Understanding the stage of lung cancer disease is vital in understanding how best to treat a patient, says Russell K. Hales, M.D.

Hales, who is a radiation oncologist at the Johns Hopkins Kimmel Cancer Center on the Johns Hopkins Bayview campus, says there are four broad stages of lung cancer. He gives patients a way to think about the full spectrum of the disease as it progresses:

  • Stage one lung cancer is “confined to tumors within the lung only, usually small, isolated nodules.”
  • “The other end of the spectrum is stage four disease, a tumor that has spread to other areas of the body”
  • “In the middle, between these two, is cancer that has spread to nearby areas, such as lymph nodes. That central area of the chest contains many lymph nodes and you can think of them as the on ramp to the rest of the body.  This is how cancer often spreads.  In order to fully stage a patient, we have to know if these lymph nodes are involved.  In patients who have larger tumors, or if these lymph nodes are involved, they would be stage two and three patients.”

Hales notes that stages can be divided into sub-stages for a more nuanced view. Early-stage disease is often treated with local therapy and more advanced lung cancer receives systemic treatment.

How are stages determined? “In order to complete a staging on patients, we not only evaluate the lymph nodes in the middle of the chest, but we also do a PET CT scan, to evaluate the body for any sites where disease may have spread, an MRI of the brain, and a biopsy,” Hales says.

Find out more from Dr. Hales about lung cancer, treatments for it, and innovative new research to help lung cancer patients in the free webinar, Lung Cancer: Serious Treatment for a Serious Cancer.

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Medical teams at the Johns Hopkins Kimmel Cancer Center on the Johns Hopkins Bayview campus “have to fight two battles in order to control the cancer,” says radiation oncologist says Russell K. Hales, M.D.

“The first is the local disease. A lung tumor is problematic, because as it grows, it can cause shortness of breath, coughing, or even cause bleeding with coughing,” Hales says.

“But lung cancer also can spread to other parts of the body, including the brain, lymph nodes, liver, bones, or other sites within the lung.  And that local disease, when it metastasizes, or spreads, can cause problems with the organ that it spreads to.  So when we think of how to fight lung cancer, we have to take in context two simultaneous battles for fighting.  Both of those have to be won, in order to win the war in a patient with lung cancer.”

Find out more from Dr. Hales about lung cancer, treatments for it, and innovative new research to help lung cancer patients in the free webinar, Lung Cancer: Serious Treatment for a Serious Cancer.

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“When we think about lung cancer, we usually think of it being associated with people who smoke,” says Russell K. Hales, M.D. “But, in fact, non-smoking associated lung cancer is common as well”.  In fact, if non-smoking associated lung cancer were its own category, it would rank in the top ten for cancer related death in the United States.  Lung cancer is the second most common cause of cancer in the United States, and over 220,000 new cases were anticipated to have been diagnosed in 2011 alone.”

Hales is a radiation oncologist at the Johns Hopkins Kimmel Cancer Center on the Johns Hopkins Bayview campus, a lung cancer center of excellence. He warns that lung cancer is an aggressive disease, with more than 157,000 people in the United States dying from it in 2011. And while cases of lung cancer are decreasing over time, that decrease is linked to the drop in smoking in the U.S. in recent years.

“But when we compare lung cancer to other types of-of cancer, such as prostate cancer and colon cancer, lung cancer is still three times more likely to cause death than other common cancers,” Hales notes.  In order to see better outcomes, he says, great innovations in lung cancer research will be needed.

Find out more from Dr. Hales about lung cancer, treatments for it, and innovative new research to help lung cancer patients in the free webinar, Lung Cancer: Serious Treatment for a Serious Cancer.

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In this technological era, I suppose it should not be all that surprising that even our bad habits have gotten a techy remake.  E-cigarettes, battery-operated devices that simulate smoking by vaporizing a liquid solution containing nicotine as well as added flavors have hit the market with storm.  Vaping—the term for the use of these electronic cigarettes—has become quite popular. Many brands feel and look like conventional cigarettes, and they provide a nicotine punch without the ashes and the nasty smell.

Reports estimate sales of $250 million to $500 million in 2011 and 2012, with four times that anticipated this year.  In fact, e-cigarettes are projected to soon outsell tobacco cigarettes.  Even more alarming is their popularity among teens.  The U.S. Centers for Disease Control and Prevention reported that more than one-quarter million teens who said they never smoked cigarettes have taken up vaping.

With e-cigarette manufacturers touting flavors like “vanilla cupcake” and “maple pancakes,” and claims like “love your lungs,” “everything you enjoy about smoking and nothing else,” “no toxic chemicals,” and my personal favorite, “Smoking is not cool anymore. Switch to electronic cigarettes,” it is not surprising that the public may be convinced that e-cigarettes are a safe and appealing alternative to tobacco cigarettes.

Before trading in one habit for another—or starting a new one—it is important to know that there are many questions about the safety of e-cigarettes, and there is increasing evidence that this unregulated smoking substitute is not as safe as its marketers want you to believe.

While most experts agree that the vapors emitted by e-cigarettes are less toxic than cigarette smoke, that doesn’t mean they are risk free. Vaping exposes users and those around them to nicotine and other potentially harmful chemicals. Emerging research is sounding a warning alarm to users, and particularly those who have underlying lung diseases, such as COPD or lung cancer.

“E-cigarettes have been marketed as devices that deliver nicotine safely and free of toxins, but little toxicity testing has been performed,” says Johns Hopkins pediatric resident Iris Leviner, M.D.  “Primary components of the nicotine solution and vapor content include propylene glycol, glycerin, and nicotine, and trace amounts of N-nitrosamines, diethylene glycol, polycyclic aromatic hydrocarbons, anabasine, myosmine, and nicotyrine. Some of these compounds are carcinogenic, a warning generally not mentioned by marketers.”

“E-cigarettes are not neutral in terms of the effects on the lungs,” says environmental health sciences researcher Shyam Biswal, Ph.D.  In a recent study conducted by Dr. Biswal and other Johns Hopkins scientists, mice that were exposed to e-cigarette vapor were found to be at greater risk of developing respiratory infections.  Mice that were exposed to both e-cigarette vapor and the bacteria that cause pneumonia and sinusitis or the flu virus were less able to fend off the “bugs” than bacteria/virus-exposed mice that were breathing in clean air instead of e-cigarette vapors.

“E-cigarette vapor alone produced mild effects on the lungs, including inflammation and genetic damage,” says Dr. Biswal’s collaborator Thomas Sussan, Ph.D. “When this exposure was followed by a bacterial or viral infection, the harmful effects of e-cigarette exposure became even more pronounced.”

With the dangers of secondhand tobacco smoke now well documented, experts like Joanna Cohen, Ph.D., of the Johns Hopkins FAMRI Center of Excellence, says e-cigarettes raise new concerns about the potential health risks caused by inhaling secondhand vapors. She says there is a lot that is still unknown about this largely unregulated product.

Want to Quit?

One thing that essentially all experts agree on is that quitting smoking is one of the most important things a person can do to improve his or her health.  Johns Hopkins has a number of programs to help:

  • Johns Hopkins Bayview Smoking Clinic:  410-550-2799
  • A Spiritual Approach to Quitting Smoking:  410-550-5990 (ask for Mary)
  • www.ResearchStudies.DrugAbuse.gov or call 1-800-535-8254 to learn about Johns Hopkins studies sponsored by the National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH) and U.S. Department of Health and Human Services.
  • See the Johns Hopkins FAMRI Center of Excellence for research and discoveries on smoking-related diseases.

More from Johns Hopkins on e-cigarettes:

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**This blog piece was written by Andrew W. Trice, Ph.D.

When I was diagnosed with pancreatic cancer in May 2013 and recognized how challenging the disease is, I went looking for the best doctors and cutting-edge treatments available. I found both at Hopkins, and I have no doubt that being a Hopkins patient has extended my life. But I also gained much more.
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Over the last two years, I’ve come to understand that a cancer journey has many layers, only some of which involve undergoing medical procedures. It’s more like a complex movie, complete with a villain (the cancer) devising and evolving diabolical strategies for bodily domination, a protagonist (the patient) struggling to respond to existentially threatening events, and a host of allies (especially the medical professionals) providing special skills and powers that the good guys hope will be sufficient.

What has impressed me so much about my indispensable supporting cast at Hopkins is how it not only delivers innovative treatments to cancer patients, but also integrates its care and engages its patients with so much compassion and spirit. Together these factors contribute tremendously to both a patient’s well-being and to medical outcomes. Let me explain this in terms of the cancer journey’s layers and my own experience with them.

At the most basic level, I understand and accept cancer as a biological phenomenon. I can’t change my biology, but Hopkins researchers and clinicians are working hard every day to better understand that biology and move treatments from bench to bedside so that patients like me can have a better shot at beating the disease. The visionary work of Dr. Elizabeth Jaffee and her collaborators on the GVAX vaccine is an outstanding example of that. The more I learn about the biology of cancer, the more appreciation I have for the extent of the challenge and the tenacious brainpower that Hopkins is applying to it, and the more privileged I feel to be able to be part of that story.

When people think about a cancer journey, they usually associate it with the medical treatments an institution can provide. For my type of cancer, Hopkins clearly excels in that arena. By almost any measure, whether volume and safety of Whipple procedures, innovations in radiation treatment, or number of and results from clinical trials, no one is better than Hopkins. When I entrusted my surgery to Dr. Christopher Wolfgang, my radiation supervision to Drs. Joe Herman and Susannah Ellsworth, and my chemotherapy plan and clinical trial monitoring to Dr. Lei Zheng, they all earned my full trust and confidence that I was receiving world-class care. That made me feel like we were doing everything we possibly could to heal me, and that all would be done to the highest standards and the best available knowledge.

The next important layer of a cancer journey is the support network. These are the special people with whom the patient makes a connection and whom they can call on for help at critical times. I could cite numerous instances in which Hopkins professionals provided above-and-beyond support to me, but let me just say a few words about three outstanding individuals in my Hopkins support network. The first is the research nurse who administers my vaccines and keeps me on track with my clinical trial, the amazing Carol Judkins, who has become a true friend and great resource for me while injecting the nicest wide-bore needles a patient could possibly ask for. The second is phlebotomist Robert Gray, who provides the highest-quality banter and gentility imaginable in a place that extracts blood. The third is the nursing assistant whose name I never learned, who held on to me while I blubbered like a baby when I began recovering from the Whipple surgery and realized that I was going to live for a while after all. These key supporting actors and others at Hopkins have made me feel cared for, stronger, and better equipped to soldier on.

Layered on top of the support network are what I label “cross-cutting virtues,” the elements of an individual’s or institution’s character that make a difficult experience like a cancer journey better and more meaningful. At Hopkins there is a can-do attitude and a lightness in the air unmatched by any other medical environment I’ve experienced. When this is coupled with the intense patient focus and quality control I’ve observed at Hopkins, it creates a positive atmosphere that can’t help but rub off on the patient.

The final layer of the cancer journey is the overall system used to manage its many dimensions. For the patient, this involves becoming the CEO, key decision-maker, advocate, and integrator of their cancer journey. As an institution, Hopkins does its executive decision-making in support of the patient through such mechanisms as its award-winning, interdisciplinary pancreatic cancer clinic, tumor boards, and extra-medical services such as counseling and social work. Perhaps patients feel like they have fallen through the cracks between specialists at some places, but that hasn’t at all been my experience here.

I’m now two years into my “cancer movie,” and have been extremely fortunate to have done so well. Enabled by the superb care I have received from Hopkins, I have been working full-time and doing all the things most fun and important to me for nearly all of this period. Given how persistent pancreatic cancer can be, it’s likely I’ll need more treatment in a future scene, and I don’t know how the movie is going to end. But no matter how the plot proceeds, I’m thrilled and grateful to have the professionals at Hopkins as the heroes walking next to me and keeping me strong.

Andrew W. Trice, Ph.D. is a pancreatic cancer survivor, husband, father of two, systems analyst, musician, and author. His book on maintaining resilience while living with cancer, Cancer Chameleon, will be published later this year.

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In this month's cancer news review podcast, Dr. William Nelson, director of the Johns Hopkins Kimmel Cancer Center, discusses top cancer stories on sun related cancers, presmenopausal breast cancer, and prostate cancer patients with asthma and more.

First, Dr. Nelson speaks about research that examines the use of vitamin B3 (niacin) and skin cancers. Skin cancers other than melanomas have a high recurrence rate. Other studies have shown that the drug in vitamin B3 nicotinamide, when taken daily may be able to prevent these skin cancers from recurring. Dr. Nelson argues the findings may need to be reassessed in another clinical trial, but for now it's progress.

Next, Nelson discusses another recent study examining premenopausal women with breast cancer and assessing a family history of the disease.

Finally, this month's Cancer News Review examines a link between asthma and prostate cancer.  The study suggests that prostate patients with asthma may have a decreased risk of advanced disease.  This shows there is some complexity to the way the immune system responses.

Listen to the full podcast to hear all of the latest cancer news this month.

Program notes:

0:34 Sun-related cancer
1:32 500 mg nicotinamide daily
2:30 Standardized genetic tests
3:32 National Institute of Standards and Technology
4:32 Altered DNA sequence in cancer
4:47 Premenopausal women with breast cancer and family history
5:49 Did not find a difference at all
6:49 Look at how we classify cancers for treatment
7:20 Asthma and prostate cancer
8:30 Inflammation involved
9:21 Complexity to immune response
10:20 End

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**This blog piece was written by Judy F. Minkove on the Communal Art Project

Picture This Page 8I’m so proud of you, Mom … I love you beyond reason … Hope you’re jammin’ in Heaven … are among hundreds of poignant messages that form an artistic expression of love and loss at the Johns Hopkins Kimmel Cancer Center. Each May, the center holds a service of remembrance to honor patients who died of cancer during the previous year. As part of the ceremony, family members and friends write notes to lost loved ones on strips of muslin cloth, then insert them into a wire and tulle sculpture (see backdrop).

After oncology chaplain Rhonda Cooper documents all of the notes, staff members volunteer time to braid them into a rope, which is now more than 50 feet long. Ultimately it will form a sculpture of an urn. Community artist Cinder Hypki, left, who conceived and designed the therapeutic art project, says it “allows for very private and collaborative public grief, longing and celebration of loved ones. Their words are transformed into a symbol of strength in unity.”

Seated beside Hypki are volunteer braiders Colleen Apostol, Weinberg 5A and 5B nurse manager, and Pain and Palliative Care Program nurse coordinator Lynn Billing.

Rachel and me at Sam's weddingThe sixth annual Service of Remembrance is scheduled for May 14 at 7 p.m. in the Weinberg Ceremonial Lobby.

Last year, I had the privilege of speaking at the Service of Remembrance about my personal experience with loss (our beautiful 28-year-old daughter died of lymphoma in July 2012) and how it shaped my understanding of hope. Afterward, when I saw people running to tables to write little messages for the sculpture pictured above, I hesitated to join them.

Honestly, the whole idea seemed hokey to me. But then I heard the buzz. I watched as hundreds of guests embraced caregivers and friends and caught up, exchanging laughter and tears. And I saw the urgency on their faces as they grabbed markers and wrote messages to loved ones.

Seconds later, I felt compelled to do the same.

I can’t quite capture how that felt. It seemed like an out-of-body experience. But I do know this: As I wrote on that tiny slip of cloth to acknowledge Rachel’s caregivers and to send my daughter a personal message, I felt empowered and uplifted. And I saw radiance wherever I turned.

Thank you, Cinder, Rhonda, Lynn and the other kind folks involved in orchestrating this beautiful project. For me and for many others there that night, participating in this effort provided a memorable touchstone—or as Cinder calls it, a healing ritual.

Learn more about the art project.

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Thousands of cancer researchers are meeting at the American Association for Cancer Research (AACR) 2015 Annual Meeting where the first research abstracts highlighted to the media included experimental immunotherapy applications to three kinds of advanced cancers: melanoma, lung cancer, and virus-associated lymphoma and leukemia in patients receiving bone marrow transplants.

Johns Hopkins melanoma and immunotherapy expert Suzanne Topalian moderated the press briefing on Sunday, April 19.

First, Antoni Ribas from UCLA presented data comparing two different types of immunotherapy drugs for melanoma: one that blocks the PD-1 receptor (pembrolizumab) and the other that blocks CTLA-4 (ipilimumab). Ribas and his team found that response rates nearly tripled, and progression-free survival and overall survival both improved significantly in patients who received pembrolizumab compared with ipilimumab. According to Topalian, ipilimumab approval by the FDA in 2011 was a landmark point, signaling the first drug of any kind to show a survival advantage for patients with advanced melanoma in a randomized trial. "Ipilimumab is now the gold standard by which everything is measured," said Topalian. " With the new data, both Topalian and Ribas say a change in the treatment landscape for melanoma is happening.

Next, Edward Garon from UCLA presented data on another immunotherapy drug that targets PD-L1 proteins in a trial of lung cancer patients. The trial also evaluated a potential biomarker for response to the immunotherapy drug class. According to the research team, most of the patients receiving the immunotherapy drug had better outcomes than would be expected with standard therapies. But results of the biomarker to predict outcomes were less clear as the range of responses to the immunotherapy drug varied over the spectrum of biomarker levels in evaluated patients. Patients with more expression of the biomarker experienced more favorable outcomes than those who had lesser expression, but, according to Topalian, "even patients with lower expression [levels of the biomarker] have good outcomes." What does this mean for patients and clinicians? According to Garon, the pursuit for more biomarkers, particularly those that can predict the level of response, continues.

Finally, Richard O'Reilly from Memorial Sloan Kettering Cancer Center presented data that demonstrates, according to Topalian, "the power of T-lymphocytes to eradicate cancer." O'Reilly and his team conducted a clinical trial to test a new immune-based treatment to treat a lethal complication of bone marrow transplantation called Epstein-Barr virus-associated lymphoproliferative disorder. The research team created a bank of immune system cells called T cells, taken from the blood of individuals without cancer, which responded to proteins associated with the Epstein-Barr virus. In patients experiencing the BMT-related complication, the research team compared this type of "banked" treatment taken from third-party healthy individuals with a similar type of T-cell treatment created from each patient's donor T cells. O'Reilly said that outcomes of transplants were similar using the T cell treatment from both third-party "banked" and transplant donor sources. The advantage, he said, is that banked treatments are immediately available to patients in need of rapid therapy.

Also included in a news briefing for the media was a preliminary human study of immunotherapy in triple-negative breast cancer, presented by Johns Hopkins Kimmel Cancer Center oncologist Leisha Emens. Emens said results show the immune-based therapy is "generally safe and well tolerated" in women with metastatic, triple-negative breast cancer, a persistently difficult form of the disease to treat.

 

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Michele Fountain

For Michele Fountain, a second-year cyclist in the Ride to Conquer Cancer benefiting the Johns Hopkins Kimmel Cancer Center, Sibley Memorial Hospital, Suburban Hospital and Howard County General Hospital, there is more than one reason why she gears up and rides. Having worked at Johns Hopkins for over 30 years—12 of which have been spent within the Kimmel Cancer Center—Michele feels compelled to ride. “It’s been a privilege to be a part of the Cancer Center’s family,” she says. “I’ve met so many dedicated people working hard each day to change the course of cancer, and I feel like I want to give back. This is the way to do it.”

Michele is also motivated for a more personal reason. “I lost my husband to cancer three years ago,” she says. “He was a patient at the Cancer Center for many years, and it was through his care and treatment here that I truly learned to appreciate the commitment of the physicians, the nurses and the staff. They have all been an inspiration to me, and I’ll be forever grateful.”

Having successfully completed her first two-day, 150-mile ride at the inaugural event last fall, Michele is even more committed to the cause now. “In the second year riding, I think I’m addicted. The 2014 ride was probably one of the most rewarding, challenging experiences of my life,” she says.

Of course, no matter how deeply connected one may be to the fight to conquer cancer, there is no denying that the ride is a challenge. From the physical training process to mastering the intricacies of fundraising, Michele asserts that it’s challenging. “But once you have the mindset that it’s a ride, not a race, and you’ve got all of these amazing people riding with you of all ages—some survivors, some expert cyclists and some just like me—that makes all the difference.”

In addition to the physical challenge of the event, the $2,500 minimum fundraising requirement for each rider can certainly seem intimidating at first. But Michele, who successfully raised over $9,000 toward last year’s event, offers this advice: “If you reach out to everyone you know—professionally, personally, your family and friends—and share a little bit of your story, that really hits home for people. This is something that impacts everyone, and there’s camaraderie in that.”

As for this year’s event, which takes place on Sept. 19 and 20, 2015, Michele is more motivated than ever. “I want to be part of this team,” she says. “We are all working toward the same goal of conquering cancer. I know in my heart that we are getting closer every day. It might not be in my lifetime, but it will hopefully be in my children’s and grandchildren’s lifetime, so to be a part of the ride is an honor to me.”

And for those who may still be on the fence about accepting the challenge to conquer cancer together, Michele shares these words: “I just can’t express how rewarding it was to get to that finish line. I knew in my mind that I wanted to do it, that was my goal. But 150 miles? That was an amazing feeling.”

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Overlea High SchoolOn March 26, 2015, a committed group of students at Overlea High School proudly presented the Kimmel Cancer Center with the funds they had raised to support the Breast Cancer Program and the patients and families whom it benefits. Under the guidance of their teacher, Mrs. Mary Demski, the students worked together to plan multiple fundraising events, including hosting a walk-a-thon on the school’s track and creating pink bracelets and t-shirts to help raise funds and awareness across the Overlea campus. Even the faculty and staff got involved in showing their support for the innovative research in breast cancer prevention, treatment, and survivorship that is taking place here at Johns Hopkins, donning pink t-shirts to help raise awareness for this cause and for the students’ efforts. Together, the students raised over $550 to help provide support to patients and families who are affected by breast cancer when they need it most. Thanks to the inspiring dedication of these students, our clinicians and scientists are one step closer to fulfilling our promise towards progress in conquering this difficult disease.

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