Cancer Report 2011
2011 Analysis:
Thyroid Cancer Figure 1
Newly Diagnosed Thyroid Cancers 2005-10 60 58 53 48 Number of Cases
43 34
16
0
2005
2006
2007
2008
2009
2010
Years
Figure 2
2010 Thyroid Cancer Cases by Race
Non-White
Dr. Paul Weinberger Assistant Professor Medical College of Georgia Department of Otolaryngology/Head and Neck Surgery Georgia Health Sciences University
African American/Black 33% Asian Indian or Pakistani 2%
35% White
65%
Figure 3
Thyroid Cancer Patient Age at Diagnosis in 2010 400 351 Number of Cases
283
205 136 62
0
62
44
0 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89 Age Range
4 90+
Thyroid cancer arises in the thyroid gland, located in the midline of the neck just under the “Adam’s apple.” The thyroid gland’s primary function is to produce thyroid hormone, which regulates the body’s overall metabolic rate. Thyroid cancer is the most common endocrine cancer (some 44,670 new cases were diagnosed in the United States in 2010, according to the American Cancer Society), with 75 percent of cases occurring in women. The incidence of thyroid carcinoma has more than doubled in the past three decades from 4.85 cases per 100,000 people to 11.03 cases per 100,000 people2, making thyroid cancer the fastest-increasing cancer type in both men and women. The GHS Cancer Center has reflected this trend, treating 252 cases in the past five years (Figure 1). Of the 48 new thyroid cancer patients in 2010, 65 percent were Caucasian, 33 percent African-American and 2 percent another ethnicity (Figure 2). Thyroid cancer affects all ages, with the average age of Georgia Health Sciences Cancer Center patients (51 years) matching national trends (Figure 3). Most cases are diagnosed when a lump in the neck (thyroid nodule) is discovered by the patient or a primary care physician, or by an imaging study such as CT-scan. While 95 percent of thyroid nodules are not cancerous, any new
lump or mass should be evaluated by a physician. Other symptoms can include trouble breathing when lying flat, difficulty swallowing and tightness or pain in the neck or throat. Scientists at GHSU, funded by the American Academy of Otolaryngology, are making great strides toward developing a blood test to diagnose thyroid cancer.
Figure 4
Stages of Thyroid Cancer Diagnosed 2000-2008 100%
Percentage of Cases
The five-year survival rate for thyroid cancer is 97 percent, although, as with many other cancers, the rate varies widely depending on when it is diagnosed. When diagnosed at stage IV, the five-year survival rate is 59 percent nationwide—a dramatic improvement from the approximately 30 percent rate just five years ago (Figure 4). Cancer treatment requires a multidisciplinary approach. The Georgia Health Sciences Thyroid and Parathyroid Center includes endocrinologists specializing in diagnosing and managing thyroid and parathyroid disorders and surgeons specializing in thyroid surgery. Diagnosis usually involves fine-needle aspiration, in which a tiny, ultrasound-guided needle is gently inserted into the thyroid nodule. Cells from the nodule are studied microscopically to determine if they are cancerous.
0
Thyroid cancer remains a daunting adversary, but the GHS Cancer Center and Thyroid/Parathyroid Center provide an ideal partnership to diagnose and treat the disease in a patient- and family-centered environment. Cutting-edge research promises improved diagnosis and treatment.
II
III
IV
NA
UNK
MCG Health
Other
Figure 5
2010 Analytic Cases: Site by Gender Colon
Surgery is the treatment of choice for primary thyroid cancers. Patients worldwide come to Georgia Health Sciences Medical Center to benefit from the worldrenowned expertise of Dr. David Terris, who specializes in minimally invasive thyroid surgery. Surgery is often followed by radioactive iodine treatment to destroy any microscopic remnants of tumor cells. This is usually given as a single, oral medication and requires an overnight stay in the hospital. Since surgery and the iodine remove the functioning thyroid gland, patients require an oral replacement thyroid hormone. The GHS Cancer Center has partnered with the National Cancer Institute to decode the genetic basis for over 20 types of cancer, including thyroid cancer. Institutions including Memorial Sloan Kettering, the Dana Farber Cancer Institute and M.D. Anderson Cancer Center are also participating in the project, called The Cancer Genome Atlas (TCGA)3. This opens the door to a multitude of discoveries concerning the causes and treatments for thyroid cancer.
I
Stage at Diagnosis
Larynx Bronchus & Lung Hematopoietic & Reticuloendo System Breast Corpus Uteri Prostate Gland Bladder Thyroid Gland Lymph Nodes
0
25 Female
1. 2. 3.
50
75
100 Male
125
150
175
283 Transsexual
American Cancer Society Cancer Facts & Figures 2010. Atlanta, GA. Page 20. Davies, L. and H.G. Welch, Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA, 2006. 295(18): p. 2164-7. The Cancer Genome Atlas. cancergenome.nih.gov. Accessed July 1, 2011.
Cancer Registry and Statistical Summary The Cancer Registry collects data and monitors all types of cancer diagnosed and/or treated at Georgia Health Sciences Cancer Center. Its database is a fundamental element of the cancer program, providing the information needed to evaluate and plan cancer services. Cancer data is submitted monthly to the Georgia Comprehensive Cancer Registry and annually to the National Cancer Data Base, both of which pool our data with that of other participating facilities. The resulting statistics illustrate statewide and nationwide trends in cancer incidence, and help clinicians and researchers evaluate treatment efficacy.
Cancer Center in 2010 (589 cases), compared to 48 percent female (557 cases). The top analytic sites are: lung, 15 percent; breast, 13 percent; prostate, 12 percent; blood, 5 percent; thyroid, 4 percent; lymph node, 4 percent; corpus uteri, 4 percent; colon, 3 percent; bladder, 3 percent; and larynx, 3 percent. National top sites are: lung, 15 percent; breast, 13 percent; prostate, 13 percent; colon, 8 percent; and bladder, 5 percent (other sites, 34 percent). The registry staff follows more than 8,000 patients annually to obtain disease status and survival information and maintains a 90 percent follow-up rate.
Nearly 18,000 cases have been added to the registry since its establishment in 1985. In 2010, 1,509 analytic and non-analytic cancer cases were added. 1,147 patients were diagnosed and/or initially treated at GHS Cancer Center, and 362 were treated here for cancer recurrence or progression. Males comprised 52 percent of cancer patients diagnosed and/or treated at Georgia Health Sciences
A Cancer Registry Manager and two Registry Services Specialists staff the Cancer Registry. The registry coordinates the facility’s cancer conferences and quarterly Cancer Committee meetings, helps prepare for the triennial Commission on Cancer accreditation survey, contributes to the Annual Report and reports data to clinicians and administrators.
Figure 5
For more information about the Cancer Registry, call 706-721-1768.
2010 Analytic Cases: Site by Gender
2010 Analytic Cases: Site by Gender Colon Larynx Bronchus & Lung Hematopoietic & Reticuloendo System Breast Corpus Uteri Prostate Gland Bladder Thyroid Gland Lymph Nodes
0
25 Female
50
75
100 Male
125
150
175
283 Transsexual
Reference: Cancer Facts and Figures: 2010, American Cancer Society
Figure 6
2010 Analysis: Geographic Distribution of Patients
Patient Origins at Diagnosis in 2010
Dade
Towns
Fannin
Catoosa
Union Whitfield
White
Lumpkin Gordon
Chattooga
Dawson Floyd
Cherokee
Cobb
Haralson
Clarke
Greene
Morgan
Jasper
Monroe
Upson
Putnam
Hancock
Jefferson
Marion Chattahoochee
Johnson
Screven
Early
Wilcox
Crisp
Lee
Coffee
Tift
Baker Miller
Berrien Mitchell
Jeff Davis
Irwin Worth
Colquitt
Thomas
Brooks
Evans
Toombs
Bryan
Tattnall
Chatham Liberty
Appling
Long
Bacon
Wayne
McIntosh
Pierce
Ware Lanier
Grady
Effingham Bulloch
Atkinson
Cook
Seminole Decatur
Candler
Telfair Ben Hill
Turner Dougherty
Wheeler
o m er y
Dodge
Webster
Calhoun
Treutlen
Mo ntg
Dooly
Sumter
Clay
Laurens
Bleckley
Houston
Pulaski
Schley
Terrell
Emanuel
Peach Macon
Burke
Jenkins
Wilkinson Twiggs
Muscogee
>100 26-99 11-25
Washington
Bibb
Taylor
Richmond
Glascock
Baldwin
Jones
Crawford
Talbot
Columbia
e
Lamar
Meriwether
Randolph
VA
uffi
Pike
Quitman
TX
Taliaferro Warren
Butts
Spalding
Stewart
SC
McD
Newton
Coweta
Harris
PA
Lincoln
Wilkes
Henry
Fayette
Troup
NY
Oglethorpe
le
Clayton
Heard
NC
Elbert
Madison
Oconee
Walton
DeKalb
Fulton
Carroll
LA
k da
Douglas
Barrow
Gwinnett
R oc
Paulding
IN
Hart
Franklin
Banks
Hall
Forsyth
Jackson Polk
IL
Stephens
Pickens
Bartow
FL
Habersham
Gilmer
Murray
Walker
AL Rabun
Brantley
Clinch Charlton
Lowndes Echols
Glynn
Camden
1-10
0
2010 Analysis:
Distribution of Analytic Patients by Cancer Site/Stage Primary Site ORAL CAVITY & PHARYNX Tongue Salivary Glands Floor of Mouth Gum & Other Mouth Nasopharynx Tonsil Oropharynx Hypopharynx Other Oral Cavity & Pharynx Total
Stg 0
Stg I
Stg II
Stg III
Stg IV
NA
Unknown
Total
0 0 0 0 0 0 0 0 0 0
7 0 1 5 0 2 0 0 0 15
5 1 2 2 1 2 1 0 0 14
5 0 0 1 0 4 0 0 0 10
6 4 3 4 0 4 0 1 0 22
0 0 0 0 3 0 0 0 2 5
1 0 1 3 0 1 1 0 0 7
24 5 7 15 4 13 2 1 2 73
DIGESTIVE SYSTEM Esophagus Stomach Small Intestine Colon Excluding Rectum Rectum & Rectosigmoid Anus, Anal Canal & Anorectum Liver & Intrahepatic Bile Duct Gallbladder Other Biliary Pancreas Retroperitoneum Total
0 0 0 0 0 0 0 0 0 0 0 0
2 1 1 6 6 1 5 1 1 3 0 27
3 3 0 10 6 1 1 0 4 7 2 37
4 5 1 9 2 3 2 2 0 10 0 38
2 0 0 11 3 0 0 1 0 7 0 24
0 0 0 1 0 0 2 0 0 0 0 3
0 1 0 0 0 1 0 0 0 0 0 2
11 10 2 37 17 6 10 4 5 27 2 131
RESPIRATORY SYSTEM Nose, Nasal Cavity & Middle Ear Larynx Lung & Bronchus Total
0 0 0 0
2 10 26 38
0 8 13 21
0 3 53 56
2 7 73 82
0 0 0 0
0 2 2 4
4 30 167 201
BONES & JOINTS Bones & Joints Total
0 0
1 1
0 0
0 0
0 0
0 0
0 0
1 1
SOFT TISSUE Soft Tissue (including Heart) Total
0 0
3 3
2 2
4 4
2 2
0 0
2 2
13 13
SKIN EXCLUDING BASAL & SQUAMOUS Melanoma -- Skin Total
7 7
10 10
5 5
2 2
2 2
0 0
0 0
26 26
BREAST Breast Total
27 27
51 51
42 42
23 23
8 8
0 0
0 0
151 151
Primary Site FEMALE GENITAL SYSTEM Cervix Uteri Corpus & Uterus, NOS Ovary Vagina Vulva Other Female Genital Organs Total
Stg 0
Stg I
Stg II
Stg III
Stg IV
NA
Unknown
Total
0 0 0 0 3 0 3
4 18 3 1 0 0 26
5 8 3 0 1 0 17
5 8 6 0 0 2 21
2 3 3 1 0 0 9
0 4 0 1 0 0 5
0 0 0 0 0 0 0
16 41 15 3 4 2 81
MALE GENITAL SYSTEM Prostate Testis Penis Total
0 0 0 0
4 2 2 8
127 1 0 128
2 3 0 5
7 0 2 9
0 0 0 0
0 0 0 0
140 6 4 150
URINARY SYSTEM Urinary Bladder Kidney & Renal Pelvis Ureter Total
3 2 2 7
7 12 0 19
5 2 0 7
7 7 1 15
11 7 0 18
1 3 0 4
1 0 0 1
35 33 3 71
BRAIN & OTHER NERVOUS SYSTEM Brain Cranial Nerves Other Nervous System Total
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
26 29 55
0 0 0
26 29 55
ENDOCRINE SYSTEM Thyroid Total
0 0
29 29
5 5
8 8
6 6
0 0
0 0
48 48
LYMPHOMA Hodgkin Lymphoma Non-Hodgkin Lymphoma Total
0 0 0
3 18 21
4 4 8
2 4 6
2 13 15
0 0 0
0 2 2
11 41 52
MYELOMA Myeloma Total
0 0
0 0
0 0
0 0
0 0
18 18
0 0
18 18
LEUKEMIA Lymphocytic Leukemia Myeloid & Monocytic Leukemia Other Leukemia Total
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
16 37 4 57
0 0 0 0
16 37 4 57
Unknown Site Unknown Site Total
0 0
0 0
0 0
0 0
0 0
19 19
0 0
19 19
Grand Total
44
248
286
188
197
111
18
1,092
2011 Cancer Conferences Conference
Meeting Frequency
Physician Contact
Administrative Contact
Gynecologic Cancer
Weekly
Sharad Ghamande, MD
Interdisciplinary Cancer
Weekly
E. James Kruse, DO
Head and Neck Cancer
Weekly
Lana Jackson, MD
Pediatric Cancer
Monthly
Roger Vega, MD
Hematology/Pathology Cancer Urologic Cancer
Weekly
Kavita Natarajan, MD
Monthly
Ronald Lewis, MD
Thoracic Cancer
Weekly
Zhonglin Hao, MD
Cutaneous Cancer
Monthly
Amanda May, MD
Breast Cancer
Weekly
Thomas Samuel, MD
Brain/Spine Cancer
Monthly
Connie Giller, MD
Luvenia Kelley 706-721-3992 Allison Sabb 706-721-2760 Ellie Pryor, 706-721-6100 Kathleen McCarty 706-721-3626 Helen Smith 706-721-2505 Allison Sabb 706-721-2760 Tiffany Thomas 706-721-6833 Tiffany Thomas 706-721-6833 Nichole Aenchbacher 706-721-4109 Jamey Motley 706-721-7124
Cancer Committee Physicians E. James Kruse, MD Surgical Oncology Cancer Committee Chair * James McLoughlin, MD Surgical Oncology Cancer Liaison James Rawson MD Radiology
Todd Merchen, MD General Surgery Amanda May, MD Medical Oncology* Colleen McDonough, MD Pediatric Oncology/Hematology Catherine L. Ferguson, MD Radiation Oncology*
Paul Biddinger, MD Pathology*
Alison Lauber, MD Palliative Services
Non-Physician Members Nichole Aenchbacher, RN, BSN Breast Health Navigator Lindsay Baker, RD, LD Cancer Center Dietitian
Summer Garrison Judith Giri, PhD Director of Tumor Bank
Steven Black, MBA Cancer Services Administrator*
Jack Evans Community Outreach Coordinator/* Communications & Marketing
Annie Blount, MSW Cancer Center Social Service*
Melissa Jarriel, RHIA, CTR Health Information Managment Services
Pamela Bourbo, RN, BSN, MPH, OCN, CCRC Cancer Clinical Research Unit
Melanie Kumrow, RN Hematology/Oncology CCOP Nurse Manager*
Kim Cheely RN, BSN, OCN Hematology/Oncology Nurse Manager
Tracey Slagle, RN, BSN, OCN, Hematology/Oncology Nurse Manager
Lonnetta Colton, RHIA, CTR Cancer Registry Manager*
Erica Gollett Steed Planning*
Kevin Corbin Pharmacy
Jane Willson Director of Rehabilitation Services
Nettie Engels American Cancer Society Patient Advisor
Committee Activity Coordinators Cancer Conference – Lonnetta Colton Quality Data of Cancer Registry – Jim McLoughlin, MD
Community Outreach – Jack Evans Quality Improvement – Erica Gollett-Steed
* Position required for accreditation by the American College of Surgeons Commission on Cancer