Tag Archives: National Cancer Institute

stem.cell

TGen researchers uncover root of myeloma relapse

Researchers have discovered why multiple myeloma, a difficult to cure cancer of the bone marrow, frequently recurs after an initially effective treatment that can keep the disease at bay for up to several years.

Working in collaboration with colleagues at Princess Margaret Hospital in Toronto, researchers from Mayo Clinic in Arizona and the Translational Genomics Research Institute (TGen) in Phoenix were part of the team that conducted the study published in the Sept. 9 issue of Cancer Cell.

The research team initially analyzed 7,500 genes in multiple myeloma cells to identify genes which when suppressed made cancer cells resistant to a common class of drugs called proteasome inhibitors such as bortezomib or carfilzomib. Then, the team studied bone marrow biopsies from patients to further understand their results. The process identified two genes (IRE1 and XBP1) that control response to the proteasome inhibitor and the mechanism underlying the drug resistance that is the barrier to cure.

The findings showed recurrence was due to an intrinsic resistance found in immature tumor progenitor (mother) cells is the root cause of the disease and also spawns relapse. The research demonstrates that although the visible cancer cells that make up most of the tumor are sensitive to the proteasome inhibitor drug, the underlying progenitor cells are untouched by this therapy. These progenitor cells then proliferate and mature to reboot the disease process, even in patients who appeared to be in complete remission.

“Our findings reveal a way forward toward a cure for multiple myeloma, which involves targeting both the progenitor cells and the plasma cells at the same time,” says Rodger Tiedemann, M.D., a hematologist specializing in multiple myeloma and lymphoma at Princess Margaret. “Now that we know that progenitor cells persist and lead to relapse after treatment, we can move quickly into clinical trials, measure this residual disease in patients, and attempt to target it with new drugs or with drugs that may already exist.”

“Some myeloma cells are too immature to be caught by the drugs and thus hide underground only to reemerge later,” says Keith Stewart, M.B., Ch.B., Dean for Research at Mayo Clinic in Arizona and contributor to the study. “This study has wide implications in the search for a cure of this common blood cancer as this ‘progenitor cell’ will have to be targeted.”

Jonathan Keats, Ph.D., head of TGen’s Multiple Myeloma Research Laboratory, said: “This study, which leverages data generated at TGen as part of the Multiple Myeloma Genomics Initiative, shows how mutations acquired by multiple myeloma tumors can make a tumor resistant to specific therapies and highlights the importance of TGen’s precision medicine approaches.”

Dr. Tiedemann says: “If you think of multiple myeloma as a weed, then proteasome inhibitors are like a goat that eats the mature foliage above ground, producing a remission, but doesn’t eat the roots, so that one day the weed returns.”

The study — Xbp1s-Negative Tumor B Cells and Pre-Plasmablasts Mediate Therapeutic Proteasome Inhibitor Resistance in Multiple Myeloma — was funded by the National Cancer Institute, Multiple Myeloma Research Foundation, Leukemla and Lymphoma Society and Canadian Cancer Society, the Arthur Macaulay Cushing Estate and The Princess Margaret Cancer Foundation.

Dr. Tiedemann is the Molly and David Bloom Chair in Multiple Myeloma Research, at the University of Toronto, Dr. Stewart is the Anna Maria and Vasek Pollack Professor of Cancer Research at Mayo Clinic. Dr. Keats is an Assistant Professor in TGen’s Integrated Cancer Genomics Division.

woman pinching stomach

Are The Symptoms You're Feeling Early Signs Of Cancer?

Reading the signs: Are the symptoms you’re feeling early signs of cancer? Why women ignore the signs, and what they may mean.


While women are busy caring for their children, their clients or both, there’s one important individual they tend to neglect — themselves. More frequently than not, women don’t make their own health a priority, ignoring symptoms that could be early signs of cancer.

“Women frequently ignore symptoms because they are simply busy,” says Dr. Daniel Maki, M.D., director of breast imaging at Scottsdale Medical Imaging (SMIL). “They are head of the household, often responsible for so many others that they put their own health on the back burner.”

What’s worse is some women believe the symptoms will just go away, so they ignore or deny the symptoms, according to Dr. Clayton Palowy, M.D., medical oncologist with Ironwood Cancer & Research Centers in Chandler.

“It’s human nature to ignore symptoms because you don’t want to view the worst, and you start rationalizing them as natural causes,” says Dr. Mike Janicek, M.D., medical director of the Cancer Genetic Risk Assessment Program at the Virginia G. Piper Cancer Center at Scottsdale Healthcare Medical Center. “I would say it’s the slowness of some of the symptoms that may sneak under the radar and makes it difficult for women to pay attention to symptoms, when in retrospect, it’s clear to them.”

Many symptoms such as bloating, irregular vaginal bleeding and pelvic pain seem typical, but, in reality, these and a few common symptoms that could be signs of various types of cancers.

Breast cancer

The stats:

Breast cancer is the most commonly diagnosed cancer among women and is the second-leading cause of cancer death among women, according to Centers for Disease Control and Prevention (CDC).

In the U.S. in 2012, it was estimated by the National Cancer Institute that there were nearly 227,000 new cases of breast cancer and more than 39,000 deaths.

The symptoms:

The most common complaint or symptom is a lump in the breast.

“Depending on what the lump (cancer) invades during its growth, it may cause a variety of different symptoms based on what it grows into,” says Dr. Maki.

“If the lump invades into the nipple or skin, it can begin causing retraction or dimpling,” he adds. “If the lump invades a blood vessel and milk duct, it can cause blood to be discharged from the nipple. If it invades nerve fibers, it can cause pain. If it invades the skin, it can cause thickening or change in texture of the skin itself.”

Other symptoms include:

  • Discharge from the nipple (particularly a bloody discharge)
  • Nipple inversion or retraction
  • Skin dimpling (along one edge of the breast) or retraction

“Sometimes patients even describe simply a ‘thickening’ of an area of the breast rather than a discrete lump,” says Dr. Maki.

Palowy says that breast changes such as a red breast is an early sign of inflammatory breast cancer and can be mistaken for infection.

Symptoms mistaken for:

Many of the symptoms are often attributed to cysts or one’s menstrual cycle, according to Maki. And in a large number of patients with lumps or pain, the assumption may often be correct.

“However, occasionally these symptoms do unfortunately represent early stages of breast cancer, and any new breast symptoms should always be brought to the attention of one’s doctor,” Dr. Maki says.

Prevention:

Mammograms and screenings are the best way to find breast cancer early. Also, be aware of your family history and risk factors. The National Cancer Institute has a Breast Cancer Risk Assessment Tool helps estimate a woman’s risk of developing invasive breast cancer. Visit cancer.gov/bcrisktool.

Cervical cancer

The stats:

All women are at risk for cervical (uterine cervix) cancer, which forms in the tissue of the cervix (the organ connecting the uterus and vagina) and is almost always caused by human papillomavirus (HPV) infection. However, it occurs more often in women over the age of 30.

In the U.S. in 2012, the National Cancer Institute estimated more than 12,000 new cases of cervical cancer and more than 4,000 deaths.

The symptoms:

  • Bleeding with intercourse: This is often mistaken for “just too much friction,” according to Dr. Deborah Wilson, M.D., of Scottsdale.
  • Bleeding after intercourse: Mistaken for the start of one’s period.
  • Irregular or heavy vaginal bleeding pre-menopausal: Mistaken for an abnormal period and could also be a symptom of uterine cancer.
  • Bleeding after menopause: Mistaken for an unexpected period and could also be a symptom of uterine cancer.

Prevention:

Two tests can help prevent or find cervical cancer early: a Pap test (or a pap smear) and the HPV test.

Ovarian cancer

The stats:

Ovarian cancer forms in the tissues of the ovary, with most ovarian cancers 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).

The National Cancer Institute estimates that there were more than 22,000 new cases of cervical cancer and more than 15,000 deaths in 2012 in the United States.

The symptoms:

  • Bloating: Mistaken for gas pain.
  • Pelvic pain: Mistaken for indigestion.
  • Early satiety
  • Chronic indigestion: Mistaken for food intolerance.

Prevention:

As with breast cancer, know your family history and inherited risk and changes, such as changes in the breast cancer susceptibility genes BRCA1 and BRCA2. However, according to the CDC, most breast and ovarian cancers are primarily due to aging, the environment and lifestyle.

“Ovarian cancer has no screening test, so that’s the one that most people focus on the symptoms,” says Janicek. “By the time you get bloating and some of the other symptoms, it’s often in its advanced stages.”

Know your history

The No. 1 symptom to consider? Family history, according Janicek.

“Family history is an unusual but very important symptom,” says Janicek. “And it’s not just for breast, but for ovarian and lynch syndrome. People don’t think of family history as a symptom, but it is. If you have a strong family history of breast or ovarian cancer, you may be at genetic risk for cancer.”

Compile your family’s health history, and go as far back as three generations. Janicek says to let other family members know when another family member gets cancer. Not only will you and your family be informed, but it will also help the doctor look for any patterns of disease in the family.

Visit My Family Health Portrait’s website at familyhistory.hhs.gov to help collect and track your family health history.

Collect the following information about both your mother’s and father’s sides of the family:

  • Number of close relatives with breast or ovarian cancer: mother, sister(s), daughter(s), grandmothers, aunt(s), niece(s), and granddaughter(s)
  • Ages when the cancers were diagnosed
  • Whether anyone had cancer of both breasts
  • Breast cancer in male relatives
  • Ashkenazi (Eastern European) Jewish ancestry

For more information about cancer treatment and prevention, visit:

Scottsdale Medical Imaging
Scottsdale Medical Center
3501 N. Scottsdale Rd., #130, Scottsdale
(480) 425-5081
esmil.com

Ironwood Cancer & Research Centers
695 S. Dobson Rd., Chandler
(480) 821-2838
ironwoodcrc.com

Scottsdale Healthcare Medical Center
Scottsdale Gynecologic Oncology
10197 N. 92nd St., #101, Scottsdale
(480) 993-2950
arizonaoncology.com

Deborah Wilson, M.D., Gynecology
8997 E. Desert Cove,  #105, Scottsdale
(480) 860-4791
drwilsonobgyn.com

Scottsdale Living Magazine Winter 2013

Breast cancer treatment

From Bugles To Breasts: Dr. Robert Kuske's Advances In Breast Cancer Treatment

Not all heroes wear capes or carry Batman-like toys.

Dr. Robert Kuske of Arizona Breast Cancer SpecialistsIn fact, in breast cancer pioneer and Scottsdale resident Dr. Robert Kuske’s case, he wears a lab coat and carries a bugle.

Yes, a bugle.

“When I was 18 years old, I left my hometown in Ohio for the bright lights of Wisconsin to play in the Bugle Corps while training to become a doctor,” Dr. Kuske says.

Over his four-year career with the group, and while getting his college education, he eventually helped to take the troop to the No. 1 ranking in the world. At 21, he was aged out of the program and put his passion into medicine — even helping to conduct nuclear physics research during his final year of professional playing.

“While I still played for fun, breast cancer treatment became my true passion thanks to my favorite professor and long-time mentor Dr. Aron,” Dr. Kuske says.

Dr. Kuske would indeed go into Dr. Aron’s profession — as a breast cancer specialist — eventually while serving as Chairman of Radiation Oncology at the famed Ochsner Clinic in New Orleans and co-developing a five-day radiation therapy alternative for women with early stage breast cancer called Accelerated Partial Breast Irradiation (APBI).

“Nationwide, more than 200,000 women are diagnosed with breast cancer each year,” Dr. Kuske says. “Surgical removal of the cancerous lump via lumpectomy is usually the first step in treatment, followed by either mastectomy or radiation.”

Today, most women choose radiation because the survival rate for such treatment is the same as with mastectomy for select early-stage breast cancers, and it allows the patient to preserve her breast.

“External beam radiation therapy, the common treatment today for early-stage breast cancer, is safe and very effective,” Dr. Kuske says. “But, it can take six time/energy-consuming weeks of daily treatment with side effects.”

APBI – or breast brachytherapy – has been researched and tested by Dr. Kuske since 1991 as a treatment method after lumpectomy. He has advanced the techniques and technology, and championed the research just as he championed his Bugle Corp into the mainstream all those years ago.

As his research progressed, Dr. Kuske found almost all of his cancer patients were strictly those with breast cancer.

So, when he moved to Scottsdale in the mid-2000s, Dr. Kuske partnered with fellow breast cancer innovator Dr. Coral Quiet and founded Arizona Breast Cancer Specialists in Scottsdale, the first organization worldwide dedicated to exclusively treating women with breast cancer with radiation.

With his focus strictly on treating breast cancer, he has been more determined than ever to move his APBI research further upstream – into the mainstream. As such, today he is co-principal investigator in the largest breast cancer radiation trial in medical history. His trial, sponsored by the National Cancer Institute, is testing 4,300 women with head-to-head, six-week, whole breast radiation versus his five-day APBI.

“I am within months of finishing the trial and believe the results will cause the biggest paradigm shift in how patients will be treated since Marie Curie herself discovered radium in 1896, which led to radiation treatment,” Dr. Kuske says.

In addition, his breast centers have also recently invested in a new technology to help women with large breasts obtain safer treatment.

“We’ve partnered with Varian Medical Systems to offer the Pivotal™ treatment solution for prone breast cancer care, a critical technology for large-breasted women that allows them to obtain treatment in the prone, or face-down, position,” Dr. Kuske says.

With this option, they are literally turning breast cancer treatment upside down.

Growing evidence shows considerable advantages in treating larger-breasted women in the prone position rather than in supine, meaning on one’s back.

According to Dr. Kuske, the advantages include a significant reduction in radiation to the heart and lungs, attainment of good dose homogeneity, minimized respiratory motion and reduced skin toxicity. The Pivotal treatment solution for prone breast care combines the prone technique with an innovative couch-top device. The design enables treatment of both right and left breast, including whole breast, partial breast and APBI.

This work has not gone unnoticed. In fact, Dr. Kuske was a 2012 finalist for both the Health Care Leadership and Health Care Hero Awards, respectively.

Oh – and he is still bugling. In fact, he volunteers his time to the Arizona Academy of Drum and Bugle Corps as its vice president and as a fundraiser. He works to help raise hundreds of thousands of dollars each year to take his kids nationwide to compete just as he did.

For more information about Dr. Kuske or breast cancer treatment, please visit breastmd.com.

Good Samaritan Hospital - AZ Business Magazine Mar/Apr 2011

Arizona’s Health Care Industry Has Flourished From Cottages To World-Class Facilities

A Century of Care

From cottages to world-class facilities, Arizona’s health care industry has flourished

Mayo Clinic Hospital - AZ Business Magazine Mar/Apr 2011 In the nearly 100 years since Arizona became a state, the health care sector has become a powerful economic force.

According to a study by Arizona State University’s L. William Seidman Research Institute, Arizona’s hospital community alone employs more than 80,000 people and contributes $11.5 billion to the gross state product. Indirectly, hospitals create about 120,000 additional jobs, more than the combined populations of Coconino, Graham and Santa Cruz counties.

Sisters of Mercy

It all started some 17 years before statehood in January 1895, when the Sisters of Mercy had collected enough money to rent a six-bedroom cottage at Fourth and Polk streets in Downtown Phoenix. Each room was equipped with two beds for TB patients, and thus was born St. Joseph’s Sanitarium, predecessor of St. Joseph’s Hospital and Medical Center and the first hospital in Phoenix. Downtown Phoenix 1900s - AZ Business Magazine Mar/Apr 2011

In the mid-1940s, the nuns purchased 10 acres at Third Avenue and Thomas Road, which was part of an old dairy farm. Today, St. Joseph’s is a 670-bed, not-for-profit hospital that is one of the cornerstones of the state’s health care industry.

A second giant in health care, Good Samaritan Hospital of Phoenix, launched its first facility in an apartment building at Third Street near Van Buren in 1911. Initially incorporated as the Arizona Deaconess Hospital and Home, it opened with 15 beds.

One-hundred years later, Banner Good Samaritan Medical Center in Downtown Phoenix is the flagship of Banner Health, with more than 662 licensed patient care beds. Banner Good Samaritan employs more than 4,200 health care professionals and support staff. Nearly 1,700 physicians representing more than 50 specialties work with Banner Good Samaritan staff to care for more than 43,000 inpatients a year.

Another early entry in the health care scene was the State Asylum for the Insane, which was rebuilt after a fire in 1911. In 1924, the asylum was informally renamed Arizona State Hospital.

Established in 1943 as a community hospital, Tucson Medical Center is among the 300 largest hospitals in the country. It is licensed for 650 adult and skilled nursing beds, and serves more than 30,000 inpatients and 122,000 outpatients a year.

St. Luke Hospital - AZ Business Magazine Mar/Apr 2011In 1971, University Medical Center — a private, nonprofit hospital located at the Arizona Health Sciences Center adjacent to the University of Arizona in Tucson — was established. UMC is Arizona’s only academic medical center, and earlier this year it became an international focal point for neurosurgery and trauma care after a gunman shot and wounded U.S. Rep. Gabrielle Giffords (D-Ariz.) and killed six people.

In Northern Arizona, the Flagstaff Medical Center, a not-for-profit hospital, was founded in 1936. A part of the Northern Arizona Healthcare family, it has some 270 beds and its medical staff includes about 200 physicians. Among its specialties are cancer, heart and sports medicine.

Health care continues to be a concern on Indian reservations throughout Arizona, particularly in some of the remote regions. A relatively new program, the American Indian Research Center for Health is designed to improve the health status of Native Americans and increase the number of Native American scientists and health professionals engaged in research. Classes for the student-training component of the program are held at the University of Arizona.

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