Dr. Bill Nelson discusses recent breast cancer studies and new recommendations on end of life care from American Society of Clinical Oncology (ASCO). Listen to these topics discussed in the most recent Cancer News Podcast.
First, Nelson reviews recent findings from the New England Journal of Medicine on lymphedema and exercise. Removing lymph nodes during breast cancer surgery is part of staging and is used to find out the extent cancer spread. Lymphedema is a side effect from lymph node removal. Lymphedema can occur when drainage of tissue fluid in the breast becomes backed up due to the removal of the lymph nodes. Painful arm swelling may occur. Previously, women had been advised to avoid exercise when their lymph nodes have been removed, but this recent study suggests women can exercise without the worry of lymphedema.
The second study takes a look at sentinel lymph node biopsy (only removing lymph nodes cancer spreads to first) verses axillary lymph node dissection (removing all lymph node). Each study looked at overall outcomes. The results found both procedures appearing to be more or less equivalent among certain types of patients. Nelson explains what makes a patient a good candidate for each procedure and why.
Finally, Nelson discusses the recent recommendations from the American Society of Clinical Oncology on terminating treatment and end-of-life care. The recommendations explain that physicians need to talk to patients earlier regarding when to end cancer treatment and palliative care. Nelson adds that physicians should have clear and informative discussions with patients on specific treatment options. Patients should know the potential benefits of anti-cancer treatments, and other palliative treatments to improve quality of life. It’s important to make sure patients’ informed preferences really drive their cancer care.
Program Notes
0:34 – New England Journal of Medicine’s study on Lymphedema and exercise
1:10 – What is a lymph node and why it needs biopsied
1:30 – Removing all lymph nodes (axillary lymph node dissection)
2:15 – Side effect of removing all lymph nodes – Lymphedema
2:40 – Study finding – Exercise is okay among women who have had lymph nodes removed
3:10 – Difference between sentinel lymph node and axillary lymph node dissection
3:20 – Sentinel lymph node biopsy, using color dye and scans to find cancer lymph nodes
4:10 – Overall outcomes of sentinel lymph node biopsy vs. axillary lymph node dissection
4:23 – Who’s a good candidate for sentinel lymph node biopsy vs. axillary lymph node dissection
5:36 – Recommendations by ASCO about terminating treatment and end of life care
7:43 – Experimental treatment near end of life care, when to have discussion with your physician
8:35 - END
Consider this blog to be a "pep talk" of sorts to those of you who are working so hard on a regular basis to support and help those living with cancer. All great coaches and teachers lead by example. You owe it to your patients, family, and most importantly yourself to exercise and eat right.
We work in a busy environment where time often moves at the speed of light. Therefore, one may make the argument that there isn't enough time to dedicate to your health and well-being. I am here today to challenge you on that notion. There are 24 hours in a day and you CAN find 30 to 60 minutes to move. I know, because I do it. I am not going to mislead you, "making the time" can be difficult and the list of excuses are plenty. But, the benefits far exceed the excuses .
Ben is a fun-loving 13 year-old who enjoys skateboarding and playing the drums. In January of 2006, Ben was diagnosed with Ewing’s Sarcoma, a rare cancer that is found in bones and soft tissue. He was 8 years old. Doctors diagnosed the disease after he started experiencing hip pain, which is unusual for a child his age. Ben’s mother, Sue, brought him to his pediatrician where he took x-rays of Ben’s hip and found a tumor in his hip joint. The pediatrician then referred him to Johns Hopkins. Ben underwent surgery to have his hip joint and a large part of his bone removed. After surgery, Ben underwent a year of chemotherapy. Because of the amount of bone that had to be removed, Ben had to wear a body cast that stretched from under his arms to below his knees for six weeks.
Four and a half years later, Ben is now cancer free. “Ben’s cancer is a part of our history. It will always be a part of who we are,” explains Sue, “but it’s just that…it’s not the black cloud you think it will be.”
When most people think about breast cancer, they don’t often think about the small, pea-sized structures that dot the body and help fight infections and other foreign substances. But it’s top-of- mind for many patients who undergo surgery for breast cancer.
Lymph nodes are sites for cancer spread, and certain nodes are removed during surgery depending on a number of factors. Data published originally in the Annals of Surgery in September 2010 and today in the Journal of the American Medical Association show that certain nodes in select patients may not need to be removed.
Whether it’s making a sticky, rubbery substance like Flubber, turning a clear solution blue, or figuring out how a normal cell turns into a cancer cell, it’s all science.
Those of us at the Kimmel Cancer Center think science is cool, and we’re hoping, with the right introduction, young students will begin to think so too; or a least become inspired to think about it a little more.
To help in this cause, each year, our doctors, researchers, and nurses host fifth graders from the East Baltimore Community School to give them a hands-on glimpse of what it’s like to be a scientist. The children conduct experiments and play games to learn about the kind of work researchers do.
Cancer is now the leading cause of death worldwide, according to the World Health Organization. It crosses all boundaries, gender, ages, ethnicities and strikes both the wealthy and poor. Thus, it will take a global effort to reduce the burden of cancer on our societies.
Stand Up to Cancer released the video below to ask each of us to stand together on this World Cancer Day and pledge our support to fight cancer. Our Stand Up to Cancer-funded researchers live this battle each day in their work to find better treatments. Each of us can join the effort too. Find your individual way to battle cancer, like quit smoking, eat more fruits and veggies, get screened, or donate to research organizations or advocacy groups. Add them all up, and we may find our group effort can have a big impact.
This month's Cancer News Review podcast with Kimmel Cancer Center director Bill Nelson begins with updates on the field of head and neck cancer in light of the encouraging news that actor Michael Douglas' cancer is in remission. Nelson says that there is an emerging story in oropharyngeal cancers (those that are in the back of the throat, tongue, soft palate and tonsils). An increasing number of these cancers are associated with certain strains of the human papillomavirus (HPV), the same virus that causes cervical cancer. Patients with HPV-associated head and neck cancers fare better than patients whose cancers are causes by alcohol or tobacco use. He says the molecular details of why this infection causes cancers and why these patients fare better is still not understood.
This post is written by Shaun Morris, Public Relations Intern, Johns Hopkins Kimmel Cancer Center
The Gerstell Academy varsity girls’ basketball team delivered 50 hand-painted Believe Mugs to cancer patients and family members in the Weinberg Building on January 5th.
This is the first year that the students have delivered the mugs, expanding on the work of cancer survivor Ivelisse Page, food service manager at Gerstell. She created and delivered similar hand-painted mugs to fellow patients during her stay. The students hope to continue the mug delivery as an annual event.
It is truly an exciting time in cancer discovery. Discoveries in cancer genetics, immunology, and cancer stem cells are leading us to new, personalized therapies that target the specific cells and cellular alterations that drive the cancer. For children, this represents a huge step forward, as this new generation of treatments will not be as toxic to healthy tissue and cells, and, therefore, may spare young patients the lasting side effects that often result from cancer treatment. These discoveries also offer new opportunities to better understand and make real progress against those pediatric cancers that do not respond to existing treatments.
Pediatric Cancer Research Advances of 2010
BREAKING NEWS – First Pediatric Cancer Genome Mapped
Johns Hopkins Kimmel Cancer Center researchers have led the world in mapping the genetic blueprints of several common adult cancers, and now, our scientists have become the first to decipher the genetic code of a pediatric cancer. Their findings were reported in the December 16, 2010, issue of the journal Science. Using sophisticated new gene sequencing technologies, the team mapped the genetic sequence of medulloblastoma, the most common type of pediatric brain cancer. As suspected, this analysis clearly shows that genetic changes in pediatric cancers are remarkably different from adult tumors. The work revealed fewer genetic alterations than are typically found in adult tumors, and the researchers believe this may make it easier to use the findings to develop new therapies. The research also uncovered epigenetic alterations, biochemical variations that occur to the environment of genes and have the ability to turn genes on and off without mutating them, as a more significant culprit in pediatric cancer than commonly thought. Using drugs to block the abnormal biochemical activity can return normal gene function and stop the development of cancer cells. Information like this, gained from gene sequencing technology, could potentially help our team change the course of some relentless childhood cancers. As a result, we hope to continue this work in other pediatric cancers.
There are few cancers that are as tough to beat as pancreatic cancer. When it is found, the disease has usually spread, and only about 20 percent of newly-diagnosed patients are eligible for surgery.
But if there is ever a time when there are high hopes for new ways to detect and treat it, the time is now. Scientists at Johns Hopkins decoded the pancreatic cancer genome, revealing more clues to how the disease develops and spreads. These same scientists sequenced the genomes of patients with pancreatic cancer and uncovered a new genetic link to one patient's cancer, setting the stage for developing ways to personalize pancreatic cancer therapies. More recently, these scientists found that the time it takes for a pancreatic cancer to develop, grow and spread is far longer than previously thought -- around 10-20 years -- providing a window of opportunity to catch these cancers earlier and intervene with life-saving treatments.
It was this discovery of the timeline of pancreatic cancer that was mentioned at the beginning of a recent episode of the Dr. Oz Show. Wednesday's program featured a discussion with Dr. Elizabeth Jaffee, who is working with Dr. Daniel Laheru and other colleagues at Johns Hopkins, to develop a new treatment for pancreatic cancer that uses the body's immune system to attack the disease. With new evidence about the genetics of pancreatic cancer and rapid improvements in medical and scientific technology, these dedicated clinicians and scientists are working harder than ever to make an impact in this relentless disease.
