Up Close: Studying bone density to help cancer survivors

Megan Oest, PhD, places a cylinder containing tiny pieces of bone into a CT scanner. Using software that takes precise measurements of the CT images, Oest creates 3-D images and identifies subtle changes in bone caused by radiation. (photo by William Mueller)

Megan Oest, PhD, places a cylinder containing tiny pieces of bone into a CT scanner. Using software that takes precise measurements of the CT images, Oest creates 3-D images and identifies subtle changes in bone caused by radiation. (photo by William Mueller)

Timothy Damron, MD, and Kenneth Mann, PhD, are studying bone fracture risk in cancer patients after radiation treatment. While radiation therapy is an important and effective treatment for many cancers, bone exposed to radiation becomes brittle and has an increased risk of fragility fracture. Unlike traumatic fractures, fragility fractures occur during normal physical activities and are difficult to predict in patients.

The researchers want to develop ways to prevent and treat these fragility fractures in cancer survivors.

Bone density is not decreased after radiation therapy. Rather, changes in the bone material itself (for example, protein crosslinking, collagen and mineral organization) — as well as the activity of cells that make, maintain and renew bone — contribute to the brittleness of bone after radiation therapy.  

Working as engineers and biologists, Damron and Mann are using translational models to understand how bone is altered by radiation therapy and test potential treatments. Their goal is to prevent post-radiotherapy bone fractures and thereby improve quality of life for cancer survivors.

Cancer Care magazine spring 2019 coverThis article appears in the spring 2019 issue of Cancer Care magazine.

Posted in bones/joints/orthopedics, cancer, health care, medical imaging/radiology, research

Recipe: Easy Summer Lasagna

lasagnaFROM THE AMERICAN INSTITUTE FOR CANCER RESEARCH

This hearty summer lasagna packs roasted eggplant, zucchini and lycopene-rich tomatoes. Whole-wheat noodles pack cancer-fighting fiber and natural plant compounds called phytochemicals, which protect cells from the type of damage that may lead to cancer. One batch serves 12, so make this recipe a part of your weekly meal prep.

Preparation

1. Preheat the oven to 450 degrees. Grease a 13-by-9-by-2-inch baking pan and set aside.

2. Slice the eggplant and zucchini in 1/2-inch slices. Layer them on two baking sheets and coat both sides of the vegetables with cooking spray. Roast for about 40 minutes.

3. Reduce the oven temperature to 375 degrees.

4. Meanwhile, in a medium bowl, mix together the ricotta and/or cottage cheeses, eggs, Parmesan, nutmeg and garlic powder.

5. To assemble: spread a thin layer of sauce over the bottom of the prepared pan. Cover with a layer of pasta. Spread with one-third of the ricotta mixture. Sprinkle one-quarter of the mozzarella over the ricotta. Spoon one-third of the roasted vegetables on top. Top with 1/2 cup of tomato sauce and continue the assembly as directed until you have four layers of pasta and three layers of filling. Spread the remaining sauce on top and sprinkle with the remaining mozzarella cheese.

6. Cover the pan with aluminum foil and bake for 30 minutes. Uncover and continue to bake until golden and bubbly, about 15 minutes more. Let stand for 15 minutes before serving.

fresh green zucchini with slice isolated on white backgroundIngredients

— 2 eggplants (about 3 pounds), quartered lengthwise

— 6 medium zucchini (about 3 pounds)

— canola oil cooking spray

— 15 ounces low-fat ricotta or low-fat cottage cheese (or a combination of both)

— 2 eggs

— 1/2 cup grated Parmesan cheese

— 1/2 teaspoon ground nutmeg

— 1/2 teaspoon garlic powder

— 4 cups low-sodium tomato sauce

— 1 pound whole-wheat, no-boil lasagna noodles

— 3 cups low-fat mozzarella cheese

Nutritional information per serving:

360 calories

11 grams total fat (5 grams saturated fat)

45 grams carbohydrate

23 grams protein

11 grams dietary fiber

310 milligrams sodium

Cancer Care magazine spring 2019 coverThis article appears in the spring 2019 issue of Cancer Care magazine.

Posted in cancer, health care, recipe

Extensive operations: Patients endure lengthy surgeries when cancer involves the face or jaw

 

Michele Giblin had cancer behind her eye, and surgery involved reconstructing her upper jaw with bone from her leg. (photo by William Mueller)

Michele Giblin had cancer behind her eye, and surgery involved reconstructing her upper jaw with bone from her leg. (photo by William Mueller)

BY AMBER SMITH

In constant pain after two root canals and months of antibiotics that were no help, Michele Giblin of Binghamton finally received a diagnosis. She had a rare cancer called adenoid cystic carcinoma. Her oral surgeon referred her to a specialized otolaryngologist at Upstate: Jesse Ryan, MD.

Giblin liked him immediately.

“He was very sincere,” she says. “I felt like I really matter to him.”

Ear, nose and throat specialist Jesse Ryan, MD, was interviewed about jaw reconstructions on Upstate's "HealthLink on Air," a podcast/radio show that airs on Sundays at 6 a.m. and 9 p.m.on WRVO radio. Hear his interview at healthlinkonair.org by searching for "Jesse Ryan." (photo by Jim Howe)

Ear, nose and throat specialist Jesse Ryan, MD, was interviewed about jaw reconstructions on Upstate’s “HealthLink on Air,” a podcast/radio show that airs on Sundays at 6 a.m. and 9 p.m.on WRVO radio. Hear his interview at healthlinkonair.org by searching for “Jesse Ryan.” (photo by Jim Howe)

Treatment for cancer that is discovered in the jaw area may require an extensive operation that’s designed to both remove the cancer and reconstruct the area. Such surgeries require expertise and stamina from a team of surgeons, since they can take more than 20 hours.

Ryan estimates he’s involved in five to 10 such operations at Upstate each year, on patients with cancer or traumatic injury requiring jaw reconstruction. “This is rare,” he says, “but this has been a major problem for this subset of the population for centuries. Initially, there was very little that could be done.”

If the front portion of the jaw is removed, its absence will impact a person’s ability to speak and swallow. Techniques evolved in the middle of the last century to use a titanium plate across the gap of missing bone, which would then be covered with skin or muscle in an attempt to preserve some of the structure, Ryan says. Infections and plate exposure over time meant this was not an ideal solution.

Advances in reconstructive surgery in the 1970s had surgeons transferring tissue from one part of a patient’s body to another, with assistance from engineers to shape the bone. Those developments shifted into jaw reconstructions, and today success rates are about 95 percent, Ryan says. The biggest challenge is establishing adequate blood flow to the transplanted area by connecting arteries and veins that are so tiny they require sutures that are smaller than a human hair.

Ryan’s education makes him a natural for this type of surgery. His undergraduate degree is in mechanical and aerospace engineering from Princeton.

After graduating from Mount Sinai School of Medicine, he completed a residency in otolaryngology and head and neck surgery at the National Naval Medical Center and then a fellowship in head and neck oncology and microvascular reconstruction at the University of Michigan in Ann Arbor. He’s been at Upstate since 2015.

Computer model of Michele Giblin's reconstructive surgery. The areas in shades of blue show what was rebuilt. (courtesy of Jesse Ryan, MD)

Computer model of Michele Giblin’s reconstructive surgery. The areas in shades of blue show what was rebuilt. (courtesy of Jesse Ryan, MD)

A leg bone that works in the jaw

Giblin spoke with Ryan before what would be a 19-hour operation in June 2017. “How do you feel about this?” she asked him.

“To be honest,” replied the surgeon, “I’m a little bit nervous.”

“Well, I’m not. I have faith in you.”

Giblin’s cancer started in a minor salivary gland in her left cheek sinus and involved her upper jaw and part of her nose. Removing it meant having to rebuild her upper jaw and palate. Replacement bone and skin came from her lower leg and was used to resurface both the inside of her nose and inside of her mouth. Then a thin layer of skin was taken from her thigh to cover the area of her lower leg.

Ryan explains that replacement bone typically comes from the fibula, a lengthy bone of the lower leg that most people don’t need.

Removing a piece of the bone may affect a marathon runner, but most people are able to walk normally afterward. “The leg bone fits pretty well in terms of the size and strength that’s needed to reconstruct the jaw,” he says.

Giblin spent seven days in intensive care. Then she spent several days on a regular hospital floor, recovering from the surgery. Later, she underwent radiation therapy.

She has some trouble eating, and must sip drinks, but two years after her surgery, Giblin feels good about the results. She was afraid she would lose the side of her cheek, but friends say she looks as she did before. Today she takes care of people with developmental disabilities as a house director for New York state. She has monthly appointments with Ryan, and she undergoes imaging scans every six months.

Computer model of Paul Desimone’s reconstructive surgery. (courtesy of Jesse Ryan, MD)

Computer model of Paul Desimone’s reconstructive surgery. (courtesy of Jesse Ryan, MD)

A skeptic who was impressed with his care

Paul Desimone, 52, of Sangerfield in Oneida County underwent a similar 20-hour surgery in October 2016. What he initially thought was a cold sore on his lip grew bigger, until he could not ignore it.

Doctors in Utica confirmed the growth was cancerous and referred Desimone to Ryan.

When Ryan proposed surgery, Desimone says, “I was skeptical. But I’m a skeptical guy. It had nothing to do with him. Trust me. I had not seen a doctor in 30 years.”

The sore on his lip was about 3 inches by 2 inches, and an affected lymph node had eroded through his lower jaw. DeSimone underwent two transplants in the same operation. First, Ryan used tissue from the forearm to re-create a lower lip. Then, he used bone and skin from the lower leg to re-create the jaw and external cheek skin. The surgeon used skin from Desimone’s hip to cover the forearm and lower leg.

Desimone went home from the hospital 16 days later. He wouldn’t undergo radiation or chemotherapy, and the cancer returned about a year later. At that time, he was willing to undergo radiation and chemotherapy, and he added two more doctors to his care team: oncologist Muhammad Naqvi, MD, and radiation oncologist Michael Lacombe, MD.

“What a pack of great guys. They really know what they’re doing,” Desimone says. He is in remission now.

Cancer Care magazine spring 2019 coverThis article appears in the spring 2019 issue of Cancer Care magazine.

 

 

Posted in bones/joints/orthopedics, cancer, ear, nose and throat/otolaryngology, health care, HealthLink on Air, patient story, surgery | Tagged , , ,

When your child has cancer: advice from a mom

Her daughter was 10 when she was diagnosed with leukemia — and Gwendolyn Webber-McLeod of Auburn began her education in parenting a child with cancer.

Gwendolyn Webber-McLeod (2019)

Gwendolyn Webber-McLeod (2019)

Her daughter, Ashley McLeod, is 33 now, with a son of her own. She’s been cancer-free for 23 years, but the impact of pediatric cancer followed her into adulthood. As she grew from pediatric cancer patient to survivor, she experienced residual effects, such as learning disabilities, depression and anxiety — as do many survivors.

Today McLeod is a healthy, confident woman. Webber-McLeod remains a support to her daughter. She recently spoke at a HOPE (Helping Oncology Patients and Parents Engage) event, sponsored by Upstate’s Waters Center for Children’s Cancer and Blood Disorders.

Webber-McLeod made these points:

Understand. A child who seems rebellious may be trying to regain some control when his/her life feels out of control.

Ashley McLeod (1997, when she was 12 and undergoing weekly chemotherapy)

Ashley McLeod (1997, when she was 12 and undergoing weekly chemotherapy)

Support your spouse. It’s difficult for parents to stay strong during cancer, especially fathers. Encourage fathers to turn to other men for emotional support. Fathers often feel helpless because they can’t protect their children from cancer.

Tend your relationship. The disease and the caregiving responsibilities will strain a marriage. Remind yourselves “we are in this together.” Schedule date nights even if you don’t feel like it.

Focus on siblings. Cancer disrupts the childhood of all your children. Do what you can to make siblings feel important. Schedule special outings with the siblings who don’t have cancer. Encourage them to share feelings and concerns.

Embrace the “new normal.” You may need to release the idea of what your family was before cancer, and learn to love, honor and respect what your family is now. There is still much to celebrate.

Ask for help. Look for relatives or friends who can talk to your child when she/he doesn’t want to talk with you. Engage nurses from the hospital who can connect with your child, too. You need a team of support to get through this.

Grieve. “Crying is the appropriate response to cancer,” Webber-McLeod says. “Give yourself permission to grieve, and grieve with an agenda. Be intentional about how you will bounce back. Our children need to believe we are OK and they will be too.”

Cancer Care magazine spring 2019 coverThis article appears in the spring 2019 issue of Cancer Care magazine.

Posted in cancer, health care, mental health/emotional health, Upstate Golisano Children's Hospital/pediatrics | Tagged , , , ,

6 surprising cancer risk factors

Bacon and other cured meats have been studied for possible links to cancer.

Bacon and other cured meats have been studied for possible links to cancer.

You know that cigarettes and radon and ultraviolet radiation can all cause cancer. Here are six things you may not have realized can increase your risk:

Alcohol

The American Society of Clinical Oncology cites evidence from 2017 that even light drinking can slightly raise a woman’s risk of breast cancer and increase a common type of esophageal cancer. Heavy drinkers are said to face much higher risks of mouth and throat cancer, cancer of the voice box, liver cancer and, to a lesser extent, colorectal cancers.

The lead author of the study, an associate professor at the University of Wisconsin Madison, told the New York Times, “The message is not ‘Don’t drink.’ It’s ‘If you want to reduce your cancer risk, drink less.’ And, ‘If you don’t drink, don’t start.’ It’s different than tobacco, where we say, ‘Never smoke. Don’t start.’ This is a little more subtle.”

Bacon

Science shows us that cells exposed to high levels of nitrates (such as found in bacon and smoked meats) are at greater risk for DNA modification. “The smoking process of meats is thought to introduce heterocyclic amine byproducts in the food, and the curing process involves nitrate salts that cause nitrosocompounds, which are thought to act as potential mutagens,” according to an article in the journal Nucleic Acids Research. Upstate neuroscientist Frank Middleton, PhD, explains that our cells can respond to these mutations and repair them, but over a person’s lifetime, cells that are continually exposed to these types of mutagens will become less efficient at repair — and cancer may develop.

Oral sex

In the United States, the human papillomavirus is the most common sexually transmitted virus and is the leading cause of oropharyngeal (oral) cancers. Oral sex is one way HPV is transmitted. More than 100 types of HPV exist, half causing warts and other skin infections, and half causing infections of the mucous membranes, says Upstate infectious disease specialist Joseph Domachowske, MD. “Most HPV infections are cleared spontaneously by our own immune system,” he says. But among those that infect the mucous membranes of the genital tract, more than 20 are known to cause cancer.

A vaccine for HPV is recommended for girls and boys before they become sexually active.

Body fat

Evidence consistently shows that excess body fat increases the risk for many common cancers including endometrial cancer, colorectal cancer, liver, kidney or pancreatic cancer, esophageal adenocarcinoma, cancer of the upper part of the stomach, multiple myeloma or a slow-growing brain tumor called meningioma, according to the National Cancer Institute.

In related research, the group says physical activity may reduce the risk of several cancers through other mechanisms, independent of the effect on obesity, including colon cancer, breast cancer and endometrial cancer.

Immunosuppression

Because of the medications people take after they have undergone an organ transplant, or if they have a disease such as lupus, their immune system is suppressed and less able to detect and destroy cancer cells or fight off infections that cause cancer. Infection with HIV also weakens the immune certain cancers, according to the National Cancer Institute.

Working nights

Long-term night shift work increases the risk of breast cancer in women, according to a 2018 study in the journal Cancer Epidemiology, Biomarkers & Prevention. The study also found increased risks for cancers of the digestive system, skin cancer and lung cancer. Researchers suspect environmental factors of modern society play a role in causing cancer  and that circadian rhythm disruption and nocturnal melatonin suppression could be carcinogenic.

Cancer Care magazine spring 2019 coverThis article appears in the spring 2019 issue of Cancer Care magazine.

 

 

 

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

After abnormal mammogram, vigilant nurse tries new combination surgery and radiation treatment for breast cancer

Chief nursing officer Nancy Page says, “I always think about, for myself and my family, where is the best care?” When she was diagnosed with breast cancer, her answer was Upstate. (photo by Susan Kahn)

Chief nursing officer Nancy Page says, “I always think about, for myself and my family, where is the best care?” When she was diagnosed with breast cancer, her answer was Upstate. (photo by Susan Kahn)

BY AMBER SMITH

In her role as chief nursing officer at Upstate University Hospital, Nancy Page is part of the leadership team that reviews major hospital purchases. In 2017, they gave the go-ahead for intraoperative radiation therapy equipment, which would allow a surgeon and a radiation oncologist to simultaneously treat breast cancer.

“When we vetted the equipment, I could see that this would allow a woman with a particular type of breast cancer to have her surgery and radiation all in one day, so she would not be returning for 15 successive treatments,” Page recalls. She could see where offering it at Upstate would boost patient quality of life. “It just seemed like a very wise investment.”

She had no way of knowing that several months later, she would need the treatment. Page, 59, was diagnosed with early-stage breast cancer after a routine mammogram in July 2018.

Mammograms matter

Page dutifully went for her annual mammogram since she was 40. She had no lumps or drainage. She was not at high risk for breast cancer. Some older relatives had different cancers, but Page did not have what doctors would consider a family history of breast cancer. So when she got a phone call asking her to return for a biopsy, her mind raced.

Her case “really underscores the importance of preventive health care,” she says.

Page’s diagnosis was “ductal carcinoma in situ,” which was cancer in the milk ducts that has not spread. Her nursing background is helpful for understanding medical terms and procedures and making sense of medical journal articles. But it can also provide a lengthy list of worst-case scenarios and things that could go wrong.

After her biopsy, she and her husband prepared for what they knew would be a three- or four-hour appointment at the Upstate Cancer Center. “We were able to talk to the breast surgeon, the radiation oncologist, the medical oncologist, and then we also spoke with a geneticist.

“In one visit we were able to go from one to the other to the other. The entire team had talked about my case before each of them came in, which I thought was really beneficial. They already had discussed the possible approaches.”

Breast cancer team of doctors at Upstate: The doctors who cared for Nancy Page during her breast cancer treatment, from left: Katherine Willer, DO, is the radiologist who performed the biopsy. Lisa Lai, MD, is the breast surgeon. Anna Shapiro, MD, is the radiation oncologist. Abi Siva, MD, is the medical oncologist. Gloria Morris, MD, PhD, is the genetic counselor. “Knowing that my treatment team understood the possible cosmetic effects of surgery was hugely comforting,” Page says.

Breast cancer team of doctors at Upstate: The doctors who cared for Nancy Page during her breast cancer treatment, from left: Katherine Willer, DO, is the radiologist who performed the biopsy. Lisa Lai, MD, is the breast surgeon. Anna Shapiro, MD, is the radiation oncologist. Abi Siva, MD, is the medical oncologist. Gloria Morris, MD, PhD, is the genetic counselor. “Knowing that my treatment team understood the possible cosmetic effects of surgery was hugely comforting,” Page says.

Choosing the best option

Page had three options:

  1. Surgery to remove the lump, followed by recovery and three weeks of daily radiation treatments.
  2. Intraoperative radiation therapy (IORT). A surgeon removes the lump and a radiation oncologist administers a focused dose of radiation in the space where the cancer had been.
  3. Participation in a clinical trial. Half of the women in the trial are treated with surgery or radiation or both, plus an annual mammogram; and the other  half opt for close monitoring and mammograms twice a year.

“What they don’t know about this type of breast cancer is: If they just let it sit, does it just sit?” Page explains. “Does it not grow? Does it not become invasive? Do women not need surgery? Do they need surgery, but do they not need radiation?”

She considered the trial, “but I just couldn’t do it,” she says. “All I could think is, what if I’m the woman whose cancer isn’t going to chill out?”

Having the surgery and radiation in one procedure made the most sense for Page.

One day surgery/radiation

The IORT procedure is straightforward.

Page registered early that morning, receiving a name bracelet just like any other patient at the Community Campus of Upstate University Hospital.

A nurse started an intravenous line, and then Page went to Upstate’s Wellspring Breast Care Center, the same place where she had her mammogram several weeks before. A radiologist placed a wire into her breast “to really point the surgeon to where, exactly, that cancerous lesion is.”

Page went to the operating room. Surgeon Lisa Lai, MD, removed the lump. With the tissue gone, she placed a balloon in the empty space, and radiation oncologist Anna Shapiro, MD, administered a targeted dose of radiation. Then the balloon was removed, the surgery was completed, and “I was home by 1 o’clock that day,” she remembers.

Treatment continues for her, in the form of a daily hormone-lowering pill shown to help prevent breast cancer recurrence.

profile of head with blank thought bubblePatient advice

Chief nursing officer Nancy Page’s advice for someone facing a breast cancer diagnosis:

Resist the urge to act immediately.

Seek trustworthy information.

Prepare questions to ask the doctors.

Get your care where you feel comfortable.

Cancer Care magazine spring 2019 coverHealthLink on Air logoThis article appears in the spring 2019 issue of Cancer Care magazine. Click here to hear  Nancy Page tell about her breast cancer experience in this radio/podcast interview with “HealthLink on Air”.

 

 

Posted in cancer, health care, HealthLink on Air, medical imaging/radiology, nursing, patient story, surgery, women's health/gynecology | Tagged ,

Ask her for help: Cancer Center librarian enjoys finding answers for patients, the public

Librarian Sarah Lawler with free books that are available at the Upstate Cancer Center. The Family Resource Center has computers so that Lawler can assist staff, patients and family members with online searches. (photo by Richard Whelsky)

Librarian Sarah Lawler with free books that are available at the Upstate Cancer Center. The Family Resource Center has computers so that Lawler can assist staff, patients and family members with online searches. (photo by Richard Whelsky)

Some people have questions about a diagnosis or treatment. Others are researching drug interactions. And others seek healthy recipes. Librarian Sarah Lawler strives to help everyone through the “Librarian on Call” service.

She is stationed in the Family Resource Center on the first floor of the Upstate Cancer Center for hours on Tuesdays, Wednesdays and Thursdays. She also responds to email at lawlersa@upstate.edu and phone calls at 315-464-7192.

“I am able to provide information on many types of health questions, not just questions related to cancer,” she says. The service is meant to help patients and visitors locate trustworthy, current, evidence-based health information. A similar service is offered in the Upstate Golisano Children’s Hospital Family Resource Center.

Lawler is a senior assistant librarian in Upstate Medical University’s Health Sciences Library, which supports the academic, research and clinical activities of the university.

Upstate Cancer Center librarian’s hours:

Tuesdays, 10 a.m. to noon

Wednesdays, 1 to 3 p.m.

Thursdays, 2 to 4 p.m.

Cancer Care magazine spring 2019 coverThis article appears in the spring 2019 issue of Cancer Care magazine.

Posted in cancer, health care, research

Battling cancer: Through 3 surgeries and 6 weeks of radiation, this determined Marine vet keeps his chin up

When radiation therapy was recommended to target any rogue cancer cells after his surgery, Howard "Mac" Waterman, 73, of Boonville, was able to travel to Oneida (instead of Syracuse) for six weeks of treatment last fall. The Upstate Cancer Center staffs a radiation oncology office in Oneida, which cut Waterman's drive time almost in half. (photo by Robert Mescavage)

When radiation therapy was recommended to target any rogue cancer cells after his surgery, Howard “Mac” Waterman, 73, of Boonville, was able to travel to Oneida (instead of Syracuse) for six weeks of treatment last fall. The Upstate Cancer Center staffs a radiation oncology office in Oneida, which cut Waterman’s drive time almost in half. (photo by Robert Mescavage)

BY DARRYL GEDDES

Howard “Mac” Waterman, 73, of Boonville is a Vietnam War veteran who saw combat as a Marine, but his biggest fight has been a recent bout with medullary thyroid and neck cancer. He appears to be outmaneuvering the enemy.

In 2015, a suspicious lump on the left side of his neck brought Waterman to the Donald J. Mitchell VA Clinic in Rome, where his primary physician set in motion testing that ultimately revealed the growth to be cancerous. An endocrinologist at the Syracuse VA Medical Center arranged for Waterman to see Mark Marzouk, MD, a specialty surgeon at Upstate University Hospital.

Within a few weeks, Waterman underwent extensive surgery to remove the cancerous thyroid and dozens of neck lymph nodes. In spite of eight of the more than 30 lymph nodes testing positive for cancer, his recovery was remarkable.

Unfortunately, 18 months later, Waterman required a second but comparatively easier operation for a recurrence of neck cancer. Again, his recovery was noteworthy, and a postponed hip replacement surgery soon followed, with a timely return to normal activity.

A third neck surgery took place less than a year ago to remove a tumor hidden below his left shoulder.  All three cancer surgeries were performed by Marzouk; Waterman credits the skill of his surgeon and the care received at Upstate for his health today.

Some of that care took place in Oneida, at a radiation oncology practice staffed by Upstate. Waterman underwent six weeks of radiation therapy during the fall of 2018, to target any rogue cancer cells.

“The initial cancer diagnosis was devastating, but the care and support from the VA and the Upstate team has been excellent this entire journey,” Waterman says. The determined Marine credits the strength and support of his wife, family, friends and fellow Marines with helping him stay upbeat, and he says he is only looking forward.

Cancer Care magazine spring 2019 coverThis article appears in the spring 2019 issue of Cancer Care magazine.

 

 

 

 

 

 

 

Posted in cancer, diabetes/endocrine/metabolism, health care, medical imaging/radiology, patient story, surgery | Tagged

Baffled? This pathologist helps you make sense of your pathology report

By AMBER SMITH

Like many women who are diagnosed with breast cancer, Amanda Gilmore of Phoenix struggled with the new knowledge that her body contained cancerous cells that she could neither see nor feel.

Pathologists view cancer cells at the microscopic level, above, run tests and issue reports with a patient's test results but do not often interact directly with patients. An Upstate pathologist is taking a different approach and is happy to meet with patients to help explain what their pathology results mean.

Pathologists view cancer cells at the microscopic level, above, run tests and issue reports with a patient’s test results but do not often interact directly with patients. An Upstate pathologist is taking a different approach and is happy to meet with patients to help explain what their pathology results mean.

She read her pathology reports, but she couldn’t understand them. She and her mother used the Internet for help with vocabulary, but it was still hard to put random words into context to know what they meant for her situation.

Then Gilmore’s surgeon, Kristine Keeney, MD, offered to bring Gilmore behind the scenes to meet with her pathologist.

A medical pathologist is a doctor who specializes in diagnosing and studying diseases using laboratory methods. He or she may supervise tests on blood and other bodily fluids and tissue, such as the breast tissue removed during Gilmore’s biopsy.

Pathologist Rohin Mehta, MD, says pathologists are the doctors’ doctors. Typically their work is in the background, with little if any direct patient contact. That’s changing in some areas of the country. Lowell General Hospital in Massachusetts launched a pathologist-patient consultation program last year called Cancer Pathology 101.

Rohin Mehta, MD

Rohin Mehta, MD

At Upstate, Mehta has begun a more modest undertaking. He offers to meet one-on-one with breast cancer patients who want help understanding the pathology of their cancer.

“I can see how scared they are, and this can give them some solace,” he says.

For Gilmore, 38, seeing images of what the cancer cells looked like in comparison to her healthy cells, with Mehta’s explanation, made her realize her situation was not so dire.

“He definitely reassured us,” she recalls. “Dr. Mehta was personable and very easy to talk to. After I met with him, I felt much better about all of it.

“It made me feel like breast cancer was no longer a foreign concept.”

Gilmore was diagnosed after a biopsy in October. Keeney operated to remove the mass in her breast in November. Then Gilmore went through radiation therapy. She

finished in January and because “my cancer showed it was reactive to estrogen,” she takes a medication to block the estrogen.

Mehta enjoys the patient interaction.

Not everyone wants to read their pathology report or see what their cancer looks like under a microscope. And many patients are satisfied with answers they can get from their primary doctor. For those with a lingering desire to know more, Mehta tries to oblige.

“I figure it’s the right thing to do,” he says. “This lets patients kind of envision what they’re fighting against.”

A few terms from a breast cancer pathology report

1 o’clock excision — refers to the geographic location of a tumor or tissue sample that was removed, if you envision the face of a clock on the breast; 1 o’clock would be above and slightly to the right of the nipple

gross description — the pathologist’s overall description of the tissue; it may be a few words or a whole paragraph

mitotic rate — tells how quickly the cancer cells are dividing

tumor focality — the number of tumors; if there are many, it’s multifocal

macrometastasis and micrometastasis — when cancer has spread to a lymph node, it will be called micro if it measures less than 2 millimeters and macro if it encompasses the whole lymph node

Cancer Care magazine spring 2019 coverHealthLink on Air logoThis article appears in the spring 2019 issue of Cancer Care magazine. Click here to hear an interview with Rohin Mehta, MD, about how to understand a pathology report.

 

 

 

Posted in cancer, health care, HealthLink on Air, pathology

Guided by love: 4 whose careers were inspired by family members who fought cancer

BY JIM HOWE

A mother who died of cancer inspired her daughter, now a nurse practitioner, to care for cancer patients. Other family members similarly influenced the career paths of a radiation therapist, a nurse and a medical student to work in the fields of hematology and oncology, which deal with blood disorders and cancer.

Here are their stories:

Her sister’s treatment showed her the value of nursing

Nurse Meghan Lewis

Nurse Meghan Lewis (photos by Robert Mescavage)

Nurse Meghan Lewis is the clinical leader of the blood and bone marrow transplant program at Upstate University Hospital. Her job is both “bedside and leadership,” she says, describing it as being “the point person for how the floor is running.”

Generally, her patients are adults newly diagnosed with acute leukemia (also lymphoma and myeloma) who stay for several weeks and go home when their immune system is strong enough.

“It’s a very vulnerable time for them. I think nursing plays an important role in helping them process the diagnosis,” she says.

Patients with blood-related cancers like leukemia tend to stay in the hospital for a long time, so “you build relationships with not just patients but with the whole family. That part is very important to me.”

“I lost my sister (Laura) when I was 10. She had osteosarcoma, a bone cancer. She was 15 when she passed away, 27 years ago.

“I always wanted to be a nurse. My mom and both grandmas were nurses, but growing up and remembering the impact nurses had on not just her but on us as her siblings really left a lasting impression on me,” Lewis says.

Laura was sick for 18 months and had to go out of town for some treatments, which were not done at Upstate at that time.  This was years before the Upstate Cancer Center and the Upstate Golisano Children’s Hospital were built.

Recalling her sister’s time in the hospital, Lewis said, “The nurses then treated us as though we were just as important as she was, which is hard to do when there’s a sick kid in the family. They always let us into playroom with her and let us spend time with her there.”

“My parents were great about it, too. We all had special days at home or with my mom and Laura. I didn’t have the feeling that she got all the attention. It was a very inclusive experience for all of us, a lot of it coming from my parents but also from nursing and physician involvement.”

“As a nurse, sometimes you want to take away that burden and be a bridge between the doctor and the patient. I feel that nursing has a crucial role in trying to make everything more manageable and being the patient’s strongest advocate.”

Her aunt’s disease led her to seek answers

Medical student Christina Marcelus

Medical student Christina Marcelus

Christina Marcelus, heading into her fourth year as a medical student, hopes to work in hematology and oncology as a physician, doing research and treating patients.

“When I was in middle school I had an aunt I was very close to who was diagnosed with breast cancer. It was my first exposure to breast cancer. I didn’t know what it meant. I thought you get sick, someone fixes it, and that’s the end of it.

“I remember being confused — my aunt, instead of getting better, was getting worse. I couldn’t understand how medicine was failing her.

“I was upset because maybe the doctors weren’t doing what they needed to do. I was not understanding that cancer can’t always be cured, that medicine is not absolute, that there is room to explore more, understand more, a lot of unknowns about medicine.

“Since then, I took an interest in science, and experimentation … to ask a complex question and find information about how to understand that question. This was my first insight into that.”

Marcelus was the first person in her family to go to college, where she majored in biology and women’s studies. She says she realized her aunt faced racial and socioeconomic, as well as medical, issues, which affected what kind of health care she was able to get.

Her questions about cancer led Marcelus to do research in a Harvard professor’s laboratory through a mentorship program, where she looked at possible links between viruses and cancer and published her findings. This was her first exposure to oncology as medicine, she says. “I was on the other end of what I had seen as a kid going to the hospital with my aunt.”

“What makes me excited about medical oncology is the personal care and being the person who orchestrates the care.  And being the most important person at that time of the patients’ life is very important to me. As an oncologist you have a lifelong relationship with this person. Even if they are cured.”

She especially likes studying blood-related disorders, because it includes a range of non-cancerous but still potentially devastating illnesses, such as sickle cell disease. She also hopes to address issues of health care access and affordability as a doctor.

Some in her family are surprised that she would want to make a career in cancer research and treatment because they find it “morbid and sad.” She, however, says, “It’s a world full of excitement. I don’t feel there is another field that is as broad, unexplored, unique, open to change, so dynamic — it changes all the time, in how we treat patients.”

She was interested because grandparents had cancer

Radiation therapist Mary Gleason

Radiation therapist Mary Gleason

Oncological radiation therapist Mary Gleason knew in high school that she wanted to work in a cancer-related field someday.

“Both my maternal grandparents and my paternal grandfather all had cancer, my dad had a scare that turned out not to be cancer, and I had friends through the years that have had cancer,” she says.

“So, oncology was the route I was going to take, but I just couldn’t decide where in the world I wanted to be,” she says. She had hoped early on to combine her interest in cancer with documentary film-making, having pursued creative writing and cinematic studies in college, but that didn’t pan out.

She then shadowed a friend who works in radiation therapy, liked the emotional connection she saw between the patients and therapists and decided this could be her niche. “I was so excited to talk with patients and have personal relationships with them. I’m a people person, so it fits in with my personality.”

“I was close to my grandmother growing up, and she died of lung cancer,” Gleason recalls. As a radiation therapy student, “I met a patient with lung cancer. She was very kind to all of us, and she was the spitting image of my grandmother.”

Gleason had to explain the treatment process and guide the woman through it. “It was so very special to me to have my first interaction be with her, also to be able to be with her on treatment. I could help her and wanted to help her because I couldn’t help my grandmother.”

The patient “adopted” all of the students, brought them homemade baked goods and wrote a goodbye letter to all of them, thanking them for their care.

These days, Gleason works in the Hill Medical Center, a few blocks north of the hospital’s downtown campus. She sets up and administers radiation for patients, and although she likes the technical parts of her job, she especially enjoys giving people the best treatment possible. Her patients might come in for 10 or as many as 45 daily treatments, so she has a chance to get to know them.

And she still thinks of that long-ago patient who reminded her of her grandmother. “She gave me recipes she developed,” Gleason recalls, noting she still has some of those recipes displayed on her refrigerator, and she still uses the recipe for buttercream frosting.

She now works with her mother’s oncologist

Nurse practitioner Kristin Soper

Nurse practitioner Kristin Soper

Nurse practitioner Kristin Soper treats patients with solid tumors. Before that she cared for cancer patients as a registered nurse.

“My mom was diagnosed with colorectal cancer when I was 15. When she was here (at Upstate) getting treatment, I would see her with all the nurses, and she would say, ‘I feel safe here.’ I’d become friends with all the nurses; everybody knew our names. It was kind of like a home away from home for us and inspired me to want to create that for all the patients I take care of,” she says.

Soper was 21 when her mother died, after fighting cancer for 6½ years.

“I knew I wanted to be a nurse as soon as I saw the impact that nurses made on the patients and the family. I felt that I could really touch a lot of lives by doing oncology. The impact is so great that you can make in patients’ lives. It’s an honor and a privilege to take care of people in that vulnerable state.”

Soper works with oncologist Sheila Lemke, MD, who treated her mother. Soper’s mother told Lemke that her daughter wanted to be an oncology nurse. “Now it’s come full circle to work with her,” Soper says.

“The most important thing is to be with the patients and make the most impact, so, I try to spend as much time as possible with the patients and their families,” she says. “As providers, we come in and often give the patients difficult news, and we’re there so briefly that I always want to be more than that. I strive to be the person who comes back to pick up the pieces and reinstall hope.”

“A lot of it is explaining what to expect,” she notes. Soper watched her mother seek comfort in the nurses, in knowing the process and in knowing that she was, although dying, still living and still in control of how she dealt with her disease. She tries to provide that comfort and hope for her patients; the same way her mother’s nurses did.

Are you inspired?

Upstate Medical University offers training for a variety of health professions that provide care to people with cancer. Three options:

Nursing –- Earn a bachelor’s degree, or a master’s degree. Upstate also offers a post-master’s program and a doctor of nursing practice degree.

Respiratory therapy –- A 21-month bachelor’s program is designed for those who want to help manage breathing problems caused by illness or injury.

Medical imaging — Bachelor’s programs in medical imaging sciences are five or six semesters. Additional training is available in computer tomography, magnetic resonance imaging and sonography.

Learn more at: upstate.edu/education

Cancer Care magazine spring 2019 coverThis article appears in the spring 2019 issue of Cancer Care magazine.

 

 

Posted in cancer, health care, health careers, medical education, medical student