Are you at risk for oral cancer?

Protect yourself Oral cancer frequently begins as a painless lesion in your mouth. Therefore, experts recommend you carefully examine your mouth on a regular basis for red or white spots, lumps or anything that looks abnormal.   Stand in front of a mirror. Using gauze for grip, lift your tongue so you can see beneath and in back of your mouth. Pull your cheeks away from your teeth to get a good look.   See your dentist or doctor if you find something unusual. “If it’s affecting your life, and it lasts longer than two weeks, then it requires professional evaluation,” advises oral surgeon Terrence Thines, a professor in Upstate University Hospital’s division of dentistry.

Protect yourself — Oral cancer frequently begins as a painless lesion in your mouth. Therefore, experts recommend you carefully examine your mouth on a regular basis for red or white spots, lumps or anything that looks abnormal.
Stand in front of a mirror. Using gauze for grip, lift your tongue so you can see beneath and in back of your mouth. Pull your cheeks away from your teeth to get a good look. See your dentist or doctor if you find something unusual. “If it’s affecting your life, and it lasts longer than two weeks, then it requires professional evaluation,” advises oral surgeon Terrence Thines, a professor in Upstate University Hospital’s division of dentistry.

Most of the people with oral cancers whom Terrence Thines cares for are in their fifth or sixth decades of life. But lately, the oral surgeon from Upstate’s division of dentistry is seeing younger patients with the same type of disease.

Many are infected with the human papilloma virus, or HPV. Infection with certain types of HPV, easily spread from one person to another during skin-to-skin contact, can cause some forms of cancer. Thines said research so far has not connected the increase in oral cancers directly to HPV, but some experts believe the rise is related to an increase in oral sex.

Hear an interview with Thines

Tobacco and alcohol use are among the strongest risk factors for oral and oropharyngeal cancers. Smokers are many times more likely than nonsmokers to develop these cancers, says the American Cancer Society, which adds that seven out of 10 patients with oral cancer are heavy drinkers. Combining the two vices ups the risk even more. “According to some studies, the risk of these cancers in heavy drinkers and smokers may be as much as 100 times more than the risk of these cancers in people who don’t smoke or drink,” the society says.

Thines said oropharyngeal cancers – cancers from the lips to the back of the throat – represent up to 4 percent of all cancer diagnoses. The death rate from oral cancer is on the decline, probably due to better diagnosis and better prevention strategies. “You have a good prognosis if the cancer is detected and treated early,” he said.

Depending on the location and type of cancer cells, surgery is likely to be the first step in treatment. That may be followed by radiation and/or chemotherapy. Surgery may be disfiguring. “That’s one of the reasons we promote early detection,” Thines said, explaining that the earlier oral cancers are detected, the smaller they are likely to be and the less tissue that has to be removed.

 Hear an interview with Thines

 

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Exceptional surgical suite allows for MRI during operations

Director of pediatric neurosurgery, Zulma Tovar-Spinoza, MD, reviews the patient’s magnetic resonance images prior to beginning surgery.

Director of pediatric neurosurgery, Zulma Tovar-Spinoza, MD, reviews the patient’s magnetic resonance images prior to beginning surgery.

The most advanced imaging options available are part of Upstate’s newest surgical suite, which allows patients to undergo magnetic resonance imaging during an operation.

The clarity of the 3-tesla MRI is ideal for conditions that involve the brain, spine and musculoskeletal system, including brain tumors, epilepsy and cancer. Its powerful imaging capabilities provide exceptional detail.

Surgeons are able to immediately verify the complete removal of tumors, verify the placement of probes and minimize the impact to healthy tissues. This helps improve patient outcomes.

Hear an interview about the new suite

This 3-D computerized image shows the inside of the patient's brain and the 3.1-millimeter opening -- a bit larger than the tip of a pen -- for the laser.

This 3-D computerized image shows the inside of the patient’s brain and the 3.1-millimeter opening — a bit larger than the tip of a pen — for the laser.

Using a laser and MRI guidance, Tovar-Spinoza will remove a tumor through a melting process called ablation.

Using a laser and MRI guidance, Tovar-Spinoza will remove a tumor through a melting process called ablation.

Once the neurosurgeon secures the laser in the patient's brain, the door to the MRI suite opens, and the patient -- still under anesthesia  -- is moved into the scanner.

Once the neurosurgeon secures the laser in the patient’s brain, the door to the MRI suite opens, and the patient — still under anesthesia — is moved into the scanner.

MRI technologists help position the patient in the scanner.

MRI technologists help position the patient in the scanner.

Tovar-Spinoza reviews the intraoperative scans to verify the tumor removal is complete.

Tovar-Spinoza reviews the intraoperative scans to verify the tumor removal is complete.

Hear an interview about the new suite

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Battling breast cancer by knocking on doors

She Matters advocate Martha Chavis-Bonner helps her neighbor, Edward Moody, sign his wife up for a mammogram at the Patricia J. Numann Center for Breast, Endocrine and Plastic Surgery at the Upstate Specialty Services Center. Moody's wife, says Chavis-Bonner, is typical of many African American women: "so busy working and taking care of her family that she doesn't take time for her own health."

She Matters advocate Martha Chavis-Bonner helps her neighbor, Edward Moody, sign his wife up for a mammogram at the Patricia J. Numann Center for Breast, Endocrine and Plastic Surgery at the Upstate Specialty Services Center. Moody’s wife, says Chavis-Bonner, is typical of many African American women: “so busy working and taking care of her family that she doesn’t take time for her own health.”

Lisa Bigelow says her father’s mindset was that he could avoid cancer simply by not getting tested for the disease. She believes early detection is the best protection – and she is helping to spread that word.

“Both my parents died of cancer. I wish they were still here. That’s why I’m involved,” Bigelow says. She is part of a team of resident health advocates that is raising awareness of breast cancer in their community.

Armed with tenants’ lists, sign up sheets, and flash cards with cancer facts, the team goes door to door at Syracuse’s Pioneer Homes, a public housing complex with 1,194 residents.

Their goal is to get women age 40 and older from Pioneer Homes and the neighboring community to have annual mammograms, and to deepen their understanding of breast cancer prevention, diagnosis, treatment and survival, which often depends on early detection.

So far, the resident health advocates — Bigelow, Martha Chavis-Bonner, Lawrence Diamond-Walls and Mary Harris — have enrolled more than 200 women in the “She Matters” breast cancer program, and 70 have had mammograms so far. (As a male, Diamond-Walls talks with men about male breast cancer and encourages them to get the women in their lives to get mammograms.)

Hear an interview about “She Matters”

What’s the process? The team works with Upstate staff to host educational sessions at the community room at Pioneer Homes, which are followed by mammogram “parties” at the Upstate Harrison Specialty Services Center. Reminder calls are made, and referral sheets are given to attendees so they can recommend friends and neighbors.

Statistics, personal experiences, and training and services from Upstate and the Onondaga County Health Department have prepared the team to do its health outreach work. The team completed a resident health advocate education program, designed and taught by Upstate staff and other local health experts. A $50,000 grant from the Susan G. Komen Foundation pays for the program.

The statistics are daunting. Nationally, African American women are more likely than all other ethnic groups to die of breast cancer. In Syracuse, more than 160 women are diagnosed with breast cancer each year, and the incidence of breast cancer is higher in Onondaga County than in the US as a whole. (In Onondaga County 132 women per 100,000 will develop breast cancer in a year. Nationally, the number is 124 per 100,000.)

Most of the women enrolled in She Matters have health insurance, reports project manager Linda Veit. Those who don’t are referred to the health department’s cancer service. Through that service, the uninsured women (five so far) receive a host of cancer screenings — colorectal, pap and clinical breast exams. Then, they return to Upstate for mammograms.

Harris says being a community health advocate means being there for the women in She Matters. “We’ll be your support system,” she promises. “We’re here if you feel nervous. We’re here if you need help.”

Plans include extending the She Matters program to other Syracuse Housing Authority residences. To find out more about the program, call She Matters at 315-464-6303 or 315-217-5825.

Hear an interview about “She Matters”

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Upstate researcher focuses on what a protein can teach about cancer

Fruit fly ovaries are made up of subunits called germanium, which house germline stem cells, as shown in green above. Germline cells are the sex cells that pass along genes to the next generation.

Fruit fly ovaries are made up of subunits called germanium, which house germline stem cells, as shown in green above. Germline cells are the sex cells that pass along genes to the next generation.

An Upstate scientist who conducts research in fruit flies is hopeful that her work will help our understanding of cancer and other diseases. Fruit flies are often used in research because their genome is similar to that of humans.

Francesca Pignoni, PhD, recently received a $161,000 grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to support her research. She is an associate professor of ophthalmology, biochemistry and molecular biology; and neuroscience and physiology.

She is studying the function of a protein that was discovered in her laboratory in Upstate. The protein allows fruit flies to keep stem cells within its ovary where they divide to ensure the passage of genetic material to the next generation through reproduction. Cancer is one disease that can be explored through this research.

Pignoni says that he protein appears to play an important role in a type of molecular communication known as BMP signaling. BMP signaling is a major regulator of a cell’s fate – including its ability to grow an multiply and to form more specialized cells. The BMP molecule is the same in the fruit fly as in the human, where it has been linked to colon cancer, breast cancer, lung cancer and some diseases of the bone. When the newly discovered protein is added in excess, the stem cells develop into tumors. Learning more about how the protein works at a cellular level can lead to a better understanding of how BMP dysfunction causes cancer.

“We clearly show in the flies that the level of this protein needs to be regulated in order for the stem cells to be under control,” said Darin Dolezal, an MD/PhD student assigned to Pignoni’s lab. “The proliferation of stem cells has to do with the growth of cancers. What we don’t know is whether this protein does, as well.”

Dolezal admits that as a boy growing up on Long Island, then attending Cornell University and aiming for a career in the medical sciences, he never imagined he would study ovaries in fruit flies. It’s not because he is interested in insect biology. Rather, he wants to determine if this protein can lead to a better way to diagnose or treat cancer.

“There are things that we can learn in the fruit fly ovaries that can directly translate into human clinical medicine. We’ll figure it out in flies and then maybe move into more complex organisms and try to understand it there,” said Dolezal.

Pignoni said she wants to understand if the protein helps cells receive or interpret only the BMP signal, or if it is part of a more general biologic process that impacts multiple signaling systems.

“In the latter case, its dysfunction would profoundly affect the ability of cells to communicate with each other,” she said. Either way, determining how the protein works at a cellular level could help explain how dysfunction of BMP, and perhaps other signaling pathways, causes cancer and other human disorders.

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Physicians Practice features stroke care, shoulder implants, urethroplasty, more

PhysPractMarch2015The March issue of Physicians Practice features stories from Upstate about stroke care, a new shoulder implant and urethroplasty. The stories are aimed at medical professionals, but anyone is welcome to browse.

Physicians Practice is a publication that is distributed to physicians throughout Upstate’s 17-county service area, stretching from the Canadian border to the Pennsylvania border.

 

Posted in orthopedic, stroke, surgery, urology | Leave a comment

Have you seen the winter issue of Cancer Care?

cancercarewinter2015Upstate’s winter issue of Cancer Care features on its cover Heather Gangemi, a young woman who remains vigilant with her health in adulthood because of her cancer diagnosis in childhood.

Also in this issue, readers will get a look at the new neurosurgical suite, which allows patients to undergo magnetic resonance imaging before surgeons close incisions. We will introduce you to two patients who wrote books about their cancer experiences, and a man whose elevated PSA mystery was solved at Upstate.

Our experts tackle questions on the risks of oral cancer, avoiding nausea, getting a good night’s rest, and deciding on the appropriate treatment for advanced lung cancer.

For a free subscription to Cancer Care, send an email to magazine@upstate.edu with “Cancer Care” in the subject line. Provide your name and mailing address. In the meantime, you can read an electronic version of this issue.

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History, hope combine in cancer biography

By Leslie Kohman, MD

maladiesDid you know that cancer has been described in Egyptian mummies?

Or that chemotherapy was developed to treat childhood leukemia, and its use in adult cancers is a much later development?

Or how the National Cancer Institute has had intermittent periods of congressional underfunding since its inception in 1937, very similar to what we are experiencing now?

Or that the American Cancer Society started with a volunteer “Women’s Field Army” that took to the streets in the 1930s to raise awareness and funds?

Or that until recently, cancer was a shameful secret that people did not discuss openly?

All these and many more fascinating anecdotes are described in the Emperor of All Maladies: A Biography of Cancer, written by Siddhartha Mukherjee, MD, a young medical oncologist at one of the major teaching hospitals in Boston.

Since President Richard Nixon signed the National Cancer Act in 1971, which became known as the beginning of the “War on Cancer,” cancer treatments, investigations and publicity have steadily increased. Countless people have dedicated their lives to learning about cancer and how to treat it, to the great benefit of innumerable patients. Nonetheless, we have not won this war yet, and the science of cancer is so complex that it may not be possible.

Mukherjee skillfully combines history, biography and science with moving stories about patients, those who have survived cancer and those who have not. He has written a fascinating book at a level accessible to the general reader as well as those with a more medical or scientific bent. He describes human conflict, failure and triumph in masterly fashion.

He also describes his own personal development as a physician as he enters with his patients into the world of cancer.

I highly recommend this extraordinary story of history and hope to anyone who has been touched by cancer or is curious about it (that is all of us!) and I look forward with great anticipation to the upcoming Ken Burns film inspired by this book, to be shown on PBS March 30, 31 and April 1, 2015.

Ken.BurnsSAVE THE DATE: Get an early look at clips from the upcoming television event, “The Story of Cancer: The Emperor of All Maladies” from 6 to 8 p.m. Wednesday, March 25.

The Upstate Cancer Center, in partnership with the WCNY television station, presents the free preview event. Parking is also free in the open lot on East Adams Street across from the center.

Physicians and staff from the cancer center will make presentations during the event. Attendees will learn about their risk of cancer and the newest treatments available.

“The Story of Cancer” is a six-hour documentary based on “The Emperor of All Maladies: A Biography of Cancer.” The film was directed by filmmakers Barak Goodman and produced by Ken Burns, who recently oversaw production of “The Roosevelts.”

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Leslie Kohman, MD, is the medical director of the Upstate Cancer Center. Hear an interview with her about the history of cancer. 

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Do results from research on children’s cancers ever shed light on cancers that adults experience?

A Syracuse woman submitted this question to “Upstate Answers,” and Amy Caruso Brown, MD, assistant professor in pediatrics and the Center for Bioethics and Humanities at Upstate, provides an enlightening answer:

(If you’ve got a general medical/science question you would like to see answered in this space, please send it to whatsup@upstate.edu)

Brown’s response:

“Yes! Definitely! There are a few ways to think about this question.

“First, around the world, thousands of researchers are studying cancer cells in their laboratories. Some study particular mechanisms that play a role in cancer development – for instance, changes in genes that cause cells to grow out of control – while others study how cancer cells respond to drugs, in test tubes or in lab animals, like mice.

“Most researchers perform experiments on several different types of cancer cells, including both pediatric and adult cancers, and cancer researchers at all levels talk to each other and exchange ideas and information. A discovery initially found in cancer cells from pediatric leukemia patients, for instance, may turn out to help us understand and better treat colon or breast cancer, which are extremely rare in children but common in adults.

“I recently worked on a protocol for a study of a new drug, a type of tyrosine kinase inhibitor, that was invented by a pediatric oncologist but also seems promising for treating some adult cancers. Since it has never been tested in humans, the first clinical trial of this new drug will be in adult patients.

“Secondly, adult patients sometimes get cancers that we would consider “pediatric” because they are much more likely to occur in childhood, and so most of what we know about how best to treat these adults comes from research done with children. We now know that young adults, particularly those with acute lymphoid leukemia (ALL), have better outcomes when they are treated with pediatric chemotherapy protocols and, in some cases, by pediatric oncologists.

“The Children’s Oncology Group is a consortium of more than 200 pediatric cancer programs (including Upstate) that supports about 85 ongoing clinical trials. Their study of the best treatment for a specific type of ALL called high-risk pre-B is currently open to patients up to age 30. ALL is the most common type of childhood cancer, but about a third of ALL patients are adults.

“Finally, outcomes for children with cancer have improved dramatically over the past 40 years, and much of that progress is due to the collaboration between pediatric oncologists and researchers around the world, through the Children’s Oncology Group and similar European research groups.

“The majority of children, adolescents and young adults with cancer – 60 percent – are enrolled in clinical trials, meaning that data on the treatment they received and how they responded is collected, analyzed and used to guide future treatment options. In contrast, fewer than 5 percent of adults with cancer participate in clinical trials.

“Many adult oncologists see the pediatric approach to research as one to emulate in order to more systematically improve outcomes for adults with cancer.”

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Fun facts, trivia included in Upstate Health magazine

Can you find the red H?

Can you find the red H?

Page three of Upstate Health magazine this quarter features five random pieces of information you might not otherwise know about Upstate, including:

* The roof of the Upstate Golisano Children’s Hospital is marked with an H in a big cross symbol so that helicopter pilots can locate their landing target in the midst of the downtown buildings in Syracuse.

* Upstate University Hospital receives about 12,000 packages per month, ranging from letters to new pieces of research or medical equipment.

sharps* Bar codes on sharps containers — where needles are disposed after use – allow for the containers to be tracked as they are sterilized and reused for up to 600 times. The new Stericycle containers are expected to save money as well as improve safety for nurses and other medical care providers, says Jason Rupert, assistant director for outpatient operations and materials. The lids on previous containers opened like post office boxes. The new ones have holes on top, a design that Rupert says has been shown to reduce accidental needle sticks by up to 80 percent.

Participating in the check presentation at the hockey game are, from left, Upstate's Gennady Bratslavsky, MD, Michael Lacombe, MD, Dmitriy Nikolovsky, MD and Srinivas Vourganti, MD.  Joining them is Jim Sarosy of the Syracuse Crunch.

Participating in the check presentation at the hockey game are, from left, Upstate’s Gennady Bratslavsky, MD, Michael Lacombe, MD, Dmitriy Nikolovsky, MD and Srinivas Vourganti, MD. Joining them is Jim Sarosy of the Syracuse Crunch.

* Upstate’s prostate cancer team helped raise money for prostate cancer research at Upstate Medical University through a Movember Mustache Challenge involving the Syracuse Crunch hockey team. The men grew facial hair throughout the month of November, and fans voted by making online donations which totaled $4.467.58.

* Upstate’s College of Graduate Studies conferred 27 degrees in 2014, including 14 doctorates, 10 masters and three MD/PhD degrees. Programs of study include biochemistry and molecular biology, cell and developmental biology, microbiology and immunology, neuroscience, pharmacology, physiology and structural biology, biochemistry and biophysics. graduates

Posted in education, Golisano, hospital, urology | Leave a comment

This team of physicians responds to crises outside of the hospital

Meet the Team: Upstate Squad 1; David Landsberg, MD; Christian Knutsen, MD; Derek R. Cooney, MD; Chris Tanski, MD and  Jeremy Joslin, MD.

Meet the Team: Upstate Squad 1; David Landsberg, MD; Christian Knutsen, MD; Derek R. Cooney, MD; Chris Tanski, MD and Jeremy Joslin, MD.

Passengers dozed as Wednesday night turned into Thursday on their trip from Toronto to New York City. The Trailways bus moved south through Syracuse on Interstate 81, lit by a full moon. It made it almost to Nedrow.

That’s where a car was left unattended in the middle of the highway. The driver of a tractor-trailer had stopped to help. The bus slammed into both about 2:30 a.m.

Operators from the Onondaga County 911 Center dispatched crews from 10 ambulances, plus rescuers from eight fire and three police departments. They also activated Upstate’s Physician Response Team to help care for the victims of the crash.

Members of the special team carry pagers 24 hours a day like volunteer firefighters. They take turns being on call, responding whenever summoned by the Onondaga County 911 Center. It’s a community service that Upstate provides without charge to individual patients.

While overseeing patient care, the physicians – all of whom are professors at Upstate – provide real-time feedback to paramedics and emergency responders, explains Derek Cooney, MD, the team’s medical director. He says the team responds to crises both large and small.

Erin Wirths, MD, was on call on the November night of the bus crash. She rushed to the scene in a Ford Expedition equipped with medical gear and medications. Christopher Tanski, MD, and David Landsberg, MD, who specializes in patients requiring intensive care, met her at the scene. Jeremy Joslin, MD, headed to Upstate University Hospital’s emergency department to coordinate the mass casualty accident. He is the director of the adult emergency department.

Tanski said many of the 52 passengers from the bus were not seriously injured. So when he arrived at the crash site, “the focus turned toward the driver who was pinned in the wreckage and was critically injured.”

Twenty-six people were transported to area hospitals, while rescuers worked for two hours to extricate the driver. One of the physicians rode with him in the ambulance to Upstate, where he was cared for until he was released.

Members of the team staffs the infirmary at the New York State Fair, provides medical oversight for large-scale events throughout Central New York and typically are summoned to incidents involving large numbers of ill or injured people.

Upstate’s physician responders provide a service residents are glad to have – but hope never to need.

Posted in community, emergency, trauma | Leave a comment