M. D. Anderson Cancer Center
Date: April 2009
Return to the Making Cancer History® Video Series
>>I was devastated, just devastated.
>>Receiving a cancer diagnosis can turn your world upside down, and it seems that just about everyone has been touched by cancer. In truth, there is no such thing as cancer. There are cancers, hundreds of them. Some cancers take the shape of a solid form, and others live and travel in the blood. Today we're going to focus on solid tumors like brain, uterine, and prostate cancer. We'll look at what makes each person's cancer different, and see how the physicians at M. D. Anderson recognize these differences. They don't just fight cancer, they fight your cancer, with the latest treatments and state of the art technologies. Stay tuned as we bring you innovations in cancer treatment with M. D. Anderson, making cancer history. ^m00:00:48
>>Hi I'm Ron Stone Jr. and welcome to M. D. Anderson. We'll start by looking at 2 different patients with 2 different cancers. ^m00:00:57
>>One day I noticed when I was walking, and I've walked this trail all the time, that I couldn't even make a mile, without going to the restroom.
>>In a few weeks things got much worse, and Barbara ended up in the emergency room with extreme pain in her abdomen.
>>They did tests, I took an MRI, I took ultrasound, and then when the results came back he told me that the tests look like you have a trace of cancer. And I just like... devastated.
>>James, another M. D. Anderson patient, found his prostate cancer through routine cancer screenings.
>>I had a slightly high PSA, and so he thought at first it might have been just an infection. So we went through all of that, and finally he did a biopsy.
>>James' biopsy came back positive for cancer, and while there is no good time for receiving bad news, fighting cancer was definitely not in James' plans.
>>I was getting married in May... the honeymoon, we had a trip to Israel set up in June, and I had a trip on the Delta Queen.
>>So James began reading up on treatment options and treatment centers. After careful research, he chose M. D. Anderson and a positive outlook.
>>We got married on May 24, went on our honeymoon, came back, within a week went to Israel and came back, and the next day I started treatment.
>>Barbara had more trouble accepting her uterine cancer diagnosis, remembering a friend who had lost her fight with cancer years earlier. ^m00:02:34
>>You say M. D. Anderson, everybody knows that's a cancer hospital facility. I hadn't been there in so many years, I mean had a friend to die and nobody's looking to go there, or to even be sick.
>>On her doctor's encouragement, Barbara came to M. D. Anderson.
>>When I went, it was just different. I mean nice big place, friendly people.
>>When you hear the words "it's cancer", there's an understandable sense of urgency to get treatment as quickly as possible. But the reality is in most cases, you have the time to take a step back, do your research, and make the most informed decision possible about your cancer.
>>Dr. Mark Gilbert is a neuro oncologist at M. D. Anderson.
>>Primary brain tumors, there are approximately 45,000 people diagnosed in the United States. Of those, approximately 18,000 or 19,000 are considered malignant. The others are considered benign. M. D. Anderson sees approximately 1,000 to 1,100 new patients each year who have primary brain tumors.
>>Dr. Gilbert recommends taking the time to find a center of excellence like M. D. Anderson.
>>I think a lot of people are very vulnerable to panic, and certainly is understandable. There is often a window of days to a few weeks that are certainly, in most instances, safe to have some time to really plan the treatment. We pride ourselves here at M. D. Anderson in being able to see patients very rapidly. Between my colleagues in the neuro oncology department, and our colleagues in Neurosurgery, we typically can see those patients within a few days. ^m00:04:19
>>Patients should always feel comfortable asking for a second opinion.
>>One of the statistics I remember about M. D. Anderson is that about 20 percent of the pathology is changed. So I'd say 100 outside cases come in, 20 of them are changed, about 10 majorly and 10 minorly. So I recently had a patient that came here and she was told she had melanoma, and in fact she has Paget's disease, which is a cancer but much, much less vigorous than melanoma. So it's really, really important that you get the right pathology up front, because then you tailor the specific treatment to the pathologic diagnosis. ^m00:04:57
>>Biopsies and imaging are crucial in making a proper diagnosis, and determining the stage of the cancer. Your future treatment is based on this information, so it must be right the first time.
>>Somebody comes to us, and they have a mass in their brain. The imaging will tell us, with a high degree of likelihood, what type of tumor; not necessarily what it's exactly going to look like under the microscope, but we see clues as to how malignant the tumor may be. And there are certain imaging characteristics that guide us in that way. The first step is to get some of that tumor material for our neuro pathology colleagues to look at under the microscope, so we can have a more definitive diagnosis.
>>Highly specialized doctors review every patient's case before getting a diagnosis, or treatment recommendation.
>>Each case is analyzed separately. So if you were to come to M. D. Anderson, we would look at your slides, we would look at your imaging, and we would see where your tumor was; how deeply invasive it was and what was the appropriate therapy for you after surgery, if that was indicated. So our care is very much customized for your case.
>>As a patient it's important to feel comfortable with your treatment plan.
>>When somebody walks in the door here, their life is changed forever. It's a terrifying experience to have to deal with potential mortality. And so I kind of acknowledge that. They are often scared, sometimes they just need a hug, and then we kind of go through their questions, their perception of what's going on. I give them the information and then we talk. I think that the biggest thing is to be able to relate to your patient and answer their questions, whatever they may be, how big or how small, because they're important to that patient. ^m00:06:47
>>At M. D. Anderson each patient has a team of specialists assigned to their care, and they work with that patient to develop the best care plan for their disease and their lifestyle. ^m00:06:58
>>M. D. Anderson is organized around individual clinics that specialize in 1 cancer type.
>>All the doctors in general are committed to basically 1 or 2 disease sites, and that's their focus and specialty.
>>Within these clinics oncologists, surgeons, pathologists, and others share space and work together as a collaborative team to benefit patients.
>>In our clinic facilities we are actually working right next to our neuro surgical colleagues, our radiation therapy colleagues, and we have onsite an expert in image analysis - a neuro radiologist - and so we're all there at the same time. It's quite easy actually, to get consultations and opinions from colleagues, and provide patients with a very rapid integration of their care.
>>Often patients have no idea the extent of the team supporting them. ^m00:07:53
>>Another aspect that I think is important for patients to understand, that even though they may only interact with 1 or 2 physicians during their course of cancer care, here at M. D. Anderson and especially at the Proton Therapy Center, there are many physicians that are actually laying eyes on that treatment plan in that case.
>>We have a, what's called a multidisciplinary disposition planning conference, long name, but basically once a week we get together and we have the GYN oncologists, we have several medical oncologists that just give chemotherapy, we have radiation oncologists, we have pathologists that actually show us the slides, and we also have radiologists. So for each case we learn about the patient, we see her imaging, we look at her pathology, and then we agree on a treatment plan; and then we convey that information to the patient.
>>With such specialized care, M. D. Anderson is the expert in both rare and common cancers.
>>We are in fact the thought leaders, in the field. And the patients benefit from our collective experience.
>>Ground breaking research and advanced technology are important, but it's also imperative for doctors to remember the person that's being treated.
>>We don't look at the person just as a cancer. We look at the whole individual.
>>Determining a patient's treatment plan takes many factors into account.
>>It's not just the cancer, it's the guilt you may feel for your family, you may have to take a leave of absence from work, it's the post-op recovery, it's the transportation coming here for your surveillance exams, and because we specialize in cancer care I think we're particularly aware of all of those different aspects that effect a patient, and we all do our best to make sure not just the patient's taken care of, but the family as well. Because we meet the family; we meet them at the time of diagnosis, we meet them after surgery, we go and speak with them, and then we see them usually at the patient's follow up visit. So we get to know them very well, and I think that's one of the reasons I chose this field, because it's not just surgery. It's really, it's chemotherapy, it's surveillance, and it's a long term relationship with your patient. ^m00:10:02
>>M. D. Anderson offers special services for patients, caregivers, and survivors; like the Place of Wellness, various support groups, and patient networking to help maintain a good quality of life.
>>It's not just a cancer diagnosis, it's a person whose life has been touched by cancer. We know what these cancer patients need and we can help them obtain it, whatever it is - even a wig, or whatever they need.
>>Standard cancer treatment such as surgery, chemotherapy, and radiation have proven effective in fighting various types of cancers. But here at M. D. Anderson doctors and researchers are constantly trying to find new and improved ways to fight and eliminate this disease. ^m00:10:44
>>In our department, just like we're multidisciplinary, we're also multidisciplinary in terms of research. So we have some people that are working in the lab trying to figure out what kind of molecular mechanisms cause uterine cancer, ovarian cancer; and then they're trying to translate those data into terms of patient care.
>>Research being conducted at M. D. Anderson is setting new standards for how cancer patients around the world are treated.
>>We have several clinical trials specifically designed for patients who have just been diagnosed. We have other trials that are designed for patients who have just failed their first or second treatment, and other treatments that are designed for patients who have seen several other regimens and now are looking for something that has less of a track record and is earlier in the stage of development. ^m00:11:34
>>No patient's care is compromised for the sake of research, and all patients are fully informed about the clinical trial they've chosen to participate in.
>>If we have some preliminary information suggesting benefit and we're now trying to confirm it, that's different than if we have a new drug that looks quite promising in the laboratory, but has no clinical track record. And they need to know that, they need to know what phase of testing a treatment is in. We've broken it down into various phases, so there's phase 1 where we're really looking at how much drug can we give safely, phase 2 where we're trying to get an initial assessment of how beneficial it is, and then the phase 3 testing where we're going to take the new treatment and compare it to an established treatment with the attempt and the hope that the new treatment will in fact trump, or be better than, the old treatment; and we've now established a new standard of care. ^m00:12:29
>>Integrating learnings from lab research to actual patient care is part of what's known as translational medicine.
>>Translational means that you find things in the laboratory, and you translate them into a treatment for patients. But I think that that doesn't do it justice. I think that there is in fact translation back.
>>Physicians and researchers can also work backwards.
>>We give a group of patients a new drug, and only a certain percentage of those patients show a response to that drug. Now if we look at their cancer, we compare their cancer to the patients with cancer who didn't respond. Maybe we can now find a signal. What was it about those specific tumors that made them responsive, versus the others that weren't responsive? And if we could find that, now we have a very important first step to personized medicine.
>>Personalized medicine, also known as targeted therapy, is where many experts at M. D. Anderson feel the future of cancer treatment lies.
>>The future of cancer is customized cancer care to the detail where we can say, we can take some of your tumor, we can test it on a molecular level, and we can say these are your treatment options. And then we can take somebody else's tumor and do that the same for that individual; because if we can get the specific information at the cellular level and see how our treatments can effect it at that very basic level, I think eventually that will be not only the future of cancer treatment, but hopefully really the future of the cure of cancer. ^m00:14:08
>>Radiation therapy is used in about 50 percent of all cancers, sometimes alone and sometimes in combination with surgery or chemotherapy. ^m00:14:18
>>Proton therapy is an advanced form of radiation.
>>Proton therapy is a form of external beam radiation. As we all know, external beam radiation has been a powerful tool in terms of curing and treating cancer. But heretofore the main mechanism by which external radiation is delivered, is via high energy x-rays. And one of the problems with x-rays is that often they'll deposit most of the radiation dose before they ever get to the target, and subsequently beyond the target they tend to keep on depositing some radiation dose. Protons are different in that instead of x-rays, they're using actual protons, which are small particles. Now these particles, they may deposit a little bit of radiation as they enter the target, or into the patient, but will deposit the majority of their dose right where the target is; right where that tumor is.
>>Because of the size and construction requirements and equipment, most hospitals are not able to offer proton therapy. In fact, M. D. Anderson is 1 of only 25 hospitals in the world to have this technology.
>>The equipment, in order to deliver proton therapy, is obviously rather complicated. But it starts out pretty simply. There's just a tank of hydrogen, which is about the size of a fire extinguisher, and through a filtering process basically the electron is stripped off and just left with the proton particle. Now that particle, in and of itself, is not going to be able to treat any tumor targets until it's accelerated. And in order to do that we here use a Synchrotron, which basically is similar to when you see children on merry-go-round at a playground, and every time the child goes around they can get it going faster and faster. And the Synchrotron can do the same thing, and it will accelerate the protons to almost the speed of light. Then it's shot down a beam line and sent to 1 of these treatment gantries, like the one behind me. And there we have trained therapists, in order to align the patient appropriately, and make sure that proton beam is treating the patient exactly where we want it to. ^m00:16:18
>>It takes a highly specialized team to design each patient's radiation treatment plan.
>>A lot of work is done behind the scenes in conjunction with our dosimetry staff, and physicists, our engineers in machine shop, to get the plan ready for actual treatment delivery. Every tumor is shaped a little bit differently, therefore a number of pieces of hardware are manufactured for that individualized patient.
>>Proton therapy is especially beneficial in certain cancers.
>>Most of the patients that are treated with proton therapy are those same patients that could be treated by x-ray therapy. So in terms of our own clinical experience, probably the most common disease sight has been prostate cancer. It tends to be a deep seated tumor, and amenable to proton therapy. But we also have developed a nice experience in cancers of the lung, as well as brain tumors and especially we're interested in treating as many pediatric cancers as we can. In general children tend to be more sensitive to even low doses of x-rays in terms of their subsequent development and side effects, and therefore anything we can do to minimize that low dose area, such as doing proton therapy, can offer a big benefit.
>>When James was diagnosed with prostate cancer, he did his research and it led him to proton therapy, and M. D. Anderson. ^m00:17:36
>>One of the disease sites, as a clinical example that can be treated with proton therapy is prostate cancer. Prostate cancer is a disease site where we have to treat with a very high dose of radiation in order to ensure that we have the best tumor control. However adjacent to the prostate are a number of sensitive areas that can be prone to radiation side effects; typically the bladder, bladder neck, as well as the rectum. Proton therapy has the ability to treat high doses to that tumor target, which typically is the entire prostate, and minimize as much of the radiation dose as possible off the bladder and rectum. That will subsequently lead to fewer side effects. ^m00:18:12
>>Like most patients, James received several weeks of treatments.
>>If I could have found out I had prostate cancer, and wouldn't have to be doing something about that... that it certainly can have a significant effect on your sexual life, and so I asked Jean if she wanted to still go ahead and get married, for that matter.
>>During and after his treatments, James had no complaints.
>>I didn't feel like I had any problems during the time, and really with doing the proton treatment as opposed to some others... like chemo and things of that sort, I didn't have any adverse experiences to speak of from that either. I don't know of anybody that really felt like they had significant problems with the proton therapy.
>>Now proton therapy has taken a step further at M. D. Anderson. ^m00:19:00
>>One of the exciting technological advances that we have here at M. D. Anderson is the pencil beam, or the scanning beam, proton therapy unit. This is subtley different than conventionally scattered proton therapy, and affords us an opportunity to make the dose distributions around the target even tighter and spare even more normal tissue, while focusing the high doses right onto the tumor.
>>Pencil beam scanning is a brand new advancement. ^m00:19:29
>>Right now in the world I think we're 1 of only 3 or 4 clinical centers that offer pencil beam scanning for proton therapy. We happen to be 1 of the first units in North America, and I think we're the first clinical center in North America to actually treat a patient with pencil beam scanning.
>>While the technology is amazing, it means nothing to a cancer patient unless there is an experienced team in charge.
>>I think M. D. Anderson has 1 of the most sophisticated and advanced proton therapy centers in the world. But having wonderful technology is only part of the solution. We have the luxury of having some of the most profound experts in the field, and some of the most dedicated professionals in order to execute that technology appropriately. Having the fancy tools and the wonderful technology will only get you part of the way there. If you don't have the expertise in order to use it appropriately, you're not going to get the job done. ^m00:20:23
>>There's no doubt that M. D. Anderson is on the forefront of cancer research. Scientists and doctors are drawn here to make a difference in the fight against cancer.
>>I did my fellowship here '94 to '96 and everyday when I walk in, still since then I think wow, this is M. D. Anderson. I mean, it's just very much a privilege to work here. It's so energetic, it's so kind to it's cancer patients, and the people we deal with are just wonderful. So it's a great place to work.
>>There are 40,000 new cases of uterine cancer diagnosed each year in the United States.
>>Very often for these patients with uterine cancer, the first step is surgery. And the reason that is, is because most of these cancers, 75 percent, are detected early because these women develop vaginal bleeding and go see their physician.
>>The Department of Gynecologic Oncology treats all types of gynecologic cancers.
>>We do ovarian cancer, fallopian tube cancer, peritoneal cancer which is like an ovarian cancer but it's a cancer of the lining of the abdomen and pelvis; we do vulvar cancer, vaginal cancer, cervical cancer, uterine cancer.
>>Medical terminology can be confusing, so be sure to ask your doctor to fully explain anything that is not clear.
>>I think sometimes people get confused because you say uterine cancer, or endometrial cancer, and they're really the same thing. So the endometrium is the lining of the uterus, and so that's why it's very often called endometrial cancer. But uterine is kind of the global term. There are also cancers that can occur in the muscles, such as sarcoma - the muscle of the uterus. And that's also called a uterine cancer. But the more common is just the basic glandular adenocarcinoma. ^m00:22:12
>>Part of what makes M. D. Anderson the top ranked cancer center is their excellence in research. M. D. Anderson depends on grants to help conduct this research. They recently received their 11th National Cancer Institute SPORE grant for brain tumors. ^m00:22:29
>>Our investigators created a specific therapy. They have created a virus which is designed to attack only tumor cells, inject it into the tumor, grows selectively in tumor cells, destroying tumor from the inside out. That program, called the Delta 24 virus, has actually just opened and we are now enrolling patients very slowly as we're going through the safety measures and the safety testing, but that is certainly cutting edge. And in laboratory, experiments using this Delta 24... there was in fact quite a remarkable cure rate of the animals bearing brain tumors who were treated with this treatment. So we're quite excited about that.
>>From technological advances to customized care, the efforts at M. D. Anderson are all driven by 1 goal: to eliminate cancer.
>>I think that the key concept that we have evolved in the area of brain tumor therapy is the idea that, as of 2009 we do not have a cure for these patients, but what we would like to strive for is to make this disease a chronic disease, and no different than other diseases; like renal failure, kidney failure, heart failure, where we find measures to keep the disease under control, prolong the patient's survival, and just as importantly, prolong a maintenance of good quality of life. ^m00:23:59
>>Each year M. D. Anderson treats over 80,000 patients, and many of them come hundreds, even thousands of miles to be treated at this top ranked cancer center. ^m00:24:10
>>Hey, how are you? Good to see you!
>>Good to see you too! ^m00:24:13
>>Barbara's tumor was completely removed, and the surgery was a success.
>>After the surgery, when I went to my first follow up, they were saying you know you had endometrial cancer? And I said oh I did? And she said, you know we got it all... we took it all out.
>>Dr. Bodurka helped Barbara to overcome not just the physical, but emotional effects of cancer.
>>One of the good things is usually you can kind of help them get through this, and then when you see them at their follow up exam you say, do you remember how it was? And I mean, they just cannot believe how much more comfortable they've gotten with their diagnosis, and also how they've kind of overcome their fear, and they're doing well. So that's... that's very much a privilege.
>>Like many cancer doctors and patients, Barbara and Dr. Bodurka developed a close bond through adversity.
>>Everything was fine. I mean, she'd say you're looking good Barbara. She'd say you're doing good Barbara, and you know... just keep doing what you're doing. You're looking good Barbara. Every test I... every time I'd go, I'd get a good report. I just thank God that I'm still here, and God is good. ^m00:25:24
>>James also received a clean bill of health when he finished proton therapy.
>>Patients undergoing proton therapy, or any radiation therapy for that matter, often go through quite a bit. The treatment courses are performed almost on a daily basis, and the courses can be quite long, on the order of 1 to 2 months. And so we've grown very attached to our patients during that time, and I hope that they grow attached to us as well. And so once they're done with the completion of all their therapies, we at the proton therapy center have them ring a gong as part of a graduation ceremony. ^m00:25:55 [ Applause ] ^m00:25:57
>>They always have a big celebration when they bring out the gong, you hit the gong and whatever, and you have to bring celebrations. ^m00:26:05
>>Through it all, James never let the cancer slow him down.
>>I'm involved with the First Baptist Church over here, and I sing in the choir; something I didn't have an opportunity to do for a long, long time. And working hard as ever before on the things that I work at or whatever. I haven't noticed any... having any effect on that at all.
>>2 more cancer survivors.
>>Happy, healthy they say... doing fine. ^m00:26:34 Whee! Alright! ^m00:26:38
>>We hope you've enjoyed this show, and hope that you've learned more information about the work being done right here at M. D. Anderson, to advance the mission to eliminate cancer. For more information or if you want to watch this show again, log onto our health page at Click2Houston.com. I'm Ron Stone Jr. Thanks for watching! ^m00:26:57 [ Music ]
Return to the Making Cancer History® Video Series
© 2007 The University of Texas M. D. Anderson Cancer Center
1515 Holcombe Blvd, Houston, TX 77030
1-800-392-1611 (USA) / 1-713-792-6161