Cancer Care Summer 2016

care

CANCER

for anyone touched by cancer Life choice: quality or quantity? page 6

t

Researching health disparities page 11

Biopsy alternatives on the horizon page 13

Bone health for breast cancer survivors page 15

A new prostate cancer risk factor page 18 Can aspirin prevent cancer? page 19

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SUMMER 2016

guide YOurGUIDE YOUR

Early detection appears to improve survival odds

While the incidence of cancer is rising, death rates are dropping, presumably because of improvements in screening that allow for earlier detection and improvements in cancer treatment options. is is the rate, per 100,000 people living in Onondaga County, of all types of cancer combined, showing incidence (new cases) and mortality (deaths).

550 500 450

468

INCIDENCE

516 INCIDENCE

541 INCIDENCE

400 350 300 250 200

213 MORTALITY

150

202 MORTALITY

1994-1998

1999-2003

190 MORTALITY

2004-2008

SOURCE: ONONDAGA COUNTY COMMUNITY HEALTH ASSESSMENT AND IMPROVEMENT PLAN, 2014-2017

Marking milestones Patients invited to ring bell in celebration

WHEN A BELL RINGS in the Upstate Cancer Center, everyone within earshot cheers. e sound of a ringing bell means that a patient has finished treatment or reached a milestone.

“Staff members gather around to watch the patient ringing the bell, but the sound travels through the halls, and everyone who hears it knows what it means,” explains Colette Zerrillo, associate director of radiation oncology.

Summer Butkins, 30, of Lafayette remembers April 11 as one of the best experiences of her life. She was the first patient to ring the bell, marking her final radiation treatment for

breast cancer. e hallway was filled with doctors, nurses and technicians who cared for her since her diagnosis in June 2015, making the experience “absolutely amazing.”

Tracy Allen, 50, of Binghamton (pictured at le) has similarly fond memories of ringing the bell when she finished her radiation treatments. “e people that are here are incredible people,” she says of the caregivers who exchanged hugs with her that day. e center has three bells, one on each treatment floor. ey were donated by Morganne Atutis of Oswego.

She got the idea from a cancer center in Texas where her fiancé was treated. ough he passed away from his illness, Atutis remembers the bells as harbingers of hope and wanted to share that feeling with patients in Central New York. ●

PHOTO BY KATHLEEN PAICE FROIO

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upstate.edu/cancer l summer 2016

INSIDE

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15

23

20

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Inside this issue CARING FOR PATIENTS

SHARING EXPERTISE

The bell survivors ring

page 2

Redefining thyroid cancers

page 4

Meet one of the oldest survivors of a pediatric brain tumor

page 5

Resiliency, at age 11

page 7

Celebrating survivors

page 8

A positive experience

page 9

A tool for surgery of the lung

back cover

SEARCHING FOR CURES Training the immune system to kill cancer

Bone health for breast cancer survivors

page 15

Should you get a 3-D mammogram?

page 16

Breast cancer gene raises prostate cancer risk

page 18

Can aspirin prevent cancer?

page 19

IMPROVING LIFE Sandplay therapy

page 20

2 cancer food myths

page 21

Tracking your pain

page 22

page 10 page 12

Life choice : quality or quantity? page 6

Resear ching racial and ethnic dispari ties page 11

ER

for anyo ne

touc hed

by canc er

SUMMER

2016

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How scientific data helps patients

care

CANC

On the cover: Ogochukwu ezeoke See story, page 11.

Biopsy alterna tives on the horizon page 13

Bone health for breast cancer survivo rs page 15

A new prostate risk factorcancer page 18

Can aspirin preven t cancer ? page 19

PHOTO BY RICHARD WHELSKY

care

CAN

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for anyone touched by cancer

SUMMER 2016

CANCER CARE

UPSTATE CANCER CENTER

EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications

INTERIM DIRECTOR

MANAGING EDITOR

Amber Smith 315-464-4822 or smithamb@upstate.edu

WRITERS DESIGNER

Leah Caldwell, Jim Howe, Jim McKeever, Amber Smith Susan Keeter

The Upstate Cancer Center provides the quarterly magazine Cancer Care for anyone touched by cancer. Send subscription requests and suggestions to magazine@upstate.edu and request additional copies by calling 315-464-4836.

Cancer Care offices are located at 250 Harrison St., Syracuse, NY 13202.

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Jeffrey Bogart, MD ASSOCIATE ADMINISTRATOR Richard J. Kilburg, MBA ASSOCIATE DIRECTOR FOR COMMUNITY OUTREACH Leslie J. Kohman, MD ASSOCIATE DIRECTOR FOR CLINICAL AFFAIRS Ajeet Gajra, MD ASSOCIATE DIRECTOR FOR CLINICAL RESEARCH Stephen Graziano, MD ASSOCIATE DIRECTOR FOR BASIC AND TRANSLATIONAL RESEARCH Leszek Kotula, MD, PhD VICE CHAIR, CANCER CENTER LEADERSHIP COMMITTEE Gennady Bratslavsky, MD

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to you by

the

Events

Learn about events that support the upstate Cancer Center at upstate.edu/cancer The upstate Cancer Center is part of upstate Medical university in Syracuse, NY, one of 64 institutions that make up the State university of New York, the largest comprehensive university system in the united States. upstate Medical university is an academic medical center with four colleges, a robust biomedical research enterprise and an extensive clinical health care system that includes upstate university Hospital’s downtown and community campuses, the upstate golisano Children’s Hospital and many outpatient facilities throughout Central New York — in addition to the upstate Cancer Center.

The Cancer Center is located at 750 e. Adams St., Syracuse, NY 13210.

CANCER CARE

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Formerly known as cancer

CARING FOR PATIENTS

Experts now view one type of thyroid growth as noncancerous BY JIM HOWE THYROID CANCER CAN USUALLY BE CURED if caught early, and one type of abnormal thyroid growth may no longer be considered a cancer at all.

THYROID CANCER INCIDENCE

e American Cancer Society predicts 62,450 people will be diagnosed with thyroid cancer this year.

Nearly three of four will be women.

e thyroid, a small gland at the base of the neck, produces hormones that control metabolism — things like heart rate, body Scott Albert, Md temperature and blood pressure — and can develop growths, oen called nodules. With the prevalence of medical scanning, thyroid nodules are being discovered more frequently, oen when the neck area is scanned for another reason.

While some nodules are cancerous and threaten to spread, others are “indolent,” meaning they tend to grow slowly, stay in one spot and not alter normal thyroid functions.

One type of thyroid nodule — affecting 10 percent to 20 percent of thyroid tumors — is so indolent that an international panel of experts recently recommended deleting the cancer term “carcinoma” from its name and treating it less aggressively.

patient, explains Scott Albert, MD, division chief of breast, endocrine and plastic surgery at Upstate.

“By reclassifying this tumor and taking the word ‘cancer’ out, it may be helpful in having the discussion of how you may not need all the treatments that a typical thyroid cancer may get,” Albert said. is might mean treating the nodule as more of a chronic disease to monitor, rather than surgically removing the entire gland. Aer the thyroid is removed, patients usually receive oral radioactive iodine or external beam radiation to finish off any remaining thyroid cells, and then patients take a thyroid hormone pill for the rest of their lives.

Chemotherapy is rarely employed for thyroid cancer, but some targeted drug therapies are coming into use.

is name change not only reflects a new approach to diagnosis and treatment, it can help avoid scaring the

In any case, Albert says, “the vast majority of patients do very well aer the diagnosis of thyroid cancer and treatment.” ●

Hear an interview at healthlinkonair.org. Search “thyroid.”

com mun it y & do wn to wn

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G RO W I N G TO G E T H E R S I N C E 2 011

upstate.edu/cancer l summer 2016

CARING FOR PATIENTS

A 50-year anniversary

PHOTO BY SUSAN KAHN

Michelle “Shelly” Kikta-Kiner, at home with her grandchildren, Cole, 8, and rowan, 7.

Meet one of Upstate’s oldest living pediatric brain tumor survivors SOME OF THE DETAILS ARE FUZZY, but 50 years aer her treatment for a brain tumor at Upstate University Hospital, Michelle “Shelly” Kikta-Kiner, 62, still considers her survival a miracle. e Verona woman is one of Upstate’s oldest living survivors of a pediatric brain tumor.

She was 12 in 1965 when her nose began bleeding sporadically. She developed headaches. en she had episodes of projectile vomiting. Her mother took her to a local doctor.

Around the same time, Kikta-Kiner’s aunt had a benign brain tumor removed at Upstate University Hospital. She mentioned Kikta-Kiner’s symptoms, and the surgeon agreed to see the young girl.

Kikta-Kiner remembers spinal taps and painful testing to locate the tumor, monthslong hospital stays and a giant teletherapy machine.

Medical advances since then have provided better ways to locate tumors, says Lawrence Chin, MD, chair of the neurosurgery department at Upstate Medical University. e painful test Kikta-Kiner described was a cerebral ventriculogram, something that seems barbaric by today’s standards. It involved tapping into the spinal canal to inject air, and then tipping the table, so the air would travel to the patient’s head and outline the fluid space in the brain. is would reveal growths or structural changes in the brain, but it created severe headaches for the patients.

BY AMBER SMITH

ough that equipment hasn’t been used in more than four decades, “the basic concept is still the same,” Chin says, explaining that painless magnetic resonance imaging scans now guide surgeons in brain biopsies.

Radiation and chemotherapy remain standard treatments for brain tumors.

Shelly’s self-portrait at age 12, before she got sick and lost her hair.

e machine that Kikta-Kiner remembers, from which she received the radioisotope cobalt-60 to kill tumor tissue, was the forerunner of today’s gamma knife, which uses cobalt radiation. “I had a lot of radiation, like 30 treatments,” she says. She missed all of eighth grade. “When I came home, my dad got me a wig, and I went back to school.

“When I first came home, my gait was off, and my le hand shook,” she says. “It’s still not as fast as my right hand, but to look at it, you wouldn’t notice anything wrong.”

Since then, Kikta-Kiner has lived a full life. She went to college, married and in recent years has dealt with other cancers. In 2006 she had her thyroid and a nearby lymph node removed. Later, doctors removed a cancerous polyp from her intestines and treated a skin cancer on her ankle.

For a while aer her childhood ordeal, she dealt with depression. Fiy years later, she has the reminder of a bald spot on her head – and the belief in her heart that her survival was a miracle.●

Shelly during treatment for a brain tumor PROVIDED PHOTO in 1966. summer 2016 l upstate.edu/cancer

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Quality or quantity?

CARING FOR PATIENTS

Serious illness prompts serious discussion

BY AMBER SMITH

SOME DOCTORS ARE RELUCTANT to recommend palliative care, particularly for patients who are younger than 65 and dealing with a serious illness. e shi from lifesaving treatment to comfort care may seem like admitting the futility of the situation.

“It’s understandable” that doctors may wish to avoid such conversations, says Ajeet Gajra, MD, a medical oncologist at Upstate who researches the utilization of palliative care. “e doctor may know there are no other meaningful treatment options, but is afraid to say that to the patient and the family.

“It’s a difficult discussion for the doctor, patient and family, Ajeet gajra, Md, in the second-floor lobby of the upstate Cancer Center.

PHOTO BY ROBERT MESCAVAGE so it’s oen avoided. Patients may feel that the doctor is Gajra says other studies show that patients may have a ‘giving up’ on them. It is important to have an open better quality of life if they are in hospice care at their discussion about the patient's hopes and wishes in the homes, rather than hospitalized in an intensive care unit, context of a limited prognosis. It is important for patients or seeking emergency care for each medical setback. to realize that such a recommendation is being made Studies also show that while timely palliative care because further treatment will cause more harm than good enhances a patient’s quality of life, it can also extend his or and that the doctor cannot put the patient knowingly in her length of life. ● harm's way.” e discussion may be that much more difficult when it centers on a young patient. Regardless of the patient’s age, Gajra says, education and information regarding palliative care should be offered early in the course of an incurable cancer. at way the patient and loved ones do not feel blindsided in the course of their fight if it’s clear that medical treatments will not help further. A patient or loved one can bring up a discussion regarding palliative care if the doctor does not.

In a paper published in the Journal of Geriatric Oncology this year, Gajra and four colleagues from Upstate studied the medical records of veterans with advanced cancer near the end of life. ey compared those older than 65 with those from 40 to 65 years of age and discovered the older veterans were referred to palliative care an average of 12 days sooner than the younger. Younger veterans’ average time in hospice care was 13 days longer.

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CHOOSING QUALITY

Palliative care focuses on providing relief from symptoms of serious illness, rather than trying for a cure or recovery.

Similarly, hospice care is meant to keep patients comfortable and pain-free during advanced illness.

Both options are designed to improve the quality of life for the patient and his or her loved ones.

UPSTATE OPTIONS

Palliative care is an option for adults and children who are treated at Upstate University Hospital. Referrals are also routinely made to Hospice of Central New York.

An outpatient palliative care program for adult patients with advanced cancer will start this fall.

upstate.edu/cancer l summer 2016

CARING FOR PATIENTS

She’s resilient 11-year-old faces Ewing sarcoma

BY AMBER SMITH

MADDIE SHAW IS COVERED with a plush purple blanket. She grasps an iPad Mini, on which she quietly battles digital zombies, while the last of her chemotherapy flows into her arm.

Part of Maddie’s resilience may come from the way her family deals with her disease. “We don’t make life about the cancer,” her mother, Amy Shaw, explains.

Her sister, Alexis (left), and Maddie are shown enjoying a respite with their mom and dad and Chesapeake Bay retriever, Mocha, in Auburn in late spring.

PROVIDED PHOTOS

It’s a Friday at the end of May, and the sixth-grader from Binghamton, NY, is completing her cancer treatment.

A woman leaps into her room. She’s got jazz hands, zebra sunglasses and a fervor that captures Maddie’s attention. e girl’s eyes abandon the electronic screen; her face melts into a smile. It’s Jody Sima, MD, her pediatric oncologist.

Nurse Tara Ingersoll marked the occasion with colored streamers and fringed pom-poms hanging from curtains in the Upstate Cancer Center. Maddie’s parents, Amy and Kevin Shaw, brought cupcakes and a fruit bouquet.

Maddie, age 11, is reserved, engrossed in her game.

“I push her when she needs to be pushed and love her when she needs to be loved,” Sima explains. Today the doctor leans over Maddie’s shoulder. e two confer privately about the best strategies for defeating the horde of zombies.

Maddie’s diagnosis came in December 2013 aer she felt a pain in her hip. Doctors discovered a tumor the size of a soball in her lung. It was Ewing sarcoma, a rare bone cancer. Aer months of chemotherapy, Maddie underwent surgery in Philadelphia on her le hip. She was in remission until August, when the cancer returned.

She renewed her cancer battle, which this time included surgery on both lungs. A month later, fire broke out in the basement of her home, killing Maddie’s hamster and destroying nearly everything her family owned.

While their house is being rebuilt, Maddie, her parents and sister, Alexis, 16, live in a rental home. Her mom and dad took turns driving her to Syracuse for chemotherapy every day for a week, every three weeks, while she was in treatment. is allowed her to attend school in the morning and sleep in her own bed each night.

On Maddie’s last day of chemotherapy, her father, Kevin Shaw, spent almost five hours riding his bicycle to the upstate Cancer Center from Binghamton, as part of his training for the ironman race taking place in July in Lake Placid. He is part of a team of athletes who participate to support Maddie. They wear shirts that say, “it’s not when you finish but why.”

summer 2016 l upstate.edu/cancer

Sima says Maddie is doing well. “She is a pretty amazing kiddo, and she bounces back quicker than any adult ever would,” the doctor told the Binghamton Press & Sun-Bulletin.

Despite missing lots of school this year, Maddie made the high honor roll. ●

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7

Surviving cancer, celebrating life

CARING FOR PATIENTS

THANKS TO EARLY DETECTION, treatment and follow-up care, more people than ever before are living with a history of cancer. ey are survivors with a shared experience.

In addition to physical side effects that may linger, survivors oen struggle emotionally to come to terms with what they’ve gone through — especially if life doesn’t get back to normal as quickly as they would like. e effects of cancer, aer all, don’t end when treatment does.

Many survivors carry memories of difficult treatment regimens. Many say cancer taught them to cherish every day and each person in their lives. Many simply celebrate life.

Upstate since 1996 has made a point to support cancer survivors through National Cancer Survivors Day, an annual celebration of life and the spirit of survivorship. is year’s event took place at the Rosamond Gifford Zoo at Burnet Park in Syracuse.

Camilla Bowman, a 16-year cancer survivor, gets her face painted at the celebration, held at the rosamond gifford Zoo this year.

e Cancer Center’s Survivor Wellness Program (315-464-5294) provides long-term, follow-up care to people who have received treatment for pediatric and adult malignancies. ● PHOTOS BY SUSAN KAHN

Brain tumor survivor Brianna Belair, 12, is mesmerized by sea urchins at the National Cancer Survivors day event. She is pictured with her parents, Ann and Brian Belair.

Breast cancer survivor Heather Kraus.

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Cancer survivor Virginia “gigi” Castro and her son, Marc.

upstate.edu/cancer l summer 2016

‘In good hands’

CARING FOR PATIENTS

Patient appreciates energized staff, warm, vibrant surrounding

BY AMBER SMITH

WHEN CARL PESKO IS at the Upstate Cancer Center for treatment, he receives chemotherapy for eight to 10 hours the first day, and then two to three hours the next.

He has had plenty of opportunity to chat with staff and to observe various procedures taking place. He says he has been extremely impressed.

Pesko is a retired high school guidance counselor who worked for 35 years at Fayetteville-Manlius High School.

He knows how emotionally taxing it must be to take care of individuals with cancer, many of whom appear to suffer far more than he does. Yet, among the nurses and doctors providing care, “everyone seems to be excited about what they’re doing. ey see improvements in their patients, and they know there is a progressive forward movement in dealing with cancer.”

Pesko, 71, of Syracuse began treatment for a type of non-Hodgkin lymphoma called follicular lymphoma in November. He returned from a vacation with his husband, Tom Krahe, feeling overly tired, lacking energy and experiencing difficulty walking.

He expected his friend and primary care doctor, Paul Cohen, MD, would tell him something was wrong with his heart. What Pesko described sounded more like a form of cancer. Testing confirmed Cohen’s suspicions, and the doctor referred Pesko to Upstate oncologist Teresa Gentile, MD, PhD, for treatment.

He was scheduled for chemotherapy every five weeks.

Aer the first two sessions, Pesko says, 90 percent of his cancer disappeared. e treatments have not caused him pain or nausea, nor hair loss. His suppressed immune system, however, requires him to avoids crowds to protect himself against infections. He drinks lots of water, avoids caffeine and alcohol, gets extra sleep and carefully washes all fruits and vegetables to help strengthen his immune system.

In addition, every Monday he comes to the Upstate Cancer Center to undergo blood tests that give Gentile feedback on how well the medications are working.

Pesko says he appreciates the design of the center, its warm, vibrant colors and the artistic elements “which almost make you forget the seriousness of the disease you are facing.”

He also appreciates the people who take care of him, who make the experience as positive as possible. “I know I am in very, very good hands,” he says. ●

summer 2016 l upstate.edu/cancer

Carl Pesko (right) with his husband, Tom Krahe, at the Cancer Center.

Below: Kelly O’Shaughnessy draws Pesko’s blood weekly while he is being treating for lymphoma.

PHOTOS BY ROBERT MESCAVAGE

ABOUT FOLLICULAR LYMPHOMA

Lymphomas begin in lymphocytes, white blood cells that are part of the body’s immune system. Because lymph tissue exists throughout the body, lymphomas can start almost anywhere. e most common sites are in the chest, neck or underarms.

Painless swelling in one or more lymph nodes is a common early sign. Others include fever, persistent fatigue, persistent cough and shortness of breath, drenching night sweats, weight loss, an enlarged spleen and itchiness.

A precise diagnosis is important since there are many subtypes of lymphomas, and they are treated differently. is means patients oen require imaging tests, blood tests and biopsies.

Follicular lymphoma, the type of non-Hodgkin lymphoma with which Pesko was diagnosed, grows slowly and usually responds well to treatment. Some patients receive chemotherapy with or without radiation. Some may require a stem cell transplant.

SOURCES: LEUKEMIA & LYMPHOMA SOCIETY, AMERICAN CANCER SOCIETY

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SEARCHING FOR CURES

Immune therapy William Kerr, Phd, in his lab.

PHOTO BY WILLIAM MUELLER

Training the body’s immune system to kill cancer RARELY DOES A PRIMARY TUMOR KILL. In cancer, death is more typical aer the cancer spreads, or metastasizes.

BY AMBER SMITH

in his lab, wondered if temporarily turning off the Ship-1 gene would make the NK cells hyper responsive, turning them into super killers? And would that wipe out tumor cells more efficiently?

Upstate’s William Kerr, PhD, is a pediatric cancer researcher focused on making the immune system better at killing cancer. Aer a patient undergoes cancer treatment, he wants to be able to “mop up” any residual cancer cells or cancer stem cells that escape surgery or conventional therapies to cause relapse later on.

Working with laboratory mice, the researchers showed they could extend survival in the case of lymphoma, a cancer of the lymph nodes.

“You might not think those last bits are important, but that’s what leads to relapse a couple months or a couple years down the road,” he says. Already his work has demonstrated how deactivating a gene called Ship-1, which helps cancer cells grow, can allow NK cells — short for natural killer cells — to locate and kill cancer cells in the body.

Now, Kerr has been awarded a Fulbright Scholarship, which will allow him to continue his work with Eric Vivier, director of the prominent Center for Immunology in Marseilles, France. e two researchers will collaborate in person for six months, starting in September. ey will focus on using small molecules or chemicals that remove the brakes that limit the NK cells’ killing of tumor cells.●

“It was a bit of a wild, counterintuitive idea,” Kerr admits, “but Matt and I tried it — and it worked.”

He and Matthew Gumbleton, an MD/PhD student working 10

CANCER CARE

upstate.edu/cancer l summer 2016

Beginning a career

SEARCHING FOR CURES

Her immunotherapy research focuses on racial, ethnic disparities

BY JAMES MCKEEVER

OGOCHUKWU EZEOKE IS EXCITED about advances in cancer treatment, especially the idea of using a patient’s immune system to fight disease.

Many breakthrough drug approvals in the past year have been immunotherapy medications, and the medical student at Upstate wants to assess the clinical trial process that leads to those approvals. gary Brooks

is summer, Ezeoke and her mentor Gary Brooks, an associate professor in the College of Health Professions, are researching racial and ethnic disparities among patients who enroll in clinical trials for new drugs.

“As cancer therapeutics evolve toward more directed drug activities, the investment in knowledge of histology-specific genetics will become even more necessary,” Ezeoke writes in her grant application. e duo received funding from the American Medical Association Foundation and the American Society of Clinical Oncology Conquer Cancer Foundation.

Born in Nigeria, Ezeoke came to the United States in 2004 and studied at Binghamton University, graduating in 2011 with a degree in cell and molecular biology. She worked four years as a research study assistant in New York City, coordinating clinical trials at Memorial Sloan Kettering Cancer Center.

“It was inspiring getting to meet patients,” she says of her time there. “ey were so positive despite the disease. It makes you want to do things to help them.”

Ezeoke’s career path is guided by her family’s experience with cancer. Her grandmother had breast cancer and died from an embolism aer a mastectomy. Her father is a prostate cancer survivor.

She says cancer research and clinical trials represent necessary behind-the-scenes work in the fight against cancer, and she hopes to contribute to the effort. ●

Ogochukwu ezeoke PHOTOS BY RICHARD WHELSKY

summer 2016 l upstate.edu/cancer

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Making Sense

SEARCHING FOR CURES

How scientific data can be quantified to help patients

BY AMBER SMITH

ernest Scalzetti, Md

based approach to diagnosis and treatment,” Scalzetti explains with colleagues in a paper in the journal Academic Radiology.

DOCTORS WONDER “If I do ‘x’ procedure, is my patient likely to benefit?” and “Is the ‘y’ medication I prescribed having any effect?”

To answer these questions, doctors may turn to quantitative imaging, the extraction of numerical or statistical features — biomarkers — from medical images such as ultrasound, positron emission tomography, magnetic resonance imaging and others.

For some aspects of cancer care, anecdotal information has been collected from multiple patients over time and standardized into a format that allows doctors to “stage” particular cancers. is is how doctors are able to accurately tell newly diagnosed patients about the prognosis of their disease and what treatments have the best outcomes.

Upstate radiologist Ernest Scalzetti, MD, is contributing to the effort to quantify such information to help guide medical care.

To recognize the potential of quantitative imaging, you first have to understand that a biomarker is something that can be objectively measured to detect the presence of some phenomenon.

Fetal measurements are used to determine the health of a developing baby, for example, and the volume of blood leaving the heart is useful in assessing congestive heart failure.

Scalzetti says many other pieces of information can potentially be quantified into other tools to help doctors help their patients, to help assess procedures and medications.

Both of these examples rely on various types of medical imaging, a field whose progress parallels advances in the understanding of the molecular underpinnings of diseases “and the rise of a more statistical and evidence-

Even with new ways to harness scientific data, he does not expect the doctor to be replaced by an algorithm. “It’s the physician’s job to integrate all of this scientific information, to arrive at what is best for the patient,” he says. “e goal is to give the individual the best chance at living his or her life.”●

Upstate students benefit from nationally recognized professors, excellent job placement and www.upstate.edu/students SUNY tuition. Open houses are held each fall and spring.

DEGREE PROGRAMS Biomedical Sciences Cardiovascular Perfusion Medical Biotechnology

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CANCER CARE

Medical imaging Medical Technology Medicine Nursing Public Health

Physician Assistant Physical Therapy radiation Therapy respiratory Therapy

Education • Health Care • Research

upstate.edu/cancer l summer 2016

SEARCHING FOR CURES

Instead of a biopsy

Scientists strive to create better noninvasive diagnostic tool for early liver cancer detection

BY AMBER SMITH

ONE OF THE REASONS liver cancer is so deadly is that people rarely discover the disease at an early stage, when it’s treatable.

What might help would be a screening test, similar to the one that exists for lung cancer. People at high risk for liver cancer could undergo medical imaging, and the resulting images could give doctors a peek at the liver without need for biopsy. Unfortunately, ultrasound, computerized tomography and magnetic resonance imaging cannot detect most liver cancer lesions, which are generally less than an inch big.

LESIONS

Upstate radiologist Andrzej Krol, PhD, is working on such a project with Ivan Korendovych, PhD, a chemist from Syracuse University.

“An urgent need exists to develop new molecular imaging tools for diagnosis, response to therapy assessment and detection of recurrence of hepatocellular carcinoma,” the scientists write in a description of their work. ey want to use an imaging scan technique called PET, short for positron emission tomography. is is a sensitive quantitative molecular imaging method already in use for many types of cancer and other diseases. Most commonly, a fluorine-containing sugar (glucose) tracer molecule is injected into the patient, and a short time later the PET scan allows visualization of glucose metabolism in the patient’s body.

Cancer cells appear as dark spots on these PET images because they have higher metabolic rates, or burn more glucose, than do normal cells. But because the healthy liver cells metabolize lots of sugar, a PET scan using this tracer is not an effective test for liver cancer. e bright spots don’t discern cancer cells from normal cells. e trick to being able to use PET for liver cancer will be to find a different tracer molecule, a task Krol says scientists have been working on for years.

summer 2016 l upstate.edu/cancer

Above are positron emission tomography images of the same patient with advanced liver cancer. At left the large lesions are visible using F18-fluorocholine radiotracer. At right the same lesions are not visible using a common fluorinecontaining sugar tracer. The proposed new tracer will allow detection of much smaller lesions typical for the early stages of liver cancer. Presently, such small lesions cannot be detected.

PHOTO CREDIT: “DETECTION OF HEPATOCELLULAR CARCINOMA WITH PET/CT” IN THE JOURNAL OF NUCLEAR MEDICINE, OCTOBER 2010.

He and Korendovych propose in their project to use a biological molecule that would be specific to liver cancer. e small fluorine-containing sugar molecule commonly used for PET would hitch a ride inside a larger molecule that already knows how to locate liver cancer cells, and it would remain attached to the liver cancer cell while a PET image is taken.

Krol says in the future, a PET scan for liver cancer could potentially provide an early warning system and replace the need for a biopsy to confirm liver cancer. Such an approach could possibly be used for other cancers, as well.●

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UPSTATE CELEBRATES NURSES It's not just what is in the hearts of our nurses that makes a difference to our patients, it's their experience.

As the region's only academic medical center, nurses at Upstate are consistently learning and teaching to ensure the best patient care experience. Each year, more nurses pursue certification in their specialty or study for an advanced degree. This extra education is a nationally acknowledged achievement that validates and increases a nurse's skills and knowledge. Upstate Nursing: the academic difference in patient care.

C A R I N G F O R PAT I E N T S . S E A RC H I N G F O R C U R E S . S AV I N G L I V E S .

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upstate.edu/cancer l summer 2016

Bone health

Breast cancer treatment affects bone mass, but you can protect yourself

SHARING EXPERTISE

BY AMBER SMITH

NO MATTER WHETHER HER BREAST CANCER is treated with surgery, radiation or medications, a woman’s resulting loss of estrogen translates into bone loss — and an increased risk for fracture.

Advances in cancer treatment have significantly improved survival rates, but “cancer therapies are also related to bone loss,” says Ruban Dhaliwal, MD, an expert in bone and mineral disorders. Dhaliwal is an assistant professor who sees patients at Upstate’s Joslin Diabetes Center and also conducts clinical research. Reduced bone mass leads to osteoporosis, in which bones become brittle and may break easily. e risk of a spinal fracture is five times higher for breast cancer patients than for the general population, Dhaliwal explained in a presentation to staff at Upstate University Hospital this spring. She also told how the loss of bone mass that occurs with cancer treatment is substantially higher than the loss that occurs with normal aging.

Osteoporosis is prevalent among women, and fractures related to osteoporosis are more common among them than heart attacks, strokes and breast cancer diagnoses combined. Dhaliwal says the best protection is to build and maintain healthy bones and to screen for osteoporosis.

A bone density test similar to an X-ray can reveal bone loss. In some patients, doctors may monitor the continual process in which new bone tissue is formed as old bone tissue is reabsorbed, a process known as bone remodeling.

Bone mass forms from birth through adolescence. Bone mass generally remains stable for most women from the second decade of life until menopause, when it declines along with the reduced production of estrogen.

If a woman faces breast cancer, “no matter which chemotherapy we use, the time of menopause is pushed forward five to 10 years,” Dhaliwal says. Chemotherapyinduced menopause results in rapid bone loss. A woman’s individual risk of bone loss is related to the type of medication she takes, for how long and in what dose.

Hormonal therapy also induces bone loss in premenopausal women. Aromatase inhibitors, a type of hormonal therapy, cause an increase in bone turnover, bone loss and fractures — although evidence shows they do a good job preventing the return of breast cancers.

Bone loss is a concern for patients with other types of cancer, too. Men with prostate cancer see a decline in testosterone, and patients with thyroid cancer may need to keep their levels of thyroid stimulating hormone below normal, which leads to bone loss. ●

summer 2016 l upstate.edu/cancer

ruban dhaliwal, Md, discusses estrogen and bone loss.

PHOTO BY SUSAN KAHN

HOW TO PROTECT YOUR BONES

Bone mass is affected by genetics, nutrition, physical activity, underlying hormonal diseases, lifestyle and overall health. How best to maximize your bone mass? l l

Getting adequate calcium, from diet and/or supplements – a total of 1,000 to 1,200 milligrams a day.

Help your body absorb calcium by taking 600 to 800 international units of vitamin D daily.

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Maintain a healthy weight.

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Participate in weight-bearing exercises, such as walking.

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Take measures to prevent falls in your home.

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Limit excessive alcohol and caffeine intake.

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Avoid tobacco.

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Seek bone mineral density screening and discuss pharmacological treatment for bone loss, if necessary, with your health care provider.

SOURCE: ENDOCRINOLOGIST RUBAN DHALIWAL, MD

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SHARING EXPERTISE

When to seek a 3-D mammogram upstate radiologist ravi Adhikary, Md, reviews images from a 3-d mammogram.

PHOTO BY SUSAN KAHN

WOMEN WITH DENSE BREAST TISSUE have the most reason to seek 3-dimensional mammography, says Ravi Adhikary, MD, director of the women’s imaging section at Upstate.

to see otherwise,” Adhikary explains. is allows cancers to be detected earlier. He also says the more accurate images create fewer false positives, which means fewer unnecessary biopsies.

Dense tissue appears white on a regular 2-dimensional mammogram, so it can mask cancer, which also usually appears white. e 3-D mammography available at Upstate provides multiple views of breast tissue. “We can see through that and find a mass that may be difficult

e newer technology exposes women to a lower dose of radiation. e breast compression time is also shorter, which Radiology Director Jennifer Caldwell says increases patient comfort. ●

Breast cancer diagnosis?

Next step: surgeon consult

IF A WOMAN HAS AN ABNORMAL FINDING on a mammogram, further tests will confirm or rule out cancer. While the vast majority will turn out to be benign conditions, the first stop for a woman who has a diagnosis of breast cancer is usually a breast surgeon.

“Getting seen quickly is important, both to relieve the woman’s anxiety and to plan her next steps, as the treatment plan is highly personalized to each patient,” commented Scott Albert, MD. Albert is a surgeon and a member of a multidisciplinary team of breast cancer experts. Together the team creates the treatment approach for breast patients. e team also offers the expertise of fellowship-trained breast surgeons. A fellowship is additional, advanced training aer medical school and residency. e Society of Surgical Oncology, which oversees the fellowship program for breast surgeons, accepts a few dozen surgeons each 16

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The upstate Cancer Center will soon provide the services of four breast surgeons.

Pictured are Mary ellen greco, Md, and Kristine Keeney, Md. in the article below Keeney discusses the role of fellowship training specifically for breast cancer and disease.

PHOTO BY ROBERT MESCAVAGE

year. e yearlong training covers breast imaging, surgery, genetics, medical oncology, plastic and reconstructive surgery, radiation oncology and psychological oncology. e goal of the training is to use the expertise to provide excellent care and contributions to the treatment team, as these areas all relate to the care of breast patients, says Kristine Keeney, MD. ● upstate.edu/cancer l summer 2016

Thinking twice

SHARING EXPERTISE SeArCHiNg FOr CureS

Why a kidney biopsy may be unnecessary

BY AMBER SMITH

FOR DECADES, KIDNEY EXPERTS believed that biopsies of the organ were not helpful in determining how to treat a small kidney tumor. Today more doctors believe a biopsy helps guide treatment.

It can — sometimes, says Gennady Bratslavsky, MD, chair of Upstate’s department of urology.

A biopsy may be appropriate for some patients with solid kidney tumors that have not spread beyond the organ. But he says the procedure, in which tissue is removed for laboratory analysis, should not be used routinely for everyone diagnosed with a renal mass.

3 PATIENTS WHO MAY REQUIRE A BIOPSY

• Patients whose tumors have grown while they are being monitored through active surveillance • Frail or elderly patients with large (greater than 3 centimeters) or rapidly growing tumors • Patients who are extremely anxious about the tumor

gennady Bratslavsky, Md,

Bratslavsky and co-authors from the Fox Chase Cancer Center in Philadelphia and the Mayo Clinic in Rochester, Minn., argue for selective use of kidney biopsy, writing in the journal European Urology that “most patients can avoid the unnecessary procedure and its associated risks.” eir article says a biopsy probably would not make sense for a patient with a small mass in the kidney, who is frail or has other serious medical conditions, since results are not likely to influence the patient’s treatment. e authors give three reasons people with small kidney tumors should not automatically undergo a biopsy: 1. Growing evidence suggests that such patients can be safely monitored through active surveillance without the tumor spreading.

2. Kidney biopsies do a poor job of predicting how likely a tumor is to grow and spread.

While learning what kind of cells make up a tumor may provide comfort — or concern — for a patient, “our experience suggests that if a renal mass in a frail, elderly or infirm patient is best managed with active surveillance, knowledge of the pathology is oen irrelevant and rarely helpful for initial management,” the authors write.

3. Many patients with kidney tumors take prescription medication that helps reduce blood clots. at increases their risk of dangerous bleeding during a biopsy. ●

89.9 & 90.3FM

Radio Show/Podcast

Now airing on Sundays on WRVO AT 6 AM & 9 PM

Interview examples: pancreas transplant, cancer, stroke, prostate ● Alzheimer’s disease.

Listen anytime: HEALTHLINKONAIR.ORG or ITUNES (search podcasts by topic)

summer 2016 l upstate.edu/cancer

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A new risk factor

SHARING EXPERTISE

Breast cancer gene also increases risk of prostate cancer

BY AMBER SMITH

ALTHOUGH PROSTATE CANCER IS the most common cancer diagnosed in men in the United States, the disease kills fewer than 3 percent of those diagnosed. It typically grows slowly, becoming deadly aer it metastasizes, or spreads, beyond the prostate.

If doctors could determine ahead of time which men harbor the most aggressive cancers, they could provide more focused interventions – and potentially save lives.

One clue is whether a man carries the BRCA mutation, better known as the breast cancer gene, which increases a woman’s risk of breast and ovarian cancers. Men who have that BRCA mutation are four times as likely to develop a prostate cancer that is aggressive and lethal, according to urology experts from Upstate.

Assistant professor Srinivas Vourganti, MD, presented research in May at the annual meeting of the American Urological Association showing that men with the BRCA mutation were much more likely to be diagnosed with a prostate cancer that had already spread or was considered more advanced.

Stephanie Gleicher, MD, was a medical student when she pitched a project to Vourganti that involved analyzing a dozen prostate cancer studies that included 261 men with the breast cancer gene. In 17 percent of those men with newly diagnosed prostate cancer, the disease was metastasized. at compares with 4 percent of newly diagnosed men in the general population.

In addition, about 40 percent of the men with the BRCA gene were diagnosed with late-stage prostate cancer, compared with 11 percent of the general population. “ey are very much at high risk of cancer, and we should be tailoring their screening to be more aggressive,” Vourganti says.

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Gleicher is now a urology resident at Upstate. She, Vourganti and colleagues published a paper on the subject in the journal e Prostate. e BRCA genes produce proteins that repair damaged DNA, which could otherwise cause cancer.

Previously, mutations of this gene were thought to be involved in as few as 5 percent of prostate cancers. e Upstate research, along with two other studies presented at the conference in May, calls that into question.

One study showed that black prostate cancer patients were more than three times as likely as white patients to have a BRCA mutation – which may help explain why prostate cancer is deadlier and more aggressive in black men. e other study focused on men who survived breast cancer, showing that they are at a 30 percent increased risk for developing prostate cancer.

Brian Helfand, MD, a urologic oncologist at NorthShore University HealthCare System in Chicago, says men with a personal or family history of breast cancer should be screened for the BRCA mutation.

“We need to recognize this as a risk factor and start screening those men more aggressively,” he told a HealthDay reporter. “BRCA is a tool we can start using to distinguish who is going to benefit from earlier treatment and more aggressive type treatments.” ●

BRCA MUTATIONS

Harmful mutations in the BRCA1 and BRCA2 genes increase the risk of several cancers, including breast, ovarian, fallopian tube, peritoneal, prostate and pancreatic cancer, according to the National Cancer Institute.

upstate.edu/cancer l summer 2016

SHARING LiViNgEXPERTISE WiTH CANCer

An aspirin a day

Can a pill protect you from colorectal cancer?

ASPIRIN HAS LONG BEEN RECOMMENDED to help prevent heart disease and reduce stroke risk in some patients. Now the U.S. Preventive Services Task Force says evidence shows the anti-inflammatory pill can reduce the risk of colorectal cancer.

But before adding aspirin to your daily intake, it’s important to weigh the risks and benefits with your primary care provider, says John Epling, MD, a member of the task force and the chair of Upstate’s department of family medicine.

Daily aspirin use can cause internal bleeding, and the drug is not for everyone. “is is about risk and benefit,” Epling says. “People need to have their doctor’s input.”

He says primary care providers can calculate their patients’ risk for heart disease and stroke and estimate their bleeding risk before advising them to take aspirin. e task force, which issues evidence-based recommendations about a variety of screenings and medications aimed at preventing illness and disease, says a

low-dose aspirin regimen is most beneficial for adults: l l

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age 50 to 59, who are not at increased risk for gastrointestinal bleeding, who have a life expectancy of at least 10 years and who are willing to take a low-dose aspirin daily for at least 10 years.

e task force guidelines say people from age 60 to 69 may also benefit, but their risk for dangerous side effects may be higher.

Evidence was not sufficient to show benefit for people younger than 50 or older than 70, and the task force did not consider people at higher risk for colon cancer. e new recommendation applies only to patients with average risk.

Research continues into exactly how aspirin affects solid tumors in the intestines and how soon its protective effect kicks in aer someone starts taking it. ●

Sun smart Teaching kids to protect themselves from skin cancer BY JIM MCKEEVER

PROTECTING YOUR SKIN from the sun starting at an early age is an important way to guard against skin cancer. at’s the message a group of medical students shares with elementary school students each spring.

“Our goal is to make the kids understand that what they do now will affect them in the future,” says Nathalie Morales, a first-year medical student and president of Upstate’s Dermatology Interest Group. Members share “sun smart” messages through the Sun Smart Syracuse project. e project began with the Salt City Road Warriors, a group of local runners that wanted to help raise awareness about the dangers of skin cancer, which is on the rise in younger populations. Warrior Maureen Clark contacted Upstate dermatologist Ramsay Farah, MD, who got the dermatology students involved.

In age-appropriate presentations, the students cover the ABCs of sun protection and point out the dangerous societal pressures that encourage tanning, either in the sun or in tanning beds. en they hand out sunscreen donated

by Wegmans and Australian Gold, UV detection bracelets and sunscreen application-tracking calendars.

summer 2016 l upstate.edu/cancer

e dermatology group is interested in scheduling presentations to school and youth groups for spring 2017.

Contact vice president Amanda Gemmiti at gemmitia@upstate.edu. ● HOW YOUR GROUP CAN DONATE The running group Salt City Road Warriors raises money for the Upstate Foundation, which manages a variety of funds that support Upstate’s mission. To learn how to set up a fund, contact the Upstate Foundation at 315-464-4416.

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Beyond child’s play

IMPROVING LIFE

Miniatures and sand prove therapeutic

BY JIM HOWE

Knai Bridges, 13, creates a sandplay assemblage as ruth McKay, medical family therapist, looks on.

PHOTO BY SUSAN KAHN

A BOX OF SAND and an assortment of miniatures helps young patients portray their world, and perhaps make sense of it, at the Waters Center for Children’s Cancer and Blood Disorders and the Pediatric Hematology-Oncology unit at the Upstate Golisano Children’s Hospital.

Sandplay therapy, as it is called, allows the children to process their feelings and thoughts about their diagnoses and treatment for life-threatening illnesses and the impact of treatment on their daily lives. “e box of sand offers a safe place to express some of the intense experiences that can come with treatment for lifethreatening illnesses,” says medical family therapist Ruth McKay. “Children engaged in sandplay therapy may not consciously understand or be able to speak about what they are going through, but they can explore their experience nonverbally with the miniatures in the sand.” e box, or sandtray, measures about 28½ inches by 18½ inches, oen with a blue interior to represent water or the sky. e patient selects from hundreds of miniature people, animals, toys, cars, household items — almost anything

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you might find in the real world, including the world of medical treatment, such as hospital beds and IV poles.

McKay, who is certified as a sandplay practitioner by the Sandplay erapists of America, adds that sandplay tends to be a part of therapy, not the only therapy a child does. A patient and his or her family may also be engaged in family therapy, or a child may be learning skills to reduce posttraumatic stress symptoms.

Among what she has seen in sandtrays, McKay cites: l

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a child adjusting to having his port accessed and blood drawn by his nurses places witches watching over sleeping children in the sand. Later he decides that he likes the nurses, because even though they do scary things, they are trying to help him get better. another patient leaves just a handprint in the sand like a signature, saying “I am here.” a boy creates a “car family,” consisting of a mommy car, a daddy car, a child car — and a car being transported continued on page 21

upstate.edu/cancer l summer 2016

IMPROVING LIFE MAKiNg A diFFereNCe

Beyond child’s play continued from page 20 l

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inside an ambulance, much like his experience of his first treatment.

“She loves it. She talks about it all the time,” Knai’s mother, Nailah Beyah, says of the sandplay.

a dying boy whose family was reluctant to talk openly about his impending death repeatedly hides a coffin containing a skeleton in different spots in McKay’s office, indicating that death was present, but not out in the open.

Most of the children McKay sees will have one or maybe two sandplay sessions, sometimes spaced several months apart, while some may engage in sandplay therapy for months. She follows a strict hospital protocol for cleaning the figures and changing the sand. ●

a girl who usually made animals run around endlessly one day places them by the water for a “spa day,” at about the same time her family was no longer feeling in crisis mode, but getting use to the new normal of treatment.

McKay makes sandplay therapy available in her office, or she wheels a well-stocked cart to patients who can’t come to her.

Knai Bridges, 13, of Syracuse, is being treated for sickle cell disease at the Waters Center and enjoys her time with sandplay. “It’s like a box of sand where you can put your toys and special friends,” she says, adding, “it’s like doing a video.”

Among the miniatures she has used are a bride and groom, various animals, hearts, a shell, a dancer and a hospital bed with an IV pole. McKay notes that Knai uses sandplay to help her to hold on to the whole of her life, not just the times when she is receiving treatment. e eighth-grader used to be in the hospital frequently and appreciates sandplay.

WHAT IS SANDPLAY? Sandplay is a therapy in which a person, usually a child, expresses thoughts or feelings by creating a scene with miniature objects in a box of sand (called a sandtray), which often has a blue interior to represent water or the sky. The therapist quietly witnesses the creative process and photographs the finished scene to observe themes developing over time. Developed by Dora Kalff, a follower of Swiss psychiatrist Carl Jung, sandplay therapy can work for people of any age.

HOW IS IT POSSIBLE? If you contribute to Paige’s Butterfly Run or related events such as Pedaling for Paige or the Pajamarama, your donation helps make sandplay possible at Upstate. Sandplay therapy is offered to pediatric hematology-oncology patients free of charge, thanks to a grant from Paige’s Butterfly Run. Learn more at pbrun.org

Sugar & Soy

Dispelling the 2 biggest food myths DON’T BLAME SUGAR.

DON’T BAN SOY.

Glucose feeds all cells in the body, and cancer cells use more blood sugar than do less active cells. But that doesn’t mean eating sugar (or not eating sugar) influences how rapidly cancer spreads, says Upstate registered dietitian nutritionist Maria Erdman.

Erdman says most recent research shows that soy foods, eaten in moderation, can be part of a healthy diet.

Sugar’s impact on the body and how it is processed is complicated. Erdman generally cautions people against eating too much added sugar because of the risk of obesity or diabetes, regardless of whether they have cancer.

She also favors natural sugars, such as those found in fruits, over foods that have added sugars. at’s because foods with added sugars typically lack nutrients. Even so, Erdman points out, a person who eats a healthy, plantbased diet can still afford the occasional sweet indulgence.

summer 2016 l upstate.edu/cancer

e worry that soy foods might cause or worsen breast cancer arose because soy beans contain phytoestrogens, plant estrogens similar in some ways to human estrogens.

High levels of human estrogen have been linked to an increased risk of breast cancer.

Recent research shows eating two or three servings of soy foods, such as tofu, edamame, or soy milk, per day is fine, and may be protective, even for patients with hormonereceptor-positive breast cancers, Erdman says, adding that research is not conclusive about the use of soy extracts or soy protein supplements. ●

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What a pain

IMPROVING LIFE MAKiNg A diFFereNCe

Communication helps you help your doctor help you DOCTORS RELY ON PATIENTS to accurately describe their pain in order to create an effective pain management plan.

Use the chart below to keep track of your pain, noting when it began, its intensity, what it feels like, its location and whether it expands. Also, take note of any medication’s effects on your pain. Some doctors ask patients to maintain a pain diary.

WHEN YOU CONTACT YOUR DOCTOR’S OFFICE, BE PREPARED TO SAY:

1.

When the pain started:

2.

Specifically where it is located (see chart at right)

3.

What it feels like (see descriptive words below)

4.

Its rating on a scale of 0 to 10:

5.

What makes the pain better:

6.

Whether anything makes it worse:

7.

e type and amount of pain medication you are taking and how it is working:

8.

Which side effects or complications you are experiencing:

WHERE IS THE PAIN LOCATED?

Circle the place(s) that are painful.

See if any of these words help describe what you feel.

Circle those word(s).

Name

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Aching

Dull

Intense

Pounding

Sharp

Tight

Annoying

Distressful

Jumping

Pulsing

Suffocating

Tingling

Agonizing

Frightful

Lacerating

Pressing

Sore

Throbbing

Blinding

Flickering

Miserable

Pinching

Spreading

Unbearable

Cold

Freezing

Nagging

Penetrating

Shooting

Vicious

Cutting

Gnawing

Nauseating

Radiating

Tender

Weak

Crushing

Grueling

Numbing

Rasping

Taut

CANCER CARE

Date Cancer patients may have chronic or continuous pain, and they may experience episodes of “breakthrough” pain. Such flare-ups should be reported promptly, as the frequency or dosage of pain medications may need to be adjusted.

upstate.edu/cancer l summer 2016

CLIP, COPY AND USE

DESCRIPTIVE WORDS

How can you help?

IMPROVING LIFE

SOME OF THE BEST GIFTS for a person facing a medical crisis are simple, with a “thinking of you” message, and many Central New Yorkers with giving spirits make such donations to Upstate University Hospital.

Some examples of recent gis that were well received:

If you would like to donate something to patients at the Upstate Cancer Center, contact Matthew Capogreco at 315464-3605 or capogrem@upstate.edu. To donate to patients at the Upstate Golisano Children’s Hospital, contact Margaret Nellis at 315-464-7547 or nellism@upstate.edu*

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New teddy bears, donated to children at the Upstate Golisano Children’s Hospital by State Police Sgt. Jeff Cicora of Baldwinsville, who has a rare form of cancer.

Adult coloring books, donated by Adam omson of Cazenovia. e books were collected for his bar mitzvah.

Totes, bags and pillows from irty-One Gis, donated by a variety of Central New York consultants.

Comfort items that stock a cart made available to outpatients and inpatients. Brandon Spillett of Syracuse receives monetary donations through his organization Room 2 Smile, and the funds pay for playing cards, puzzle books, greeting cards and personal care items for the cart.

Hats and caps, 400 of which were donated by students from Norwich Elementary School.

Blankets, donated by Central New York Subaru dealers and e Leukemia & Lymphoma Society.

*Note: All donation ideas must be approved.

State Police Sgt. Jeff Cicora, who is battling stage 4 cancer, threw a party for patients at the upstate golisano Children’s Hospital to take his mind off his health problems. Cicora was joined by about 20 fellow troopers and police dogs.

PHOTO BY KATHLEEN PAICE FROIO

ARE YOU GRATEFUL? There are many ways to make donations to the Upstate Cancer Center and the Upstate Golisano Children’s Hospital. For details, contact the Upstate Foundation at 315-464-4416 or www.FoundationForUpstate.org

BRAIN EXPERTS REGION’S FIRST & ONLY COMPREHENSIVE STROKE CENTER

Neurologist Hesham Masoud, MBBCh, neuroradiologist Amar Swarnkar, MD, and neurosurgeon Grahame Gould, MD, are part of the team of experts who provide round-the-clock stroke care at Upstate. They offer stroke patients their expertise in the swift removal of brain clots, which greatly improves the patients’ odds of survival and recovery.

IF YOU SEE SIGNS OF A STROKE, ACT FAST.* CALL 911.

TO LEARN MORE, CALL UPSTATE CONNECT AT 800.464.8668 OR VISIT WWW.UPSTATE.EDU/STROKE *Face, Arm, Speech, Time

summer 2016 l upstate.edu/cancer

CANCER CARE

23

750 East Adams Street l Syracuse, NY 13210

UPClose

16.241 0716 39.6M ELsk

SURGERY ON THE LUNGS was done as an open operation as early as 1911.

Starting in the 1950s, surgery on the lung became more commonplace because of the increase in lung cancer. Open surgery remains an option today, and the best option for some patients. But the percentage of procedures done in a minimally invasive style is increasing.

Some patients who need biopsies of lesions in a lung or lymph nodes undergo endobronchial ultrasound, a technique offered by pulmonary and thoracic surgeons, says Robert Dunton, MD, chief of cardiac and thoracic surgery at Upstate University Hospital. e convex probe (magnified in the picture) is slightly thicker than a standard ballpoint pen. It’s inserted through a bronchoscope positioned in the patient’s windpipe. A rectangular ultrasound scanner near the end of the probe acquires images to project on a screen in the operating room. Once the probe is at the proper location, a balloon on its tip is inflated with sterile water to keep it stable. A small needle or knife is deployed from an opening in the probe to retrieve a sample of tissue.