Clinical Trials

Colorectal Cancer Awareness

Dr. Seth Rosen Colorectal cancer is the fourth most common cancer in both men and women in the United States. The American Cancer Society estimates there will be 95,520 new cases of colon cancer and 39,910 new cases of rectal cancer in 2017.

What is Colorectal Cancer?

Most colorectal cancers start as a growth, called a polyp, in the inner lining of the colon or rectum and slowly progresses through the other layers. Removing a noncancerous polyp early can keep it from becoming a cancerous tumor, which is why screening is such an important tool for preventing this disease.

Colorectal Cancer Symptoms

Colorectal cancer doesn’t always cause symptoms. It’s important to get screened regularly.

If you do have symptoms, they may include:

  • Stomach pain, aches, or cramps that don’t go away
  • Weakness and fatigue
  • Rectal bleeding
  • Blood in stool
  • Unintended weight loss

If you develop symptoms, it’s important to talk to your doctor immediately.

Colorectal Cancer Risk Factors

Your risk for developing colorectal cancer increases as you get older. Younger adults can get colorectal cancer, but more than 90% of cases occur in people who are 50 years old or older.

Other risk factors include:

  • Inflammatory bowel diseases
  • Personal or Family History of colorectal cancer or colorectal polyps
  • Tobacco use
  • Heavy alcohol use
  • Your racial and ethnic background
  • Type 2 diabetes
  • Lack of regular physical activity
  • A diet low in fruits and vegetables
  • A low-fiber and high-fat diet
  • Overweight and obesity

Colorectal Cancer Screenings

Several tests are used to detect colorectal cancers, one of the most commonly used tests is a colonoscopy. During this test, the doctor uses a colonoscope (a thin tube with a small video camera on the end) to look at the entire length of the colon and rectum. Special instruments can be passed through the colonoscope to biopsy or remove any suspicious-looking polyps.

Other tests include:

  • Double-contrast barium enema (DCBE)
  • CT colonography (virtual colonoscopy)
  • Guaiac-based fecal occult blood test (gFOBT)
  • Fecal immunochemical test (FIT)
  • Stool DNA test

When should I get screened? 

The U.S. Preventive Services Task Force (USPSTF) recommends that adults age 50 to 75 get screened for colorectal cancer. Adults age 76 to 85 should ask their doctor if they should be tested. However, you may need to get screened earlier than 50 if you meet certain risk factors.

If you believe you are at an increased risk for colorectal cancer, talk with your doctor to determine how often you should be tested and what screening is right for you.

Colorectal Cancer Treatments

There are many ways to treat colorectal cancer depending on its type and stage.

  • Some treatments may include local therapies such as: surgery, radiation therapy, ablation or embolization
    • These treatments are often used for earlier stage cancers
  • Systematic treatments including chemotherapy and targeted therapy may be used because they can reach cancer cells anywhere in the body

Next Steps

If you have been diagnosed with colorectal cancer, please call 404-778-1900 or 888-946-7447 to make an appointment or request an appointment online.

Winship Cancer Care

Your Winship multidisciplinary care team includes oncology surgeons, colorectal surgeons, radiologists, pathologists, pharmacists, nutritionists, social workers and advanced practice nurses with expertise in colorectal and gastrointestinal cancers. The benefits of our multidisciplinary and highly experienced teams include:

  • Access to doctors and surgeons who rank among the top colorectal cancer experts in the world
  • Weekly review of patient cases by the full team of experts
  • Coordinated scheduling for appointments among various specialties
  • Access to a nurse navigator to assist you throughout the treatment process
  • Access to support groups and education classes for you and your caregivers
  • Availability of new treatment options within our clinical trials program

Bio – Dr. Seth Rosen

Dr. Seth Rosen is a board certified colon and rectal surgeon. He’s an Assistant Professor in the Department of Surgery at Emory University School of Medicine. As chair of Emory Healthcare’s Robotic Institute Committee, Dr. Rosen leads a team that is tracking utilization of robotic surgery throughout Emory Healthcare, including outcomes, quality, cost, and efficiency; identifying areas for improvement; and initiating plans based on its recommendations.

Dr. Rosen is a Fellow of The American Society of Colon and Rectal Surgeons and a current member of the Medical Association of Georgia.

He’s also a member of the Cancer Prevention and Control Research Program at Winship Cancer Institute of Emory University.

Winship key to four new myeloma drugs in 2015

lonial patientThe U.S. Food and Drug Administration (FDA) approved elotuzumab as part of an innovative immune-based therapy treatment for patients with relapsed multiple myeloma. This is the third myeloma drug approved by the FDA within the last month and the fourth new myeloma treatment approved within the last year. All four new agents were tested in clinical trials at Winship Cancer Institute of Emory University.

Sagar Lonial, MD, chief medical officer of Winship, says the potential of elotuzumab can be seen in the overall response rate as well as the longer duration of progression-free survival.

“The Winship multiple myeloma team has shepherded several of these treatments from the beginning stages of testing through to their approval,” said Lonial. “It’s a great source of pride to know we were instrumental in the process that has led to many more treatment options for our patients.”

Read the full press release here.

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Landmark Multiple Myeloma Studies from Winship

In recognition of September being Blood Caner Awareness Month, Dr. Sagar Lonial, Winship’s Chief Medical Officer shares a video about his Winship phase III clinical trial study on elotuzumab in treating myeloma patients.

Many cancers have benefited from FDA approvals for monoclonal antibodies (mAbs). Multiple myeloma, a second common blood cancer, had limited outcome improvements with mAbs until Dr. Lonial’s recent work. Dr. Lonial’s research was presented at the 2015 American Society of Clinical Oncology (ASCO) Annual Meeting and was published in the New England Journal of Medicine earlier this year.

Learn more about Winship Cancer Institute of Emory University.

No Patient Left Behind: Tracking Cancer Disparities

Veronica Reynolds' multiple myeloma is now in remission. She says Dr. Leon Bernal-Mizrachi "walked with me every step of the way. He's a great spirit. It doesn't matter who you are, you will be treated the same way."

Veronica Reynolds’ multiple myeloma is now in remission. She says Dr. Leon Bernal-Mizrachi “walked with me every step of the way. He’s a great spirit. It doesn’t matter who you are, you will be treated the same way.”

Why are some individuals more likely to develop cancer or to develop a more aggressive form of cancer? Winship clinicians and researchers confront such disparities daily – and are working to understand and change them.

Genetic research is a key to understanding how either race or ethnicity affect the incidence of different cancers and how these factors may contribute to different responses to the same treatments. Multiple myeloma, a blood cancer of the immune system’s plasma cells, occurs two to three times more often in African Americans than in Caucasians. Finding out why could lead to better therapies for all. Winship researchers couldn’t do it without people like Veronica Reynolds.

In her mid-50s, the busy realtor developed severe pain. She asked herself if she had strained her back, driving back and forth showing houses or picking up grandchildren? She told herself it would go away. It got worse. One doctor told her she looked too well to hurt as much as she claimed. Another believed her but his pills barely helped. After two years, she feared her heart would stop from pain. At Grady Memorial Hospital, imaging revealed fractured bones, due to bone destruction. Other tests provided the multiple myeloma diagnosis – and led Reynolds to Dr. Leon Bernal-Mizrachi, a Winship hematologist/oncologist who sees patients at Grady.

Reynolds credits God for sending her to Bernal-Mizrachi and to Dr. Jonathan Kaufman, director of Winship’s ambulatory infusion center, who oversaw her stem cell transplant following high dose chemotherapy. She credits herself for following the complex treatment regimens. And she’s “ecstatic,” she adds, about being part of her doctors’ research. “I hope I have enough fight in me to live to see it help many people like me.”

Reynolds – and her genes – are part of a massive multi-institutional study to sequence the entire genome (more than three billion DNA base pairs) of 1,049 African Americans with multiple myeloma and another 7,084 without the disease. The Winship component, headed by Drs. Sagar Lonial, Bernal-Mizrachi, and Ajay Nooka, has gathered almost a third of the study’s participants, thanks to the researchers’ commitment and Georgia’s high African-American population. Although still in process, the study is already producing valuable insights. Winship physicians routinely take tissue cells from multiple myeloma patients, looking for genetic variants that indicate who is at higher risk of relapse. They hope this new study will help identify why this disease occurs more frequently among African Americans and determine if there are treatments that may be specific to these patients.

The incidence of multiple myeloma in the African-American community is just one of the cancer disparities that Winship researchers are aggressively investigating. This blog is excerpted from a more comprehensive magazine article about health disparity research at Winship which can be accessed at https://winshipcancer.emory.edu/magazine/issues/2015/summer/features/no_patient_left_behind/index.html.

Winship Trial Reduces Mortality Rate for APL Patients

Winship's APL team (left to right): Martha Arellano, Kaitlin Sitchenko, Anand P. Jillella, Vamsi Kota, Ann Shen, Emily Bennett.

Winship’s APL team (left to right): Martha Arellano, Kaitlin Sitchenko, Anand P. Jillella, Vamsi Kota, Ann Shen, Emily Bennett.

Winship oncologist Anand Jillella, MD is spearheading a clinical trial for patients with Acute Promyelocytic Leukemia (APL) that could change the mortality rate for this disease on a major scale.

Often called the heart attack of leukemias, APL is a highly aggressive disease that is curable if treated early. A third of patients, however, do not survive the first month of treatment. By observing and analyzing the problem, Jillella and his team of physicians, nurses, and research staff came up with a collaborative approach that decreases mortality from 30 percent to about five percent. This new trial is open to patients all across the country.

Jillella has found that some physicians who treat patients with APL may not be familiar with the potential complications that can develop during treatment. He took a very detailed treatment algorithm and boiled it down to a three-step process that can be easily shared. “As soon as we get a call from a community physician, we send the simplified algorithm via smart phone,” says Jillella. “We come up with a treatment plan based on what the patient is experiencing and follow up with them regularly to get them through that difficult first month.”

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Winship Cancer Institute Expands Hospital Access

winship expands sign picWinship Cancer Institute has expanded access to its high quality cancer care in alignment with its broad clinical research program at both Emory Saint Joseph’s Hospital (ESJH) and Emory Johns Creek Hospital (EJCH). In addition, Winship has established the Winship Cancer Network as a means to improve access to such vital services throughout Georgia and the Southeast.

Longstanding and continued support from the Robert W. Woodruff Foundation has enabled Winship to advance cancer care and access to services like these for tens of thousands of patients throughout Georgia and beyond.

In addition to expanding services at ESJH and EJCH, the Woodruff Foundation’s most recent grant will be used to expand and improve Winship’s Shared Resource portfolio with special emphasis on its Cancer Prevention and Control Research Program. Researchers in this program are continually evaluating the best methods to reduce and eliminate the development of cancer among high-risk individuals across Georgia and the Southeast.

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A New Method to Find the Site of Returning Prostate Cancer

prostate cancer diagram

The yellow arrow and the white arrows on the pictures above indicate areas of prostate cancer that were invisible to previously available imaging techniques. Instead, they were detected using a new positron-emission tomography (PET) test called FACBC, which was developed and is being tested at Emory University.

A voluntary research study is being conducted to help men with recurring prostate cancer by using advanced imaging technology called FACBC to guide radiotherapy and determine the best possible course of treatment. This study would be added as an extra layer in your ongoing cancer treatment.*

We are looking for patients to participate in this clinical trial.

“By participating in this study, patients may have the opportunity to have an FACBC scan. The precision of this type of scan could help guide more effective treatment for patients whose cancer has returned,” says Ashesh Jani, MD, radiation oncologist and principal investigator.

Have you previously had surgery to treat prostate cancer, but think the cancer has returned? Has your doctor recommended radiation therapy as the next step in your care?

Participants must meet specific eligibility criteria:
• You are over 18 years of age.
• You had surgery (prostatectomy) to treat your prostate cancer.
• Your doctor suspects that the cancer has returned (as indicated by a rising PSA).
• Radiation therapy is now being considered as the next step in your care.

The trial is open at these locations: Winship Cancer Institute on the Clifton Road campus, Winship at Emory University Hospital Midtown, Winship at Emory Saint Joseph’s Hospital and Georgia Cancer Center for Excellence at Grady.

*You will be followed for a minimum of three years, with PSA levels checked every six months, in addition to having study-related lab work. There is no cost for the FACBC scan or the Food & Drug Administration (FDA) required lab work. All other imaging, lab work, biopsies (if any), radiation therapy and any other therapy will be billed to your insurance provider or paid out of pocket by you. You may be eligible for a travel voucher if you are chosen to undergo the FACBC scan.

For more information or to enroll, contact Ashesh Jani, MD, at (404) 778-3827 or abjani@emory.edu.

Learn more about Winship’s approach to Prostate Cancer Treatment
Read Winship’s Brochure on FACBC

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Recurrent Prostate Cancer: Where is it?

Tiffany Dunphy and Van Jackson, radiation therapists at Winship at Emory Saint Joseph's Hospital, work with prostate cancer patients undergoing radiation treatment.

Tiffany Dunphy and Van Jackson, radiation therapists at Winship at Emory Saint Joseph’s Hospital, work with prostate cancer patients undergoing radiation treatment.

“It’s a lot easier to plan the attack, if we know where the enemy is,” says Winship urologist Peter Nieh, MD. “If a cancer is still localized, we may want to try salvage therapy, either radiation or surgery, before advancing to something systemic.”

Depending on how primary treatment took place, a prostate cancer often comes back in the prostate bed (where the prostate gland was), and may appear in nearby lymph nodes. In advanced cases, the cancer may spread to the bones.

Emory radiologist and Winship member David Schuster, MD and radiochemist and Winship member Mark Goodman, PhD have been developing a PET (positron emission tomography) imaging probe that shows considerable potential for detecting recurrent prostate cancer.

Usually in PET imaging, radioactive glucose is injected into the body, and since cancer cells have a sweet tooth, they take up a lot of the radioactive tracer. But the tracer also appears in the urine, complicating prostate cancer detection efforts since the prostate is so close to the bladder. In contrast, the probe 18F-FACBC, based on amino acids, is taken up by prostate cancer cells but doesn’t appear as much in urine.

FACBC has its limitations. It also may be taken up in benign prostate hyperplasia or inflammation. This means it probably won’t be as useful by itself for evaluating primary prostate cancers, but it has a lengthening track record in recurrent cancer.

In a 2011 publication, Schuster and his colleagues compared FACBC to ProstaScint, a commercially available probe. FACBC showed superior sensitivity and specificity in detecting tumors outside the prostate bed. Schuster is now collaborating with Winship radiation oncologist Ashesh Jani, MD to study FACBC’s benefits in designing radiation treatments for patients with recurrent prostate cancer after prostatectomy.

In Jani’s clinical trial study for recurrent prostate cancer, which lasts until 2017, one group of patients is examined using FACBC, while another gets conventional imaging. The question is whether using information gleaned from FACBC to direct the radiation results in a longer lasting remission than with the control group.

Marble countertop salesman Paul Reckamp, who was a participant in Jani’s study, keeps a file on his phone noting his PSA levels for the last several years. Reckamp had a radical prostatectomy in July 2010 at Emory Saint Joseph’s Hospital, but the cancer appeared to come back a year and a half later. FACBC imaging confirmed that the cancer had appeared in nearby lymph nodes but not elsewhere, and doctors could then plan radiation treatment that drove his PSA levels back down again.

“I couldn’t have been more pleased with the study,” he says. “It told me and the doctors what we wanted to know.”

As a National Cancer Institute (NCI) designated cancer center, Winship Cancer Institute of Emory University’s participation in clinical trials ensures our prostate patients have access to progressive resources and technology. For men with recurrent prostate cancer, there are newer methods of imaging such as magnetic resonance imaging (MRI) and positron emission tomography (PET). 

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What is High Dose Rate Brachytherapy?

One of the most technically advanced and convenient options for cancer treatment is called high dose rate brachytherapy (HDR). It is a precise type of radiation therapy that is commonly used to treat localized gynecologic, lung, breast and prostate cancers that have not spread to lymph nodes. As opposed to low dose rate (LDR) brachytherapy, where tiny radioactive “seeds” are permanently placed inside or near a tumor, HDR brachytherapy involves temporarily placing high intensity sources of radiation inside the body with a catheter, for example, and then removing them once treatment is complete.

With short treatment and recovery times, HDR brachytherapy can help patients get back to their lives with minimal disruption. At Winship Cancer Institute of Emory University, the therapy is usually performed on an outpatient basis and carried out in two short sessions over one to two weeks. This results in an extremely precise radiation dose and minimal toxicity to the patient. Patients considering HDR brachytherapy may wonder if they will be radioactive following treatment. The answer is no. The radiation flows like the light that shines from a flashlight; it is not present once the treatment session is completed and the device used to deliver the radiation is removed.

HDR brachytherapy is performed at Winship locations by knowledgeable radiation oncologists with special expertise and certification in brachytherapy. The Department of Radiation Oncology at Winship is the only program in Georgia with advanced credentialing recognized by the National Cancer Institute for both LDR and HDR brachytherapy administration and expert usage.

Watch the short video below to learn more about how HDR brachytherapy is used to treat prostate cancer.

Find a Doctor

HDR Brachytherapy is performed at Winship locations by the following physicians:

For more information regarding HDR brachytherapy treatment at Winship Cancer Institute, please visit Emory Radiation Oncology.

In addition to regular treatments, a voluntary research study is being conducted to help men with recurring prostate cancer by using advanced imaging technology called FACBC to guide radiotherapy and determine the best possible course of treatment. Read more>>

About Dr. Rossi

Peter Rossi, MDPeter Rossi, MD, is a board certified radiation oncologist and the Medical Director of Radiation Oncology at Winship at Emory St. Joseph’s Hospital. Dr. Rossi specializes in the treatment of prostate cancer, cervical cancer and ovarian cancer, and his expertise is in the use of external radiation therapy and brachytherapy for treating prostate and gynecologic tumors. Dr. Rossi is on the Quality Assurance Committee of the American Brachytherapy Society. He lectures, proctors and mentors physicians on the use of HDR brachytherapy for the treatment of prostate cancer at Winship and internationally.

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Massage Therapy Used to Combat Breast Cancer-Related Fatigue

cancer and massage therapyFatigue is the most common side effect of cancer treatment according to the National Cancer Institute. Many breast cancer survivors describe their fatigue as more intense than the feelings of being tired that we all experience from time to time. Reported characteristics include feeling tired, weak, worn-out, heavy, slow, or lack of energy and difficulty getting-up-and-going.

Currently, researchers from Winship Cancer Institute of Emory University are investigating the benefits of massage therapy on breast cancer survivors with extreme fatigue.

“We decided to look at massage therapy for cancer fatigue because cancer-related fatigue is one of the most prevalent and debilitating symptoms experienced by people with cancer,” explains Mark Rapaport, MD, principle investigator for this study. “Many studies investigating massage for patients with cancer have been focused on depression, anxiety or pain.”

“We already know that frequent massage can enhance the immune system and reduce anxiety, and it has been reported that massage therapy can stimulate energy, and reduce symptoms such as nausea and pain,” says Mylin Torres, MD, associate professor in Emory’s Department of Radiation Oncology, serves as a co-investigator on the study. “We believe that there are many positive effects to be gained by therapeutic massage and we hope to prove that, among other biological advantages, massage may diminish the incapacitation that cancer-related fatigue can cause for our patients.”

Participants in the six-week study are post-surgery breast cancer patients, between the ages of 18 and 65, who have been treated with standard chemotherapy, chemoprevention and/or radiation, and are suffering with breast cancer-related fatigue. They are broken into three groups.

  • Group one receives a typical Swedish-type massage
  • Group two does not receive a massage
  • Group three receives a light touch massage.

Throughout the clinical trial, participants’ vital signs are taken and blood drawn to check for immune markers. The study staff also regularly checks in with each participant to record any changes in their life or their health. So far, the findings are promising.

View this Fox21 news clip to learn more about recent findings from the cancer fatigue trial!

 

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