Offering job training for young adults with disabilities

Project Search Graduates

Graduation for the Project Search Class of 2018 was held in Upstate’s Weiskotten Hall on June 13. The graduates, from left: Richard Nguyen, Marquale Johnson, Mazjalay Mickle, Jade Johnson, Lakota McCulloh, Mayon Brown, Jackson Muzehe and Joel Pizzarro. Photo by Amani Mike.

“I loved wearing hospital scrubs and working with my supervisor,” explained Marquale Johnson, a Project Search student at Upstate Medical University. “Without this program, I’d be a couch potato.”

Johnson’s comments get at the heart of Project Search’s purpose. It’s a year-long program that helps young adults with disabilities become acclimated to work environments so they can get jobs and have productive work lives. To be eligible, students must be at least 18, have completed three years of high school, and have an individualized education program (an IEP, the document for public school students who need special education).

Richard Nguyen with his perfect attendance certificate. Nguyen said, “I loved interning in Central Supply. My teachers were very smart.” Photo by Amani Mike.

From Monday through Friday for nine months, Johnson and seven other Project Search interns — all of whom were students of the Syracuse City School District — had career training and classroom study at Upstate Medical University. Their days started at 7:50 a.m. with class, followed by job training from 9 a.m. to 1 p.m., and additional classroom work until 2:45 p.m. Their job training took place in nearly 20 Upstate departments including environmental services, operating room materials, linen and laundry, and food services. Their classroom work combined teaching job skills such as time management and communication with math and writing coursework. Their day-to-day activities were led by Christine Gutske, a special education teacher from the Syracuse City School District.

Now in its ninth year at Upstate, the impact of Project Search is impressive. Students who complete the program have an 80 to 90 percent job placement, according to Katherine Teasdale-Edwards, Project Search program coordinator and  Syracuse City School District staff member. After completing the program, Project Search graduates get continued support from ARC of Onondaga and are hired at businesses throughout the community, including Upstate Medical University.

Project Search graduate Mazjalay Mickle reflects on the program: “Being part of this internship helped me become a better person. It taught me how to get along with people at work.”

The program has accepted 14 new students for the 2018-2019 school year. Upstate hosts an open house for students interested in Project Search. For more information click here.

Posted in community, disability, education, health care, health careers

Recipe: Chicken and White Bean Soup

bean soup

You can have “homemade” chicken soup quickly with the help of a store-bought rotisserie chicken. The mildly seasoned plain or lemon pepper chickens are recommended. This soup uses protein-packed beans instead of noodles, but you’re welcome to substitute ½ cup of egg noodles for the beans if you seek a classic chicken noodle soup. Also, you can boost the nutritional value by adding a few handfuls of baby spinach right before serving. This recipe serves 6 to 8.

Preparation

1. Remove wings from chicken and reserve. Remove skin from breast and discard. Shred the meat from the breast and break off breastbones.

2.   In a stockpot over medium heat, add oil. Sauté the carrots, celery, onion, chicken wings and breastbones for 8 to 10 minutes, or until vegetables soften.

3.   Add water and chicken broth and bring to a boil, stirring to combine. Reduce the heat, cover and simmer for 15 to 20 minutes. Add beans and chicken meat and cook for 5 minutes. If too thick, add additional broth or water. Discard bones and wings before serving. Season with salt and pepper.

Ingredients

1 rotisserie chicken breast section, or 3 cups chopped white chicken meat

1 tablespoon canola oil

3 carrots, sliced

2 celery stalks, sliced

1 onion, chopped

2 cups water

6 cups reduced–sodium chicken broth

1 15-ounce can Great Northern beans, rinsed and drained

Salt and freshly ground black pepper

Nutritional information

per serving:

235 calories

5 grams total fat

60 milligrams cholesterol

675 milligrams sodium

17 grams total carbohydrate

5 grams dietary fiber

5 grams sugars

28 grams protein

Source: American Cancer Society’s “The Great American Eat-Right Cookbook”

Cancer Care magazine spring 2018 coverThis article appears in the spring 2018 issue of Upstate Health magazine

Posted in cancer, health care, recipe | Tagged , , ,

 Complete and complex: More cancer patients benefit from molecular diagnostics

This image, made with fluorescent probes, shows amplification of HER2, a gene that can play a role in breast cancer. (from the lab of Steven Sperber, PhD)

This image, made with fluorescent probes, shows amplification of HER2, a gene that can play a role in breast cancer. (from the lab of Steven Sperber, PhD)

BY AMBER SMITH

We are used to differentiating cancers by where they were discovered: breast cancer, lung cancer, colon cancer.

Cancer doctors and scientists today are starting to label cancers based on their genetic makeup — and that’s only the beginning of a new era in cancer treatment happening in Syracuse.

Robert Corona, DO

Robert Corona, DO

Already, some Upstate patients take drugs that fight cancer not by killing cancer cells but by allowing their immune systems to put the brakes on cancer’s growth. Some patients undergo simple blood tests known as liquid biopsies to check for traces of cancer DNA. Some have tissue specimens analyzed by clinical geneticists. Some receive treatment recommendations from cancer doctors who confer with molecular pathologists about which drugs are most likely to work best.

“Upstate provides access to the most advanced testing and therapeutic options,” Robert Corona, DO, told community leaders in a presentation recently. As leader of the medical center’s pathology department, he is raising the quality of cancer diagnostics for patients in the region to be on par with leading national institutions.

How? Through the recruitment of experts in clinical genetics and molecular diagnostics:

Steven Sperber, PhD

Steven Sperber, PhD

Steven Sperber, PhD, is a clinical molecular geneticist who is bringing to the molecular pathology laboratory at Upstate “next generation sequencing.” Instead of examining a single gene, next generation sequencing creates a molecular profile of dozens, hundreds or even thousands of genes at once. It’s faster, easier and provides more complete analysis, Sperber explains, and the results can be complex.

He completed his clinical molecular genetics fellowships at the National Human Genome Research Institute in 2009 and worked in diagnostics testing laboratories and academia before joining Upstate last fall. His doctorate in cellular and molecular medicine is from the University of Ottawa.

“Our big goal is to get a profile of a tumor, whether it’s a solid tumor, a lymphoma or a blood-related cancer,” Sperber says. The job then becomes finding and interpreting the mutations, particularly those for which clinical therapies are available.

A growing number of medications with companion diagnostics are receiving approval from the Food and Drug Administration. Patients have to be tested before they can receive the drug. The first of these so-called precision treatments was approved in 1998. The drug, Herceptin, treats an aggressive form of breast cancer; its companion diagnostic looks for a particular protein or extra copies of a particular gene in a patient’s tumor to predict whether Herceptin will be effective.

Then there are the “tissue agnostic” therapies, the first of which — Keytruda — was approved in May 2017. It’s meant to treat solid tumors bearing a specific genetic marker, regardless of where they arise.

Jeffrey Ross, MD

Jeffrey Ross, MD

Jeffrey Ross, MD, is a molecular pathologist. He leads the Upstate Cancer Center’s monthly “molecular tumor board” meetings. That’s when a team of cancer doctors gathers to discuss treatment options for patients whose DNA has been sequenced. Ross describes the mutations and how they may impact the selection of treatment for each individual. Together, the team comes up with a precision treatment recommendation.

“Instead of the one-size-fits-all approach and the sequential use of drugs based on the performance of the previous regimen, now we want to give each patient a custom-designed treatment that’s essentially driven by the genomic makeup of their cancer,” explains Ross. He went to medical school at the University of Buffalo and is board certified in anatomic pathology and clinical pathology. He joined Upstate this year.

Most patients whose cases are discussed at the molecular tumor board have advanced cancers that have either spread or been treated and relapsed. Precision treatment —also sometimes called personalized medicine — can prolong their lives.

Ross says pharmaceutical companies are excited about making these drugs because “the patient often transitions from what is an acute and possibly fatal disease into a chronic and survivable disease. The drug becomes a maintenance drug, meaning the patient never goes off treatment but lives months or years or tens of years while still on the drug — which makes that, of course, very financially attractive to drug makers.”

The most direct application of sequencing DNA from cancer cells applies to anti-cancer drugs, but Ross says radiation therapy is sometimes also impacted.

“Radiation can now be given to increase the number of mutations in the patient’s cancer, which will then help immunize the patient against their own cancer cells. And then, when the immunotherapy drugs are given, the patient starts to reject their own cancer like it was a transplanted organ from an unrelated donor.”

An exciting time

Many of the cancer treatments available today were not even thought of before 2003, when the human genome was sequenced. Doctors and caregivers typically consult laboratory geneticists like Sperber or molecular pathologists like Ross before ordering molecular tests. “The field is changing so fast, and it’s complicated,” Sperber says, “and different laboratories offer different tests.”

He says it’s an exciting time to be a scientist.

Researchers are trying to develop ultrasensitive methods of detecting genetic mutations from blood samples long before a patient exhibits signs or symptoms. This could help diagnose cancers like ovarian, lung and pancreatic cancer, which typically are not discovered until they are advanced.

“You could literally see it coming years ahead, or at least months ahead,” Sperber says of the potential for using molecular testing to predict cancers at the earliest stages in the future.

New terms for the new era

Bioinformatics — the science of collecting and analyzing genetic information or other complex biological data.

Genome — the complete set of genes or genetic material in a cell or organism.

Genomic driver — what it is about a gene that drives the recurrence of a genomic aberration.

Genetic mutation — a permanent alteration in a genomic sequence.

Immunotherapy — treatment that boosts or suppresses the body’s immune response.

Next generation sequencing — technology that revolutionizes biological sciences, thanks to engineering and computing power, and allows for analysis of a whole genome rather than a single gene.

Pan-cancer — an ongoing project that analyzes what’s common and what’s different across a variety of tumor types.

Personalized medicine — customized treatment made possible with genetic sequencing.

Phenotype — observable characteristics that occur because of the interaction of an individual’s genotype (or genetic identity) with the environment.

Tissue-agnostic — refers to a drug designed to work on cancers with a specific mutation, rather than cancers that originate in a particular area of the body.

Finding the right drug for the patient

Julio Licinio, MD, PhD

Julio Licinio, MD, PhD

Researchers share their work related to the clinical application of genomic science in The Pharmacogenomics Journal, an international peer-reviewed quarterly publication whose founding editor-in-chief is Julio Licinio, MD, PhD, dean of Upstate’s College of Medicine.

The journal was launched in 2001.

Licinio, a professor of psychiatry, pharmacology and medicine, has expertise in pharmacogenomics, the science of how a person’s genetic makeup affects how his or her body responds to drugs.

Looking for a career?

Clinical molecular geneticist Sperber says a shortage exists of people with training in molecular diagnostics and molecular technology.

Upstate offers training in clinical laboratory sciences, including bachelor’s degrees in medical biotechnology and medical technology, and master’s degrees in medical technology. Learn more at www.upstate.edu/chp.

Cancer Care magazine spring 2018 coverHealthLink on Air logoThis article appears in the spring 2018 issue of Cancer Care magazine. Click here for a “HealthLink on Air” podcast/radio interview with Jeffrey Ross, MD, on how cancer care is becoming more individualized due to advances in genetics.

 

Posted in cancer, drugs/medications/pharmacy, genetics, health care, health careers, research, technology | Tagged , , , , , , , , , , , , ,

The talcum powder – ovarian cancer connection

Talcum powder BY AMBER SMITH

Talcum powder may increase by about 20 percent a woman’s risk for developing ovarian cancer.

Chemicals in the powder, which some women use in the genital area to promote dryness, can ascend through the vagina into the genital tract and Fallopian tubes, providing a toxic exposure over time, says Upstate gynecologist Jennifer Makin, MD.

Jennifer Makin, MD (photo by Jim Howe)

Jennifer Makin, MD (photo by Jim Howe)

The International Agency for Research on Cancer classifies talcum powder as a possible carcinogen, she says, adding that case control studies have shown an association between talc and ovarian cancer. However, Makin notes, association has not been shown in any prospective studies, so there is no proof of causation.

Makin advises her patients not to use talcum powder for that reason. She also discourages the use of cornstarch powder because it can alter vaginal pH, or acidity, levels and prompt the growth of harmful bacteria.

“Using powder in the genital area is not recommended,” she says. “If moisture or odor is a problem, we can investigate those possible causes.”

Talc is a mineral made up of magnesium, silicon and oxygen. In its natural form, talc contains asbestos, a substance known to cause cancers in and around the lungs when inhaled, according to the American Cancer Society. Since the 1970s, household talcum products have been free of asbestos.

HealthLink on Air logoCancer Care magazine spring 2018 coverThis article appears in the spring 2018 issue of Cancer Care magazine. Click here for a podcast/radio interview with Makin about the possible dangers associated with talcum powder.

Posted in cancer, health care, women's health/gynecology | Tagged ,

20-plus years of helping kids and their families fight cancer

Runners of all ages participate in Paige’s Butterfly Run to support children with cancer. (photo by Susan Keeter)

Runners of all ages participate in Paige’s Butterfly Run to support children with cancer. (photo by Susan Keeter)

Runners and their supporters at Paige’s Butterfly Run have raised more than $2 million over the last 20 years to support pediatric cancer research and cancer care at the Upstate Golisano Children’s Hospital.

Paige Arnold, in whose memory the run was founded in 1997 by teachers, friends and family in her memory.

Paige Arnold, in whose memory the run was founded in 1997 by teachers, friends and family in her memory.

The 2018 run will be held this Saturday, June 2, in downtown Syracuse, during the annual Taste of Syracuse festival. The event includes a 5K race, a 3K fun run/walk and a 40-foot Caterpillar Crawl for children 5 and younger. For details, go to www.pbrun.org

Chris Arnold and Ellen Yeomans started the run in honor of their daughter Paige, who died from leukemia in 1994. Over the years, the run has become the centerpiece of a year-round fundraising effort coordinated by the Paige’s board. Other events include a Pedaling for Paige event, a Clams for Cures clambake and a Pajamarama, in which students and teachers make donations and in return get to wear pajamas to school on a certain day.

Tutus and butterfly wings were part of the uniform for this YMCA team at Paige's Butterfly Run. (photo by Susan Keeter)

Tutus and butterfly wings were part of the uniform for this YMCA team at Paige’s Butterfly Run. (photo by Susan Keeter)

Last year’s 20th anniversary run brought in $210,000, which was presented to the children’s hospital in the form of a check. “The contributions from Paige’s Run have a direct impact on the families receiving care at Upstate but also support research in the hope of ending childhood cancer for all,” says Toni Gary, director of community relations for The Upstate Foundation.

Money from Paige’s helps pay for a variety of services, including:

— materials for sand therapy, a type of therapy where ill children can express themselves by creating scenes using figurines in a sand table;

— a “family fun” fund that child life specialists tap to help pay for birthday and holiday celebrations;

— equipment for hemophilia patients;

Jillian Tandle, Samantha Prayne and Eden Prayner came from Seneca Falls to take part in the event. (photo by Susan Keeter)

Jillian Tandle, Samantha Prayne and Eden Prayner came from Seneca Falls to take part in the event. (photo by Susan Keeter)

— backpack comfort kits (with toiletries and gift cards for food and gas) for newly diagnosed patients;

— assistance for families who have financial difficulties as a result of their child’s illness;

— burial costs and grief counseling;

— neuropsychological testing for children with cancer;

— education for local and outlying doctors and other medical providers;

— and research projects related to childhood cancer.

William Baugh, center, and his family volunteer at Paige’s Butterfly Run in memory of their daughter, Arie, who died of kidney cancer at 22 months. (photo by Susan Keeter)

William Baugh, center, and his family volunteer at Paige’s Butterfly Run in memory of their daughter, Arie, who died of kidney cancer at 22 months. (photo by Susan Keeter)

Cancer Care magazine spring 2018 coverThis article appears in the spring 2018 issue of Upstate Health magazine

 

Posted in adolescents, cancer, community, fundraising, health care, Upstate Golisano Children's Hospital/pediatrics | Tagged , ,

5 reasons you need a team of experts for esophageal or gastric cancer

1. Cancers that arise in the stomach or along the tube that goes from the mouth to the stomach are sometimes difficult to distinguish. Both esophageal and gastric cancers usually begin in the cells that line the upper gastrointestinal tract, and they can produce some of the same symptoms: declining appetite, belly pain, trouble swallowing or a feeling of fullness after eating a small meal.

Jason Wallen, MD

Jason Wallen, MD

2. Distinguishing between esophageal and gastric cancer is important because the treatments of these cancers differ.

3. Treatment for esophageal and gastric cancers can be highly complex and highly variable.

4. Many of these cancers are advanced by the time they are discovered. They tend to spread to the liver and the lungs.

5. Because of where esophageal and gastric cancers are located, surgery may require approaches from the chest and from the abdomen. Having doctors who specialize in each area as part of the care team means they draw on one another’s expertise.

Not all medical centers have the expertise and equipment to manage cancers of the stomach and esophagus.

Upstate does.

Ajay Jain, MD

Ajay Jain, MD

A new patient at Upstate’s gastric and esophageal cancer program typically undergoes an endoscopic procedure or laparoscopic surgery to locate and “stage” his or her tumor. This is the process of confirming the location of the tumor and determining the severity of the cancer.

“We’re looking for how are we going to be able to remove this tumor and, more importantly, how are we going to be able to put things together again once it’s out?” explains Jason Wallen, MD, the chief of thoracic surgery, who co-directs the gastric and esophageal cancer program with Ajay Jain, MD, the chief of surgical oncology.

While the surgeons work closely together, Wallen or another chest surgeon usually cares for the patients with esophageal cancer. Jain or one of his abdominal surgery partners usually handles those with stomach cancer.

Chest and abdominal surgeons collaborate with medical oncologists, pathologists, radiation oncologists, radiologists, gastroenterologists and nurse navigators who make up a care team for patients with gastric or esophageal cancers. Each patient’s case is discussed among the team. In a majority of cases, the team members end up agreeing on a recommendation. But not always.

“When you have different specialists around the table, and something comes up that no one is sure about, it ultimately always leads to better care for our patients,” Wallen says. He related one situation in which the team could not agree, so specimens from the patient were sent to the National Cancer Institute for additional analysis, and further review by the Upstate team.

digestive system diagramThe team might recommend surgery, but maybe not if tests reveal microscopic disease in the abdomen, or if distant lymph nodes are involved. Surgery might come later.

Wallen explains: “One of the reasons we do chemotherapy and sometimes even radiation up front is that it’s so likely these cancers have spread beyond what we see at the point of diagnosis that we really need to take care of that disease that has spread beyond the initial area of the tumor.

“That’s what is really dangerous. People don’t die from cancers in their stomach or esophagus. They die from the cancers that have spread to other parts of their body. So that becomes the treatment priority.”

Jain says that surgery might be effective if a tumor has grown into surrounding tissue, but shrinking the tumor first may give the patient a better outcome. It depends on many factors.

“These distinctions can be subtle, as to whether you should do chemotherapy first or surgery first,” he says. “You really do need an experienced group of people putting their heads together to come up with an individualized plan.”

Patients interested in Upstate’s gastric and esophageal cancer program can call 315-464-HOPE (4673.)

Cancer Care magazine spring 2018 coverThis article appears in the spring 2018 issue of Cancer Care magazine.

Posted in cancer, digestive/gastrointestinal, health care, surgery | Tagged , , , , ,

Connecting, helping pediatric cancer families

The Waters Center for Children’s Cancer and Blood Disorders at the Upstate Cancer Center

The Waters Center for Children’s Cancer and Blood Disorders at the Upstate Cancer Center

The Upstate Cancer Center and the Upstate Golisano Children’s Hospital provide a connection group for pediatric cancer families. It’s called H.O.P.E., Helping Oncology Patients and Parents Engage.

Kristen Thomas, RN

Kristen Thomas, RN

Kaushal Nanavati, MD, medical director of integrative therapy, led the first group session, discussing strategies for stress management.

The second event will include a paint night for adults, crafts for kids and a pizza party for teens. Child care will be available.

To learn more about H.O.P.E., contact Kristen Thomas at 315-464-7227 or ThomaKri@upstate.edu

Cancer Care magazine spring 2018 coverThis article appears in the spring 2018 issue of Cancer Care magazine. 

 

 

 

Posted in adolescents, cancer, community, Upstate Golisano Children's Hospital/pediatrics | Tagged ,

Helping a patient navigate through cancer’s challenges

Upstate oncologist Stephen Graziano, MD, talks with his patient, Sandra Floyd. (photos by John Berry)

Upstate oncologist Stephen Graziano, MD, talks with his patient, Sandra Floyd. (photos by John Berry)

Palliative care team helps Sandra Floyd reach the treatment goals she set for herself

BY JIM HOWE

“There are a lot of ups and downs when you’ve got cancer, a lot of wind in your sails, then the wind stops,” says Sandra Floyd as she describes living with cancer.

Floyd, 68, lives in Georgetown, Madison County, and receives outpatient palliative care at the Upstate Cancer Center as part of her treatment for adenocarcinoma of the gallbladder.

In many ways, she exemplifies what palliative care is designed to achieve as she deals with her disease:

  • Figuring out what she wants to accomplish at this stage of her life, then setting goals on how to get there.
  • Deciding to live with cancer without letting it define her.
  • Working with her medical team to decide which treatments are best for her and how to maintain the best possible quality of life while dealing with her disease, pain and side effects.
Sandra Floyd

Floyd

Floyd, who runs the Fabius post office, could have retired six years ago but chose to keep working because “working gives you purpose. I usually enjoy my job, and I have a fantastic crew that works with me. If it hadn’t had been for them when I was first diagnosed, I probably wouldn’t have been able to maintain my job,” she noted.

“I lost a lot of weight initially, but other than just being tired and a couple of episodes of pain, it’s under control.

I really don’t have much pain at all anymore,” she said.

When Floyd first came to the cancer center, in the fall of 2015, it was barely two months after finding out that she had incurable cancer and being told she had, at most, a year to live.

Gallbladder cancer is rare and hard to detect early. In her case, gastrointestinal pain was the first hint of a cancer that had already spread to her lungs and lymph nodes and advanced to its most serious stage, IV B.

Since then, she has tried chemotherapy and immunotherapy, with limited success, and is

currently taking a drug being tested for new uses in the MATCH trials. (See accompanying  story, below.)

That drug, Kadcyla, is used to fight breast cancer but is being tested on other cancers, and genetic testing of Floyd’s tumor suggested she could benefit.

Floyd developed a low platelet count as a side effect of the drug.  This endangered her blood’s clotting ability and forced her to withdraw from the trial.

She was able to keep taking the drug at the cancer center, however, where she is getting more time between doses to allow her platelets to recover, says her medical oncologist, Stephen Graziano, MD, Upstate’s chief of adult hematology and oncology.

The drug “delivers a toxin directly to tumor cells,” Graziano explained. “It’s greatly benefiting her.”

“She’s pretty remarkable. We hope she keeps doing well for as long as possible,” Graziano said. “Our goals are control, remission, shrink it down and improve her quality of life, we’ve been able to do all those things for her.”

He noted a trend to get palliative care involved right at the beginning for advanced cancer cases, to help the patient deal with pain, quality of life issues and decisions about treatment.

Floyd, left, with Linda Troia, a physician assistant in the palliative care service at the Upstate Cancer Center.

Floyd, left, with Linda Troia, a physician assistant in the palliative care service at the Upstate Cancer Center.

Dealing with those issues is just what Linda Troia, a physician assistant on the cancer center’s palliative care team, has helped Floyd to do.

“One of the things I respect about Sandy is that she is someone who had cancer, and from the beginning, her goal was for it not to define her. She is aware she has it, doesn’t deny it and takes care of it, but she tries to live the best quality of life. She has been able to continue a life pretty much like her pre-cancer life, and it hasn’t been an easy task. She really focuses on living,” Troia said.

“Something that I believe helps people is having goals. To continue to work is meaningful to her. Having goals you work toward gives people a sense of purpose, and that is important because for some people cancer strips away that purpose. When they don’t have confidence in looking toward the future, they start to get stuck, depressed and lose their sense of purpose.

“The goal helps to keep you motivated but reminds you of who you are and who you were before the cancer and, what makes you hold on,” Troia said.

Floyd gets emotional support as well as medical care from Troia. “Linda has given me pep talks every time I come in, she does my pain meds and some of the other meds for me, and she is basically just a shoulder to lean on. It’s been really good,” Floyd said.

MATCH trials and ‘precision’ cancer care

The National Cancer Institute sponsors tests of cancer treatments that analyze a patient’s tumor and take direct aim at certain genetic changes.

If patients have a tumor with the genetic changes that match a drug being tested, they may be eligible to take part in a trial.

This is a type of “precision” medicine, meaning it is tailored to the specific patient. While precision cancer treatments are progressing rapidly, they not yet routine nor available in all cases.

These trials are for patients with rare cancers or advanced cancers who have gone through standard treatments.

The name MATCH stands for Molecular Analysis for Therapy Choice.

— Source: National Cancer Institute

Advice for those in the same boat

What would Sandra Floyd, who has outlived her original survival estimate by nearly two years, tell someone who has gallbladder cancer?

“Don’t believe everything you read about it. It’s not an immediate death sentence. You just have to make up your mind to take care of yourself, don’t dwell in the negative as much as the positive, and just keep going,” she said.

“I would also tell people to check for any drug trial out there.”

Cancer Care magazine spring 2018 coverThis article appears in the spring 2018 issue of Cancer Care magazine. 

Posted in blood/blood-related conditions/hematology, cancer, drugs/medications/pharmacy, health care, liver/ gallbladder/ pancreas, palliative care, pancreas/liver/gallbladder/bile ducts | Tagged , , , , , ,

A new option: Technique heats the body’s water molecules to destroy cancer cells

Katsuhiro Kobayashi, MD, reviews images of the patient’s liver prior to the microwave ablation procedure. (photo by William Mueller)

Katsuhiro Kobayashi, MD, reviews images of the patient’s liver prior to the microwave ablation procedure. (photo by William Mueller)

BY AMBER SMITH

Options are important when you have cancer of the liver.

Vascular and interventional radiologists at Upstate now offer microwave ablation, a technique that uses heat to destroy cancer cells. The minimally invasive procedure can be an alternative to surgery. It may be used in addition to chemotherapy or radiation therapy.

Katsuhiro Kobayashi, MD, says the Ethicon NeuWave equipment was purchased thanks to a grant from the Upstate Foundation. He appreciates that it can be used to ablate lesions — abnormalities — in a variety of shapes and sizes, and he finds it more precise than radiofrequency ablation, another method of destroying cancer with heat.

Microwave ablation is an option for cancers in organs that contain a high percentage of water, such as the liver and kidneys. It can also be used on bone lesions.

Here’s how it works:

An illustration shows the tip of the probe and the microwaves it generates. (courtesy of Ethicon)

An illustration shows the tip of the probe and the microwaves it generates. (courtesy of Ethicon)

The patient is sedated or anesthetized during the procedures, so he or she is not bothered by the burning sensation.

Kobayashi inserts a probe through the skin and into the tumor, periodically consulting medical images to make sure his trajectory is correct. Once the probe is in place, images confirm that it is in precisely the best location.

Depending on the shape of the tumor, the tip of the probe emits either a circular or elongated sphere of microwaves, whose widths are controlled by the amount of time the machine is activated. When microwaves force them to oscillate — move back and forth — water molecules within the tissue create heat, which disintegrates the cancer cells. Those dead cells are gradually replaced by scar tissue that shrinks over time.

Microwaves are not impeded by blood vessels, and their heat dissipates much less than it does from radiofrequency waves. It’s generally quicker and more accurate.

The ablation takes a few minutes. Afterward, Kobayashi examines three-dimensional images that look like ink drawings to see the area of destruction. “I think we got it all,” he says.

To guard against any remaining cancer cells spreading along the probe track as the doctor retracts the probe, the machine cauterizes the area on the way out.

He says microwave ablation is a good option for many patients, especially those who might have difficulty with traditional surgery.

Reach Vascular and Interventional Radiology bat Upstate by calling 315-464-5189.

Kobayashi inserts the 15-gauge probe into the patient’s liver. The microwave ablation, which disintegrates the tumor, lasts less than seven minutes. In the foreground is the Ethicon NeuWave equipment, which is loaded with images of the patient’s liver and surrounding organs. (photo by William Mueller)

Kobayashi inserts the 15-gauge probe into the patient’s liver. The microwave ablation, which disintegrates the tumor, lasts less than seven minutes. In the foreground is the Ethicon NeuWave equipment, which is loaded with images of the patient’s liver and surrounding organs. (photo by William Mueller)

Cancer Care magazine spring 2018 coverThis article appears in the spring 2018 issue of Cancer Care magazine.

 

 

 

 

Posted in cancer, health care, medical imaging/radiology, technology | Tagged , , ,

3 reasons your doctor might recommend robotic surgery

From left, urologists Gennady Bratslavsky, MD, Oleg Shapiro, MD, and Rakesh Khanna, MD, in one of the robotic surgery suites. Upstate has 13 robotically trained urologic surgeons, performing the highest volumes in the region. Other distinctions include the region’s first thoracic and hepatobiliary robotic surgery teams, to treat cancer and other conditions involving the chest, liver, gallbladder and pancreas. (photo by Susan Kahn)

From left, urologists Gennady Bratslavsky, MD, Oleg Shapiro, MD, and Rakesh Khanna, MD, in one of the robotic surgery suites. Upstate has 13 robotically trained urologic surgeons, performing the highest volumes in the region. Other distinctions include the region’s first thoracic and hepatobiliary robotic surgery teams, to treat cancer and other conditions involving the chest, liver, gallbladder and pancreas. (photo by Susan Kahn)

BY LEAH CALDWELL

Depending on the type of cancer and its stage, your care plan may include surgery. Robotic surgery is one type of minimally invasive surgery. The surgeon uses a flexible scope with a camera and blade and views the site through a monitor, rather than doing the procedure over the patient.

“For patients who are not familiar with the technology, we explain that the robot is a tool that gives us special capabilities. It does not perform the surgery—the surgeon is always in control,” explains Mark Crye, MD, a thoracic surgeon who treats lung cancer and other conditions.

Here are three reasons your cancer care team may recommend robotic surgery:

3-D view

The camera provides a 3-D visualization of the area. When that image is magnified on the monitor, it allows the surgeon to operate in very tight spaces with a good view and great dexterity. The robotic instruments mimic the human hand and wrist. “That really allows us the freedom to operate on very delicate structures, explains Crye.

Patient comfort

Robotic surgery uses a very small incision site and tiny instruments, so patients often are able to return to regular activities sooner. But having a surgery team close to home provides an additional type of comfort, beyond the physical. “We see our patients through the entire course of their treatment, whether it’s days, weeks or longer. If a surgery patient needs follow-up, they can be seen quickly by us and not have to be far from their family or home,” adds Ajay Jain, MD, who treats complicated stomach, liver, gallbladder and pancreatic cancers using robotic surgery.

Experience

Some types of cancer treatments increasingly are performed with robotic surgery, but the use of the tool is in concert with the surgeons’ skills. The Upstate Cancer Center has both developed its robotic capability and brought in new faculty with the expertise. “Cancer care is complex, and that’s why American Board of Surgery has recognized surgical oncology as a separate specialty,” explains Mashaal Dhir, MD, who is board certified and fellowship trained in both complex general surgical oncology and endocrine surgery, and also robotically trained.

Of note: The words “board certified” and “fellowship trained” indicate that a doctor has passed rigorous tests to national standards (“the boards”) and has performed years of training (a fellowship) in addition to a standard medical residency.

Cancer Care magazine spring 2018 coverHealthLink on Air logoThis article appears in the spring 2018 issue of Cancer Care magazine. Hear more on this topic by going to healthlinkonair.org and entering the term“robotic” in the search window (on the right side of the page).

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