Cancer-fighting Recipe: White Beans and Winter Greens Gratin

Try incorporating more meatless meals in to your everyday dinners.  This gratin is a wonderfully warming dish.  It can be quite filling and is a great one pot meal in itself.  The beans, greens and tomatoes have cancer fighting properties along with the garlic. The herb thyme in addition to it’s wonderful fragrance, has potential antibacterial properties. If you only have dried thyme available, try substituting ¼ tsp. of dried thyme or more depending on your taste preference.

White Beans and Winter Greens Gratin

Ingredients
1 cup white beans (cannelloni or great northern - use canned beans to save time)
1 bay leaf
1 sprig thyme
1 teaspoon salt
1 large bunch winter greens (mustard, chard, turnip, or a mixture)
2 tablespoons light olive oil
2 garlic cloves, finely chopped
1 cup peeled, seeded, and chopped tomatoes
1/2 teaspoon salt
1/2 cup chicken stock, homemade or canned
Topping:
1 cup of fresh bread crumbs
3 tablespoons light olive oil
1/8 teaspoon salt

Directions
If using dry beans, soak the white beans in 4 cups of cold water for 8 hours or overnight. In a medium pot, add the drained beans, 3 cups of fresh water, and the bay leaf and thyme sprig Simmer the beans for 45 minutes, and then add the salt. Continue cooking for another 15 to 20 minutes or until the beans are tender but not mushy. There should be no more than 1/2 cup of liquid left in the pot. Remove bay leaf and thyme.

Preheat the oven to 350 degrees F. Remove the stalks from the greens and wash and dry leaves. Stack them and cut crosswise into ribbons. In a large pan, sauté and the garlic in oil for approximately 7 minutes or until tender. Add the tomatoes and salt. Mix the beans and their cooking liquid, and the greens. Add some chicken stock if the mixture seems dry and spoon into a 9-inch round or a 10-inch oval oiled gratin dish.

Prepare the topping: Mix the bread crumbs with the remaining 4 tablespoons of oil and 1/4 teaspoon of salt and spread evenly on top of the bans. Bake in the oven for 40 to 50 minutes. Served with a crisp, green salad or a salad of shared fennel and pears, this is a welcome dish for a cold winter day. If you like add some sautéed pancetta or little pieces of harm to the greens and beans mixture before turning it into the grain dish.

Serves 4.

Nutrient analysis for 8 servings: 200 calories, 7g protein, 6g fiber, 1g fat, 250mg sodium.
Adapted from Greens: A Country Garden Cookbook by Sibella Kraus.

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Protect Yourself From Skin Cancer

Rachel Woods, RN, is a nurse with surgical dermatology at Penn Medicine. 

February is National Cancer Prevention month and it’s a great time to remind everyone about the simple guidelines that can prevent or decrease the risk of certain types of cancer.

Along with routine screening exams such as mammograms and colonoscopies, your healthcare provider may recommend checking your skin for any new or changing lesions, moles, or marks.

Skin cancer is the most common cancer in the United States. Each year, there are more new cases of skin cancer than lung, breast, prostate and colon cancer combined.

The good news is that skin cancer is the easiest to treat and cure if detected early. And, although most people know if they are at a higher risk for skin cancer, some may not.

There are three types of skin cancer:

• Basal cell carcinoma
• Squamous cell carcinoma
• Melanoma

Here are some risk factors for skin cancer:

• Red or blond hair
• Fair skin
• A blistering sunburn early in life
• Prone to sunburn
• Any tanning bed use
• Spending a lot of time outdoors for work or recreation

Historically, skin cancer was most commonly diagnosed in older adults. More cases are now being seen in younger people and an alarming increase of melanoma in young women that is likely associated with tanning bad use.

How to look for skin cancer

It is never too early to start screening your skin. Take a few minutes to look at yourself in a full-length mirror and use a handheld to visualize areas hard to see. You should be familiar with the moles and freckles on your body. Take note of anything that is changing in size, shape, or color. Also watch for pink shiny or scaly lesions that may bleed easily and don’t heal.

Now that you know to give your skin a good look on a regular basis, it’s important to know sun protection. There are three things everyone needs to remember when it comes to precautions outdoors:

1. Seek shade.
2. Cover up.
3. Use sunscreen.

Shade is important particularly when the sun is at its strongest. Typically this is between the hours of 11am and 4 pm. If the sun is at its strongest, your shadow will be shorter than you.

Covering up with clothing is a good start, but all clothing is not created equal when it comes to sun protection.

Clothing with UPF (ultraviolet protection factor) is specifically designed to protect from both UVA and UVB rays yet is cool and comfortable. These garments are perfect for children and anyone who spends a lot of time outdoors. Be aware that the efficacy of these garments decreases over time as the garment is worn and washed.

You can add UPF to regular cotton clothing by adding a sun guard detergent to your wash (sunguardsunprotection.com). This adds an invisible shield to your cotton clothing that bumps a regular white cotton T-shirt to UPF 30 through 20 washes.

Also, keep your eyes safe. Look for sunglasses that block 100 percent of UV rays and wear them even if your contact lenses have UV protection. To further protect your eyes in addition to scalp, ears, and neck, wear hats with a wide brim.

Using sunscreen is not a new recommendation. However, the U.S. Food and Drug Administration (FDA) recently changed the rules about sunscreen labeling to help consumers understand what they are buying.

Sunscreen labels must be accurate and cannot claim to do things the product hasn’t been proven to do. Be wary of older products that claim to be “water or sweat proof,” offer “instant protection,” or “block” the sun’s harmful rays.

These are examples of unproven claims are no longer allowed on packaging.
When purchasing sunscreen, look for:

• Broad spectrum sunscreen (or the ingredient “avobenzone”), which means that it covers both UVA and UVB rays.
• No less than 30 SPF, as recommended by The American Academy of Dermatologists.
• Water-resistant products if you will be swimming or sweating.

How to apply sunscreen

1. Apply liberally to skin at least 15 minutes prior to sun exposure. If you are in a bathing suit “liberally” means enough to fill a shot glass.
2. Reapply at least every two hours or after you swim.
3. Don’t forget your lips! Use an SPF 30 lip balm to keep this sensitive skin protected.

Free skin cancer screening

Take advantage of Penn Dermatology’s annual free skin cancer screening clinic on Saturday, May 19. Call 215-662-2737 to make an appointment now.

Remember, sun safety is year-round. Sign up for a free skin cancer screening today.
Melanoma Skin Cancer – Get the Facts

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Use Herbs for Health

Eat Your Herbs is a workshop to explore the use of health promoting herbs in your everyday cooking.


Using, drying and freezing the herbs will also be discussed as well as where to purchase quality herbs. Many herbs contain cancer fighting properties as well and will entice your tastebuds to enjoy foods like never before.



This program may be particularly useful to you if you are undergoing cancer treatment or if medications have changed your taste.

Eat Your Herbs Workshop

Date: Wednesday, February 29, 2012
Time: 2 to 4 pm
Location: Joan Karnell Cancer Center at Pennsylvania Hospital, 230 W. Washington Square, Farm Journal Building, First floor conference room
Registration: Please call 215-829-6560 to register as space is limited.

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Cancer Prevention Tips for Childhood Cancer Survivors

Melanie Gaffney is a proud childhood cancer survivor, and a contributor to the Focus On Cancer blog. Today she is cancer-free, but lives with the after effects of her cancer treatments. 

It is no secret that once you survive cancer, your chances increase for future health problems. Depending on the type and location of the cancer you survived and how it was treated,  you may be at an increased risk for getting cancer again.

Childhood cancer survivors are a little bit different from adults and have a unique set of factors that may increase their risk. Children with cancer are treated during an important time, when they are developing both physically and mentally.

Because of this, they may have long term health effects. These effects may not show up until weeks, months or many years after treatment and are called late effects.

After going through cancer and enduring the treatments, many survivors are reluctant to continue to receive follow-up care, often because they are scared about finding additional health problems. They may even feel that they have experienced enough illness and don’t want to see doctors anymore - getting tests and diagnoses can bring up many feelings of the past. Survivors of childhood cancer (and anyone for that matter) can minimize the severity of late effects and reduce their risk for recurrent cancers and other diseases by following these tips:

• Don't smoke or chew tobacco and avoid secondhand smoke.
• Protect skin from sun exposure.
• Limit alcohol consumption.
• Avoid illegal drug use.
• Eat a healthy diet low in fat and high in fiber.
• Exercise regularly.
• Get recommended vaccinations, such as a flu shot.

As well as preventive methods, cancer survivors need a to take responsibility of their health. They must be proactive in their healthcare, take the time to read and research their specific risks and find a great doctor or team to manage their care. It’s important for cancer survivors to keep their appointments and share all of their concerns, aches and pains and issues they may be experiencing.

Here are some important things to remember as a cancer survivor:

• Education about potential late effects for your specific diagnosis and treatment
• Screening for and monitoring of late effects
• Referrals to doctors who specialize in areas of the body affected by late effects
• Help with treatment-related school and work difficulties
• Support for emotional issues of survivors, post-traumatic stress syndrome can sneak up years later.
• Assistance with health insurance and financial issues

It’s important to remember that each one of us are our own are biggest healthcare advocates. Cancer survivor or not, it’s crucial to fight for our right to good health and healthcare.

After all, a cancer survivor has already fought once; this is nothing in comparison.

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Learn About Pancreatic Cancer at This Free Event

Penn’s Abramson Cancer Center invites you and your loved ones to attend Focus On Pancreatic Cancer, a FREE educational conference about pancreatic cancer.

Penn’s Focus On Pancreatic Cancer Conference is a day designed to address the personal and medical issues facing people with pancreatic cancer including those in treatment, survivors, their loved ones, relatives and caregivers.

The conference provides patient-focused information on the latest advances in pancreatic cancer risk, prevention, diagnosis, treatment, symptom management and psychosocial issues; as well as the opportunity to network and gain support from other pancreatic cancer patients and survivors.

Who Should Attend

• Newly diagnosed with pancreatic cancer
• At risk for pancreatic cancer due to a diagnosis of:
• BRCA2 carrier
• Hereditary pancreatitis
• Familial atypical mole and multiple melanoma (FAMMM) syndrome
• Patients with pancreatic cyst
• Pancreatic cancer survivor
• Family member or caregiver of a pancreatic cancer patient or survivor

Join Us

Time: 7:30 am to 3 pm
Date: Friday, March 2, 2012
Location: Hilton Hotel located at 4200 City Avenue, Philadelphia, PA
Registration: OncoLink.org/Conference/Pancreas or call 800-789-PENN (7366)
Cost: FREE

Unable to Attend?

If you are unable to attend in person, join the conference via free livestream. View the conference livestream for free at PennMedicine.org/Abramson/PanCaLive from 7:30 am to 3 pm EST on March 2.

In addition to being able to watch the conference live online, there will be a live web-chat from the conference with a panel of expert clinicians who will answer questions about risk, diagnosis and treatment. To participate in the live web chat or submit a question ahead of time, visit www.OncoLink.org/Webchat. The web-chat will take place March 2, 1:15 pm, ET.

Follow Penn Medicine on Twitter for event information before the conference date, and live tweeting throughout the conference with the hashtag #PanCaACC.

You are welcome to “re-tweet” Penn Medicine's  messages to your followers for our event.

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Screening for Lung Cancer

When it comes to lung cancer, the numbers are not good. More people in the U.S. die from lung cancer than any other type of cancer.






Consider these facts:

• In 2011, more than 220,000 Americans will be diagnosed with lung cancer and more than 156,000 people will die of lung or bronchus cancer.
• Smokers are 10 to 20 times more likely to get lung cancer. About 90 percent of lung cancer deaths in men and almost 80 percent of lung cancer deaths in women are due to smoking.
• There are more than 94 million current or former smokers in the U.S.
• Among both men and women in the United States, lung cancer is the second most common type of cancer, accounting for more deaths than breast cancer, prostate cancer, and colon cancer combined.

Screening uses tests or exams to find a disease like cancer in people who don't have any symptoms. Because lung cancer often spreads beyond the lungs before it causes symptoms, a screening test that finds lung cancer early could save many lives.

In the past, no lung cancer screening test had been shown to lower the risk of dying from this disease. Studies involving spiral CT (or helical CT) have shown some promise in finding early lung cancers in heavy smokers and former smokers. So far, major medical groups have not recommended routine screening tests for all people or even for people at increased risk, such as smokers.

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Penn Study Tests Effects of Exercise for Reducing Breast Cancer Risk

While cancer research has come a long way in helping identify ways in which people can prevent certain types of cancer, cancer researchers are still looking for new, effective cancer prevention strategies.

Cancer researchers at Penn Medicine are testing to see if women who are at higher-than-average risk of developing breast cancer during their lifetimes may be able to reduce their risk with exercise. 
Research has already proven that female athletes have reduced estrogen levels as a result of exercise.   There is also evidence that lower estrogen levels can reduce breast cancer risk over a woman’s lifetime.  The hypothesis of the study is that if estrogen levels can be reduced through exercise, the risk of a future breast cancer diagnosis may be lower as well.

The Women in Steady Exercise Research (WISER) Sister project at Penn, is a five-year study for women at elevated risk of developing breast cancer. The study examines the effects of exercise on estrogen levels. Women in the WISER Sister study are asked to exercise a certain amount each week for about five months.  Their estrogen levels are measured before they start exercising and again during their final months of exercise in order to measure the amount of hormonal change.   

The research team is trying to learn how much exercise is necessary to reduce estrogen levels, as most women do not have hours each day to devote to exercise.  They are also exploring whether estrogen levels in the at-risk population respond differently than those in the average population.  If the researchers can prove this hypothesis, women at increased risk of developing breast cancer may have an alternative to conventional and often invasive prevention techniques.  The results of the study may provide those women with some additional time to carefully weigh their options before having to make any potentially difficult decisions.  

Even if enough data are gathered to prove the  hypothesis, it’s important to know that exercise is beneficial to “EVERY BODY.”  Exercise can help prevent the onset of a number of different chronic conditions such as type 2 diabetes and hypertension, and can be used as a means of treating countless others.  Women who exercise may be both physically and mentally healthier than those who do not.  Exercise also promotes synergy between the body and mind, and may give women the self-assurance and confidence they need to be mentally resilient and physically fit if they do face cancer. 

And women who use exercise to prevent cancer might experience an added benefit that everyone can wish for—the ability to fit into that smaller pair of jeans.

Watch Kathyrn Schmitz Ph.D., MPH, discuss more about the study.

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Tips from People Who Have Lost Weight - and Kept it Off

Maintaining a healthy weight (a weight that falls within a BMI of 18.5-24.5) ranks at the top of the American Institute of Cancer Research’s recommendations for cancer prevention.

The National Weight Control Registry (NWCR) has been collecting data for more than a decade from people who have lost weight and have been able to maintain their weight loss.

They are sharing with us the top six trends that have come out of their surveillance. Nearly 90 percent of the members surveyed by NWCR reportedthey combined diet and exercise  to lose weight. So dig out your sneakers and get ready to move!

• Exercise. More than 50 percent of NWCR members reported expending 2000 calories a week. Check out AICR’s website for some suggestions of how you burn those calories too.
• Limit TV. Nearly two-thirds of NWCR members reported watching less than 10 hours of TV a week.
• Eat a low-calorie, low-fat diet. NWCR members maintain a similar diet 365 days a year Try filling half your plate with non-starchy fruits and vegetables that pack cancer fighting properties like spinach, broccoli, cucumbers, berries, grapes or melon.
• Eat breakfast. People surveyed said eating breakfast helped curb hunger and grouchiness as well as curb overeating later in the day
• Eat when hungry. Successful dieters from the NWCR maintained their weight loss by eating when they are hungry, not because the cake looked good or because they didn’t want to offend someone by not eating their dish. They also avoid the vending machine because when they are bored or stressed.
• Self monitor. And while you are looking for your sneakers, keep your eye out for your scale and smartphone. More than half of these successful dieters continue to weigh themselves weekly and keep a food journal. There are plenty of free websites and phone apps where you can log the calories you consumed and calories you burned each day.

Have you lost weight and kept it off? What are some of your tips?

Carly Roop RD, CSO, provides nutrition education and support to patients and their families at Joan Karnell Cancer Center. She addresses nutrition-related side effects from chemotherapy and radiation as well as nutrition for survivorship, and provides educational nutrition programs, which are open to patients as well as the community.

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Quit Smoking with the Comprehensive Smoking Treatment Program at Penn

Frank T. Leone, MD, MS, associate professor of medicine, is director of the Comprehensive Smoking Treatment Program at Penn Medicine.

Nicotine addiction is complex. People who are addicted to nicotine know it’s bad for them, yet they can’t stop. And those who aren’t addicted to nicotine can’t understand why smokers can’t quit. Even family members and friends have a hard time understanding nicotine addiction.

In this video, Dr. Leone discusses what patients can expect when they commit to a healthier lifestyle through the Comprehensive Smoking Treatment Program at Penn Medicine.





You can listen to Dr. Leone talk more about smoking-related health complications and how those who smoke find it hard to quit – even with the growing trend against smoking in public locations.

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Cancer-fighting Recipe: Winter Squash and Apple Soup

This recipe is for winter squash soup is great when you are trying to manage small bowel obstruction - especially for women with gynecologic cancers.

Winter Squash and Apple Soup

Serves 4 to 6
Roasting squash and apples intensifies their flavors. Use a mixture of winter squash varieties for a more complex taste. This recipe can be frozen which will be a welcomed treat if you aren’t up to cooking.

Ingredients

3 pounds (about 8 cups) winter squash such as butternut, kabocha, acorn or delicata, peeled and cut into 1-inch chunks
2 Granny Smith apples, peeled, cored and cut into 1-inch chunks
1 yellow onion, chopped
4 cloves garlic, sliced
1 teaspoon ground ginger
3 cups low-sodium vegetable broth
1/4 cup chopped fresh parsley (to garnish)

Directions

Preheat oven to 400°F. Line two rimmed baking sheets or shallow roasting pans with parchment paper. In a large bowl, toss squash, apples, onion, garlic and ginger until mixed well. Spread mixture on baking sheets in a single layer.

Roast squash mixture until tender and beginning to brown, about 45 to 50 minutes, rotating pans between oven racks halfway through baking. Remove from oven and puree squash mixture with broth, 1 cup water and nutritional yeast in a blender or food processor in 2 batches until smooth or transfer to a pot and puree with immersion blender until smooth. After pureed, bring soup to a simmer over medium heat. Add more water if needed to thin soup to desired consistency.

Serve garnished with parsley.

**Cutting squash can be a difficult feat, if you are feeling fatigued or short on time- look for squash that has already been peeled and cubed in the produce aisle.

For more recipes like this check out: www.wholefoodsmarket.com/recipes/ 

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Are you at risk for cancer?

When a friend or family member is diagnosed with cancer, one may wonder: Am I at risk for cancer?

What’s My Risk? is a comprehensive cancer risk tool at OncoLink designed to help individuals learn about the factors that determine their personal cancer risk and what they can do to decrease that risk. By completing a detailed questionnaire about their habits, lifestyle and health history, the program identifies their risk for cancer by creating a detailed report. The report includes information about each risk factor, how it affects cancer risk and resources to change those factors that can be changed.

Some good can come from a family member or friend being diagnosed with cancer. In the medical community, it is called a “teachable moment.” It is that time when a person is so affected by their loved one’s diagnosis that they vow, whether publicly or privately, to make changes in their life to reduce their risk of being in a similar situation. Maybe they’ll start exercising, make a diet change or quit smoking. So at this moment in time when they are most open to making changes, how do they know where to start? Do they really know what habits increase their cancer risk or how to go about changing them?

What’s My Risk? is a “teachable moment;” a chance to live healthier and reduce cancer risk.

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New Breast Imaging Has Advantage Over Traditional Mammograms

Penn radiologists are getting a new kind of clarity when it comes to breast imaging.

A revolutionary way to perform mammograms combining traditional mammography with 3D technology, called digital breast tomosynthesis (DBT), allows for more accurate pictures of breast health.

Every woman who comes to the Perelman Center for Advanced Medicine (PCAM) for their screening mammograms will get the new DBT test.

“DBT is more accurate – even more accurate than digital mammograms – because it uses traditional X-ray technology to capture images of the breast, while moving along a small arc around the breast to record images at different depths and angles,” says Emily Conant, MD, director of women’s imaging at the Hospital of the University of Pennsylvania. “In preliminary research, it has been shown to reduce the number of false-positives and some false-negatives making mammography more accurate.”

Like traditional mammogram, the breast is compressed for about four to five seconds while a series of low-dose X-rays are taken to capture high-resolution images of the breast. These images are then digitally “stacked” to construct a total 3D image of the breast. This 3D image allows radiologists to scroll through, and “peel apart” the layers of the breast to view the breast tissue at different depths and angles. Radiologists can also magnify images to reveal minute details.

“DBT allows Penn radiologists to manipulate and see parts of the breast that we couldn’t before,” says Dr. Conant. “Therefore, we can reduce some unnecessary imaging and stress for some women.”

Breast images through DBT also allow radiologists to make new recommendations for follow-up screening and tests.

“DBT lets us to see the through some of the density of a breast,” says Dr. Conant. “For a woman with dense breasts we can personalize her screening and make different recommendations than we do for a woman who does not have dense breast tissue.”

Women who get their mammograms using the new DBT technology may find they are called les often for follow-up visits and more tests.

These new imaging advantages and advances in risk assessment are part of a collaborative effort between radiologists, medical oncologists and surgeons to try to improve breast cancer detection for women.

Technology continues to evolve, but collaborative research across all disciplines at Penn Medicine means patients who come to Penn for their mammograms benefit from the latest medical breakthroughs.

The DBT technology is still new and Penn researchers are studying ways to decrease its radiation exposure without losing image integrity.

“DBT is just one more step to improving breast care on an individual, personalized basis,” says Dr. Conant. “Combining personal history, genetic testing and new breast images creates a better, overall picture for breast health.”

For more information about breast cancer diagnosis and treatment at Penn Medicine, or to schedule an appointment, please visit PennMedicine.org/cancer/breast-cancer or call 800.789.PENN (7366).

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Proton Therapy Center at Penn Celebrates 2nd Anniversary

Dr. Stephen Hahn is Chair and Professor of the Department of Radiation Oncology at the University of Pennsylvania. He is board certified in radiation oncology, medical oncology, and internal medicine and is internationally renowned for his work in Photodynamic Therapy (PDT). At Penn, he was Director of the PDT program from 1996 until 2006, and he continues as a senior advisor to the program.

Since its opening in January 2010, Penn’s Roberts Proton Therapy Center remains the world’s largest proton therapy center physically located within a comprehensive cancer center and has treated hundreds of people with cancer using a most sophisticated and precise form of radiation therapy.

Proton therapy is radiation therapy that uses positive-charged protons accelerated at very high speeds to create a particle beam. While protons work very much like conventional radiation therapy in killing cancer cells, the speed and energy of the proton beam allows for more accurate targeting of tumors with, in many cases, the potential for less damage to surrounding normal tissue.

As the Roberts Proton Therapy Center enters its third year, Penn researchers continue to establish the optimal uses of proton therapy as an effective tool for treating a wide range of cancers including:

• Brain tumors
• Head and neck cancers
• Lung cancer
• Sarcomas
• Gastrointestinal tumors
• Pediatric cancers  
• Prostate cancer

One of the most exciting and emerging applications for proton therapy treatment is the retreatment of many cancers previously treated with radiation. For these patients, proton therapy can be a viable treatment option when other approaches have failed.

Currently, there are only nine proton therapy facilities in the United States, but even among this select group, the Roberts Proton Therapy Center stands out as a leader in treatment and research. The Roberts Center has the advantage of being part of a world class academic medical center, Penn Medicine, and an NCI-designated Comprehensive Cancer Center, Penn’s Abramson Cancer Center. The Abramson Cancer Center brings together top experts in every cancer-related specialty in one extraordinary facility. Penn’s team of cancer specialists works together to develop individualized treatment plans, ensuring that every patient has the benefit of the best treatment options available. The Roberts Center also offers advanced technologies such as multileaf collimators that are not available at any other proton center in the world.

In addition to an internationally recognized clinical and research faculty, both the Abramson Cancer Center and the Roberts Proton Therapy Center deliver care in a supportive and comfortable environment. Support services including patient navigation, social work, counseling and integrative healing modalities are readily available to all patients.

The delivery of exceptional, high quality patient care is the highest priority and all patients are treated with the highest level of clinical expertise combined with compassionate care for the patient, as well as family members and caregivers.

A variety of educational programs are available to patients before receiving radiation therapy treatment and Penn’s radiation therapy experts are always available to answer questions at any time.

To ensure the highest level of comfort to patients who are undergoing radiation therapy treatment, free valet parking is available at Perelman Center for Advanced Medicine, where the Penn Radiation Oncology is located. This service is available throughout the entire course of treatment.

The innovation of radiation therapy as a treatment for many types of cancer is at the core of Penn Radiation Oncology. Every day, Penn’s radiation oncologists work as part of a comprehensive cancer team dedicated to offering and delivering every possible treatment option to people with cancer. This team looks forward to continuing and enhancing the use of proton therapy in the fight against cancer.

Stephen M. Hahn, MD
Chairman, Department of Radiation Oncology
Penn Medicine

Watch Dr. Hahn discuss proton therapy at Penn Medicine in this video. 

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Managing Small Bowel Obstructions

Some gynecological cancer survivors are at high risk for a small bowel obstruction.  This may be due to surgical adhesions or the tumor itself.  First, it is important to know what the signs and symptoms are of a partial small bowel obstruction.

Symptoms may be cramping, gas, bowel changes, nausea and vomiting.  Vomiting, increased abdominal girth and pain may indicate a total obstruction.  Keep in mind that symptoms may vary by individual and the severity of the obstruction.  It is important to notify your doctor immediately if you notice these symptoms.

Dietary Changes

With a partial small bowel obstruction, there may be dietary changes to minimize discomfort.  Here are some tips and strategies to help minimize discomfort:

• Eat smaller meals, more frequently throughout the day.  Think appetizers, all day long.
• High fiber foods may be more gas forming and be harder to pass through a narrow opening.
• Follow a low fiber diet.  Avoid the skins on fruits and vegetables; avoid whole grains, nuts and seeds. 
• Switch to white bread, white flour pasta and peeled potatoes which may be better tolerated.  
• Eat lower fiber cereals (cereals with less than 3 gm of fiber per serving.) Some low fiber cereals include: puffed rice, Cheerios, cream of rice or cornflakes. 
• Avoid fatty and greasy foods. These are much more difficult to digest and may stay in the stomach longer causing greater discomfort.
• Drink plenty of fluids: water, broth, tea, gelatin and juice may help you stay well hydrated.  Some people find that “full” liquids: hot cereals, cream blended soups, puddings, milkshakes and nutritional drinks are tolerated.  If nausea is persistent, switching to nutritional concentrated liquids is worth trying.
• Avoid lactose containing drinks if gas or milk intolerance is a problem.
• Avoid gas-forming foods such as gassy vegetables (beans, brussels sprouts, cabbage, onions, and cauliflower), soft drinks and chewing gum.

If the above strategies do not work, reach out to a registered dietitian with a CSO credential (certified specialist in oncology) who is well versed in symptom management of partial small bowel obstructions.

For more individualized assistance, contact the registered dietitian for Pennsylvania Hospital’s Joan Karnell Cancer Center at 215-829-6560.

For the Abramson Cancer Center, the contact number is 215-615-0538.

If you are not within this system, you may ask your oncologist for a referral or visit Eatright.org to identify a nutrition professional in your area.

Debra DeMille, MS, RD, CSO is a nutritional counselor at the Joan Karnell Cancer Center. Debra has worked at Pennsylvania Hospital since 1988 with the last 12 years specializing in oncology. Debra guides individuals receiving chemotherapy and radiation as well as addressing survivorship issues including the use of integrative therapies.


She conducts cooking programs and group counseling sessions for cancer survivors.

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Immunotherapy - a Personalized Approach to Medicine

Researchers at Penn’s Abramson Cancer Center recently published study results considered to be a major breakthrough in cancer treatment for chronic lymphocytic leukemia. The study, published in The New England Journal of Medicine, used patients’ own T cells genetically engineered to kill cancer tumors, and has been hailed as a cancer breakthrough 20 years in the making.

“What we’re doing falls under the area of personalized medicine in the extreme sense – using a person’s own white blood cells or tumor cells to develop a personalized vaccine,” said Carl H. June, MD, director of translational research at the Abramson Cancer Center (ACC), who is overseeing the development of these vaccines.

Dr. June, widely regarded as one of the world’s leading cancer immunologists, has spent years conducting research at the ACC with modified T-cells, cells in the body that are capable of recognizing, attacking, and destroying foreign invaders, and assembling a team of physician-scientists to advance immunotherapy for many types of cancer.

Immunotherapy removes cells from patients and modifies them in Penn’s Clinical Cell and Vaccine Production Facility (CCVPF), a Abramson Cancer Center Core Facility under the direction of Bruce L. Levine, PhD. The modified cells are infused back into the patients following chemotherapy.

“This isn’t a drug in a bottle or a vaccine in a vial,” Dr. June said. “This is more like a next-generation blood transfusion.”

The recent immunotherapy discovery in chronic lymphocytic leukemia is an exciting turning point in the way cancer is treated and will provide hope to thousands of cancer patients and their families, according to Dr. June.

Here are a few examples of leading-edge treatments for cancer being developed right here at Penn Medicine.

Immunotherapy for Lymphoma

Stephen J. Schuster, MD
Director, Lymphoma Translational Research Center
Lymphomas can be a complex and difficult-to-treat cancers and treatments are often toxic to normal organs and not entirely effective. However, Dr. Schuster and researchers at the Abramson Cancer Center may have found a way of improving the therapy available in the treatment of lymphoma and related diseases. A clinical trial using expansion technology to test infusions of T-cells, following chemotherapy for chronic lymphocytic leukemia is showing promising results. In another study, personalized vaccines made with patients own tumor cells, were found to significantly improve the average remission period for patients with the disease.

Immunotherapy for Mesothelioma and Pleural Malignancies

Steven M. Albelda, MD
Vice Chief, Pulmonary, Allergy, and Critical Care Division
A current phase I/II trial investigates the effectiveness of gene therapy when used in combination with chemotherapy for the treatment of mesothelioma. There is evidence that this method of treatment will prove quite effective, and the hope is that it may someday be integrated into the standard of care for mesothelioma patients. This trial is specific to mesothelioma, but Dr. Albelda and his team are hopeful that this therapy will show practical applications for other cancers of the pleural cavity.

Immunotherapy for Pancreatic Cancer

Robert H. Vonderheide, MD, DPhil
Associate Director for Translational Research
An early-stage clinical trial may lead to new treatment options for patients with advanced pancreatic cancer. The treatment appears to work differently than expected, attacking tumors primarily by altering their surrounding tissue. This means that attacking the dense tissues surrounding the cancer is another approach to consider. Similar to attacking a brick wall by dissolving the mortar in the wall, the immune system is able to eat away at this tissue surrounding the cancer, and the tumors fall apart as a result of that assault. These results provide fresh insight to build new immune therapies for cancer.

Immunotherapy for Ovarian Cancer

George Coukos, MD, PhD
Director, Penn’s Ovarian Cancer Research Center
The treatment for ovarian cancer usually involves a combination of surgery and chemotherapy, but for the majority of women with the disease the standard treatment stops working. New approaches to treating ovarian cancer are necessary to improve survival rates and immunotherapy is proving to be hopeful for patients. At the time of surgery, the patient’s tumor is saved for future use in a vaccine. After completing standard chemotherapy, patients will then have access to individualized immunotherapy treatments using their own tumor tissue to fight their cancer should it recur. Dr. Coukos is leading a number of phase I and II clinical trials testing the effectiveness of these vaccines and is seeing promising results. In addition, Dr Coukos and his colleagues at the Ovarian Cancer Research Center are launching T cell based immunotherapies using blood-derived, engineered T cells, or tumor-derived T cells.

Immunotherapy for Prostate Cancer

Jihyun Lee
Post Doctoral Researcher in Dr. June’s lab
While hormone therapy has worked to delay the progression of cancer, it is not curative and in some advanced malignant forms of prostate cancer, the cancer will progress. Dr. Lee’s research focuses on the development and optimization of an anti-PSMA CAR that would be used in adoptive T cell clinical trials to treat malignant and recurring prostate cancers.

Dr. Lee is optimistic that it is now possible to develop and deliver a sufficient number of properly activated T cells that have sufficient power to overcome tolerance and eradicate prostate cancer. A clinical trial will soon be in place, which would determine the effectiveness in patients.

Immunotherapy for Breast Cancer

Brian Czerniecki, MD, PhD
Co-Director, Rena Rowan Breast Center
Surgical Director, Immunotherapy Program
A phase II clinical trial sheds new light on how vaccines can inhibit tumor growth, lessen the severity of the disease, and prevent its recurrence in patients with early stage breast cancer, ductal carcinoma in-situ (DCIS). Over-expression of the HER-2/neu gene is linked to about 50 to 60 percent of DCIS cases, and helps predict the severity of the disease, as well as the risk of recurrence of invasive breast cancer. By treating dendritic cells, specialized white blood cells that play a major role in activating immune response, with HER-2/neu, Dr. Czerniecki produced a vaccine that may prompt an immune response. Results have shown that nearly all patients exhibited an initial immune reaction to the vaccine, and half showed markedly reduced levels of HER-2/neu expression, leading to overall improvement in the severity of the disease.

Immunotherapy for Chronic Lymphocytic Leukemia

David L. Porter, MD
Director, Blood and Bone Marrow Transplantation Program
The latest ground-breaking clinical trial among advanced chronic lymphocytic leukemia (CLL) patients treated with genetically engineered versions of their own T cells showed extreme promise demonstrating sustained remissions of up to a year. The findings are the first demonstration of the use of immunotherapy to create “serial killer” T cells aimed at cancerous tumors, providing a tumor-attack roadmap for the treatment of other cancers.

“The therapy could replace the need for bone marrow transplantation. This is currently the only curative therapy for most patients with leukemia” says Dr. Porter.

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Learn the Symptoms of Cervical Cancer

January is cervical cancer awareness month. This article is the third in a series that discusses cervical cancer, its prevention, symptoms and treatment.

In its early stages, cervical cancer usually has no symptoms. It develops slowly, beginning as a pre-cancerous condition called dysplasia. Symptoms of cervical cancer often do not begin until the cancer spreads into nearby tissue.

Cervical cancer starts in the lower part of the uterus that opens at the top of the vagina. If cervical cancer spreads into nearby tissue, symptoms may include:

• Increased vaginal discharge including discharge that is pale, watery, pink, brown, bloody or foul-smelling
• Abnormal vaginal bleeding between periods, after intercourse, or after menopause
• Periods become heavier and last longer than usual
• Any bleeding after menopause
• Pain during intercourse

These symptoms can also be caused by other conditions, so it is best to contact a physician for a diagnosis. If interested in making an appointment with a Penn Medicine physician, call 1-800-789-PENN (7366) or make an online appointment here.

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The Future of Breast Cancer Treatment

Kevin Fox MD, is the Mariann T. and Robert J. MacDonald Professor of Medicine and medical director of the Rena Rowan Breast Center at Penn’s Abramson Cancer Center. He treats all aspects of early stage and advanced stage breast cancer researches adjuvant therapy of breast cancer.

The future of breast cancer treatment

The next 20 years will bring more targeted therapy for the treatment of advanced breast cancer, and will most likely see a decline in the use of chemotherapy.

Special drugs will continue to be developed that attack special “targets” that exist only in breast cancer cells. These drugs, we hope, will spare the patient’s normal cells, thus avoiding many of the side effects we have come to expect from chemotherapy.

Drugs with names like PARP inhibitors and MTOR inhibitors will become part of our everyday language, and more drugs that target HER-2 like trastuzumab will be released in the very near future.

Twenty years from now, many things about breast cancer treatment will have changed again. Tomograms may replace mammograms as the standard method of breast cancer detection,surgeons may not need to remove lymph nodes at all, and radiation therapy may become shorter in duration. Perhaps chemotherapy will have become a thing of the past.

Whatever the case, treatments will be better, more patients will be cured, and in every respect, there will be less suffering for patients at every stage of treatment.

Learn more about breast cancer treatment at the Abramson Cancer Center in Philadelphia.

Watch conference presentations from the 2011 Life After Breast Cancer conference.

Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

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Cervical Cancer Risk and Prevention

January is cervical cancer awareness month. This article is part two in a series that discusses cervical cancer, its prevention, symptoms and treatment.

Cervical Cancer Risk and Prevention

Most risk factors for cervical cancer, like age and family history, cannot be prevented. Patients who feel they are at higher risk for cervical cancer may benefit from consulting with a risk assessment specialist through one of Penn Medicine’s programs at the Abramson Cancer Center or the Joan Karnell Cancer Center at Pennsylvania Hospital.

Cervical Cancer Risk Factors

Risk factors affect the chance of developing cervical cancer. Having a risk factor, or even several, does not mean that someone will get cancer.
All women need to be aware of the risk factors for cervical cancer, and what they can do to prevent it.

Penn Medicine gynecologists work with patients to identify their risk of developing cervical cancer and the steps they can take to lower their risk.
The human papilloma virus, or HPV, causes the majority of cervical cancers. HPV is a group of more than 100 related viruses that can infect cells on the surface of the skin, genitals, anus, mouth and throat.

Genital HPV is the most common sexually transmitted virus in the United States. An estimated 75 to 80 percent of males and females will be infected with HPV during their lifetime. For most people, the virus clears on its own. When it doesn’t, HPV can cause genital warts, precancerous dysplasia and cervical, vulvar or vaginal

Other risk factors for cervical cancer include:

• Having sex early
• Multiple sexual partners, or having sex with someone who has had multiple partners
• Sexual partners who have multiple partners or who participate in high-risk sexual activities
• A weakened immune system
• Lack of regular pap tests
• Weakened immune system
• Smoking
• Long term birth control use
• Having more than 5 children
• DES exposure

• Poor economic status or inadequate health coverage
• HPV infection or genital warts

Cervical cancer is easily treated if it is caught early, so it is important for women to get regular screening exams including a Pap test and HPV test.

Cervical Cancer Prevention

Penn Medicine gynecologists recommend several methods to prevent cervical cancer. Regular screenings, vaccines for preventing the human papilloma virus (HPV) and lifestyle choices can prevent cervical cancer or help find cervical cancer at an early stage when it is most treatable.

Pelvic Exam, Pap Test and HPV Test

Pelvic exams, Pap test screening and HPV testing can detect cervical cancer in its early stages. Pap tests are one of the most effective screening tools used to determine if women have infections, abnormal (unhealthy) cervical cells, cervical cancer or other reproductive problems. A Pap test is the screening of cells scraped from the cervix during a pelvic exam that are examined under a microscope. Pap tests screen for pre-cancers and cancer, but do not provide a final diagnosis.

The American College of Obstetrics and Gynecologists (ACOG) recommends that cervical cancer screening begin at age 21. Most women under the age 30 should undergo cervical screening once every two years and women 30 and older with no other risk factors can be screened every three years. These are not the guidelines. See below.

• Under 21 and never sexually active: No pap
• Adolescent: Within 3 yrs of onset of sexual activity
• 21 to 29 years old: Annual pelvic exam with Pap Smear
• 30 to 64 years old: ACOG recommends annual Pap. After 3 consecutive normal paps, screening = every 2-3 years. (This is only if the patient has never had CIN 2 or 3, is not immune-compromised or HIV-positive, and has not been exposed to diethylstilbestrol (DES) in utero.
• 65 and older:  Pap Smears may be disontinued if the woman has had 3 or more consecutive negative paps; no abnormal tests in the previous 10 years; no history of cervical cancer; no DES-exposure; is HIV negative and has a normal immune system; and has no other risk factors for STDs. 

The above was taken from http://www.kltv.com/story/10543955/acog-changes-pap-smear-guidelines. i had trouble accessing the ACOG site.

Preventing HPV: The HPV vaccine

Vaccines are now available that protect against four major types of HPV, including the two types that cause about 70 percent of cervical cancer cases and two types that cause about 90 percent of genital warts.

The HPV vaccine is expected to be long-lasting, but because the vaccine does not protect against all HPV types that cause cervical cancer vaccinated women still need cervical cancer screening (Pap tests and HPV tests). The vaccine does prevent HPV, but does not protect against HPV exposure before vaccination. Also add that it is not a cure.

Condoms do not protect completely against HPV because they don't cover all of the potential HPV-infected areas of the body. However, condoms do provide some protection against HPV, and they protect against HIV and other sexually transmitted diseases.

Although penetrative intercourse is not necessary to get and spread HPV women can do the following to decrease their risk of cervical cancer:

• Stay up-to-date with recommended paps and exams.
• Avoid smoking
• Avoid early onset of sexual activity and sexual activity with people who have had several sexual partners.
• Use condoms
• Try to maintain a healthy immune system
• Limit the amount of sexual partners

Women may avoid HPV, and therefore reduce their risk of cervical cancer, by waiting to have sex until they are older and limiting the number of sexual partners. They should also avoid having sex with anyone who has had multiple sexual partners.

Learn more about cervical cancer treatment at the Abramson Cancer Center.

Learn more about the Jordan Center for Gynecologic Cancer.

Learn more about the MacDonald Women’s Cancer Risk Evaluation Center.

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Include These Vegetables in Your Diet to Prevent Gynecologic Cancer

Nutrition plays a role in the prevention of various gynecological cancers.

The World Cancer Research Fund along with the American Institute for Cancer Research analyzed research on nutrition and its role in cancer and published the “Food, Nutrition and the Prevention of Cancer: A Global Perspective."



The recommendations for the general public are as follows:

• Be as lean as possible within the normal range of body weight.
• Be physically active as part of everyday life.
• Limit consumption of energy-dense foods.  Avoid sugary drinks.
• Eat mostly foods of plant origin.
• Limit intake of red meat and avoid processed meat.
• Limit alcoholic drinks.
• Limit consumption of salt.
• Aim to meet nutritional needs through diet alone.

This report analyzes the evidence by cancer type including three gynecological cancers.

Nutrition to prevent cervical cancer

Specific to cervical cancer, there is some evidence that an intake of carrots may protect again cervical cancer.  According to the American Institute for Cancer Research “The evidence, from case-control studies only, is sparse but consistent.  There is limited evidence suggesting that carrots protect against cervical cancer.”

Additional sources of produce high in carotenoids include:

• Sweet potatoes
• Spinach
• Kale and other greens
• Papaya
• Oranges
• Sweet peppers
• Tomatoes

Nutrition to prevent ovarian cancer

For ovarian cancer, evidence suggests that consuming these non-starchy vegetables may decrease the risk of ovarian cancer:

• Asparagus
• Carrots
• Tomatoes
• Cauliflower
• Broccoli

Nutrition to prevent endometrial (uterine) cancer

For endometrial cancer, a high percentage of body fat as well as weight gain in the adult years may increase the risk of endometrial cancer.

So clearly at the top on your priority is weight management and just as your mother said “eat your vegetables."

The two work hand in hand as well as vegetables are a very high fiber, low calorie food which can provide cancer fighting compounds and assist with the feeling of fullness.  Easy ways to incorporate vegetables in your diet are:

• Breakfast: Top your cereal off with berries or make a spinach omelet.
• Lunch: Layer sandwiches with greens, tomatoes and cucumber.  Have raw vegetables on the side instead of chips.
• Dinner: always include a colorful salad and aim to fill half your dinner plate with non-starchy vegetables like steamed asparagus, broccoli and carrots.
• Snacks: Try baby carrots, sugar snaps peas and sliced red peppers dipped into hummus.

Continue following this blog for more recipes with cancer fighting properties.

Debra DeMille, MS, RD, CSO is a nutritional counselor at the Joan Karnell Cancer Center.  Debra has worked at Pennsylvania Hospital since 1988 with the last 12 years specializing in oncology.  Debra guides individuals receiving chemotherapy and radiation as well as addressing survivorship issues including the use of Integrative therapies.  She conducts cooking programs and group counseling sessions for cancer survivors. 

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What is Cervical Cancer?

January is cervical cancer awareness month. This article is part one in a series that discusses cervical cancer and its prevention symptoms and treatment.

According to National Cancer Institue, there were approximately 12,000 women diagnosed with cervical cancer last year. Cervical cancer develops in the cervix, the narrow outer end of the uterus that extends into the vagina. When diagnosed early, cervical cancer is generally curable and patients have an excellent chance of recovery. Penn Medicine physicians and scientists are working together to develop new ways to diagnose and treat cervical cancer.

There are two types of cervical cancer:

• Squamous cell carcinoma. The most common type of cervical cancer consisting of flat, thin cells called squamous cells that cover the surface of the cervix.
• Adenocarcinoma. Develops in the mucus-producing glands of the endocervix or opening to the uterus.

About half of the women diagnosed with cervical cancer are between the ages of 35 and 55 (check stats). The majority of cases are caused by exposure to the human papillomavirus (HPV), a common sexually transmitted disease. HPV affects up to 80 percent of females and males in their lifetime. Many cases of HPV clear on their own, but certain types of HPV can cause cervical, vulvar and vaginal cancer in females.

Cervical cancer treatment at Penn Medicine is provided by the Jordan Center for Gynecologic Cancers. As part of Penn’s Abramson Cancer Center, the Jordan Center takes a multidisciplinary approach to care, combining the expertise of Abramson Cancer physicians and scientists from the Penn’s division of gynecologic oncology, the Joan Karnell Cancer Center and the Penn Ovarian Cancer Research Center.

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The BRCA Gene Mutation: Should You Tell Your Children?

Parents of who children learn they have the BRCA gene mutation have a difficult question to answer: Should they tell their children?

Jill Stopfer,MS, genetic counselor at Penn Medicine's Abramson Cancer Center, was recently interviewed by the Huffington Post about this topic.

"One of the questions we all have and we all worry about in this area is 'how much information is too much?'" said Stopfer. "Are we hopefully helping our children and not hurting them?"

Read the full article about telling children about a BRCA gene mutation here.  

Learn more about the MacDonald Women’s Cancer Risk Evaluation Center.

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More Advances in Breast Cancer Treatment

Kevin Fox MD, is the Mariann T. and Robert J. MacDonald Professor of Medicine and medical director of the Rena Rowan Breast Center at Penn’s Abramson Cancer Center. He treats all aspects of early stage and advanced stage breast cancer researches adjuvant therapy of breast cancer.

Advances in surgery for breast cancer

Surgeons began using a technique in the mid-1990s called the sentinel node procedure to evaluate whether a breast cancer has spread to the lymph nodes under the arm.

For almost a century, the standard of care included removing a large number of lymph nodes from the underarm of most breast cancer patients in an operation called an axillary dissection. This procedure left many patients in pain, disabled, or with a swollen arm.

The sentinel node procedure allows the surgeon to detect the first lymph node in the underarm. If that lymph node contains no cancer, then the surgeon doesn’t need to perform the axillary dissection: if the first lymph node is cancer-free, the other lymph nodes will almost always be free of cancer as well.

Using this technique, hundreds of thousands of patients have avoided unnecessary axillary dissections.

Advances in radiation therapy for breast cancer

Radiation treatments for breast cancer, particularly in those women who do not choose a mastectomy, have also advanced during the last 20 years.

Partial breast radiation describes several techniques in which the radiation is applied only to the portion of the breast where the cancer was found, rather than the whole breast. Until recently, whole-breast radiation had been the standard of care. Partial breast techniques are not appropriate for all women, but are being offered to patients with increasing frequency.

At the present time, radiation oncologists are exploring more targeted, shorter treatment periods in the hope that many patients can finish treatment in as little as three or four weeks, rather than the current six or seven.

Adjuvant therapy for breast cancer

Most women who have early stage breast cancer have adjuvant therapy after surgery.

Adjuvant therapy describes drug treatments that are given for a period of time after surgery in order to reduce the risk of recurrence or spread of the breast cancer.

Patients may receive several months or years of adjuvant therapy in the form of chemotherapy, hormonal therapy or both.

The most significant advance in the adjuvant therapy of early stage breast cancer came in 2005 in the form of a substance called trastuzumab, or Herceptin®. Trastuzumab is an antibody that attacks HER-2, a protein that is present in large amounts on certain breast cancer cells.

Only 20 percent of breast cancer patients are HER-2 positive (have too much of the protein), but these cancers can be very aggressive and spread quickly and often. Patients treated with this antibody for a year, along with several months of chemotherapy, reduce the risk of their cancer spreading by 50 percent.

Nearly every patient with HER-2 positive invasive breast cancer now receives trastuzumab in addition to chemotherapy..

In 2006, we began using a special test called the Oncotype DX® assay in patients who had cancers that were considered hormone-sensitive, particularly women whose hormone-sensitive cancers has not spread to the lymph nodes.

Oncotype is a diagnostic test that can provide information about the biological activity of the specific tumor. Along with other information, the test results can help in making decisions about whether or not to include chemotherapy in the treatment plan and indicate how likely it is that a woman’s cancer may return in the future.

For many years, patients with hormone-sensitive cancers that have not affected the lymph nodes received both chemotherapy and hormonal therapy. The Oncotype assay enables us to determine which of these women really need the chemotherapy and determine those who can do just as well without it.

Up to 50 percent of women with this type of breast cancer don’t need chemotherapy at all.

Hormone therapy for breast cancer

Even the way in which we use hormonal therapy for early stage breast cancer has changed.

Hormone therapy works by blocking the actions of certain hormones that may trigger cancer growth, preventing the body from producing hormones that may trigger cancer growth, or eliminate hormone receptor in the body.

For many years, the drug tamoxifen was prescribed for most women who had hormone-sensitive breast cancers and it was very effective in reducing the risk of recurrence or spread of the cancer.

In late 2001, we began to prescribe a new type of pill called an aromatase inhibitor. Aromatase inhibitors work better in women who have entered menopause at the time they are first diagnosed with breast cancer.

Tamoxifen remains the best choice for premenopausal women with early stage breast cancer.

Chemotherapy for breast cancer

Over the years, the use of chemotherapy for treating patients with early stage breast cancer has changed considerably.

In general, courses of chemotherapy are now shorter, lasting from 12 to 18 weeks instead of 24 weeks or even longer. Different drugs, particularly paclitaxel and docetaxel, are used in almost every patient who receives chemotherapy. Many of the most dreaded side effects of chemotherapy, particularly nausea and the risk of infection, have decreased considerably as a result of the changes we have made in the last 20 years.

Advances in treating advanced breast cancer

The treatment of advanced (metastatic or stage IV) breast cancer has seen drastic changes in the last 20 years.

Six new chemotherapy drugs have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of advanced breast cancer since 1992, and several other chemotherapy drugs used for other types of cancer are given routinely to breast cancer patients as well, with some success.

For patients with hormone-sensitive breast cancer, the aromatase inhibitors mentioned above have proven very useful, as has the drug fulvestrant.

Special compounds such as pamidronate, zoledronate, and denosumab are used routinely in women whose breast cancer has spread to the bones. These compounds are not cancer treatments, but protect the bones against the injuries that the cancer can cause.


Learn more about breast cancer treatment at the Abramson Cancer Center in Philadelphia.


Watch conference presentations from the 2011 Life After Breast Cancer conference.


Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

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I Survived Cancer, Now I Want a Family!

Melanie Gaffney is a proud childhood cancer survivor, and a contributor to the Focus On Cancer blog. Today she is cancer-free, but lives with the after effects of her cancer treatments.

Before I ever pictured myself in the “what-do-you-want-to-be-when-you-grow-up” role, being a mom always foreshadowed any career or profession. I had a vivid concept/vision in my head about motherhood: the mother I would try to be, the hugs and kisses I would smother a child with, life lessons I would teach, even the sex --  I always envisioned boy and girl twins.

This was even after I was told that a baby, especially “babies,” might not be possible. I had come to terms with knowing that I might not be able to conceive, carry or deliver because of my cancer treatments and health limitations. I knew if I couldn’t conceive, I would adopt. I realized this about the age of 13. I know it sounds young, but I think when forced to battle for your life at a young age, your outlook and decisions about life tend to mature quickly.

During my treatments I received radiation directly to my pelvic area and my left ovary was in the direct line of radiation. It could not be protected, but someone, even back in 1982 during the early stages of this research, had the foresight to shield my right ovary.

Now I have my dream: a 5-year-old boy and 1-year-old little girl. Pregnancy was hard on my body and I was under constant supervision from my multidisciplinary, high-risk pregnancy team at Penn. But I have bounced back. I wouldn’t change a thing. I thank the incredible medical team I have and I thank myself, the sheer will to achieve and fight for what you want can be surprisingly strong.

I am a Cancer Survivor and I got more than I ever thought I would, my family!

Advances in childhood cancer treatment have significantly improved a patient’s chance of survival, which results in a large number of adult childhood cancer survivors who are hoping for the same life they would have if they had never had cancer. 

One big concern is about the effects of treatment on reproductive possibilities. For myself and many other women, there are indications that both radiation and chemotherapy may affect how well the ovaries function (if you are left with just one) and the health of the uterus. All of these can lead to infertility, negative pregnancy outcomes and entering menopause at an earlier age.

We are very thankful for surviving and the chance to live our lives, but we also want to experience life, not just survive it. Having children plays an incredibly important role in the lives of many people.  Along with advances in cancer treatments over the years, the advancement of preserving fertility has grown as well.

The Cancer Survivorship Program at CHOP’s Cancer Center is working with Fertile Hope, an organization dedicated to addressing fertility concerns for cancer survivors, and they have developed ways to help preserve a woman’s fertility.

Penn Fertility Care at Penn Medicine is a leader in helping adult survivors of childhood cancer realize their dreams of parenthood. The physicians are working with patients who were not able to take advantage of the fertility services during that small window, before their cancer treatment begins. These physicians are doing what they can to help these women realize their dreams of a family.

Learn more about Penn Fertility Care at Penn Medicine.

Learn more about the Living Well After Childhood Cancer Survivorship Program at the Abramson Cancer Center.

In addition to being a mom and a wife, Melanie operates a small marketing and graphic design boutique called Melanie Gaffney. Read more about Melanie here.

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Cancer-fighting Recipe: Winter Miso Soup

This recipe for miso soup has great cancer-fighting ingredients. Garlic, carrots, cabbage, mushrooms, ginger and 2 forms of soy are all cancer-fighting foods.

Ginger and garlic are anti-inflammatory foods; carrots are full of carotenoids, an antioxidants; cabbage has indole 3 carbinol and sulforaphan – natural detoxification compounds; mushrooms may help the immune system with beta glucans and tofu and miso come from soybeans.

 

Miso Soup

Ingredients:
3 tablespoons dark miso paste
1 tablespoon canola oil
1 celery rib (about 2 ounces), sliced thin
1 medium red onion (about 5 ounces), sliced thin
1 garlic clove, peeled and crushed
1 medium carrot (about 3 ounces), peeled and sliced thin
2 cups shredded white, savoy, or Chinese cabbage
1 cup sliced mushrooms
½ teaspoon grated fresh ginger
2 teaspoons rice wine vinegar or sherry vinegar
1 tablespoon tamari (a Japanese soy sauce)
Salt and freshly ground black pepper
2 teaspoon brown sugar
½ pound extra-firm low-fat (lite) tofu, cut into small cubes
2 scallions, sliced thin, for garnish
Serves 4 to 6


Directions:
1. In a large bowl, dissolve the miso paste into 6 cups boiling water or whatever the package instructions call for – usually 1 tablespoon miso for 2 cups water. Stir to combine well. Set aside.
2. Heat the canola oil in a large nonstick saucepan over medium-high heat. Add the celery, onion, and garlic and cook, stirring often, for 5 minutes.
3. Add the carrot, cabbage, and mushrooms.  Continue cooking for 15 more minutes; lower the heat if necessary and stir often to prevent browning.
4. Add the ginger and miso-water mixture, bring to a boil, then reduce the heat so the mixture simmers.
5. Cook for 15 to 20 minutes, then season with the rice wine vinegar, tamari, salt and pepper to taste, and brown sugar.
6. Add tofu 1 to 2 minutes before serving. Garnish with scallions.


One serving (based on 4 servings): 135 calories, 8g protein, 15g carbohydrates, 5g fat, 4g fiber, 0g saturated fat.

Source: Laura Pensiero, RD, co-owner, Gigi Trattoria, Rhinebeck, New York; Nutritionist, Strang Cancer Prevention Center.

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Power of Philanthropy in Penn’s Cancer Research at Penn

Tricia Bruning is Senior Executive Director and Principal Gifts Officer of Development at Penn Medicine for the Abramson Cancer Center, Department of Radiation Oncology and Pennsylvania Hospital.  In her nearly ten years at Penn Medicine, Tricia has overseen the programmatic and fundraising efforts for our premier clinical and research efforts in the area of cancer.

2011 was an amazing year for cancer research and clinical care at Penn’s Abramson Cancer Center. 

As we celebrate the advances made in the fight against cancer at Penn’s Abramson Cancer Center, we are grateful for the vital role that philanthropy has played, and the hope it has brought to patients and families in the community and around the world.

Renewing philanthropic support is essential to moving research and patient care advances forward.

Penn’s Abramson Cancer Center provides this hope throughout the year. A gift to the Abramson Cancer Center Annual Fund provides essential funding for current and new programs for cancer patients and their families.

Just like every patient is different, every gift the Abramson Cancer Center receives is special and very important. Each gift provides the Abramson Cancer Center with the necessary resources to provide cutting-edge research and the best in cancer care to patients and their families in the Philadelphia region.

Charitable giving to the cancer center’s annual fund is essential in the fight against cancer. Individually, each person can make a difference; collectively, the many friends of the Abramson Cancer Center can shape the future of cancer research and patient care.

This year, make a gift to the Abramson Cancer Center and help patients and families fight and cope with a cancer diagnosis.

Ways to give to the Abramson Cancer Center Annual Fund

Online

Make an online gift on the cancer center’s secure giving site.

By mail

Print and fill out a gift form and mail your gift to the Office of Development and Alumni Relations, where your gift will be processed quickly and securely:

Development and Alumni Relations
Abramson Cancer Center
3535 Market Street, Suite 750
Philadelphia, PA 19104-3309
Phone: 215-898-0578

Thanks to you, the Abramson Cancer Center continues to achieve victories in the ongoing effort to conquer cancer. Everyone at the Abramson Cancer Center thanks you for your generosity.

Learn more about giving to Penn’s Abramson Cancer Center.

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How to Build Strength After Cervical Cancer Treatment

A common, but manageable side effect of cervical cancer treatment is the loss of strength and flexibility of the pelvic floor.

The pelvic floor refers to the muscles and connective tissue that span the area under the pelvis. In women, the pelvic floor muscles support the bladder, intestines and uterus. Like other muscles in the body, these muscles need to be strong and flexible in order to work correctly.

Strong muscles and tissues in the pelvic floor are important to for sexual activity, maintaining urinary and anal continence and providing support for the abdomen and lower back.

Women who have undergone radiation therapy in the pelvic region may have difficulty with strength and flexibility of their pelvic floor muscles and surrounding tissues. Your vaginal wall, hips and upper thighs may lose normal motion due to radiation fibrosis. Gentle exercises including Kegel exercises and dilators can help them regain mobility and strength in these tissues. 

Kegel exercises build strength in the pelvic floor muscles. Strong pelvic floor muscles help maintain urinary continence. Some women describe this exercise as if they were stopping a stream of urine.

In order to perform a correct pelvic floor exercise, you should:

• Place one hand on top of your pubic bone.
• Tighten, and draw in the muscles around the anal and the vaginal openings so that you feel the muscles lift towards your pubic bone and squeeze the openings shut.
• Start lying down with your knees bent and supported with pillows.

There are two types of exercise contractions: 

1. Quick contractions that tighten, lift and release.
2. Endurance contractions that tighten, lift and hold the muscles for up to 10 seconds.

Kegel exercises can be performed sitting or standing.

Treatment for cervical cancer can also cause the vagina and vaginal opening to shrink. This can make it difficult for a doctor to perform internal exams, and can also make sexual intercourse difficult and uncomfortable.

A vaginal dilator stretches the scar tissue that has formed in the vagina. It can take up to eight to 12 weeks to feel an increase in the size of the vaginal opening and a softening of the tissues. 

Because the process takes several weeks, patience is important. For most women, there is a period of adjustment, and then using the dilator will become more routine.

Building strength of your pelvic floor will make you feel better all over.  Strength and flexibility of these muscles can help you feel more in control and more like yourself.

Some women find it difficult to do Kegel exercises or use their dilator, especially when they first start. If you are having difficulty a physical therapist who specializes in treating the pelvic region can help. Good Shepherd Penn Partners has pelvic floor specialists. If interested in making an appointment call 1-877-9-MY-REHAB.

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