Cancer Update November 2015

NOV

2015

Issue No. 32 IN TH I S I SSU E 5 BREAST CENTER: Pushing forward in breast health care 8 GENE EDITING: Research pioneer directs new institute 13 FRIENDS: Celebration of Hope gala raises funds to support patient care

The Hepatobiliary/Pancreatic Multidisciplinary Center at the Helen F. Graham Cancer Center & Research Institute

Offering comprehensive strategies to treat complex cancers STORY ON PAGE 2

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TREATING COMPLEX CANCERS

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hen Lorraine Macasevich fell ill with pneumonia last summer, her trip to the emergency room uncovered a much greater challenge. Doctors found a large tumor growing in the right side of her liver and told her it was cancer.

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These types of cancers are often complex, requiring patients to be evaluated by more than one specialist for treatment.

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R A A FAT A B D E L - M ISI H, M .D.

“My husband, Tom, and I were pretty much in denial at that point,” she said, “but that visit to the hospital turned out to be a blessing in disguise.”

Soon afterward, even though Macasevich was too sick to attend, the Hepatobiliary/ Pancreatic Multidisciplinary Center team at the Helen F. Graham Cancer Center & Research Institute sat down together to construct a treatment plan.

Team members include surgical oncologists, medical oncologists, radiation oncologists, interventional radiologists, nuclear medicine specialists and a nurse navigator who can connect patients with a host of supportive services, including social work, health psychology and nutrition. Cancer research nurses facilitate access to the latest clinical trial opportunities.

The Hepatobiliary/Pancreatic MDC specializes in treating patients with cancers of the liver, pancreas and biliary tree, which includes bile ducts and gallbladder.

“These types of cancers are often complex, requiring patients to be evaluated by more than one specialist for treatment with surgery, chemotherapy and/ or radiation,” said Surgical Oncologist Raafat Abdel-Misih, M.D., who together with Joseph Bennett, M.D., leads the MDC team. “A multidisciplinary team approach where we all sit down together in discussion often provides the most timely and optimum course of action for our patient.”

Advanced techniques The size of Macasevich’s tumor required extensive liver surgery to remove all but a small portion of the left lobe. The surgery, known as right trisegmentectomy, is highly specialized, offered only at major centers. Christiana Care is the only center in Delaware that offers the procedure.

But first, the MDC team recommended another selective procedure called hepatic portal vein embolization (PVE), performed by the interventional radiologist.

PVE blocks blood flow to the side of the liver that contains the tumor. This allows the other side of the liver to grow to a size that can sustain liver function after surgery.

Cover photo: Medical Oncologist Pamela Simpson, M.D., and Lorraine Macasevich.

Above: Dr. Simpson meets with Lorraine and her husband Tom.

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Patients like Macasevich, who previously were not candidates for surgery because only a small portion of liver would be left behind, can now undergo surgery

(left to right): Cyndy Fanning, LCSW, Erin Grady, M.D., Nancy Lambert, MSN, RN, OCN, Joseph Bennett, M.D., Raafat Abdel-Misih, M.D., Kathir Suppiah, M.D., Kevin Lie, M.D., Hung Q. Dam, M.D. Not pictured: Pamela Simpson, M.D., Timothy Manzone, MD., Daniel Leung, M.D., Demetrios Agriantonis, M.D., Michael Dignazio, M.D., Christopher Grilli, D.O., Shannon Collins, RN, MSN, OCN, LNCC.

MDC teamwork safely after PVE, and have their entire tumors removed successfully.

According to MDC Surgical Oncologist Joseph Bennett, M.D., “PVE may work well enough so that pre-operative chemotherapy is not necessary to downstage the tumor and shrink it.

Essentially, instead of shrinking the tumor, we are getting the future liver to grow,” he said. If pre-operative chemotherapy is recommended, he said, close management by the medical oncologist is essential to preserve healthy liver tissue.

“When you have to refer a patient to multiple specialists, as in a case like this, it could take weeks to

coordinate a plan of care,” Dr. Bennett said. “At the MDC, we can consult together and make decisions right in the moment. That can really make a powerful impact on a patient’s confidence.”

Macasevich agrees. “I am so happy to have a facility like the Graham Cancer Center nearby for my treatment. I had heard from others that I would get top-notch care, and they were right. I was blessed to have Drs. Bennett and Abdel-Misih and the entire team taking care of me. It is a wonderful place, filled with caring, compassionate people.”

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When you refer a patient to multiple specialists...it can take weeks to coordinate. At the MDC, we can consult together and make decisions right in the moment.

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J O SEP H BENNE T T, M. D.

CONTINUED

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TREATING COMPLEX CANCERS

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A bridge to transplant

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arol Grysbowski wants to spend more time with her 4-year-old great-granddaughter.

To ensure she can, she is waiting for a liver transplant. The Hepatobiliary/Pancreatic MDC team are helping her get there.

Carol Grysbowski’s doctors in Philadelphia referred her to the Graham Cancer Center, where the MDC team is collaborating to shrink her inoperable liver tumor.

Her doctors in Philadelphia referred Grysbowski to the MDC team to treat her liver cancer. Surgery was ruled out, but the MDC team offered another option — radioembolization to shrink her liver tumor.

With radioembolization, radioactive particles are delivered through an artery in the groin, directly to the tumor to kill cancer cells. The interventional radiologist performs anatomic vascular mapping and positions the catheter for treatment. The nuclear medicine specialist determines the precise dose of radiation to shrink the tumor without harming surrounding healthy liver tissue.

“This type of radiation treatment to the liver from the inside out is generally better tolerated by patients than chemoembolization, which involves directing chemotherapy at the blood supply of the tumor,” said Erin Grady, M.D., FACNM, the MDC’s nuclear medicine specialist. “Collaboration with interventional radiology and the other specialists on the MDC team has produced very good results with our patients.”

The team specializes in two types of small particle technology to destroy liver cancers: Yittrium-90 SIR-Spheres to treat metastatic liver disease and Yittrium-90 TheraSpheres, the kind Grysbowski received, to treat liver cell cancers.

Radioembolization can serve as a bridge to transplant, helping to shrink inoperable tumors and keep them from growing while patients wait for a liver donor.

“Everyone at the Graham Cancer Center is working so hard for me, I want to stay strong and keep fighting too,” Grysbowski said. “My greatgranddaughter turns 5 in January and I want to enjoy her for as many more years as I can.” ¤

“ Collaboration with interventional radiology and the other specialists on the MDC team has produced very good results with our patients.” Erin Grady, M.D., FACNM

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Finding New Ways to Guide Patient Centered Care

Christiana Care Breast Center specialists are pushing the field forward in breast health care

EXPERT CARE Diana Dickson-Witmer, M.D., medical director of the Breast Center and Breast Health program, left, and Jacqueline Holt, M.D., chief of Breast Imaging.

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he Christiana Care Breast Center and Breast Health program at the Helen F. Graham Cancer Center & Research Institute is home to a multidisciplinary team of specialists building new opportunities for evidence-based practices to guide patient-centered care.

“In recent years there have been remarkable practice-changing advances in our ability to detect and treat breast cancer,” said Diana Dickson-Witmer, M.D., medical director of the Christiana Care Breast Center and Breast Health program. “Our breast surgeons, radiologists and nurses are working together with specialists from every pertinent discipline to capture the very best of what is new in breast medicine to address each patient’s individual and personal health care needs.”

The Breast Center multidisciplinary team is charting several new clinical pathways that follow national guidelines to improve outcomes.

“Our goal is to achieve the same optimum control of the patient’s cancer without subjecting her to unnecessary anxiety, procedures or adverse consequential side effects,” Dr. Dickson-Witmer said.

CONTINUED

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Our surgeons, radiologists and nurses are working together with specialists from every pertinent discipline to capture the very best of what is new in breast medicine.

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DI AN A DIC K S ON- W I T MER , M.D. November 2015

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SPECIALISTS ARE PUSHING THE FIELD FORWARD

Finding New Ways to Guide Patient Centered Care

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disparities in breast cancer outcomes in our own communities. Studies underway include:

Less aggressive surgeries.

Not every patient with localized breast cancer requires a full axillary (underarm) lymph node dissection. Removing most or all of the underarm lymph nodes can lead to several debilitating side effects including lymphedema, nerve damage and impaired arm mobility. Close coordination among the surgical/medical team will enable patients who meet the guidelines with node-negative (and even some node-positive) sentinel node biopsies to avoid full axillary dissection when they undergo breast surgery (lumpectomy or mastectomy).

Shorter wait times for treatment.

Ordering the Oncotype DX test earlier will minimize delays to further treatment. This test helps doctors determine whether a particular cancer will respond to chemotherapy.

Targeted radiation therapy.

Partial breast irradiation is an option for selected patients with early stage breast cancer after breast conserving surgery. Treating only the area where the tumor was removed, rather than the entire breast, minimizes harmful radiation to healthy tissue and shortens the course of treatment.

Fewer repeat surgical procedures.

Traditionally about 25 percent of women who have a lumpectomy make repeat trips to the operating room based on the pathologist’s report. The pathologist uses special ink to delineate the tumor under the microscope. New guidelines say that margins of normal tissue around the tumor can be small, as long as there is no ink touching them. This new “no ink on tumor” rule could cut in half the number of times a woman has to endure repeat surgeries to ensure that all her cancer is removed.

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• Targeting therapy side effects to relieve symptoms and improve medication compliance.

• Identifying accurate early predictors of cancer risk and/or recurrence to minimize overtreatment.

“There is a synergy inside these walls that is charging our physicians and nurses, along with the other health care professionals on staff, to do more, better, faster when it comes to breast care.

Everyone is dedicated to providing our patients with compassionate care of the highest quality.”

REN I E MULL ANE Y, MS

Patient-focused research Backed by a robust national cancer clinical trials program, the Breast Center also supports an active in-house research team led by Dr. DicksonWitmer and Jennifer Sims-Mourtada, Ph.D., senior clinical scientist for the Center for Translational Cancer Research at the Graham Cancer Center.

The team includes Christiana Care physician investigators and nurses, as well as academic researchers from the University of Delaware.

Their goal is to promote evidencebased research to improve the lives of breast cancer patients and eliminate

HELEN F. GRAHAM CANCER CENTER & RESEARCH INSTITUTE

• Finding more effective ways to treat aggressive breast cancers.

• Analyzing biological/psychosocial impact on outcomes.

• Access to care for minority populations, working to infuse new ideas into the research program to benefit all Delawareans.

Comprehensive breast health center At the core of Christiana Care’s breast health program is the Christiana Care Breast Center, the only one in the region devoted exclusively to breast care, diagnosis and treatment with a wide array of supportive resources. The designation as a Breast Imaging Center of Excellence by the American College of Radiology certifies technology and expertise to ensure the highest level of image quality and patient safety.

Under the direction of Jacqueline Holt, M.D., chief of Breast Imaging, the Breast Center offers screening and diagnostic mammograms to detect breast abnormalities at the earliest possible stage. State-of-the-art tools and procedures include low-dose 3D mammography (tomosynthesis), the only dedicated breast MRI in the region, as well as stereotactic breast biopsy, breast ultrasound and ultrasound-guided biopsy. Radiologists read mammograms on-site and are available to meet quickly with patients to discuss results and recommendations for care.

Breast surgeons are also available for consultation.

Team approach Multidisciplinary specialty care is the foundation of every patient evaluation and treatment plan. At the Graham Cancer Center, multidisciplinary teams meet every week to participate in breast cancer tumor conferences, where newly diagnosed patient cases are presented to develop the best possible treatment plan for each individual patient.

“There is a synergy inside these walls that is charging our physicians and nurses, along with the other health care professionals on staff, to do more, better, faster when it comes to breast care,” said Breast Center Director Renie Mullaney, MS. “Everyone is dedicated to providing our patients with compassionate care of the highest quality.”

Breast Center nurses are at the heart of every patient experience. They are certified to perform clinical breast exams, offer health education and help to navigate care and schedule patients’ services coordinating with genetic counselors for patients in the High-Risk Breast and Ovarian Cancer Surveillance Program.

To address patients’ desire to decrease wait times, the Breast Center team

has instituted a new model of care to ensure that patients can access a breast surgeon appointment within 72 business hours. A breast surgeon evaluates urgent cases within 24 hours.

“Facing the possibility of breast cancer is never easy,” said Joanne Antonio, RN. “At the Breast Center, our nurses and entire team are here to make sure, you never have to feel alone.” ¤

LEARN MORE For more information about breast screening or to sign up for an appointment with the Nurse Navigator, call 302-623-4500.

CHRISTIANA CARE BREAST CENTER PHYSICIANS (left to right): Dennis Witmer, M.D., Greg Pahnke, M.D., Diana Dickson-Witmer, M.D., Danielle Press, M.D., Emily Penman, M.D., J. Wesley Clayton, M.D., James Tikellis, M.D., Raafat Abdel-Misih, M.D., Katherine Sahm, M.D.

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Progress Toward Personalized Genetic Medicine

It’s in the genes

Scientists at the new Gene Editing Institute develop tools for tomorrow’s medicine Pictured with Eric Kmiec, Ph.D., director of the Gene Editing institute are from left Kevin Bloh, research assistant, Natalia Rivera-Torres, doctoral student from the University of Delaware, Elise Lankiewicz, undergraduate research intern from Davidson University, NC and Pawel Bialk, research associate.

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Christiana Care’s Helen F. Graham Cancer Center & Research Institute has established a Gene Editing Institute at the Center for Translational Cancer Research (CTCR) under the direction of world-renowned molecular biologist and gene editing pioneer Eric Kmiec, Ph.D. Dr. Kmiec has worked for 25 years creating tools to help scientists understand how genes change and mutate to cause disease. He has led research teams in developing gene-editing technologies, including seminal work on oligonucleotide gene repair, and genetic therapies for inherited disorders such as sickle cell anemia, muscular dystrophy and Huntington’s disease. He has helped start three biotech companies, authored more than 145 publications and secured 18 patents.

Dr. Kmiec joins Christiana Care Health System as director of the Gene Editing Institute, positioning the CTCR among a handful of companies and institutions in the world capable of making next-generation genome-engineering tools.

“The installation of the Gene Editing Institute under the direction of Dr. Kmiec at the CTCR places our translational science program on equal footing with the very best in the nation,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute. “Bringing together scientists such as Dr. Kmiec and his team with our clinicians under

one roof promises to be the catalyst that will skyrocket progress toward personalized genetic medicine for our patients.”

The CTCR’s Gene Editing Institute is dedicated to education, technology development and scientific research into the very core of the human genome. This means designing the tools scientists need to manipulate and alter human genetic material more easily and effectively than ever before in order to better understand and cure many genetic diseases, including cancer.

According to Dr. Kmiec, “Only in the last four or five years have scientists succeeded in putting together a genetic toolbox for us to manipulate and control the genetic material in human cells for therapeutic purposes. This could change everything from the way we develop treatments to how we impact patients.” ¤

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Bringing together scientists such as Dr. Kmiec and his team with our clinicians under one roof promises to be the catalyst that will skyrocket progress toward personalized genetic medicine for our patients.

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NIC HOLAS J. PETRELLI , M.D.

Bank of America Endowed Medical Director of the Helen F. Graham Cancer Center & Research Institute

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Specialists in Your Corner

Welcome the newest members of our team

Christopher Mitchell, M.D. Dr. Mitchell is director of Robotic Surgery at the Helen F. Graham Cancer Center & Research Institute and a member of Brandywine Urology Consultants in Wilmington. He brings expertise in some of the most advanced and complex minimally invasive robotic surgical techniques in the field of urology today.

With his arrival, Christiana Care is one of only a handful of centers in the United States to offer holmium laser enucleation of the prostate. This new procedure is shown to be highly effective in treating enlarged prostate or BPH (benign prostate hyperplasia), a non-cancerous condition that affects most men as they age.

Dr. Mitchell earned his medical degree from the University of Maryland, where he received the Gold Medal Award for outstanding scholarly accomplishments and those qualities of humanity and dedication most desirable in a physician.

Following a one-year internship in general surgery, he completed residency training in urology at the Mayo Clinic, followed by a two-year fellowship in laparoscopy/endourology at Vanderbilt Medical Center in Nashville, Tenn.

Dr. Mitchell has published and presented both nationally and internationally on the topics of kidney cancer, prostate cancer, BPH and stone disease. He is collaborating currently with a team of surgeons and engineers to design and develop a new transurethral robot to improve surgery for benign prostate conditions. ¤

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Stephanie Jean, M.D. Dr. Jean is the director of Gynecologic Oncology Research, and is a gynecologic oncologist at the Helen F. Graham Cancer Center & Research Institute. She is board-certified in obstetrics and gynecology by the American Board of Obstetrics and Gynecology.

Dr. Jean graduated from Stanford University with departmental honors in biological sciences. She earned her medical degree from the State University of New York at Stony Brook School of Medicine, where she was inducted into Alpha Omega Alpha. She completed her residency with the Department of Obstetrics and Gynecology at the Hospital of the University of Pennsylvania, serving as administrative chief resident her final year. Dr. Jean completed her fellowship in gynecologic oncology at University of Pennsylvania, and was an instructor performing genetics research as a recipient of a Foundation for Women’s Cancer Research Grant.

Dr. Jean has co-authored abstracts and articles published in Cancer Cell, Journal of Obstetrics & Gynecology, Gynecological Oncology, American Journal of Surgery and Proceedings of the National Academy of Sciences.

She has presented at the American Society of Clinical Oncology and the American Association for Cancer Research. Dr. Jean is a fellow of the American Congress of Obstetricians and Gynecologists, and is a member of the Society of Gynecologic Oncologists. ¤

Lindsay Brown Romak, M.D. Dr. Romak is a radiation oncologist at the Helen F. Graham Cancer Center & Research Institute. She graduated from Dartmouth College with honors in Biochemistry and Molecular Biology. She earned her medical degree from the University of Connecticut School of Medicine with multiple honors, including the Dean’s Award for Academic Excellence and First Place in the Dean’s Symposium on Patient Safety and Quality Improvement. She completed a transitional internship at Yale University and the Hospital of Saint Raphael, in New Haven, Conn., where she was named Intern of the Year, and residency training in Radiation Oncology at the Mayo Clinic in Rochester, Minn., where she served as chief resident from 2014-2015.

Pulak Ray, M.D. Dr. Ray has been a neurosurgeon with the Helen F. Graham Cancer Center & Research Institute since 2013. He has served as a member of the Cancer Center’s Neurosurgery Multidisciplinary teams in neuro-oncology as well as pain management. He is an attending with the Delaware Neurosurgical Group in Newark, Delaware, and serves on Christiana Care’s Neurovascular Review Committee.

Dr. Ray earned his medical degree from the University of Maryland School of Medicine and completed residency training in Neurological Surgery at Temple University School of Medicine in Philadelphia. He did a one-year fellowship in the Laboratory of Biochemical Genetics at the National Heart, Lung, and Blood Institute of the National Institutes of Health in Bethesda, Md., and has been involved in multiple translation research endeavors in the field of neuroscience.

Dr. Ray has co-authored articles in peer-reviewed journals and presented in his specialty and has served as a member of the American College of Graduate Medical Education Review Board. Dr. Ray is involved in translational cancer research with the Center for Translational Cancer Research at the Graham Cancer Center in collaboration with Deni Galileo, Ph.D., from the Department of Biological Sciences at the University of Delaware. ¤

Dr. Romak is an editor and reviewer for two peer-reviewed journals, Rare Tumors and Frontiers in Radiation Oncology, and co-author of numerous peer-reviewed articles and abstracts in her specialty. Her research and clinical interests include cancer radiotherapy and associated morbidities, and she has presented at professional oncology and brachytherapy symposia and annual meetings around the country. She is a member of multiple professional societies and organizations, including the American Brachytherapy Society, the American College of Radiology, the American Society for Radiation Oncology and the Particle Therapy Co-Operative Group. ¤

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Kimberley Hudson Administrative Assistant Christiana Care Breast Center

“At the Breast Center, I’m the go-to person for payroll, supplies, catering and more, but as with everyone on staff, our patients are my first priority. I think besides all the latest technology and expert medical care offered here, our patients come because of the kind and caring staff. I really enjoy being part of a team dedicated to promoting breast health for everyone in our community.” ¤

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The Impact of Community Cancer Centers

Helen F. Graham Cancer Center & Research Institute and The Wistar Institute apply to become joint NCI-designated Cancer Center program The Helen F. Graham Cancer Center & Research Institute and The Wistar Institute in Philadelphia are pursuing the next phase of their historic four-year partnership by finalizing preparations to apply to become a National Cancer Institute (NCI) designated Cancer Center. Wistar has been NCI-designated since 1972.

On Nov. 19, Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute and Dario C. Altieri, M.D., president and CEO of The Wistar Institute and director of the Wistar Institute Cancer Center, made a formal presentation to NCI as part of the NCI designation application. If the status is granted in 2018 following on-site program evaluations, the Graham Cancer Center and Wistar will be recognized as partners with a cohesive research agenda and defined clinical goals.

Dario C. Altieri, M.D., president and CEO of The Wistar Institute and director of the Wistar Institute Cancer Center and Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute.

“At the moment there is no cancer consortium program between an NCI-designated research program, such as Wistar, and an NCI-selected Community Cancer Center such as Christiana Care. We would be the first,” said Dr. Petrelli who joined Dr. Altieri in a presentation on the partnership at the Graham Cancer Center on Oct. 16. ¤

The Helen F. Graham Cancer Center & Research Institute joins a small group of community cancer centers in developing hybrid models of care to reach more patients A recent article in MedPage Today featured the Helen F. Graham Cancer Center & Research Institute among a small group of community cancer centers developing alternative models of care that combine the best of academic research with community medicine.

Featured along with the Graham Cancer Center were Carolinas HealthCare’s Levine Cancer Institute in Charlotte, N.C. the Gibbs Cancer Center in Spartanburg, S.C., and the Inova Dwight and Martha Schar Cancer Institute in northern Virginia.

The shining potential from these emerging hybrids is local access for more patients to more and earlier phase clinical

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trials and better care than they might receive in traditional community settings.

A common denominator is strong, innovative leadership backed by supportive resources and the vision that community oncologists can both practice medicine and conduct clinical research with more immediate potential benefit to their patients.

Nicholas J. Petrelli, M.D., Bank of America Endowed medical director of the Helen F. Graham Cancer Center & Research Institute, was interviewed for the article. ¤

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A Celebration of Hope

The Friends of the Helen F. Graham Cancer Center & Research Institute raises $193,000 at Celebration of Hope gala More than 250 generous supporters of the Christiana Care’s Helen F. Graham Cancer Center & Research Institute gathered on Oct. 3 for an inspirational gala to strengthen patient-centered care at one of the nation’s most advanced centers of cancer treatment.

The “Celebration of Hope” gala at the Wilmington Country Club raised $193,000, thanks to the dedicated efforts of The Friends of the Helen F. Graham Cancer Center. Proceeds benefit the Psychosocial Oncology & Survivorship Program, which provides counseling and other services to patients and families affected by cancer.

“We help people live as fully as they can from diagnosis to treatment and beyond,”

said Scott Siegel, Ph.D., a licensed psychologist and the director of Psychosocial Oncology & Survivorship.

“We assist with a lot of the human challenges that come with being diagnosed or having a loved one dealing with cancer.”

There is strong demand for these services, in that about 48 percent of the patients followed annually by Graham Cancer Center clinicians have a need for some type of psychosocial support.

“Our biggest challenge is in keeping up with the demand,” Dr. Siegel said.

The Celebration of Hope gala will help meet that demand and enable the cancer psychology team to implement new models of care. ¤

Diane du Pont, Elisa Komins Morris, Lois Galinat, Amanda Friz and Karen Kimmel Legum, 2015 co-chairs of the Friends of the Helen F. Graham Cancer Center & Research Institute’s Celebration of Hope gala.

THE FRIENDS OF THE HELEN F. GRAHAM CANCER CENTER is a group of 65 volunteers celebrating their 12th year of supporting patients and clinicians at one of the nation’s first centers selected as a U.S. National Cancer Institute Community Cancer Center.

The Friends work in cooperation with the clinical staff of the Graham Cancer Center to help fund programs that enhance the patient care experience, support cancer research and provide education on prevention, early detection and treatment of cancer.

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Clinical capsule Controlling overtreatment of low-risk thyroid cancers at the Helen F. Graham Cancer Center & Research Institute

Recent studies suggest that some patients with earlystage thyroid cancers, with tumors measuring 1.0 cm or less, do not require aggressive surgery or treatment with Radioactive Iodine (RAI). Overtreatment can lead to unnecessary and adverse side effects.

Although there has been an increase in the diagnosis of early stage thyroid cancers in the last 10 years, experts regionally attribute this rise to more powerful diagnostic imaging tools. New treatment guidelines from the American Thyroid Association are expected to downsize aggressive management of low-risk thyroid cancers.

The Christiana Care Cancer Committee at the Helen F. Graham Cancer Center & Research Institute monitors incidence and quality of care for cancer patients.

The Cancer Committee analyzed 50 cases treated at Christiana Care in 2014 that met the tumor size criteria of 1.0 cm or less. Of these, 43 patients (86 percent) did not receive RAI. Of the seven patients (14 percent) who did receive RAI, six were female one was male, ranging in age from 21 to 68 years. Chart reviews of these seven cases did not reveal a reason for the RAI administration.

Christiana Care cancer specialists continue to promote best-practice guidelines to control overtreatment of low-risk thyroid cancers. 造

Trends in diagnosis of thyroid cancers by tumor size at Christiana Care

Experts attribute the increase in the detection of early stage thyroid cancers to more powerful diagnostic imaging tools.

Cases of no radioactive iodine given

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CHRISTIANA CARE CANCER PROGRAM 2014 ANALYTIC* CASE DISTRIBUTION YEAR CASES SEEN AT CHRISTIANA CARE HEALTH SYSTEM PRIMARY SITE

2014 CASES BY AJCC STAGE GROUPS

2006

2007

2008

2009

2010

2011

2012

2013

2014

0

I

II

ORAL

51

68

73

78

87

74

82

96

110

0

22

15

8

61

4

Tongue

18

26

25

26

29

25

27

26

33

0

9

4

2

17

1

Mouth

25

29

41

45

47

34

48

62

62

0

12

11

4

32

3

Pharynx

8

13

7

7

11

15

7

8

15

0

1

0

2

12

0

DIGESTIVE

444

460

498

442

433

473

460

502

478

14

86

126

112

101

39

Esophagus

18

29

36

29

20

39

30

30

31

0

4

5

12

9

1

Stomach

35

35

34

25

32

30

36

42

28

0

2

8

8

4

6

Small Intestine

III

IV

UNK/NA

8

8

16

15

13

18

21

8

20

0

2

7

7

3

1

Colon

178

168

179

158

155

138

144

161

147

8

34

42

31

28

4

Rectum/Rectosigmoid

81

76

80

68

72

74

58

76

79

6

19

16

23

14

1

Liver/IHBD

29

35

30

32

36

36

47

46

40

0

12

10

6

4

8

Pancreas

67

69

83

77

69

85

75

90

77

0

9

26

11

27

4

Other Digestive

28

40

40

38

36

53

49

49

56

0

4

12

14

12

14

RESPIRATORY

477

439

465

446

521

469

429

470

481

3

158

34

87

192

7

Larynx

20

21

28

32

29

30

25

29

26

3

13

1

3

6

0

Lung

451

401

421

399

479

426

395

431

438

0

142

32

82

179

3

Mesothelioma

5

9

7

6

8

10

8

5

11

0

3

1

2

5

0

Other Respiratory

1

8

9

9

5

3

9

5

6

0

0

0

0

2

4

BONE & CONNECTIVE TISSUE

24

28

25

28

20

32

20

23

28

0

7

9

6

4

2

Bone/Joints

5

4

7

5

5

5

6

5

1

0

0

0

0

1

0

Connective/Soft Tissue

19

24

18

23

15

27

14

18

27

0

7

9

6

3

2

MELANOMA

121

118

145

160

136

145

108

126

157

38

68

21

12

10

8 3

Other Skin Cancer

7

9

13

6

7

8

13

12

9

0

2

1

2

1

BREAST

534

597

639

703

652

698

747

789

760

175

303

207

45

24

6

FEMALE ORGANS

194

229

198

228

202

257

252

267

245

5

139

28

34

31

8

Cervix

27

48

33

41

41

33

37

30

36

0

17

5

7

6

1

Uterus

103

113

101

110

110

154

152

157

132

2

95

9

7

16

3

Ovary

47

54

37

52

39

53

41

51

48

0

14

9

16

8

1

Other Female Organs

17

14

27

25

12

17

22

29

29

3

13

5

4

1

3

MALE ORGANS

381

407

401

302

285

225

213

218

212

0

39

121

23

25

4

Prostate

368

393

390

290

274

217

204

207

192

0

28

119

18

25

2

Testis

11

13

11

10

8

8

7

9

15

0

8

1

5

0

1

Other Male Organs

2

1

0

2

3

0

2

2

5

0

3

1

0

0

1

URINARY

179

188

179

199

215

216

216

218

226

61

96

17

14

30

8

Bladder

100

109

83

104

105

124

115

128

117

57

31

12

3

13

1

Kidney/Renal Pelvis

68

72

89

90

105

89

96

80

101

2

62

5

10

17

5

Other Urinary

11

7

7

5

5

3

5

10

8

2

3

0

1

0

2

BRAIN/CNS

116

113

123

116

112

102

106

90

103

0

0

0

0

0

103

ENDOCRINE

72

95

117

129

133

144

125

142

175

0

113

11

16

12

23

Thyroid

60

69

93

94

108

131

110

120

154

0

113

11

15

12

3

Endocrine/Other

12

26

24

35

25

13

15

22

21

0

0

0

1

0

20

LEUKEMIA

60

68

79

37

53

57

76

46

51

0

0

0

0

0

51

Hodgkin Lymphoma

18

10

20

20

25

15

9

16

14

0

3

5

4

2

0

Non-Hodgkin Lymphoma

102

102

130

126

97

108

86

97

117

0

28

24

22

40

3

Myeloma

25

26

39

28

25

28

34

36

34

0

0

0

0

0

34

ALL OTHER/UNDEFINED

58

58

74

64

79

63

64

54

59

0

3

1

2

5

48

2863

3015

3218

3112

3082

3114

3048

3202

3259

296

1067

620

387

538

351

TOTAL

*Analytic cases involve patients newly diagnosed or who were newly treated by Christiana Care Health System.

Source: Oncology Data Center

PRSRT STD U.S. POSTAGE PAID WILMINGTON DE PERMIT NO. 357

P.O. Box 1668 Wilmington, DE 19899-1668

The Multidisciplinary Cancer Centers at the Helen F. Graham Cancer Center & Research Institute offer comprehensive care and treatment.

Breast Cancer Bone Sarcoma Genetic Risk Assessment Genitourinary Cancer Head & Neck Cancer/Thyroid Hepatobiliary/Pancreatic Cancers Lymphoma Medical Support Melanoma/Soft Tissue Sarcoma Ostomy Care Rectal/Anal Cancers Skin Screening Thoracic/Esophageal Cancers Young Adult Follow-up

Learn how we are transforming cancer care and treatment at www.christianacare.org/cancer Christiana Care is a private, not-for-profit regional health care system that relies in part on the generosity of individuals, foundations and corporations to fulfill its mission. To learn more about our mission, please visit christianacare.org/donors.

Cancer Update is produced by Christiana Care Health System. Š Christiana Care Health System, 2015. All rights reserved.

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