Wellness

What You Need to Know About Personalized Cancer Care

personal cancer careThe most promising advances in cancer treatment today center around personalized or precision medicine, but what exactly does that mean? We asked Dr. Fadlo Khuri, deputy director of the Winship Cancer Institute of Emory University, to explain the terms and help us understand who is benefitting from these types of treatment.

Q: What is personalized or precision medicine in cancer treatment?

Khuri: The best individualized care plan for every patient is one that delivers the most precise, informed and effective treatment possible. One of the new tools we use today in order to add to the patient’s medical history, social history, and pathologic diagnosis, is modern molecular testing.

Q: What is molecular testing?

Khuri: Molecular testing in cancer is performed on tissue taken during a tumor biopsy. Several tests can be done to reveal the genetic makeup of the mutation present in the cells of a particular cancer, such as non-small cell lung cancer. This genetic mapping, or DNA sequencing, is called genomics.

Q: People are familiar with genetic testing for the BRCA gene mutations that cause ovarian and breast cancers. But how are genomics or genetic targeting used in cancer treatment?

Khuri: Genomics uses modern DNA sequencing methods, recombinant DNA and informatics to study the complete genetic makeup of individual cells, patients, populations and their diseases. We learn how certain gene mutations, such as EGFR or ALK mutations in lung cancer, determine a tumor’s behavior and survival. We use these driver mutations to design treatments that specifically target the protein product of the mutated (or altered) genes. This leads to more targeted treatments based on an individual patient’s cancer.

Q: What is immunotherapy and how is it being used at Winship?

Khuri: Immunotherapy is a type of treatment that stimulates a patient’s own immune system to either work harder overall, or to attack cancer cells specifically. We are exploring immunotherapy at Winship through research and clinical trials. We have a series of clinical trials designed to activate or drive the immune system to recognize the individual’s cancer as foreign to their body, such as vaccines or immune checkpoint inhibitors, to attack the tumor.

Q: Which type of patients benefit from immunotherapy?

Khuri: Patients with leukemia, lymphomas, myeloma, lung cancer, kidney cancer and especially melanoma seem to benefit from immunotherapy. Other diseases are also being studied. Immunotherapies are demonstrating durable (long lasting) responses in a number of the above tumor types, and this has added a powerful new option to the toolbox of targeted therapies of cancer.

Q: What are the advantages and challenges?

Khuri: The advantages include the durability of the responses seen, but the people with cancer who benefit are in the minority so far. Efforts at developing efficient and precise ways to deliver immunotherapy are ongoing.

Q: What is the latest research at Winship that is related to precision medicine?

Khuri: Winship has clinical trials in myeloma, lung cancer, leukemia, lymphoma, breast cancer, colon cancer, thyroid cancer and melanoma which target specific driver mutations and are excellent examples of precision medicine.

Q: How have these approaches changed the way doctors now treat cancer patients?

Khuri: Many centers, like Winship, do reflex testing, which automatically sends a patient’s sample for a molecular screening panel that looks for tumor mutations. Certain gene mutations are known to drive cancer growth, cause drug resistance or susceptibility, or are currently under investigation as therapeutic targets in clinical trials, so the results of those tests can determine the type of treatment a patient receives.

About Dr. Khuri

Fadlo Khuri, MDFadlo R. Khuri, MD, deputy director of the Winship Cancer Institute of Emory University and Professor and Chairman of the Department of Hematology & Medical Oncology, Emory University School of Medicine, is a leading researcher and physician in the treatment of lung and head and neck cancers. He is Editor-in-Chief of the American Cancer Society’s peer-reviewed journal, Cancer.
Dr. Khuri’s contributions have been recognized by a number of national awards, including the prestigious 2013 Richard and Hinda Rosenthal Memorial Award, given to an outstanding cancer researcher by the American Association for Cancer Research.

An accomplished molecular oncologist and translational thought leader, Dr. Khuri has conducted seminal research on oncolytic viral therapy, developed molecular-targeted therapeutic approaches for lung and head and neck tumors combining signal transduction inhibitors with chemotherapy, and has led major chemoprevention efforts in lung and head and neck cancers. Dr. Khuri’s clinical interests include thoracic and head and neck oncology. His research interests include development of molecular, prognostic, therapeutic, and chemopreventive approaches to improve the standard of care for patients with tobacco related cancers. His laboratory is investigating the mechanism of action of signal transduction inhibitors in lung and aerodigestive track cancers.

Related Resources

Genomic Testing for Lung Cancer: What Does it Mean for You?

A few Healthy Resolutions to Consider Before the New Year

Your Health Resolutions in the New YearRecent news that even a small bit of alcohol consumption increases a woman’s risk of breast cancer got me thinking. The authors of the study, published in early November in the Journal of the American Medical Association, talked in news media interviews about the fact that many respondents might actually have under-reported their alcohol consumption. They went on to say that it is very important to accurately report your lifestyle habits when your doctor asks.

So here’s what got me thinking. A few years back, I had a breast cancer scare. Perhaps the fear made me especially conscientious about reporting any bad habits – you know, fear being a powerful motivator and all.

When the nurse asked me about whether I smoked, I was able to honestly answer a resounding “NO!” When she asked whether I exercised, I was able to report honestly that I exercise at least five days a week. Then, when she asked whether I drank and how much, that one had me a little nervous.

I don’t know what it was – stress, too much travel associated with my job or just the plain seductive powers of alcohol and my own enjoyment of it – but I was a bit concerned about my alcohol consumption. During that time of my life, I was drinking probably seven to 10 drinks a week, way more than I ever did in the past. I had been a little worried, but, wow, with the thought of a 3 cm mass in my breast, I was really concerned. Time to ‘fess up and come out with the truth, which I did at that time and planned to continue to do when I later sought a second opinion.

It was a few months later when I sought that opinion. To prepare for my visit, I asked for records from the hospital at which I had previously sought treatment (I did not have breast cancer, but still had many questions about the mass). I got the records, checked them out, and there on the exam notes, it said that “patient reports having 10 shots of alcohol a day.” Holy moley! I almost fell off my chair.

In my first visit, I had disclosed to my nurse that I was consuming between 7-10 drinks per week. I was shocked to see such a glaring error when that number was erroneously reported as 7-10 drinks per day! The word “shot” also really got to me!

Images of me stumbling up to a bar, saying “hit me again, sister” came to mind. Ten shots a day? I wouldn’t have been able to work, drive or even eat, it seemed to me.

The incident brought home a few things to me. First, how important it is to be transparent with your medical team and to make sure you are aware of the content of your medical records. In hindsight, if I had seen my records earlier, I would have been able to correct the misreporting of my information. Furthermore, if the information they thought I disclosed about my drinking was alarming, I wish we would have discussed it. If this step had been taken, it would have clarified the errors in my records and also, would have made me feel more comfortable as a patient knowing my care team was on top of it and truly cared about me.

So when this recent news story came out about a slightly elevated risk of breast cancer existing in women who drink even moderately, I realized a few things. First, I need to take ownership of my health, including all my lifestyle issues and behaviors that can affect my risk of getting cancer.  That means not smoking, getting regular exercise, little to no drinking, eating lots of fruits and vegetables, avoiding excessive sun exposure and maintaining a healthy body weight.

It also means enlisting the aid of my healthcare providers and asking them for help in my problem areas. And it means absolute transparency is required when I report my lifestyle habits – as is making sure my habits are recorded accurately! This has changed the way I think about who plays a role in my care. Through this experience I have realized that I must take part in and own my healthcare and partner with providers I trust are willing to help fill in any gaps I may leave behind.

Related Resources:

6 Cancer-Related Considerations Before You Make Alcohol Part of Your Holiday Celebration

Drinking during holidaysMost of us have heard that moderate drinking – a glass of wine a day – can be beneficial in preventing heart disease.

A study published in the Journal of the American Medical Association in early November, however, suggests that even moderate alcohol consumption can increase a woman’s lifetime risk of developing breast cancer. Alcohol use already has been linked to oropharyngeal cancers, esophageal and, to lesser degree, stomach and colon cancers, so what does this news mean to you as you go into the holidays?

It doesn’t mean that you shouldn’t imbibe, but it does mean that you should be aware that alcohol is considered a carcinogen.

Here are six things to think about as you get ready for the parties and the tree-trimming.

  1. The JAMA article reported that women who drank three to six alcoholic beverages a week had a 15% increased risk of breast cancer. Women who consumed two drinks per day had a more than 50% greater risk than women who did not drink.
  2. If you drink to decrease your risk of heart disease, reconsider. There are far better ways to do that, experts suggest, than by having an alcoholic beverage. Regular exercise, weight control, not smoking, controlling blood pressure and cholesterol and healthy eating are all more beneficial. While it may be hard to factor in gym time during the holidays, try to manage at least a brisk walk of 30 minutes each day.
  3. Lifetime consumption of alcohol may be a factor in cancer risk, the authors of the study suggest. Cumulative consumption of alcoholic beverages over a period of years appears to place a woman at higher risk of developing breast cancer. Thus, if you are an older woman – particularly post-menopausal when excess body fat increases the amount of circulating estrogen in the body – think about slowing down the flow of alcohol.
  4. “But I only drink a few drinks once a week,” such as at a party, dinner or girls’ night out, you might think. Doesn’t matter, the experts say, and binge drinking – typically defined as drinking three or more drinks in one setting – may actually be more detrimental than three drinks spread over the course of a week.
  5. Consider the effect on your body of the empty calories of alcohol. A glass of wine is 125 calories; a martini is about 190. To burn off the martini, you would need to walk about 45 minutes or swim about 20.
  6. The study’s authors – as well as many other researchers – note that alcohol consumption is often under-reported. That is, patients do not typically like to tell their doctors how much they drink. Remember that  your physician is there to keep you healthy or to heal you, not judge. Make sure you accurately report your drinking patterns to him or her.

 

A Year of Momentum in Raising Breast Cancer Awareness… & We’re Not Done Yet!

Breast Cancer Awareness Year RoundIn November of last year, right after Breast Cancer Awareness Month wrapped up in October, we pledged to keep pushing for breast cancer awareness year-round. It’s been almost a year since that date, and we’ve made some great strides in raising community awareness and action around breast cancer.

September 2010 – Emory Healthcare launched an overhauled breast health microsite to provide educational resources on breast health and breast cancer to web users. Website release is followed by launch of Emory Healthcare and Winship at Emory cancer blog.

November 2010Pledged to keep breast cancer awareness going throughout the year. Started by asking for feedback from the community. Those who provided feedback, tips & stories were entered to win tickets to the GA Tech v. UConn women’s basketball game.

Feburary 2011 - The Emory Breast Center and Winship Cancer Institute partnered with Georgia Tech women’s basketball again, this time for their “PINK” game. Breast cancer survivors joined together to form the tunnel the Lady Yellow Jackets ran through to enter the game.

March 2011 – The Winship Cancer Institute of Emory University received a high impact donation from the Wilbur and Hilda Glenn Family Foundation in the amount of $5 million. The donation contributes to supporting breast cancer patient care, research, education and community outreach.

October 2011 – The Winship Cancer Institute and Emory Breast Center kick off Breast Cancer Awareness Month by hosting a live online web chat with breast surgeon and surgical oncologist, Dr. Toncred Styblo. The well-attended chat provided a free opportunity for the community to ask questions about breast cancer risk, prevention, screening and more.

October 2011Emory Healthcare and the Winship Cancer Institute partner with 11 Alive News for an hour-long community education special on beating breast and prostate cancer that is aired across the Atlanta area and various cities across the nation.

And we’re not done yet! The Emory Breast Center has a number of events lined up in the month of October to keep momentum going.

All of our team members from Emory Healthcare, the Winship Cancer Institute and the Emory Breast Center would like to thank our community for helping us make this an awesome year for breast cancer prevention awareness. We have lots more to do to keep the momentum going!

In the comments below, we’d love it if you’d share with us an example of something you’ve done over the last year to help promote breast cancer awareness.

Breast Cancer Questions? Dr. Styblo Has Your Answers

Breast Cancer Doctor Chat

Breast cancer is the second most common cancer affecting women. In fact, 13% of all women will develop breast cancer in their lives. Many women are concerned about their risk for breast cancer, and are unsure what their next steps should be. Our doctors frequently get questions such as, Is getting yearly check-ups sufficient? At what age should I start scheduling regular mammograms? What symptoms should I look out for?

Are you concerned about breast cancer? If you have unanswered questions related to breast cancer, look no further. To kick off October as Breast Cancer Awareness Month, surgical oncologist and breast surgeon at the Winship Cancer Institute, Dr. Toncred Styblo will be hosting a live 1-hour web chat to answer all of your breast cancer questions.

Wonder if you’re at high risk for developing breast cancer and what you should do? Dr. Styblo will provide guidance on how to determine if you are high risk and steps you can take if you are. And as an expert in surgical oncology, Dr. Styblo will also be able to answer questions related to breast cancer treatment and surgical options.

Don’t forget, early detection is key to providing the best chance for cure. So take action and control of your health by scheduling your mammogram today and remind a friend to do the same! And, make sure to sign up for Dr. Styblo’s breast cancer chat and bring your questions with you. We’ll see you on October 4th for what’s sure to be a great discussion!

Get the 4-1-1 on Ovarian Cancer & Ovarian Cancer Awareness Month

Ovarian Cancer Awareness Month

September is Ovarian Cancer Awareness Month, and as the fifth most common cancer among women in the U.S., we want to share with you some general ovarian cancer information with you and steps you can take to assess your risk for ovarian cancer, and support your body in preventing such a disease.

Ovarian cancer is a gynecologic cancer that the National Cancer Institute (NCI) describes ovarian cancer as, “cancer that forms in tissues of the ovary (one of a pair of female reproductive glands in which the ova, or eggs, are formed). Most ovarian cancers are either ovarian epithelial carcinomas (cancer that begins in the cells on the surface of the ovary) or malignant germ cell tumors (cancer that begins in egg cells).”1 The NCI estimates that there will be 21,990 new cases of ovarian cancer in the United States in 2011, and that deaths from ovarian cancer in 2011 will hit 15,460.

Ovarian Cancer Risk Factors

  • Family history of cancer - A family history  of ovarian, breast, uterus, and rectal cancer. Keep in mind that paternal history is also important – that is, your father’s mother or sister’s having had ovarian or breast cancer puts you at higher risk.
  • Age - About 90%of women who get ovarian cancer are over the age of 40. Women over the age of 55 are at higher risk.
  • Never been pregnant - women who have given birth or been pregnant are at a lower risk for ovarian cancer than women who have never been pregnant.
  • Personal history of cancer - according to the NCI, women who have had breast, uterus, colon or rectal cancer are at a higher risk for ovarian cancer.

Ovarian Cancer Symptoms

  • Pressure or pain in the abdomen, pelvis, back, or legs
  • A swollen or bloated abdomen
  • Nausea, indigestion, gas, constipation, or diarrhea
  • Feeling very tired all the time
  • Shortness of breath
  • Feeling the need to urinate often
  • Unusual vaginal bleeding (heavy periods, or bleeding after menopause)

Ovarian Cancer Detection

Contrary to popular belief, pap tests or pap smears do not test for ovarian cancer. If you have any of the ovarian cancer symptoms listed above, you should see your doctor, who may recommend a more involved test, such as a rectovaginal pelvic exam or a transvaginal ultrasound.

Ovarian Cancer Prevention

Birth Control

You’ll need to consult with your physician to determine if birth control is a right for you, but women who use oral contraceptives may be at lower risk for ovarian cancer.

Nutrition

In general, fruits, vegetables and whole grains, among others, are known to contain vital nutrients that may help prevent cancer. Aside from maintaining a healthy diet, there are a few foods and beverages that studies have shown may be extremely powerful in preventing ovarian cancer:

Tea – Tea contains flavonoids that may also help prevent ovarian cancer. In fact, researchers in Sweden looked at tea consumption and ovarian cancer in more than 60,000 women over 15 years and discovered that women who drank two or more cups of tea a day had a 46 percent lower risk of ovarian cancer than those who didn’t drink tea.2
Tomatoes - Tomatoes contain lycopenes, and a study from the American Cancer Society shows that women who ate two or more one-half cup servings of tomato sauce per week had a 40 percent decrease in risk for ovarian cancer, compared to women who reported eating tomato sauce less than once a month.3

Lowering Ovarian Cancer Risk

Many risk factors for ovarian cancer, such as some of those listed above, cannot be prevented. While we can’t control our age or our family’s history of cancer, we can increase the protective and preventive steps we take to improve our overall health and help protect ourselves from cancers, such as ovarian cancer. Participating in regular exercise, reducing stress, avoiding smoking, and prioritizing good nutrition are all necessary steps to take when improving health and lowering cancer risk.

For more information on ovarian cancer, you can visit the National Cancer Institute’s website on the topic. For information on how ovarian cancer is treated at an NCI designated cancer center, check out the Winship Cancer Institute’s ovarian cancer information.

The content of this blog post has been reviewed by a physician at the Winship Cancer Institute, Georgia’s only NCI-designated Cancer Center.

Dietary Recommendations & Nutrition for Cancer Patients – Keep Your Body Strong During Cancer Treatment

dietary recommendations for cancer patientsMost of us know that fruits, veggies and whole grains are important parts of a healthy diet, but you may not know that people diagnosed with cancer have very different nutritional needs from the average adult. In fact, many cancer treatments can make it difficult for cancer patients to get enough nutrition, and, for some, can even make it difficult just to eat. Cancer patients, especially those undergoing treatments such as chemotherapy and radiation, can combat some of the weakness and fatigue with nutrition that strengthens their health.

While cancer treatments are designed to obliterate cancerous cells, they also can kill off healthy cells in the process. As a result of this healthy cell damage, side effects, such as those that pose a barrier to eating, can present themselves. Dry mouth, nausea, vomiting, constipation and changes in a patient’s taste, smell and general appetite are not uncommon. While these symptoms can make it difficult or unappealing to eat, some cancer treatments also can result in changes inside the body that hinder the body’s ability to absorb the nutrients being consumed. Both the decline in ability or desire to eat, and the decline in the body’s ability to properly absorb food can add to the already ever-present sense of fatigue and weakness facing many cancer patients. So the question is, what can cancer patients do from a nutritional standpoint to support their body in beating the fight against cancer?

  • Start eating healthy before treatment starts - building strength prior to cancer treatment is key. It will help you build a foundation and do a better job of maintaining strength during treatment.
  • Eat extra protein and calories - cancer patients often need more calories, specifically, calories from protein than non-cancer patients. Higher protein levels help support your strength and aid in fighting fatigue and weakness.
  • Recognize patterns – you may notice as a cancer patient that your appetite is strongest, for example, in the mornings. If that’s the case, prioritize taking in more calories during that time.
  • Talk with a dietitian – most cancer treatment programs will (and should) include the opportunity for cancer patients to consult with a registered dietitian. Seek advice from your treatment team, including your doctors and nurses, and if available to you through your treatment plan, your dietitian. They can help make specific recommendations based on your body and the symptoms you’re experiencing.
  • Lots of liquids – whenever you’re able, take in as much healthy liquid as possible, especially water. Hydration is key to your body being able to perform at its optimal state and fight infection
  • Don’t make your immune system work any harder – some cancer treatment options can compromise the immune system of cancer patients and make it harder to fight off infection. Make sure to pay special attention to food handling, cooking and storing techniques. If you are a cancer patient, avoid buffets and buying food in bulk from bins that can increase the bacteria to which you are exposed. Similarly, stay away from unpasteurized liquids, raw fish and other foods and drinks that can expose you to increased and potentially harmful bacteria.

Hear More from Dr. Kucuk on Nutrition for Cancer Patients in the Podcast Below:


For more tips and nutrition information for cancer patients, the National Cancer Institute (NCI) has a great ebook, “Eating Hints,” that offers lots of information, ideas, and recommendations on how cancer patients can better cope with their disease through nutrition.

You also can learn more right here at home from Winship at Emory’s Nutrition Services program.

Myths About Tobacco-Related (Bladder) Cancer Go Up in Smoke

Smoking Bladder Cancer RiskMany people think that cigarette smoking causes only lung cancer. If you are one of them, think again.

A study published just this week in the Journal of the American Medical Association (JAMA) finds that risk of developing bladder cancer – for men and women – is higher among smokers than previously believed.

Doctors such as Dr. Viraj Master, associate professor of urology, Emory School of Medicine and director of clinical urology research at the Winship Cancer Institute of Emory University, see patients every week whose cancers likely were caused by smoking.

“Patients are often surprised to hear of the link between smoking and bladder cancer, but it’s there and it’s real,” says Dr. Master. “Smoking’s effects on the body are both pervasive and lethal.”

How could it be that cigarette smoke gets into your bladder? As it turns out, the actual smoke does not, but the carcinogens in tobacco smoke do get into your blood stream and thus into other parts of your body. The study, authored by researchers at the National Cancer Institute, suggests that an apparent increase in the concentration of carcinogens has occurred in the past 50 years, even as tar and nicotine concentrations have been reduced.

Other cancers caused from smoking include: throat, mouth, nasal cavity, esophagus, stomach, pancreas, kidney, bladder, cervix, and acute myeloid leukemia. If you or a loved one would like help to quit smoking, you can call the Georgia Tobacco Quit Line at 877-270-STOP (7867).

Also, if you are a heavy smoker between 55 and 74, you may be interested in having a CT screening of your lungs. Emory University Hospital began offering such scans in early August. A study published this summer in the New England Journal of Medicine showed that low-dose spiral CT scans of heavy smokers aged 55 to 74 reduced mortality by 20 percent. People who are screened need to be aware that false positives may occur and that further testing may be required.

Healthy Grilling – You can have fun and be healthy, too

Healthy GrillingGrilling is more than just a way to cook in the summertime.  It’s also a social event and a bonding experience. While cookouts are great for dusting off your “Kiss the Cook” apron and chatting with your neighbors, it’s important to keep your health in mind as well.

Eating red meat has long been considered a potential risk factor in developing certain types of cancer. Not to rain on your picnic and cookout, but there has been a large body of research conducted in the past few years that suggests grilling these meats is even worse for your health than if you baked or roasted them. The American Institute for Cancer Research recently conducted a meta-analysis on the causes of colorectal cancer and determined that consuming grilled or processed meats is a  “convincing” cause of the disease.

Why?

When meat is grilled using high levels of heat, the muscle proteins are broken down, causing the formation of compounds called heterocyclic amines (HCAs).  The longer the meat is cooked, the more HCAs form. The Department of Health and Human Services named HCAs on their list of carcinogens in 2005 due to their capabilities to damage DNA.  In fact, a recent study found that people who regularly consumed well-done meat were 60 percent more likely to get cancer.

It is also suggested to avoid the consumption of processed meats such as sausage, hot dogs, salami, bacon, ham, and pepperoni. This is because many of these foods contain the meat preservatives nitrates and nitrites, which have been linked to both colon and bladder cancers in humans.

Still want to have your steak and eat it too?

Here are some helpful ways to cook meat in a healthier manner:

  • Use a microwave to preheat the meat to reduce the time it spends on the grill.
  • Cover the surface of the grill with punctured aluminum foil and avoiding charring the meat or exposing it to flame.
  • Prepare smaller or thinner pieces, as it takes less time for them to cook.
  • Use meat with lower fat content, as more fat means more flames.
  • Flip the meat frequently to avoid constant exposure  to high temperatures.
  • Keep your grill rack as high as possible so that the meat is farther away from the flames.
  • Marinate meat for at least 10 minutes to help to protect it from burning.

About Dr. Dr. Bassel El-Rayes

Dr. Bassel El-Rayes, associate professor of Hematology and Medical Oncology at Winship Cancer Institute of Emory University and an expert in treating gastrointestinal cancers, notes that it is important to think of grilling other things besides meat. Salmon and other fish are healthy options, for example. Also, Dr. El-Rayes reminds people to include plenty of fruits, vegetables and legumes for a healthy cookout. Adding such things as watermelon, strawberries, squash, peppers and tomatoes not only makes the menu more inviting but also keeps it healthy, Dr. El-Rayes says.

To learn more, visit: