A new study shows using ultrasound to guide the surgical removal of tumors from women with palpable breast cancer is significantly better than the standard approach in ensuring that all cancerous tissue is removed while minimizing the removal of healthy tissue.
Dr. Krekel and her colleagues randomly assigned 124 patients with palpable early-stage breast cancer to either ultrasound-guided surgery or palpation-guided surgery. They found that only 3.3 percent of the margins in the ultrasound-guided surgery group contained cancer cells, compared with 16.4 percent in the palpation-guided surgery group. They also found that less healthy tissue was removed in the ultrasound-guided surgery group.
“If we get the same results in the United States, and these results can be incorporated into community practice, it will spare many women unnecessary re-excision surgery,” said Dr. Jo Anne Zujewski, head of Breast Cancer Therapeutics in NCI’s Division of Cancer Treatment and Diagnosis.
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Fifty years after the discovery of the first direct genetic link to cancer, scientists are assessing the state of so-called targeted therapy — with nearly 30 treatments on the market and a dozen or so more under study.
“We’re still not using the ‘C’ word, ‘cure,’” cautioned personalized medicine director Jeff Boyd of Fox Chase Cancer Center, who helped organized a meeting in Philadelphia today to mark the anniversary and examine the future of targeted therapy.
But, he added, “there is real potential to transform many cancers into chronic diseases.”
One next challenge is how to expand the number of targets to attack, in part by answering what the new chief of the National Cancer Institute calls the “big questions” about what makes this disease so intractable.
Questions like: What makes a tumor metastasize, or spread through the body? Metastasis is what kills, yet scientists don’t know why some tumors spread and others don’t, and what programs those tumor cells to invade, say, the liver instead of the bone or the lung — factors that undoubtedly could be new treatment targets.
Starting in October, Dr. Harold Varmus, the NCI’s director, will begin quizzing top researchers from around the country about which of oncology’s underlying mysteries should be part of his “Big Questions Initiative,” a new focus of government cancer research.
Answering those questions “would get you over a roadblock that keeps us from making better progress,” Varmus told a meeting of his scientific advisers earlier this month.
For Dr. Otis Brawley of the American Cancer Society, such a project might finally offer clues to a huge problem facing patients today: How to tell who needs the most aggressive treatment, and who would be OK skipping the big guns.
A domino effect of genetic alterations is required to cause any of the 200 diseases collectively called cancer. Some occur in the person, making them more prone to illness. But tumors also have their own genetic signature — four to seven genetic changes that are critical to turning, say, a normal breast or colon or liver cell into a cancerous one, and a pattern of activity that signals how aggressive that malignancy will be. Those unique patterns also offer targets for treatment, drugs that zero in on the particular genetic pathways fueling the person’s cancer — and even vaccine-like therapies, a fledgling field that aims to train patients’ immune systems to recognize and fight their tumors.
It all started with the 1960 publication of what was dubbed the Philadelphia chromosome, a funny-looking chromosome that two scientists — one from the University of Pennsylvania, one from Fox Chase — spotted only in patients with a specific kind of leukemia. Fast-forward to the 2001 approval of the groundbreaking drug Gleevec, which has turned chronic myeloid leukemia from a fast killer into a disease that many patients today manage with a daily pill. It works by targeting the cancer-causing protein produced by the Philadelphia chromosome.
Gleevec wasn’t the first genetic targeted therapy for cancer — the decades of research sparked by that discovery actually paid off for some other cancers first.
Boyd predicts there will be more than 100 targeted therapies available within several more years, and the real quest is for targets that prove as crucial to holding cancer in check as Gleevec’s did.,
Generating particular excitement now are possible new drugs for hard-to-treat breast cancer, compounds called PARP inhibitors that block enzymes needed for cell growth.
by Nimal Gernando, cancer survivor and Cancer Services client
One beautiful day in June 2008, I was attending a conference in Indianapolis and developed a slight and sudden pain in my lower abdomen. I tried to shrug it off, but it didn’t go away and actually got worse. I had a bad feeling about it, so I decided to head home. I called my wife on the way, and she suggested that I call the doctor. The doctor saw me right away, but he couldn’t find anything and suggested that I get a CAT scan. The scan showed a tumor blocking my colon, so I had a colonoscopy, which confirmed the tumor and I underwent surgery to remove it immediately. That was the beginning of a new life for me and one that has been humbling and challenging.
After my diagnosis, I found Cancer Services of Northeast Indiana, which has been a huge source of support and encouragement to me and my family. My Client Advocate, Brandon, has been there at every turn and has never hesitated to provide the information that I need. I have also been enjoying the massages provided through its new program, Caring Touch. The experience is so relaxing and comforting. I am thankful to Cancer Services for the support and services provided on my journey.
My life goes on and I am enjoying it to the fullest. I have learned to look on the bright side and have been counting my blessings. I have two boys: Nathan (8) and Nelig (7). My wife, Shanthinie, has been strong and is taking care of me and the two boys with much courage and perseverance. She is scared, yet she has been there to support me and take care of the family throughout this journey. We do not have family in the area, so she has found strength in the community, especially from our church family, which has rallied around us and offered encouragement and support. Life is a struggle but I am keeping my hope alive.