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Finding Powerful Tools to Fight Ovarian Cancer

GeneticsThe last decade has produced amazing advances in our understanding of the genetic risk factors for ovarian cancer. Of the one in 70 women who will develop ovarian cancer in their lifetime, 20 to 25 percent are the result of a major genetic cause. This means that of the 22,000 new diagnoses of ovarian cancer expected in the US in 2014, over 5,000 may be associated with an underlying hereditary cancer syndrome.

Hereditary Breast and Ovarian Cancer syndrome (HBOC) is the most common cause of inherited ovarian cancer risk. HBOC is due to changes (mutations) in the BRCA1 and BRCA2 genes (BRCA1/2). In families where a BRCA1/2 mutation is present, there may be early-onset breast cancer, ovarian cancer, and sometimes melanoma, pancreatic or prostate cancer. Several individuals on one side of the family (either mother or father’s side) in more than one generation may be affected. For women who inherit a BRCA1/2 mutation, the lifetime risk for ovarian cancer is 20 to 40 percent, in contrast to the general population risk of less than two percent. These women also have greatly increased chance of developing breast cancer (50 to 80 percent by age 70), which often occurs at a young age.

For a patient who has ovarian cancer, genetic counseling and testing can be very important. First, there are promising new treatments in the final stages of research that are especially effective in women with a BRCA1/2-related ovarian cancer. Second, each of this individual’s children and siblings have a one in two or 50-percent chance to have inherited the same BRCA1/2 mutation. For a woman who has a BRCA1/2 mutation, increased screening and risk-reducing options are available. Several studies have shown that these special management strategies can dramatically reduce her risk to develop breast or ovarian cancer, and may save her life. For family members who do not carry the BRCA1/2 mutation, their risks are considered the same as in the general population.

HBOC is just one of the known inherited causes of ovarian cancer. There are several other hereditary cancer syndromes associated with an increased risk for ovarian, as well as other cancers such as colon, uterine, brain, stomach, pancreatic, adrenal and leukemias. Because up to one-quarter of all ovarian cancers have an underlying genetic cause, it is now being recommended that all women with this diagnosis be offered cancer genetic services.

If you, or someone in your family has ovarian cancer, you should collect as much information as possible about any other cancers in your family. Bring this information to your doctor, and request a consultation with a cancer genetics professional. Understanding your genetic risk for ovarian cancer can be a powerful tool in the fight against this deadly disease.

Qualified cancer genetics professionals can be located at the following sites:

About Cecelia Bellcross, PhD, MS, CGC

Cecilia BellcrossCecelia Bellcross, PhD, MS, CGC, is an Assistant Professor with the Department of Human Genetics, Emory University School of Medicine, where she developed and is Director of the new Emory Genetic Counseling Training Program. Her areas of interest and expertise include hereditary cancer and translational genomics. She obtained her Master of Science degree in Medical Genetics through the University of Wisconsin-Madison Genetic Counseling program in 1990, and her Ph.D. from the U.W.-Madison Department of Population Health Sciences in 2007. Dr. Bellcross received her certification from the American Board of Genetic Counseling (ABGC) in 1993, and recently served on the Accreditation Council for Genetic Counseling.

Related Resources

Should You Be Tested for BRCA (BRCA1 & BRCA2) Genes?

How Will I Cope with Cancer?

Wendy Baer, MDGetting diagnosed with cancer is a unique experience for every person. It can mean many different things depending on the type of cancer, the stage, the treatment options and the overall health of the person. Regardless of the type of cancer, most people experience a whirlwind of emotions during the time of diagnosis. Uncertainty and loss of control are two common feelings. Uncertainty is especially intense in the work-up phase when you are not sure what kind of cancer you have, what your options are for treatment or who is going to take care of you during treatment. Loss of control may be an issue when you feel your body is broken, tumors may be growing, cells may be multiplying, and you wonder about dying. You may feel loss of control over your energy since you are not able to do activities or work you enjoy. The time needed for appointments may make you may feel as if the medical system has taken control of your entire schedule.

If you are asking yourself the question, “How will I cope?” you are actually in a good starting place. Actively thinking about how to manage emotions such as uncertainty and loss of control is a sign that you will be able to get through your cancer experience.

There are two key questions to ponder as you work through the issue of how to cope during cancer. How have I coped before? And, what do I like?

How have I coped before? When faced with difficult situations in the past, everything from a new school or a new home to a relationship breakup or a job loss, what have I done to get by? What thoughts or behaviors helped me manage my emotions? There are definitely many unhelpful coping strategies during stressful life events, such as becoming isolated, sleeping too much or using more alcohol. Unhelpful coping strategies should be noted and avoided. More helpful coping strategies include being with people who really care about your wellbeing, spending time outdoors, listening to music, breathing deeply and slowly, making lists and schedules and allowing other people to help you with chores.

What do I like? Not just what flavor of ice cream or what kind of movie, but what makes you feel joyful? What do you care about, what do you want to be good at? Who in your life matters to you? Who do you like to be around? Cancer can make your own mortality prominent in your mind on a day-to-day basis. The question, “what do I like?” is essential to consider when you recognize time is limited. Thinking about what matters to you, even writing those things down, encourages you to then take steps to include them in your life. Make a list with specifics. There may be simple pleasures you can enjoy during cancer treatment, and others that will have to wait until after treatment, but plan them, talk about them, work towards getting there. Having both short and long term goals can help you cope with cancer.

Some people are not able to answer these two questions because clinical depression gets in the way of seeing anything pleasant or joyful, or severe anxiety short-circuits the ability to think logically. Drugs and alcohol interfere with the ability to experience pleasure in a meaningful way. Emotional and behavior disturbances can be treated, both with medication and with talk therapy. A comprehensive cancer center offers psychiatrists, psychologists and social workers willing and interested in helping you get your mind in a healthy place to answer the two important questions. Taking care of your brain is critical for overall health.

You can cope. Answering the first question shows that you’ve coped with hard things before. Answering the second question gives you motivation to get through treatment for cancer. There may be challenges, really tough ones, but you can absolutely conquer these challenges. How do I know? I witness people surviving and thriving everyday at Winship.

Wishing you well,

Dr. Baer

About Dr. Baer

Wendy Baer, MD is the Medical Director of Psychiatric Oncology at Winship Cancer Institute of Emory University. In her work at Winship, Dr. Baer helps patients and their families deal with the stress of receiving a cancer diagnosis and subsequent treatment. As a psychiatrist, she has expertise in treating clinical depression and anxiety both with medications and psychotherapy to help people manage emotions, behaviors and relationships. The fundamental goal of Dr. Baer’s practice is to promote wellness and maximize patients’ quality of life as much as possible. She believes strongly in the team approach to patient care and collaborates regularly with patients’ doctors, nurses and social workers.

Doctor as Patient

Dr. Sagar LonialWinship multiple myeloma expert Dr. Sagar Lonial has seen hundreds of patients through the ups and downs of treatment and recovery, and has pioneered many new drug therapies that have changed the course of survival for multiple myeloma patients. He found his sense of purpose early in his career, seeing discoveries in the lab benefit the patients he was caring for and knowing that his research was intimately tied to their struggles.

But it wasn’t until he became a patient himself that he gained full insight into how purpose drives the trajectory of a patient’s journey. Late in 2013, Dr. Lonial sustained a fall that resulted in severely broken bones requiring surgery, hospitalization and months of physical therapy.

Lonial wrote about this insight in a recently published essay. Here is an excerpt from his story:

Recently, I experienced a medical issue that allowed me to experience the importance of purpose from the other side of the stethoscope. While it was in no way analogous to what my patients go through during the rigors of aggressive therapy or a transplant (I lay in a hospital bed recovering from surgery to repair broken bones), I felt a strong need to push my recovery.

There were numerous cards and notes from my patients, friends, and family urging me to get better. This showering of prayers and positive energy was humbling but also provided my motivation. That first day it was a small step—sitting up on the side of the bed by my own power—but it was an important step.

I had to get back to work. I had patients waiting on me, willing me to get better. I could not leave them in the lurch. Each day as I worked to regain strength and mobility and to keep my spirits up, it was this purpose—to get back to helping my patients—that drove me to push through my pain and physical setbacks. Purpose provided me with motivation, and, at the same time, it was a powerful analgesic.
It’s exciting to do what I do. I feel very fortunate to be able to share in the lives of patients in their journeys, and to be a part of a system that offers them new hope. I consider my patients to be my friends, and when I meet them I try to understand what the purpose is that motivates them. I use that unique motivation when times are tough.

On my worst clinic days when a friend has died, I go back to the lab and try to understand how I can do better. The ability to do more than what we can do today, to understand more than what we understand today, serves more than solace and comfort—it provides additional purpose.

I hate to lose and I hate losing friends even more, so “making science work for patients” is how I fight back. It’s not always enough but it keeps me hopeful and allows me to give hope to my friends.

[Copyrighted material]
This essay is excerpted, with permission of the author, from The Big Casino: America’s Best Cancer Doctors Share Their Most Powerful Stories, a collection of 40 essays chronicling the extraordinary experiences of patients battling this life-changing disease. Co-author Stanley Winokur, MD, a retired oncologist who practiced in Atlanta for many years, explains that “the big casino” was a phrase sometimes used by doctors in referring to cancer and that the book is an effort “to put a human face and a human heart on this most feared of maladies.” Winship’s deputy director, Fadlo R. Khuri, MD, also contributed a moving essay to the book.

About Dr. Lonial

Dr. Sagar Lonial is Vice Chair of Clinical Affairs for the Department of Hematology and Medical Oncology at the Winship Cancer Institute of Emory University, and Director of the Translational Research for the B-Cell Malignancy Program. He is also a professor in the Emory University School of Medicine.

Dr. Lonial’s research focuses on combination therapy in B-cell malignancies focusing on myeloma. He is a trained bone marrow transplant physician with an interest in molecular therapy for lymphoma and myeloma. His clinical interests include evaluating the combination of new molecular targeted agents for B-cell tumors as well as target discovery and validation.

Dr. Lonial has authored or coauthored over 200 publications and recently was awarded the Celgene ‘Young Investigator’ Award, the MMRF ‘Top 15 Innovator’ Award, and the MMRC ‘Center of the Year’ award.

He earned his medical degree from the University Of Louisville School Of Medicine. He completed his internship and residency at Baylor College of Medicine in Houston, Texas, followed by a fellowship in Hematology/Oncology at Emory University School of Medicine in Atlanta, Georgia.

 

Bone Marrow Transplant Patient Story: Georgia Teacher Finds Perfect Match Across the Globe

Bone Marrow Transplant Patient StoryErin Blonshine, a 29 year old teacher from Dacula, Georgia, was diagnosed at 21 with AML, a form of Leukemia. Across the globe, Johannes Saur from Ulm, in southern Germany had joined his country’s bone marrow registry at the age of 18, and at 20, when Erin was diagnosed, Johannes got a call that he was a match for an American. At that time, Erin’s cancer went into remission before the transplant was needed, but a year later, it resurfaced. “Her leukemia relapsed, and we knew that the only potential cure was a transplant,” says Amelia Langston, MD, Medical Director of Winship’s Bone Marrow & Stem Cell Transplant Center. In August of 2009, Johanne’s bone marrow was flown to the U.S. for Erin’s transplant, and today, she has made a complete recovery. “5 years, for most leukemia survivors, means cure. It means we’re done worrying about the leukemia,” says Langston. If Erin ever wondered if her perfect match was out there, now she knows. To learn more about Winship’s Bone Marrow Transplant Center and Erin’s journey to recovery after her transplant, check out the video story from Fox 5 News below:

4 Ways Men Can Lower Their Risk of Cancer

Family ManOne out of every two men in the United States will be diagnosed with cancer at some point in our lives. It’s a sobering statistic to consider as we head into Father’s Day weekend. Beyond skin cancer, men are most frequently diagnosed with prostate, lung or colorectal cancer. Those are also the three malignancies responsible for the highest number of deaths in men.

Reducing your risk of cancer is more important than ever. Here are four ways to make an impact today.

  1. If you use any tobacco products, quit now. Cigarette smoking is responsible for more than a dozen types of cancer including those involving our lungs, bladder, and mouth. Chewing tobacco and snuff can also cause head and neck, esophageal, stomach or pancreatic cancer. Talk with your doctor about the best ways to help you kick the habit for good. Finding a support group can also make a big difference in whether you succeed.
  2. Cut back on alcohol consumption. Heavy drinking can cause health problems, but did you also know that alcohol can increase your risk for cancers of the mouth, throat, liver and colon? Even worse: drinking and smoking at the same time. It is recommended that men consume no more than two alcoholic drinks a day. In case you were wondering, one drink contains 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
  3. Listen to your wife or partner and get a checkup. Starting at the age of 50, men at average risk for colorectal cancer should have a colonoscopy. If no polyps are found, the test should be repeated every 10 years. Your doctor may recommend a fecal occult blood test at an earlier age. Also at 50, talk with your doctor about the pros and cons of getting a PSA test to screen for prostate cancer. If you are considered to be in a high-risk group, your doctor may recommend that you be tested earlier.
  4. Get off the couch and get some exercise. You’ve heard it before, but as a doctor, I can tell you that regular physical activity is one of the best ways to control your weight, reduce stress and lower your risk of cancer. Try to get at least 150 minutes of moderate intensity exercise each week or 75 minutes of vigorous workouts.

As you get ready to celebrate Father’s Day, put down that cigarette and beer, get outside and grab a tennis racket, a soccer ball or even a Frisbee. Also don’t forget to wear sunscreen…at least with a SPF of 30! Have a great Father’s Day!!!

About Dr. Curran

Walter Curran, MDWalter J. Curran, Jr., MD was appointed Executive Director of Winship Cancer Institute of Emory University in 2009. He joined Emory in January 2008, as the Lawrence W. Davis Professor and Chairman of Emory’s Department of Radiation Oncology. He also serves as Group Chairman and Principal Investigator of the Radiation Therapy Oncology Group (RTOG), a National Cancer Institute-funded cooperative group, a position he has held since 1997. Curran has been named a Georgia Research Alliance Eminent Scholar and Chair in Cancer Research as well as a Georgia Cancer Coalition Distinguished Cancer Scholar.

Dr. Curran has been a principal investigator on over thirty National Cancer Institute-supported grants and is considered an international expert in the management of patients with locally advanced lung cancer and malignant brain tumors. He has led several landmark clinical and translational trials in both areas and is responsible for defining a universally adopted staging system for patients with malignant glioma and for leading the randomized trial which defined the best therapeutic approach to patients with locally advanced lung cancer. He serves as the Founding Secretary/Treasurer of the Coalition of Cancer Cooperative Groups and is a Board Member of the Georgia Center for Oncology Research and Education (Georgia CORE). Dr. Curran is the only radiation oncologist to have ever served as Director of a National Cancer Institute-Designated Cancer Center.

Dr. Curran is a Fellow in the American College of Radiology and has been awarded honorary memberships in the European Society of Therapeutic Radiology and Oncology and the Canadian Association of Radiation Oncology. According to the Blue Ridge Institute for Medical Research, Dr. Curran ranked among the top ten principal investigators in terms of National Cancer Institute grant awards in 2013, and was first among investigators in Georgia, and first among cancer center directors.

Sign-up to Learn the Biology of Cancer

biology-cancerHave you ever wondered about the biology behind cancer? If so, join Assistant Professor of Hematology and Medical Oncology, Gregg Orloff, Ph.D, on Tuesday, August 6 at noon for an interactive, live, web chat on the “Biology of Cancer.” He will be available to discuss questions such as:

  • What is cancer?
  • What causes cancer?
  • What can you do to prevent cancer?
  • How is cancer diagnosed and treated?
  • What is the role of infectious organisms like viruses in cancer?
  • Why and how cancer spreads.
  • Why do cancer drugs not always work.

This interesting chat will open your eyes to what cancer is and what you can do to help reduce the chances that you or your family members will be diagnosed with the disease.

Chat Sign Up

Find Out the Best Medicine for Melanoma

Thank you for joining us for the live online chat on the topic of Skin Cancer and Melanoma on May 28. We had excellent questions on skin cancer and melanoma. The key takeaway from the chat is that prevention is the best medicine for skin cancer and melanoma. Once you are burned the damage is already done to your skin.  So remember to wear your sunscreen (SPF of 30 or greater), wear hats and protective clothing and avoid the sun in the heat of the day (10am – 2pm). Take action now to avoid detrimental long term effects from the sun.You can read a full transcript of the Skin Cancer and Melanoma chat here.

Healthy Holiday Eating Web Chat

‘Tis the season for indulgence, fa la la la la la la la laaaaa! With the holiday season upon us, it’s hard to resist the urge to overindulge. While it is important for everyone to know how to make healthy choices when it comes to nutrition and exercise, incorporating the right foods a nutritional elements into one’s diet is especially important for cancer survivors. According to the National Cancer Institute, an individual is considered a cancer survivor from the time of diagnosis through the balance of his or her life. Understanding the role nutrition plays before, during, and after cancer treatment is critical to ensuring cancer survivors are as strong as possible through their journey in the fight against cancer.

Because nutritional recommendations can be very different for cancer patients than for the average healthy adult, Tiffany Barrett, MS, RD, CSO, LD, of the Winship Cancer Institute of Emory University, is hosting an online chat on Tuesday, December 11, 2012 at noon EST to share her insights on optimal nutrition to support the journey in the fight against cancer.

Be proactive this holiday season and join Tiffany and our other chat participants to share tips, ideas, and get questions answered related to the best nutritional choices you can make this holiday season and beyond!

Related Resources

Dr. Styblo Follows Up with Answers to Breast Cancer Questions

We held a chat on the topic of breast cancer with Dr. Toncred Styblo in October. From that chat, we got lots of great questions and feedback and even a couple questions we couldn’t get to in the chat’s allotted time. Dr. Styblo has taken the time to answer those questions for this follow up blog post, mostly covering questions related to ductal carcinoma in situ (DCIS), a type of breast cancer typically found in the lining of the milk ducts that has not yet invaded nearby tissues.

Below are the questions Dr. Styblo has covered in this post:

  • How long does one continue to follow up with oncologist and surgeon after DCIS diagnosis and resultant mastectomy?
  • What is the risk of recurrence in other breast after DCIS and mastectomy?
  • Does that include blood work for Ca27-29, and how often?
  • I’m interested in risk of recurrence after DCIS diagnosis. If you continue to follow your patients for life (which Dr. Styblo mentioned in the chat that she does), that suggests a moderate risk for recurrence.]
  • What would you suggest in the case of multifocal DCIS?

Answers from Dr. Styblo:

Toncred Marya Styblo, M.D.DCIS, intraductal cancer and in situ ductal cancer are names for stage “0″ breast cancer. Stage 0 breast cancer is cured by removing it completely with surgery, but does not have any affect on the risk of developing a second breast cancer in that breast or the other breast.

The surgery to remove the cancer may be a lumpectomy or it might be a mastectomy.  This risk of a patient developing another breast cancer post-surgery is dependent on many factors and the risk is best assessed by your doctor.  The subsequent follow up and recommendations about screening and risk reduction will be dependent on additional factors including the pathologic features of the DCIS and the patient’s risk of developing a second breast cancer.

Because DCIS is stage 0 breast cancer, follow up is primarily to screen for another breast cancer rather than recurrence.  The screening includes breast imaging and clinical exam, there are no blood tests indicated.


Dr. Styblo also received a question on the topic of support in the chat: What role, in your opinion does emotional support play in achieving the best possible outcome after breast cancer? Where or how do you recommend patients find advocates? The Winship Cancer Institute has several programs for survivors and support, including the Peer Partner Program which “matches cancer survivors and caregivers with cancer patients and caregivers dealing with a similar diagnosis of cancer, pre-cancerous condition, or benign tumor.”

Breast Health & Breast Cancer Related Resources:

 

 

Why a Pap Smear Might Not Catch All Cervical Cancers

Most women are familiar with the Pap smear, also known as the pap test. Most of us are also aware that the main goal of the Pap smear is to identify cancerous or abnormal cells that may turn into cancer after collecting them from the lining of the cervix. However, based on findings recently published in the International Journal of Cancer, Pap smears may not be the most reliable way to pinpoint cancer types that can often be harder to detect.

According to Kevin Ault, MD, an associate professor of obstetrics and gynecology at Emory’s School of Medicine and Winship Cancer Institute, the Pap smear is not always effective in the diagnosis of adenocarcinoma. Ault came to this conclusion after conducting a post-hoc analysis of Gardasil vaccine trials. Adenocarcinoma is a type of cervical cancer that begins significantly far up the cervical canal, an area that often is not sampled when a Pap smear is conducted.

Andenocarcinoma is the second most common type of cervical cancer, accounting for about 20 percent of all cervical cancer cases. While the overall incidence rate of cervical cancer is on the decline, Ault reports the proportion of andenocarcinoma cervical cancer is rising.

As the 8th most common type of cancer in American women, more than 12,000 new cases of invasive cervical cancer are diagnosed each year. Scientists believe that pre-invasive cervical cancer may develop over a period of months or years after the cervix is infected with the sexually transmitted HPV.

A leading expert and pioneer in the field of human papilloma virus (HPV), Ault suggests women might seek an HPV and Pap test at the same time. Why? A positive HPV test may be an indicator for early stages of adenocarcinoma cervical cancer that can’t be determined via a standard Pap test.