Oncology News - Vol. 1, No. 4

Oncology News
Texas Health Presbyterian Hospital Dallas 

Vol. 1, No. 4  -  May 2011 

In this Issue

BrainSuite — GPS for Brain Surgery
By J. Michael Desaloms, M.D.

In the United States, 20 to 25 of every 100,000 people will be diagnosed with a brain tumor. Brain cancer is the leading cause of cancer-related death in patients younger than age 35. Approximately 19,000 people in the United States are diagnosed with primary brain cancer each year, and about 13,000 die of the disease.

A surgical resection is the recommended course of treatment for brain tumors.  For benign tumors, complete resection can be curative.  For malignant tumors, aggressive resection extends survival.

Advanced surgical technology is available at Texas Health Presbyterian Hospital Dallas to optimize brain-tumor resections and improve patient outcomes. Open since 2006, the Nancy Hamon BrainSuite is a fully integrated operative suite that combines an intra-operative MRI with a surgical navigation system. Surgeons at Texas Health Dallas were the first in the U.S. to use this technology.

The high-field iMRI provides neurosurgeons immediate access to new images of the brain before, during and at the conclusion of the surgical procedure. Traditionally these images have been available only prior to the surgery or after the surgery has been completed. Access to real-time images assists surgeons in removing as much tumor as possible by allowing them to more fully differentiate diseased tissue from healthy tissue. These real-time images can also help protect critical areas of the brain.

Another key element of the technology is the SUITE's neuro-navigation system, which links the real-time MRI images with the actual position of the surgical instruments. The navigation system serves like a global positioning system (GPS) for the brain, providing instant updates on the location of the instruments in relation to the tumor.

Technological advances have made surgery for brain tumors safer and more effective.  Fortunately for patients in North Texas, Texas Health Dallas is at the forefront of these advances.

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Know the Risks — Genetic Testing for Cancer
By Becky Althaus

Along with traits such as brown eyes or curly hair, some families pass along genes that place members at higher risk of cancer. The Center for Cancer Risk and Genetics at Texas Health Presbyterian Hospital Dallas provides genetic testing for predisposition to cancer genes.

A genetic counselor specializing in oncology genetics provides information about how these genes are inherited, the risks for cancer which family members could benefit from testing, and the medical management options available.

Genetic testing for cancer is important because it provides key information that can lead to prevention or early detection of cancer. People who learn they have a gene mutation can undergo increased surveillance (tests such as colonoscopies or MRIs), take medicine or undergo preventive surgery to increase their chances of living long, healthy lives.

The most common cancer genes for which testing is provided are the BRCA genes related to breast and ovarian cancer. Families with the following are at increased risk of carrying a mutation in a BRCA gene:

• Individuals who have had breast cancer diagnosed before age 50
• Individuals with breast cancer diagnosed in both breasts
• A woman with ovarian cancer at any age
• A man with breast cancer at any age
• Ashkenazi Jewish heritage

Genetic testing for colon cancer is also available at Texas Health Dallas. Indicators that a hereditary colon cancer gene mutation may be present are the following:

• Colon or rectal cancer diagnosed before age 50
• Uterine cancer
• Ovarian cancer
• Gastric cancer
• Bladder or renal cancer

Although genetic testing can provide additional information regarding potential cancer risks and health-risk information that is potentially important for family members, it does not detect all causes of hereditary cancer. Texas Health Dallas always encourages regular visits with your primary care physician.

Most health insurance policies pay for genetic testing. Federal and state laws protect persons from changes in their health insurance coverage due to identification of a predisposition for cancer resulting from a gene mutation. For more information about the Genetic Counseling and Testing Program at Texas Health Dallas, call 214-345-8365.

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2011 Breast Cancer Survivors Retreat — Hope and Answers

On Saturday, March 26, 84 breast cancer survivors gathered at Cancer Support Community North Texas for Texas Health Dallas' annual Breast Cancer Survivors retreat. The retreat is a unique event bringing survivors and caregivers together for a time of celebration and education.

The opening panel discussion gave the survivors the unique opportunity to ask questions to a panel of a wide range of specialists, including breast surgeons, a medical oncologist, a plastic and reconstructive surgeon, a radiation oncologist and a breast radiologist. The 90-minute discussion covered topics ranging from causes of breast cancer to genetic testing and management of side effects. 

After the large group concluded, attendees were invited to choose from a variety of small breakout sessions for in-depth discussions in a more intimate atmosphere. Sessions included "Telling Your Story," "Cancer Survival," "Nutrition: It Makes a Difference," "Love, Anger, and Forgiveness," "Looking Your Best," "Getting Back in Touch with Massage Therapy" and a talk from a survivor on "Long Term Survivorship." 

Feedback is always important, and the attendee evaluations were awesome!  One attendee's comment summed up the event: "Every survivor needs this seminar." 

The day ended with hugs and tears of support from new-found friends and from patients reuniting with care providers, all vowing to return next year to meet again. 

The retreat is held annually at the end of March. If you would like more information or wish to be added to the mailing list, contact Jeanice Janes, Breast Cancer Patient Navigator, at 214-345-2036.

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Determined to Find Cancer Early
By Sharon Hillgartner, N.P.

The numbers are scary: this year about 569,490 Americans are expected to die of cancer, more than 1,500 a day. In the U.S., cancer accounts for nearly one of every four deaths. Recognizing these staggering statistics, Texas Health Dallas has developed the Center for Cancer Risk Reduction & Genetics. The goal of the Center is help individuals understand their risk and detect cancer early, when it is most treatable.

To help fight the battle against breast cancer, the Center for Cancer Risk Reduction and Genetics worked with Massachusetts General Hospitals on the development of a specialized breast cancer risk assessment survey. This survey combines several nationally recognized risk calculators into one tool that can accurately identify women at increased or high risk for breast cancer. This tool looks at personal and family history, previous biopsies and known risk factors such as age, ethnicity, hormonal factors and genetics. Taking all these factors into account, the tool is able to generate a percentage risk score.

Each survey is personally reviewed by a nurse practitioner at the center, and those at increased risk are able to take advantage of services offered by the center, including:

• Increased surveillance
• Genetic counseling
• Individualized disease management, such as nutrition and fitness recommendations
• Referral to imaging such as ultrasound, MRI and 3-D mammography
• Support groups
• Psychosocial counseling

If indicated, referrals may also be made to the nurse navigator, medical oncologist, breast surgeon or radiation oncologist for preventive care.
The goal of the Center is to empower women with the knowledge to make informed decisions.

The risk-assessment survey is available free of charge online. To see if you are at increased risk, go to myhealthriskonline.com and complete this brief but potentially life-saving survey.

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The Cancer Journey at Texas Health Dallas — A Patient’s Story

One December morning two years ago, Judith Oglesby went to work aware of abdominal discomfort. By noon she was in severe pain and decided to drive herself to the Emergency Department at Texas Health Presbyterian Hospital Dallas.

Physicians on the medical staff of Texas Health Dallas ran diagnostics. Oglesby reported that she had recently undergone her annual physical and that her primary physician should have the blood test results. Thanks to shared electronic documents, surgeon Randall Kirby, M.D., was able to reference the blood test. 

He came to Oglesby in the ER and told her that she definitely had colon cancer and that the large tumor in her colon was adjacent to perforations he had detected that could lead to toxic septicemia. It was 2 p.m., and he was gathering a team for emergency surgery at 4 p.m.  She was stunned, yet confident of Dr. Kirby's skills.  She then met Kristi McIntyre, M.D., of Texas Oncology at Texas Health Dallas, who would be her oncologist and direct her medical care following surgery.

In those two hours, Oglesby called family, friends and church; prayed for the surgical team; and prepared herself mentally for the long recovery ahead. Before the surgery, she insisted on a pastor from the pastoral care department, and a wonderful man came to hold her hand in prayer.

"From the beginning, I placed my care in God's hands and the competent and caring hands of the physicians and skilled nursing staff at Texas Health Dallas," said Oglesby. "Every person I encountered seemed compassionate and supportive, patiently treating and instructing me on the care required by my body following the removal of the colon."

By month's end, she had two additional surgeries, and Kirby determined that the disease had metastasized, spreading to the liver and certain lymph nodes. The cancer was Stage IV, the most serious diagnosis. Oglesby determined to wait to research life-expectancy statistics until she had adjusted to the debilitation at hand. She set her mind on physical therapy, nutrition and follow-up medical care, determined she would recover in time and "outlive" whatever results she discovered. Because dehydration and blood clots are common in patients with her diagnosis, she was hospitalized with these issues several times during the first year. Now she receives all her treatments on an outpatient basis.

"In the beginning I could not physically walk through my condominium; the distance from living room to bedroom was only a few yards but seemed like a mile," Oglesby said. "Dr. McIntyre assured me I would recover in time, and her staff of nurses gave me many knowledgeable suggestions."

Eventually she was introduced to "I Can Cope," a cancer support group providing education and speakers as well as a supportive atmosphere for patients with similar experiences. She also discovered "Fit Steps 4 Life," an exercise program for Texas Health Dallas oncology patients who use the Texas Health Finley Ewing Cardiovascular & Center at Texas Health Dallas. There, assigned personal trainers direct patients in individual fitness programs.

Today Oglesby undergoes a demanding regime of chemotherapy for three days every other week.  Due to the nature of chemotherapy, she cannot work full time but remains very optimistic about her life.  She is an officer at Highland Park Presbyterian Church. 

"Each time I walk into the lobby of Texas Health Presbyterian, I see the images of the three founders of this extraordinary hospital, men from my church, who could see the immediate need for a hospital in North Dallas decades ago," said Oglesby. "They raised the initial funds to build the dream, a first-rate hospital that continues to grow today. I am thankful for Texas Health Presbyterian Dallas."

Oglesby, a former public relations/advertising executive, plans to resume her career as a freelance writer and business consultant on a part-time basis. She also makes handcrafted jewelry, Originals by Judith. You can contact her via email.

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Upcoming Events

May 9
Grand opening of Center for Cancer Risk Reduction and Genetics 
Texas Health Dallas, Margot Perot Lobby
6:30 to 8:30 p.m. 
RSVP required: 214-345-6284

May 13
Relay for Life
Town North Family YMCA
6 p.m. to 6 a.m.
Texas Health Presbyterian Hospital Dallas and Texas Oncology have partnered to form team Cancer Crusaders for Life. For more information or to sign up as a Survivor, visit the Relay for Life website.

June 5
National Cancer Survivor's Day Celebration
Texas Health Dallas, Fogelson building
2 to 4 p.m.
Survivors and their families are welcome to attend
Cost: Free

June 18
Dadfest 
8 a.m. to noon
Family-friendly event featuring a run/walk and free prostate cancer risk assessment and screening. To register for the screening, visit diduidid.com. For more information about the event, visit dadfest.com.

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