Cancer Update October 2008

Issue No. 18 / October 2008

In this issue 3 PROFILES IN CANCER MEDICINE: Treating Pancreatic Cancer – A Multidisciplinary Approach 10 Multidisciplinary Cancer Care Centers at the Helen F. Graham Cancer Center 11 2007 Oncology Data Center Analytic Case Distribution

cancer update Helen F. Graham Cancer Center Welcomes Three New Cancer Specialists

12 Dr. Witt receives UD Distinguished Alumnus Award

LAURA E. SIMONELLI, PH.D.

D.O. KERRY TOBIAS,

M.D. DUNGOG, MARK G. CA

LAURA E. SIMONELLI, PH.D., comes to the Helen F. Graham Cancer Center from The Cleveland Clinic, where she recently completed a postdoctoral fellowship in clinical health psychology that included a rotation at the Center for Headache and Pain. Much of her research has focused on stress, coping and quality of life issues related to chronic illnesses, including breast and gynecologic cancers. She has co-authored numerous articles on these subjects.

According to health psychologist Scott Siegel, Ph.D., at the Helen F. Graham Cancer Center, “Dr. Simonelli trained at some of the top institutions for health psychology in the country.

She comes to us with a particular expertise in women’s health and in helping individuals find meaning in their cancer experience, which will be an excellent complement to the support services we currently provide. In addition, he adds, “Dr. Simonelli will help us expand and improve our programs and services so that we better assist our patients.”

In 2000, Dr. Simonelli graduated from the Schreyer Honors College at Pennsylvania State University, where she majored in psychology with a statistics minor. She began graduate work in clinical health psychology at Ohio State University in 2001, earning her Ph.D. in clinical psychology in 2007. During that time, she completed a clinical psychology internship at the University of Medicine & Dentistry of New Jersey – Robert Wood Johnson Medical School, which included providing evaluation and treatment for cancer patients/survivors at the Cancer Institute of New Jersey. (continued on next page)

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Helen F. Graham Cancer Center Welcomes Three New Cancer Specialists

KERRY TOBIAS, D.O., a physical medicine and rehabilitation specialist, joins us from the National Institutes of Health in Bethesda, MD, where she recently completed a fellowship in palliative medicine. After finishing her residency in physical medicine and rehabilitation at Thomas Jefferson University Hospital in 2006, Dr. Tobias proceeded to complete an interventional pain management fellowship at the University of California, Davis.

She first came to Christiana Care while chief resident at Jefferson to do an elective rotation in cancer rehabilitation and pain management with Theresa Gillis, M.D., medical director, Oncology Rehabilitation and Pain Management at the Helen F. Graham Cancer Center.

“Dr. Tobias has an outstanding combination of skills to care for patients with advancing cancer and those experiencing severe or worsening symptoms to help them achieve relief and, when appropriate, transition from aggressive anti-cancer therapy,” explains Dr. Gillis.

MARK G. CADUNGOG, M.D., comes to the Helen F. Graham Cancer Center from the Hospital of the University of Pennsylvania, where he recently completed a three-year fellowship in gynecologic oncology, focusing on the medical and surgical management of ovarian and other gynecological cancers.

In addition to performing radical open surgical procedures, including radical hysterectomy, for a range of gynecologic cancers, Dr. Cadungog specializes in advanced laparoscopic and robotic surgery. He follows patients requiring chemotherapy for advanced or recurrent malignancies or those at a high risk of recurrence.

2 Christiana Care Health System

“Through her residency she obtained a very solid understanding of neurological and musculoskeletal disorders and rehabilitative care for these conditions; through fellowship training she has added the ability to utilize invasive techniques at the spine and peripheral nerves to ease severe pain not controlled by traditional medication therapy. She will enhance our care of outpatients at the Cancer Center but also provide invaluable service to inpatients at Christiana Care.

Dr. Tobias earned her medical degree from the New England College of Osteopathic Medicine in 2002.

She completed an osteopathic rotating internship at Doctor’s Hospital in Columbus, OH, before beginning residency training at Jefferson in 2003. In addition to rowing and fencing, she pursues life-long interests in theater and music, graduating from Denison University in Ohio with a BFA in theater and a minor in music.

She is board-certified by the American Board of Physical Medicine and Rehabilitation and is board-eligible for both the American Board of Hospice and Palliative Medicine and the Pain Medicine Subspecialty Board Certifications, recognized by the American Board of Medical Specialties.

“Dr. Cadungog’s expertise in minimally invasive and robotic surgical technique is a huge asset to the Helen F. Graham Cancer Center especially as we move forward with our plans for taking gynecologic oncology surgery in that direction,” says Mark Borowsky, M.D., director of gynecologic oncology. “We are delighted that with all the other programs offering opportunities for an expert with his skills, Dr. Cadungog chose Christiana Care.”

Dr. Cadungog earned his medical degree in 2001 from Temple University School of Medicine. In 2003, he served as a Galloway Fellow at Memorial Sloan-Kettering Cancer Center in New York City. He completed his residency in obstetrics and gynecology in 2005 at the New York University School of Medicine.

Dr. Cadungog graduated magna cum laude from the University of Notre Dame in 1997 with a BS in chemical engineering. He is board-eligible from the American Board of Obstetrics and Gynecology and is a candidate member of the Society of Gynecologic Oncologists.

PROFILES IN CANCER MEDICINE

Treating Pancreatic Cancer – A Multidisciplinary Approach There is no cure for pancreatic cancer, but timely and appropriate treatment can improve survival rates and quality of life for people diagnosed with it. Choosing an experienced hospital with a qualified team of specialists broadens treatment options and significantly improves outcomes.

From 2000 to 2007, the Delaware Cancer Registry recorded 734 diagnosed cases of pancreatic cancer.

Of those, 440 (from Delaware and out-of-state) were diagnosed and/or received initial treatment at Christiana Care, where survival rates continue to climb.

Five cancer specialists with the Helen F. Graham Cancer Center – medical oncologist/hematologist, Jamil Khatri, M.D.; surgical oncologist, Joseph J. Bennett, M.D.; radiation oncologist, Jon F. Strasser, M.D.; vascular and interventional radiologist, Mark J. Garcia, M.D.; and Robert McBride, director of the Christiana Care Oncology Data Center – share their insights for a multidisciplinary approach to treating this aggressive cancer.

Prevalence of pancreatic cancer According to the American Cancer Society, 30,000 new cases of pancreatic cancer are diagnosed each year in the United States. Fortunately, the annual rate of incidence has remained steady since 1975.

Although pancreatic cancer occurs less frequently in the general population than some of the other prominent cancers (i.e., skin, breast, lung, prostate or colon cancer), it is the fourth leading cause of cancer deaths in the United States. The best outcomes are achieved when pancreatic cancer can be surgically removed, followed by treatment with a combination of radiation and chemotherapy.

Jamil Khatri, M.D.

Joseph J. Bennett, M.D.

Mark J. Garcia, M.D.

Jon F. Strasser, M.D.

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Robert McBride

Cancer Update 3

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PROFILES IN CANCER MEDICINE

Treating Pancreatic Cancer – A Multidisciplinary Approach Risk factors The risk of pancreatic cancer rises with age. Most patients are between 60-80 years old at diagnosis.

Men tend to have pancreatic cancer slightly more often than women, but that gap is narrowing.

African-Americans also have this type of cancer more often than Caucasians. Other known risk factors include smoking, chronic inflammation of the pancreas, too much of a certain kind of stomach bacteria or too much stomach acid. Poor diet, obesity, lack of exercise and over exposure to environmental hazards such as radiation or certain chemicals also play a role. We do not know how to prevent pancreatic cancer, but we do know that a healthy lifestyle that includes a balanced diet, exercise and no smoking can lessen the risks.

Genetic Risk Assessment Program Sometimes pancreatic cancer runs in families. About 1 in 10 cases is caused by the kinds of inherited changes in DNA that increase the risk for other cancers. The Christiana Care Genetic Risk Assessment Program offers counseling and genetic testing for people at high risk for all types of cancer in their families. Knowing the risk for hereditary pancreatic cancer is the first step to ensuring closer surveillance, potential early detection and prompt treatment.

Common pancreatic cancers The pancreas is a carrot-shaped organ approximately six inches long, tucked behind the stomach. Cancer can grow in any of the cells and tissues of the pancreas, but the most common type occurs in the exocrine glands. These are the glands that make the pancreatic enzymes the body needs to break down fats and proteins. Cancer tumors in the exocrine glands are called adenocarcinomas and appear mostly in the upper part of the pancreas in what is called the head and neck region. Adenocarcinomas account for about 95 percent of all pancreatic cancers. Cancer may also occur in the body or tail of the pancreas.

Signs and symptoms Often, there are no early warning signs for pancreatic cancer. By the time symptoms appear, the cancer is usually large and has spread to other parts of the body. Symptoms may include jaundice, changes in stool color (light to dark depending on the location of the cancer), dark urine, vomiting, itching, inflammation in the pancreas, and deep, penetrating pain in the upper abdomen radiating to the back. More generalized symptoms may include fatigue and weakness, anorexia, weight loss and even depression.

Bile duct

Pancreatic duct Pancreas

Duodenum

4 Christiana Care Health System

Diagnosing pancreatic cancer When the health care team suspects pancreatic cancer, they will obtain a detailed medical history (including surgical and family medical history), and a list of current medications taken and then conduct a thorough physical exam. Sometimes pancreatic cancer spreads to the lymph nodes or the liver so it is necessary to thoroughly check the abdominal area for swelling. The team should examine the skin and white parts of the eyes for jaundice. A blood test that shows elevated tumor marker levels (CA 19-9) may indicate the presence of advanced pancreatic cancer.

Imaging tests offer more specific information about the extent and location of the cancer and whether it has spread to other structures and organs such as the bowel, abdominal cavity, stomach, blood vessels and nerves or to the liver. The best imaging test is a CT scan with contrast dye. Other tests may include a chest X-ray, a contrast MRI, MRCP, or possibly a PET scan or PET/CT scan. In some cases, angiography may be used to look for blocked or narrowed blood vessels near the pancreas. An ERCP (Endoscopic Retrograde Cholangiopancreatography) test which uses a small camera passed down the throat to examine the pancreas and bile ducts can identify blockages that could be cancer.

Under CT guidance, a fine needle aspiration (FNA) biopsy by the interventional radiologist can collect cells from the tumor for microscopic examination by the pathologist. This is the best way to determine if pancreatic cancer is present. In most cases, a diagnosis of cancer will indicate either adenocarcinoma or a poorly differentiated non-small cell carcinoma. If a patient has a mass in the pancreas and is jaundiced, a biopsy may not be necessary if the surgeon thinks the tumor is a cancer and can be removed.

Staging If the pathologist confirms the diagnosis of pancreatic cancer, a process called staging will help determine the extent of the disease. Staging uses a standardized way of determining how large the cancer is and how widely it has spread. Staging provides information for determining treatment and for predicting survival.

At Christiana Care, one of the methods used for staging pancreatic cancer follows the guidelines developed by the American Joint Committee on Cancer (AJCC). The general stages of pancreatic cancer may be grouped as follows:

Stages I and II Clearly resectable: Cancer has not spread beyond the pancreas and there is no involvement of major organs, blood vessels or nerves. Surgery is possible to remove the entire tumor.

Stage III Potentially resectable: Involvement of major blood vessels, organs or nerves is unclear. Surgery may be possible upon closer examination.

Stages III and IV A Locally advanced, unresectable: Cancer has spread to major blood vessels, organs or nerves around the pancreas but not to distant organs. Surgery may relieve symptoms or correct other problems.

Stage IV B Distant or metastatic disease: Cancer has spread to distant organs. Surgery may relieve symptoms or other problems.

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Cancer Update 5

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PROFILES IN CANCER MEDICINE

Treating Pancreatic Cancer – A Multidisciplinary Approach Treating pancreatic cancer Surgery, chemotherapy and radiation are used to treat pancreatic cancer. All three or a combination of these therapies may be used depending on the stage of the cancer and the age and overall condition of the patient.

Most often, chemotherapy and radiation therapy are recommended following surgery to target any remaining cancer cells in the pancreas and those that may have spread to other parts of the body. In some cases, chemotherapy and radiation treatments prior to surgery can potentially shrink the tumor enough to enable the surgeon to remove all of the cancer.

Surgery Surgery to remove pancreatic cancer is difficult and requires precision. It is perhaps one of the most serious operations a patient can undergo. Only about 10 percent of cancers appear to be contained entirely within the pancreas, but surgery to remove only part of the cancer from the pancreas has not been shown to help patients live longer.

To get a closer look prior to surgery, the surgeon may first perform a diagnostic laparoscopy. This minimally invasive or “keyhole” procedure involves inserting a camera through a small incision in the abdomen to determine whether small pancreatic cancer nodules have spread throughout the abdomen. About 20 to 30 percent of patients who appear to have operable tumors on their diagnostic CT scan will actually have more widespread, inoperable disease.

CT scan of abdomen showing pancreatic cancer

Pancreatic cancer

Kidneys

When the tumor is small and does not appear to involve surrounding structures, the surgeon most commonly performs the Whipple procedure to try to remove all the cancer. This is a highly complex surgical technique that involves removing the head or more of the pancreas along with the tumor and all the nearby lymph nodes. Surrounding tissues and organs including the gallbladder, small intestine and part of the common bile duct are also removed. Following that, reconstructive surgery is performed to reconnect the stomach, bile duct and pancreatic bile duct to the intestinal track. When the cancer is located in the body or tail of the pancreas, a different operation from the Whipple procedure is performed, removing the back of the pancreas. In these cases both the spleen and nearby lymph nodes are also removed, but reconstructive surgery is generally not required.

In the hands of a skilled surgeon who has performed the procedure many times and who is assisted by an experienced OR team, the Whipple procedure can add months and even years to the life of patient with pancreatic cancer. At Christiania Care, on average, surgeons perform between 20-30 Whipple procedures annually.

This level of experience has helped to extend survival rates for patients with pancreatic cancer for months to even years. Currently, about 10 percent of patients who have the procedure remain cancer free at five years.

MRI of abdomen showing pancreatic cancer Liver Bile duct Kidney Pancreatic cancer

6 Christiana Care Health System

Radiation therapy After surgery to remove pancreatic cancer, the standard course of treatment is five to six weeks of daily radiation combined with chemotherapy. This approach is intended to help prevent local recurrence and potentially improve survival. Before surgery, the same course of treatment may be used to try to shrink potentially operable tumors.

Christiana Care uses the latest radiotherapy techniques to target pancreatic cancer. Three-dimensional conformal radiotherapy allows the radiation oncologist to shape and direct high energy beams to the contours of the tumor and treatment site. Intensity Modulated Radiation Therapy (IMRT) administers even higher doses of radiation with more precise dose shaping to critical areas, minimizing the risk to surrounding tissues and organs such as the liver, kidneys and spinal cord. IMRT causes fewer debilitating side effects commonly associated with radiation therapy, such as skin irritation, vomiting, nausea or diarrhea.

Select patients with inoperable pancreatic cancer are candidates for CyberKnife, the latest noninvasive alternative to surgery which is now available at the Helen F. Graham Cancer Center. The CyberKnife robotic radiosurgery system delivers maximum doses of radiation with extreme accuracy to hard-to-reach areas of the body including the pancreas. The procedure is painless and requires no anesthesia.

Unlike traditional stereotactic radiosurgery, CyberKnfe’s robotic tracking affords greater patient comfort without the need for a restrictive body frame.

Plus, CyberKnife treatment is delivered over three days compared to traditional five to six weeks of daily treatments.

Chemotherapy Chemotherapy following surgery focuses on killing the remaining cancer cells within the pancreas and reducing the risk of cancer spreading to other areas of the body where it is not easily detectable. Studies show that a six-month post-operative course of chemotherapy can improve cure rates and survival.

Currently, one of the most effective drugs used to treat pancreatic cancer is called gemcitabine (GemzarÂŽ). Ongoing studies are looking at gemcitabine alone and in combination with other drugs to determine which works better in treating early and advanced pancreatic cancers. One such study in which Christiana Care took part (Radiation Therapy Oncology Group (RTOG) 9704) found that adding gemcitabine to a postoperative course of standard chemo/radiation therapy with a drug called 5-Fluorouracil (5 FU) significantly improves survival in patients with pancreatic adenocarcinomas.

Others, including (RTOG 0411), are targeting locally advanced, inoperable cancers. Newer drugs work differently to target cancer cells, and some, including erlotinib (TarcevaÂŽ) have shown promise in treating patients with advanced pancreatic cancer.

Researching new ways to fight cancer Christiana Care investigators are collaborating with pharmaceutical companies, the National Cancer Institute and research sites internationally on a variety of translational and clinical studies focused on cancer treatment and prevention. The Helen F. Graham Cancer Center is part of a new consortium of elite research centers specifically focused on treating gastrointestinal cancers, including pancreatic cancer, by streamlining clinical pathways for the most promising, newly discovered anti-cancer drugs. These efforts and our continued outreach through the National Community Cancer Centers Program (NCCCP) will produce opportunities for our patients to participate in new pancreatic cancer clinical trials that offer the chance for better cure and survival rates. (continued on next page)

Cancer Update 7

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PROFILES IN CANCER MEDICINE

Treating Pancreatic Cancer – A Multidisciplinary Approach Palliative treatment Helping patients with pancreatic cancer manage their symptoms and maintain quality of life is an important goal of the multidisciplinary team of health care professionals at the Helen F. Graham Cancer Center. Our hepatobiliary/pancreatic cancer team includes medical oncologists, surgical oncologists, and interventional radiologists who are joined when appropriate by radiation oncologists, gastroenterologists, and other specialists. They are backed by certified oncology nurses and other care coordinators specializing in pain management, psychology, pastoral care, genetic counseling, nutrition and social services.

Interventional procedures Some patients may need an interventional procedure to relieve symptoms or correct problems associated with pancreatic cancer. Although surgery is generally not recommended to relieve symptoms, during an operation to potentially cure the cancer, the surgeon may proceed with other palliative measures. For example, a bile-duct blockage can be decompressed to a drainage bag or circumvented by re-routing the flow of bile from the liver back to the small intestine.

This can be accomplished by inserting a metal or plastic stent to open the bile duct. If surgery is not indicated, either the interventional radiologist or gastroenterologist can relieve the obstructed bile duct by inserting a drainage catheter or stent. This outpatient procedure can be performed either by coming through the liver into the bile duct from above the blockage, or through a camera (endoscope) placed into the bowel and into the duct from below the blockage. In patients with isolated liver metastases, liver-directed therapies may be performed in an attempt to contain the disease. These procedures may include chemoembolization, radiofrequency ablation (burning the tumor) or cryoablation (freezing the tumor). On the horizon, a promising newer technique to be evaluated is IRE (Irreversible Electroporation).

8 Christiana Care Health System

Pain management Pain associated with pancreatic cancer can be extremely debilitating. Severe abdominal pain that radiates to the back is most often associated with the celiac nerve located near the head of the pancreas.

Approximately 50 percent of patients find relief with a nerve block, an outpatient procedure performed under local anesthesia. Using CT-scan guidance, an interventional radiologist injects ethanol (alcohol) through a long thin needle inserted into the celiac nerve. The Theresa Gillis, M.D., ethanol damages some of medical director, Oncology the sensory nerves that are Rehabilitation and Pain Management at the Helen F. causing the pain. As the Graham Cancer Center. nerves heal however, pain may return requiring a repeat procedure. Nerve blocks and other pain relief interventions are performed routinely at Christiana Hospital for patients with pancreatic cancer.

Specialists at the Oncology Rehabilitation Multidisciplinary Disease Site Clinic (MDC) at the Helen F. Graham Cancer Center counsel patients about their pain management options.

Nutrition support Due to the physical changes caused by Registered dieticians, Elena Schumacher, RD, pancreatic cancer, CDN (left) and Martha Czymmek, MS, RD, CDN, patients may expeoffer individualized nutrition counseling for patients and families at the Helen F. Graham rience a host of Cancer Center. problems that can lead to weight loss and weakness, including loss of appetite, changes in taste or full stomach sensations, persistent nausea and bowel dysfunction or obstructions. Most of these problems can be addressed with nutrition

education, medications, nutritional supplements and careful monitoring. Occasionally patients can benefit from either feeding tubes (G-tube or J-Tube) or intravenous nutrition (TPN) to boost energy levels.

A registered dietician at the Helen F. Graham Cancer Center counsels pancreatic cancer patients and families on healthy nutrition.

Psychological counseling Depression is common among patients with pancreatic cancer. For many, uncertainty about the future is worse than hearing an objective assessment

of their prognosis. Studies show that patients experience less depression when they are fully aware of their condition.

At the Helen F. Graham Cancer Center, behavioral psychologists, social workers and chaplains are just some of the resources available to help meet the emotional, spiritual and mental health needs of patients and their families.

Health Psychologist Scott Siegel, Ph.D., is part of the multidisciplinary team of specialists available at the Helen F. Graham Cancer Center to help meet the emotional and mental health needs of cancer patients and their families.

Surviving pancreatic cancer Survival rates are the percentages of patients who have lived one or more years beyond their initial diagnosis of pancreatic cancer. Survival rates are a national benchmark for treatment success. At Christiana Care, they are an important indicator of our experience and effectiveness in treating pancreatic cancer.

The Christiana Care Oncology Data Center (ODC) collects, manages, analyzes and reports cancer data for all patients diagnosed and/or receiving treatment at Christiana Care. The ODC is an important component of Christiana care’s certification as a teaching hospital cancer program by the American college of Surgeons’ Commission on Cancer.

Long-term follow-up of cancer survivors is also a significant national objective and as such, one of the requirements of that certification is to report all newly diagnosed cancer cases to the National Cancer Data Base (NCDB). Registry data that Christiana

Care collects and provides are used on an ongoing basis to evaluate cancer care and to assist physicians in devising the best treatment strategies for their patients.

Data in Table 1, collected by Robert McBride, ODC’s director, shows the latest available survival figures for patients with pancreatic cancer, diagnosed and/or treated at Christiana Care, compared with the state as a whole and the nation. Recent reports suggest Christiana Care is experiencing success in treating all stages of pancreatic cancer.

Table 1. Pancreatic Cancer Survival Rates by Year from Diagnosis for all AJCC Stages Survival Years

1998 – 2000

1998 – 2003

2003 - 2005

CCHS Delaware NCDB

CCHS Delaware NCDB

CCHS Delaware NCDB

1

20.2%

18.5%

24.5%

20.5%

17.7%

N/A

34.7%

28.0%

N/A

2

4.5%

7.0%

10.3%

6.5%

6.2%

N/A

12.0%

9.7%

N/A

3

3.4%

6.5%

6.5%

3.5%

4.6%

N/A

7.1%

4.8%

N/A

4

2.2%

4.5%

4.8%

3.0%

3.4%

N/A

5.8%

2.9%

N/A

5

2.2%

3.5%

4.1%

2.5%

2.5%

N/A

3.5%

1.0%

N/A

Data sources: Christiana Care Health System (CCHS), Delaware Cancer Registry and National Cancer Data Base (NCDB)

Cancer Update 9

MULTIDISCIPLINARY CANCER CARE The multidisciplinary approach to treating cancer at the Helen F. Graham Cancer Center offers patients the opportunity to discuss and make decisions about their course of treatment in a group meeting with their doctors and family members. At this meeting, all appropriate standard treatment options and clinical trial opportunities are examined. Weekly tumor conferences consider selected cases within a broader gathering of health professionals. These settings provide for an important interchange of views from all pertinent medical specialties as well as added opportunities for learning about and considering various treatment options in concert with National Comprehensive Cancer Network (NCCN) guidelines.

Patients tell us formally through regularly disseminated satisfaction surveys and informally through letters and cards that this approach has been extremely helpful to them. The many support services available to patients through the Helen F. Graham Cancer Center are an integral component of multidisciplinary cancer care.

Our experience confirms that easy access to and participation in these services with the help and coordination of the oncology nurse care coordinator contributes greatly to improving quality of life for our patients.

M U L T I D I S C I P L I N A R Y C A N C E R C E N T E R S at the Helen F. Graham Cancer Center

• Anorectal Cancer • Brain and Spinal Cord • Breast Cancer • Genetic Risk Assessment • General Oncology • Genitourinary Cancer • Gynecology Oncology • Head and Neck Cancer

• Hepatobiliary/Pancreatic Cancers • Hepatoma Screening Center • Lymphoma • Pain and Symptom Management • Thoracic and Esophageal Cancer

• Thyroid Cancer • Upper Gastrointestinal/Melanoma/Sarcoma/Bone • Young Adult Follow-Up

10 Christiana Care Health System

2007 Oncology Data Center Analytic* Case Distribution at Christiana Care Health System Year Seen at CCHS PRIMARY SITE

AJCC Stage Groups

2003

2004

2005

2006

2007

0

I

II

III

IV

Unk/NA

ORAL Lip Tongue Mouth Pharynx

52 0 19 27 6

60 3 10 34 13

67 1 21 35 10

51 2 18 23 8

68 3 26 26 13

2 0 1 1 0

14 3 2 6 3

8 0 2 5 1

14 0 8 3 3

19 0 9 6 4

11 0 4 5 2

DIGESTIVE Esophagus Stomach Small Intestine Colon Rectum/Rectosigmoid Liver Pancreas Other Digestive

425 34 29 9 191 69 29 47 17

418 32 31 14 157 72 22 63 27

401 15 32 7 171 67 21 63 25

444 18 35 8 178 81 29 67 28

460 29 35 8 168 76 35 69 40

13 1 0 0 9 3 0 0 0

79 1 4 1 35 14 10 5 9

104 4 5 1 42 15 3 21 13

101 6 9 2 38 28 10 4 4

113 10 14 0 36 8 7 34 4

50 7 3 4 8 8 5 5 10

RESPIRATORY Larynx Lung Other Respiratory

463 20 440 3

467 30 430 7

444 35 406 3

472 20 451 1

430 21 401 8

0 0 0 0

97 5 90 2

29 5 24 0

112 7 105 0

171 4 163 4

21 0 19 2

BONE & CONN. TISSUE Bone Connective Tissue

17 3 14

21 4 17

17 6 11

24 5 19

28 4 24

0 0 0

6 0 6

2 0 2

3 0 3

6 2 4

11 2 9

MELANOMA Other Skin Cancer

117 7

114 4

116 6

121 7

118 9

32 1

47 2

8 2

13 0

3 0

15 4

BREAST

556

488

557

534

597

131

220

147

60

26

13

FEMALE ORGANS Cervix Uteri Corpus Uteri Ovary Other Female Organs

184 27 90 49 18

196 31 97 53 15

182 37 98 41 6

194 27 103 47 17

229 48 113 54 14

7 7 0 0 0

106 18 73 9 6

23 6 7 8 2

42 5 16 19 2

32 4 8 18 2

19 8 9 0 2

MALE ORGANS Prostate Testis Other Male

374 357 17 0

329 319 8 2

328 316 10 2

381 368 11 2

407 393 13 1

1 0 0 1

8 0 8 0

333 332 1 0

34 30 4 0

12 12 0 0

19 19 0 0

URINARY Bladder Kidney/Renal Pelvis Other Urinary

171 94 68 9

198 117 77 4

190 91 90 9

179 100 68 11

188 109 72 7

55 54 1 0

58 20 37 1

29 20 8 1

10 2 6 2

22 6 14 2

14 7 6 1

EYE

0

1

1

1

0

0

0

0

0

0

0

BRAIN/CNS

66

103

92

116

113

0

0

0

0

0

113

ENDOCRINE Thyroid Endocrine/Other

75 68 7

68 61 7

94 77 17

72 60 12

95 69 26

0 0 0

44 44 0

7 7 0

8 8 0

5 5 0

31 5 26

LEUKEMIA

28

43

58

60

68

0

0

0

0

0

68

OTHER HEMATOPOIETIC Hodgkin’s Non-Hodgkin Multiple Myeloma

147 23 102 22

130 6 103 21

137 23 96 18

145 18 102 25

138 10 102 26

0 0 0 0

36 2 34 0

24 4 20 0

32 2 30 0

18 2 16 0

28 0 2 26

ALL OTHER/UNDEFINED

90

69

55

62

67

1

1

0

1

4

61

2772

2709

2745

2863

3015

243

718

716

430

431

478

TOTAL

* Analytic cases are only cases that are newly diagnosed and/or newly treated at Christiana Care Health System in 2007.

Data Source: Oncology Data Center. Prepared by R. McBride, CTR.

Cancer Update 11

Dr. Witt receives UD Distinguished Alumnus Award Robert Witt, M.D., section chief of Head and Neck Oncology at the Helen F. Graham Cancer Center, was recognized as the 2008 Distinguished Alumnus for the Department of Biological Sciences at the University of Delaware (UD) at graduation ceremonies in May. Dr. Witt earned his bachelor's degree in biological sciences in 1977.

Through the Center for Translational Cancer Research (CTCR), Dr. Witt is collaborating with UD on a research program on vocal fold implants. He also is studying efforts to create artificial salivary glands for people with glands damaged by radiation treatments.

A prolific writer, Dr. Witt recently completed his second book, Advances in the Management of Thyroid Cancer, Surgical Oncology Clinics of North America (Elsevier Saunders Publishers). His first book, Salivary Gland Diseases (Thieme Medical Publishers), was published in 2006.

An associate professor at Jefferson Medical College in Philadelphia, Dr. Witt has published more than 40 papers and abstracts. He has presented more than 25 lectures in the past five years and has accepted an invitation to be a panelist at an International Salivary Gland Society meeting in Paris in July 2009, his fourth international panel in two years.

www.christianacare.org 12

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