Treatment

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.

Emory Saint Joseph’s Hospital to offer Gamma Knife Treatment

Winship Cancer Institute at Emory Saint Joseph’s Hospital is the first hospital in the state and one of only seven medical centers in the nation to offer advanced radiosurgery for the brain with the Gamma Knife Icon. The device delivers minimally invasive radiation treatment for malignant and nonmalignant tumors, trigeminal neuralgia (facial pain syndrome) and other neurological disorders.

“This technology pinpoints the tumor with the greatest accuracy to date, and also preserves cognitive function by avoiding critical brain structures. The Gamma Knife Icon is the best combination of all we’ve come to learn about stereotactic radiosurgery for the brain,” says Peter Rossi, MD, Winship director of radiation oncology at Emory Saint Joseph’s.

Gamma Knife Treatment

Gamma Knife treatment is an alternative to open brain surgery, as it does not require a scalpel or an incision. The procedure treats brain lesions with enough radiation to control them. As a result, the lesion will disappear, shrink or stop growing. This often occurs in the most critical, difficult-to-access areas of the brain. With Gamma Knife treatment, patients avoid whole brain radiation therapy, and do not experience side effects such as memory loss.

The Gamma Knife treatment lasts from 20 minutes to two hours, and patients go home the same day. The day of the procedure, the patient will first receive an MRI. The treatment team, a neurosurgeon, radiation oncologist and physicist, will then use the MRI to carefully plan and identify the area of the brain to be treated. Next, the patient is fitted with either a head frame or mask to stabilize the head during the procedure. The patient is then moved into the machine for treatment.

“There is minimal pain involved for patients,” says Shannon Kahn, MD, Winship radiation oncologist at Emory Saint Joseph’s. “After being fitted with either the head frame or mask, patients lay on a table with a comfortable mattress and often sleep during treatment. After treatment is complete, patients can go home the same day.”

Gamma Knife Patient Experience

Joseph Garrett, the first patient at Emory Saint Joseph’s to be treated with the Gamma Knife Icon, was pleased with his treatment. Garrett, who experienced vision problems and was later diagnosed with a benign brain tumor, said, “I didn’t experience any side effects at all.” He reported treatment to be painless, and immediately returned to normal activities.

Kidney Cancer and Robotic Cancer Treatment

kidney-concept250x250The American Cancer Society estimates about 62,700 new cases of kidney cancer (39,650 in men and 23,050 in women) will occur in in the United States this year.

When people think about the kidneys it’s likely they picture a pair of bean-shaped organs, one on the left and the other just to the right of the backbone. It’s not likely that people think about connections to the heart or even the toes through a large vein called the vena cava. The kidneys are apart of a complex system that extends into the main blood vessels and the heart.

Kidney cancer can begin in either the outer part of the kidney or its inner lining. The outer cortex of the kidney filters the blood and concentrates the excrement into urine. Kidney cancer that occurs in the outer portion of the kidney is known as renal cell carcinoma (RCC).

Kidney cancer that starts in the inner lining of the kidney, which funnels and drains urine, is known as urothelial or transitional cell carcinoma. Urothelial carcinoma is very similar in many ways to most types of bladder cancer.

Treatment of both types of kidney cancer requires either partial or whole nephrectomy, or removal of the kidney. Urothelial carcinoma treatment also involves the surgical removal of a portion of the ureter.

Kidney Cancer Symptoms and Risk Factors

Kidney cancers in the early stages usually do not cause any signs or symptoms, but patients will sometimes experience signs that should be brought to a doctor’s attention, such as:

  • Noticing blood or very dark urine
  • Flank/back pain on one side (not caused by injury)
  • A mass (lump) on the side or lower back
  • Fatigue (tiredness)
  • Loss of appetite
  • Weight loss not caused by dieting
  • Fever that is not caused by an infection and doesn’t go away

Contact your doctor if you see changes like these. Recognizing your body’s warning signals can reduce your risks.

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About Viraj Master, MD

master-virajDr. Master is an Associate Professor of Urology at the Emory University School of Medicine, Associate Chair for Clinical Affairs and Quality, and Director of Clinical Research Unit.

Following his undergraduate education at Northwestern University, Dr. Master attended medical school at the University of Chicago where he received both MD and PhD degrees. He completed his urology residency and two fellowships training at the University of California in San Francisco (UCSF) before joining the Department of Urology at Emory University in 2005. Dr. Master is a diplomate of the American Board of Urology (2006) a Fellow of the American College of Surgery (FACS).

Dr. Master’s primary clinical interest is urologic oncology, in particular kidney cancer, adrenal tumors, testicular cancer, high-risk prostate cancer and penile cancers. Dr. Master is a renowned national expert in the surgical treatment of kidney cancer particularly a complex variety that extends into the main blood vessels and the heart. He also has a special interest in minimally invasive laparoscopic technique that removes of cancerous lymph nodes with minimal interference with the patients’ quality of life.

As the Director of Clinical Research, he is active in investigating the role of inflammation in cancers and in researching “host” (patient) interaction with the disease. In his role as Associate Chair for Clinical Affairs and Quality, he works closely with all faculty members towards a common goal of providing the highest quality of care to our patients. Emory University Hospital (EUH) ranks number one hospital (out of 187) in both Georgia and metro Atlanta (2013-2014 U.S. News & World Report), and the Department of Urology ranks as one of Emory’s top ten high-performing adult specialty areas.

The Emory Department of Urology is leading the way in the treatment of kidney cancers, treating the smallest to the most advanced tumors. Our physicians provide expertise in focally treating kidney tumors while sparing the healthy portion of the kidney. Avoiding the removal of the entire kidney lessens the chance of kidney failure and other complications after surgery. This treatment for kidney cancer, in which only the tumorous portion of the kidney is removed, is also known as a The Emory Department of Urology is leading the way in the treatment of kidney cancers, treating the smallest to the most advanced tumors. Our physicians provide expertise in focally treating kidney tumors while sparing the healthy portion of the kidney. Avoiding the removal of the entire kidney lessens the chance of kidney failure and other complications after surgery. This treatment for kidney cancer, in which only the tumorous portion of the kidney is removed, is also known as a robotic partial nephrectomy.

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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Prostate Cancer: Is Active Surveillance an Option?

guys (1)For many years, most men with prostate cancer were given the option of either surgery or radiation. Over time, doctors saw many men had prostate cancer that was less aggressive and unlikely to spread to other parts of the body or shorten lifespan. Doctors were also learning that many of these men were experiencing the downsides of prostate cancer treatment (e.g. difficulty with erections, leakage of urine) without benefit.

In response to “over treatment”, some centers offered men with low-risk prostate cancer prognosis were enrolled in a clinical trial of “active surveillance”. After 15 years of follow-up, half of the patients were able to avoid prostate cancer treatment. Today, these studies—with nearly 20 years follow-up—show excellent results of active surveillance for low-risk prostate cancer.

Men with low prostate-specific antigen (PSA) test results, low-grade tumors, and minimal abnormalities on the prostate exam are considered for the newer protocols. Active surveillance programs usually involve repeat biopsies every one to two years and PSA tests every three to six months. Treatment is recommended if the patient is found to have higher-risk disease.

It is difficult to hear a cancer diagnosis and then be presented with surveillance as an option to avoid treatment. Yet, cancer patients can trust that active surveillance is a process that can delay or avoid cancer treatment side effects with rare risk of death from prostate cancer. Newer technologies, like multiparametric magnetic-resonance imaging and molecular biomarkers, may identify more prostate cancer patients who would benefit from active surveillance.

In the end, among selected patients on active surveillance, death or progression of cancer is rare. There is no evidence that prostate cancer patients who undergo delayed prostate cancer treatment fare worse than those treated immediately. In fact, they avoid the side effects of cancer treatment over that time. If newly diagnosed with prostate cancer, active surveillance may be an option worth discussing with your urologist or radiation oncologist.

Additional Resource:
The Prostate Cancer Support Group meets the 1st Wednesday of every month from 11:00 AM – 12:30 PM at the Clifton Campus. If you’re interested in further details visit: https://winshipcancer.emory.edu/about-us/events/

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Cancer Clinical Study Leads to Video Tool for Prostate Cancer Patients
Two Patients Benefit from Two Alternative Treatment Options for Prostate Cancer
PSA Screening for Prostate Cancer – A Healthy Debate
Questions on Validity of PSA Test as Prostate Cancer Screening Tool
Prostate Cancer, To Screen or Not?
Winship’s Approach to Prostate Cancer Treatment

About Dr. Filson

filsonChristopher Filson, MD, MS, is an assistant professor of urology at Emory University School of Medicine. Dr. Filson started practicing with Emory Healthcare in July 2015. His main clinical specialties include robotic surgery, laparoscopic surgery, cystectomy, urinary diversion, prostatectomy and nephrectomy. Dr. Filson received his Medical Degree from University of Michigan in Ann Arbor MI. His postdoctoral training included a surgery internship and urology residency also at University of Michigan and a Fellowship in Urologic Oncology at University of California Los Angeles.

Pancreatic Cancer Surgery Options

There are a variety of treatment options for pancreatic cancer depending on the size and location of the tumor, whether the cancer has spread and the overall health of the patient.   Dr. David Kooby, surgical oncologist at Winship Cancer Institute of Emory University, describes the surgical treatment options available to patients diagnosed with pancreatic cancer.

Procedures include:

Whipple Procedure or Pancreaticoduodenectomy: this method is used when the tumor is in the head of the pancreas. The surgeon removes the head of the pancreas and parts of the bile ducts, small intestines and stomach.

Distal Pancreatectomy: in this procedure, the body and tail of the pancreas are removed in addition to the spleen.

Total Pancreatectomy: the entire pancreas is removed along with part of the small intestine, a portion of the stomach, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes.

Learn more about Winship Cancer Institute of Emory University

Reclassifying Brain Tumors with Precision

8-24 cancerGroundbreaking study will change the way brain tumor patients are diagnosed.

Winship cancer researcher and neuropathologist Dan Brat is the first author of a groundbreaking study that will change the way patients with diffuse gliomas, a form of brain tumor, will be diagnosed and treated in the future.

Brat and 306 other researchers from 44 institutions studied a group of six related brain tumors that has been surrounded by diagnostic confusion for decades. They used a large number of advanced molecular platforms capable of examining the genetic make-up of brain tumors (e.g. mutations, gene deletions, and other genetic changes) and were able to determine that there are three well-defined types of tumors based on this analysis, rather than six as previously thought.

Brat explains, “The use of the biomarkers in the diagnosis of these forms of brain tumors will lead to a much more consistent manner of diagnosis and patient management. It will also allow us to investigate these tumors as unified groups in a way that should advance our understanding.”

Brat will join an international group of neuropathologists in Heidelberg, Germany, meeting this summer to revise the World Health Organization classification of brain tumors based on new molecular findings. This is a major step in starting to classify and treat brain tumors more precisely based on their genetic makeup.

RELATED RESOURCES:
Brain Tumor Treatment at Winship
Battling this brain tumor takes a combination of powerful tools Emory News Center 7/31/14
Progesterone could become tool versus brain cancer Emory News Center 6/18/14
New York Times story: http://nyti.ms/1GgdQ66

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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Related Resources
Emory Johns Creek Hospital
Emory Saint Joseph’s Hospital

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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RELATED RESOURCES:

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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