Focus On Cancer

Guest: Leif Ellisen, MD, PhD Host: Lee Freedman, MD A new program at Massachusetts General Hospital in Boston includes extracting the DNA from its cancer patients’ tumors to determine which abnormalities occur in the tumor cells, specific to the type of tumor. From these results, physicians hope to create better, targeted cancer therapies. Host Dr. Lee Freedman asks Dr. Leif Ellisen, associate professor of medicine at Harvard Medical School, about the details of this program. Will genetic tumor profiling be conducted at many more cancer centers in the near future?

Guest: Monica Morrow, MD Host: Mark Nolan Hill, MD As we expand the scope of breast-conserving surgery for patients with breast cancer, have we focused too much on the cosmetic results, to the potential detriment of the oncologic outcome? It's a question that concerns some in the field of breast surgery, who believe the evidence to establish clinical efficacy for certain procedures is not yet in. Dr. Monica Morrow, chief of the breast service in the department of surgery, and the Anne Burnett Windfohr Chair of Clinical Oncology at Memorial Sloan-Kettering Cancer Center in New York, joins host Dr. Mark Nolan Hill to explore how we can address the potential pitfalls of emphasizing cosmesis in breast-conserving surgery while maintaining the sound principles of oncologic surgery.

Host: Jennifer Shu, MD Guest: Elvira Lang, MD We've known anecdotally that simply waiting for the results of a tumor biopsy can be as stressful as coping with an unfavorable diagnosis itself. There is even some evidence to suggest that this stressful waiting period may subsequently impact the treatment of those patients who are found to have cancer. How do we explain this hypothesis? Further, how can we ease the anxiety of those patients awaiting cancer test results, and can we shorten the time patients must wait for their diagnosis? Host Dr. Jennifer Shu explores these key issues in the diagnostic process with Dr. Elvira Lang, associate professor of radiology at Harvard Medical School, and an interventional radiologist at Beth Israel Deaconess Medical Center in Boston.

Guest: Arthur Derse, MD, JD Host: Shira Johnson, MD Matters of life and death occur constantly in emergency departments, but some ED doctors are not well trained for the death that's expected. There is a new push inside hospitals and medical schools to train ED personnel in palliative care. Dr. Arthur Derse, director of medical and legal affairs and associate director of the Medical College of Wisconsin's Center for the Study of Bioethics, joins host Dr. Shira Johnson to discuss the new techniques being taught to ED residents for dealing with end-of-life issues. They also look at a new sub-specialty in emergency room medicine that focuses on hospice and palliative care.

Guest: Arthur Derse, MD, JD Host: Shira Johnson, MD More than 500,000 Americans die from cancer every year, and many of those people spend their final hours in the emergency department. More and more patients and their families turn to ED doctors to help make difficult decisions when it comes to end-of-life issues. Dr. Arthur Derse, director of medical and legal affairs and associate director of the Medical College of Wisconsin's Center for the Study of Bioethics and professor of bioethics and emergency medicine, joins host Dr. Shira Johnson to look at how doctors can help terminally ill patients and their loved ones when it comes to living wills, life support and pain management.

Guest: Marc Hedrick, MD Host: Bruce Japsen Many view the promise of stem cells as something far off in the distance, but these regenerative cells are nearing commercialization in the area of cosmetic and plastic surgery, particularly for women who are in need of reconstructive breast surgery. Dr. Marc Hedrick, president of San Diego based Cytori Therapeutics, tells the Chicago Tribune's Bruce Japsen about a commercialized device in Europe that uses adult stem cells derived from fat as a way to reconstruct breasts following surgery. Clinical trials may begin in the US in the next year.

Guest: Scott Waldman, MD, PhD Host: Lee Freedman, MD How is the biomarker guanylyl cyclase 2C helping to predict colorectal cancer recurrence rates? Host Dr. Lee Freedman welcomes Dr. Scott Waldman, professor in the departments of medicine and biochemistry at Thomas Jefferson University, to discuss how this biomarker found in regional lymph nodes can predict the recurrence rate for colorectal cancer patients. How does the presence of metastatic tumor cells predict clinical outcomes?

Guest: Lajos Pusztai, MD Host: Lee Freedman, MD What does microarray-based gene expression profiling tell us in terms of diagnosing and treating breast cancer? How is this technology changing our perceptions of breast cancer? Dr. Lajos Pusztai, associate professor of medicine at the University of Texas M.D. Anderson Cancer Center, discusses some clinical applications of a multigene assay. Dr. Lee Freedman hosts.

Host: Jennifer Shu, MD Guest: Per-Henrik Zahl, MD, PhD The widespread use of mammography to screen for breast cancer has resulted in a decrease in breast tumor detection, as well as decrease in mortality rates associated with the disease. But the natural course of malignant diseases such as different types of cancer can vary considerably. Is it possible-even common-for some invasive breast tumors to regress without treatment? And if this is the case, how could this impact our strategies for screening, diagnosing and treating breast cancer? For more on these intriguing ideas, host Dr. Jennifer Shu welcomes Dr. Per-Henrik Zahl, epidemiologist and senior statistician at the Norwegian Institute of Public Health in Oslo, Norway, and lead author of a study published in the Archives of Internal Medicine that "raises the possibility that the natural course of some screen-detected invasive breast tumors is to spontaneously regress."

Guest: Keith Black, MD Host: Mark Nolan Hill, MD Despite our best efforts at surgery and chemotherapy for patients with glioblastoma, survival time is often far too limited. One novel weapon in our arsenal could be a vaccine that bolsters the immune system in the body's fight against these tumors. As we move forward with research toward a vaccine, what are the keys to boosting its efficacy? How much additional time could a vaccine buy for our glioblastoma patients? Host Dr. Mark Nolan Hill probes these questions and more with Dr. Keith Black, professor of neurosurgery and chair of the department of neurosurgery, and director of the Maxine Dunitz Neurosurgical Institute at Cedars-Sinai Medical Center in Los Angeles. Dr. Black also describes the fascinating process by which the research team collects tissue from each patient, which is subsequently applied toward the formation of a vaccine customized for the individual's condition.

Guest: H. Richard Alexander, MD Host: Mark Nolan Hill, MD Whether cancer originates in the colon, breast, or elsewhere in the body, the liver is one of the most common places to which a malignancy will spread. When this occurs, if it's possible to control the metastasis in the liver, we may have a much better shot at holding the original tumor at bay. A technique called hepatic perfusion may help us do this. For more on hepatic perfusion and its potential role in the chemotherapeutic process, host Dr. Mark Nolan Hill talks with Dr. H. Richard Alexander, associate chairman for clinical research in the department of surgery at the University of Maryland School of Medicine. How might this technique, which affords us the opportunity to deliver high-dose therapy while circumventing most side effects, begin to change our perspective on the limitations of chemotherapeutics?

Guest: Gary D. Steinberg, MD Host: Mark Nolan Hill, MD Early diagnosis of bladder cancer is a significant step toward survival. Over the years, findings have suggested that women and African-Americans are particularly vulnerable to the disease, and often times, we are delayed in our diagnosis and subsequent treatment of these more highly susceptible populations. What are the most effective steps we can take to improve our recognition of bladder cancer earlier in its progression? Host Dr. Mark Nolan Hill welcomes Dr. Gary Steinberg, professor and vice chairman of urology, and director of urologic oncology at the University of Chicago Pritzker School of Medicine, to discuss the key issues relative to gender and race, as well as awareness among patients and primary care physicians toward prevention of a delayed diagnosis of bladder cancer.

Host: Jennifer Shu, MD Guest: David Abramson, MD Survival rates for retinoblastoma now approach 100 percent, but in years past, enucleation was the only sure way to cure this rare pediatric malignancy. We're now seeing advances in chemotherapy that not only spare the child's eye, but can preserve vision as well. What makes this chemotherapy regimen so effective, and how can we build on its effectiveness to enhance the vision and the livelihood of children affected by retinoblastoma? Dr. David Abramson, chief of the ophthalmic oncology service at Memorial Sloan-Kettering Cancer Center in New York, joins host Dr. Jennifer Shu to talk about the breadth of retinoblastoma research that has helped us take important strides toward remediation of this disease.

Guest: Greg Brown Host: Bruce Japsen Lymphedema is a condition faced by many breast cancer survivors, and it can be debilitating for one in five of these women. But lymphadema can be detected early. Greg Brown, chief executive officer of Australia-based ImpediMed tells host Bruce Japsen about the benefits of early detection and the coming technology platforms to assist doctors in this regard.

Guest: Greg Brown Host: Bruce Japsen For breast cancer patients, there is often an untold story after mastectomy and treatment. Greg Brown, chief executive officer of ImpediMed, tells host Bruce Japsen about how women can suffer a debilitating complication known as lymphedema and how test makers are moving to help diagnose the problem early.

Guest: William Foulkes, MD, PhD Host: Bruce Bloom, DDS, JD The need to manage the health of patients with cancer, and at risk for developing cancer, has given rise to the field of cancer genomics. What is this field? What are the roles within the specialty? And how do they work with patients?Host Dr. Bruce Bloom talks with Dr. William Foulkes, director of the cancer genetics program at McGill University in Montreal, Canada.

Host: Bruce Bloom, DDS, JD Guest: William Foulkes, MD, PhD What has genetic research taught us about the inheritance of common cancers? And how can we use this knowledge to help patients? Dr. William Foulkes, director of the cancer genetics program at McGill University in Canada, talks with host Dr. Bruce Bloom about the questions raised and the answers revealed when we look at cancer risk from a genetic perspective.

Guest: John Docherty Host: Bruce Japsen Cancer cells can be made to become more vulnerable to treatments like chemotherapy, and there are therapeutics under development which are designed to impact this so-called microenvironment of tumor cells. John Docherty, president of Toronto-based Helix BioPharma, tells host Bruce Japsen about a new wave of treatments and therapies in the biotechnology industry that could better target cancer cells and in turn help patients deal with the side effects of chemotherapy.

Guest: John Docherty Host: Bruce Japsen While vaccines have emerged to treat a cancer caused by human papilloma virus, there is still a need for therapies to treat cancerous tissue caused by HPV. John Docherty, president of Toronto-based Helix BioPharma, tells host Bruce Japsen about his company's research and that of the biotech industry in the study and treatment of HPV, a key virus in the development of cervical cancer.

Guest: Benjamin Griffith, MD Host: Leslie P. Lundt, MD What is the connection between anxiety and pancreatic cancer? Certainly, patients can develop problems with anxiety after a cancer diagnosis. But pancreatic cancer seems to have the curious characteristic of anxiety as a presenting symptom. The age at which anxiety presents itself may be a clue as to whether you're looking at mental illness or a possible cancer diagnosis. Dr. Benjamin Griffith, assistant professor of medicine at the University of Virginia and the Edward Via Virginia College of Osteopathic Medicine, explains to host Dr. Leslie Lundt.