Have you seen the summer issue of Cancer Care magazine?

cancercaresummerWelcome to Cancer Care magazine’s summer 2016 issue.

Medical student Ogochukwu Ezeoke, smiling from our cover, aspires to a career in cancer research, and like many scientists she’s intrigued with the idea of using a patient’s immune system to fight disease. In this issue, read about the research she’s doing on racial and ethnic disparities in clinical trials, and the research William Kerr, PhD, is doing to make the immune system better at killing cancer. (Kerr is collaborating with scientists in France on a Fulbright Scholarship.)

Other Upstate scientists featured in Cancer Care include Andrzej Krol, PhD, a professor of radiology who is working to create a better noninvasive diagnostic tool for early liver cancer detection, and radiologist Ernest Scalzetti, MD, who contributes to the effort to quantify information from medical images that can guide medical care.

This issue also features stories from a variety of patients, including one of Upstate’s oldest living pediatric brain tumor survivors, a man with follicular lymphoma, and an 11-year-old girl with Ewing sarcoma. Read about the special bell patients may ring when they finish treatment or reach a milestone.

Upstate experts also share information about the best way for breast cancer survivors to protect their bone health, whether kidney biopsies are always necessary and an important new risk factor for prostate cancer. They also address whether aspirin can protect against colorectal cancer, and they dispel dietary myths about sugar and soy.

If you have story suggestions for future issue of Cancer Care, contact editor Amber Smith at smithamb@upstate.edu Thanks for reading.

Posted in bioethics & humanities, bones/joints/orthopedics, brain/spine/neurosurgery, cancer, dermatology/skin care, genetics, health care, history, kidney/renal/nephrology, research, surgery, urology, women's health/gynecology

Breast cancer gene also increases risk of prostate cancer

BY AMBER SMITH

Although prostate cancer is the most common cancer diagnosed in men in the United States, the disease kills fewer than 3 percent of those diagnosed. It typically grows slowly, becoming deadly after it metastasizes, or spreads beyond the prostate.

Layout 1If doctors could determine ahead of time which men harbor the most aggressive cancers, they could provide more focused interventions – and potentially save lives.

One clue is whether a man carries the BRCA mutation, better known as the breast cancer gene, which increases a woman’s risk of breast and ovarian cancers. Men who have that BRCA mutation are four times as likely to develop a prostate cancer that is aggressive and lethal, according to urology experts from Upstate.

Assistant professor Srinivas Vourganti, MD, presented research in May at the annual meeting of the American Urological Association showing that men with the BRCA mutation were much more likely to be diagnosed with a prostate cancer that had already spread or was considered more advanced.

Stephanie Gleicher, MD, was a medical student when she pitched a project to Vourganti that involved analyzing a dozen prostate cancer studies that included 261 men with the breast cancer gene. In 17 percent of those men with newly diagnosed prostate cancer, the disease was metastasized. That compares with 4 percent of newly diagnosed men in the general population.

In addition, about 40 percent of the men with the BRCA gene were diagnosed with late-stage prostate cancer, compared with 11 percent of the general population.

“They are very much at high risk of cancer, and we should be tailoring their screening to be more aggressive,” Vourganti says.

Gleicher is now a urology resident at Upstate. She, Vourganti and colleagues published a paper on the subject in the journal The Prostate.

The BRCA genes produce proteins that repair damaged DNA, which could otherwise cause cancer. Previously, mutations of this gene were thought to be involved in as few as 5 percent of prostate cancers. The Upstate research, along with two other studies presented at the conference in May, calls that into question.

One study showed that black prostate cancer patients were more than three times as likely as white patients to have a BRCA mutation – which may help explain why prostate cancer is more aggressive and more deadly in black men.

The other study focused on men who survived breast cancer, showing that they are at a 30 percent increased risk for developing prostate cancer.

Brian Helfand, MD, a urologic oncologist at NorthShore University HealthCare System in Chicago, says men with a personal or family history of breast cancer should be screened for the BRCA mutation.

“We need to recognize this as a risk factor and start screening those men more aggressively,” he told a HealthDay reporter. “BRCA is a tool we can start using to distinguish who is going to benefit from earlier treatment and more aggressive type treatments.”

BRCA mutations

Harmful mutations in the BRCA1 and BRCA2 genes increase the risk of several cancers, including breast, ovarian, fallopian tube, peritoneal, prostate and pancreatic cancer, according to the National Cancer Institute.

HLOA-4C-VERT-REVcancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine. Hear a radio interview/podcast with Vourganti on the BRCA mutation and its relationship to prostate cancer.

Posted in cancer, genetics, health care, HealthLink on Air, illness, men's health, prevention/preventive medicine, public health, research, urology, women's health/gynecology

Breast cancer treatment affects bone mass, but you can protect your bone health

 

Ruban Dhaliwal, MD, discusses estrogen and bone loss. (PHOTO BY SUSAN KAHN)

Ruban Dhaliwal, MD, discusses estrogen and bone loss. (PHOTO BY SUSAN KAHN)

BY AMBER SMITH

No matter whether her breast cancer is treated with surgery, radiation or medications, a woman’s resulting loss of estrogen translates into bone loss – and an increased risk for fracture.

Advances in cancer treatment have significantly improved survival rates, but “cancer therapies are related to bone loss,” says Ruban Dhaliwal, MD, an expert in bone and mineral disorders. Dhaliwal is an assistant professor who sees patients at Upstate’s Joslin Diabetes Center and also conducts clinical research. Reduced bone mass leads to osteoporosis, in which bones become brittle and may break easily.

The risk of a spinal fracture is five times higher for breast cancer patients than for the general population, Dhaliwal explained in a presentation to staff at Upstate University Hospital this spring. She also told how the loss of bone mass that occurs with cancer treatment is substantially higher than the loss that occurs with normal aging.

Osteoporosis is prevalent among women, and fractures related to osteoporosis are more common among them than heart attacks, strokes and breast cancer diagnoses combined. Dhaliwal says the best protection is to build and maintain healthy bones, and screen for osteoporosis.

A bone density test similar to an X-ray can reveal bone loss. In some patients, doctors may monitor the continual process in which new bone tissue is formed as old bone tissue is reabsorbed, a process known as bone remodeling.

Bone mass forms from birth through adolescence. Bone mass generally remains stable for most women from the second decade of life until menopause, when it declines along with the reduced production of estrogen.

If a woman faces breast cancer, “no matter which chemotherapy we use, the time of menopause is pushed forward five to 10 years,” Dhaliwal says. Chemotherapy-induced menopause results in rapid bone loss. A woman’s individual risk of bone loss is related to the type of medication she takes, for how long and in what dose.

Hormonal therapy also induces bone loss in pre-menopausal women. Aromatase inhibitors, a type of hormonal therapy, cause an increase in bone turnover, bone loss and fractures — although evidence shows they do a good job preventing the return of breast cancers.

Bone loss is a concern for patients with other types of cancer, too. Men with prostate cancer see a decline in testosterone, and patients with thyroid cancer may need to keep their levels of thyroid stimulating hormone below normal, which leads to bone loss.

How to protect your bones

Bone mass is affected by genetics, nutrition, physical activity, underlying hormonal diseases, lifestyle and overall health. How best to maximize your bone mass?

  • Getting adequate calcium, from diet and/or supplements – a total of 1,000 to 1,200 milligrams a day.
  • Help your body absorb calcium by taking 600 to 800 international units of vitamin D daily.
  • Maintain a healthy weight.
  • Participate in weight-bearing exercises, such as walking.
  • Take measures to prevent falls in your home.
  • Limit excessive alcohol and caffeine intake.
  • Avoid tobacco.
  • Seek bone mineral density screening and discuss pharmacological treatment for bone loss, if necessary, with your health care provider.

Source: Endocrinologist Ruban Dhaliwal, MD

cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.

Posted in aging/geriatrics, bones/joints/orthopedics, cancer, diabetes/endocrine/metabolism, illness, Joslin Diabetes Center, medical imaging/radiology, prevention/preventive medicine, public health, research, safety, women's health/gynecology

Experiences with cancer point medical student toward career in immunotherapy research

BY JIM McKEEVER

Ogochukwu Ezeoke is excited about advances in cancer treatment, especially the idea of using a patient’s immune system to fight disease. Many breakthrough drug approvals in the past year have been immunotherapy medications, and the first-year medical student at Upstate wants to assess the clinical trial process that leads to those approvals.

Ogochukwu Esoke (PHOTOS BY RICHARD WHELSKY)

Ogochukwu Esoke (PHOTOS BY RICHARD WHELSKY)

Gary Brooks

Gary Brooks, who holds a doctorate in public health, is a mentor to Ezeoke.

This summer, Ezeoke and her mentor Gary Brooks, an associate professor in the College of Health Professions, will research racial and ethnic disparities among patients who enroll in clinical trials for new drugs.

“As cancer therapeutics evolve toward more directed drug activities, the investment in knowledge of histology-specific genetics will become even more necessary,” Ezeoke writes in her grant application. The duo received funding from the American Medical Association Foundation and the American Society of Clinical Oncology Conquer Cancer Foundation.

Born in Nigeria, Ezeoke came to United States in 2004 and studied at Binghamton University, graduating in 2011 with a degree in cell and molecular biology. She worked four years as a research study assistant in New York City, coordinating clinical trials at Memorial Sloan Kettering Cancer Center.

“It was inspiring getting to meet patients,” she says of her time there. “They were so positive despite the disease. It makes you want to do things to help them.”

Ezeoke’s career path is guided by her family’s experience with cancer. Her grandmother had breast cancer and died from an embolism after a mastectomy. Her father is a prostate cancer survivor.

She says cancer research and clinical trials represent necessary behind-the-scenes work in the fight against cancer, and she hopes to contribute to the effort.

cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.

Posted in cancer, drugs/medications/pharmacy, genetics, health care, health careers, medical student, research

Immune therapy: Training the body’s immune system to kill cancer

William Kerr, PhD, in his lab at Upstate. (PHOTO BY WILLIAM MUELLER)

William Kerr, PhD, in his lab at Upstate. (PHOTO BY WILLIAM MUELLER)

BY AMBER SMITH

Rarely does a primary tumor kill. In cancer, death is more typical after the cancer spreads, or metastasizes.

Upstate’s William Kerr, PhD, is a pediatric cancer researcher focused on making the immune system better at killing cancer. After a patient undergoes cancer treatment, he wants to be able to “mop up” any residual cancer cells or cancer stem cells that escape surgery or conventional therapies to cause relapse later on.

“You might not think those last bits are important, but that’s what leads to relapse a couple months or a couple years down the road,” he says. Already his work has demonstrated how deactivating a gene called Ship-1, which helps cancer cells grow, can allow NK cells — short for natural killer cells — to locate and kill cancer cells in the body.

He and Matthew Gumbleton, an MD/PhD student working in his lab, wondered if temporarily turning off the Ship-1 gene would make the NK cells hyper responsive, turning them into super killers? And would that wipe out tumor cells more efficiently?

“It was a bit of a wild, counterintuitive idea,” Kerr admits, “but Matt and I tried it — and it worked.”

Working with laboratory mice, the researchers showed they could extend survival in the case of lymphoma, a cancer of the lymph nodes.

Now, Kerr has been awarded a Fulbright Scholarship, which will allow him to continue his work with Eric Vivier, director of the prominent Center for Immunology in Marseilles, France. The two researchers will collaborate in person for six months, starting in September. They will focus on using small molecules or chemicals that remove the brakes that limit the NK cells’ killing of tumor cells.

cancercaresummerHLOA-4C-VERT-REVThis article appears in the summer 2016 issue of Cancer Care magazine. Hear an interview with Kerr on his research into prompting the body’s immune system to kill cancer cells and the accelerated efforts of American scientists to solve cancer by 2020.

Posted in cancer, genetics, health care, HealthLink on Air, international health care, medical student, research

Should you be getting 3-D mammograms?

Upstate radiologist Ravi Adhikary, MD, reviews images from a 3-D mammogram. (PHOTO BY SUSAN KAHN)

Upstate radiologist Ravi Adhikary, MD, reviews images from a 3-D mammogram. (PHOTO BY SUSAN KAHN)

Women with dense breast tissue have the most reason to seek 3-dimensional mammography, says Ravi Adhikary, MD, director of the women’s imaging section at Upstate.

Dense tissue appears white on a regular 2-dimensional mammogram, so it can mask cancer, which also usually appears white.

The 3-D mammography available at Upstate provides images of multiple slices of breast tissue. “We can see through that and find a mass that may be difficult to see otherwise,” Adhikary explains. This allows cancers to be detected earlier. He also says the more accurate images create fewer false positives, which means fewer unnecessary biopsies.

The newer technology exposes women to a lower dose of radiation. And, the breast compression time is shorter, which Upstate Radiology Director Jennifer Caldwell says increases patient comfort.

cancercaresummerHLOA-4C-VERT-REVThis article appears in the summer 2016 issue of Cancer Care magazineHear Adhikary and Jennifer Caldwell, Upstate’s director of radiology, discuss 3-D mammography in a radio/podcast interview with “HealthLink on Air.”

Posted in cancer, health care, HealthLink on Air, medical imaging/radiology, prevention/preventive medicine, public health, safety, technology, women's health/gynecology

Formerly known as cancer: Experts now view one type of thyroid growth as noncancerous

The thyroid is a small gland at the base of the neck. Using a new term for one type of thyroid nodule might make it easier for patients to discuss treatment options with their physicians.

The thyroid is a small gland at the base of the neck.

BY JIM HOWE

Thyroid cancer can usually be cured if caught early, and one type of abnormal thyroid growth may no longer be considered a cancer at all.

The thyroid, a small gland at the base of the neck, produces hormones that control metabolism — things like heart rate, body temperature and blood pressure — and can develop growths, often called nodules. With the prevalence of medical scanning, thyroid nodules are being discovered more frequently, often when the neck area is scanned for another reason.

Scott Albert, MD

Scott Albert, MD

While some nodules are cancerous and threaten to spread, others are “indolent,” meaning they tend to grow slowly, stay in one spot and not alter normal thyroid functions.

One type of thyroid nodule — affecting 10 percent to 20 percent of thyroid tumors — is so indolent that an international panel of experts recently recommended deleting the cancer term “carcinoma” from its name and treating it less aggressively.

This name change not only reflects a new approach to diagnosis and treatment, it can help avoid scaring the patient, explains Scott Albert, MD, division chief of breast, endocrine and plastic surgery at Upstate.

“By reclassifying this tumor and taking the word ‘cancer’ out, it may be helpful in having the discussion of how you may not need all the treatments that a typical thyroid cancer may get,” Albert said.

This might mean treating the nodule as more of a chronic disease to monitor, rather than surgically removing the entire gland. After the thyroid is removed, patients usually receive oral radioactive iodine or external beam radiation to finish off any remaining thyroid cells, and then patients take a thyroid hormone pill for the rest of their lives.

Chemotherapy is rarely employed for thyroid cancer, but some targeted drug therapies are coming into use.

In any case, Albert says, “the vast majority of patients do very well after the diagnosis of thyroid cancer and treatment.”

Thyroid cancer incidence

The American Cancer Society predicts 62,450 people will be diagnosed with thyroid cancer this year.

Nearly three of four will be women.

Layout 1hloa-art2This article appears in the summer 2016 issue of Cancer Care magazine. Hear a radio/podcast interview with Albert that explores this topic as well as the thyroid’s functions and the uses of scans, biopsies and radioactive iodine.

Posted in cancer, drugs/medications/pharmacy, health care, HealthLink on Air, illness, medical imaging/radiology, research, surgery

An aspirin a day: Can a pill protect you from colorectal cancer?

pillsAspirin has long been recommended to help prevent heart disease and reduce stroke risk in some patients. Now the U.S. Preventive Services Task Force says evidence shows the anti-inflammatory pill can reduce the risk of colorectal cancer.

But before adding aspirin to your daily intake, it’s important to weigh the risks and benefits with your primary care provider, says John Epling, MD, a member of the task force and the chair of Upstate’s department of family medicine.

John Epling, MD

John Epling, MD

Daily aspirin use can cause internal bleeding, and the drug is not for everyone.

“This is about risk and benefit,” Epling says. “People need to have their doctor’s input.”

He says primary care providers can calculate their patients’ risk for heart disease and stroke and estimate their bleeding risk before advising them to take aspirin.

The task force, which issues evidence-based recommendations about a variety of screenings and medications aimed at preventing illness and disease, says a low-dose aspirin regimen is most beneficial for:

* adults age 50 to 59,

* who are not at risk for gastrointestinal bleeding,

* who have a life expectancy of at least 10 years,

* and who are willing to take a low-dose aspirin daily for at least 10 years.

The task force guidelines say people from age 60 to 69 may also benefit, but their risk for dangerous side effects may be higher.

Evidence was not sufficient to show benefits for people younger than 50 or older than 70, and the task force did not consider people at higher risk for colon cancer. The new recommendation applies only to patients with average risk.

Research continues into exactly how aspirin affects solid tumors in the intestines and how soon its protective effect kicks in after someone starts taking it.

Layout 1This article appears in the summer 2016 issue of Cancer Care magazine.

Posted in aging/geriatrics, cancer, digestive/gastrointestinal, drugs/medications/pharmacy, health care, heart/cardiovascular, illness, prevention/preventive medicine, research, stroke

Making sense: How scientific data can be quantified to help patients

human body medical future

BY AMBER SMITH

Doctors wonder, “If I do ‘x’ procedure, is my patient likely to benefit?” and “Is the ‘y’ medication I prescribed having any effect?”

To answer these questions, doctors may turn to quantitative imaging, the extraction of numerical or statistical features – biomarkers — from medical images such as ultrasound, positron emission tomography, magnetic resonance imaging and others.

Ernest Scalzetti, MD

Ernest Scalzetti, MD

Upstate radiologist Ernest Scalzetti, MD, is contributing to the effort to quantify such information to help guide medical care.

To recognize the potential of quantitative imaging, you first have to understand that a biomarker is something that can be objectively measured to detect the presence of some phenomenon. Fetal measurements are used to determine the health of a developing baby, for example, and the volume of blood leaving the heart is useful in assessing congestive heart failure.

Both of these examples rely on various types of medical imaging, a field whose progress parallels with advances in the understanding of the molecular underpinnings of diseases “and the rise of a more statistical and evidence-based approach to diagnosis and treatment,” Scalzetti explains with colleagues in a paper in the journal Academic Radiology.

For some aspects of cancer care, anecdotal information has been collected from multiple patients over time and standardized into a format that allows doctors to “stage” particular cancers. This is how doctors are able to accurately tell newly diagnosed patients about the prognosis of their disease and what treatments have the best outcomes.

Scalzetti says many other pieces of information can potentially be quantified into other tools to help doctors help their patients, to help assess procedures and medications.

Even with new ways to harness scientific data, he does not expect the doctor to be replaced by an algorithm. “It’s the physician’s job to integrate all of this scientific information, to arrive at what is best for the patient,” he says. “The goal is to give the individual the best chance at living his or her life.”

Layout 1This article appears in the summer 2016 issue of Cancer Care magazine.

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

Julia’s dream: prosthetics for a better world

Christopher Neville, PT, PhD, and research assistant Julia Rogers in the Motion Analysis Lab at Upstate. They are reviewing files associated with Neville’s studies on the mechanical effects of flatfoot deformity. Photo by Susan Keeter

Christopher Neville, PhD, a physical therapist and associate professor of physical therapy education, and research assistant Julia Rogers in the Motion Analysis Lab at Upstate. They are reviewing files associated with Neville’s studies on the mechanical effects of flatfoot deformity. (PHOTOS BY SUSAN KEETER)

BY SUSAN KEETER

Julia Rogers’ dream is to design prosthetics for amputees.

As a high school student in Lagos, Nigeria, Rogers saw people who faced tremendous obstacles trying to meet their basic needs. “Dad would be driving me home from school, and our car would be swarmed by people who were missing limbs, blind, children barely able to walk,” she explains.  “They begged, ‘I am hurt; I need help.’ The only power they had was to use their disabilities to gain sympathy and a few coins from passers-by.

“In our world, we have so much technology, so much everything,” Rogers continues. “Nobody should live with anything less than what is possible.”

That belief led Rogers, a biomedical engineering student at Syracuse University, to look for experience using technology to develop orthotics and prosthetics for people with mobility disabilities. Orthotic devices support or brace a weak body part, such as a knee brace. Prosthetic devices replace or augment a missing or impaired body part, such as an artificial arm or leg.

She read about the research of Christopher Neville, PhD, and, via email, expressed interest in working with him in the Motion Analysis Lab at Upstate Medical University.

Neville, who is principal investigator for several clinical trials, responded to Rogers’ interest. “People working in this area often come through an engineering program,” he explains.  “It’s well worth it to give Julia the opportunity to see inside the world of prosthetics and orthotics. It’s a good way for her to see what she really likes.”

As a volunteer research assistant, Rogers is analyzing data from Neville’s clinical trial  titled “Kinematic and Kinetic Effects of Orthotic Devices for Subjects with Stage II Posterior Tibial Tendon Dysfunction.”

Julia Rogers holds an orthotic device used to help people with progressive flat foot.

Rogers holds an orthotic device used to help people with progressive flatfoot.

People suffering from posterior tibial tendon dysfunction, commonly known as progressive flatfoot,  wear ankle-foot orthoses, or corrective devices, to reduce pain and assist with daily function. The goal of Neville’s clinical trial is to test the clinical effectiveness of the braces and understand how they work.

During the testing completed in the Motion Lab, subjects were photographed wearing light-sensitive markers on their thighs, feet and lumbar areas while a camera recorded their movements. Using The MotionMonitor visualization software from a Chicago-based company (Innovative Sports Training Inc.), Neville is able to analyze the gait of the subject three-dimensionally and in motion.

To the average viewer, the images look much like those created by architects and cartoon animators using computer-assisted design software.

Rogers’ task is to help analyze the data collected when the subjects were recorded. She began with Excel spreadsheets, looking for common trends in the data. Once she gained an understanding of the data, Neville encouraged her to consider questions such as, “What is the data showing us? How are the foot and ankle braces working for the people in the study?”

This research experience is providing Rogers with a variety of opportunities, such as learning to use The MotionMonitor software and going to the Upstate Bone and Joint Center to observe the process of casting patients’ extremities to fit them for orthotic devices. Neville has also put her in touch with Hanger Clinic, a prosthetic and orthotic practice that works with Upstate’s Orthopedics Department.

“Biomedical engineering is hands-on, physical,” says Rogers as she considers the value of the work. “I’ll be able to have an impact on people’s lives.”

Three-dimensional model of the foot of a patient enrolled in a clinical trial on flat foot deformity. From the lab of Christopher Neville, PhD, Upstate Medical University. (Model generated with The Motion Monitor (Innsport Inc. Chicago, IL).

Three-dimensional model of the foot of a patient enrolled in the clinical trial on flatfoot deformity, from Neville’s lab at Upstate. (Model generated with The MotionMonitor, from Innsport Inc., Chicago, Ill.).

Posted in bones/joints/orthopedics, disability, education, health care, health careers, physical therapy/rehabilitation, public health, research, technology, volunteers