In many cancers, early screening has helped improve your chances of a successful outcome when cancer is detected. But lung cancer has not had that type of effective screening tool until last year,  says Russell K. Hales, M.D.,  a radiation oncologist at the Johns Hopkins Kimmel Cancer Center on the Johns Hopkins Bayview campus, a lung cancer center of excellence.

“At Hopkins, we participated in a large study of over 50,000 patients who had high risk for lung cancer.  They were screened with either a chest x-ray, or a chest CT scan, and the results we saw were very promising,” Hales says. “In patients who received a CT scan to screen for lung cancer, there was an increased number of patients who had lung cancer detected, compared to those who had x-rays.”

Hales says that this research study, which was published in the New England Journal of Medicine in 2013, showed something even more exciting: Patients who were screened with CT scans had a decreased chance of dying from lung cancer, suggesting that tumors were picked up at an earlier stage.  That translated to a full 20% reduction in lung cancer death that occurred with CT screening, he notes.

Hales says the study means that patients who are at high risk of lung cancer should seek CT screening just as routinely as they do PSA screening for prostate cancer or mammograms for breast 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. To schedule a CT screening at the Johns Hopkins Kimmel Cancer Center on the Johns Hopkins Bayview campus, call 410-955-LUNG.

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morgansgift

**This blog post was written by Kimmel Cancer Center's Development Specialist, Allison Rich.

For most young girls, birthdays are a time of celebration – parties, gifts, and blowing out yet another candle are some of the typical highlights to look forward to. This year, however, one very special girl dreamed of something more – she dreamed of giving hope to other families battling cancer.

Morgan Tuttle, who just completed the fifth grade, knows firsthand how much of an impact a cancer diagnosis can have in the lives of patients and their families. Having watched her grandfather, whom she calls Poppy, stoically battle colon cancer for over three years, she knew that other families should never have to face this same experience. She knew that cancer needed to be stopped, and was not about to let her age serve as an impediment. As part of a class assignment, Morgan set out to spread the word about the role each of us can play in stopping cancer in its tracks. She created a website, crafted a presentation for her class, and shared her mission with friends and family – an effort which resulted in her successfully raising over $2,000 to support the colon cancer research being conducted by Dr. Nilofer Azad, a befitting tribute both to her Poppy and to the team who cared for him here at the Kimmel Cancer Center.

This July, Morgan and her family traveled over 400 miles from North Carolina to the Johns Hopkins Sidney Kimmel Cancer Center in Baltimore to not only present the funds she had raised, but to visit the faculty and staff who had played such a role in their lives for so many years. And Morgan’s desire to make a difference did not stop with her fundraising efforts alone – as a special surprise, she also collected two toy chests filled with gifts for the children being treated in the Division of Pediatric Oncology. The toys will be shared with the campers at Camp Sunrise, the annual camp hosted by the Division which provides a week of fun, camaraderie, and support for pediatric oncology patients, including those who are still in active treatment.

The reality is that all of us have been touched by cancer in some way. Morgan’s generosity is a beautiful example of the capacity we all have to make a difference in the lives of others, and the power of philanthropy to shape the landscape of cancer medicine – no matter how old we are.

For most young girls, birthdays are a time of celebration – parties, gifts, and blowing out yet another candle are some of the typical highlights to look forward to. This year, however, one very special girl dreamed of something more – she dreamed of giving hope to other families battling cancer.

Morgan Tuttle, who just completed the fifth grade, knows firsthand how much of an impact a cancer diagnosis can have in the lives of patients and their families. Having watched her grandfather, whom she calls Poppy, stoically battle colon cancer for over three years, she knew that other families should never have to face this same experience. She knew that cancer needed to be stopped, and was not about to let her age serve as an impediment. As part of a class assignment, Morgan set out to spread the word about the role each of us can play in stopping cancer in its tracks. She created a website, crafted a presentation for her class, and shared her mission with friends and family – an effort which resulted in her successfully raising over $2,000 to support the colon cancer research being conducted by Dr. Nilofer Azad, a befitting tribute both to her Poppy and to the team who cared for him here at the Kimmel Cancer Center.

This July, Morgan and her family traveled over 400 miles from North Carolina to the Johns Hopkins Sidney Kimmel Cancer Center in Baltimore to not only present the funds she had raised, but to visit the faculty and staff who had played such a role in their lives for so many years. And Morgan’s desire to make a difference did not stop with her fundraising efforts alone – as a special surprise, she also collected two toy chests filled with gifts for the children being treated in the Division of Pediatric Oncology. The toys will be shared with the campers at Camp Sunrise, the annual camp hosted by the Division which provides a week of fun, camaraderie, and support for pediatric oncology patients, including those who are still in active treatment.

The reality is that all of us have been touched by cancer in some way. Morgan’s generosity is a beautiful example of the capacity we all have to make a difference in the lives of others, and the power of philanthropy to shape the landscape of cancer medicine – no matter how old we are.

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Your lung cancer care has an entire team behind it at the Johns Hopkins Kimmel Cancer Center on the Johns Hopkins Bayview campus, says radiation oncologist Russell K. Hales, M.D. The goal of these multi-disciplinary teams is to provide faster, more effective, coordinated care for lung cancer patients.

Who will be on your lung cancer care team? Hales notes that the multi-disciplinary treatment teams include several types of specialist physicians:  “Not only a thoracic surgeon, or a surgeon who specializes in lung cancer, but a medical oncologist, or a specialist in chemotherapy.  I'm a radiation oncologist, and involved in decision making with lung cancer patients, in terms of radiation treatment.  Pulmonologists look at the overall health of the lungs, and help keep these healthy during therapy,” Hales explains.

Other health professionals also guide your treatment, he notes: “Nursing helps to keep our patients healthy during therapy, and is a critical component in our team.  Pathologists evaluate the biopsy, radiologists look at scans, and then the whole compliment to the rest of the team: nutritionists, social work, pain management, and smoking cessation.  These are all interconnected and vital parts of our team, to help make the best decision for individual patient.”

You can watch a video of the lung cancer multi-disciplinary treatment team in action at the Johns Hopkins Kimmel Cancer Center on the Johns Hopkins Bayview campus, and 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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“It used to take a month or more for a newly diagnosed lung cancer patient to hop from one specialist to another to put a treatment plan in place,” says Russell K. Hales, M.D. That’s because of the complex nature of lung cancer—which requires many complicated decisions—as well as the aggressive nature of the disease.

Hales, who is a radiation oncologist at the Johns Hopkins Kimmel Cancer Center on the Johns Hopkins Bayview campus, says, “At Hopkins, we recognized this limitation, and last year established a multidisciplinary clinic to help our patients.  Patients with a new diagnosis of lung cancer can now be evaluated by an entire team of specialists working together.  The necessary scans, and studies can be obtained on the same day, and recommendations are given by a joint team.  Now patients can go from having a diagnosis of lung cancer, to, having an entire plan to treat their tumor put together within a few day.  We feel that this expedited care is the best way to treat this aggressive disease. “

You can watch a video of the lung cancer multi-disciplinary treatment team in action at the Johns Hopkins Kimmel Cancer Center on the Johns Hopkins Bayview campus, and 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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Knowing your stage of cancer is essential to helping your treatment team figure out the best approach to tackling your lung cancer, says Russell K. Hales, M.D.  But stage alone doesn't drive recommendations for treatment.

“A stage is only a part of the whole person.  A person's overall health is also going to drive our recommendations.  We want our therapy to be as targeted, and as direct as possible at controlling a tumor, but we can't do that at the expense of giving a therapy that's more than a patient can tolerate,” says Hales, a radiation oncologist at the Johns Hopkins Kimmel Cancer Center on the Johns Hopkins Bayview campus. “As a result, we evaluate a patient's overall health, in making a decision.  And we also, most importantly, put the patient in the driver's seat.  In that sense, they are the ones making a decision, as to what therapy they would like.”

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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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:

___________________

Update July 18, 2016

The following update is in response to several comments on this blog post.

In general, the U.S. position—and most American experts agree—is that more research is needed to determine whether e-cigarettes are a safe and effective smoking cessation tool. Right now, there is no long-term data that permits us to fully know their risks or benefits as a smoking cessation method, says environmental health sciences expert Shyam Biswal, whose research revealed a higher risk of respiratory infections with e-cigarette use.

Let’s not forget that the full health affects of cigarettes were not fully understood until decades after they were marketed and millions of people became addicted. As a result, people around the world continue to pay the price in the form of heart disease, cancer, and many other diseases.

“Right now, many believe that e-cigarettes are less harmful than cigarettes, and that may turn out to be true, but it has not been proven yet,” says environmental health sciences expert Tom Sussan. Cancer prevention and control expert Elizabeth Platz reminds us that there are proven ways to quit smoking.

In the U.S., public health experts at Johns Hopkins and elsewhere are particularly concerned about the possibility of a negative impact on teens whose use of e-cigarettes is on the rise. Experts say what is most alarming is that some kids who never smoked are using e-cigarettes.

“We just don’t know if the use of e-cigarettes is a good or bad smoking cessation approach for the population overall, but evidence continues to accumulate, so hopefully, we’ll get a better handle on trends soon,” says Joanna Cohen, Director of the Johns Hopkins Bloomberg School of Public Health Institute for Global Tobacco Control.

Ideally, the greatest health benefit would come from not smoking cigarettes and not using using e-cigarettes. I think we can all agree that inhaling anything into our lungs that does not naturally belong there is unlikely to be a good thing. For current smokers, each person must make his or her own decision, working in conjunction with a health care provider and using the best available information to identify the safest and most effective way to quit smoking.

For more information on e-cigarettes:

E-Cigarette Information for the Centers for Disease Control

Cigarette smoking among U.S. high school students at an all-time low, but e-cigarette use a concern

More Nonsmoking Teens Inhaling Flavored Nicotine Through Vaping

Feds Announce Much Tougher E-Cigarette, Cigar Rule

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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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