Upstate's Cancer Care magazine

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care CANCER

for anyone touched by cancer

How does your tumor cell grow? Key prostate cancer facts Keeping your colon healthy PLUS: Safer infusions

Tiny tiles treat brain cancer

Brought to you by the

Summer 2021


YOUR GUIDE

Architect’s rendering of the Upstate Cancer Center at Verona, scheduled to open in October 2022. ARCHITECTEAM, SYRACUSE, NY

New Upstate cancer center coming to Verona BY KEVIN MORROW

he Upstate Cancer Center will expand its reach

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with a comprehensive cancer care center in Verona, bringing cancer care closer to home

for residents of Madison and Oneida counties. The new, 30,000-square-foot facility will provide expanded diagnostic and treatment services in a convenient location just off Exit 33 of the New York State Thruway. Upstate’s existing cancer center on Seneca Street in Oneida, about 15 minutes away, will relocate to Verona next year. The Upstate Cancer Center at Verona will offer medical oncology, radiation therapy, radiology, laboratory, pharmacy and consultative services similar to those found at the Upstate Cancer Center — without the need to travel to downtown Syracuse. Whether in Syracuse, Oswego, Oneida or Verona, Upstate patients have access to the latest cancer-fighting technology and clinical trials not available anywhere else in the region. The Verona site will continue Upstate’s tradition of offering multidisciplinary care with a team of experts that includes surgeons, medical oncologists, radiation oncologists and other specialists who consult together to manage each patient’s specific treatment. The Upstate Cancer Center at Verona is expected to open in October 2022. CC 2

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care C O N T E N T S CANCER

On the cover: Neurosurgeon Harish Babu, MD, PhD, is co-director of Upstate’s brain tumor program and director of minimally invasive neurosurgery. See story, page 11. PHOTO BY SUSAN KAHN

Summer 2021

CARING FOR PATIENTS He turned 1 in the hospital

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A complex surgery for a rare cancer

page 6

One woman’s story of cervical cancer treatment

page 8

SHARING EXPERTISE Brain tumors come out, tiny tiles go in

page 11

Should you be screened for lung cancer?

page 12

7 facts every man needs to know about prostate cancer

page 13

RESEARCHING FOR ANSWERS Why basic research matters

page 14

How does your tumor cell grow?

page 15

Green tea antioxidant shows anti-cancer promise

page 16

Can reducing calories help fight breast cancer?

page 18

What animals teach us about breast cancer

page 19

Cracking a protein code to improve cancer drugs

page 20

LIVING WITH CANCER Cooking for a healthy colon

page 23

AJ Pass, 36, of Owego, is able to enjoy the outdoors after a complex surgery for a rare cancer. See story, page 6. PHOTO BY ROBERT MESCAVAGE

CANCER CARE

UPSTATE CANCER CENTER

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

DIRECTOR (INTERIM) Thomas VanderMeer, MD

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

MANAGING EDITOR

WRITERS

DESIGNER

Jim Howe Emily Kulkus Kevin Morrow Amber Smith Susan Keeter

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

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 315-4644836. Cancer Care offices are located at 250 Harrison St., Syracuse, NY 13202. The Upstate Cancer Center is part of Upstate Medical University in Syracuse, New York, 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, Upstate Community Hospital, 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.

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CARING FOR PATIENTS

Resilient and recovering Hospital staff helps family whose baby had a brain tumor BY AMBER SMITH

nzo Gentile’s first

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birthday celebration turned out to be

something his mother had never imagined. He was hospitalized at the Upstate Golisano Children’s Hospital, recovering from surgery to remove a brain tumor in January 2017. He’s 5 now, and again he’s recovering Enzo Gentile and his mother, Shiloh Gentile, napping in his room in the pediatric from surgery, this time to remove a new tumor attached to his brainstem. He’s back intensive care unit of the Upstate Golisano Children’s Hospital in 2017. PROVIDED PHOTO at his Binghamton home, playing with his spread wherever cerebrospinal fluid flows, around the brain big brother, Dominic, and their two puppies. or spinal cord. He was 11 months old. Enzo was an infant, vacationing with his family in January In the four years since, Enzo’s treatment odyssey has 2017 in North Carolina, when he started vomiting. His included his doctors arranging six weeks of proton radiation mom, Shiloh Gentile — a nurse who takes care of adults therapy at the Children’s Hospital of Philadelphia, two brain with cancer — thought the boy might have picked up a surgeries at Upstate, another at New York-Presbyterian stomach bug. When he kept vomiting, they returned from Hospital, a multitude of imaging scans, plus almost four vacation to see Enzo’s pediatrician. Soon Enzo was months of chemotherapy appointments at Upstate. transferred by ambulance to Upstate. Pediatric oncology chief Melanie Comito, MD, is part of He and his mom arrived late at night. Gentile remembers Upstate’s pediatric neuro-oncology program. She oversees a sense of relief. Enzo’s care. “One of the memories that sticks out to me the most is After the first surgery, the team of specialists caring for how the doctor called at midnight. He was like, ‘We will get Enzo recommended proton radiation, which is only available this figured out.’ I felt like he listened. And he hadn’t even at a few medical centers in the country. met us yet.” Enzo had a brain tumor called an anaplastic ependymoma. It’s a fast-growing tumor that is tricky to treat because it can 4

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While the goal is to reduce travel for patients needing care, Comito says, “We will be honest with them. Once in a while


CARING FOR PATIENTS

Among the doctors who care for Enzo Gentile are pediatric oncologist Melanie Comito, MD, and neurosurgeon Satish Krishnamurthy, MD.

Enzo Gentile, now 5, wears an “Enzo Strong” shirt while playing with his puppy, Tank. PHOTO BY ROBERT MESCAVAGE

if we can’t do everything we think they need, we will know where to send them.”

Comito will continue taking care of Enzo, helping decide whether and what additional therapies might help him.

Comito talked with Gentile about whether Enzo should participate in a clinical trial that was analyzing the benefit of chemotherapy in treating ependymomas in children. Upstate is part of the Children’s Oncology Group — an organization devoted exclusively to pediatric cancer research and supported by the National Cancer Institute — which means patients at Upstate can participate in trials from across the country without leaving Upstate. Gentile enrolled Enzo.

The first part of Enzo’s treatment was a surgery at Upstate that lasted about 11 hours, two days before he turned 1.

“I think she was glad she picked something that gave him the best chance,” Comito says. “Chemotherapy has been shown to improve survival. It’s not 100 percent. But Enzo did well for three years.” Comito says his medical visits are strategically spaced out in the hopes of finding any problems before symptoms arise. An imaging scan revealed a new nodule in Enzo’s brainstem late in 2020. Comito recommended Gentile bring her son to a surgeon at New York-Presbyterian with a specific technique for removing intraventricular brain tumors. Gentile keeps friends and family updated on a Facebook page about Enzo. In May, she posted from New York City that “they were not able to visualize the tumor initially but removed some bone and were able to see it perfectly. The tumor was attached to his brainstem, yet again, so there will be some microscopic pieces left over.”

Enzo’s tumor originated in the fourth ventricle of the brain, which is located within the brainstem. This is the area of the brain that regulates heart rate, breathing, sleeping and more. Surrounding it is the cerebellum, responsible for the body’s motor movements, balance and coordination. As the tumor grew, it filled the ventricle space and then began pressing on nerves. Upstate neurosurgeon Satish Krishnamurthy, MD, had to remove as much of the tumor as possible without damaging anything around it. He also placed a shunt to drain the accumulation of fluid, a condition called hydrocephalus. Gentile was impressed with the nurses and doctors who cared for Enzo at Upstate. As her baby recovered from his first surgery, she became familiar with other important members of his care team. “The child life team is incredible,” she says. “They made life absolutely amazing for us.” Even though his first birthday celebration was not one she had imagined for her son, Gentile says the staff did an outstanding job. “They decorated his room for him and got him presents to unwrap.”CC

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CARING FOR PATIENTS

Among the physicians caring for AJ Pass are Mashaal Dhir, MD, left, a surgical oncologist and section chief of surgical oncology for hepatobiliary and pancreatic surgery, and Gennady Bratslavsky, MD, chair of the urology department.

Saved by a team of surgeons Owego man undergoes complex cancer operation BY AMBER SMITH

AJ

Pass had faith in his surgeons. He also knew he could die.

They had been straight with him: A proportion of patients who would undergo a surgery like he needed would not survive the operation. Also, the mass they would remove was probably cancerous. The week before, Pass, 36, was running an information technology company from his home in the Tioga County village of Owego, alongside his wife, who did her job as a marketing coordinator from home, too. Now the couple faced a multitude of worrisome decisions. They were sure about Pass’ doctors, though: Mashaal Dhir, MD, and Gennady Bratslavsky, MD. “I felt like they truly loved me and cared about me in such a short period of time. Dr. Dhir had a way about him that was so gentle and calm,” Pass says. “And when I look back on it, I’m so grateful that Dr. Bratslavsky did not scare me.” Pass’ medical crisis began as a weird abdominal pain that would only bother him in the morning. It left him alone the rest of the day, but it was back the next morning. His wife, Michelle, made him seek care. He wondered whether it might be a hernia. 6

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The nurse practitioner Pass saw at Lourdes Hospital in nearby Binghamton sent him for a medical imaging scan. The results showed that Pass had what appeared to be a softball-sized cyst in the vicinity of his liver. He got an appointment the next morning to see Dhir, a surgical oncologist and section chief of hepatobiliary and pancreatic surgery at Upstate. More tests helped determine it wasn’t a liver cyst. The mass, which originated in his adrenal gland, was adjacent to his heart and growing into the inferior cava, the largest vein in the body, which returns blood to the heart. At its widest point, the mass was 15 centimeters, or about 6 inches. Surgery, Dhir told him, was the most effective treatment for such a mass.


CARING FOR PATIENTS

AJ Pass enjoys trail riding near his home in Owego. PHOTO BY ROBERT MESCAVAGE

After he met with Dhir, Pass got a phone call from Bratslavsky, who leads Upstate’s department of urology. He was out of town but had discussed Pass’ case with Dhir.

In Pass’ case, he had what surgeons triumphantly call “negative margins.” Pathologists found no cancer cells at the edges of the tissue that was removed.

Because the mass was growing so quickly and getting so close to Pass’ heart, Bratslavsky explained that “this was one of those rare scenarios where I felt we needed to proceed with surgery as soon as possible.”

The tumor weighed about 16 pounds and had grown to within a centimeter — two-fifths of an inch — of Pass’ heart. Doctors originally feared it might be an aggressive type of adrenal cancer. The tumor turned out to be Ewing’s sarcoma, a rare and aggressive cancer that often occurs in and around the bones, in children. It’s almost unheard of to arise in the adrenal gland of an adult.

Pass says Bratslavsky quickly put him at ease. “He was so confident he was going to be able to go in and fix it.” Pass never felt sick. He says he felt great the morning in April 2019 when he walked into Upstate University Hospital in downtown Syracuse for the surgery, which would last 12 hours. Bratslavsky and Dhir teamed up with thoracic surgeon Mark Crye, MD, and surgeon Rauf Shahbazov, MD, PhD, who has expertise in liver surgery. The tumor started in the adrenal gland at the top of Pass’ right kidney. The gland and the organ had to be removed, along with half of his liver, half of his diaphragm and his vena cava, the largest vein in the body. And they had to be removed simultaneously, rather than sequentially. “We remove masses like this en bloc,” Bratslavsky explains. “Everything comes out together. We make all the necessary maneuvers to be able to remove this mass with adjacent organs and vessels as one.” This requires a coordinated team, and it helps ensure that no stray tumor cells are left behind.

Because this type of tumor is so rare, “there is really no good knowledge about how rapidly they grow, no understanding of its natural history and very little information on diagnosis and treatment,” Bratslavsky says. Pass’ operation was complicated when his blood pressure dropped and his heart slowed. It did not stop beating, but Bratslavsky had to use his hand to pump Pass’ heart adequately. He praised the rapid intervention of heart surgeon, Aqeel Sandu, MD, who placed the patient on a cardiac bypass machine after the direct heart massage. “I’m here because Dr. Bratslavsky didn’t give up,” Pass says. His left kidney stopped functioning — something Bratslavsky says may happen during big surgeries. The kidney eventually resumed functioning on its own. continued on page 10 upstate.edu/cancer l summer 2021 l C A N C E R C A R E

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CARING FOR PATIENTS

Finding a polyp Regular screening detects cervical cancer early – when it’s most treatable BY AMBER SMITH

ostponing routine medical visits might have been

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tempting during the pandemic. Nina Alfano, 37, a school bus driver in North Syracuse, is glad

she kept the appointment with her gynecologist. Alfano had not heard of cervical polyps when her doctor found one during an exam in March 2020. The doctor called Alfano two days later with results from the laboratory: The polyp was cancerous, and she was arranging for Alfano to see Mary Cunningham, MD, chief of gynecologic oncology and a professor of obstetrics and gynecology at Upstate.

After being healthy her whole life, Alfano now faced a health crisis. But because she was vigilant with routine gynecological care, she would have a good chance at successful treatment. She went to the appointment with Cunningham. After the exam, they met in a conference room. “She said, ‘You really had someone on your side. If this was six months later, we would be having a very different conversation,’” Alfano recalls.

Nina Alfano and her son, Gregory, at William’s Beach in Cicero. She had surgery to treat cervical cancer discovered during the pandemic. PHOTO BY SUSAN KAHN

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CARING FOR PATIENTS

Uterus

Cervical canal Cervix Vagina

About cervical cancer l For

the best chance of successful treatment, the American Cancer Society recommends regular screening tests for cervical cancer beginning at age 25.

Gynecological oncologist Mary Cunningham, MD PHOTO BY SUSAN KAHN

The cancer was called an adenocarcinoma. Cunningham asked whether Alfano planned to have more children – her son, Gregory is 7 – and explained that the best treatment would be a hysterectomy, to remove the uterus and cervix. Alfano underwent a series of medical imaging scans and other preoperative tests at the same time restaurants and businesses were closing and sending workers home because of the growing outbreak of coronavirus. Surgery was a success. “I could not have been put in better hands,” Alfano says. “Dr. Cunningham is phenomenal.” The pathology report indicated Alfano would not require chemotherapy or radiation treatments. And, she says her scar has healed so well, “you can barely even tell that I was cut.” In the first year since the surgery, Alfano had checkups with Cunningham every three months. They’ll be scheduled less frequently in her second and third years. They are appointments that, even during a pandemic, Alfano says she will keep. CC

#

l Cervical

cancer usually produces no symptoms at first.

l As

the cancer grows, symptoms may include abnormal vaginal bleeding or discharge, pain in the pelvic region or during sex, abnormal vaginal bleeding, bleeding between periods or after sex, bleeding after menopause, or menstrual periods that are longer or heavier than usual.

l More

advanced disease may cause swelling in the legs, problems urinating or having a bowel movement, or blood in the urine. SOURCE: AMERICAN CANCER SOCIETY

35 Best Large Employer in America

www.upstate.edu/jobs

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CARING FOR PATIENTS

Saved by a team of surgeons THE OPERATION FOR A 16-POUND TUMOR A team of surgeons at Upstate University Hospital removed a 16-pound tumor, along with adjacent organs and vessels, from AJ Pass’ abdomen in March 2019. Pathologists found no cancer cells along the edges of the tissue. Doctors refer to this desired outcome as “negative margins.” 1

2

Vena cava The part of this large vein that had to be removed was behind the liver. Several smaller veins in that region took on the function of returning blood from the lower part of the body to the heart.

Liver About half was removed. The remaining organ regenerates, and in two years has grown back to about 90% of its original size.

3

4

Heart Intraoperative CPR, cardiopulmonary resuscitation, was required when the patient’s blood pressure dropped, and he had to be temporarily placed on a cardiac bypass machine.

5 4 5 1 2

continued from page 7

Diaphragm About half was removed. Mesh was sewn into place to help prevent breathing complications and to help keep abdominal organs from herniating into the chest.

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Right kidney with adrenal gland Removed. The kidney and adrenal gland on the left side function adequately for the whole body.

Pass remembers receiving anesthesia at the beginning and feeling comfortable surrounded by darkness. At one point, Pass says, “it felt like I fell through the bed and was just going through outer space at a million miles an hour. I felt the wind, and I felt cold. It felt like an eternity. A white light was coming up from behind my back, getting brighter and brighter. “I eventually hit what felt like a net, and slowly I slowed down. What felt like hands, or a force, lifted me back up through space, and someone was telling me my time was not over,” he says of his experience.

AJ Pass’ surgical team also included thoracic surgeon Mark Crye, MD, (left) and transplant surgeon Rauf Shahbazov, MD, PhD, (right) who has expertise in liver surgery.

Pass was in a coma for six days after the surgery. A team of urologists from Bratslavsky’s department helped manage his recovery. He was well enough to go home after 24 days. Across his torso is a scar that looks like a Mercedes logo.

He credits positron emission tomography, or PET scan, with finding a papillary thyroid carcinoma. Dhir operated again, to remove Pass’ thyroid gland, in June of 2020.

One month to the day after Pass traveled to Upstate for surgery, he was back in Syracuse. This time he was at Hancock International Airport, where he boarded a flight to Charlotte, North Carolina. His sister was getting married, and he needed to be there. Bratslavsky — not wanting his patient to endure an 11- to 12-hour car ride each way — opened his own pocket and surprised Pass with airfare. Because Ewing’s sarcoma is known to recur, Pass now undergoes scans of his body every three months as a precaution. 10

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Then in October 2020, another scan revealed a spot in his left lung. His Upstate team recommended he see a specialist, so Pass traveled to the Cleveland Clinic in Ohio. Part of his lung was removed, and pathologists confirmed that the nodule was comprised of Ewing’s sarcoma cells. Pass returned to Central New York with what he describes as a “pretty good prognosis” and plans to undergo chemotherapy with medical oncologist Rahul Seth, MD. As he prepares himself for more treatment, Pass reflects on how grateful he is for his surgical team. “They saved my life.”CC


SHARING EXPERTISE

Brain tumors come out; brain ‘tiles’ go in BY AMBER SMITH

atients with some types of cancerous brain tumors

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require radiation treatment after they have the tumor removed, to destroy any remaining

cancer cells.

Now there’s the option to have the tumor removed and replaced by postage stamp-sized radiation sources, in the same operation. It’s called GammaTile Therapy. “We place the radiation sources inside the brain at the site of the surgery, so the radiation begins right at the moment after surgery,” explains Harish Babu, MD, PhD, co-director of the brain tumor program at Upstate and director of minimally invasive neurosurgery. He says the bioabsorbable collagen tiles, which look similar to flattened Lego pieces, hold their shape as their radiation is delivered. About 50% of the therapeutic dose is delivered in the first 10 days after surgery, with about 95% delivered in six weeks. Over time, the body naturally absorbs the collagen tile. GammaTile’s radiation source, cesium-131, has a dramatically shorter half-life than iodine-125, which has been used in earlier types of brachytherapy, Babu says. Brachytherapy is a general term for the implantation of radioactive sources adjacent to tissues that may contain cancer cells. The shorter half-life means patients receive the same amount of radiation in a shorter period of time. Traditional, or external beam, radiation after brain surgery requires almost daily medical visits over a period of several weeks. Side effects can include headaches, hair loss, nausea and vomiting, fatigue, skin and scalp discoloration, and memory or cognitive problems. GammaTile produces fewer side effects and is designed to allow patients to get on with their lives during treatment. CC

To learn more about brain tumor treatment options, contact Upstate’s Neuro Oncology Program at 315-464-3510.

Neurosurgeon Harish Babu, MD, PhD, is co-director of Upstate’s brain tumor program and director of minimally invasive neurosurgery. PHOTO BY SUSAN KAHN PHOTO BY SUSAN KAHN

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SHARING EXPERTISE

A reason to screen When lung cancers are found early, they can be treated

any more people are

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recommended for an annual lung cancer screening under

revised guidelines from the U.S. Preventive Services Task Force. Since symptoms of lung cancer usually don’t emerge until the disease is advanced, experts say screening helps to improve survival rates. Screening involves a low-dose computerized tomography scan, known as a CT or CAT scan. Of people who follow the screening guidelines, Jason Wallen, MD, says, “we detect their lung cancers earlier, at much more treatable stages. There are dramatic improvements in survival related to that.” Wallen is chief of thoracic surgery at Upstate University Hospital and medical director of the lung cancer and Thoracic Oncology Program at the Upstate Cancer Center. “We are now recommending lung cancer screening for younger patients and for patients who don’t have as significant a smoking history as in the previous guidelines,” he says. Who should be screened? People age 50 to 80 with a 20 pack-year smoking history, who continue to smoke or who have quit within the last 15 years. A “pack year” is smoking an average of one pack of cigarettes per day for one year. A person has a 20 pack-year history, for example, by smoking one pack a day for 20 years, or by smoking two packs a day for 10 years. CC

Who should be screened? People age 50 to 80 who: l have a 20 pack-year smoking history (a pack a day

Contact Upstate’s lung cancer screening program by calling 315-464-7460.

for 20 years, or equivalent) l and who currently smoke or have quit within the

last 15 years SOURCE: U.S. PREVENTIVE SERVICES TASK FORCE

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SHARING EXPERTISE

Seminal vesicle

7 facts about prostate cancer enerally, men find out they have prostate cancer not from noticing a symptom,

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but from a routine screening by their primary-care provider.

The screening involves a blood test for PSA, or prostate-specific antigen, and a rectal exam to check for prostate surface irregularities, explains Upstate urologist Joseph Jacob, MD. Jacob specializes in treating cancers of the urinary tract and the male reproductive organs. The prostate is the male reproductive gland that surrounds the urethra, the tube that empties the bladder, and it produces a fluid for semen. The prostate can develop cancer later in life, typically in a man’s 60s or 70s. Jacob offers these points about how prostate cancer is detected and treated:

1. 2. 3. 4.

Primary-care doctors and urologists tailor the frequency of testing and aggressiveness of treatment to the individual’s risks, needs and desires.

5.

When to start screening is generally around 55, but doctors may recommend it earlier based on risk factors. PSA level above 4 nanograms per milliliter generally signals that further prostate cancer investigation is needed. PSA levels can vary widely and do not guarantee that cancer is present, but the test does help catch cancer early, when it is more treatable. A prostate biopsy is often the next step after a high PSA reading. A bit of prostate tissue is extracted through a needle, then examined under a microscope to confirm whether cancer is present and how aggressive it is.

6. 7.

In most cases, where the cancer has not spread beyond the prostate, it can be successfully treated with radiation, surgery or, if slow-growing, with “active surveillance” — just being watched. The most common surgical option is prostate removal, performed laparoscopically through small incisions with robotic assistance. Patients usually go home the same day or after an overnight stay. Any treatment runs the risk of affecting sexual function and urinary issues, at least temporarily, and this must be discussed with the patient beforehand. These risks have lessened in recent years. There is no proven diet to prevent prostate cancer, so doctors recommend the same thing as for overall good health: a sensible diet, regular exercise and not smoking.

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RESEARCHING FOR ANSWERS

Curiosity can create cures Why basic science is important to cancer BY AMBER SMITH

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id you know that studying toe hairs of the gecko inspired the design of medical adhesives that are

now used on delicate human skin? Or that understanding how a specific protein repairs damaged DNA led to the development of a drug that blocks the repair process in cancer cells, effectively killing those cancer cells? Or that a drug used today to treat testicular, ovarian and bladder cancers was discovered only after a researcher noticed bacteria were not dividing normally in his experiments on the effect of electrical fields on bacteria? He traced the cause to platinum compounds that formed when electrodes made contact with the liquid containing bacteria, then tested a range of compounds containing platinum to discover that cisplatin was the most effective. Further testing found cisplatin could stop or slow the growth of certain cancer cells. Basic scientists do work that may later translate into practical applications. They study life processes – how and when and why cancer cells spread, for instance – that lead the way toward being able to predict, diagnose and treat diseases including cancer. On the right, here’s a look at some of the cancer-related research underway in laboratories at Upstate Medical University. Their stories follow.

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l Cancer biologist Dimitra Bourboulia, PhD, seeks to limit the spread of invasive cancers of the kidney, prostate, breast and lung. (Page 15) l Biochemist/molecular biologists Stewart Loh, PhD, and Michael Cosgrove, PhD, are researching a compound in green tea that could lead to a tumor-suppressing drug. (Page 16) l Radiation oncologist Brittany Simone, DO, wants to improve overall survival of breast cancer patients and make immunotherapy more effective. (Page 18) l Breast surgeon Lisa Lai, MD, is working on a way to determine the risk level of patients with breast cancer. (Page 19) l Cancer biologist Mehdi Mollapour, PhD, is focused on molecular chaperones, a group of proteins that are involved in looking after other proteins that play essential roles in cancer. (Page 20) CC


RESEARCHING FOR ANSWERS

How does your tumor cell grow? BY EMILY KULKUS

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rom her laboratory at Upstate, Dimitra Bourboulia, PhD, is

working toward ways to limit the spread of invasive cancers. Dimitra Bourboulia, PhD

Bourboulia was recently awarded a $1.3 million, four-year grant from the National Institutes of Health to study what makes tumor cells grow and spread throughout the body. She has been investigating for more than a decade the regulation and function of secreted proteolytic enzymes, or MMPs, predominately in tumors that invade through surrounding tissue. In her new project — titled “Regulation of the Extracellular Hsp90 Chaperone Machinery” — she examines how multiple regulators (activators and inhibitors) interact and signal outside the cell to tweak the activity of MMPs. Normally, cells release proteins that function to build and maintain a healthy surrounding environment, called the extracellular matrix, a well-organized, supporting 3D structure. In cancers and some other diseases, this matrix can be damaged when MMPs fail to perform their function in a normal way. “This research essentially focuses on key secreted proteins and their binding partners that function as a team not inside, but outside, the cell,” Bourboulia says. “If we want to therapeutically target invasive tumors and limit their spread, we need to understand what makes this extracellular Hsp90 pro-invasive machinery so powerful. Unfortunately, we know how only very few components of this machinery work.” Her project has direct ties to many human cancers, including kidney, prostate, breast and lung, with a focus on cases where aggressive tumors have spread through the body. Bourboulia, an associate professor of urology and biochemistry and molecular biology at Upstate, is an expert in extracellular protein signaling and homeostasis. Because of her contribution to deciphering the function of extracellular Hsp90 in cancer, she was presented with the 2020 Ritossa Early Career Award. CC upstate.edu/cancer l summer 2021 l C A N C E R C A R E

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RESEARCHING FOR ANSWERS

A promising brew? Green tea antioxidant is studied for anti-cancer properties BY JIM HOWE

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an drinking green tea prevent cancer?

Probably not, although scientists are unlocking the brew’s benefits. “Hundreds of millions of people drink green tea every day. If it were a miracle cancer drug, we would have known it by now,” says Upstate researcher Stewart Loh, PhD. An antioxidant in green tea, however, could point the way to new cancer-fighting drugs through its interaction with an anti-cancer protein in the body, according to a recent study. The labs of Loh and Upstate colleague Michael Cosgrove, PhD, took part in the study, published in the journal Nature Communications. They are professors of biochemistry and molecular biology, and Loh is also that department’s vice chair.

The science in a nutshell Antioxidants help to undo the damage caused during the normal process of oxygen metabolism, by which the body gets energy. Green tea’s major antioxidant is called EGCG, which stands for epigallocatechin-3 gallate.

In this model, the p53 tumor suppressor (the multicolored molecule), binds to DNA (the blue strand) and activates genes that defend against cancer. Green tea (the plant and dried leaves at top), contains the compound EGCG (shown by the green dots), which binds to p53 and helps it resist being degraded by cancer cells. P53 MODEL COURTESY OF ÖZLEM DEMIR, EMILIA P. BARROS, TAVINA L. OFFUTT, MIA ROSENFELD AND ROMMIE E. AMARO, FROM “AN INTEGRATED VIEW OF P53 DYNAMICS, FUNCTION, AND REACTIVATION,” CURRENT OPINION IN STRUCTURAL BIOLOGY, VOLUME 67, 2021, PAGES 187-194, ISSN 0959-440X, HTTPS://DOI.ORG/10.1016/J.SBI.2020.11.005

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Green tea is unfermented or lightly fermented. Black tea is fully fermented, and it is the most commonly consumed tea in the United States and around the world. The tea served in most restaurants and the tea bags found in most home kitchens are black tea. EGCG is also found in black tea, but at about one-eighth the level of green tea. EGCG is also available as an herbal supplement, but Loh and Cosgrove advise against trying to consume it that way, because its safety and effectiveness are unknown. Both the National Cancer Institute and the National Center for Complementary and Integrative Health say the evidence is


RESEARCHING FOR ANSWERS

Stewart Loh, PhD

Michael Cosgrove, PhD PHOTO BY RICHARD WHELSKY

SUBMITTED PHOTO

inconclusive on whether anything in green tea can prevent cancer.

cancer cells, and if it’s too active, it’ll kill everything. So the MDM2 protein reins in the activity.

The anti-cancer protein is called p53. It is nicknamed the “guardian of the genome” because it can repair DNA damage to cells, keep cells from multiplying too rapidly and destroy cancer cells.

“But when MDM2 is overactive, which happens in a lot of cancers, then it reduces the amount of p53 in your cells by so much that the cancer takes over. EGCG competes and helps disrupt that interaction between those two proteins, so that allows p53 activity to increase.”

“Now we find that there is a previously unknown, direct interaction between EGCG and p53, which points to a new path for developing anti-cancer drugs. Our work helps to “explain how EGCG is able to boost p53’s anti-cancer activity, opening the door to developing drugs with EGCG-like compounds,” says the study’s lead author, Chunyu Wang, MD, PhD, a professor at Rensselaer Polytechnic Institute in Troy, New York.

Wake up ‘the good guy,’ but carefully Loh, who has been studying p53 for 25 years, calls it “arguably the most important protein in your body when it comes to cancer. “P53 is the good guy. That's the molecule that’s keeping you from getting cancer,” Loh says. He explains the drama playing out at a microscopic level: “P53 is a tumor suppressor, so you’re trying to wake it up, and that entails making it active, but anything that’s too active is going to be a problem. So, we’re trying to wake it up just enough. “MDM2 (or murine double minute 2, another protein) is the one that's sort of controlling p53. Each is needed for the other because p53 protects you against cancer by killing

A previously unknown interaction Loh notes that it is generally thought that half of all human cancers are driven by mutations in p53. “And in the other half, p53 is not mutated. It’s normal. “So why do you get cancer? It’s because of things like MDM2. It's the way that p53 is regulated, gets screwed up by either mutation, or something else. EGCG targets roughly half of human cancers.” He says their research was published because it’s the first time anyone showed that EGCG binds to this important tumor suppressor. Loh’s lab helped make the form of p53 protein needed for the study, a difficult and tricky process. Cosgrove’s lab helped process the research data by using a technique developed in his lab and by showing that the protein’s shape changed during interactions, which is a key to understanding how it works. Also assisting in the study were Allen Blayney and Jeung Hoi-Ha from Loh’s lab and Michael Connelly and Ashley Canning from Cosgrove’s lab. Both labs receive funding from the National Cancer Institute for their research. CC upstate.edu/cancer l summer 2021 l C A N C E R C A R E

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RESEARCHING FOR ANSWERS

Cutting calories– Will it help fight breast cancer? BY AMBER SMITH

I

mmunotherapy drugs don’t work well in breast cancer because they depend on white blood cells that help fight cancer, called lymphocytes — and not many of

those cells invade breast tumors. So, radiation oncologist Brittany Simone, DO, is exploring how to increase the number of lymphocytes in breast tumors and improve overall survival. She received Brittany Simone, DO a grant from The Baldwin Fund in 2020 that allows her to continue her research. Simone is focusing on calorie restriction in her laboratory, and an aggressive type of breast cancer called triple-negative breast cancer. Previously, Simone showed that reducing a patient’s calorie intake by 20 to 40 percent, along with radiation therapy, delayed the spread of breast cancer and improved survival rates. She also showed that pairing calorie restriction with chemotherapy increased survival by helping to reduce inflammation caused by chemotherapy. “One of the hallmarks of cancer is that it finds a way to get around the immune system,” Simone says. That’s why she wants to see whether calorie restriction can increase what scientists call “cell immunosurveillance.” Regulatory T cells, called Tregs, provide surveillance for the immune system by identifying cancer cells. Patients who are overweight or dealing with inflammation have fewer Tregs. Will calorie restriction lead to an increase in the number of Tregs? Can it help increase the number of lymphocytes that invade the tumor? Those are questions Simone hopes to answer affirmatively. CC

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RESEARCHING FOR ANSWERS

Dogs, cats and humans What animals can teach us about breast cancer BY AMBER SMITH

ogs and cats have a high

D

incidence of breast cancer, compared with horses, pigs

and cows, which have a low incidence. Researchers wonder what they can learn

and donors without cancer who receive treatment at Upstate and who want to help advance research. Gennady Bratslavsky, MD, is the director, and Dawn Post, PhD, is the coordinator. Lai and Van de Walle hope to confirm a significant difference in microRNA levels between humans with cancer and humans without cancer. If they do, they envision a screening tool might be developed to help identify those at highest risk for breast cancer. CC

from that difference. Upstate breast surgeon Lisa Lai, MD, has teamed up with Cornell University veterinarian Gerlinde Van de Walle, DVM, PhD, to study the levels of microRNA particles present in blood, saliva and urine. MicroRNA are small molecules involved in regulating a cell’s activity and appear to play an important role in many biological processes and diseases. Van de Walle already identified microRNA that exists in significantly different levels in dogs and cats, who frequently develop breast cancer, and horses, pigs and sheep, who rarely develop breast cancer. Now she and Lai will investigate whether a similar difference exists in humans with breast cancer, compared to humans who do not have breast cancer. “This is really in its infancy. So much of modern medicine began in an animal lab and then got expanded to humans,” Lai says of the collaboration. A grant from The Baldwin Fund will help pay for the project, which Lai says will rely on samples from the Upstate Medical University Biorepository. The repository collects, processes, stores and distributes specimens from donors with cancer upstate.edu/cancer l summer 2021 l C A N C E R C A R E

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RESEARCHING FOR ANSWERS

The chaperone code Cracking it may improve cancer drugs BY EMILY KULKUS

A

n Upstate researcher and professor received a $2.2 million

the second international chaperone code meeting after the first, held virtually in 2020, attracted more than 300 attendees.

continue studying the chaperone code,

The NIH grant is a prestigious Maximizing Investigators’ Research Award, which supports investigators’ overall research programs through a single, unified grant rather than individual project grants. The goal is to provide investigators with greater stability and flexibility, thereby enhancing scientific productivity and the chances for breakthroughs.

which plays an important role in cancer

Mollapour credits the work of everyone in his lab, as well as department leadership, for help obtaining the grant. CC

grant from the National

Institutes of Health that allows him to

and neurodegenerative diseases. Mehdi Mollapour, PhD, a professor of urology, biochemistry and molecular biology, and vice chair for translational research in the department of urology, has studied the chaperone code for nearly 20 years. Molecular chaperones are a group of proteins that are involved in looking after other proteins that play an essential role in health and maladies such as cancer and neurodegenerative diseases. One such chaperone, Hsp90, is a guardian of cancer that can be targeted by small molecule inhibitors. These drugs are currently being evaluated in phase III clinical trials in cancer patients. “While the genetic code specifies how DNA makes proteins, the chaperone code controls how proteins are folded to produce a functional proteome,” Mollapour explains. “Deciphering or cracking the code is important in understanding how chaperones work in normal cells as well as cancer cells. It will also allow us to improve the efficacy of chaperone drugs (Hsp90 drugs) in treating cancer patients.” A proteome is the complete set of proteins that cells make and regulate; it provides structure and other functions and is vital to research. Mollapour is an expert in the chaperone code. The Journal of Biological Chemistry recently published an invited review by Mollapour on the subject. He is also helping to organize

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Mehdi Mollapour, PhD PHOTO BY SUSAN KAHN


Impacting patient education, research, and community health Impacting patient care, education, research and community Impacting patient care, care, education, research, and community health and well-being through charitable giving. health and well-being through charitable giving. and well-being through charitable giving. Foundation

Watertownfire firecaptain captaingrateful gratefulfor for Watertown Gratefully, cancer patient care after battling horrifi blaze care after battling horrifi c cblaze

finally rings bell

Unaware the impending coronavirus “On thedown, ride down, I faded anEofout of Unaware of theof impending coronavirus “On the ride I faded in anEinout pandemic, the Upstate Foundation consciousness,” Kolb“But said.I’ll “But pandemic, the Upstate Foundation beganbegan consciousness,” Kolb said. tellI’ll tell preparing its annual observance you, I you, feltlove suchorlove or support preparing for itsfor annual observance neverI never felt such support “If kindness goodness Dr.as Graziano would and celebration of Doctors’ Day. As in years asatI did that moment and celebration ofand Doctors’ Day.were As inelectricity, years I did thatatmoment thosethose lightFoundation up thestaff world. ” received past, staff opened.” past, Foundation received nearlynearly 1,000 1,000 doorsdoors opened.” from gratitude notesnotes from gratitude Suchpatients were patients theexpressing wordsexpressing on the thank-you note written by Roland Andthere then there And then was was toWoolridge a array wide of array ofproviders care providers at Upstate Upstateoncologist to a wide care Upstate of Phoenix, Newat York, to the Stephen expert care Kolb the expert care Kolb University Hospital. Among UIF most University Hospital. Among Graziano, MD, as part ofUIF themost Upstate Foundation’s annual Doctors’ received from the received from the inspiring stories was ofand Watertown re share inspiring was that ofthat Watertown re fiElaine, Daystories observance. Woolridge hisfiwife, the story multidisciplinary multidisciplinary captain T.G. captain T.G. Kolb. behind the Kolb. 75-year-old man’s battle with cancer, and the care he at Upstate. team team at Upstate. received at the Upstate Cancer Center. longstill andongoing still ongoing of persever-FacedFaced with immeKolb’sKolb’s long and tale oftale perseverwith immeance ahusband fiarevacant in a vacant diate “Thebegan first myin met Dr.building Graziano was in threats 2006,threats when ance began withtime awith fire building in in diate posedposed Watertown, in on February 2018. The byeye, numerous Roland had NFX YPSL, a lymphoma the optic nerve inby hisnumerous left ” Elaine Watertown, NFX YPSL, in February 2018. The ed“Radiation entry byghters fi refighters – leaving them crushed and broexplained. partially removed the cancer. Roland blaze blaze defi eddefi entry by firefi – leaving them crushed and also browith the ostensibly safer option of battling ken required surgery, which had 39 stitches from earbones, to ear, serious with the ostensibly saferafter option of he battling ken bones, serious the flames from outside the structure. he lostnerve nerve damage, over the top of his head. Unfortunately, vision in that eye. ” and the flames from outside the structure. damage, and Suddenly, and unpredictably, a two-story injuries injuries to multiple Suddenly, and unpredictably, a two-story to multiple Fast-forward 13 years to January 2019. After Roland felt fatigue, brickcollapsed, wall collapsed, injuring two firefighters.organs, organs, Upstate’s brick wall injuring two refileft ghters. Upstate’s aches and “a wicked pain” in fihis shoulder, his general practiOne escaped with minor injuries; however, trauma trauma team tackled One escaped with minor injuries; however, team tackled tioner at first suspected a stubborn virus. But Roland’s history with Kolb suffmajor ered major harm to the lower por- the immediate the immediate risks to Kolb suff ered harm to the lower porrisks to cancer also triggered a positron-emission tomography, or PET, of his body. Kolb’s life. Next, weeks tion oftion his body. Kolb’s life. Next, weeks scan, which determined cancer was back in force. This time, of traction and multiple of traction and multiple kept shouting myevident crewme ‘1ut meblood down, lymphoma was indown, his and bones. “I kept“IB-cell shouting to myto crew ‘1ut surgeries, by orthopedic surgeries, led byled orthopedic I’m OK!’ as they pulled me away from the I’m OK!’When as they away from the only modest six pulled rounds me of radiation yielded results, Graziano Kistler lb on surgeon %S Brian surgeon %S Brian Kistler lb on wreckage,” said Kolb. Such theregimen numbing wreckage,” said Kolb. Such the is numbing suggested adding an is aggressive of chemotherapy. the long road to recovery. And countless the long road to recovery. And countless of shock. the nearest effecteff ofect shock. SwiftlySwiftly takentaken to theto nearest sessions in Upstate’s physical medicine As head of medical oncology at the Upstate Cancer Center, sessions in Upstate’s physical medicine and and local emergency department, it became local emergency department, it became rehabilitation department enabled Graziano provided candid and compassionate guidance, and the rehabilitation department enabled him tohim to clear trauma care would be needed. clear trauma care would be needed. With With leave the hospital after only six weeks, so Woolridges decided to push ahead. It was a decision that Roland leave the hospital after only six weeks, so an airlift outtodue to inclement an airlift ruled ruled out due inclement flight flight Kolb’s at-home rehabilitation could begin. says he began to regret when the treatment “was becoming worse Kolb’s at-home rehabilitation could begin. conditions, Kolbplaced was placed aboard conditions, Kolb was aboard an an than the disease. ” ambulance and taken to Upstate. “Myspent wife spent thetwo firstweeks two weeks ambulance and taken to Upstate. “My wife the first by by After nearly deciding to end chemotherapy after his fifth treatment, Roland persevered my side in the hospital, then drove from was during thisKolb timediscovered Kolb discovered It wasItduring this time the the my side in the hospital, then drove from and completed his sixth and final round. He celebrated with the traditional ceremony Watertown to Syracuse for four weeks,” human support structure around him was Watertown to Syracuse for four weeks,” human support structure around him was in which patients ring even a bell ifwhile surroundedsaid by their cancer team. saidUpstate Kolb. my “She, mycare friends and my family Kolb. “She, friends and my family extensive and strong, the building extensive and strong, even if the building were all so impressed by the care I received. were all so impressed by the care I received. “When Roland rang that been. bell, he did it with such force, I thought he would tear it off that harmed him hadn’t that harmed him hadn’t been. I call Upstate my ‘miracle team,’ because mygave ‘miracle because the wall!” exclaimed Elaine. “Everyone clappedI call and Upstate smiled and hugs.team,’ They were Firsthis was his older brother,aalso a Watertown First was older brother, Watertown I’mThey grateful alive and walking I’m grateful tomade be to alive and walking thanksthanks beaming with delightalso over Roland’s accomplishment. usbe feel like a person fire captain and paramedic who happened fire captain and paramedic who happened to them.” to them.” and not a number.” onthat dutysame that same evening and took to be to onbe duty evening and took more than two years later, Kolb’s Today, more than two later, Kolb’s jour- jourNow in remission, confirmed by another PET scan,Today, Roland is glad heyears opted to fight. the harrowing rideas with Kolb the from the the harrowing ride with Kolb from ney and health issues continue. “I have ney and health continue. have good good He and Elaine are participating in the “Live Strong” program atissues their local YMCA,“Iwhich Country to Syracuse. Concurrent NorthNorth Country to Syracuse. Concurrent days and bad days,” he said. Fortunately days 25 andpounds bad days,” Fortunately he, he, hasride, helped Roland his strength and of thehe 60said. he lost during with that ride, Kolb’s wife made hertoway to regain with that Kolb’s wiferecover made her way like his support system, remains strong. likeyears his support treatment. And is looking forward to the ahead. system, remains strong. Upstate, even asRoland Newstate York state police Upstate, even as New York police were were dispatched to SUNY colleges at Cortland “You to andSUNY your colleges team holdataCortland special place in my heart,” wrote Roland in his Doctors’ Day dispatched and Binghamton to notify and retrieve his was uncertainty. You gave me my life back.” note card. “You brought when and Binghamton to notify andcomfort retrieve his there daughters from school. Alerted that one of gratitude is a meaningful daughters from school. Alerted that one A gift Aofgift gratitude is a meaningful way toway to ofown theirhad ownbeen had been seriously injured, express appreciation to special caregivers of their seriously injured, express appreciation to special caregivers next came the moral support of Syracuse and help andpatients help patients during theirof time of next came the moral support of Syracuse during their time gift of gratitude is a meaningful way to express appreciation to caregivers and help fiA refi ghters, who up lined up in uniform need. To donate, contact firefighters, who lined in uniform as as great great need. donate, contact the the patients during their time of great need. To donate, contactTothe Upstate Foundation Kolblifted was lifted from the ambulance Upstate Foundation at 315-464-4416 Kolb was from the ambulance upon upon Upstate Foundation at 315-464-4416 or go or go at 315-464-4416 orTrauma go to www.upstatefoundation.org/donate. reaching Upstate’s Center. to www.UpstateFoundation.org/donate. reaching Upstate’s Trauma Center. to www.UpstateFoundation.org/donate.

grateful? AreAre youyou grateful?

Watertown fire captain Watertown fire captain T.G. Kolb’s recovery T.G. Kolb’s recovery a long and arduous was awas long and arduous but it made was made one, one, but it was easier a wide easier by a by wide and and With his wife, Elaine, diverse support network diverse support network including family, cancer survivor including family, the the Upstate team, fellow Upstate team, fellow Roland Woolridge fi refi ghters, and fidons refighters, andshirt eveneven a ribbon strangers. Here’s strangers. Here’s KolbKolb honoring during hishis time during his time in in Upstate’s rehabilitation Upstate’s rehabilitation Native American department displaying department displaying heritage. a “Thank You Hero” a “Thank You Hero” sign autographed sign autographed by by students Sherman students fromfrom Sherman Elementary School Elementary School in in Watertown. Watertown.

Are you grateful?

upstate.edu/cancer l summer 2021 l C A N C E R C A R E

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LIVING WITH CANCER

Low fat, high fiber A healthy diet can reduce colorectal cancer risk BY AMBER SMITH

A

body does not digest — but fiber still plays an important role in the body.

s we age, our risk for developing colorectal cancer increases.

A family history of colorectal cancer or polyps, of certain genetic syndromes or of an inflammatory bowel disease can also increase risk. Kristina Go, MD “Having a risk factor, or even many, doesn’t mean that you’ll necessarily get the disease,” says Upstate colorectal surgeon Kristina Go, MD. “Conversely, there’s still a chance of being diagnosed with colorectal cancer even in the absence of risk factors.”

She explains that some risk factors can be modified. You can reduce your chance of developing colorectal cancer if you are physically active, if you maintain a healthy weight, if you are not a smoker and if you are not a heavy or moderate consumer of alcohol. Katie Krawczyk is a registered dietitian nutritionist at the Upstate Cancer Center. She says research suggests a diet low in animal fats and high in fruits, vegetables and whole grains to help reduce the risk of colorectal cancers. “What we eat plays a crucial role in the risk of colorectal cancer. A diet high in fiber and adequate in folic acid, or folate, helps reduce our risk,” Krawczyk says. Fiber is also known as roughage or bulk. It’s the parts of plant foods that the

“Fiber helps process food through our digestive system and on to elimination, so it reduces the time that potential carcinogens sit in the intestines. It also has anti-inflammatory properties,” Krawczyk says. She advises shooting for 25 to 30 grams of fiber per day. Eating oatmeal for breakfast can get you started with 5 grams. Folate is a B vitamin, an essential nutrient that’s important for cell growth. The recommended daily amount of folate for adults is 400 micrograms. Foods that are high in folate include beans, broccoli, Brussels sprouts and leafy green vegetables such as cabbage, kale and spinach. These foods also happen to be high in fiber — making them ideal foods for colon health. CC See recipes, page 23.

Patrick the camel, with zookeepers Tyler Mesick and Travis Pyland (right), from the “Zoo to You” video.

Virtual Cancer Survivors Day For 24 years, Upstate has hosted a National Cancer Survivors Day Celebration, and in recent years, it has been held at the Rosamond Gifford Zoo. This year, due to COVID-19, the “Zoo to You” event was virtual and premiered on June 6. It can be viewed at: www.upstate.edu/media/ncsd 22

C A N C E R C A R E l summer 2021 l upstate.edu/cancer


LIVING WITH CANCER

RECIPES Sweet potato black bean chili Preparation

Ingredients

1. In a large pot over medium heat, sweat onions in 1 tablespoon oil, seasoning with a healthy pinch of salt and pepper. Stir and continue cooking on medium heat until translucent and soft.

1 medium yellow or white onion, diced

2 teaspoons ground cumin (optional)

1 tablespoon coconut or olive oil

1/2 teaspoon ground cinnamon (optional)

2. Add sweet potatoes and any desired spices at this time. Cook for 3 minutes. Then add salsa, water, and vegetable stock.

3 medium sweet potatoes, or about 4 cups, scrubbed clean and cut into bitesized pieces

1/2 teaspoon chipotle powder (optional)

1 16-ounce jar chunky salsa

Fresh cilantro, for serving

1 15-ounce can black beans, slightly drained

Chopped red onion, for serving

2 cups vegetable stock

Sliced avocado, for serving

2 cups water

Lime juice, for serving

1 tablespoon chili powder (optional)

Salt and pepper

3. Bring mixture to a low boil on medium high heat and then lower heat to medium-low and simmer. Add black beans, cover and cook for at least 20 minutes more, preferably 30 – or until the sweet potatoes are fork tender and the soup has thickened. This soup is at its best when prepared the night before or allowed to rest for a few hours, so the flavor marries with the vegetables and beans. 4. Serve with fresh cilantro, onion, avocado and/or lime juice. Chips make an excellent spoon. FROM MINIMALISTBAKER.COM

1 to 2 teaspoons hot sauce (optional)

Nutritional Information Serving size: One bowl; recipe makes six servings

Calories: 213 Carbohydrates: 47 grams Protein: 7 grams Fat: 1/2 gram Cholesterol: zero

Sodium: 611 milligrams Fiber: 9 grams Sugar: 4 grams

Carrot cake quinoa bowl Preparation

Ingredients

1. In a large saucepan, heat the quinoa and milk over medium heat.

• 2/3 cup uncooked quinoa

2. Once the mixture starts to simmer, add in the carrots, cinnamon and vanilla extract. Reduce the heat to low. Cover and cook for about 15 minutes, stirring occasionally.

• 1 3/4 cups unsweetened coconut milk and/or almond milk • 3/4 cup grated carrots • 1 teaspoon cinnamon

• 2 tablespoons maple syrup • 1 tablespoon almond butter, plus more for topping • Pinch of salt • 1/4 cup chopped, toasted walnuts

3. Add in the maple syrup, almond butter and a pinch of salt. Stir until combined and thickened.

• 1/2 teaspoon vanilla extract

4. Pour the quinoa into 4 bowls. Top each portion with extra almond butter and toasted walnuts.

Nutritional Information

FROM DESTINATIONDELISH.COM

Serving size: One bowl; recipe makes four bowls

Calories: 245 Fat: 11 grams Carbohydrates: 30 grams Fiber: 4 grams

Protein: 7 grams Sugar: 7 grams Sodium: 56 milligrams

upstate.edu/cancer l summer 2021 l C A N C E R C A R E

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Non Profit Org. US Postage

PAID

750 East Adams Street l Syracuse, NY 13210

UPClose System used to mix chemotherapy infusions is designed for patients’ safety What happens when your doctor prescribes an infusion? The prescription order travels electronically to the pharmacy team. When you arrive for your scheduled infusion, your nurse gets you ready while your medication is prepared by a pharmacy technician. The Upstate Cancer Center uses a system called Pyxis IV Prep for the mixing of cancer treatments. “The system adds many layers of safety to our chemotherapy mixing and dispensing process,” says Andrew Burgdorf, PharmD, senior clinical pharmacist. Each step of the mixing process relies on “real-time, weight-based gravimetric verification.” That means pictures are taken and weights measured at every step. Medications have bar codes, so as technicians scan the codes during preparation, the pharmacy inventory automatically adjusts.

21.0800626.9mELsk

After the technician finishes mixing your chemotherapy infusion, a pharmacist reviews the records. Then the infusion is ready for you. Pyxis IV Prep means every technician mixes medications in exactly the same way. The overall process takes a bit more time. Burgdorf says it’s worth it to increase patient safety. CC PHOTO BY DEBBIE REXINE

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