Treating Prostate Cancer with Proton Therapy

Neha Vapiwala, MD, chief of the genitourinary service for Penn Radiation Oncology, discusses proton therapy for prostate cancer, available at Penn Medicine.

Proton therapy, available at Penn’s Roberts Proton Therapy Center, is an incredible new way to deliver targeted radiation therapy to many types of tumors, including prostate cancer.  Penn Medicine recently celebrated the second anniversary of the proton therapy center.

In this interview, Dr. Vapiwala discusses how specialists throughout Penn Medicine and Penn's Abramson Cancer Center, an NCI-designated comprehensive cancer center, collaborate on developing innovative ways to enhance the prevention, diagnosis and treatment of genitourinary cancer through research and patient care.







Learn more about proton therapy at Penn Medicine

• Watch a patient talk about his experience with proton therapy for prostate cancer at Penn Medicine. 
• Learn more about proton therapy for prostate cancer.
• Watch a webcast about proton therapy for prostate cancer.

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Incidence of Neuroendocrine Tumors on the Rise

David C. Metz, MD

David C. Metz, MD, is the co-director of the Penn Neuroendocrine Tumor Treatment Program, and  associate chief for clinical affairs in the division of gastroenterology at Penn Medicine. Dr. Metz is one of the course directors for the upcoming Penn Neuroendocrine Tumor Symposium.

The incidence of neuroendocrine tumors (NETs) is steadily increasing. There are more than 100,000 patients with NETs alive in the United States today. In terms of just gastrointestinal cancers, NETs are second only to colorectal cancer in frequency.

 
That is why it is my absolute pleasure to inform you of Penn Medicine’s Neuroendocrine Tumor (NET) Symposium, a CME-certified course*, scheduled for Friday, Sept. 9 on the Penn campus. 

Penn Medicine’s NET program has been designed to provide excellent state-of-the-art diagnosis and management of patients with gastrointestinal NETs, including alimentary tract carcinoids or pancreatic NETs, as well as pheochromocytomas and paragangliomas.

Most practicing clinicians can expect to encounter patients with NETs.  NETs present in a remarkably varied manner because they may:

• Arise in multiple different primary sites.
• Be functional or non functional (functional syndromes also vary significantly between patients).
• Have variable biological behavior which is difficult to predict.

Many tumors also arise as a component of an inherited syndrome such as MEN-1 or 2 or one of the phacomatoses (neurocutaneous syndromes).  The management of localized disease is primarily surgical, but commonly patients present with metastases requiring a multidisciplinary approach for effective long-term management.

This CME course has been designed to demonstrate the broad expertise available at Penn Medicine as well as to provide in-depth lectures on all the various disciplines involved in the management of NET patients.   This will be an excellent learning experience for physicians, extenders, nurses and trainees.  We hope to provide a general algorithm for the management of these often complex and difficult to treat and diagnosis patients.  Hopefully, you will be able to join us.

Where: Biomedical Research Building II/III, 421 Curie Boulevard, Philadelphia, PA

When: Friday, September 9, 2011, 7:30 am (Continental breakfast); 8 am to 5 pm (education session)

How to register: Registration forms may be mailed or faxed to the CME Office with payment or register (fee only) on-line at http://cme.med.upenn.edu/eventinfo_7853.html. Click on CME Activities/Live Events.

Designation of credit: The Perelman School of Medicine at the University of Pennsylvania designates this live activity for a maximum of 7.5 AMA PRA Category 1 Credits™.

Download the Penn Neuroendocrine Tumor CME Symposium Brochure.

* Accreditation:  The Perelman School of Medicine at the University of Pennsylvania is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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Tips for Washing Fresh Produce (and a Note About Raw Sprouts)

Content for this post provided by Joan Karnell Cancer Center

In Beware of Pesticides, we discussed how some produce items are rife with pesticides. Here are some tips for preparing fruits and vegetables for patients undergoing cancer treatement  that reduce the chance of becoming ill from food.

1. All fruits and vegetables should be thoroughly washed under running water just before eating, cutting or cooking.
2. Cut away any damaged or bruised areas of fresh fruits and vegetables before preparing and/or eating. Produce that looks rotten should be discarded.
3. Even foods that are peeled  before eating, should be washed first.
4. Washing fruits and vegetables with soap or detergent or using commercial produce washes is not recommended.
5. Scrub firm produce, such as melons and cucumbers, with a clean produce brush.
6. Dry produce with a clean cloth towel or paper towel to further reduce bacteria that may be present. 
7. Many precut, bagged produce items like lettuce are pre-washed. As an extra measure of caution, wash the produce again just before use.

Health Risks with Raw Sprouts
Raw sprouts may contain bacteria that can cause foodborne illness, or food poisoning. Rinsing sprouts before eating does not remove bacteria. Even home-grown sprouts present a health risk if they are eaten raw or lightly cooked.

To reduce the risk of illness, do not eat raw bean, alfalfa, clover, or radish sprouts. All sprouts should be cooked thoroughly before eating to reduce the risk of illness.   
Information is adapted from FDA “Resources for You. Produce Safety: Safe Handling of Raw Produce and Fresh-Squeezed Fruit and Vegetable Juices”.

The full report is available at http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm114299

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Cancer Fighting Cupboard: Chicken Pot Pie

Content for this post provided by Joan Karnell Cancer Center.

This chicken pot pie has been “enhanced” with cancer fighting ingredients by Diana Dyer.  Diana is a three-time cancer survivor and an inspiration for cancer survivors everywhere.  Her website, cancerrd.com is a wonderful resource if you are seeking to take charge of the way you eat and live.  In addition, her entertaining blog http://www.365daysofkale.com/ includes more great recipes.

Ingredients:

• 2 tbsp. olive oil + 1 tsp. olive oil
• 3 tbsp. whole wheat pastry flour
• 1 can (14 oz) veggie broth (if using homemade veggie stock, may need to add salt to taste)
• 1/2 teaspoon turmeric
• 2-3 teaspoon fresh rosemary
• 12 oz. soy milk (unflavored)
• 1 medium yellow onion, sliced
• 16 ounce bag mixed frozen veggies, thawed and drained
• 1/2 -16 ounce can of beans (ex: Adzuki beans - save the other half to add on top of a homemade pizza later in the week or add to a can of ready-to-eat soup)
• Tabasco sauce - just a few drops is enough for a slight kick
• 1 whole chicken breast (3/4 pound), roasted and cut into cubes (can use leftovers)
• 2-3 sheets of phyllo dough (thawed)
• 1 egg white, slightly beaten

Use leftover chicken or sprinkle chicken breasts with dried Italian herbs and bake for approximately 30 minutes at 350 degrees.  Cool and cut into cubes. Increase oven to 400 degrees after the chicken is done cooking. In a large saucepan, heat olive oil over medium high heat. Add flour, stirring with a whisk to make a paste. Stir for a minute or two to toast the flour. Mix in the broth, a quarter cup at a time, until smooth. Whisk in the rosemary, turmeric, and salt (if using salt, start with only 1/4 teaspoon, add more to taste after sauce is done cooking). Continue whisking after broth is added for an additional 5-7 minutes until sauce is starting to thicken. Add soymilk and continue cooking with occasional stirring for 5-7 more minutes. Reduce heat slightly if boiling too rapidly. The sauce will be a beautiful golden yellow. Heat the additional teaspoon of olive oil in a non-stick skillet. Add the onions and heat over medium heat until caramelized (10-15 minutes). Add drained veggies and beans along with the hot sauce. Stir together. Spray a 9 x 9 baking dish with non-stick spray. Place chicken and veggie mixture into dish and then add the sauce over all. The dish will be nearly full. Place 2-3 sheets of the phyllo dough (see directions on box for how to handle so the sheets do not dry out) over the dish, tucking in the edges. Brush the top of the dough with the egg whites. Cut a few slits into the top of the dough. Bake at 400 degrees for 35 minutes or until crust is golden and the dish is piping hot. Serve over whole wheat couscous with fresh fruit and a green salad. Nothing else was needed.

Reprinted with permission from Diana Dyer, MS, RD, founder of the web site http://www.cancerrd.com/ and author of the book A Dietitian's Cancer Story.

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Patients Show Resilience in the Face of Cancer

Christine Wilson, cancer survivor, shares her experiences from the Focus On Melanoma conference in the last of a series of four blog posts.  

Bernie Parent addressed the Abramson Cancer Center's Focus On Melanoma Conference on the topic of resilience — overcoming fear with purpose. Judging by the warm reception given to former Flyer goalie, Parent's contributions to two Stanley Cup winning seasons in the mid 1970s have not been forgotten. 

But for me, the real meaning of resilience became clear listening to the patients who participated in the panel discussion that followed his talk.

As I listened to the four panelists, so varied in age and background, yet sharing a common diagnosis, I thought of the program that aired last year on SHOWTIME®, called "The Big C." It purported to be a brave, gutsy, straight-on look at what it means to face a diagnosis of stage IV melanoma.  The main character, a 40-ish school teacher in Minnesota, learns she has the disease and decides to change her life, But she accepts her fate based on a single chest X-ray from a single physician (who looks like he barely finished high school). She doesn't tell a soul, not her husband, her son or a best friend, nor does she seek treatment.  I watched it twice and it made me too angry to watch again.

The voices heard at the conference could not be more different than this TV creation.  These were people who were fighting their cancers. They had formed a tight partnership of trust and hope with their treatment teams and endured multiple painful and debilitating treatments.  Every one in their own way had found meaning in the struggle.  No one suggested that there was a simple formula for becoming and remaining resilient.  They spoke of grief, anger and denial, but also of love, determination and the strength they draw from what may seem like life's smaller joys: a card from a friend, playing catch with their son.  Regardless of the state of their disease, each was deeply grateful for a continued existence, and every one of them expressed profound appreciation for the support and love provided by their friends and family.
 
Alice, the youngest of the group, was only 29 when she was diagnosed five years ago, long after Parent's heroics on the ice. She attributed some of her resilience to a form of denial, to "refusing to believe in her own end" as she put it.  She summed up the feelings of the group, and of so many people who have traveled down the cancer pathway with these words.

"I learned that despite having cancer, life marches on.  Things are still happening around you, work, vacations, babies, weddings," Alice said.  "I learned to accept the reality of the disease as a part of my life, but not as something that defines me. I will give what is due, but I won't let it become who I am."

For more information, view the Focus On Melanoma conference video and Melanoma Treatment: A Patient Video Guide, on the ACC website.

Learn more about melanoma treatment at Penn Medicine.

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Cancer Fighting Cupboard: Chopped Kale Salad

Content provided by the Joan Karnell Cancer Center
 
Many foods have cancer fighting properties, like this chopped kale salad that can be paired with almost any food or can be a meal itself.

Kale, a form of cabbage, is ripe with two cancer-fighting compounds: indoles and isothiocyanates. Indoles are nitrogen compounds that researchers believe may prevent certain lesions from turning into cancerous cells. Likewise, isothiocyanates, a phytochemical found in kale, is believed to suppress tumor growth.

The salad dressing also has cancer-fighting properties. Lemon is high in vitamin C and limonene, the chemical that gives lemons their citrus smell and has been shown to have tumor-shrinking properties. As an added bonus, the strong flavors of red wine vinegar and mustard help spark the salad's flavors for those with impaired taste.

Ingredients

• 1 head of kale, chopped or thinly sliced
• 1 red pepper, diced
• 1 green or yellow pepper, diced
• 1 red onion, chopped
• 1 can of chickpeas, rinsed
• 1 can of black olives, pitted and sliced

Dressing

• 1/4 cup lemon juice
• 1/4 cup olive oil
• 1/4 cup red wine vinegar
• 1/4 teaspoon dried mustard
• Salt and pepper to taste

Wash and prepare vegetables and combine in a large salad bowl. Mix salad dressing ingredients and whisk prior to pouring over salad mixture. This salad tastes better the longer it sits, and can be used for up to three days, so let it rest in the refrigerator at least overnight.

Serves 6-8 people as a side dish

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Delivering Personalized Medicine for Cancer

Christine Wilson, cancer survivor, shares her experiences from the Focus On Melanoma conference in the third in a series of four blog posts.  

One of the key concepts in medicine today is "personalized medicine."  What few people may realize is that the emerging ability to talk about individual profiles for specific cancers results entirely from the type of research being done by people like Jessie Villaneuva, PhD, and Robert Vonderheide, MD. Drs. Villaneuva and Vonderheide presented highlights of their research at the Abramson Cancer Center's Focus On Melanoma Conference.

In the last few years, it has become possible to begin identifying subsets of patients based on the molecular characteristics of their cancers, and tailor new treatments to match those specific profiles.

Identifying these molecular characteristics is critical in treating many cancers, and increasingly so in melanoma.  Mutations in the BRAF gene occur in approximately 50 percent of patients with advanced melanoma and provide a valuable target for new therapies.  These therapies, however, are only effective for those who have the BRAF mutation.  The same principle holds true for other less frequent mutations. 

Finding this target has major implications for both developing new drugs and for delivering treatment to patients with melanoma.  It means more drugs are needed to hit multiple targets and that new drugs are likely to be more potent and more specific.  They will work better and be less toxic but in smaller populations of patients.  It also makes it critical that patients be aware of the need to collect sufficient tumor tissue to allow for molecular profiling of their tumor so they can receive the therapies designed to work best for their type of cancer.  Tissue collection is vital both at the time of diagnosis and if and when metastatic disease occurs as cancers often change their genetic profiles as they grow and spread.

For more information, view the Focus On Melanoma conference video and Melanoma Treatment: A Patient Video Guide, on the ACC website.

Learn more about melanoma treatment at Penn Medicine.

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