications in the area of proteomics, metabolomics and diagnostics,” says Bruce Knutson, PhD, assistant professor of biochemistry and molecular biology.

19.225 1119 28.8mELsk

Among the work expected to be carried out with the mass spectrometer are projects related to biomarker discovery. The machine, housed in Weiskotten Hall, is available for use by researchers at nearby institutions, including Syracuse University, SUNY College of Environmental Science and Forestry and SUNY Oswego. Ebbing De Jong, PhD, is director of the proteomics and mass spectrometry facility and an assistant professor of biochemistry and molecular biology. CC

Ebbing Bruce De Jong, Knutson, PhD PhD