Lasers treat pediatric brain tumors, epilepsy

Maisie Chapman was treated for seizures with a laser beam. (PHOTO BY SUSAN KAHN)

Maisie Chapman was treated for seizures with a laser beam. (PHOTO BY SUSAN KAHN)

BY AMBER SMITH

Maisie Chapman of Cortland was just 3 months old when her seizures began. Ethan Stinson of Pierrepont Manor, near Watertown, was 15. Both wound up as patients of  Zulma Tovar-Spinoza, MD, a pioneering pediatric neurosurgeon at Upstate University Hospital in Syracuse.

Both patients were treated with image-guided laser ablation, a technique that’s an option for some patients with brain tumors or certain types of epilepsy.

Zulma Tovar-Spinoza, MD

Zulma Tovar-Spinoza, MD

Guided by magnetic resonance imaging, Tovar-Spinoza operates through a 4-millimeter opening in the skull. She directs a thin laser light beam, which uses heat to destroy the tumor or the area where seizures originate. Her work is done in a modern surgical suite that is equipped with an MRI machine.

“Neurosurgery keeps progressing to try to do more less-invasive procedures,” she explains. “This technology was developed to address brain lesions without having the complexity of open surgery.”

Most patients are able to go home the next day. In some cases, multiple treatments are required.

Meghan Chapman’s daughter, Maisie, is 4 now and doing better after two laser treatments performed by Tovar-Spinoza.

Initially the little girl’s neurologist treated her seizures with medications. Between the seizures and the side effects, Maisie’s development from infancy into her toddler years was stalled.

Neurological testing revealed that her seizures originate from one spot in her brain. Maisie underwent her first laser ablation in January 2015 and again in September 2017.

“Right now, everything looks good,” Chapman’s mother says, explaining that Maisie has been free of seizures and hopes to taper off medications soon.

Since the last treatment by Tovar-Spinoza, Chapman says her daughter’s development is significantly back on track. She’s optimistic because Maisie talks more. She soon started to put sentences together and use new words.

Laser technology is destroying malformed blood vessels in Ethan Stinson's brain. (PHOTO BY SUSAN KAHN)

Laser technology is destroying malformed blood vessels in Ethan Stinson’s brain. (PHOTO BY SUSAN KAHN)

Ethan Stinson is also on the mend, although he has had three treatments with the laser and expects to have more.

His mother, Brittany Stinson, says, “Ethan started having seizures kind of out of nowhere. We started noticing it toward the end of February 2017.”

He was diagnosed with eight cavernous angiomas in his brain. Those are areas where malformed blood vessels create an abnormality called a benign vascular lesion. Some vessels were bleeding in deep areas of Ethan’s brain. Open surgery offered many possible complications. Ethan’s neurologist in Watertown referred him to Tovar-Spinoza at Upstate.

Ethan had recently gotten his driving permit. He was told he couldn’t drive, and he couldn’t play contact sports.

“It was pretty hard for him to deal with all of that, being a high schooler,” his mother recalls.

After the first laser treatment, she prepared herself to see Ethan in the recovery room. “I was shocked,” she says. Her son was sitting up in the hospital bed working ona Sudoku puzzle. He went home from the hospital the next day.

The family hopes Ethan can finish his treatments before his senior year of high school begins in the fall.

He’s been able to swim, and he expects to run track. His long-term goals are to drive, and return to playing baseball and soccer.

“We are very excited, as he hasn’t had a seizure in almost five months, after his first ablation,” Brittany Stinson says. “We’re taking it step by step by step but very grateful for having the opportunity to be treated with this modern laser technology at Upstate.”

MRI-guided laser ablation:

—  is a minimally invasive neurosurgical technique used to treat brain tumors and selective intractable epilepsy patients.

— uses magnetic resonance images before and during the operation, so neurosurgeons can precisely target the laser, avoid healthy brain tissue and verify in real time the ablation of the area of concern.

— gives neurosurgeons better access to tumors or lesions deep in the brain or too close to sensitive structures for traditional open surgery.

== uses a tiny opening in the skull that allows patients to recover more quickly and with less pain than in open surgery.

Upstate Health magazine spring 2018 cover

Upstate Health magazine spring 2018 cover

This article appears in the spring 2018 issue of Upstate Health magazine. 

Posted in brain/spine/neurosurgery, health care, patient story, surgery, technology, Upstate Golisano Children's Hospital/pediatrics | Tagged , , , , ,

Emergency care takes time … for many reasons

Nurses Arlinda Carey and Melanie Charleston prep an incubator in the back of an ambulance at Upstate University Hospital’s downtown emergency department.  They are members of Upstate’s pediatric critical care transport team who offer intensive care to critically ill children at other hospitals from the Canadian to the Pennsylvania borders. They are pictured with emergency medical technician Marc Battaglia, right. (PHOTO BY JOHN BERRY)

Nurses Arlinda Carey and Melanie Charleston prep an incubator in the back of an ambulance at Upstate University Hospital’s downtown emergency department.  They are members of Upstate’s pediatric critical care transport team who offer intensive care to critically ill children at other hospitals from the Canadian to the Pennsylvania borders. They are pictured with emergency medical technician Marc Battaglia, right. (PHOTO BY JOHN BERRY)

Doctors, nurses and technicians working in Upstate University Hospital’s emergency department strive to provide care quickly, but many aspects of good care take time.

The typical emergency visit in the United States averages four hours, and it varies based on whether you ultimately are admitted to the hospital. Your experience may vary depending on what your problem is and depending on how many other people are seeking care at the same time.

Patients are not seen on a first-come, first-served basis in emergency departments. Staff “triage” people as they arrive, putting the most seriously injured or ill at the front of the line.

Diagnosing what’s wrong with someone is a thorough process that may take a while.

For instance, X-ray results or the results of blood or urine analysis may not be ready for 90 minutes. Ultrasound or computerized tomography scans may not be complete for two to three hours. And if a patient requires a specialist, summoning an orthopedic surgeon, an eye doctor or cardiologist could take a few hours — again, depending on how many other people concurrently need the care of that specialist.

Often in the emergency department, patience is a requirement.

Upstate Health magazine spring 2018 cover

This article appears in the spring 2018 issue of Upstate Health magazine. 

Posted in emergency medicine/trauma, health care

Recipe: Crunchy ‘Oven-Fried’ Chicken Nuggets

chicken nuggets This recipe from “The Great American Eat-Right Cookbook” is a healthful rendition of chicken nuggets – and likely to appeal to kids and adults. The coating adds crunch, while keeping the meat tender and moist.

Preparation takes less than a half hour, and this recipe serves four.

Chef’s tip: Line your baking sheet with aluminum foil or parchment paper to speed cleanup.

Preparation

  1. Preheat the oven to 400 degrees. Place a cooling rack on a rimmed baking sheet.

2. In a food processor, pulse the melba toast until pieces are about ⅛ inch in size, with some smaller and larger pieces. Don’t over-process. Add oil and pulse once or twice, or until crumbs are just moistened. (You can also use a rolling pin or a meat mallet to crush the toasts by hand in a zip-top bag. Then mix the oil and crumbs together in a bowl.) Transfer crumbs to a plate.

3. In a bowl, beat egg. Add mustard, oregano, salt and garlic powder and beat to combine. Dip chicken in egg mixture, then in crumbs, pressing to coat all sides of the meat. Place on the rack.

  1. Bake for 15 minutes, or until cooked through.

Ingredients

10 whole-grain or classic melba toasts (2 pouches)

1 tablespoon canola oil

1 egg

1 teaspoon Dijon mustard

¼ teaspoon salt

¼ teaspoon dried oregano

¼ teaspoon garlic powder

1 pound boneless, skinless chicken breasts, cut into 2-inch “nuggets”

Nutritional information

230 calories

8 grams fat

120 milligrams cholesterol

335 milligrams sodium

10 grams carbohydrate

1 gram fiber

27 grams protein

Source: American Cancer Society website

Cancer Care magazine winter 2018 issueThis article appears in the winter 2018 issue of Cancer Care magazine.

Posted in cancer, health care, recipe

Teens ‘Look Good’ and ‘Feel Better’

BY SUSAN KEETER

“It was as if she was trying to disappear inside her clothes,” explains nurse Kristen Thomas, remembering hot summer days when a teenage cancer patient showed up for appointments hidden under a woolen ski cap and layers of heavy clothing.

When Thomas overheard that patient confess that dealing with her changed appearance was harder than coping with cancer, Thomas knew she had to do something. Melanie Comito, MD, chief of the Upstate Cancer Center’s Waters Center for Children’s Cancer and Blood Disorders, guided Thomas to the American Cancer Society’s “Look Good Feel Better” program. It is a national program that teaches beauty techniques to people with cancer to help them manage appearance-related side effects of cancer treatment.

Thomas and Molly Napier, nurse manager of the pediatric outpatient unit, applied for the Upstate Cancer Center to become the first “Look Good Feel Better” site for teens in New York state.

On Oct. 23, patients Artesia Gjoncari, Julia Nguyen, Taylor Way and Amanda Wilson gathered in a conference room at the cancer center. Licensed cosmetologists Maria Ascrizzi and Angela McBride greeted each of the young women with a gift bag of cosmetics donated by companies including Estee Lauder, Smashbox and Burt’s Bees. Ascrizzi and McBride offered step-by-step instruction on everything from wearing turbans to drawing natural-looking eyebrows.

The room was quiet at first, and two girls sat alone. But, thanks to experimenting with eye shadow and wig brushes, the girls started talking and laughing, comparing makeup tips and gulping down soft drinks and snacks.

“It’s not just about makeup, it’s about making connections with other teens in a fun environment,” explains Thomas. “Cancer treatment can be isolating.”

“Side effects can take a big toll. Patients lose confidence,” notes Stephanie D’Amico of the American Cancer Society. “This program is transformative.”

Ascrizzi and McBride have been volunteering with “Look Good Feel Better” for adults since 1989, but this was their first experience working with teens with cancer. Ascrizzi, a 20-plus year cancer survivor, says that they are motivated by the opportunity to give back in a nontraditional way.

Upstate plans to offer the teen program several times a year. While the goal is to keep the sessions small and intimate, “Look Good Feel Better for Teens” at Upstate will be open to any teenager with cancer in New York state.

The young women from ‘Look Good Feel Better’:

Artesia Gjoncari, 20, of Syracuse

Artesia Gjoncari

Artesia Gjoncari

Diagnosis: osteosarcoma

Symptoms: knee pain

Physicians: Timothy Damron, MD, and Philip Monteleone, MD

Treatment: chemotherapy, surgery and physical therapy

Her thoughts: “It was a shock when my waist-length, curly hair fell out two weeks after I started chemotherapy. At the session, I learned how to do my eyebrows and how to tie scarves.”

Julia Nguyen, 16, of Camillus

Julia Nguyen

Julia Nguyen

Diagnosis: primary mediastinal large B-cell lymphoma

Symptoms: swelling in face, not feeling well

Physician: Irene Cherrick, MD

Treatment: chemotherapy

Her thoughts: “I’d never used makeup before, so it was all new, and fun. I liked learning about wearing a scarf with a prom dress when you have a chest port.”

Taylor Way, 15, of Cuyler

Taylor Way

Taylor Way

Diagnosis: Ewing’s sarcoma

Symptoms: hip pain

Physicians: Philip Monteleone, MD, and Paul Aridgides, MD

Treatment: chemotherapy and radiation

Her thoughts: “It was nice to learn about makeup, especially eye shadow. But when I lost my hair, I decided there was no need to wear a scarf or wig. This is who I am now.”

Amanda Wilson, 16, of Tully

Amanda Wilson

Amanda Wilson

Diagnosis: non-Hodgkin lymphoma

Symptoms: chest pain

Physician: Andrea Dvorak, MD

Treatment: chemotherapy

Her thoughts: “I spent a lot of time playing with makeup and watching how-to videos when I was in the hospital. The session added to my knowledge, especially about good sanitary practices. You can’t have fake nails when you’re in treatment because of bacteria.”

How to participate

Are you a teenager or adult with cancer interested in a “Look Good Feel Better” session?

In the Syracuse area, sessions are offered at the Upstate Cancer Center (teens and adults) and the East Syracuse office of the American Cancer Society (adults only). Contact the Upstate Cancer Center, 800-464-HOPE (4673), or the American Cancer Society at cancer.org or 800-227-2345.

Are you a licensed cosmetologist interested in becoming a “Look Good Feel Better” volunteer?

Contact the American Cancer Society.

Tips from the cosmetologists

Losing your hair?

Some cancer patients, like Taylor Way, are comfortable showing their bald heads when chemotherapy or radiation have caused hair loss. If that’s not for you, there are wigs, hats and turbans for your head and makeup solutions to camouflage the loss of eyelashes and eyebrows.

Cut your hair and save a lock

If your doctor says that you are likely to lose your hair during treatment, consider cutting it short before you begin to lose it. Save a lock of hair, so you can match the color if you decide to get a wig.

If your hair has not been colored or permed, and you need to cut off at least 6 inches, consider donating it to a nonprofit organization that makes wigs for people with medical hair loss.

Scarves and turbans

Use cotton, not silky fabrics, which will slip on your head.

Make Your Own Turban

Creating a turbanYou can make a turban out of a T-shirt.

  1. Use any all-cotton T-shirt. Cut straight across the shirt, just under the sleeves.
  2. Take the bottom portion of the shirt (the “tube”) and center it on your forehead at your hairline.
  3. Holding each side of the “tube” at the back of your head, cross the piece of fabric in the right hand over the left, creating a figure 8.
  4. With the fabric crossed, pull the lower half of the figure 8 from the back of your head to the front, creating a headband.
  5. Tuck any extra fabric under the twisted band.

No eyelashes?

Create the illusion of lashes by using a fine-tip eyeliner to draw a series of dots at the edge of your upper and lower lids. These will look like eyelashes when someone looks at you directly. Want a bolder look? Use an eyeliner pencil. Apply a thin long line across the upper and lower lids. Smudge for a softer look.

Avoid using false eyelashes with adhesive. The glue may cause skin damage and infection.

No eyebrows?

Draw eyebrows

drawing eyebrowsTo fill in a thinning brow or re-create an entire eyebrow:

  1. Find the brow bone with your fingertip. Use an eyebrow pencil.
  1. Hold the pencil straight against your nose, parallel to the inside corner of your eye. Draw a dot just above the brow bone. This is where your eyebrow should begin.
  1. Looking straight ahead, place the pencil parallel to the outside edge of your iris (the colored part of your eye.) Place a dot where the highest point of the brow line should be.
  1. Place the pencil diagonally from the bottom corner of your nose, past the corner of your eye, and draw a dot on your brow bone. Make sure the outer edge of the brow isnot lower than the inside.
  1. Once the dots are placed, connect them with into a brow line with feathery strokes of color. Make the brow fuller on the inside (near your nose).

Wigs

Wigs are made of either synthetic material or human hair. Most are made with more hair than is needed, so they can be cut and styled.

A turban or wide headband worn with a wig camouflages the hairline and makes the wig look more natural.

Wig care

Avoid using standard hairbrushes. They can stretch and damage the hair on the wig. Use a wide brush with loose bristles. Think reverse when brushing your wig. Start at the ends and work up.

Don’t use hair dryers, crimpers or curling irons on wigs.

Don’t cook, grill or shower in a wig. Avoid steam heat from clothes dryers and microwaves. The wig will frizz or melt.

Wash your wig every week or two. Fill a sink with water and add a few drops of clear dish soap. Submerge the wig and swish it around. Drain the sink and refill it with clear water. Submerge the wig in the clear water to wash out the soap. Wrap the wig in a towel. Avoid scrubbing, which causes frizz. Dry your wig on a shower head or a bottle, not a wig stand. (The stand will stretch the wig.)

Changes in your skin?

Concealer

Dark circles under your eyes, redness and discoloration can occur during cancer treatment. To camouflage skin changes, use a concealer that matches your skin color. Apply dots at areas that you wish to correct, then blot or lightly pat using your finger or a sponge.

Moisturizer, sunscreen, perfumes, etc.

With chemotherapy — Moisturizer and sunscreen are important because chemotherapy can cause skin to become dry and more sensitive to sun.

With radiation — Don’t use cosmetics, perfumes or deodorants on treated areas without checking with your physician. Avoid exposing treated areas to the sun.

Done with chemotherapy?

Get new makeup after you are finished with treatments. Dispose of the makeup you used while you were in treatment. It will have absorbed the chemotherapy medication when it touched your skin.

Got a chest port?

Create a scarf with a rosette

Creating a scarfIf you’d like to wear something with a low-cut neckline,  get an extra large (one yard) square silky scarf that complements your outfit (For example, a red scarf for a black dress). It’s a great solution for a prom dress or other formal attire.

  1. Fold the scarf diagonally in half to create a triangle.
  2. Knot the two long points together into a tight knot.
  3. Put the knot over your left wrist.

— With your left hand, hold the point of the bottom layer of the scarf.

  1. Hold the point of the top layer of the scarf in your right hand and pull the two points, creating a rosette.

— Then, take the opposite ends and tie them together, so the scarf looks like a sling.

— Hang the knotted area of the scarf over your arm.

— Grasp the untied/knotted points of the scarf with the same hand.

— With the opposite hand, hold the piece of scarf closest to you. Pull your arm through, and it will create a knot.

  1. Drape the scarf over your shoulder.

— Use a safety pin or decorative brooch to hold the scarf in place on the back of your dress or on your bra strap.

Cancer Care magazine winter 2018 issueThis article appears in the winter 2018 issue of Cancer Care magazine.

 

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

Group offers helping hand to cancer patients in need

Joseph Michael Chubbuck with his dog, Shadow, in May 2011. Shadow was battling cancer at the time this photo was taken and died in 2012, while Chubbuck was in an intensive care unit fighting his own cancer.

Joseph Michael Chubbuck with his dog, Shadow, in May 2011. Shadow was battling cancer at the time this photo was taken and died in 2012, while Chubbuck was in an intensive care unit fighting his own cancer.

BY JIM HOWE

Central New York cancer patients facing money problems can get some help from a foundation dedicated to a young Rome, N.Y., native who died of a rare and aggressive cancer.

Everything from help with travel expenses to arranging a final holiday meal for a dying patient and her family has been paid for with grants of up to $300 per patient from the Joseph Michael Chubbuck Foundation, based in Rome.

Those grants total about $43,000 and include help to roughly a hundred patients a year, as well as donations to several of Central New York’s treatment centers, such as $1,000 for a special chair in a treatment room at the Upstate Golisano Children’s Hospital. The foundation helps residents of Onondaga, Oneida, Madison and Herkimer counties and honors the memory of Joseph Michael Chubbuck, who was diagnosed with a rare, aggressive and unidentifiable form of cancer at age 21 in March 2012, while a student at Utica College and member of the Army National Guard.

Chubbuck in his Army National Guard uniform in August 2011. He was diagnosed with a rare form of cancer in March 2012.

Chubbuck in his Army National Guard uniform in August 2011. He was diagnosed with a rare form of cancer in March 2012.

The cancer, discovered during an emergency appendectomy, held a genetic mutation commonly found in a rare, incurable type of sarcoma. He underwent major surgeries and aggressive chemotherapy treatments at various cancer centers around the country and died in August 2013 at age 22.

Before his death, he asked his family to start a charity to help others facing cancer. The foundation was launched and began helping cancer patients in January 2015.

The aid is often arranged through a medical social worker, such as Chevelle Jones-Moore of Upstate, who says the foundation money has helped numerous patients at the Upstate Cancer Center and the children’s hospital.

“They are very consistent, they are faithful, they are dependable, they are flexible, and they are willing to hear what you have to say, so they can figure out how they can accommodate your needs,” Jones-Moore says of the foundation.

Barbara Chubbuck, Joseph’s mother and the foundation’s vice president, says, “When an individual is fighting cancer, they shouldn’t have to worry about how their monthly bills are going to get paid. Knowing that the foundation can help ease the financial burden of these patients, even a little, makes me feel good. I know it is what my son wanted.”

For more about the foundation, including how to apply for help, go to its website, the jmcf.orgwhich also offers general information and advice for cancer patients.

This article appears in the winter 2018 issue of Cancer Care magazine.

Posted in cancer, community, fundraising, health care

Ethics consult: Will your health care proxy honor your wishes?

Thomas Curran, MD, and Robert Olick, JD, PhD, are hospital ethics consultants and members of Upstate’s bioethics and humanities faculty

They provide advice to patients and families who find themselves in ethically charged situations surrounding care at Upstate University Hospital. Disagreements having to do with end-of-life care are one of the most common reasons for a consult.

“When the patient has mental capacity, there’s no argument. Patients are allowed to make what you could consider to be bad decisions if they have capacity. It’s when they lose capacity and you have to figure out ‘What would this patient want?’ where it gets muddy,” says Curran.

Robert Olick, JD, PhD, left, and Thomas Curran, MD

Robert Olick, JD, PhD, left, and Thomas Curran, MD

He and Olick tell about a muddy situation:

A 63-year-old woman arrived at the emergency department with sudden respiratory failure. She had lung cancer that was so advanced she had to be placed on a breathing machine. Chemotherapy was not an option. Her diagnosis wasn’t a surprise; the woman had known for 10 months about a mass in her lung and ignored treatment recommendations.

Because of her condition, her lucidity waned. The woman’s ability to make decisions would come and go.

When she was lucid, she indicated she wanted to go home to die in peace.

When she was not lucid, the person she had selected as her health care proxy, her husband, insisted that she wanted life-sustaining measures.

Sometimes when she was lucid and her husband was present, the woman would defer to him.

So the ethicists sought to get family members and caregivers in the same room at the same time, when the woman was lucid, to discuss her wishes. They talked about how she neglected to seek care for 10 months, and how that may have foreshadowed the type of care she really wanted.

“The principle is to respect patient autonomy,” says Curran.

Olick points out that “it’s also important to understand the husband’s role as health care proxy only has force if she lacks capacity.

“It’s her wishes that control what happens. He doesn’t have authority to override that.”

In the end, the woman died in the hospital before things could be settled.

Curran says the situation illustrates the importance of choosing a proxy who will respect your wishes. “In this case, she appeared to have done a poor job of selecting a health care proxy because he appeared to be acting in opposition to her wishes.”

Ensuring your end-of-life wishes are followed

  1. It takes foresight and courage to confront the future possibilities of your mortality — and to be open about that with the people who care about you most.
  2. Carefully choose a proxy (someone who will speak on your behalf if you are incapacitated) who will be able to bear the burdens of the decisions that may be placed on him or her.
  3. In addition to completing the proper paperwork, conversations are important. Consider looping in multiple family members or loved ones, plus your doctor.

Cancer Care magazine winter 2018 issueHealthLink on Air logoThis article appears in the winter 2018 issue of Cancer Care magazine. Click here to hear Curran and Olick discuss another ethics case they handled at Upstate University Hospital.

Posted in bioethics & humanities, cancer, death/dying, health care, HealthLink on Air | Tagged ,

Peer experts share best practices

The Upstate Cancer Center

The Upstate Cancer Center

The Upstate Cancer Center has joined the Association of American Cancer Institutes, an organization dedicated to reducing the burden of cancer by enhancing the impact of North America’s leading academic cancer centers.

The association, based in Pittsburgh, is made up of National Cancer Institute-designated centers and academic-based cancer research programs that receive NCI support.

“Membership in this organization is another distinguishing feature of the Upstate Cancer Center, as it recognizes our expertise in various areas, from our faculty to our research to our patient care,” said Interim Director Jeffrey Bogart, MD, professor and chair of the department of radiation oncology.

A key element of the association’s mission is to assist the centers in keeping pace with the changing landscape in science, technology and health care. This is done by gathering and sharing best practices among cancer centers and providing a forum for members to address common challenges. The association also educates policymakers about the important role cancer centers play in advancing cancer discovery.

Cancer Care magazine winter 2018 issueThis article appears in the winter 2018 issue of Cancer Care magazine.

Posted in cancer, health care

St. Baldrick’s money to boost clinical trials

St. Baldrick’s Day in Syracuse raises money for the cure of childhood cancer. Participants are shown at Kitty Hoynes, an Irish pub in Syracuse, on April 2, 2017. Last year, more than 530 people had their locks shaved off in honor of cancer survivors and those who have passed away. (PHOTO BY DENNIS NETT/syracuse.com)

St. Baldrick’s Day in Syracuse raises money for the cure of childhood cancer. Participants are shown at Kitty Hoynes, an Irish pub in Syracuse, on April 2, 2017. Last year, more than 530 people had their locks shaved off in honor of cancer survivors and those who have passed away. (PHOTO BY DENNIS NETT/syracuse.com)

Upstate is one of 39 institutions nationwide selected to share $2.2 million in grant money from the St. Baldrick’s Foundation to advance patient access to clinical trials.

Having access to clinical trials is vital to the treatment of childhood cancers. Nearly 80 percent of childhood cancer patients at Upstate are enrolled in a clinical trial, a number consistent with national trends.

The main St. Baldrick’s fundraisers are events in which men, women and children raise money by pledging to have their heads shaved. Kitty Hoynes hosted 530 “shavees” in 2017, and the Syracuse pub raised the most money in the country — more than $540,000 — for the second year in a row.

Melanie Comito, MD, chief of pediatric hematology/oncology and professor of pediatrics at the Upstate Golisano Children’s Hospital, is appreciative of the St. Baldrick’s support and says it helps toward the long-term goal of curing all children with cancer. “With the new grant,” she says, “we are able to adequately staff our clinical research program, making it possible to provide the most up-to-date care to the children and teenagers in our region.”

Cancer Care magazine winter 2018 issueThis article appears in the winter 2018 issue of Cancer Care magazine.

 

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

Many options: Caregiving team considers multiple factors in managing patients with lung cancer  

BY AMBER SMITH

People diagnosed with lung cancer a century ago had few options.

The earliest surgical techniques, in the 1930s, involved cutting open a patient’s chest and removing an entire lung. While that is sometimes still necessary today, surgeons are more apt to operate through tiny incisions to remove just a lobe, or a piece of a lobe. They may also pair surgery with radiation therapy, or recommend radiation therapy instead of surgery.

Jeffrey Bogart, MD, Upstate chair of radiation oncology. (PHOTO BY SUSAN KAHN)

Jeffrey Bogart, MD, Upstate chair of radiation oncology. (PHOTO BY SUSAN KAHN)

Despite progress in diagnosis and treatment, lung cancer remains the most common cause of cancer death in both men and women.

Up to 85 percent of lung cancers are non-small cell lung cancers, which arise from a variety of lung cells. For patients with this diagnosis, optimal care comes from a collaborative multidisciplinary approach that includes thoracic surgeons, medical oncologists, radiation oncologists, pulmonologists and pathologists, according to an overview of lung cancer management written by a radiation oncologist and a thoracic surgeon from Upstate and published in the Journal of Oncology Practice in February 2017.

Multidisciplinary care is offered at most academic medical centers, including the Upstate Cancer Center. It means experts from several medical backgrounds confer together about what’s best for each patient. In deciding what to recommend, they consider the tumor’s size and location, its cellular makeup and the patient’scondition and desires.

This era holds many options.

Best care comes from team

Radiation oncologist Jeffrey Bogart, MD, and thoracic surgeon Jason Wallen, MD, explain in their article that the standard therapy for patients with an early-stage lung cancer is to remove the affected lobe through minimally invasive surgery.

Jason Wallen, MD, Upstate chief of thoracic surgery. (PHOTO BY SUSAN KAHN)

Jason Wallen, MD, Upstate chief of thoracic surgery. (PHOTO BY SUSAN KAHN)

Minimally invasive surgery is preferred because patients recover more quickly, have their chest tubes removed sooner after surgery and require fewer days of hospitalization. Also, their survival rates four years later are higher than for those who undergo surgery in which their chest is cut open.

Doctors want to determine if survival and the risk of cancer recurrence is the same when they remove just a portion of the lobe, rather than the entire lobe.

Studies underway in the United States and Japan focus on which procedure is best for patients with lung masses that are smaller than 2 centimeters (.78 inches) in diameter.

Additional research since the mid-1990s has compared treatment options for patients who are at high risk for lung surgery — including those who smoke, have other health problems or are older than 60.

Especially for these patients, the best way of treating lung cancer may mean removing just a wedge or a section of a lobe, perhaps combined with or followed by some type of radiation therapy. Or, it may mean undergoing stereotactic radiotherapy instead of surgery.

With so many options to consider, and so much ongoing research, patients with a lung cancer diagnosis get the best care at an academic medical center, as it offers a team approach.

Radiation therapy options

Stereotactic body radiotherapy

high-dose radiation precisely targets the tumor, requiring fewer treatments than traditional external beam radiation.

Brachytherapy

radioactive material is placed inside the body, so that radiation can be delivered to a specific area.

Ablative techniques

relying on advanced imaging, a thin, needlelike probe goes through the skin and into a tumor near the outer edge of the lung, and then high-energy radio waves heat the tumor to destroy cancer cells.

Fractionated radiotherapy

a technique in which the total radiation dose is divided into multiple small doses that are dispensed over several days to reduce toxic effects on healthy cells.

Lung surgery options

Lobectomy

the surgeon removes the lobe containing the tumor; the right lung has three lobes, and the left has two.

Anatomic segmentectomy

the surgeon removes the tumor without removing excessive amounts of healthy lung tissue in this technically demanding procedure.

Wide wedge resection

the surgeon removes a triangle-shaped slice of tissue containing the tumor and a small amount of healthy tissue around it.

Robotic surgery

Upstate has the only robotic thoracic surgery program in the region, providing advanced, minimally invasive options.

Cancer Care magazine winter 2018 issue

This article appears in the winter 2018 issue of Cancer Care magazine.

 

 

Posted in cancer, health care, lung/pulmonary, medical imaging/radiology, research, surgery | Tagged , , , , , ,

Ongoing battle: Vigilance helps contain a rare, aggressive thyroid cancer

BY AMBER SMITH

The man was in his mid-50s in 2011 when he sought care for enlarged lymph nodes in the back of his neck. It was thyroid cancer.

Surgeons in Binghamton removed his thyroid gland, and the man received radioactive iodine therapy afterward.

That typically is all the treatment that’s required.

Abirami Sivapiragasam, MD

Abirami Sivapiragasam, MD

But when the man returned six months later for a follow-up scan, more cancer showed up. That’s when he was referred to doctors at Upstate. He had more tissue removed from the left side of his neck. Then six months after that, cancer appeared again, and more tissue had to be removed from the right side.

As a patient at Syracuse’s only academic medical center, the man received expert care — while his physicians simultaneously learned and taught others about his unique type of thyroid cancer. They wrote about his case in the journal Case Reports in Oncological Medicine to educate other physicians.

The patient had an uncommon type of thyroid cancer, a “tall cell variant,” which grows and spreads rapidly, along with a genetic mutation that seems to make cancer more likely to grow and spread to other parts of the body.

It was 2014 when one of the man’s routine follow-up scans revealed cancer where his thyroid used to be. “At that time, he was symptomatic, with more fatigue and weight loss,” Abirami Sivapiragasam, MD, wrote in the journal. She’s an assistant professor of medicine at Upstate, specializing in hematology and oncology.

Joseph Fullmer, MD, PhD

Joseph Fullmer, MD, PhD

The man underwent surgery to remove additional lymph nodes and tissue. From the medical laboratory, Upstate pathologist Joseph Fullmer, MD, PhD, discovered recurrent papillary thyroid carcinoma, the same cancer the man had before, but also another type of cancer called squamous cell carcinoma.

At this point, things were not adding up. The man had been treated successfully, but cancer kept coming back.

Fullmer sent samples and conferred with pathologists from Memorial Sloan Kettering Cancer Center in New York City for a second opinion.

The physicians believe the man’s papillary cancer transformed into squamous cell cancer. His papillary cancer was particularly aggressive, and although it’s rare, “it can evolve into different types,” explained Alina Basnet, MBBS, one of the man’s Upstate doctors.

Alina Basnet, MBBS

Alina Basnet, MBBS

They decided the best treatment for the man would be six weeks of radiation therapy, during which time he would receive weekly chemotherapy. Because he lived in the Binghamton area, he received treatment close to his home.

Three months after he was done, another scan showed “near-complete resolution of metabolic activity in the thyroid bed and regional lymph node areas,” according to the journal article.

The patient continues to be closely monitored.

His case is a good example of the benefit of collaboration when a patient has a complicated diagnosis or signs and symptoms that don’t add up. Bringing experts together produces a novel treatment plan.

About thyroid cancer

  • The butterfly-shaped thyroid gland is below the Adam’s apple in the front of the neck. It has two main types of cells: follicular, which use iodine from the blood to make hormones that help regulate metabolism, and C cells, which make a hormone that helps the body use calcium.
  • Nearly three out of four cases are in women.
  • About 80 percent of thyroid cancers are papillary carcinomas, which tend to grow slowly and to develop in only one lobe of the thyroid. Fewer than 10 percent of thyroid cancers are follicular. Medullary thyroid cancer, arising from the C cells, is the third most common, making up about 3 percent of thyroid cancers.
  • The most common subtypes of papillary cancer have a good prognosis for treatment and outcome when found early. Some of the less common — including one called “tall cell variant” — grow and spread more quickly.
  • Treatment often includes two or more of these options: surgery, radioactive iodine treatment, thyroid hormone therapy, external beam radiation, chemotherapy or targeted therapy.
  • Most thyroid cancers can be cured, especially if they have not spread to distant parts of the body.
  • In rare cases, a papillary thyroid cancer may be aggressive and could possibly transform into another type of cancer, such as squamous cell carcinoma.
Cancer Care magazine winter 2018 issue

Cancer Care magazine winter 2018 issue

This article appears in the winter 2018 issue of Cancer Care magazine.

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